Infant Feeding in Emergencies: Experiences from Former Yugoslavia
Anne Walsh - Health Adviser, Children's Aid Direct.
War in the former Yugoslavia presented a relatively new situation to the international aid community whose prior emergency experience had mostly been in less developed countries. This was a European country which endured intense civil war leading to massive displacement of people. Food supplies suffered severe interruptions or complete stoppages for long periods and large numbers of people became increasingly impoverished due to sale of assets and virtual siege conditions in large towns.
Yugoslavia had a highly educated population with extremely developed health and education services. These services managed to continue in some fashion during the war in spite of seriously depleted resources. Many professionals left the country during this period although there were some who stayed with their communities. The humanitarian response came from all segments of the international community: the UN, major donors, established NGOs, new NGOs and even concerned individuals or community groups.
In the field of infant feeding there were many issues to address, and few or no standard or established practices in dealing with them, that were felt to be appropriate to a European culture. A need for specialist foods for infants was often expressed by national doctors and other health workers, local authorities and individual mothers themselves.
The humanitarian community, at all levels including the UN and ECHO, responded to those expressed needs by sending 'infant formula' and 'weaning foods'.
Since May 1995 I have been in close contact with field workers implementing our programmes on the ground in former Yugoslavia. Our programmes included food and hygiene item distribution and Mother and Child Health (MCH) centre support. By talking to our staff and through my own analysis of the situation it is obvious that there are a number of recurring problems and issues around infant feeding in this type of situation which the relief community needs to recognise and address.
Some of the issues:
A bottle-feeding culture
Local medical staff stated that 70% of women could not breastfeed and that infants were dying because there was no infant formula milk available. Yugoslavia was known to have a predominantly bottle-feeding culture. Furthermore, wet nursing was or is not practised.
Due to the complexity of the war, the number of factions fighting at various times and the continuously changing hands of territories, sound data on infant feeding practices became lost or unavailable. Security and staffing were not conducive to new data collection and surveys to assess the real extent of the problem.
National or international breastfeeding specialists were not available to advise field staff. As aresult of this, field staff often saw no alternative but to answer the pleas of health professionals and mothers by distributing infant formula.
The benefits of breastmilk and breastfeeding were either not sufficiently understood or given enough credence for field workers and other health staff to make the additional efforts required to promote breastfeeding.
Many aid workers lacked experience or technical training in emergency work or knowledge of appropriate maternal and child care practices. Untrained aid workers were oblivious to there being important issues involved in infant feeding - especially in an emergency context. Others were aware of the issues but had no answers to the problems they were faced with other than to supply infant formula foods to prevent further suffering. As a result, many questionable beliefs and practices were in evidence.
The belief that stress prevents a mother from breastfeeding was innate and reinforced by families and health professionals. If a mother felt that stress was preventing her from breastfeeding, the only known solution was to supply breastmilk substitute.
Health worker training in Yugoslavia, as in many other European countries, did not focus on the benefits of breastmilk and ways to support mothers wishing to breastfeed. More often, training promoted the idea of the need to 'top-up' with breastmilk substitutes, or that it was good or even better for the baby to be bottle-fed.
Most aid workers believe strongly in the right of a woman to choose how to feed her child. They don't necessarily realise that an informed choice is difficult to achieve in normal circumstances. Getting information and then support for mothers during a war may be virtually impossible.
Field staff in former Yugoslavia acted in ways they felt were best to meet the needs of mothers and
infants during the war. Although mistakes were pointed out to them and some practices did improve e.g. more controlled methods for distribution of formula milk established, the critical problem of getting mothers to breastfeed when they believed that they were not capable of doing so could not be practically solved during this emergency. A field worker faced with a hungry infant and distressed mother does not have the time, even where there is knowledge or experience, to be able to give individual breastfeeding counselling and ongoing support. What they can do is give infant formula, with preparation instructions in local language, labelled without a brand name to avoid free advertising for formula companies. To refuse the provision of infant formula in these situations is sometimes a recommended strategy. However there is insufficient evidence to show that this approach would encourage the mother to return to or initiate breastfeeding.
The Next Crisis
Even now, following analysis of what happened in former Yugoslavia, we do not have clear practical guidelines on what to do in the future. Are we clear on what would be accepted as best practice for helping mothers to breastfeed their children? Do we have ways of informing the well meaning aid worker who might not have the understanding or training to deal with the conflict, between accepted best practice and practical constraints on the ground.
There is still a lot of debate, research, and documentation required in order to strengthen our infant feeding practices in emergencies. Practical and accessible guidelines that can be implemented in the face of a real emergency, in a culture not convinced of the benefits and robustness of breastfeeding, are urgently needed.
- Infant formula feeds were distributed when and in the form available. Issues like avoiding the distribu tion of brand labelled products were either not understood or felt to be irrelevant when that was all that was on offer.
- Supplies were often provided with no instructions, with instructions written in the language of the country of origin, or with had translations of instruc tions.
- Supplies were distributed in incorrect quantities, to incorrect age groups, and to mothers without the necessary information or environment to safely use the products.
