Infant feeding: policies and guidelines

Summary of a review¹

In 1993 UNICEF compiled a collection of policy and guideline documents relating to the feeding of infants in emergency situations. In June 2000 Save the Children UK, UNICEF and the Institute of Child Health (ICH) undertook a review of those documents updating the list and identifying the common ground that exists among the different policies. The review also analysed the consistency of the policy framework, and highlighted important areas where guidelines are missing or unclear. An article has recently been published which outlines the main issues arising from this review.

The key conclusions indicated that there is a general consensus on what constitutes best practice in infant feeding. However, the lack of clarity in the respective responsibilities of key UN agencies (in particular UNICEF, UNHCR and WFP) over issues relating to co-ordination of activities which affect infant-feeding interventions constrains the implementation of systems to support best practice. While responsibility for this function most obviously falls with UNICEF, the existing Memorandum of Understandings between the agencies does not make this explicit, allowing room for alternative scenarios. Other important functions hitherto overlooked by the policies and guidelines are the monitoring and control of unsolicited donations of infant feeding items and the co-ordination of NGO and military activities in infant feeding. Given that many agencies are potentially involved in supporting infant feeding activities (from water, logistics, food, health and transport agencies) the co-ordination function will be challenging and must therefore be adequately resourced.

The authors also conclude that the weak evidence base on effective and appropriate intervention strategies for supporting optimal infant feeding in emergencies implies a poor understanding of the practical tasks needed to support mothers and minimise infant morbidity and mortality. One of the most important gaps in current policies and guidelines is evidence-based practical recommendations for promoting and supporting breastfeeding and supporting the safe use of substitutes when these are necessary. While some important experience has been gained in the Balkan crisis by national and international NGOs, there is relatively little understanding of feasibility of options in different emergency contexts including situations where there is a high prevalence of HIV/AIDS.

Two recommendations are made:

1. the operational UN agencies primarily UNICEF, should examine the options for improving coordination on a range of activities to uphold best practice of infant feeding in emergencies;
2. urgent attention needs to be given to developing and supporting operational research in different emergency contexts on the promotion of optimal infant-feeding interventions.

¹Seal.A, Taylor. A, Gostelow. L, and McGrath.M (2001). Review of Policies and Guidelines on Infant feeding in Emergencies: Common Ground and Gaps. Disasters, Volume 25, pp 136-148.