Operational Guidance on Breastfeeding Counselling in Emergencies

Scope and purpose

In 2018, the World Health Organization (WHO) published Counselling of Women to Improve Breastfeeding Practices, a guideline with recommendations and best practice statements for breastfeeding counselling. The guidelines are complemented by the WHO and UNICEF (2021) Implementation Guidance on Counselling to Improve Breastfeeding Practices (IG-BFC) which explains how to execute the recommendations in practice. Due to the particular complexities of operating in emergencies, the need for specific and separate guidance was identified in a WHO-convened meeting in November 2019.

This Operational Guidance on Breastfeeding Counselling in Emergencies (OG-BFC/E) is a pragmatic guide which covers key considerations and potential adaptations when applying WHO's 2018 guidelines in an emergency setting. This guidance is intended to be used by policymakers and other decision makers and programmers working in emergencies (both local/national emergencies and humanitarian emergencies) including governments, United Nations (UN) agencies, national and international non-governmental organisations (NGOs), as well as donors, volunteer groups and providers of care to pregnant women and families with infants and young children.

This document recognises that how and when to introduce complementary foods in a manner that
does not disrupt exclusive breastfeeding until six months of age and the subsequent continuation of breastfeeding are an important part of counselling. It acknowledges the critical importance of ensuring access to adequate amounts of appropriate, safe, complementary foods and associated support during emergencies. However, this document does not cover complementary feeding counselling specifically.

Development process

The guidance was developed using a structured approach combining 1) interviews with key informants with experience and expertise in implementing breastfeeding counselling in emergency settings, 2) case studies of breastfeeding counselling interventions in emergency settings and 3) a desk review of grey and peer reviewed literature. Successes, challenges, gaps, required resources, compromises and adaptations for implementing counselling interventions in emergency settings were identified. The development of this document was guided by an expert peer review group comprised of IFE Core Group members and drew upon the WHO's guidelines on Counselling of Women to Improve Breastfeeding Practices and Improving Early Childhood Developmenti. The guidance is considered an addendum to the WHO and UNICEF (2021) IG BFC.

How to use this guidance

The guidance is divided into three main sections. The first section, BREASTFEEDING COUNSELLING, discusses what breastfeeding counselling is and the entry points for breastfeeding counselling. The second section, PROVIDING BREASTFEEDING COUNSELLING IN EMERGENCIES, covers the application of five of WHO's recommendations in emergency settings including who to prioritise for counselling, when, how often and how to provide counselling. For each recommendation, first consult the 'Challenges and Solutions' section to consider which challenges may be present in your context and to identify possible solutions. If there are no feasible solutions, move to 'Adaptations and Compromises'. The third section, COUNSELLING CAPACITY IN EMERGENCIES, provides guidance on WHO's recommendation on who can provide counselling services and how to operationalise counselling services through ensuring adequate capacity is in place. Refer to the IG-BFC for guidance which applies to both emergency and non-emergency settings as well as further considerations on advocacy and policy, service planning, coordination, leadership, monitoring and evaluation, special populations and emergency preparedness.