Infant Feeding In Emergencies
Infant Feeding In Emergencies Kathy Carter 27.08.99
Re: Infant Feeding In Emergencies Ted Greiner 30.08.99

Date: Fri, 27 Aug 1999 06:40:32 -0400

From: Kathy Carter <>

Subject: Infant Feeding In Emergencies


You may have heard that WHO, LINKAGES, UNICEF and IBFAN are supporting a project to develop A training modlule for humanitarian aid workers on the subject of infant feeding in emergencies.

This material should be based on reality so I am asking you to send your opinions and experiences on the following questions (any other comments welcomed)! Thanks to all who have already been contacted and have responded:

1/ What is the feasibility of providing mother and child centres to provide protection and support mothers of young infants together? What would be needed to make this a routine?

2/ What is the feasibility of some form of breastfeeding counselling being made available in the initial emergency phase?

3/ Should breastfeeding support be a separate program or should it be integrated in an existing sector? If integrated, then where/ how?

4/ What is the feasibility of an organised relactation program?

5/ What is the best way to target infant formula only to those who really need it and without risking undermining breastfeeding by mothers?

6/ Who should be given training on this subject?

Thanks for your time.


Kathy Carter

for WHO/Linkages.

Date: Mon, 30 Aug 1999 15:53:10 +0100

From: "Ted Greiner" <>

Subject: Re: Infant Feeding In Emergencies


It is good that this issue is finally being given attention. I don't have any experience to offer other than that breastfeeding protection, support and promotion NEVER work well when "integrated" into other activities unless people are given specific training. (A very large-scale quasi-experimental study from Bangladesh is coming soon in J Tropical Pediatrics showing that an extremely successful nutrition education program in Bangladesh failed to have any impact on breastfeeding, I think because all they did was to give mothers standard messages.) And even then, as personnel shifts occur, effectiveness will decline. The standard "integrated approach" is even less likely to work well in emergency situation where quite specific skills and knowledge are needed.

My reading of why this is the case is mainly because basic training for all health workers (major exception in some places: midwives) instills (or supports their existing feeling) that "breast is best" and that this is the full amount of knowledge needed to promote it adequately. I have never met someone who did not receive specific training on breastfeeding (or did significant self-study) who either knew much of anything about it or felt he/she was lacking in any of the necessary knowledge. Only when they happen to land in a course for whatever reason do most health workers realize all that they did not know they did not know. Being a professor, a journal editor or an advanced researcher makes no difference. Witness all the studies that fail to define breastfeeding properly yet continue to be trotted out (one even got mentioned on CNN yesterday) on HIV transmission rates through breastfeeding.

Lack of much specific knowledge and skill among health workers on breastfeeding may be a major reason why nothing much happened in improving breastfeeding rates until the 1980s when training began in parts of the world, and why nothing much is happening in improving exclusive breastfeeding rates in most of the world now. I have only seen evidence for improved rates in a few places where the BFHI is strong and working on ways to influence feeding patterns beyond the first days of life.



Ted Greiner