Breastfeeding: From mother to child
"Breastfeeding - a vital emergency response: Are you ready?". This is the theme of World Breastfeeding Week 2009
World Breastfeeding Week (WBW) is here, but how many of us are aware of its importance, especially during emergencies.
This year's WBW, celebrated from August 1 to 7, also echoes the same theme, "Breastfeeding - a vital emergency response. Are you ready?". It highlights the need to protect, promote and support breastfeeding in emergencies for infant and young child survival, health and development.
The week commemorates the Innocenti Declaration made by World Health Organisation (WHO) and The United Nations Children's Fund (UNICEF) in August 1990 to protect, promote and support breastfeeding.
Did you know?
Children are among the most vulnerable groups during emergencies, and infants are the most vulnerable of all, owing to increased risk of death due to malnutrition, diarrhea and pneumonia.
Published total mortality rates for infants under one year of age in emergencies are much higher than at ordinary times, ranging from 12 percent to 53 percent. Sub-optimal breastfeeding practices are responsible for 1.4 million deaths of children under five years in low-income countries and settings worldwide
Even during non-emergency situations, optimal infant feeding practices can make a difference between life and death. Thirteen percent of under–five deaths could be saved through exclusive and continued breastfeeding until one year of age. One-fifth of neo-natal deaths could be prevented by early initiation of exclusive breastfeeding (breastfeeding within the first hour)
Breastfeeding is the best way to provide newborns with the nutrients they need. Breast milk is the one safe and secure source of food for babies, instantly available, providing active protection against illness and keeping an infant warm and close to mother.
WHO recommends protecting, promoting and supporting early initiation and exclusive breastfeeding for six months, followed by continued breastfeeding with the introduction of appropriate and safe complementary foods, until two years or beyond, will provide optimum protection in this risk-laden environment.
Breastfeeding: A lifeline during emergencies
Nowhere is ‘immune’ to an emergency. Be it an earthquake, conflict, flood or flu pandemic – the story is the same: breastfeeding saves lives.
Can you imagine the difference that optimal breastfeeding could make in an emergency? Let’s take, as an example, the most vulnerable: a newborn infant, born into a situation of insecurity and poor sanitation, with dirty water, scant food and no shelter. Extreme weather conditions, lack of skilled birth attendance and medical care, and premature birth increase risks even further.
Skin-to skin contact from immediately after birth and initiation of breastfeeding within one hour reduces deaths by nourishing and actively protecting the infant, and helping to stabilize his/her body temperature. It also reduces the risk of post-partum haemorrhage in the mother – a leading cause of maternal mortality worldwide.
During emergencies, unsolicited or uncontrolled donations of breast-milk substitutes may undermine breastfeeding and should be avoided. As part of emergency preparedness, hospitals and other health care services should have trained health workers who can help mothers establish breastfeeding and/or overcome difficulties.
Objectives of WBW 2009
To reinforce the vital role that breastfeeding plays in emergency response worldwide.
To advocate for active protection and support of breastfeeding before and during emergencies.
To inform mothers, breastfeeding advocates, communities, health professionals, governments, aid agencies, donors, and the media, about how they can actively support breastfeeding before and during an emergency.
To mobilise action and promote networking and collaboration between those with breastfeeding management skills and those involved in emergency response.
Infant and Young Child in Emegencies (IFE)
An emergency is an extraordinary and extreme situation that immediately puts the health and survival of a population at risk. IFE focuses on the protection and support of safe and appropriate feeding for infants and young children in emergencies.
It addresses both emergency preparedness and a timely and appropriate humanitarian response in the event of an emergency, to safeguard the survival, health, growth and development of infants and young children.
Dispelling Myths on Breastfeeding
Myth 1: Malnourished mothers cannot breastfeed.
Fact: Malnourished mothers can breastfeed. Moderate maternal malnutrition has little or no effect on milk production. In fact, the mother will continue to produce milk, at the expense of her own body stores. Extra food and fluids are needed to replenish the mother’s own reserves, and micronutrient supplementation may be needed. She also needs encouragement and support to breastfeed frequently.
Solution: Feed, nurture and support the mother and let her feed the baby.’
Myth 2: Stress prevents mothers from producing milk.
Fact: Stress does not prevent production of milk, but may temporarily interfere with its flow. Breastfeeding mothers have lower stress hormone levels than non-breastfeeding mothers.
Solution: Create conditions for mothers that lessen stress as far as possible – a protected area, a mother-baby tent, reassurance from other women, keeping mothers and babies together, listening to mothers’ special needs – and making sure the child keeps suckling so that milk flow continues.
Myth 3: Once a mother stops breastfeeding, she can’t restart.
