Happy IBCLC Day! As a part of our celebrations, we are highlighting IBCLCs around the globe that are making the ILCA vision a reality: world health transformed through skilled lactation care. In today’s guest post, Jodine Chase highlights the critical work of the ad hoc group Infant Feeding Support for Refugee Children. This group’s work is a key example of how IBCLCs are, every day around the world, implementing the six primary interventions that are proven to increase breastfeeding rates.

Every infant and child has the right to adequate nutrition.

This fundamental tenant of the UN Convention of the Rights of the Child is crucial when populations are impacted by crisis, emergency, or natural disaster. Children are among the most vulnerable. Without steps to protect and promote safe and appropriate infant and young child feeding, the risk of illness, death, and malnutrition soars.

In emergencies many barriers can interrupt breastfeeding, including stress, lack of food, lack of privacy, and the uncontrolled distribution of breast milk substitutes. This can lead to the rapid decline of a child’s health. Guidance for infant and young child feeding in emergencies (IYCF-E) is provided by the Infant Feeding in Emergencies Core Group (IFE Core Group) interagency expert advisory group coordinated by the Emergency Nutrition Network. IFE Core Group members include the World Food Programme, UNICEF, WHO, UNHCR, and a number of NGOs including World Vision and Save the Children.

Major disasters and emergencies, like earthquakes or typhoons or mass migration due to famine or war, trigger guidance tailored to the specific emergency. Within hours of the 2010 earthquake in Haiti, IFE Core Group members had adapted guidance used in Myanmar and China for use in Haiti and a United Nations Interagency Joint Statement was issued to fit the Haitian context.

https://www.facebook.com/safelyfed/videos/213290672350931/

The Syrian refugee crisis has been well documented. In June 2015, men accounted for about three quarters of the people moving across Europe. More than 1,000,000 refugees crossed into Europe in that year, and the number of women and children on the move has been increasing. It now exceeds the number of adult males. Last September, the world awoke to the image of Alan Kurdi, a two-year-old boy drowned and washed ashore on a Turkish beach, a casualty of his family’s attempt to flee across the Aegean Sea to the Greek Island of Kos. NGOs and grassroots volunteers alike were thrust into the spotlight. In October 2015, Interim Operational Considerations for the feeding support of Infants and Young Children under 2 years of age in refugee and migrant transit settings in Europe were issued by the UN’s High Commission for Refugees (UNHCR.) The guidelines reflect difficulties supporting a breastfeeding population on the move. For families in transit, they note, “Conditions can undermine maternal confidence and breastfeeding practices. There is a risk that breastfeeding mothers stop [or] reduce breastfeeding, especially if also using infant formula (mixed feeding) before the transit.” Other considerations include lack of fresh water, increasing the risk of diseases like diarrhea and chest infections. “In the emergency environment, such conditions can be fatal.”

Social media quickly showed the world the growing crisis through circulation of the Alan Kurdi photo, and a stream of first-hand reports from volunteers in Greece and Europe. Social media documents the terrible impact of this migration on pregnant and breastfeeding women. Reports of infants drowning in the arms of their mothers, dying in frigid tents, and of women leaving life rafts and giving birth on the beaches of Greek Islands circulate almost daily. Social media is also playing a strong role in uniting the breastfeeding helper community across Europe and the Middle East in their efforts to support these families.

The Facebook group Infant Feeding Support for Refugee Children (IFSfRC) helps infants and children receive appropriate milk. Through this hub, several important initiatives are being supported. Here is a highlight of some of the the IBCLCs who felt compelled to jump into action to help.

Ada Palandjian, IBCLC is co-area coordinator for leaders (ACL) for La Leche League Greece and was contacted by Ellen Mateer, ACL of La Leche League Great Britain, after Ellen saw the photo of Alan Kurdi. Rising calls for donation of infant formula prompted La Leche League Great Britain to ask for donations of funds directly to La Leche League Greece, helping Greek Leaders actively support refugee families to breastfeed through their cross-continental journey.

