What emergency relief staff and programme managers need to know about infant and young child feeding in emergencies
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In emergency and relief situations, a secure supply of clean water, fuel to sterilize bottles and refrigeration to store formula products are all scarce or unavailable. Formula feeding under these conditions is dangerous, resulting in increased illness, malnutrition and death. As well, transporting shipments of formula into stricken areas is a poor use of limited transportation resources. Unfortunately, many aid and relief agencies continue to solicit for donations of baby milks during times of crisis. Often donations of baby milks stand in the way of healthy infant feeding practices and grant deceptive endorsement to formula feeding as a safe means to feed infants.
In these situations breastfeeding is of critical importance. It saves infant and young child lives; prevents malnutrition and serious infectious diseases such as diarrhea. By contrast, formula or artificial feeding increases the risks of malnutrition, disease and death. Extreme care must be used in targeting these artificial feed products to “needs only” situations; careful instructions and the necessary inputs of clean water, fuel and refrigeration must be in place to reduce the associated risks.
Myths about breastfeeding in emergencies
MYTH 1: Malnourished mothers cannot breastfeed
In virtually all cases, a sub-optimally nourished mother can breastfeed her child. The important response is to feed the mother so that she can feed her child. It is far safer and more effective to provide nutritional support for the mother than to risk her infant’s health by feeding breastmilk substitutes. Mothers in these situations need help and support to enable them to breastfeed.
Myth 2: Stress makes a mother’s milk dry up
Although extreme stress or fear may temporarily reduce a mother’s milk supply, this response is often of short duration. On the other hand, breastfeeding produces hormones that have a calming effect on mother and baby and creates an inseparable bond between the mother and her child. There is virtually no abandonment of babies in emergency situations when mother and baby are breastfeeding and kept together.
Myth 3: Babies with diarrheal disease need water or tea
Breastmilk contains about 90% water. Exclusive breastfeeding provides all the water, nutrition and immunology a baby needs, without the risk of contamination. Feeding an infant water can introduce disease-causing bacteria and other contaminants, especially if safe water is scarce or unavailable. It is only in the case of severe diarrhea that infants may need rehydration fluids in addition to breastmilk.
Myth 4: Mothers cannot resume lactation once breastfeeding has stopped
Mothers and babies can restart breastfeeding even after a period of not breastfeeding. Increased skin-to-skin contact and frequent access to the breast helps to increase milk supply and enables mothers to resume full breastfeeding. This can be critical for babies during emergencies.
In situations where infants are orphaned, where mothers are ill and unable to breastfeed, or choose not to breastfeed, other feeding options may be needed. In order of preference these are:
Mothers own expressed breastmilk
Locally available milks suitable for older infants and young children
Locally purchased infant formulas may be used if conditions permit safe preparation use and storage.
What does the World Health Organization International Code of Marketing of Breast-milk Substitutes recommend?
In emergency situations, breastfeeding protection is more critical than at any other time. The donations and use of infant formulas may actually increase malnutrition, diarrheal disease and death. Hence the World Health Organization has set out recommendations to restrict the donations and use of baby milks to situations of medical or social needs only.
Donations of infant formula, baby milks, bottles and baby foods should be refused.
If needed, breastmilk substitutes should be purchased locally.
Breastmilk substitutes may only be used after careful consideration of need and safety of use and preparation. Careful monitoring is needed to ensure appropriate use and manage the side effects of not breastfeeding.
Bottles and teats should never be distributed. If breastmilk substitutes are needed, then cup feeding should be encouraged.
Special places such as mother and baby tents can be safe and secure places for feeding, rest, care and support for mothers and their children. These special places also help to prevent separation of mother and baby and provide peer support through a time of severe infants and mothers who are malnourished.