From Marie McGrath on Thursday 1 October at 3:25 PM
I am happy to share Interim Operational Considerations for the feeding support of Infants and Young Children under 2 years of age in refugee and migrant transit settings in Europe. It has been developed by UNHCR, UNICEF, WHO, Save the Children & ENN with review by ACF, IBFAN-GIFA, IOCC, World Vision, Karleen Gribble & Mary Lung’aho.
This note draws from key policy guidance and provides direction where guidance is limited for this context. It outlines the minimum level of assessment and support that is needed. A more detailed programmatic guidance is in development and will be posted on en-net.
This is a working document and feedback from people using it in the field is welcome. Please provide feedback directly on en-net or contact UNHCR/UNICEF/Save the Children directly (named contacts are included in the guidance note).
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CLICK HERE for discussion on the Emergency Nutrition Network
We have been alerted to appeals on Facebook pages and elsewhere for baby milks and bottles etc as response to the Refugee crisis in Europe.
There is now a much better understanding amongst NGOs about the risks of artificial feeding in emergencies and the potential for commercial exploitation. The baby feeding companies like nothing more than to be seen as rescuers in emergencies and are more than keen to send donations so its important to be on guard. However many of these appeals are from well meaning small operations and collectives that are being set up to respond to the crisis. In this chaos its going to be incredibly difficult to ensure proper needs assessments by qualified health and nutrition workers – ideally trained in infant feeding who can support mothers and help them maintain breastfeeding/relactate. And since bottle feeding rates are quite high in Syria many women will be facing extremely difficult problems feeding their babies safely. They will all certainly need help.
Do send any information you have: firstname.lastname@example.org
IBFAN pages on emergency are here: http://ibfan.org/infant-feeding-in-emergencies
There is an interesting discussion on the Emergency Nutrition Network website following a question I posed. Here are some of the responses:
I think this is an extremely challenging situation, which only increases the importance of having a good response. I recall, during the Asia Regional IYCF-E training meeting in Bali some years ago that a scenario not dissimilar to this situation in terms of large numbers of non-breastfed infants was given for consideration of developing a plan of response and no one wanted to touch it! Too difficult.
I think it’s important to note (and I am sure that this is well understood by those on the ground) that requests for formula are not necessarily an indication of need (they always occur) and that all of the other factors that impact infant feeding will be in play- so there will be many breastfeeding women who feel that their milk supply is being impacted by stress etc who are in need of support and not formula. And it is also important to note that supporting women in their informed choice is the goal which involves helping women and their families to understand the potential ramifications of infant feeding decisions in their changed circumstances. It’s complicated, more complicated than usual. And there are well meaning individuals and organisations who do not understand this. For example, there have been people raising money to buy breast pumps to distribute in Calais refugee camps! Not very helpful.
I now work for a Belgian government organisation who does the follow up of all children born until 3 years old. This includes any new arrivals to Belgium. I work in a small town, so the number of refugees we see is manageable, not the massive arrival of groups like it is in the capital or other major cities. The issue of breastfeeding is indeed a challenge. Mothers who breastfeed often change their feeding choice once formula is available free of charge (which is the case in the first couple of months they arrive), due to lack of time, stress, PTSD but also lack of qualified support. Quite often I have also seen that psychiatrists tell mothers with PTSD to stop breastfeeding in order to be able to prescribe medication. I put a big effort in helping mothers who give birth here to make an informed choice and help breastfeeding started, since free formula is only available during the period when they apply for a stay permit, it finishes once they get it or once their application is denied, then they are on their own. One of the organisations who provides housing and income was also reimbursing formula but once there was new funds available we managed to instate a system where women in difficult financial situations (Belgian and other nationality) get a small sum of money every month instead of having formula reimbursed. Still, the major challenge is that women deal with many health providers: family doctors, pediatricians, midwifes, nurses and there is very little consistency in the support (or lack of) of breastfeeding….In the above comment I meant that only breastfeeding women get a small sum of money instead of having formula reimbursed.
Here is IBFANs report to the Committee on the Rights of the Child for Syria, Session 58 September-October 2011. As you will see breastfeeding rates are very low (early initiation 32%)
CLICK here for Update story about the Philippines and how volunteers from IBFAN’s group help mothers
All infants with diarrhea, near death with dehydration and sent to hospitals straight from C-130 (planes) are all bottle – and formula-fed…All babies who are breastfed are well and not even sick despite getting soaked cold last Friday (when Yolanda hit).
Haide Acuna, a breastfeeding campaigner visiting the evacuation centers in Cebu 1
With our water and food supply running low, I just breastfed and breastfed my son…If our child had been dependent on milk formula, I would have taken part in looting, too….When we went out to forage for food, I saw people looting formula milk for their babies…Even if the baby were bottle-fed before Yolanda, the baby could be breastfed anytime.