Infant Feeding in Emergencies - the challenges

To the uninitiated, Infant Feeding in Emergencies (IFE) may seem like a pretty innocuous topic which gets a lot of media coverage when crises occur. The fact is that there is a plethora of issues, interests and viewpoints surrounding the subject of Infant Feeding in Emergencies. In this issue of Field Exchange we have given special emphasis to this topic in that it features in different guises in each of our sections; field articles, reviews, letters, resources. We hope to raise awareness and stimulate debate on some of the issues involved, as well as inform current thinking by highlighting real constraints on the ground. Below is a shortintroduction to some of the players and their perspectives in the IFE arena.

First of all there are the infant formula companies who stand to make a profit every time a baby is not breast fed. They sometimes break international marketing codes to expand their market to new customers, regardless of whether their products can be safely used in the new environments. They donate infant formula to hospitals as free samples to entice mothers to feed artificially rather than naturally. in emergency situations, where infectious diseases are rampant, this can have serious consequences - increasing infant deaths as well as the loss of the contraceptive effects of breast feeding.

The basic resources needed for artificial feeding are often not available in emergency and relief situations. These resources include: a safe water supply; fuel for sterilising feeding equipment and boiling water; adequate storage conditions; a continuous supply of affordable Breast Milk Substitutes (BMS); and, of course, instructions on preparation that can be easily understood.

Secondly there are the infant feeding experts who give evidence based reassurance that breastfeeding is robust and rarely affected by stress or malnutrition. Those attached to teaching institutions provide appropriate courses for health workers. They produce the papers and the guidelines and are a great resource on best practice.

There are the breastfeeding advocates like the IBFAN member groups, who work for better child health and nutrition through the promotion of breastfeeding and the elimination of irresponsible marketing of infant foods fed with bottles and teats.

There are the NGOs working in the emergency and relief sector, some of whom have developed policies on the protection, support and promotion of breastfeeding yet encounter constraints to implementation in practice (see field level articles IFE: Experience from Former Yugoslavia and IFE: Experience from Rwanda). Other NGOs are simply not aware of the issues and merrily distribute free donations of infant formula to mothers who might otherwise breastfeed in situations where it is near impossible to prepare formula feeds safely.

Then there are the mothers who ultimately decide or are coerced to (depending on your point of view) feed their babies by one or other method. The mothers' perspectives are probably as diverse as the cultures, environments and individual situations from which they come, but there seems to be little known about this point of view in emergency situations. It would obviously be very useful to know if, why, and how mothers change feeding practices when, for example, they are displaced from their homes or when their social environment changes dramatically. It would also be useful to know what factors are likely to influence change, for example the availability of free milk. An effort should also be made, in different emergency settings, to find out what mothers' understandings are regarding what is better for their babies, as well as the constraints they experience in striving for the best for their infants. Some work has been carried out on socio-cultural considerations of infant-feeding in emergencies which improves understanding for some specific settings. However, there is seldom a systematic approach to finding out about the experience of mothers in the emergency setting. Kathy Carter has produced some practical guidelines for Oxfam which may change this in the future (guidelines reviewed here).

Last amongst the players, but certainly not least, there are the infants themselves for whom, to use a well worn cliche, breast is best.

That's the introduction - now happy reading. Special focus in the next issue is 'Supplementary Feeding' so if you have relevant experiences, research or evaluation findings or questions, write in, fax, e-mail or phone, and get involved.

(Introduction by Fiona O'Reilly - ENN)