On Tuesday 28th, Dr Ruth Stirton of the University of Sussex joined forces with the World Breastfeeding Trends Initiative (WBTi) Steering Group, along with Marie McGrath of the Emergency Nutrition Network, to present on the topic of safe provision for feeding infants and young children in emergencies in the UK. This WBTi UK first anniversary forum was hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament.
Participants included infant feeding specialists and policy makers, emergency planners, international academics, and third sector organisations such as UNICEF UK Baby Friendly Initiative and Save the Children.
We heard from Clare Meynell and Helen Gray (WBTi UK) on the findings, gaps and recommendations from the WBTi UK report surrounding infant feeding in emergencies. Ruth Stirton presented on the legal and regulatory framework and the minimal place of infants and young children in the current framework. Marie McGrath then described the recently published 2017 Operational Guidance on Infant Feeding in Emergencies, and explored how it might be adapted to the UK context.
The audience engaged in lively group discussion, considering:
the issues in the immediate response phase
how best to support formula feeding families in emergency situations
mapping the existing local capabilities that emergency plans could call upon
issues surrounding communication with the public and front line responders about how best to support infants and young children in emergencies
the wider policy framework and how best to ensure that infants and young children are specifically provided for
issues for the longer term recovery phase after the emergency
A report will be published in 2018 making recommendations for improvements. If you would like to contribute written comments to the report, please look at the presentations and group materials and send comments by email to Ruth Stirton firstname.lastname@example.org
Indicator 9 focuses on national planning for the protection of infants and young children in case of emergency: is there a strategy in place to ensure that suitable nutrition and support is quickly put in place for families in the event of a disaster?
Infants and young children are our most vulnerable citizens in any emergency situation. They need protection, as their immune systems are immature, they have specific nutritional requirements, and they can’t wait several days for an emergency response to meet their needs, especially in a high-risk setting.
Disasters and emergencies in the UK
The UK is not immune from disasters. These can range from storms and flooding, to catastrophic fires and terrorist incidents.
More recently, in response to the arrival of Hurricane Ophelia in Ireland and the UK, the WBTi team has joined in setting up a social media awareness campaign on protecting infants and young children in emergencies, using memes like the one below to communicate key concepts on the Safely Fed UK Facebook page.
Gaps in policies worldwide
Yet around the world, the WBTi global report has found that planning for infants in emergencies is one of the weakest policy areas in infant feeding in many countries.
Global guidance and recommendations
The World Health Assembly (WHA), composed of delegations from all our countries, has recognized the importance of including planning for infants and young children in all disaster-preparedness planning. WHA Resolution 63.23 calls on all nations to incorporate the international standards outlines in the Operational Guidance on Infant Feeding in Emergencies.
The newest update of the Operational Guidance has just been published by the international Infant Feeding in Emergencies Core Group, which brings together leading humanitarian organisations and experts working in this field.
Planning for the protection of infants in emergencies in the UK
The WBTi assessment of UK policy in 2016 found that there is no central national strategy on infant and young child feeding in emergencies, but that emergency planning is devolved to local areas.
(See Indicator 9 on UK policy on planning for infants in emergencies here )
Our first Anniversary Forum, to be hosted by Alison Thewliss MP, chair of the All Party Parliamentary Group on Infant Feeding and Inequalities, at the Houses of Parliament in November, will bring together emergency planners, members of Local Resilience Forums, government agencies, researchers and infant nutrition specialists to explore how protecting infants and young children can be woven into the UK emergency-preparedness system.
Helen Gray IBCLC is Joint Coordinator of the World Breastfeeding Trends Initiative (WBTi) UK Working Group. She is on the national committee of Lactation Consultants of Great Britain, and is also an accredited La Leche League Leader. She represents LLLGB on the UK Baby Feeding Law Group, and serves on the La Leche League International special committee on the International Code.
Guidance is needed on infant and young child feeding for families in the UK affected by disasters and emergencies.
Heather Trickey and Helen Gray.
Disaster and emergency situations – floods, fires, terrorist attacks and widespread power failures – can affect any country, including the UK. In any disaster or emergency, babies are vulnerable and continued access to adequate and safe nutrition is essential. Families need support to ensure that children continue to be cared for and fed in line with their needs.
