Breastfeeding in Emergencies
by Anne Eglash MD, IBCLC, FABM
The Academy of Breastfeeding Medicine (ABM) recently published their position statement on breastfeeding in emergencies. The authors explain that breastfeeding is crucial for infant feeding during emergencies because it safeguards the infant from infection, malnutrition, stress, and pain. Breastfeeding also supports the mental health of the mother, improves birth spacing, and lowers the risk of postpartum hemorrhage. Breastfeeding does not require clean water, feeding utensils, electricity or other supplies.
Infants dependent on commercial infant formula face the risk of food insecurity due to inaccessibility of feeding resources such as clean water, formula, and feeding vessels.
The position statement emphasizes the need for basic training of emergency relief personnel, and the presence of trained personnel to support breastfeeding parents. This involves understanding the harm of providing commercial infant formula.
There are many more recommendations in this document. See the question to check your knowledge!
- Local informal milk sharing is preferred over banked milk because of availability and lower cost.
- Mothers who are separated from their infants should be given breast pumps to support their milk production.
- Mother-baby areas should be set up as protected spaces to support maternal mental health, breastfeeding and other health needs.
- For non-breastfed infants, commercial infant formula should be prioritized over wet-nursing.
- Donations of commercial infant formula, bottles, nipples, and breast pumps should be discouraged.
- Complementary feeding should begin at 4 months rather than 6 months to provide extra calories.
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Abstract
Background
During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies.
Key Information
Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support. Recommendations: Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.
The ABM position statement on breastfeeding during emergencies includes a graphic depicting the hierarchy of feeding options: first is direct breastfeeding from the mother, followed by mother’s own expressed milk by cup, relactation, wet-nursing, expressed donor milk by cup, and finally, commercial infant formula. ABM advises prioritizing banked milk over local informal breastmilk sharing.
If mothers are separated from their infants, lactation should be supported by hand expression rather than breast pumps unless there are resources to wash pump parts with hot water.
The authors emphasize the importance of distinguishing between breastfeeding and human milk feeding. Direct breastfeeding is optimal as it negates the need to clean feeding vessels, store expressed milk, and breastmilk is the most biologically active when fresh.
Non-breastfed infants should be considered a vulnerable population, and ABM recommends breastfeeding or donor milk as initial options for these infants. Complementary feeding should only commence after 6 months of age. For infants without access to breastfeeding or donor milk, commercial infant formula is recommended until 6 months of age, when complementary feeding can begin. Beyond 6 months, either animal milk or commercial infant formula may be used but infants consuming animal milk should receive high-iron foods.
The statement advises that commercial infant formula should be purchased rather than donated, to prioritize re-lactation, wet-nursing and breastfeeding. The influx and indiscriminate use of commercial infant formula can harm breastfeeding practices and increase the risk of infant morbidity and mortality.
This position statement also includes specific recommendations tailored to different types of emergencies, such as blizzards, fires, earthquakes, etc. It is an excellent comprehensive and evidence-based guide on supporting mother-infant dyads in emergencies.