How breastfeeding may be affected and what challenges there may be in an emergency setting, and how those working in health can assit to overcome these challenges?

Emergency situations can seriously threaten breastfeeding practices and consequently child nutrition, health and survival. Misconceptions of mothers, community members and those involved in the relief effort about the effects of trauma, stress and maternal malnutrition on breast milk may reduce a mother’s confidence in her ability to breastfeed. Though a woman’s ability to produce breast milk is not affected by a stressful situation, her body’s capacity to ‘let down’ milk can be impaired by stress. The inability of the mother to let down can interfere with effective suckling and further reduce her confidence. A lack of privacy in shelters or camp settings may restrict a mother's ability to comfortably breastfeed and heighten her stress level. As well, post-traumatic stress, illness, sexual violence and severe depression – all potentially elevated during emergency settings – may cause mothers, to reject their infants or the act of breastfeeding. Time constraints may also be heightened during emergency settings and undermine breastfeeding. Women who must travel long distances, queue in long lines for food, water and fuel rations, and carry rations back to communities may be unable to travel with their infants. This interferes with on-demand and frequent feeding necessary to maintain breast milk supply. These activities also restrict the time the mothers can dedicate to appropriate breastfeeding and care of their children. Lastly, the unregulated distribution of breast milk substitutes (BMS), which includes powdered milk provided in food rations, may also undermine women’s efforts to breastfeed. (Note: BMS are any food being marketed or otherwise represented as a partial or total replacement for breast milk, whether or not it is suitable for that purpose. This includes infant formula, other milk products, therapeutic milk and bottle-fed complementary foods marketed for children up to two years of age, and complementary foods, juices and teas marketed for infants less than six months.)

Mothers have the right to specialist support to reinforce and restore their confidence and capacity to breastfeed their children. Given the unique challenges and heightened risks in emergency situations, specific and extra efforts must be taken to ensure that breastfeeding is protected and promoted. Protection and support of non-breastfed infants and young children must also be provided. Baby-friendly tents are one strategy for addressing many of these challenges.

Humanitarian organizations must protect, promote, and support breastfeeding in emergencies. Policies need to be in place that prohibit the donation of breast-milk substitutes and control their procurement and distribution in emergencies, based on appropriate needs assessments. Skilled breastfeeding assistance needs to be part of health services and private places need to be made accessible for mothers to feel safe breastfeeding. Special attention needs to be paid to the care and nutrition of women who are pregnant or breastfeeding. In emergencies where not enough nutrient-rich food is available, these women should be given vitamin and mineral supplements. Finally, multiple communication channels are needed to reach mothers and their family members with messages on the importance of continued breastfeeding and the dangers of using breast-milk substitutes ... (more)