Supporting breastfeeding during humanitarian emergencies

Abstract

Infants (birth to one year of age) are among the most vulnera-ble population groups during humanitarian emergencies. 1 In these situations, preventable diseases such as malnutrition, diarrheal dis-eases, and acute respiratory infections are some of the most com-mon contributors to infant death and disease. 2 As such, survival strategies targeting infant and child nutrition have been empha-sized as emergency response priorities, with much of the discourse on this topic focusing on the merits of breastfeeding (typically in comparison to infant formula). The World Health Organization recommends that all infants are exclusively breastfed (ie given only breast milk unless medically necessary) from birth until 6 months of age, followed by the intro-duction of complementary foods and continued breastfeeding for up to 2 years. 3,4 Decades of research supports this recommendation, providing evidence for the far-reaching benefits of breastfeeding for both mothers and infants. 5 Some breastfeeding-related benefits are especially vital during a humanitarian emergency. Breast milk is regarded as the optimal source of nourishment for infants, thus reducing the risk of malnutrition. 6,7 Not only is breast milk nutri-tionally superior to formula in that it provides the appropriate bal-ance of carbohydrates, fatty acids, protein, vitamins, and minerals in highly digestible forms, but breast milk also adapts its composi-tion to meet the nutritional needs of growing infants. 7 In addition, breastfeeding protects infants against infection-related morbidity 8 and mortality 9 due to the antimicrobial, anti-inflammatory, and an-tioxidant biomolecules found in breast milk. 10 Mothers also receive benefits from breastfeeding including a reduced physiological re-sponse to stress. 11 This may assist in dealing with the taxing circum-stances of an emergency, as well as reduce stress-induced immuno-suppression and its associated health sequelae. 12,13 Further, breastfeeding provides a sustainable infant feeding option in the face of poor sanitation, lack of clean water access, and poverty. 14 In accounting for one week's worth of emergency supplies, an Australian study showed that it costs A$50 to provide necessary supplies for an exclusively breastfed infant, A$250 for an infant fed with powdered formula, and A$550 for an infant fed with ready-to-use liquid formula. 15 The authors also noted that while 2 items (diapers and wipes) are needed to support breastfed infants, 12 to 16 items (eg formula, detergent, feeding bottles) are required for formula-fed infants. The amount of time needed to safely and properly prepare formula can also be burdensome. Authors of a study conducted in a rural South African setting where electrici-ty, gas, and tap water were inaccessible found that it took 21 to 25 minutes to prepare one formula feed, for a total of 2.5 hours of daily feeding preparation without accounting for time spent feeding the infant. 16