Thursday, May 31, 2007

Infant feeding in emergencies in the news

Two articles today deal with the difficult subject of infant feeding in emergencies. One, in The Guardian, picks up on the paper’s recent investigation of Nestlé’s marketing in Bangladesh and stresses that the marketing requirements Nestlé should be abiding by are even more important in emergency situations. The trouble is that when an emergency hits the headlines, shortly afterwards formula hits the refugee camps. Sometimes distributed without thought, with labels in the wrong language, to any family with a baby. In situations where safe water and hygienic conditions are likely to be in short supply, the protection given by breastfeeding is even more important.

The Emergency Nutrition Network brings together experienced field workers to share and disseminate best practice. Marie McGrath, co-director of the Emergency Nutrition Network, and IFE Core Group coordinator and author of the article in today’s Guardian, recalls a recent example showing the importance of supporting breastfeeding. For the full article see:,,2090780,00.html

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Moorhead [author of the article on Nestlé in Bangaldesh] - in her description of a ward in the "diarrhoea hospital" in Dhaka, where most patients are babies and "not one is crying: they are all much too weak for that" - very clearly showed the acute risks that formula feeding presents to infants where there aren't the resources to safely support it. Put these infants in the face of a humanitarian disaster and the risks multiply. This was highlighted most blatantly in an outbreak of diarrhoea among artificially fed infants in Botswana in 2006, due to contaminated water supplies. Babies who were not breastfed were 50 times more likely to be hospitalised with diarrhoea, and seven times more likely to die, than babies who were breastfed.
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She also recalls that in the Kosovo crisis, UNICEF gathered 27 tonnes of breastmilk substitutes.

While UNICEF was trying to stop the indiscriminate distribution of formula in refugee camps, we were working to try to stop well-meaning people filling trucks with formula to send. Our partners in the International Baby Food Action Network (IBFAN) went into action in other countries.

The International Baby Food Action Network (IBFAN – Baby Milk Action is the UK member) forms part of the ENN Infant Feeding in Emergencies core group. This has produced training modules for agencies so that mistakes of the past are not repeated, while what works to save lives is. You can find out more at:

IBFAN’s Infant Feeding in Emergencies (IFE) working group has information here:

Our IBFAN partners in Albania worked in the refugee camps supporting mothers with breastfeeding – some needing assistance in re-lactating after the stress of fleeing their homes, perhaps having left men folk behind.

They also worked to ensure formula was correctly prepared for those infants who needed it. At one of our regional meetings where we evaluated the experience, we heard how someone - agency or company or well-meaning members of the public - distributed formula indiscriminately in the camp, leaving a tin of formula outside each tent where there was a child. There was no discussion as to whether it was needed or how it should be prepared. The labels were in the wrong language.

We knew the same would happen when the tsunami hit Indonesia and other countries on the Indian Ocean on Boxing Day 2004. We immediately made our briefing on infant feeding in emergencies live, and put up the banner advertisement we have ready for such times:

Next time there is an emergency, drop it onto your site or blog if appropriate, with a link to:

We contacted people and the media when we heard of appeals for formula. But the voice of experience is not always appreciated. People want to do something and in a culture where bottle-feeding is seen by many as the same or almost the same as breastfeeding, sending formula seems a caring thing to do.

We finally invoked the fact that it was illegal under UK law against exporting formula with labels in the wrong language. See:

Still formula gets through. Marie McGrath recalls that some of the donations during the Kosovo crisis were huge, suggesting a commercial source. In past emergencies there has been a definite commercial link.

Flooding a country with formula in an emergency can have an impact for years - a disaster for the population and big profits for baby food companies. When I interviewed our IBFAN partner from Armenia in 2006, she recalled that breastfeeding rates there had only recently recovered to the levels before the Armenian earthquake of 1988. Donations of formula coming from rich nations had undermined breastfeeding to the point that only 20% of infants were predominantly breastfed at 4 months (that is breastfed exclusively or fed breastmilk with water, tea or juice). You can listen to the interview, included alongside those with other IBFANers, here:

You can find a written interview about the Armenian experience here:

The interviewer in the Armenian Weekly raises questions over the risk of HIV through breastfeeding. This brings me to the second article of today. This is an article based on a report on BBC television breakfast news. It is by Kate Silverton who travelled to Lesotho with UNICEF. Here is a quote. The full article is at:

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If [Lesotho] is to survive it needs to find a way of creating a new generation that is born free of HIV and UNICEF is supporting a government campaign that aims to do just that.

It wants everyone in the country to be tested for the virus, and has committed the drugs for treatment should they test positive.

It's also actively promoting a programme that teaches HIV positive mothers how to avoid passing on the virus to their children.

The risk of passing on the virus can fall from 35% to just 2% if a mother follows a few simple steps.

If she takes the right drugs during pregnancy and after birth and exclusively breastfeeds for six months, her child is likely to be born HIV free.

It sounds incredibly simple - and goes against local customs where young infants are given a mix of traditional food as well as breast milk - but new research from the World Health Organisation has found that breast milk can actually protect the child from the virus.

The feeding has to be exclusive however because anything other than breast milk can serve as an irritant in the gut and allow the virus to pass through.
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In the HIV emergency the baby food marketing requirements are also critically important. We have exposed in the past how companies have exploited HIV to try to have regulations over turned.

It is great this information is finally finding its way into the mainstream news.

I even had the opportunity to post a comment on the Guardian article addressing Nestlé’s untrue comments about its marketing activities, rectifying somewhat the situation I described on Monday. See:

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