• IFE Core Group
• IFE Core Group members and mandate
• IFE Activities
  • IFE Orientation Package (2009)
  • Guide for the general public
    • The harsh reality
    • What should happen in emergencies?
    • How does this all look on the ground?
    • Myths that put babies at risk
    • But wouldn't aid agencies and health authorities make sure that babies aren't harmed?
    • What is the scale of the problem?
    • Do YOU want to help infants in emergencies?
    • Your feedback
    • Key contacts
    • Further reading and resources
    • Sample letters
  • World Breastfeeding Week 2009
• Training and meeting plans
• Networking
• Key contacts
• Translations and adaptations
• IFE Resource Library

How does this all look on the ground?

It’s all very well to describe the theory of what should happen, but how does this look on the ground at the emergency site? In order to protect both breastfed babies and babies who cannot be breastfed, targeted humanitarian aid is necessary.

Safe spaces

Experience has shown that providing breastfeeding mothers with safe spaces where they can receive encouragement, be in contact with health workers and meet with other breastfeeding women is helpful. In these safe spaces women who are relactating can be supported. Aid agencies have also found that training peer counsellors who support and provide assistance to breastfeeding mothers and warn them of the dangers of artificial feeding is incredibly successful in maximising child survival in emergency situations. Breastfeeding women can be provided with additional rations of food as an encouragement to continue breastfeeding.

Dangers of milk powder

Protecting all babies by ensuring that powdered milk is not freely available is very important. Past experiences suggest that if powdered milk is distributed as a part of general rations, it is likely to be used to feed babies. Such milk is nutritionally deficient as a food for non-breastfed babies, placing them at even greater risk than normal. If powdered milk is used to feed babies who would otherwise be breastfed, it increases the risk of death because it replaces breastmilk, it introduces a source of infection and because it is nutritionally deficient. In order to protect babies, any powdered milk that is to be distributed should be mixed with the local milled staple cereal before delivery so that it cannot be used as a breastmilk substitute (a cereal/milk powder mix can make porridge for young children and infants over six months).

Minimising risk for babies who cannot be breastfed and controlling the supply of infant formula

As discussed, babies who cannot be breastfed are at great risk in emergency situations and special attention must be given to protect them. This includes:

• Assessment of the need for infant formula on a case-by-case basis by a qualified health professional to ensure that it is only provided when there is no other option.
• Providing the carers of such babies with not just infant formula but also feeding implements, clean water, fuel to boil water for cleaning and education about how to use infant formula.
• Providing health care and monitoring of formula-fed babies.
• Ensuring that infant formula containers are labelled with instructions in the local language and if possible non-branded so that a particular brand of infant formula is not promoted.
• Avoiding the use of baby bottles, which are difficult to adequately clean meaning that bacterial contamination poses an unacceptable risk. Formula-fed babies should be fed using a cup, which can be a very effective way of feeding even young babies and can be used long-term.

Preventing ‘spill-over’ of the use of infant formula to breastfed babies may be achieved by providing only a small amount of formula at a time or even by providing only made up formula direct to babies at a central distribution point. In the latter instance, this method of distribution may be used when household conditions are particularly poor to help ensure that the infant formula is correctly constituted, that the feeding implements are clean and that the baby is monitored.

Some may suggest that many of the problems associated with the use of infant formula could be avoided by the use of ‘ready-to-feed’ infant formula since it does not require the addition of water before use. However, the use of ‘ready-to-feed’ infant formula does not completely remove the risks associated with contaminated water because feeding utensils must still be cleaned. In addition, ‘ready-to-feed’ infant formula is often packaged so it provides more than a single feed for an infant and once opened, it must be refrigerated to suppress bacterial growth - this alone makes it unsuitable for use in emergencies. ‘Ready-to-feed’ formula is often unavailable in areas affected by emergencies (and if obtained elsewhere may be labelled in the wrong language), is expensive to purchase and difficult to transport. For these reasons, ‘ready-to-feed’ formulas are not considered appropriate for use in situations where most emergencies arise.