What are the guidelines for breastfeeding in disaster situations?

Breastfeeding Guidelines in Disaster Situations

Even in disaster situations, including famine, breastfeeding remains the best option for meeting infants' nutritional needs and should be actively protected, promoted, and supported as a critical component of emergency response. 1

Core Principle: Breastfeeding is Life-Saving in Emergencies

Breastfeeding provides reliable nutrition and protection against infectious diseases without requiring clean water, feeding implements, electricity, or external supplies—all of which may be scarce or unavailable during disasters. 2 The health benefits are particularly critical when environmental conditions increase infection risk and access to safe water is compromised. 3

Essential Emergency Preparedness Requirements

Protection, promotion, and support of breastfeeding must be an integral part of all emergency preparedness plans, with breastfeeding specialists included in both plan development and emergency relief personnel deployment. 2

Key Infrastructure Elements:

• Prioritize keeping mothers and infants together at all times during evacuation, shelter placement, and relief operations 2
• Provide culturally sensitive, private, and protected spaces for mothers to breastfeed or express milk 2
• Prioritize caregivers of infants in food and water distribution to maintain maternal nutrition and hydration 2
• Deploy breastfeeding specialists as part of emergency relief teams 2

Critical Interventions During Active Disasters

Immediate Support Measures:

• Rapidly identify mothers with breastfeeding difficulties and those separated from their infants, making them priority cases 2
• Provide breastfeeding support to all women experiencing difficulties, including those needing reassurance, as stress and trauma are common 2, 4
• Address dehydration and missed feedings promptly, as these can impact milk production (though stress alone does not reduce milk supply) 2

Common Challenges Requiring Intervention:

Mothers in disaster settings face multiple barriers including lack of privacy, inadequate shelter and warmth, poor hygiene conditions, emotional trauma (shock, fear, stress), and difficulties accessing basic necessities. 4 These environmental factors can lead to breast rejection by infants, engorgement, feeding difficulties, and perceived reduction in milk production. 4

Strict Formula Control Protocol

No donations of commercial milk formula, feeding bottles, teats, or breast pumps should be accepted in emergencies. 2 This is a critical safeguard because indiscriminate distribution of breast-milk substitutes undermines breastfeeding and places infants at substantially increased risk. 5

When Formula is Unavoidable:

• Distribution must be highly controlled and provided only when infants cannot be breastfed based on individual assessment 2, 3
• Procurement and distribution should be conducted by a single center under strict control, adhering to International Code requirements and Codex Alimentarius standards 3
• Formula provision must be accompanied by a comprehensive package of support, including education on safe preparation and use 3
• Identify nonbreastfed infants as a priority group requiring intensive support 2

Alternative Feeding Strategies Before Formula

Before resorting to formula, consider relactation, wet-nursing, or donor human milk for nonbreastfed infants. 2, 3 These alternatives maintain the protective benefits of human milk while addressing feeding needs when direct breastfeeding is not immediately possible.

Complementary Feeding for Older Infants

For infants older than 6 months, appropriate complementary feeding should be initiated alongside continued breastfeeding, with foods that support growth and development and are stored, prepared, and served safely. 3

Common Pitfalls to Avoid

• Do not assume stress alone reduces milk production—focus instead on addressing dehydration, missed feedings, and providing reassurance 2
• Do not separate mothers and infants during evacuation or shelter placement, as this disrupts breastfeeding and increases risk 2
• Do not accept well-meaning formula donations, as uncontrolled distribution causes more harm than benefit 2, 5
• Do not neglect the reproductive health implications—breastfeeding protects against postpartum hemorrhage, maternal depletion, anemia, and closely spaced births 5

Training and Collaboration Requirements

Emergency relief personnel must receive training on the critical importance of breastfeeding in disasters and appropriate support strategies. 2 Greater collaboration between nutrition and reproductive health sectors is essential to protect breastfeeding women and their children effectively. 5