Myths that put babies at risk
There are several common beliefs about infant feeding in emergencies that contribute to problems in the field.
Myth: Stressed or malnourished women cannot breastfeed
That milk supply is adversely impacted by stress or that trauma will cause a mother’s milk to ‘dry up’ are common myths. These beliefs may be held by health professionals, aid workers, individuals affected by the emergency, by individuals in donor countries and by mothers themselves and their peers. These beliefs can result in mothers requesting infant formula from relief staff and in donors wanting to supply infant formula.
The truth is that psychological stress does not impact milk supply but there are other factors associated with emergency conditions that may lead to the conclusion that it does. Milk ‘let-down’ (the release of milk from the breast) may be slower than usual when a mother is acutely stressed, which can result in her saying that she has ‘less milk than usual.’ Reassuring such mothers that they are only experiencing a delay in let-down and that they are still capable of making enough milk for their baby will help them to regain confidence in their milk supply and continue breastfeeding. In addition, in the upheaval of an acute emergency, babies may be fed less frequently than usual, which can have a negative impact on mothers’ milk production. However, this need only be temporary and with more frequent breastfeeds the milk supply will quickly increase.
Mothers who are concerned about their ability to breastfeed their babies need encouragement and reassurance, which can be provided via the safe spaces and peer counselling already described. Breastfeeding can actually help mothers to cope better with the stress they are experiencing because it suppresses the release of stress hormones and involves close physical contact and the release of relaxant hormones that promote mothering behaviours. Thus, breastfeeding can not only assist mothers in their caregiving but also help to limit the emotional damage of trauma.
It is also commonly believed that women who are malnourished are unable to make enough milk for their babies. However, in all but the most extreme cases, malnourished women continue to make milk. If a mother’s condition is limiting her milk supply, ensuring the quality and quantity of her food rations as well as ensuring that she has enough to drink will help her to recover and enable her to feed her baby. By feeding the mother, you also feed the baby.
Myth: Large amounts of donated infant formula are required in emergencies
Governments, community groups or individuals may send uninvited donations of infant formula. They do this because they want to help and they think that large amounts of infant formula will be required at the site of the emergency. Unsolicited donations often arrive in enormous quantities in emergency areas. However well-meaning, these uninvited donations of infant formula are problematic for several reasons. Firstly, controlling the distribution of these donations is often very difficult since they can simply arrive without being under the control of any particular organisation. Secondly, they can end up in the hands of agencies that do not understand the critical need to tightly control their distribution. Thirdly, these donations may not even be suitable for use if they are of the wrong sort, labelled in the wrong language or close to their ‘use by’ date. The management of unsolicited donations and disposal of inappropriate donations of infant formula can be very difficult and expensive for aid agencies and take away resources from the relief effort.
The experience of past emergencies has shown that there is usually only a relatively small amount of infant formula that is required and that supplies are best procured locally by the agencies on the ground. It is much better to prevent unsolicited donations of infant formula from happening than to attempt to deal with donations when they arrive at the site of the emergency. Expending efforts preventing unsolicited donations of infant formula and encouraging donations of money rather than supplies in-kind are the best way to assist aid agencies to help all babies, including those who cannot be breastfed. It is important to note that donations of infant formula may not always be well intended. Infant formula manufacturers may consider donations of infant formula as a way of marketing their product to large numbers of people and as a way to increase market share in the area affected by the emergency.
Myth: Infant formula is safe and is the best food for babies if it can be afforded
A belief in the safety, and even superiority, of infant formula contributes to the problem of its inappropriate use in emergency situations. Western aid staff may come from places where infants are predominantly bottle fed and where infant mortality rates are very low and extrapolate their western experience to the emergency situation. They may consider infant formula as essential for babies and be oblivious of the risk in which non-breastfed infants are placed in an emergency situation. Therefore, they may be unaware of the need for great care in the distribution of infant formula.
The high value of infant formula may make rejection and destruction of unsolicited donations very difficult for local aid workers and non-government organisations. It is also the case that in many parts of the developing world (where most humanitarian emergencies occur) that the persuasive marketing of infant formula manufacturers has convinced members of the public that infant formula is a superior food for babies. This may be particularly true in middle-income countries, where mothers may consider breastfeeding the ‘poor woman’s option’ and aspire to feed their babies infant formula like mothers do in wealthy nations. Under normal circumstances, formula feeding is not an option for many women because of its expense. In an emergency, mothers who are breastfeeding (but who might choose to formula feed if they had the finances) will seek donated infant formula from aid agencies because they believe that formula would be best for their babies.
As one aid worker said in a past emergency, “(this disaster took) infant formula off the shelves where it was too expensive to buy and put it into the clinics and food distributions centres where it is free.” Breastfeeding mothers who request infant formula need support and education to ensure that they do not place their baby at risk by using donated infant formula.
Myth: Babies are only at risk from formula feeding in the most underdeveloped contexts
It’s easy to understand why formula feeding may be dangerous in the most underdeveloped situations where clean water and good medical care are absent even before the emergency. However, babies and young children are at risk even where the pre-emergency situation is relatively developed; an emergency can change the conditions very quickly. For instance, before the war in Kosovo (1996-1999) and the conflict in Lebanon (2006), formula feeding was not uncommon. Under these circumstances, use of infant formula was relatively safe because many in the population were affluent, infant formula was affordable, the water supply was clean and medical care was available. However, the devastation and destruction of war meant that pre-conflict acceptable standards of water and sanitation, storage facilities and supplies of infant formula suddenly no longer existed. In these circumstances, appropriate support for both breastfed and non-breastfed infants was critically important. Such examples demonstrate that regardless of the context, it is important to ensure that the accepted guidelines for infant and young child feeding in emergencies are followed.
