Breastfeeding in emergencies.

It's been a week of disasters in Burma and China, and I've been thinking a lot about the victims of these horrific events. 

I traveled in Burma in the early 1990's with a good friend.  The country was beautiful (especially Pagan, shown to the right) and the political repression was palpable.  One memory:  My friend became quite ill, and we found a doctor who came to our hotel and treated her.  When we asked how much we could pay her, she refused to accept anything.  We were so grateful for her help, and asked for her address so that we could send her a gift when we got home.  She wouldn't give us her address, telling us that she didn't want to be seen as connected in any way to people outside the country. 

But back to the disasters, and the importance of breastfeeding in emergencies.  In a disaster such as the one in Burma, breastfeeding can be a life-saving act.  Why?  In emergencies formula is often not available.  If it is available, water supplies are often compromised.  Formula mixed with contaminated water can cause diarrhea and dehydration, which can quickly become life-threatening to infants.  Power to sterilize and refrigerate formula is also often not available.

Sometimes, well meaning humanitarian efforts result in such an influx of formula that efforts to protect and support breastfeeding are disrupted.  This is such a concern that in 1994 the World Health Organization adopted the following policy, urging member states to "exercise extreme caution when planning, implementing, or supporting emergency relief operations, by protecting, promoting, and supporting breastfeeding for infants," and to ensure that formula is distributed only under specific conditions.

Still, there is a lot of confusion about the role of breastfeeding in these situations.  INFACT Canada has a great write up taking on myths about breastfeeding in emergencies, which I've posted below:

MYTH 1:  Malnourished mothers cannot breastfeed.

In virtually all cases, a sub-optimally nourished mother can breastfeed her child.  The important response is to feed the mother so that she can feed her child.  It is far safe and more effective to provide nutritional support for the mother than to risk her infant's health by feeding breastmilk subsitutes.  Mothers in these situations need help and support to enable them to breastfeed.

MYTH 2:  Stress makes a mother's milk dry up.

Although extreme stress or fear may temporarily reduce a mother's milk supply, this response is often of short duration.  On the other hand, breastfeeding produces hormones that have a calming effect on mother and baby and creates an inseparable bond between the mother and her child.  There is virtually no abandonment of babies in emergency situations when mother and baby are breastfeeding and kept together.

MYTH 3:  Babies with diarrheal disease need water or tea.

Breastmilk contains about 90% water.  Exclusive breastfeeding provides all the water, nutrition and immunology a baby needs, without the risk of contamination.  Feeding an infant water can introduce disease-causing bacteria and other contaminants, especially if safe water is scarce or unavailable.  It is only in the case of severe diarrhea that infants may need rehydration fluids in addition to breastmilk.

MYTH 4:  Mothers cannot resume lactation once breastfeeding has stopped.

Mothers and babies can restart breastfeeding even after a period of not breastfeeding.  Increased skin-to-skin contact and frequent access to the breast helps to increase milk supply and enables mothers to resume full breastfeeding.  This can be critical for babies during emergencies.

Want to get email updates from the Motherwear Blog?  Subscribe here.  Want an RSS feed?  Click here.

Comments

[Half Pint Pixie]

Great information there, thanks! Although by no means a massive emergency such as those in Burma and China, I remember when we moved to Galway the public water was contaminated wiith a potentially fatal parasite for a few months. You could drink the water if it was boiled for 10 minutes, most people switched to bottled water. I rang the health nurse to see what I had to do with a baby in the house, and she said "You're breastfeeding, don't worry, she's safe". They were really encouraging mums of newborns to breastfeed as the only options for making up formula were bottled water (which is mostly too high in sodium) or 10-minute boiled water (which can be too concentrated) so what a choice! I was so glad to be breastfeeding and know littlepixie was safe!

Another issue which occurs in emergencies is well-meaning people often donate formula in food donation programs, this is a huge problem as the safety information on the cans is in English which may not be understood by its recipients. IFBAN.org have a very useful brochure "Infant feeding in emergencies".

I remember reading in a parenting magazine about the issue of formula handouts after hurricanes in the US and they had the following advice, take the free formula and drink it yourself, your baby will be safe on your breastmilk!

[Nina]

Hello,

I think this is an interesting issue and that there should be a process in place to inform NGOs, and aid organizations about alternatives to providing formula. World Hall provides a way for advocates of breastfeeding to come together to inform these organizations of what should be done.

Begin forwarded message:

I want to tell you about a new web resource that can be of real service to the breastfeeding community and beyond. World Hall enables us to discuss policy issues, identify who can do something about them, propose actions and vote ---- to have our voices heard by those in positions to implement change.

This is a unique opportunity: World Hall is being launched in the breastfeeding community. Actions regarding ban the bags, breastfeeding in public, breastfeeding in the workplace, insurance coverage for lactation services and others are already posted on World Hall.

World Hall is different than a breastfeeding listserv or blog. We will be joined in the conversation by activists in other areas allowing for cross conversation and voting, enriching all involved. Our active engagement in World Hall will raise the visibility of breastfeeding to all who are listening to and conversing on World Hall. World Hall is free and non-commercial. It was developed by students at the New England Complex Systems Institute (necsi.edu) with support from the Centers for Disease Control and Prevention. The CDC is a great example of a major player that is watching the system and paying attention to the actions proposed and discussed.

Your active engagement in World Hall will help to raise the visibility of the issues we all work on every day. Please vote, add new actions, comments, and identify new issues and players. Share World Hall with others.

The site is at:
http://www.worldhall.org/breastfeeding

I look forward to meeting you there.

------------------------------------------
Naomi Bar-Yam Ph.D.
Executive Director
Mothers' Milk Bank of New England

Naomi@milkbankne.org
617-964-6676
www.milkbankne.org
------------------------------------------

Regards,

Nina

[crunchy domestic goddess]

great information here, as always, tanya. thank you for this reminder on the importance of breastfeeding.

[Carrie]

Every time I hear about a natural disaster in the news, I think about this issue. I wonder how many moms think about this when they're deciding whether to breastfeed?

Nursing in an emergency calms mom and baby, and there's no worry about getting formula and clean water for baby. Great article!

[Lori]

Regarding the subject of the role of breastfeeding during natural disasters, last night on CNN I saw a story about an Chinese policewoman who saved NINE babies by breastfeeding them after the recent earthquake! Five of the babies had been orphaned; the other four babies' mothers survived, but their milk supplies were compromised in the wake of the disaster. The policewoman's own child is being cared for by inlaws in another town. The orphans have been taken to institutions.

The policewoman was very modest and said that during disasters people do what they can to help one another, that she now feels bonded to the babies that she nursed as if they were her own, and that what she did was "a small thing, hardly worth mentioning". The mothers that were interviewed all seemed very grateful.

The reporter was unclear about the reasons why the mothers were unable to feed due their babies (possibly injury, separation, or decreased supply due to severe stress/trauma, or insufficient clean water/food?) but I hope that the mother/baby pairs are able to resume breastfeeding on their own, and that the policewoman's own child will be able to resume breastfeeding once they are reunited. Clearly the policewoman's supply hasn't been compromised during their separation. What an amazing woman and an amazing gift!

[Tara]

This is excellent info! I heard Jule Ware, MD, FAAP, FABM, IBCLC (AAP Cheif Chapter Breastfeeding Coordinator) speak about the drive to help women relactate after the hurricanes in the US at the Art of Breastfeeding Conference last year. It was remarkable! The results were not as great as one might have hoped. But the more people armed with this info, the more impact we can make.