What are the guidelines for breastfeeding in a disaster situation?

Breastfeeding in Disaster Situations

Primary Recommendation

Breastfeeding must be continued and actively protected during all disaster situations, including natural disasters, armed conflicts, and famines, as it provides reliable nutrition and protection against infectious diseases without requiring clean water, feeding implements, electricity, or external supplies. 1, 2

Core Principles for Disaster Response

Immediate Priorities

• Keep mothers and infants together at all times to maintain breastfeeding continuity and prevent separation-related feeding difficulties 2
• Prioritize breastfeeding mothers and infants in all food and water distribution to support maternal nutrition and milk production 2
• Provide private and protected spaces for mothers to breastfeed or express milk, addressing the privacy concerns that commonly arise in temporary shelters 2, 3
• Deploy breastfeeding specialists as part of emergency relief personnel to provide immediate support and identify mothers experiencing difficulties 2

Critical Understanding About Milk Production

• Dehydration and missed feedings can impact milk production, but stress alone does not reduce milk supply 2
• Mothers who are injured or experiencing food shortages can still continue breastfeeding and do not require infant formula 4
• Even in famine conditions, breastfeeding remains the optimal feeding method for infants 5, 1

Management of Breastfeeding Difficulties

Rapid Identification and Support

• Quickly identify mothers experiencing breastfeeding difficulties (breast rejection, engorgement, reduced milk production, feeding issues) and provide immediate specialized support 2, 3
• Provide reassurance and practical assistance to all mothers who request help, as emotional difficulties (shock, fear, stress) are common and can undermine confidence 3
• Identify separated mother-infant pairs as highest priority for reunification and feeding support 2

Continued Feeding During Diarrheal Disease

• Infants who are breastfed should continue to receive breast milk during diarrheal illness, which is common in disaster settings 5
• For infants receiving formula in feeding centers, dilute with equal volume of clean water until diarrhea stops, but breastfed infants should continue normal breastfeeding 5
• Exclusive breastfeeding for 6 months reduces severe or persistent diarrhea by 30% compared to shorter durations 5

Strict Control of Infant Formula

Absolute Prohibitions

• No donations of commercial milk formula, feeding bottles, teats, or breast pumps should be accepted in emergencies 2
• The indiscriminate distribution of breast-milk substitutes undermines women's ability to breastfeed and places infants at increased risk 6
• Artificial feeding in emergencies is dangerous to infants, difficult to implement safely, and requires substantial resources that are typically unavailable 6

Limited Formula Distribution Protocol

If formula must be used (only when infants cannot be breastfed): 2

• Distribution must be highly controlled and restricted
• Provide only as part of a comprehensive support package
• Identify non-breastfed infants as a priority group requiring intensive support
• Consider relactation, wet-nursing, or donor milk as alternatives before resorting to formula 2

Specific Disaster Considerations

Infrastructure Challenges

• Contaminated water makes formula preparation extremely hazardous, increasing risks of infectious diseases and mortality 1, 6
• Lack of electricity, clean feeding implements, and sterilization capacity makes artificial feeding nearly impossible to do safely 1, 2
• Basic life needs (housing, warmth, hygiene/sanitation) are compromised in temporary shelters, making breastfeeding even more critical 3

Maternal Health Protection

• Breastfeeding protects against postpartum hemorrhage, maternal depletion, maternal anemia, and closely spaced births—all critical concerns in disaster settings where reproductive health services are limited 6
• Mothers require adequate hydration and nutrition to maintain milk production, making their prioritization in resource distribution essential 2

Emergency Preparedness Requirements

Pre-Disaster Planning

• Include breastfeeding protection, promotion, and support as integral components of all emergency preparedness plans 2
• Involve breastfeeding specialists in plan development before disasters occur 2
• Train all emergency relief personnel on appropriate infant feeding practices and the dangers of formula distribution 2, 7

Cultural Sensitivity

• Provide culturally sensitive environments for breastfeeding that respect local practices while maintaining evidence-based support 2
• Address privacy concerns proactively, as lack of private space is a major barrier reported by mothers in disaster settings 3

Common Pitfalls to Avoid

• Do not assume stress prevents milk production—this misconception leads to unnecessary formula supplementation 2
• Do not separate mothers and infants for logistical convenience—this disrupts breastfeeding and increases infant mortality risk 2
• Do not accept well-meaning formula donations—they cause more harm than good in emergency settings 2, 6
• Do not delay breastfeeding support until mothers request help—proactive identification and assistance prevent problems from escalating 2, 3