Call for support for appropriate infant and young child feeding in Haiti
UNICEF, WHO and WFP call for support for appropriate infant and young child feeding in the current emergency, and caution about unnecessary and potentially harmful donations and use of breast-milk substitutes
During emergency situations, disease and death rates among under-five children are higher than for any other age group; the younger the infant the higher the risk. Mortality risk is particularly high because of the combined impact of a greatly increased prevalence of communicable diseases and diarrhoea and soaring rates of under-nutrition. Appropriate feeding and care of infants and young children is essential to preventing malnutrition, morbidity and mortality.
Major health problems among Haitian children, which have been exacerbated by this crisis, are acute and chronic malnutrition and communicable diseases. Given the structural damage caused by the earthquake to water supply systems, there is an additional risk of water borne diseases affecting large numbers of the urban, rural and displaced populations. Many infants and young children have been orphaned or separated from their mothers. Risks to children in Haiti are exacerbated by pre-earthquake poor infant and young child feeding practices and malnutrition. In this emergency situation, the lifeline offered by exclusive breastfeeding to children for the first six months of life and continued breastfeeding with complementary feeding for two years or more is of utmost importance and must be protected, promoted and supported as much as possible.
Most mothers initiate breastfeeding in Haiti, and the majority of infants less than six months of age were at least partially breastfed prior to the earthquake. At this stage it is critical to encourage and support mothers to initiate breastfeeding immediately after the delivery, exclusively breastfeed up to six months and for those with infants below six months who ‘mix feed’ to revert to exclusive breastfeeding. Nonbreastfed infants are at especially high risk and need early identification and targeted skilled support, including re-establishing breastfeeding (relactation).
Protection and support for breastfeeding women
Therefore, creation of a protective environment and provision of skilled support to breastfeeding women are essential interventions. There is a common misconception that in emergencies, many mothers can no longer breastfeed adequately because of stress or inadequate nutrition. Concern for these mothers and their infants can fuel donations of breastmilk substitutes (BMS) such as infant formula. Although stress can temporarily interfere with the flow of breastmilk, it is not likely to inhibit breastmilk production, provided mothers and infants remain together and are supported to initiate and continue breastfeeding.
Mothers who lack food or who are malnourished can still breastfeed. Provision of adequate fluids and food for mothers must be a priority as it will help to protect their health and well-being as well as that of their young children.
Basic interventions to facilitate breastfeeding include prioritising mothers with young children for shelter, food, security, and water and sanitation, enabling mother-to-mother support, providing specific space for skilled breastfeeding counselling and support to maintain or re-establish lactation. Traumatised and depressed mothers may have difficulty responding to their infants and require particular mental and emotional support. UNICEF, WHO and other organizations involved in infant feeding in emergencies will support training of staff on individual assessment of the best options for feeding infants, as well as education and support of caregivers on optimal infant feeding in these emergency circumstances.
Feeding of the non-breastfed child less than six months of age
Any needed breast-milk substitutes should adhere to Codex Alimentarius Standards and should be procured in an efficient and rapid manner, in coordination with UNICEF, the nutrition coordinating agency in Haiti. The preferred type of breast-milk substitute is ready-to-use formula. Any distribution and use of breast-milk substitutes should be carefully monitored to ensure that only the designated infants receive the product. For further information UNICEF should be contacted (see contact below).
When breast-milk substitutes are used caregivers should be encouraged and taught to feed with a cup and spoon. Bottles and teats should not be provided as they are more difficult to clean. Skilled support by appropriately trained staff should be provided to caregivers on how to use the breast-milk substitute safely. Because infants’ receiving breast-milk substitutes are at increased risk for illness, a mechanism to monitor their health should be established.
Donations and procurement of breast-milk substitutes and other milk products
Complementary feeding of children above six months of age
Feeding infants and young children in the context of HIV
Treatment of severe acute malnutrition
Specially formulated therapeutic milks F75 and F100 and ready to use therapeutic food are required.
UNICEF office in Port-au-Prince:
WFP office in Rome:
Messages for the media in Haiti: http://www.ennonline.net/resources/735
Module 2 on Infant Feeding in Emergencies, v1.1, Dec 2007, for health and nutrition workers in emergency situations. http://www.ennonline.net/ife/view.aspx?resid=4
HIV and Infant Feeding: Revised Principles and Recommendations. Rapid Advice. WHO. 2009.
International Code of Marketing of Breastmilk Substitutes and subsequent relevant World Health Assembly
Global Nutrition Cluster Toolkit on Nutrition in Emergencies :