Breastfeeding International Emergency Response with IBFAN Pakistan Report


June 2022,  The worst .floods in Pakistan‘s  history put a third of the country under water and  killed 1,717 people.   The monsoon rains, melting glaciers and severe heat wave were all linked to climate change. It is the world’s deadliest flood since the 2020 South Asian floods.  IBFAN Pakistan is  providing health, nutrition and breastfeeding counselling, and education on avoiding ultra-processed products and eating healthy local foods. Photo: Magdalena Whoolery.   Please send donations marked PAKISTAN

A Team Effort: Protecting Breastfeeding Saves Lives!

IBFAN Pakistan supports the Ministry of Health’s Call to Action to Ensure safer Infant and Young Child Feeding in Emergencies.

30th August 2022.

Click HERE for Pakistan Ministry of Health IYCF-E Statement

Following Pakistan’s unprecedented Monsoon flooding, IBFAN Pakistan is urging solidarity in supporting the call from Pakistan’s Ministry of Health for appropriate IYCF-E infant and young child feeding in emergencies.  In order to avoid unnecessary disease outbreaks and deaths of children, the protection, promotion and support of breastfeeding and appropriate complementary feeding is critical. The agencies are warning that donations of unnecessary ultra-processed products, including formula, should not be distributed to vulnerable communities.

During emergencies, disease and death rates among children under five are higher than for any other age group. The younger the infant, the higher the risk of death. Babies are at great risk of water-related diseases, with diarrhoeal disease the second biggest killer of under-fives.  The mortality risk is high due to poor sanitation,  high rates of malnutrition and disease outbreaks. Inappropriate infant formula donations exacerbate these problems. Pre-floods Pakistan already had high rates of malnutrition with four out of 10 children under five stunted and 17.7% suffering from wasting.(1) Donations of baby feeding products can undermine efforts to protect breastfeeding – a practice that is resilient and provides food, care, immune support and protection from the worst of emergency conditions. Indeed breastfeeding prevents malnutrition in ALL its forms (2) and inappropriate donations risk exacerbating the malnutrition crisis further.

Aside from its crucial role in child survival, breastfeeding is the most environmentally friendly way to feed an infant that contributes to local food and water security. It is a renewable, sustainable food system that creates no waste or pollution and, unlike artificial feeding, does not add to the environmental burden that is exacerbating the climate crisis.

Donations of infant formula and other powdered milk products during emergencies carry many risks and are often in violation of Pakistan’s Breastfeeding Protection Laws (3), the Global IYCF Strategy (4) and the IFE Operational Guidance for emergency Relief Staff (5). Feeding bottles and teats are extremely difficult to clean and can increase the risk of infection.

A commitment by ALL emergency responders is needed to meet this ongoing humanitarian crisis and prevent disease outbreaks and child deaths. Any inappropriate donations, especially from food companies, should be reported to Ministry of Health, UNICEF, WHO and IBFAN.


General Guidance

Feeding of children less than six months of age

Breastmilk should be the exclusive food for children under six-months. No other food or liquid, not even water, honey, sugar or cereal is required. Mothers should be supported to initiate breastfeeding within the first hour after birth, and to continue breastfeeding exclusively for the first six months. Formula companies make false claims that their products build immunity – knowing  that their products have ZERO antibodies. This is FALSE! (6) It is breastfeeding that passes immunity protections against infections, including protections of COVID-19 antibodies in breastmilk. As conditions are often unhygienic in emergencies, breastfeeding is especially vital. Breastfeeding saves lives and must be protected.

In our emergency work, we must always remember to “First Cause No Harm” and “Walk the Talk” by following the Operational Guidance for IYCF-E. There is a common misconception, spread by formula companies and their “proxies”,  that in emergencies, mothers can no longer breastfeed due to stress, inadequate nutrition or malnutrition.  Studies have found NO difference in breastmilk quality between a malnourished and well nourished mother. (7) If a Mother is malnourished, then nutritional support should be provided for her own health and well-being. Giving formula risks her child AND the mother becoming malnourished, a double burden of suffering on a family and a burden to public health. Another fact is that stress does NOT hinder breastmilk production, provided mothers and infants remain together and continue frequent breastfeeding, especially at night when milk producing hormone Prolactin is highest. Prioritising access to adequate clean drinking water and extra food for mothers will help to protect a mother’s health, as well as that of her children. Mothers and children require safe spaces, skilled breastfeeding support, nutrition from local healthy foods and psycho-social support in times of stress. 

The evidence-based IYCF in Emergencies Guidelines for Pakistan applies a clear strategic approach to feeding: 

1. Breastmilk from own mother by Breastfeeding

2. Breastmilk from own mother, expressed (fed by cup, not bottle);

3. Breastfeeding/Breastmilk from a Wet-Nurse/Razai Dai;

Last option: 4. Breastmilk Substitute (Formula) fed by Cup (not bottle).

Any provision of formula as a Breastmilk Substitute, must follow Operational Guidance for IYCFE and strict protocols, for example, ensuring that it is provided via Ministries of Health and UNICEF (NOT through companies). Donor agencies, NGOs, media and well-meaning individuals should avoid requesting and distributing donations of baby feeding products and should refuse them when offered.  General distribution of these products are likely to end up in the hands of breastfeeding mothers, undermining breastfeeding and ultimately taking children’s lives.