“I gathered leaflets in Arabic and English from La Leche League, UNICEF, ELACTA, as well as images without words, laminated them, and sent them to Lesvos to our local La Leche League Leaders,” said Palandjian. “I activated the local Leaders, along with mothers attending the local group in Mytilene, the capital city of Lesvos Island, to meet up and find ways [in] which they could take turns visiting the refugee camps. The local team was able to find a volunteer mother to take up a position as a part timer at Save the Children mother—baby space in the refugee camp at Kara Tepe in Mytilene.” With volunteers teeming in from all over the world to help the tens of  thousands of refugees, Palandjian brought an IBCLC colleague from Athens, Maria Fertaki, to Lesvos to assess the situation and to support training.

Maria Fertaki, BA, MA, IBCLC, LLLL has been a volunteer with Galaxias, the Greek IBCLC Association, since 2007. She works with refugees in Greece, combining the distribution of slings and carriers with breastfeeding support and safe infant-feeding counseling. Through her La Leche League connections and with her IBCLC experience, she provides training for La Leche League leaders and mothers on the Greek Island of Lesvos, where many families land after an often perilous sail from the shores of Turkey, and in Athens, where many families wind up in refugee camps. Fertaki is frank about the challenges faced by League volunteers in Greece: “Helping refugees is not one of the five basic responsibilities of LLL leaders! However many of the Greek leaders have spontaneously started doing relief work at or near the towns [in which] they are staying. We are used to reaching out as one mother to another, helping one mother at a time.”

Her training and work as an IBCLC helped her with issues involving safe formula preparation. “All organizations have been so overwhelmed by the numbers of people arriving that the issue of breastfeeding and safe infant feeding in transit was largely overlooked, and no one seemed to have a policy that worked. The strict ‘no formula’ policy left many babies and parents and volunteers crying. The unchecked formula distribution with no proper assessment has undoubtedly caused unnecessary weaning and health issues to babies that could have breastfed.”

Fertaki and her colleagues bring critical on-the-ground observations and expertise to the Infant Feeding Support for Refugee Children (IFSfRC) Facebook group, and they can also use the group to access technical knowledge from IYCF-E experts.

“I realized the importance of safe instructions of formula preparation and safer ways of feeding rather than bottle feeding, and I wrote an article to be published in the Greek La Leche League magazine Galoucho, to inform Leaders and mothers,” said Palandjian, who is also arranging a seminar led by Greek’s La Leche League leaders on safe infant feeding for local NGO volunteers in Athens and Lesvos. Some materials Fertaki and Palandjian and team have worked on have been translated into a number of languages by the IFSfRC team and are in use across Europe.

Brooke Bauer, MPH is from the United States, has lived overseas for the last decade. She has worked on global health projects in Kenya, Bolivia, Europe, and the Middle East. Post Traumatic Stress Disorder after the 2010 birth of her daughter convinced her to shift her focus to maternal and infant health and breastfeeding projects. Bauer is determined to help change birth culture to prevent other families from experiencing what her family did. She is a certified doula, certified breastfeeding counselor, and childbirth educator.

Bauer has lived in the Middle East for the past four years and says, “When the refugee crisis began, we felt it every day. In December, I was asked by a friend to accompany her on a trip as an infant feeding specialist to Lesvos, Greece. Once I began to research common practices on the ground, I realized there was quite a large gap with regards to infant feeding. I began asking around on volunteer boards about infant feeding practices on the islands and was invited to the Facebook group Infant Feeding Support for Refugee Children. There I connected with many lactation professionals that I have collaborated with on a few projects, and Nurture Project International was created from there.”

“It is important to make sure that you are properly informed before you send people into the field, doing a comprehensive assessment is imperative,” says Bauer, determined to avoid duplication of efforts. She focuses on developing training to support other NGOs already in Greece. “We have been consulting with health professionals as they have been implementing infant feeding programs,” says Bauer. “It is beautiful how it has blossomed.” Most of Bauer’s volunteers are IBCLCs. She says, “IBCLCs provide a really important role in infant feeding in emergencies. They are able to provide the expertise that is so desperately needed. In infant feeding support, the knowledge that IBCLCs have is invaluable. Breastfeeding saves lives, especially in emergencies.”

