US embassy cable - 03KUWAIT2100

UNCLAS SECTION 01 OF 04 KUWAIT 002100 
 
SIPDIS 
 
STATE ALSO PASS USAID/W 
STATE PLEASE REPEAT TO IO COLLECTIVE 
STATE FOR PRM/ANE, EUR/SE, NEA/NGA, IO AND SA/PAB 
NSC FOR EABRAMS, SMCCORMICK, STAHIR-KHELI, JDWORKEN 
USAID FOR USAID/A, DCHA/AA, DCHA/RMT, DCHA/FFP 
USAID FOR DCHA/OTI, DCHA/DG, ANE/AA 
USAID FOR DCHA/OFDA:WGARVELINK, BMCCONNELL, KFARNSWORTH 
USAID FOR ANE/AA:WCHAMBERLIN 
ROME FOR FODAG 
GENEVA FOR RMA AND NKYLOH 
ANKARA FOR AMB WRPEARSON, ECON AJSIROTIC AND DART 
AMMAN FOR USAID AND DART 
 
E.O. 12958:  N/A 
TAGS: EAID, PREF, IZ, WFP 
SUBJECT:  INFANT FORMULA AND THE PDS IN BASRAH GOVERNORATE 
 
 
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SUMMARY 
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1.  UNICEF recently released a policy paper recommending 
that infant formula be immediately deleted from the OFF 
general ration.  The following report summarizes information 
gathered by the DART from WFP local female staff, home 
interviews, and IDP interviews in Basrah Governorate between 
4 and 11 May.  Although a more thorough investigation of the 
use of infant formula is necessary in Basrah and other Iraqi 
governorates, the issues raised during interviews indicate 
to the DART that the risks involved in removing this 
commodity from the OFF general food ration for children 
under one year of age cannot be justified prior to the 
establishment of a functioning maternal and child safety net 
and health education program.  End Summary 
 
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USE OF INFANT FORMULA 
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2.  Basrah is Iraq's second largest city, with an estimated 
population of 1.2 million people.  The population of Basrah 
governorate is estimated at 1.8 million.  Although overall 
rates of exclusive breastfeeding in Iraq increased during 
the sanctions period (from 17 percent to 30 percent), 
interviews of U.N. World Food Program (WFP) local staff who 
have sampled Basrah's urban and rural populations indicate 
that there is significant variance in the rates of 
breastfeeding between rural and urban and uneducated versus 
educated women.  WFP indicates that there is almost 
universal breastfeeding in rural areas of Basrah 
governorate, while in the city more than 75 percent of women 
bottle-feed for at least a portion of an infant's first 
year. 
 
3.  According to WFP, bottle-feeding is particularly common 
to women working outside the home, even though most women 
are provided six months to a year of maternity leave after 
giving birth.  Bottle-feeding among working and educated 
women appears to be largely a matter of preference. 
 
4.  In interviews with poorer women, and with internally 
displaced persons (IDPs) in Al Zubayr, bottle-feeding was 
linked to a mother's perception that her own milk supply was 
insufficient.  Among the seven IDP families interviewed by 
the DART, three reported using infant formula (IF) because 
their own milk was insufficient, with two of these estimated 
that they did not eat enough to be able to produce milk.  A 
fourth indicated that she was on medication, and was worried 
that the drug would pass to her baby if she tried to nurse. 
 
5.  All women indicated that they used either bottled or 
boiled water to prepare IF, and in the absence of 
refrigeration, discarded any milk that was not consumed 
immediately.  However, when asked how bottles were cleaned, 
it became apparent that a significant risk of contamination 
of the IF was common to these women.  Bottles are washed in 
unsafe water with other household dishes, and they are not 
dried thoroughly prior to use.  When asked whether diarrhea 
or other digestive complaints were common to their infants, 
three of the seven reported that their infants currently had 
diarrhea and vomiting. 
 
6.  One infant, six days old, whose mother had reported 
having very little breast-milk and insufficient food for 
herself, was clearly dehydrated.  This particular family 
grouping (one male, two females, and four children) was the 
most needy of the IDPs visited in Al Zubayr, with 
malnutrition apparent in three of the four children (one 
with oedema), and respiratory infections in two of these 
three.  When asked why the children had not been taken to 
the hospital or clinic, the mother reported that they did 
not have the money.  Other IDP families living in the same 
building had provided some IF and other commodities to this 
family, but supplies among this group were obviously 
limited.  WFP's partner for vulnerable group and IDP feeding 
in Basra governorate will coordinate with IOM to provide 
these families assistance. 
 