More like this
FEX: Infant Feeding in Bosnia
Infant Feeding in Bosnia Dear Editors, The comments in the letter to the editors (Field Exchange, issue 2) on the article "Infant Feeding in Emergencies: Experience from...
FEX: Letter on infant feeding in Former Yugoslavia, by Fiona Watson, Aileen Robertson and Aida Filipovic
Dear Editors, We would like to comment on the article "Infant Feeding in Emergencies: Experience from Former Yugoslavia" (Field Exchange, Issue 1, May '97). Our...
FEX: Caring for premature babies in a conflict zone
Summary of published experiences1 This paper describes aspects of the authors work as a midwife with Médecins Sans Frontieres (MSF) in a north-western regional hospital in Côte...
FEX: Artificial feeding in emergencies: experiences from the ongoing Syrian crisis
By Suzanne Mboya Suzanne Mboya is a consultant nutritionist. In 2014 she completed a sixth month mission supporting the Syrian crisis IYCF-E response through a partnership...
FEX: Infant feeding in the South Asia earthquake aftermath
By Maaike Arts Maaike Arts was seconded to UNICEF Pakistan in November 2005, until January 2006. Formerly she was Project Officer in Nutrition/Early Childhood Care with UNICEF...
FEX: Infant Feeding Practices: Observations from Macedonia and Kosovo
As a result of concerns expressed about the usage of infant formula and a need for more information regarding weaning practices during and after the conflict in Kosovo, Action...
FEX: Infant and young child feeding support in Lebanon: strengthening the national system
By Pressila Darjani and Linda Shaker Berbari Pressila Derjany is the Infant and Young Child Coordinator at IOCC. She has a B.Sc. in Nutrition and Dietetics. She joined IOCC...
FEX: Retrospective qualitative analysis of an infant and young child feeding intervention among refugees in Europe
Summary of MSc thesis By Alexandra Svoboda Alexandra Svoboda is a student on the MSc Nutrition for Global Health course at the London School of Hygiene and Tropical Medicine...
What knowledge gaps are there currently in breastfeeding? What are some of the challenges mothers are getting in practising exclusive breasfeeding, especially in third world...
FEX: Postscript to 'Infant feeding in tsunami affected villages in India'
Dr Bethou is a paediatrician currently based at the Mahatma Gandhi Medical College and Research Institute, Pondicherry, India and was one of the researchers in the study just...
FEX: Emerging cases of malnutrition amongst IDPs in Tal Abyad district, Syria
By Maartje Hoetjes, Wendy Rhymer, Lea Matasci-Phelippeau, Saskia van der Kam Maartje Hoetjes is a Medical member of the MSF emergency team, currently working in South Sudan....
FEX: Responding to nutrition gaps in Jordan in the Syrian Refugee Crisis: Infant and Young Child Feeding education and malnutrition treatment
By Gabriele Fänder and Megan Frega Gabriele Fänder is the Regional Health and Nutrition Advisor with Medair in the Syria Crisis Response Programme, based in Amman....
FEX: Infant Feeding Alternatives for HIV Positive Mothers in Kenya
By Tom Oguta, Abiud Omwega and Jaswant Sehmi Tom Oguta is currently a PhD student of Nutrition at the University of Nairobi. He has worked as a Research Officer at KIRDI...
FEX: Infant Feeding in Emergencies: Experiences from Indonesia and Lebanon
By Ali Maclaine and Mary Corbett Ali Maclaine has a MSc in Human Nutrition from the London School of Hygiene and Tropical Medicine. She has been involved in infant feeding and...
FEX: Contributing to the Infant and Young Child Feeding in Emergencies (IYCF-E) response in the Philippines: a local NGO perspective
By Romelei Camiling-Alfonso, Donna Isabel S. Capili, Katherine Ann V. Reyes, A.M. Francesca Tatad and Maria Asuncion Silvestre Romelei Camiling-Alfonso has worked for the...
FEX: Breastfeeding support in the refugee camps of North Western Tanzania
By Lucas Kulwa Machibya Lucas Machibya has been working for UNHCR since June 1994 in the north-western Tanzania refugee operation as National Public Health Nutrition Officer....
en-net: Safe alternatives to breast milk in rural sub-Saharan Africa that are not formula milk?
In South Sudan, many women report not being able to breastfeed. Whilst in some cases this is about traditional beliefs and practices around infant feeding, maternal nutrition...
FEX: Letter on relevance of IFE guidelines in developed countries, by Sarah Saunby
Recently, ENN was party to an exchange of questions and discussion between field staff and 'experts' relating to decisions on the use of readymade therapeutic products versus...
FEX: Breastfeeding Support Groups in Tajikistan
Uma Palaniappan and Zinaida Abdullaeva Uma Palaniappan & Zinaida Abdullaeva Uma Palaniappan is the Nutrition Programme Manager of Action Against Hunger in Kurgan Tyube in...
en-net: Perceptions of SAM treatment amongst infants under 6 months
The latest edition of Nutrition Exchange has an article that shares summary findings of a study of the perceptions of SAM treatment amongst infants under 6 months in...
Reference this page
Anne Walsh (). Infant Feeding in Emergencies: Experiences from Former Yugoslavia. Field Exchange 1, May 1997. p2. www.ennonline.net/fex/1/feeding