Questions/Answers

The Sharjah Baby-Friendly City (SBFC) initiative (previously ‘Sharjah Baby-Friendly Emirate Campaign’) introduced the concept of a ‘baby-friendly’ city, under the theme ‘A Right Beginning for a Better Future’, through encouraging and promoting awareness about breastfeeding, its importance for early childhood development, and immense health benefits for both mother and baby. SBF initiative implemented four sub-initiatives simultaneously for the first time in the world, including: ‘Baby-Friendly Health Facilities’ - which is based on the 1991 WHO and UNICEF ‘Baby-Friendly Hospitals’ initiative (BFHI). The three other initiatives were: breastfeeding-friendly nurseries, mother-friendly workplaces, and mother and baby-friendly public places. The project is responsible for assessing, evaluating and accrediting institutions and public places according to each category’s criteria. Sharjah’s innovative implementation of the BFHI alongside three community-focused initiatives within a localized context, earned Sharjah the world’s first ‘Baby-Friendly City’ title, by UNICEF and WHO in December 2015. The project is ongoing, currently being implemented and overseen by the Sharjah Child Friendly Office (SCFO), and continues to oversee accreditations of new institutions and the renewal of those previously accredited under each category. The initiative works towards the fulfilment of six objectives: • Promote a culture of breastfeeding in the community • Spread awareness about the benefits of natural feeding for 0-2-year-olds and the risks and side effects of breastmilk substitutes. • Protect the public, especially mothers, from unethical and misleading marketing of formula milk manufacturers. • Reinforce a breastfeeding-friendly culture across healthcare facilities. • Provide necessary emotional and practical support for mothers to resolve or prevent breastfeeding difficulties. • Safeguard the rights of working mothers by ensuring proper implementation of maternity leave and breastfeeding breaks during work hours. All four initiatives (baby-friendly health facilities, breastfeeding-friendly nurseries, mother-friendly workplaces, and mother and baby-friendly public places) target specific groups of stakeholders and audiences and provide accreditations for committed institutions.

The SBFC initiative aims to accelerate all the registered institutions to reach the SDGs through three strategic goals: Raising community awareness: Targeting members of the community directly or indirectly affected by or can affect breastfeeding practice: families, medical professionals, child care providers and the community at large. Capacity building for professionals: Focusing on developing skills and knowledge of medical and non-medical staff who provide prenatal, antenatal and infant care. Providing organisational incentives: This goal complements the first two with an effective incentive scheme: institutional accreditations. All four initiatives have the authority to provide 3-year accreditations subject to renewal upon review.

SDG 2: Zero hunger & SDG 3: Good Health and Well Being Breast milk is the perfect nutrition for newborn; develop protection from illnesses and safeguard them from the inside out as they start life. Breastfeeding provides a complete and ideal source of nutrition for infants up to six months of age and continues to be important after the first six months until 2 years or beyond with complementary food. Breastfeeding improves the health and wellbeing of babies, mothers and families. The other SDGs include SDG 4 (Quality education) that start with communication on the importance of breastfeeding in early pregnancy to make the best decision how they want to feed their babies, SDG5 (Gender equality) provide breastfeeding room all over Sharjah including public places such as malls, parks, airports etc. with maternal leave 90 days and paternal leave, SDG 7 (Affordable & Clean energy) ensures that breastfeeding is affordable and does not involve cost, SDG 10 (Reduced inequality) supports fathers role, SDG 11 (Sustainable cities and communities) aims to protect, promote and support breastfeeding in the cities and communities and SDG 17 (Partnership to achieve the goal) in collaboration with UNICEF and WHO, Sharjah has achieved world’s first ‘baby friendly city’ title in 2015.

• The initiative reflects the best interest of the child by encouraging a culture of breastfeeding using both Arabic and English languages in order to maximize reach among the Sharjah community. • The initiative launched by a mandate from the government. • The initiative started with funding from donors and later institutionalized under one government entity. • All registered organization created their own mothers room, which is self sustained and monitored through accreditation process. • All the registered facilities were at mandate to comply with national and international code of marketing of breastmilk substitutes.

The “Sharjah Baby Friendly” was initially launched in Sharjah following an Emiri Decree No. (4) 2011 for organizing ‘Sharjah Baby-Friendly Emirate’ Campaign. This support and patronage were enough to secure most public sector stakeholders. The initiative was supporting both public and private alike. All the institutions registered with the initiatives were benefited in achieving baby/mother friendly accreditation. Initially there were only 2 breastfeeding room all over Sharjah and now it has reached to 165.The exclusive breastfeeding rate was only 18% in 2011. However, with the launch of SBF initiative, the breastfeeding rate increased to 60% by 2020. More than 70% of health facilities and community sectors at Sharjah have been either baby or mother friendly accredited. 95% of staff dealing with mothers and babies have been trained to 20 hours BFHI training which is a mandate training for baby friendly implementation. Baby friendly implementation, training and practices at various sectors have been promoted through social media, TV/newspaper advertisements and PR agencies. The initiative also supports parents who are formula feeding by providing information making up feeds and helping them to feed safely and responsively and we also advocate for better regulation of marketing of breastmilk substitutes.