Aunchalee Palmquist, PhD, IBCLC is a medical anthropologist researching and teaching about global maternal—child health, infant and young child feeding, and health disparities. She fits her volunteer work with IFSfRC around her work as assistant professor of anthropology at Elon University in North Carolina.

“I am doing my part to bring the evidence that we have for IYCF-E to a broader audience, so people who are working with refugee families can have the best sources of information at their fingertips, and people who wish to donate money can find ways to do this that are actually helpful. We are also really working hard to help the general public get the message that, contrary to what they may believe, infant formula isn’t always life saving. The loss of breastfeeding culture around much of the world has led to dire rates of infant mortality, and this is even worse in disasters and emergencies. We have forgotten how powerful breastfeeding is, particularly as it relates to infant survival. Breastfeeding is robust, resilient, and powerful and is necessary for infant health at so many levels–nutritionally, immunologically, and psychologically. Breastfeeding is a pillar of global maternal—child health.”

Palmquist notes IBCLCs work in settings across the world to promote, support, and protect breastfeeding and says international scope of IBCLC practice means, “We can learn a lot about how to support breastfeeding in many different situations and circumstances by working with people who come from various backgrounds, with unique expertise, and cultural knowledge.” She adds, “This has been true for our IFSfRC group, where we are learning about the unique situation of refugees in transit, and how to adapt the support measures that are in place to meet their special IYCF-E needs.” The IFSfRC team has created compelling graphics and videos supported by thoughtful text to drive people to the support measures that are in place to meet the special IYCF-E needs of refugees in transit.

Bauer says, “There is such a need for IBCLCs both online and in the field. We are growing really quickly and are looking for input in all aspects of our work. We would love to have IBCLCs on our board and joining our team as well.”  Palmquist adds, “I, personally, would like to see our organization, ILCA, provide more opportunities for IBCLCs to serve as leaders in the global response to breastfeeding in emergencies. Collectively, IBCLCs have the training and expertise needed to be leaders in local communities that mobilize breastfeeding response to crises situations across the world.”

Palandjian says, “Volunteers need a plan of action to get more involved, and many steps have been accomplished into that effect, but even more needs to be done. Refugee crises will remain an issue to be handled for a substantial time in the future, and we all need to be there to help in all ways possible.”

Palmquist says she envisions ILCA, “Organizing a means for IBCLCs across the world to serve as an emergency breastfeeding response network, so that those who already have the training to work in emergencies and humanitarian crises can be mobilized quickly, partner with other agencies, and deliver timely and effective IYCF-E support. It would be great if ILCA membership dues and conference fees had a means for people to donate to such an effort, or if we could parlay ILCA’s relationship with global health organizations WHO, UNICEF, UNHCR to make this happen. We also need more IBCLCs and people on the ILCA Board and various committees who are working in global health and in international settings. This type of networking will make responses to disasters with proper IYCF-E support much more effective, and that will save many lives.”

Bauer is encouraged to see ILCA members “working more closely in IYCF-E globally.” She says, “Perhaps a global response unit put together by the ILCA where IBCLCs can quickly find placements within humanitarian responses would be great to see.”                                                                                               

Jodine Chase is a public relations and communications consultant specializing in issues and crisis management news analysis. Jodine is a long-time breastfeeding advocate who, as a volunteer, works for many breastfeeding related causes, including advocating for the reestablishment of milk banks, appropriate infant and young child feeding during emergencies including the Syrian refugee crisis, and amending policies and legislation to protect breastfeeding rights. Jodine serves on the board of her local breastfeeding advocacy group, the Breastfeeding Action Committee of Edmonton (BACE), Best for Babes Foundation, and also volunteers with ILCA, INFACT Canada, Friends of the WHO Code, Infant Feeding Support for Refugee Children and SafelyFed Canada.