7.  For those who can afford to buy IF, it is available in 
local markets.  Pre-war market prices for IF in Basra city 
ranged from 450 to 500 Iraqi dinars for 450 grams.  By 
contrast, the PDS food ration is 250 dinars per person. 
Post-war prices stand at 1,400 to 1,500 Iraqi dinar.  Three 
percent of women receiving IF report selling it.  The most 
common reason for sale is to purchase a different brand of 
formula.  WFP reports that brands and respective quantities 
of half-fat and whole-fat IF have varied from distribution 
to distribution.   Mothers report that the variation causes 
diarrhea and other digestive disorders in their infants, so 
if previously distributed brands are available on the 
market, they will sell or swap newly distributed brands 
and/or formulations. 
 
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AVAILABILITY OF INFANT FORMULA AND OTHER USES 
--------------------------------------------- 
 
8.  The United Nations Children's Fund (UNICEF) recently 
released a policy paper, following a meeting in Amman, that 
recommends the immediate deletion of IF from the Oil for 
Food (OFF) general ration.  Approximately 20 percent of 
Iraq's total estimated IF requirements would continue to be 
imported under OFF for distribution through medical centers 
and UNICEF's Targeted Nutrition Program.  The policy paper 
cites the monthly distribution of double rations since 
November as evidence that sufficient quantities of IF have 
been distributed to last through August.  In their planning 
framework, this date would provide UNICEF and its partners 
ample time to establish/re-establish a nutritional safety- 
net for mothers and infants.  The plan includes the 
provision of IF only when medically prescribed and otherwise 
removes IF from the OFF food basket immediately.  WFP local 
staff strongly disagree with this analysis for the following 
reasons: 
--  Not enough weaning cereals and powdered milk were 
distributed before the war.  Distribution of powdered milk 
has ranged from 13 percent to 25 percent of a full ration 
since the "April-May" distributions, and was not complete in 
earlier distributions.  In many cases, IF has been used to 
supplement the lack of powdered milk.  (Note:  Powdered milk 
is one of the most valued commodities in the OFF food basket 
because it is the sole "breakfast" commodity.   WFP staff 
from all southern governorates indicate powdered milk 
provides urban families their primary source of yogurt-a 
staple in the Iraqi diet.  End Note.)  Staff report that in 
urban areas particularly, where other options for the 
procurement of milk are limited, mothers have been 
using/purchasing IF to complement the diets of weaning-age 
and older children. 
 
--  WFP staff report that when a child is born, it can take 
from two to four months for him or her to be registered in 
the PDS system.  This means that families with children born 
since January are unlikely to have received infant formula 
during the multi-month distributions provided in January, 
February, or March.  With the interruption of the PDS 
registration and tracking systems, this trend is likely to 
continue for several more months.  Under these 
circumstances, families with an excess of IF will give IF to 
families with unregistered infants, either through sale or 
exchange.  Further, WFP staff doubt that existing stores 
will meet even minimum requirements through June. 
 
--  WFP monthly monitoring post-distribution prior to the 
conflict consistently indicated that the OFF food basket 
provided families between 20 to 25 days of their monthly 
food requirements.  WFP staff indicate that the war, and the 
assumption of power by Coalition forces, has raised hopes 
that the ration will be increased.  Deleting any item from 
the food basket now risks being interpreted as disregard for 
the Iraqi people by the Coalition, and deleting something 
that is considered to be necessary will generate even more 
distrust of Iraq's interim administration.  WFP points to 
the last time an attempt was made to remove IF from the food 
basket, and the politicized debate it caused as evidence 
that the issue is too sensitive to approach now as a 
unilateral policy decision. 
 
(Comment:  The first two reasons above question the 
assumption that previously distributed quantities of IF will 
tide over bottle-fed infants over until August, and they 
underscore the importance of ensuring that viable 
alternatives and assistance exist for Iraqi women PRIOR to 
the removal of IF from the OFF basket.  The third reason, 
while meaningless in the analysis of the benefits of breast 
feeding over bottle feeding, is certainly relevant to 
attempts to reestablish the PDS as a way of providing the 
population a sense of stability and security during this 
uncertain time.  It also highlights the necessity of 
ensuring a "fit" between sectoral programmatic decisions and 
the political realities of a volatile environment for which 
they are being made.  End Comment.) 
 
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RECOMMENDATION 
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9.  Given the considerations above, the DART strongly 
recommends that WFP attempt to ensure that 100 percent of 
the IF ration is included in the OFF food basket throughout 
the planned EMOP program period (September). 
 
JONES