In the UAE, women enjoy the same constitutional rights as men and has set special policies to protect women and promote gender equality in the workplace. • All the mothers at Sharjah is entitled for a maternity leave (3 months of full pay – up from 45 to 60 days previously). • Fathers have been granted paternal leave as the initiative encouraged fathers and mothers work as a team around the care of children; thus, create a haven within which these children can grow and thrive. • Mothers have breastfeeding breaks from 6 to 18 months and all workplaces provided breastfeeding rooms.

The SBFC initiative is primarily tasked with overseeing the continuation and implementation of breastfeeding targeting age group 0-2 years including mothers. The initiative also targeted fathers as their emotional support is crucial for mothers to complete her breastfeeding journey. Another important target group was child care providers. All the mentioned group were reached through healthcare providers, HR/administrative staff at workplaces and childcare providers at nurseries. Various resources were produced to educate the mothers, fathers and child care providers in the form of counselling cards, educational calendars and educational videos. They were also encourage to attend group discussions and one to one education. The education emphasized the importance of only breastfeeding from birth to 6 months and continuing till 2 years or beyond. The mothers were also educated on the early initiation of breastfeeding, its importance and health benefits and how to sustain the breastfeeding. Workshops have been routinely conducted for parents, grandparents and caregivers. This resulted in increasing exclusive breastfeeding rate at 6 months to 60% surpassing global rate 50% by 2025. Childcare providers encouraged breastfeeding and provided support to non-breastfeeding babies. HR or administrative staff supported breastfeeding mothers with breastfeeding breaks, breastfeeding rooms with facilities and various training.

2011 – Emiri Decree No. 4 issued for launching ‘Sharjah Baby Friendly Initiative 2012 – Launched ‘Sharjah Baby Friendly Initiative’ (All the institutions from public and private were called for registration and all the registered facilities were at mandate to comply with national and international code of marketing of breastmilk substitutes. The initiative provided guidance and technical support (resources and training) throughout their journey in achieving baby friendly title and continue supporting them in reaccreditation. SBFC monitor and gather baby friendly implementation data from all the health facilities and community sectors. SBFC motivates hospitals providing maternity and newborn services to implement the Ten Steps to Successful Breastfeeding by WHO/UNICEF and Community Health Care Sectors (Primary Healthcare Centers) to implement UNICEF UK’s ‘Seven Steps Plan’ for sustaining breastfeeding. All the health facilities were provided BFHI training, nonclinical staff training and lactation management training. Community sectors were also trained to implement successful breastfeeding. All the facilities were audited by SBFC and awarded baby/mother friendly accreditation after they have effectively implemented baby friendly practices and having successfully passed interviews). 2015 – 140 organization received ‘baby friendly’ accreditation 2015 – Sharjah receives title ‘World’s First Baby Friendly City’ by UNICEF 2016 – Launched ‘Sharjah Child Friendly’ to focus on the rights of child and youth 2018 – Launched ‘National Code of Marketing of Breastmilk’ under the Decree of the Cabinet No. (21) 2019 – Sharjah received UNICEF’S ‘Child Friendly Cities Initiatives’ award at Germany 2020 – Sharjah baby friendly initiative upscaled to ‘family friendly’ to strategically include and empower parents, families and other caregivers to promote, protect and support early childhood development. 2020 – 182 baby friendly accredited institutions from various sectors such as health facilities, public places, nurseries and public places at Sharjah have been accredited baby/mother friendly. Also introduced ‘SCFO academy’ to widely publish the resources, training, workshops and webinars.

• Government patronage helped guarantee better public-sector cooperation, but it was more difficult to reach and onboard private-sector nurseries, workplaces, health facilities. • Disproportionate focus on women and less focus on men (particularly fathers) risks limiting scope of project and impact. • Securing privacy for women when breastfeeding anytime, anywhere proves more difficult in a conservative society. • Securing budgets for wider marketing activities. Sharjah has now more than 160 breastfeeding rooms all over the regions, increased maternity leave (3 months of full pay), breastfeeding breaks and paternity leave. Private sectors have been provided with free registration, incentives, training and accreditation.

