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Information note

Joint statement from the Nutrition Cluster on breastfeeding and breast-milk substitutes

UNICEF, WHO, WFP, Save the Children, and International Medical Corps 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 substitut

NEW YORK. 21 March 2011 - 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 diarrhea and possible increase in rates of under-nutrition. High concentration of people can be a major risk for water- borne diseases affecting large numbers of people. Breastfeeding confers critical protection from infection in environments without safe water supply and sanitation.

Misconception: During emergencies, mothers can no longer breastfeed adequately because of stress or inadequate nutrition
Although stress can temporarily interfere with the flow of breast milk, it is not likely to inhibit breast milk 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 to help protect their health and well-being as well as that of their young children.

Donations and procurement of breast-milk substitutes and other milk products
In accordance with internationally accepted guidelines, donations of infant formula, bottles and teats and other powdered or liquid milk and milk products should not be made. Experience with past emergencies has shown an excessive quantity of products, which are poorly targeted, endangering infants’ lives. Any use and procurement of breast-milk substitutes (BMS) should be based on careful needs assessment and UNICEF can provide technical assistance. Breast-milk substitutes should adhere to Codex Alimentarius Standards. The preferred type of breast-milk substitute is a 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.

Feeding of the non-breastfed child less than six months of age
The priority to feed infants less than six months of age who are not breastfed should be relactation (re-starting breastfeeding). If this is not possible or when artificial feeding is indicated by skilled staff such as health providers or infant feeding counselors, BMS are necessary and must be accompanied by training on hygiene, preparation and use to minimize their associated risks. Artificial feeding in an emergency carries high risks of malnutrition, illness and death and is a last resort only when other safer options have first been fully explored.

Complementary feeding of children above six months of age
Children from the age of six months require nutrient-rich, age-appropriate and safe complementary foods in addition to breast milk.  Priority should be placed on locally available, culturally-acceptable, nutritionally adequate and age-appropriate foods.

UNICEF, WHO, WFP, Save the Children, and International Medical Corps strongly urge all who are involved in funding, planning and implementing the emergency response in Northern Africa to avoid unnecessary illness and death by promoting, protecting and supporting breastfeeding and appropriate complementary feeding and by preventing uncontrolled distribution and use of breast-milk substitutes.

All queries and any information about donations should be directed to UNICEF, the designated nutrition coordinating agency in the North Africa emergency operation.


Guide for the media on infant and young child feeding in emergencies:

International Code of Marketing of Breast-milk Substitutes and subsequent relevant World Health Assembly
Resolutions. WHO (1981): https://www.unicef.org/nutrition/files/nutrition_code_english.pdf
and: http://www.ibfan.org/site2005/Pages/list2.php?iui=1&cat_id=46

Global Nutrition Cluster Toolkit on Nutrition in Emergencies :

The Operational Guidance on Infant and Young Child Feeding in Emergencies – sets out the dos and don’ts during a emergency response. Endorsed by WHA resolution 63.23, 2010. Available in English, Arabic, French and other languages at: http://www.ennonline.net/resources/6

Additional orientation, training and other materials on infant and young child feeding in emergencies is available free at: www.ennonline.net/ife

For more information please contact:
UNICEF Nutrition Section, New York:
Nune Mangasaryan, ,
Tel + 1 212 326 7159

Ilka Esquivel,
Tel + 1 212 326 7756,

UNICEF office in Amman:
Mahendra Sheth, Regional Health Advisor,
Tel + 962796663399

WFP office in Rome:
Margot Van Der Velden, margot.vandervelden@wfp.org,
Tel + 39 06 6513 2171

WHO office in Geneva:
Zita Weise Prinzo,
Tel + 41 22 791 4440

Carmen Casanovas, ,
Tel + 41 22 791 2968

Randa Saadeh, ,
Tel + 41 22 791 3315

WHO Eastern Mediterranean Regional Office in Cairo:
Ayoub Eid Al-Jawaldeh , Regional Nutrition Advisor,
Tel + 202 670 2535

Save the Children
Ali Maclaine
Tel + 44 20 7012 6482

International Medical Corps
Caroline Abla, Director, Nutrition and Food Security Unit
Tel + 961 70 15 90 66




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