Every effort should be made to identify ways to breastfeed infants and young children who are separated from their mothers, for example by a wet-nurse (another woman, usually a relative breastfeeding the child or providing her breastmilk and feeding it to the infant with cup). 

If an infant less than six months age is mixed feeding (formula and breastmilk) the mother should receive counselling and be supported to breastfeed exclusively. Frequent breastfeeding and skin to skin contact increases a mother’s milk supply. If an infant is fully formula feeding, mothers who receive skilled breastfeeding counseling are often willing to re-establish breastfeeding.  With skilled support most mothers are able to successfully relactate.

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, or the use of a wet nurse. If all efforts have been exhausted, it is only then that artificial feeding is indicated, and then after careful assessment.

Use of feeding bottles and teats is NOT recommended due to the risk of infection and potential diarrhea outbreaks. Mothers can be easily taught to safely Cup Feed babies. If our premature babies can Cup Feed, so can older babies. If an infant is fully formula feeding, mothers who receive skilled counseling are often willing to re-establish breastfeeding and most mothers are able to successfully relactate with the right support.

Mothers should be counseled on the risks of bottle feeding and with consent, bottles should be removed and exchanged with clean cups. Bottles/teats require deep cleaning and sterilization, which is often not possible in emergencies. Cups do not need to be sterilized, requiring washing in hot soapy water. It is less time consuming and removes extra stress from already stressed out families. 

Complementary feeding of children above six months old

Children from the age of six months require complementary, nutritious local foods, in addition to breastfeeding, which should continue two years and beyond.

Mothers do NOT need to drink milk to produce milk – this is a formula company strategy to hook mothers onto unnecessary, unhealthy and expensive products. Breastmilk is not made from stomach content, but from our blood and nutrients in our blood stream. The distribution of commercial formula powders for mothers, often means she fills-up on these ultra processed products instead of eating local nutritious foods. This can exacerbate maternal malnutrition, diabetes and heart disease. Instead,  donate healthy local foods.

Breastfeeding is not a one woman job. It’s a team effort. The protection of mothers, infants and young children is a human rights issue for everyone. IBFAN urges all who are involved in funding, planning and implementing emergency responses to avoid unnecessary illness and death by:

   i) protecting, promoting and supporting breastfeeding and appropriate complementary feeding and

   ii) preventing uncontrolled distribution and ultra processed products including formulas and related products.

The transnational companies who market baby feeding products make multi-billions from unethical marketing to parents and health workers.  There is decades of evidence of how they have used emergencies to reposition themselves as ‘partners’ in health simply to increase market share. They call it “help”, when in fact it is clever public relations strategy. Using unethical tactics during emergencies is not unique to Pakistan.  WHO and UNICEF have recently released several reports about the predatory marketing being used – including during the COVID-19 Pandemic. Well-known Western companies, have convinced many Pakistanis that they are trustworthy. To learn more, watch the true story, turned Hollywood Movie called Tigers’, about a Nestlé Pakistani Whistleblower. Tigers has received international film festival acclaims, but few Pakistani’s even know about the Nestlé scandals or the #BoycottNestle campaign.

In emergencies it is vital that we protect breastfeeding, because it can mean the difference between life and death. IBFAN calls on our solidarity and urges us all to support Ministry of Health, UNICEF and WHO to avoid inappropriate donations and support, health, nutrition and breastfeeding.

– END-

For more information contact:

IBFAN Pakistan: Mr Abid Ali,


1: Infant and Young Child Feeding in Emergencies (IYCF-E) encompasses a range of multi-sectoral actions to support appropriate feeding practices during emergencies. IYCF-E activities focus on infants, young children up to 5 years, pregnant and breastfeeding women, and non-breastfed children in emergency settings.

UNICEF IYCF Emergencies Guidelines (Pakistan) 2017  2018 Pakistan National Nutrition Survey (NNS 2018), Key findings.—NationalNutritionSurvey2018.pdf  UNICEF Call for support for Appropriate Infant and Young Child Feeding in Yemen, Joint statement 11 April 2017

2: The Lancet Breastfeeding series, 2016

3: Pakistan Breastfeeding Protection Laws: 2002 The Protection of Breast-feeding and Child Nutrition Ordinance, 2002; 2012; The Protection of Breast-feeding and Child Nutrition Ordinance, as amended 2012, 2018 Punjab Food Authority (Baby Food) Regulations.

4 :Global strategy for infant and young child feeding  WHO 2003

5: Operational Guidance for Emergency Relief Staff and Programme Managers Developed by the IFE Core Group. Version 3. October 2017

6: Feeding children under 2 years in emergency situations What to do in an emergency with a child in your arms, how to organize feeding and secure the baby? UNICEF.

7: Maternal nutrition during lactation. Nancy F Butte, PhD, Alison Stuebe, MD, MSc.


Recommendation from the  Operational Guidance for Emergency Relief Staff and Programme Managers


Further Links on Emergencies:

IBFAN focus area on health and environmental impacts

The baby food industry’s destruction of an irreplaceable natural resource. IBFAN Statement  for Cop 26 5th Nov 2021

IYCF-E Hub — The IYCF-E global portal to infographics and resources related to infant and young child nutrition in humanitarian contexts.

Why formula donations can be a risk – examples from Ukraine and Myanmar

Infant feeding in emergencies – links to blogs

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