UNICEF position regarding close contact and breastfeeding in COVID-19 context

In line with the UN Convention on the Rights of the Child[1] and World Health Organization (WHO) technical guidance as the UN lead agency in health, WHO and UNICEF recommendation regarding the importance of exclusive breastfeeding in the first six months of a baby’s life, WHO and UNICEF’s Baby-friendly Hospital Initiative (BFHI) or Ten Steps to Successful Breastfeeding, UNICEF’s Breastfeeding and family-friendly policies, Policy brief 2019, and the International Code of Marketing of Breast-milk Substitutes, WHO Recommendation on breasting in the context of COVID-19 and, the recently released UNICEF guidance brief on Infant and Young child feeding in the Context of COVID-19[2], UNICEF in Romania highlights the importance of close and safe contact and maintenance of exclusive breastfeeding also in COVID-19 context.

Breast milk provides protection against many illnesses and is the best source of nutrition for most infants. Breastfeed children have better chances to survive and thrive. In the context of COVID19, there is no evidence that the illness can be transmitted through the breastmilk, hence the recent guidance is that women with COVID-19 are recommended to continue breastfeeding (early exclusive breastfeeding from birth to 6 months and then continuing up to 2 years of age and beyond), but they should take precautions, including practicing respiratory hygiene[3] during feeding, including wearing a mask covering mouth and nose, washing hands with soap and water for 20 seconds before and after touching the baby and, routinely cleaning and disinfecting surfaces they have touched. Therefore, a breastfeeding mother with COVID-19 should be supported to hold her newborn skin to skin, breastfeed safely, and share a room with her baby.

When the baby is 6-month-old, diverse and adequate complementary feeding should be available while the mentioned hygienic precautions are respected.

Breastfeeding of infants who are sick should be also continued by increasing the frequency or the duration of each feeding and while the mother is taking the necessary protection measures. If the infant is unable to breastfeed, help the mother to give expressed milk.

In situations when severe illness in a mother with COVID-19 or other health complications, prevents her from caring for her infant or prevents her from continuing direct breastfeeding, mothers should be encouraged and supported to express milk, and safely provide breastmilk to the infant, while applying appropriate hygiene measures. If the mother is expressing breast milk with a hand, manual or electric breast pump, she should wash her hands before expressing breastmilk or touching any pump or bottle parts and ensure proper pump cleaning after each use.  The expressed breastmilk should be fed to the child using a clean cup and/or spoon, preferably by a person who has no signs or symptoms of illness and with whom the baby feels comfortable.

Intensifying the protection, promotion and support to adequate infant and young child feeding is therefore a critical action to be safeguarded by the health personnel even in the context of COVID-19. Especially in poor rural isolated areas, for vulnerable mothers the support of community nurses and Roma health mediators is essential. We need to take into consideration that 1 in 10 children in Romania is given birth by an adolescent mother, and we only have 1650 community nurses in the country while World Bank estimated a need of 6.000. 

As pandemic COVID-19 evolves, the availability and access to health care needs to be continued for all women of reproductive age, pregnant women and their newborns. This would include both routine care and care related to COVID- 19. Efforts must be made to maintain quality clinical services such as antenatal care, childbirth services, postpartum & postnatal care. Continuation of regular health services must be context - specific and, as far as possible, based on the documented health service impact of the pandemic.

There should be no promotion of breastmilk substitutes, donation of feeding bottles and teats, pacifiers or dummies or donations of breastmilk substitutes in any part of facilities providing maternity and newborn services, or by any of the staff.

In the context of lockdown and concern for family members, ensuring that accurate health and nutrition information is available to all communities and parents, is critical.

[1] Where at Article 24 the Convention recognizes the child right to be breastfeed and settles the 

the obligation of the governments to make available for the families relevant information on the nutrition of the child, especially on breastfeeding.

[2] Jointly developed by UNICEF, Global Nutrition Cluster and GTAM, March 30 2020

[3] According to CDC, covering one’s mouth and nose when sneezing or coughing, using paper tissues and throwing them after use, washing and disinfecting hands after each touching of mouth or nose.