Brooke Bauer, the GNC Technical Alliance's IYCF-E advisor sat down and shared some insights about the importance of supporting IYCF-E in emergencies as we mark World Breastfeeding Week.
Why are you passionate about supporting IYCF, particularly breastfeeding in nutrition emergencies?
When a mother or caregiver breastfeeds, everyone benefits including the child to the mother, family, and community. Optimal infant and young child feeding practices, including exclusive and extended breastfeeding, is the single most lifesaving intervention for children under five globally. Despite lifesaving benefits, globally only around 40% of infants under six months are exclusively breastfed.
The World Health Organization (WHO) and United Nations Children’s Fund (UNICEF) recommend that infants should initiate exclusive breastfeeding within one hour of birth and continue exclusively breastfeeding for the first six months of life. After this time, infants should continue breastfeeding to two years of age or beyond while also receiving age-appropriate, nutritious and hygienic complementary foods.
Increasing breastfeeding worldwide would prevent more than 800,000 child deaths each year, particularly those associated with diarrhoea and pneumonia.
During emergencies, breastfeeding is even more important and life-saving. Conflicts, natural disasters and epidemics often force families to flee their homes which results in food insecurity, disruption of services, separation of families and social systems, and limited access to clean water. In these settings, women and children are especially vulnerable.
Particularly in displacement and emergencies, breastfeeding is a child’s food security. It guarantees food that is nutritious, accessible, appropriate, affordable, and always ready. And it also provides protection against malnutrition, disease, and death for children, especially those under six months.
This year the theme of World Breastfeeding Week is: “Protect breastfeeding: a shared responsibility.” It is the responsibility of all from the government to health centres to the community to family- to protect, promote, and support the breastfeeding mother and child. If a support system is not in place the success of exclusive and long-term breastfeeding is less than if the mother and child feel supported and able to breastfeed optimally.
Why do you think it is important to celebrate Breast Feeding week?
The World Breastfeeding Week (WBW) 2021 theme is “Protect breastfeeding: a shared responsibility is about how breastfeeding contributes to the survival, health and wellbeing of all.” This is an important focus, especially within the humanitarian sphere. We understand that while support at the individual level is important, it requires all actors in an emergency, from the government to frontline workers, to understand the importance and life-saving effects of breastfeeding on not only the child and family but the entire community itself.
A multi-sectoral response is critical in emergencies to reduce childhood malnutrition and death. By working together, we can support families in achieving breastfeeding success and increase breastfeeding duration to ensure a better outcome for children. By celebrating World Breastfeeding Week we can bring these common goals to raise awareness among stakeholders, decision-makers, healthcare professionals, humanitarian response agencies, and governments that it is the responsibility of all to help increase breastfeeding rates to reduce the risk of childhood malnutrition, illness and death.
What are some of the challenges that caregivers face in breastfeeding, particularly in emergency contexts?
Emergencies cause instability and seriously threaten breastfeeding practices and consequently child nutrition, health and survival. Myths and Misconceptions are common across the globe regarding breastfeeding and emergencies. It is often believed by mothers, community members and those involved in the relief effort that trauma, stress and maternal malnutrition effects on breastmilk may reduce a mother’s confidence in her ability to breastfeed. While a woman’s ability to produce breastmilk is not directly affected by a stressful situation itself, her body may be slower to release the milk causing her confidence to be affected. Additionally, a lack of privacy in shelters or camp settings may restrict a mother's ability to comfortably breastfeed and heighten her stress level. It is important that in these situations there is support available where a woman can have privacy, a calm environment, and support to build confidence in her body’s ability to feed her child.
Time and the burden of additional household tasks are also heightened during emergencies and contribute to undermining breastfeeding. When displaced, families often must travel long distances, queue in long lines for food, water and fuel rations, and carry rations back to communities causing separation from their infants. This interferes with on-demand and frequent feeding necessary to optimally breastfeed the child by restricting the time the mothers can dedicate to appropriate breastfeeding and care of their children. Lastly, the unregulated distribution of breast milk substitutes (BMS) and infant formula, which includes uncontrolled infant formula or powdered milk provided in food rations, also undermines optimal breastfeeding.
Many times, volunteers or others within an emergency response well-meaningly distribute infant formula thinking they are helping, but in reality, this is an incredibly dangerous practice. Often in these situations because of all of the things mentioned above, confidence, lack of security, lack of privacy, etc. Even breastfeeding women will take infant formula milk.
