"Breastfeeding-a vital emergency response. Are you ready?"
This theme for World Breastfeeding Week this year brings into focus the need to promote and support breastfeeding during emergencies for the survival, health and development of infants and young children. World Health Organization (WHO) recommends exclusive breastfeeding for infants till they are six months old, followed by additional nutritious food, supplemented alongside breast milk until age two or beyond.
Breast milk-the best milk
Breast milk is instantly available and it is the safest and the most secure source of nourishment for babies. It protects the baby against illness and ensures warmth and comfort to the baby that is held close to the nursing mother. Statistics prove that universally, even in non-emergency times, optimal infant feeding practices such as breastfeeding hold the promise of a healthy growth for babies in their formative years. Recent statistics show:-
• About 1.4 million deaths of children aged below two years in settings worldwide, especially in low income countries, are due to sub optimal breastfeeding practices
• One fifth of neonatal deaths can be prevented by initiating exclusive breastfeeding as early as possible (breastfeeding within the first hour after birth)
• 13% of under- five deaths can be prevented through exclusive and continued breastfeeding at least till the baby is a year old
History has shown that children are among the most vulnerable groups in emergencies brought about by natural calamities such as floods, hurricanes, earthquakes, tsunami, drought, famine or man made complications such as war and terrorist attacks. Very small children are the most vulnerable of all, facing death risks due to diarrhea, respiratory diseases, severe infections and malnutrition. Emergencies can happen at any time and anywhere in the world and the common formula is: Breastfeeding can save lives. Read a few statistics from emergency experiences:
• Recorded total mortality rates for babies under one year of age in emergencies are 12% to 53% higher than ordinary times
• 95% of the 43,529 children in malnourished cases admitted for a therapeutic feeding program in Niger in 2005 were below two years of age
• In the first three months of armed conflict in Guinea-Bissau in 1998, the mortality rate among 9-20 month- old children who were not breast fed was six times higher than among breast fed children in the same age group
Challenges to promoting breastfeeding in an emergency
Though it is common knowledge that breastfeeding is beneficial to babies and exceptionally important during emergencies, 'making it happen' is seriously challenged by common misconceptions, risks of artificial feeding and donations in times of emergencies. Prevailing feeding practices, nutritional status of women and children, available resources and the nature of humanitarian aid influence the impact of emergency on children.
In times of emergency, unsolicited or uncontrolled donations of breast-milk substitutes should be avoided as they may undermine breastfeeding practice. Widespread distribution of donated infant formula following the earthquake in Indonesia in 2006, led to its increased use among breastfeeding infants. The result was a doubling of Diarrhoea prevalence among babies who received donations of infant formula (25%) compared to those who were breastfed (12%).
The Botswana experience in 2005/06 serves to highlight the risks of artificial feeding especially in troubled times. HIV infected mothers were supplied infant formula as Replacement feeding as part of a nationwide program to prevent transmission of AIDS. Severe flooding led to water contamination that resulted in a diarrhea and malnutrition in children. Nationwide under-five death rate increased by over 18% compared to previous years. Non breastfed babies were fifty times more likely to need hospital treatment and were even dying, than breastfed babies. Moreover, using infant formula "spilled over" unnecessarily to 15% of women without HIV who could have breastfed their children but subjected their babies to needless risk. Lesson learnt from the experience was that wherever artificial feeding is done, strong breastfeeding support should be in place to protect artificially fed babies.
It is noted that a HIV -infected woman can pass on the virus to her child during pregnancy, birth, or breastfeeding. One-fourth to one-half of all mother-to-infant HIV transmissions occur through breast feeding, depending on its duration. Yet among the uninfected babies born to untreated mothers with HIV, more than 80% remain uninfected even when breastfeeding continues for two years.
Emergency preparedness should include trained health workers (in hospitals and other health care services) who can help and encourage mothers take to breastfeeding and overcome difficulties. Some common myths affecting breastfeeding in emergencies are, undernourished mothers cannot breastfeed, stress blocks the production of breast milk, a breastfeeding mother who has stopped breastfeeding her baby cannot restart and women raped cannot breast feed.
Specially trained breastfeeding counsellors who can handle emergencies can be of immense help during difficult situations helping mothers who are traumatized, infants and mothers who are malnourished, mothers who need support with re-lactation and women in crisis situations who need support to wet nurse.
Some women freeze when it comes to breastfeeding during emergencies and this happens in countries all over the world. When Hurricane Katrina hit the US in 2005, a woman who was stuck on a rooftop with many other family members and with little access to clean water, bottle fed her two week old baby for two weeks and when rescued later, asked for help to dry up her breast milk because her breast felt sore with the accumulated milk. When asked why she didn't breastfeed her baby the mother replied that she "felt quite unable to do this." The baby later died in a hospital.
A health counselor who worked with survivors of Katrina said sadly, "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."
Are you ready?
The World Alliance for Breastfeeding Action (WABA) has laid down guidelines to help inform mothers, breastfeeding counselors, supporters, communities, health professionals, governments, NGOs, donors, and the media on how breastfeeding can be actively supported before and during an emergency. Though emergency preparedness is important, simple measures to protect and support the lactating mother are of vital importance once the emergency strikes:
• Ensure that mothers and babies are kept together, secure and have priority access to food for the family, shelter and water
• Arrange for safe places for mothers to breastfeed and privacy where it is culturally required
• Integrate basic frontline protection and prioritise support for breastfeeding to save infants
• Be sympathetic and listen to the needs of women and communities because they often know how best to create supportive environments for their families and themselves
• Encourage to form mother support groups
• Be vigilant to plans or reports of infant formula donations
• Reinforce optimal feeding practices wherever and whatever the emergency
Supporting breastfeeding during ordinary times will strengthen mothers' capacity to cope during emergencies and breastfeed their babies. World Breastfeeding Week brings into focus the importance of breastfeeding for mothers and children and address the need for a timely and appropriate humanitarian response during an emergency to safeguard and nourish young lives.