Anticipated outcomes of the meeting:

• Gather representatives from national and international organizations to collaborate on strategies for the protection of breastfeeding in emergencies
• Identify key constraints and strategies, develop policy guidance, and enhance capacity building efforts

The meeting was facilitated by the IFE Core Group (UNICEF, WHO, UNHCR, WFP, IBFAN-FIGA, CARE USA, Fondation Terres des homes (Tdh), and the Emergency Nutrition Network). Attendees included approximately 50 representatives from national and international relief organizations, aid donor organizations, and other stakeholders.

• Despite the evidence that breastfeeding saves lives, many local and international agencies (including the military, governments, formula industry, NGOs, and well-meaning individuals) typically respond to emergencies by distributing huge quantities of commercial formula products. Of particular concern are the inappropriate donations of powdered formula and formula concentrate that must be mixed in an environment of non-existent or contaminated water.
  • Examples: Post-survey after May 2006 Java earthquake near Yogyakarta, Indonesia revealed that 75% of children under age 2 had been given breastmilk substitutes, including 70% of infants under 6 months. 46% had received powdered milk.
• Formula donations typically contribute to dramatic decreases in breastfeeding rates often seen after an emergency.
  • Example: After the Indonesia tsunami, rates of formula feeding increased from 27% prior to the crisis to 80% after the disaster.
• Increased use of formula after an emergency results in significant increases in diarrheal disease and deaths among infants.
  • Example: After the heavy floods in Botswana in 2005-06 and the huge supplies of infant formula that were donated, diarrheal disease among infants and young children increased from 9,166 cases before the disaster to 22,500 cases after the disaster. The death rate of infants as a result of diarrhea increased from 21 before the disaster to 470 afterwards. Nearly all of the deaths were to infants who were not breastfed.
• Emergency situations tend to result in massive violations of the International Code with regard to inappropriate donations of infant formula. The Code has specific provisions for appropriate use of infant formula in an emergency.
• There tends to be mass ignorance among health professionals about the ability of a mother to produce milk under stress, and lack of training in managing breastfeeding in more challenging circumstances.
• Training and peer support CAN make a difference.
  • UNICEF Indonesia implemented a peer training and support program that resulted in 65% of the women who were followed by these peer helpers continuing to breastfeed exclusively.
  • In Dadaab, 180 "Traditional Birth Attendants" were trained to assist breastfeeding mothers.
  • The IFE Core Group has developed a training program for health professionals and relief workers. These modules are available as a free download on the ENN website at: http://www.ennonline.net/

• ILCA provided information on ways IBCLCs can assist with training and providing lactation assistance in an emergency.
• Strategies were proposed to:
  • Educate donor organizations and the general public about the harmful effects of inappropriate donations of infant formula after an emergency;
  • Expand the reach of available breastfeeding in emergencies materials available through the IFE Core Group;
  • Coordinate international media response both before, during, and after an emergency;
  • Increase capacity building of trained health workers to assist following an emergency;

It is recommended that ILCA:

• Sign on as a supporter of the IFE Operational Guidance Document published in August 2006 by the IFE Core Group and available at http://www.ennonline.net/
• Include the IFE Operational Guidance Document, and information about other available resources, in the ILCA "Breastfeeding in Emergencies" kit under development.
• Continue to include sessions about issues with infant feeding in emergencies at the ILCA Conference when possible.
• Outreach national and international relief organizations with information about the role of IBCLCs in assisting with training of healthcare workers and peer helpers, and assisting with direct assistance to breastfeeding mothers.
• Establish a network of IBCLCs who are available to provide training to healthcare workers and peer helpers using the IFE breastfeeding in emergencies modules.

Report Submitted by: Cathy Carothers, ILCA Director of Marketing