This World Breastfeeding Week, Brooke Bauer – the GNC Technical Alliance's Maternal, Infant & Young Child Nutrition in Emergencies (MIYCN-E) and Gender Advisor – shares why it’s important to promote breastfeeding in emergencies. 

Why is breastfeeding such an important intervention during emergencies? 
Maternal, infant and young child feeding practices that support nutrition throughout the first 1,000 days– including maternal nutrition, early, exclusive and extended breastfeeding, and timely introduction of complementary foods– is the single most life-saving intervention for children under five globally. Breastmilk is the safest and most nutritious, affordable and reliable source of food for infants under six months. It is always the right temperature, requires no preparation and is readily available even in settings with limited access to clean water and adequate hygiene. And the benefits do not stop at six months of age. Breastfeeding continues to offer all of these benefits after solid food is introduced at six months of age and continues to provide nutrition during extended breastfeeding up to two years and beyond.

During emergencies, breastfeeding is even more important and life-saving. Conflicts, natural disasters and epidemics often force families to flee their homes, which results in food insecurity and the disruption of essential services, separates families and disrupts social systems and limits access to clean water. In these settings, women and children become especially vulnerable, so breastfeeding becomes a child’s food security. It guarantees food that is nutritious, accessible, appropriate, affordable and always ready. And breastfeeding also provides protection against malnutrition, disease and death for children – especially those under six months.

Yet despite its life-saving benefits, only around 40 per cent of infants under six months are exclusively breastfed worldwide. However, if we can increase breastfeeding globally, we could prevent more than 800,000 child deaths each year – particularly those associated with diarrhoea and pneumonia.

What are the baseline recommendations for breastfeeding?
The World Health Organization (WHO)  and United Nations Children’s Fund (UNICEF)  recommend that infants should initiate exclusive breastfeeding within one hour of birth and continue exclusively breastfeeding for the first six months of life. After this time, infants should continue breastfeeding up to two years of age or beyond while also receiving age-appropriate, nutritious and hygienic complementary foods. These are the recommendations we should be regularly promoting and adopting in our nutrition responses, especially during emergencies.

Why do you think it is important to celebrate World Breastfeeding Week? 
Breastfeeding is essential if we are to meet the Sustainable Development Goals  in a post-pandemic world, as it improves nutrition, provides food security and reduces inequality.  By celebrating World Breastfeeding Week, we can shed light on this important intervention as a shared responsibility of actors to protect, promote and support breastfeeding across all levels of society. From government to frontline workers, it is our shared duty to understand the importance and life-saving effects of breastfeeding on not only the child and family but the entire community itself.

What are some of the challenges that caregivers face in breastfeeding – particularly in emergency contexts?
Emergencies cause instability, which seriously threatens breastfeeding practices and children’s nutrition, health and survival. It’s important to continue promoting breastfeeding in emergencies while swiftly dispelling myths and addressing misconceptions.  For example, it is often believed by mothers, community members and those involved in the relief efforts that trauma, stress and maternal malnutrition have negative effects on a mother’s breast milk production. However, a woman’s ability to produce breast milk is not directly affected by a stressful situation itself, but her body may be slower to release the milk, which can lead the mother to lose her confidence and look for other solutions.

A lack of privacy in shelters or camp settings may also make a mother uncomfortable breastfeeding her child and heighten her stress level. It is important that in these situations there is support available where a woman can have privacy, a calm environment and support to build confidence in her body’s ability to feed her child.

Time and the burden of additional household tasks are also heightened during emergencies and can undermine breastfeeding. When displaced, families frequently must travel long distances, queue in long lines for food, water and fuel rations, often taking them away from their infants for long stretches in order to carry rations back to their communities. This makes on-demand and frequent feeding – which is necessary to optimally breastfeed the child – very difficult and restricts the time the mothers can dedicate to appropriate breastfeeding and caring of their children.

Why is breastfeeding a safer, more effective intervention to promote in emergencies than breast milk substitutes (BMS) like infant formula?
Many times, volunteers or others within an emergency response distribute infant formula and other breast milk substitutes (BMS) thinking they are helping, but in reality, this is an incredibly dangerous practice that undermines breastfeeding. Infant formula use in refugee camps is dangerous because when the supply is unstable, families will often dilute the milk to make it last longer. But by adding too much water to the BMS the infants do not receive enough nutrients.  Also, oftentimes the powdered milk – which is not sterile – can’t be heated properly to kill any bacteria in the formula as fuel is limited. Just as we don’t eat raw chicken, we can’t drink formula without using boiled water that will kill bacteria in the formula itself. This is very dangerous for infants as their young, growing bodies are even more vulnerable to illness.  Given the unique challenges and heightened risks in emergencies, specific and extra efforts must be taken to ensure that breastfeeding is protected and promoted.

How can we protect breastfeeding mothers in nutrition emergencies?
Countries have shown that it is possible to protect, promote and support breastfeeding in emergencies. As humanitarian professionals, we must make it the norm and abide by global health, nutrition and humanitarian standards. All actors have a responsibility to support national policies and guidance that protect breastfeeding, prioritize breastfeeding in government and humanitarian responses and make it a part of emergency preparedness. By providing a holistic, cross-sector breastfeeding environment in emergencies, we can create a situation where mothers and infants are supported, even if they are displaced or living in an insecure environment.   It is also crucial that as humanitarian actors we share accurate information with partners across all sectors about the life-saving value of breastfeeding and its importance in emergency settings.

We must also work collectively to strengthen the capacity of health and nutrition actors to be able to provide high-quality breastfeeding support and life-saving interventions to ensure that breastfeeding is protected. We must also highlight the dangers and risks associated with the use of infant formula and bottle use, especially in emergencies.  Humanitarian partners must be informed on how to monitor and report the distribution of infant formula or bottles appropriately to control these types of dangerous activities in an emergency. And these violations must be reported to the relevant authorities to ensure that breastfeeding mothers are not exploited for commercial interests – a sad, yet common practice by infant formula companies and others who can profit from emergencies. Ultimately, breastfeeding is one of the most sustainable, cost-effective and safest ways we can support the health and nutrition of infants and young children affected by emergencies. We all need to do our part to protect and promote this life-saving practice.

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