Fact: A mother can restart breastfeeding (re-lactate) – there is no time limit. In some contexts, grandmothers have breastfed their grandchildren!!
Solution: Offer support for breastfeeding and re-lactation.
Myth 4: When a woman has been raped, she cannot breastfeed.
Fact: Experience of violence does not spoil breast milk or the ability to breastfeed.
Solution: All traumatised women need special attention and support. There may be traditional practices that restore a woman’s readiness to breastfeed after sexual trauma. Breastfeeding can sometimes help women to heal after sexual trauma but respecting and supporting their decisions and needs is a priority.
Myth 5: HIV positive mothers should never breastfeed.
Fact: Exclusive breastfeeding for six months is the safest option and gives the best chance of HIV-free child survival, unless total replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS) – most unlikely in emergencies. After six months, if replacement feeding is still not AFASS, then continued breastfeeding with adequate complementary foods is the safest option.
The risk of postnatal transmission can be lowered with mother and/or infant receiving anti-retroviral (ARV) drugs. Mixed feeding in the first six months (combining breastfeeding and formula feeding and/or too-early introduction of complementary foods) is the most risky feeding option, since it increases the risk of both HIV transmission and infections due to other causes, such as diarrhoea. Where the HIV status of individual mothers is unknown, then recommended feeding practices are the same optimal feeding practices as for the general population, irrespective of the prevalence of HIV in the population.
Solution: For guidance on programming for HIV and infant feeding in emergencies, see www.ennonline.net and/or www.waba.org.my
What can be Done?
First and foremost, recognise that you have a role. Think of how you can act, prepare yourself and take action. And foremost, make make sure that a story of similar kind does not ever repeat...
“A mother had been stuck on a rooftop with many family members and her two week old baby who was bottle fed. They had no access to safe water for five days. Her baby was immediately hospitalized when they arrived in Austin, but she died several days later. The nutritionist of a relief organisation supplying food aid asked the mother if there was anything else she could help her with. The mother asked for help drying up her breast milk as her breasts were still sore."
"The nutritionist asked the mother why she hadn’t breastfed her baby while she was stuck on the rooftop. But the mother had felt quite unable to do this. What amazes me is that no one with the mother in New Orleans knew to have the mother put her baby to her breast. So many generations had not considered breastfeeding as a way to feed babies that the memory was lost. The baby was lost, also.”– Experience of a peer counsellor, Hurricane Katrina, USA, 2005
Emergency preparedness is the key to quick, appropriate actions. Development of protective policy, strong Code legislation, capacity building of staff and strengthening of the Baby-Friendly Initiative (BFI) are necessary at all times, not just in crisis.
Advocate with policy-makers and managers to make effective infant feeding support a part of normal health care and of collaborative emergency preparedness plans.
Formulate plans to prevent donations of BMS, bottles and teats and have a plan of action ready to handle any donations that do arrive during an emergency. Network and collaborate across sectors.
The best preparation for a mother facing an emergency is well established breastfeeding. A mother who practises and is confident in her own capacity to breastfeed her infant in any circumstance will be best placed to do just that, and to help other mothers to do the same.
Once an emergency strikes, simple measures can make all the difference in the world to a mother caught up in it. Ensure that mothers are secure, have priority access to food for the family, water, shelter, and when necessary, safe places to breastfeed (with privacy, where culturally required).
From water and sanitation, to health, to nutrition, to child protection, to food security and livelihoods response – see how you can integrate basic frontline protection and support for breastfeeding in your line of work.
Listen to the needs of the women and communities – they often know best how to create supportive environments for themselves and their families. Mother support groups can play an important role.
Protection and support also need to come ‘from afar’ – from donors, the media, and the general public who, through their actions, funding, donations, and press articles, affect emergency response.
Be alert to plans or reports of donations of infant formula, milk products, other BMS, baby bottles/teats. Monitoring and reporting Code violations in emergencies is an important step towards protecting breastfeeding.
Be proactive – an Interagency Joint Statement (see Model Joint Statement) and press releases can be used to prevent donations.
Work on communication. Use the Media Guide on IFE to develop press release messages that strengthen – not undermine – breastfeeding in emergencies.
Apply your knowledge – reinforce optimal feeding practices in the context of whatever emergency is happening in your setting, sharing links to key resources and materials.
Trained breastfeeding counsellors who can offer skilled breastfeeding assistance are of great help during an emergency. Breastfeeding counsellors may need extra training with specialized skills related to the emergency situation – for example, how to help mothers who are traumatised, infants/mothers who are malnourished, mothers who need relactation support, women who need support to wet-nurse.
