Feeding in emergencies for infants under six months: Practical Guidelines

by Kathy Carter, Public Health Team, Oxfam, September 1996

The stated aim of these guidelines is to inform Oxfam health personnel about the problems of feeding infants under six months old in emergencies and to provide some practical guidance on ways of overcoming these problems. The guidelines will however be useful for health and nutrition personnel in all agencies both at headquarters and field level. Although it is not an Oxfam publication per se, the document is available from the Oxfam offices in Oxford.

The guidelines begin by giving a background to the problem highlighting the examples of emergencies in 'middle income' countries where a high proportion of women normally (that is pre emergency) feed their infants using infant formula and bottles. This has created problems for those offering relief; the population displacement found in such emergencies removes both safe conditions for feed preparation and certainty of its supply.

Recent emergencies in both Iraq and former Yugoslavia have focussed attention on this problem. - both being countries where more than half of the infants under six months of age were fed breast milk substitutes (BMS) prior to the emergency. Carter recognises that in such situations there is a need for BMS, but in supplying it that there is a danger of increasing infant morbidity and mortality as well as contributing to a reduction in the proportion of babies being breastfed.

The author identifies the need for targeting assistance to mothers with infants under six months old in a way that takes into account their pre-crisis feeding practices and their cultural and individual beliefs, while also being appropriate to the ongoing emergency situation.

The document goes on to discuss the benefits of breastfeeding, as well as factors that do and do not affect it, e.g. confidence, ability, stress, malnutrition, stimulation and fluids. It also discusses appropriate interventions - giving guiding principals on support for breast feeding, relactation, the role of wet nurses and problems of HIV transmission. The author highlights the fact that few health professionals in the West have appropriate theoretical and practical expertise on the subject of lactation.

Perhaps one of the more novel aspects of the guidelines is the comprehensive and detailed guide for the assessment of infant feeding practices in emergencies. This guide is practical and particularly attractive for field level use because of its explicitness. It outlines the objectives of assessment, suggests assessment methods and provides an example of a checklist and samples of questions for assessing feeding practices. Some examples of assessment objectives include; to review traditional feeding practices and how they have changed, to identify main infant feeding difficulties, to review practical constraints on hygienic preparation of BMS and to investigate local availability of BMS and ease of use by carers. Suggested methods for the collection of this information include a review of information from secondary sources, collection of quantitative information using RRA and PRA techniques and gathering quantitative information during some other activity e.g. a nutrition survey. As these guidelines on assessment remain untested we at the ENN would be interested to hear (as no doubt would the author and Oxfam) of any field experiences of using these guidelines to assess infant feeding practices.

Carter concludes that increased awareness and commitment among NGOs and lOs on this subject must lead to clear policies, practical guidelines and increased staff capacity to deal with the problem of feeding infants under 6 months old in an emergency. The document gives a comprehensive list of key texts on this subject.

For further information contact Helen Young, Emergencies Dept. Oxfam, 274 Banbury Road, Oxford 0X4 7DZ UK. E-mail hyoung@Oxfam.org.uk