Sharjah was the first emirate to implement a public health campaign that target multi-sectors and extended the scope to the communities. SBFC implemented four initiatives simultaneously for the first time in the world, including: ‘Baby-Friendly Health Facilities’ - which is based on the 1991 WHO and UNICEF ‘Baby-Friendly Hospitals’ initiative (BFHI), breastfeeding-friendly nurseries, mother-friendly workplaces, and mother and baby-friendly public places. Innovative designing allowed project to operate on multiple levels simultaneously (individual, communal, institutional, governmental). Another innovation was introducing a branded mobile mothers room (caravan) dedicated for families where children could play and read while mothers breastfeed.

Sharjah gained the inspiration from UNICEF UK’s baby friendly initiative transforming healthcare for babies, their mothers and families. UNICEF UK had evidence based stage accreditation program supports maternity, neonatal, health visiting and children’s centre services to transform their care. Sharjah was inspired with this and worked with the government in launching this initiative with an Emiri Decree. The project succeeded in implementing four community centered initiatives knowing how baby friendly programme impacts on culture and practice, thus leading to changes in infant care and feeding, with long term effects on children’s lives.

The SBFC initiative created a website (www.sharjahchildfriendlyoffice.ae) with all the information related to the project. The website included the steps to successful breastfeeding, how to register with the initiative and their commitment and process to achieve baby friendly accreditation. The website updates its achievements periodically. An academy site was launched to include all the announcement related to training, workshops, webinars and releases of resources. It also included all the resources produced by the initiative. All the resources are available through our social media accounts (@SCFOacademy). Digital data collection initiated by SBFC in the form of KPIs in dashboards and presentations.

The innovative, community and human-centered approach taken by SBFC initiative resulted in Sharjah being named the world’s first ‘Baby Friendly City’ by WHO and UNICEF in 2015; a title created for the first time in the world to recognise our city’s achievements. Other cities in the UAE have approached the SCFO for resources created, requesting assistance in the implementation of the approach that can be replicated in any country or city and personalized according to its needs and to seek influential public figures that are deemed as reputable sources that are ‘true supporters’ of the cause. Following ‘baby friendly city’ title, SBFC opened registration outside Sharjah and other cities in UAE have sought help: - Al Dhafra city in Abu Dhabi launched baby friendly campaign at community sectors and SBFC resources were collected for their use. - Supreme Council for Motherhood & Childhood UAE, launched ‘Emirates mother, child and adolescents friendly’ campaign. - MOHAP started baby friendly implementation and assessment at community level. - While Sharjah implemented a 90-day paid maternity leave for government employees since June 2014 (up from 60 days), federal government extended maternity leave in 2016 and Dubai followed suit in March 2017.

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The resources used to implement the initiatives were: 1. Advocated for designing SBFC initiative in 2010. 2. SBFC called for a mandate emiri decree. 3. Budget allotted from government to SBFC office. 4. Budget was used for marketing, preparing materials, training and resources. 5. Initially financial aid was provided by private sector and taken over by government. 6. Sharjah University students and researchers helped the office to conduct studies. 7. Training materials for care providers. 8. Prepared policies for health sectors and other community sectors and shared with entities. 9. Auditing tools 10. Digital data collection

As part of the initiative, SBFC is collaborating with ministries responsible for health and education and HR as baby friendly policies are sustained by these entities. The initiative started with funding from donors and later institutionalized under one government entity. All registered organizations created their own mothers room, which is self-sustained. SBFC launched child friendly project expanding its scope from encouraging breastfeeding to focusing on the rights of all children and youth. SBFC has scaled up the three community initiatives to Sharjah Family Friendly in order to strategically include and empower parents, families, and other caregivers.

Yes

The initiative’s achievements were formally evaluated in 2015 and Sharjah won the ‘first baby friendly city’ title by WHO and UNICEF. The results of accredited facilities are published through TV/Newspapers, PR and website. An article was published in Breastfeeding Medicine Journal (Vol. 10. Issue No. 9: October 26, 2015) on ‘The Sharjah Baby Friendly campaign: A community based model for breastfeeding promotion, protection and support’ (http://doi.org/10.1089/bfm.2015.0095). A scientific review by Prof. Arthur I. Eidelman in his introductory article in the same journal (http://doi.org/10.1089/bfm.2015.29014.eid). SBFC represents Sharjah as a ‘baby friendly city’ in major conferences.

