Friday, August 17, 2007

Emergencies in Iraq and Peru

We have received reports of free formula being distributed in Iraq and have raised this with the UK authorities and partners. News just in is that UNICEF is calling for the Government of Iraq to take action by enforcing the International Code of Marketing of Breastmilk Substitutes and subsequent, relevant World Health Assembly Resolutions. The experiences in Iraq and during the Asian tsunami of 2004 show why donating formula to Peru, hit by an earthquake this week, is the wrong way of trying to help.

The Code and Resolutions aim to protect and promote breastfeeding and to ensure the safe use of breastmilk substitutes if these are necessary.

In a UNICEF press release Roger Wright, UNICEF’s Representative for Iraq, called on Iraq’s government to reinforce national compliance with the International Code on Marketing of Breastmilk Substitutes. He also urged Iraq’s communities to give new mothers special care and support to help them breastfeed successfully. “Exclusive breastfeeding is the single most powerful means of protecting the health of Iraqi babies during this time of crisis,” he said.


According to UNICEF, free formula is being distributed to all infants as food rations as part of Iraq's Public Distribution System (PDS).

---UNICEF press release extract

Dr. Nidhal, Manager of the Breastfeeding Programme for Iraq’s Ministry of Health, noted that Iraq’s rate of exclusive breastfeeding was worryingly low, at just 25 per cent for infants under six months. The free distribution of infant formula through the PDS is a negative factor in contributing to these low rates, discouraging the traditional and much better exclusive breastfeeding.

“Breast milk is the best possible nourishment for children and contains everything they need to be healthy for the first six months,” she said. “It protects against diarrhoea from contaminated water, and also provides vital antibodies against pneumonia and other illnesses that could affect many Iraqi children during infancy. Mothers must not risk any other food or additional water for their young babies.”

---extract ends

The situation for mothers and babies in particular is very difficult in Iraq.
According to UNICEF about one in 10 children under five in Iraq are underweight and one in five are short for their age, this report states:
Baby Milk Action and our partners in the International Baby Food Action Network (IBFAN) have long worked as part of the Emergency Nutrition Network on raising awareness of appropriate infant feeding support in emergency situations.

During the response to the asian tsunami at the end of 2004 we had to resort to warning the public in the UK that they were breaking the law if they sent free formula to the region as labels would not be in the appropriate language. It is far better for any required formula to be sourced locally so the instructions are in the correct language and distribution can be appropriate and accompanied by training. See:

However, in an Indian survey in Pondicherry it was found that infant formula was distributed by Non-Governmental Organisations (NGOs) indiscriminantly and: "The occurrence of diarrhea was three times higher among children who were fed with free breast milk substitutes (BMS) than in those who were not fed with the same."

Our IBFAN partners, the Breastfeeding Protection Network of India (BPNI) reviewed this and other studies at its national convention in December 2005. The proceedings can be downloaded by clicking here:

A survey on the response to the tsunami in Tamil Nedu, where Nestlé formula was routinely distributed by NGOs, found that "64% NGOs, 76% social workers, 32% paramedical staff and 87% victims" were unaware of the importance of breastfeeding in emergency situations.

The importance of promoting the benefits of breastfeeding before an emergency and enforcing the International Code and Resolutions (implemented comprehensively in India as the Infant Milk Substitutes Act) was stressed.

Also important is training of field workers on supporting mothers who may experience difficulties with breastfeeding due to stress and, in extreme cases, their own poor diet (though undernourished mothers are able to breastfeed). The Emergency Nutrition Network produces training modules for field workers.

IBFAN has a guide for the public, warning not to send donations of formula. With the tragic situation in Peru, which has just been hit by an earthquake, we are making our banner advertisement to this live to help to stop a bad situation being made worse by well-meaning people sending formula. See:

Feel free to copy the banner to your site, with the above link:

We have worked closely with organisations such as Save the Children and Oxfam in the past. Both are responding to the Peruvian earthquake and have good operational guidance to make sure interventions are appropriate. Oxfam reports that 150,000 people are affected and so the effort to provide assistance will be considerable. You can donate following the links to the organisations.

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