The nuclear emergency guidance note mentioned in this blog aims to help healthcare workers and emergency planners on the ground in their responses to infant and young child feeding in emergencies (IYCF-E) immediately after a nuclear power plant accident. The note does not cover IYCF in the context of nuclear warfare and should be used in conjunction with existing guidance for the general public, healthcare workers and policy makers.
Given the current disruption to the Zaporizhzhia nuclear power plant in Ukraine, there is ongoing concern around nuclear accidents and emergencies in the region. Although nuclear radiation exposure poses a health risk to all individuals, it is breastfeeding women, infants and young children that are among those identified as vulnerable groups in need of support. The World Health Organization highlights that children have a higher sensitivity to radiation and the potential transfer of radioactive substances from mother to infant via breastmilk in the case of a nuclear power plant accident has caused concern]. Many international bodies have clear guidance on what to do in the case of a nuclear power plant accident for the general population, however specific and comprehensive guidance on infant and young child feeding in emergencies (IYCF-E) is hard to find, with limited guidance available to caregivers and health workers providing feeding support. Guidance has been contradictory or often focused on the risk of exposure to radioactive materials without fully balancing the risks of morbidity and mortality associated with not breastfeeding. Therefore, the Infant Feeding in Emergencies (IFE) Core Group saw a need to step in and address this gap through coordinating the development of a guidance note on infant and young child feeding to be used in the first three days after a nuclear power plant accident
The IFE Core Group consists of different expert organisational bodies and individuals from across the globe who come together regularly to address policy, guidance, training, and other gaps regarding infant and young child feeding in emergencies. In this case, given the lack of clear guidance regarding IYCF-E in the context of a nuclear power plant accident, the IFE Core Group convened experts from the fields of radiation, nuclear emergency, IYCF-E to agree on guidance based on the best available knowledge. This guidance has now been launched and is available on the IFE Core Group resource page .
Hiroko Hongo, a member of the IFE Core Group and the chair of the Infant and Young Child Feeding Support Network in Japan recently shared her experiences with us regarding the Fukushima nuclear accident in 2011;
”Some agencies measured the human milk contamination, mass media released [this information] widely and many mothers stopped breastfeeding... because mass media focused on contamination… and because of fear.
After Fukushima’s nuclear accident, those who said it was safe to breastfeed were sometimes labeled as pro-nuclear-plant by citizens… as anti-environmentalists… or fanatical believers in breastfeeding [and that] the benefits of breastfeeding were over-empathised. The reality is that most people do not know the importance of breastfeeding. Although Japanese Ministry of Health and Labour recommends breastfeeding as standard, they also wrote not to insist on exclusive breastfeeding in their guidance in 2019. Mass media misquoted a part of guidance that there was no difference between exclusive breastfeeding and mixed feeding. The Japanese breastfeeding rate has declined lately as the current social norm is pro-mixed feeding, which may be partially created by mass media influenced from companies promoting infant formula, especially ready to use infant formula (RUIF).…and most people know the risk of bacterial contamination in powdered formula if not preparing properly and believe that there is no risk of using RUIF. Many people may not aware that formula lacks properties to protect infants from infection which is often prevalent in emergencies”
Many families are still not fully of the benefits of breastfeeding, as well as the risks of breastmilk substitutes (BMS). WHO describes breastfeeding as one of the most effective methods for ensuring optimal child health and survival, giving children the healthiest start in life. Breastfeeding provides safe, clean food for infants, ideal for meeting a child’s nutritional needs and containing antibodies that help to protect the infant against many common illnesses in childhood. The Global Breastfeeding Collective, in partnership with UNICEF and WHO, highlight that the aggressive tactics used to market BMS have created a barrier to breastfeeding, reducing breastfeeding rates and ultimately impacting the health of both mother and child. The unnecessary and inappropriate usage of BMS has further been associated with increased deaths in children under five years old, as well as increased risk of developing respiratory and diarrhoeal diseases which are amplified during a disaster or emergency. Unfortunately, many companies marketing BMS fail to detail the risks associated with BMS and interrupting breastfeeding.
Hiroko also told us that the Japanese government, at the time of the Fukushima accident, had no clear recommendations around infant feeding in the context of a nuclear power plant accident . The fear of transferring radioactive materials to infants through breastmilk, inevitably led to many mothers switching from breastfeeding to formula feeding, despite being advised by health authorities to continue breastfeeding. To add to this, there was no mass media campaign discussing the importance of breastfeeding and the harm from interrupting breastfeeding. This may have contributed to increased fears around breastfeeding after the nuclear accident as research indicates the rate of exclusive formula feeding increased. Nuclear accidents such as Fukushima demonstrate how critically important it is to provide clear and accurate information, reassurance and guidance to ensure appropriate infant and young child feeding in a nuclear emergency.
Speaking with Hiroko and having the opportunity to hear valuable insights and lessons learned after the Fukushima nuclear accident have greatly shaped the way we will disseminate and communicate on the recently finalised guidance note in the context of the Ukraine crisis. In the era of social media, the risk of miscommunication is large, and we have responsibility to reduce fear amongst the breastfeeding population. The creation of this guidance and the associated key messages are based on the best available knowledge and experience amongst the IFE core group. It emphasises the importance of breastfeeding and the risks of interrupting breastfeeding, which a lot of other guidance has failed to emphasise, to avoid unnecessary disruptions to breastfeeding.
Rachael Menezes is a Nutritionist with Emergency Nutrition Network, working on the Management of small & nutritionally At-risk Infants under six months & their Mothers (MAMI), as well as Infant Feeding in Emergencies (IFE). Rachael obtained her MSc in Nutrition for Global Health at the London School of Hygiene and Tropical Medicine and her previous work with ENN focused primarily on adolescent nutritional status in Eastern and South Africa, and the Middle East and North Africa, as well as work related to maternal nutrition.