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Breastfeeding is Shield that protects infants in emergencies
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Introduction
Appropriate feeding practices are essential for the nutritional status, growth, development and survival of
infants and young children. Infants should be exclusively breastfed for the first six months of life, and
thereafter should receive nutritionally adequate and safe complementary foods while breastfeeding continues up
to two years and beyond. Special attention and practical support is needed for feeding in exceptionally difficult
circumstances such as infants and children in emergencies.
| In Pakistan, 73 infants die out of 1000 live births every year out of these 57 are
those who die before reaching one month of age due to diarrhea, pneumonia, respiratory infections and
malnutrition. These infants can be saved if they are protected through natural protection of mother’s milk upto
first six months. |
Natural and man-made disasters – earthquakes, floods, droughts and wars – regularly put lives at risk. And babies
caught in the ensuing chaos are vulnerable to malnutrition and death. In 2005, Pakistan was struck by major
earthquake with a magnitude of 7.6 in which more than 81,000 people were killed and 3 million left homeless.
In the recent conflict situation of Swat, Malakand, Buner and Dir, more than two million have been internally
displaced. A recent UN report indicates that this Internal Displacement of over two million people is the biggest
displacement in the past fifteen years. In such emergencies, infants and young children are the most vulnerable to
diseases due to improper feeding practices, un-safe drinking water and lack of hygiene etc. Health service
providers, NGO workers and other stakeholders responsible for emergency preparedness and response in infant and
young child feeding in emergencies have an important role in helping to protect infants in emergencies by not
supporting appeals for donations of infant formula and by reminding the nation that breastmilk is a reliable and
sterile food that helps to prevent illness, while artificial feeding may further add to the health risks.
Ministry of Health-Pakistan has issued GUIDELINES to
address the problem of nutrition in emergencies.
| In such emergencies, infants and young children are the most
vulnerable to diseases due to improper feeding practices, un-safe drinking water and lack of
hygiene etc. |
Why are infants vulnerable?
Babies have specific nutritional needs and are born with an undeveloped immune system. For infants who are
breastfed, breastmilk provides both food and immune support, which protects them from the worst of emergency
conditions. However, the situation is very different for babies who are not breastfed. In an emergency, food
supplies are disrupted, there may be no clean water with which to make up infant formula or sterile feeding
implements and the health care system is stretched past breaking point. This means that babies who are not
breastfed are vulnerable to infection and to developing diarrhoea. Babies with diarrhea easily become malnourished
and dehydrated and so are at real risk of death.
Whenever there is an emergency, it is extremely important that babies who are already being breastfed continue to
be and that babies who are not breastfed re-start breastfeeding or, if this is not possible, are given infant
formula in the safest possible way.
What about young children?
It is not only babies that are vulnerable. Under five year olds, and especially children under 2 years, are at risk of increased illness and death in emergencies. Breastfeeding still protects these children and the World Health Organization (WHO) recommends that breastfeeding be continued until at least 2 years of age. Young children also need enough nourishing food that
is safely prepared – this too can be a real challenge in an emergency.
| A Centre for Disease Classification (CDC) investigation of the post-flood deaths
of more than 500 children in Botswana in 2005-06, found that nearly all of the babies who died were formula fed.
Here the risk of hospitalization for babies who were not breastfed was 50 times greater than that of breastfed
infants. |
What is the problem?
Past experience worldwide has shown that when there is an emergency, massive amounts of infant formula and
powdered milk are commonly donated. In the confusion that surrounds emergencies, these products are often
distributed in an uncontrolled way and used by mothers who would otherwise breastfeed their babies. This results
in unnecessary illness and death for many infants. For instance, a UNICEF audit after the 2006 Yogyakarta
earthquake in Indonesia found that although breastfeeding rates were initially very high, 70% of children under
six months had been given donated infant formula. In another example, a Centre for Disease Classification (CDC)
investigation of the post-flood deaths of more than 500 children in Botswana in 2005-06, found that nearly all of
the babies who died were formula fed. Here the risk of hospitalization for babies who were not breastfed was 50
times greater than that of breastfed infants. It is also extremely common for powdered milk to be distributed as
a part of general rations. However, this is also problematic since experience has shown that about half of such
milk will be given to babies.
How can babies and young children be protected in emergencies?
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Mothers who are breastfeeding their babies are to be given support and practical assistance to continue, they
should not be given infant formula or powdered milk. Experience has found that peer support programs can help
mothers to care for their babies and keep breastfeeding.
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Mothers who have stopped breastfeeding completely, i.e. weaned their babies, should be encouraged to restart
breastfeeding (relactate) and the option of wet nursing (where another woman breastfeeds the baby) should be
explored for babies without mothers.
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If there are infants who cannot be breastfed they should be provided with infant formula and the associated
necessary resources to prepare it, under close supervision. Carers should be provided with education and support
and the health of the baby monitored. Baby bottles should never be used because of the risk of contamination due
to the difficulty of effectively cleaning them – even young babies can be fed via cup or spoon.
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If powdered milk is to be provided it should be mixed with the local staple cereal prior to distribution so
that it cannot be used as a breastmilk substitute. There is no need for donations of infant formula, powdered
milk or baby bottles to be sent to the site of an emergency.
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Efforts to protect and support breastfeeding and ensure safe artificial feeding should extend to all young
children.
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Emergencies may be used by infant formula manufacturers as a way to enter new markets and increase sales.
Unethical marketing of infant formula is a problem worldwide and an international code has been developed to
protect mothers and babies from such unethical marketing.
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Members of the public who become aware of aid agencies distributing infant formula or powdered milk
inappropriately should report these activities to the relevant authorities (UNICEF, WHO, TheNetwork, WFP and
Nutrition Wing, MoH).
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