Infant formula use in refugee camps is dangerous because when the supply is unstable families will dilute the milk to make it last, by adding water to it the infants won’t get enough nutrients. Often the powdered milk, which is not sterile, can’t be heated properly to kill any bacteria in the formula as fuel is limited. Just as you don’t eat raw chicken, you can’t drink formula without using boiled water that will kill bacteria in the formula itself.
Just as you can’t feed someone with raw chicken with a way to heat the meat and kill the bacteria, the same goes for infant formula, it is just as dangerous, if not more dangerous as it is being fed to already vulnerable infants.
Mothers and caregivers have the right to specialist support to reinforce and restore their confidence and capacity to breastfeed their children. Given the unique challenges and heightened risks in emergencies, specific and extra efforts must be taken to ensure that breastfeeding is protected and promoted. Protection and support of non-breastfed infants and young children must be provided.
What impacts have you seen from COVID-19 on breastfeeding?
During the COVID-19 pandemic, there has been a lot of misinformation regarding the safety of breastfeeding and a belief that there is a need to separate mother and infant after delivery, a practice that is harmful and not recommended. These practices and others, including the increase of infant formula companies taking advantage of the pandemic to promote their products, has led to a decrease in breastfeeding around the globe.
Myths and misconceptions regarding breastfeeding and infant feeding have long been an issue globally and the pandemic only exacerbated these creating restrictions to health centres, hospitals and other health and nutrition care due to lockdowns.
Recommendations from the World Health Organisation (WHO) did not change due to the pandemic, it continues to be recommended that an infant is exclusively breastfed (nothing other than breastmilk) for the first six months of life. This practice is the single most life-saving practice for children globally, including during the pandemic. Newborn babies are vulnerable to illness, especially respiratory infection and diarrhoea. It is breastmilk where they receive their initial immunity. Breastmilk is the infant’s first vaccine and this must be protected and supported.
When the pandemic began to spread widely and countries saw their cases rise, hospitals and clinics began limiting visitors and the practice of separating mothers and infants after delivery- sometimes for days- began to become common practice in many contexts. Among WHO recommendations of exclusive and extended breastfeeding, it is also recommended that mothers initiate breastfeeding within one hour of birth. By doing this the chances of longer-term exclusive breastfeeding rise and the risk of illness and malnutrition decrease. Additionally, by separating mother and baby skin-to-skin contact, a practice that not only increases the risk of breastfeeding success but also regulates the infant’s body temperature and heartbeat as well as promoting the sharing of beneficial bacteria between mother and infant is delayed creating risk for both mother and child health. Additionally, many hospitals or health centres limited visitors or birth supporters which can leave new mothers feeling alone and afraid and can also hinder breastfeeding success.
Formula companies have reinforced these misconceptions and fears by taking advantage of this lack of information and separation during the pandemic and have promoted their infant formula products to families and healthcare professionals, a dangerous and life-threatening practice.
We all must continue to protect, promote, and support breastfeeding from all levels to protect the mothers and infants that need that support the most.
How can we protect breastfeeding in Nutrition emergencies?
Breastfeeding, very simply, provides life-saving food security. It is the safest, most nutritious, most affordable, and most reliable source of food for infants under the age of six months. It is always the right temperature, requires no preparation and is readily available even in settings with limited access to clean water and adequate hygiene. And it doesn’t stop at 6 months, breastfeeding continues to offer all of this even after six months when solid food is introduced and these benefits continue up to the age of two years and beyond.
Countries have shown that in emergencies it is possible to protect, promote and support breastfeeding. As humanitarian professionals we must make it the norm, we must abide by global health, nutrition, and humanitarian standards.
Supporting national policies and guidance that protect breastfeeding must be at the forefront of response from governments and humanitarian actors. Breastfeeding protection must also be at the centre of emergency preparedness, by normalizing breastfeeding in emergencies we will create an environment where mothers and infants are supported even if they are displaced or living in an insecure environment.
It is crucial that as humanitarian actors we share accurate information to all partners, across all sectors, about the life-saving value of breastfeeding and its importance in emergency settings. We must also work collectively to strengthen the capacity of health and nutrition actors to be able to provide quality, holistic breastfeeding support and life-saving interventions to ensure that breastfeeding is protected. We must also highlight the dangers and risks associated with the use of infant formula and bottle use, especially in emergencies.
Partners must be informed on how to monitor and report the distribution of infant formula or bottles appropriately to control these types of dangerous activities in an emergency. These violations must be reported to the relevant authorities to ensure that emergencies are not exploited for commercial interests, a common practice by infant formula companies and others who can profit from emergencies.