Indicators used by SBFC: • No. of hospitals baby friendly accredited • No. of primary health centers baby friendly accredited • No. of workplaces mother friendly accredited • No. of public places mother friendly accredited • No. of Nurseries baby friendly accredited • Percentage of training at health facilities • Percentage of training at community sectors • Rate of breastfeeding at health facilities • Percentage of education provided to mothers, fathers and caregivers Tools used for measuring these indicators: • Monthly monitoring dashboard created by the initiative • Staff competency by WHO/UNICEF • Audit tools by WHO/UNICEF • Checklist created to assess the community sectors by initiative

• Increased breastfeeding rates in Sharjah from 18% in 2012 to 60% in 2020 (surpassing WHO 2025 target 50%). • Accreditations (2011-2020): o 100% baby-friendly government health facilities & 60% private health facilities o 90% mother and baby-friendly public places o 100% breastfeeding-friendly government nurseries o 90% mother-friendly government workplaces • 165 breastfeeding rooms at Sharjah. • Launched and distributed Arabic version of 2018 revised ‘Ten Steps to Successful Breastfeeding’ to healthcare facilities • Distributed over 30,000 brochures, educational posters and pamphlets in Arabic and English to healthcare professionals and expectant mothers. • Arranged 30,000 training hours for 4,000 health professionals in Sharjah, approved by the UAE Ministry of Health. • 20 hour BHFI Training modules for healthcare professionals. • Arranged over 50 days of clinical practice training program. • Over 100 training courses and lectures for nursery workers and workplaces to encourage them to comply with the project. • Educational DVDs in different languages distributed to the breastfeeding mothers. • Launched advanced lactation training program level 1 (for nurses) and level 2 (for doctors). • Mobile mother friendly room (caravan) was stationed at various events to help mothers breastfeeding. • Sharing best practices through hosting and participating in regional and international breastfeeding conferences. • Introduced social media including whatsapp messaging to reach mothers.

The SBFC initiative works under Sharjah Child Friendly Office, a subsidiary of the Supreme Council for Family Affairs (SCFA) in Sharjah. It was established in 2011 under the directives of His Highness Sheikh Dr. Sultan bin Muhammad Al Qasimi, Member of the Supreme Council and Ruler of Sharjah, and his wife, Sheikha Jawaher bint Mohammed Al Qasimi, Chairperson of SCFA, to work in collaboration with relevant bodies to design and implement targeted strategies and programs to safeguard the rights of children and youth, and enhance their wellbeing. SCFO is the official body for granting ‘baby friendly’, ‘child friendly’ and ‘family friendly’ accreditations to relevant entities in Sharjah, and works with international and national organizations such as Ministry of Health, to implement accreditation programmes to promote, protect and support breastfeeding and promote children’s rights. SCFO runs several projects to strengthen Sharjah’s status as a child, youth, and family-friendly city. It seeks to protect and promote children’s rights in Sharjah and across the UAE by raising the community’s awareness of these rights, and encouraging their implementation in public and private institutions as well as in families, to enhance children’s care and development, empower parents and ultimately create a stronger family friendly environment.

In 2011 when the Sharjah Baby Friendly initiative was launched, the office collaborated with Ministry of Health, WHO and UNICEF in designing and implementing baby friendly practices at Sharjah. Consultation with academia local and government HR, education, public authorities responsible for public spaces and NGOs. Also mothers consultation through focus groups and surveys. A scientific committee was formed by SBFC that included training heads and coordinators, clinical instructors, educational coordinators and research and evaluation expertise. The scientific committee was responsible in designing resources such as training modules, KPIs, staff training, mothers training, educational booklets and posters. The resources were widely distributed at all the sectors of Sharjah and several orientation sessions were arranged for all the sectors. Subsequently government entities from different sectors were registered with SBFC including private sectors. The office monitored and addressed each facility as per their field and supported them in promoting and supporting breastfeeding. The project was recognized by WHO EMRO and invited to share our experience in Sharjah in several regional and international meetings and it was published in their nutritional website as a successful story (emro.who.int/nutrition/success-stories).

The initiative faced challenges, despite the aid from government patronage helped guarantee better public-sector cooperation, to reach and onboard private-sector nurseries, workplaces, health facilities. Success factors • SBFC’s community-centered initiatives implemented in local context were best suited for the Sharjah community. Community initiatives designed as awards allowed project to operate on multiple levels simultaneously (individual, communal, institutional, governmental). • Alignment of SBFC project goals with Sharjah Government’s vision and immense support and patronage from the Sharjah ruling family. • Project operated within a context of shared community, religious, traditional values that encourage and support breastfeeding The SBFC aims to offer greater focus on securing private partnerships with health facilities and large businesses, a higher focus on the family as a unit, including fathers and mothers equally and develop targeted key messages for segmented stakeholder groups to ensure more authentic engagement. Continuous monitoring of data is linked to the internal quality program in the institution. To ensure wider participation, SCFO launched ‘child friendly city’ and included children of all ages (upto 18 years) and ‘family friendly’ to strategically include and empower parents, families and other caregivers to promote, protect and support early childhood development.