World Breastfeeding Week 2013: The Response to Crisis and Emergency Circle of Support

During World Breastfeeding Week 2013, we will be highlighting the work of lactation professionals in each of the 5 Circles of Support mentioned in this year’s theme ~ Breastfeeding Support: Close to Mothers. Each weekday during this celebratory week, we will be shining the light on innovative and exciting models of care in each of these areas. Check back everyday for more encouraging examples of breastfeeding supporters being close to mothers.

Ali Maclaine, UK

photo 2Ali Maclaine is currently the Senior Humanitarian Nutrition Advisor for Save the Children based in London. Save the Children works in 120 countries worldwide and in many of the emergency affected countries, they are undertaking breastfeeding support through their Infant and Young Child Feeding in Emergencies (IYCF-E) program. The level of support varies from messaging, group education sessions, or peer support to one-on-one counseling. As well as providing support themselves, Save the Children often works with partners and undertakes trainings so that others can also learn about the life-saving importance of breastfeeding, especially in emergencies. She shared with us the following responses.

This year’s World Breastfeeding Week theme is “Breastfeeding Support: Close to Mothers”. The organizers have identified 5 Circles of Support that are critical for breastfeeding mothers in our world and one of those circles is “Response to Crisis and Emergency”. Can you describe for us a bit about the work you are currently doing in the field of lactation to support breastfeeding mothers in crisis? How did you become involved in this work? When emergencies happen, what might a day of support look like?

Following the completion of my Masters in Public Health Nutrition, I was a Consultant on a report called ‘Cracking the Code’ that looked at violations of the International Code of Marketing of Breastmilk Substitutes worldwide. This work increased my interest in breastfeeding. My first field placement with Save the Children was following the 2006 conflict in Lebanon. I saw how an influx of donations of breastmilk substitutes were undermining breastfeeding. I also saw the effects of common myths and misconceptions on breastfeeding and the lack of skilled breastfeeding support. During that crisis and in all the others I have worked in subsequently (Philippines, Indonesia, Haiti, East Africa, Syria, etc), the thing that I see is that breastfeeding mothers and their support circle often do not know how robust breastfeeding is. They instead seek formula to ease the burden of the breastfeeding. Many kind hearted people give formula as they want to help babies in emergencies but are not aware of the risks of artificial feeding during an emergency. Breastfeeding saves lives.

However, I have also seen many mothers who have sought breastfeeding support during emergencies and have not been able to find it – either the health workers have disappeared, are too busy, or they are not trained about the emergency aspects of breastfeeding. They often repeat the normal breastfeeding messages which do not have the impact or relevance during an emergency. For example, families are often encouraged to exclusively breastfeeding for 6 months when, in reality, they simply need to get through the next 24 hours while caring for their family in a shelter.

Where we have the funding to have dedicated IYCF-E activities, we are able to provide key messages to mothers and into the wider community. We also provide mother-baby caravans/areas where mothers can go to breastfeed, meet other mothers and access skilled breastfeeding support, as well as be a part of educational sessions. There is also support for relactation and wet nursing.

The World Breastfeeding Week organizers stated “This circle of support represents the need for support if a woman finds herself in an unexpected and/or serious situation, with little control. Situations that require special planning and support could include natural disasters, refugee camps, divorce proceedings, critical illness of mother or baby, or living in an area of high HIV/AIDS prevalence with no support for breastfeeding.” Can you expand a bit on what some of the unique challenges are that breastfeeding women and babies who are in crisis face?

Breastfeeding women and babies have a number of challenges during emergencies:

  • There are often a huge number of additional myths and misconceptions that undermine breastfeeding during conflicts. Common emergency related myths/misconceptions are: Stress drying up breastmilk, lack of food or change of food negatively affecting breastfeeding, tension or even grief being passed on to the baby.
  • Many of the countries that we are currently working in are Muslim and populations are commonly displaced. Muslim mothers often will not breastfeed in public or even in tents, which they may share with other men. Hence, there needs to be dedicated private breastfeeding spaces.
  • Often there are huge donations and untargeted distributions of breastmilk substitutes (often labeled in the wrong language or near/past use-by-date) which are given to caregivers, and even to breastfeeding mothers. We have found that if a mother is given these, she is much more likely to use it and that it can then lead to breastfeeding difficulties and undermines breastfeeding. Often, these donations are only given for a short time, meaning that as her breastmilk supply has been affected, the mother has to then find formula and the money to continue to feed her child.
  • People often think that when the volume of breastmilk is diminishing, it can’t be increased. They mistakenly believe that there is no hope for increasing the supply that might have been impacted by the crisis.
  • There is often a lack of skilled support for breastfeeding mothers in emergencies. The health workers may have also been affected by the emergency, may be taking care of their own families, and there may be a lack of health workers who have been trained on breastfeeding before the emergency.
  • There is a lack of funding for programs to support breastfeeding in emergencies. Donors pay lip-service about the importance of breastfeeding but don’t give the money.
  • Communities often do not prioritize breastfeeding support during emergencies as a NEED. This is an issue we are increasingly looking at as “accountability to beneficiaries” is a key issue and we must prioritize our emergency responses based on what the community says it needs. Whilst this works in terms of shelter and water, I think that this methodology is flawed for identifying the need for breastfeeding support. The community leaders are rarely women and culturally, it would be difficult in some circumstances for women to tell their community leaders/outsiders about the need for breastfeeding support.

The challenges and need for support for women in crisis is ongoing. But there is hope! What are some of the most recent initiatives that have made breastfeeding for women in crisis easier? What are your hopes for the future?

Save the Children is creating an IYCF-E Toolkit, which it is hoping to get input in from other NGOs including those from the IFE Core Group which should ensure that we can provide breastfeeding support in a quality way quickly in emergencies. We also have partners who have undertaken work on the psycho-social support needs of breastfeeding mothers in emergencies that all agencies are trying to learn from.

My hope for the future is that health and nutrition workers in emergency prone countries are taught about breastfeeding in emergencies during their training so that they are equipped to support mothers during the additional stress of an emergency. Also,  that during an emergency, breastfeeding support is regarded as part of our key work – that every person that works in the field in an emergency response is aware of the need and how to support breastfeeding mothers. I hope that we are systematically able to provide the quality support that breastfeeding mothers need in that context.

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