Considerations regarding the use of infant formula products in infant and young child feeding in emergencies (IYCF-E) programs

Abstract

Infants and young children are vulnerable in emergencies. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides direction to governments, aid organisations and individuals on how to support the wellbeing of this population. The importance of breastfeeding in promoting child survival in emergencies cannot be overestimated. Therefore, the primary intervention in infant and young child feeding in emergencies (IYCF-E) is to support exclusive breastfeeding for infants 0-6 months and then continued breastfeeding alongside complementary feeding for children 6-24 months. However, non-breastfeeding children are vulnerable in emergencies and require intensive support. The OG-IFE outlines requirements and protocols to minimise the risks of artificial feeding in emergencies. This paper explains the reasoning behind, and the application of, these requirements. The OG-IFE emphasises that infant formula should not be provided unless breastfeeding is not possible and that except in extraordinary circumstances, individual assessment of the need for infant formula is required. It states that infant formula should be purchased and not donated and that neither follow-on formula nor toddler milks should be used. It notes that whether ready-to-use liquid infant formula or powdered infant formula is most suitable for a program will depend upon factors such as the availability of funds, of products, of water and fuel, and of storage facilities. It says that infant formula labelling should meet the requirements of the International Code of Marketing of Breastmilk Substitutes and be in the language of the recipient population, with appropriate instructions and warnings. It describes how caregivers should be discouraged from using bottles and supported to use easily cleanable cups for feeding infant formula. It notes that infant formula should be provided to infants unable to access breastmilk until they are at least 6 months of age. It also says that caregivers of formula-fed infants should be supported with a package of other resources to support safer feeding that includes: fuel, clean water, equipment for household preparation and feeding of infant formula, one-to-one education and demonstrations on safe preparation of infant formula feeds, and growth and health monitoring of the infant. It stresses that breastfeeding support should be provided alongside any artificial feeding program so as not to displace breastfeeding. Finally, it notes that in order to maximise effectiveness, IYCF-E requires a cross sectorial response with the involvement of various sectors, including child protection, water sanitation and hygiene (WASH), health, HIV, mental health and psychosocial support, education, disability, logistics, shelter, food security and livelihoods, and cash transfer programs.