Babies who are fully or partially formula fed are at risk if their caregivers lose access to clean water, are unable to sterilise feeding equipment or suffer disruption or contamination of their formula milk supplies. A suitable environment for preparation and storage of feeds, sterilising equipment, boiling water and safe storage such as a refrigerator, are all needed to prevent bacterial contamination
Risks for breastfed babies
Breastfeeding protects against infection and can be comforting to infants and mothers during difficult times. Mothers’ supply of breastmilk is resilient, however, chaos, displacement and emotional strain, coupled with commonly held misconceptions about how breastfeeding works, can undermine a mother’s confidence and result in less frequent feeding. Breastfeeding mothers need access to the option of feeding in a private space and reassurance that continuing to breastfeed is the best option for their baby.
Skilled support can help mothers resolve breastfeeding problems and maintain the protective effect of full or partial breastfeeding. If breastfeeding helpers are not pre-authorised as part of planned disaster response the immediate help that families need can be delayed.
Risks associated with donated formula milk
The world is a better place than we sometimes think. When a disaster strikes, ordinary people often respond with an outpouring of generosity. We give clothes, equipment and food spontaneously and in response to public calls.
In the absence of guidance, agencies responsible for co-ordinating emergency response and volunteers working on the front line are often not aware that donations of formula milk can put babies at risk. Risks from donated formula milk include inadvertently distributing products that are unsuitable for babies under six months or for babies with special nutritional needs, as well as distributing milk that is contaminated or out-of-date. There is also a risk that donations will be inappropriately provided to parents of breastfed babies, which can undermine the protective effect of breastfeeding and cause parents to become dependent on a continued supply of formula milk.
International guidelines for emergency feeding caution against accepting donations of formula milk. It is recommended that emergency planners and first responders, with expert advice, take responsibility for purchase and distribution of appropriate formula milks in line with the needs of each family.
UK-based emergencies have tended to be highly localised and short-term. However, UK guidance will need to ensure preparedness for longer-term support needs, for UK charities and for displaced families and unaccompanied children who have sought refuge from outside of the UK.
Several UK agencies have developed guidance with limited scope. The Food Safety Agency has issued guidance to support safe preparation of formula milk in response to flooding and contamination of local water supplies. A toolkit has also been developed to support food banks, including preventing and managing unsolicited formula milk donations.
How to help ensure babies’ nutritional needs are protected
In the absence of national guidance, relief co-ordinators and agencies and members of the public will be concerned to do the right thing in response to a disaster. There is an urgent need to improve planning and raise awareness about the best ways to support infant and child feeding. These key points from have been adapted from UK and international guidance: 1) Members of the public
DO donate money to key agencies. This is the best way to support parents who need to buy formula milk. Money will allow parents, caregivers or coordinating aid organisations to buy the most appropriate milk to meet the individual needs of each baby. Donated formula milk can inadvertently put babies at risk.
DO offer your time to help agencies co-ordinating relief. Support and encourage mothers who are breastfeeding. Breastfeeding is protective against infection, and provides the baby with the safest possible nutrition.
2) Relief workers and aid agencies
DO have a local plan to support infant and young child feeding in emergencies in place for local authorities, first responders and aid agencies. All families should be screened to ensure they receive appropriate support or supplies.
DO ensure that mothers who are fully or partially breastfeeding have the support they need to continue. Mothers can seek support from their midwife or health visitor. Local emergency planning should have identified appropriate infant feeding support from local health and voluntary services. There are telephone helplines which support caregivers with all aspects of infant feeding:
NCT helpline (0300 330 0700)
The National Breastfeeding Helpline (0300 100 0212).
DO encourage donations of money to recognised agencies so that parents, caregivers and agencies can buy any formula or supplies needed, rather than donations of formula products.
Appropriate support or supplies including cash cards specifically for the purchase of infant formula and complementary foods for young children could be considered.
DO ensure that formula milk is purchased and distributed only for babies who need formula milk, following basic screening of families (simple triage tools have been recently been developed for use in emergency situations in Greece and Canada).
DO NOT distribute formula milk in an untargeted way.
There is an urgent need for UK governments to ensure infant and child nutrition is protected as part of the planned new strategy for resilience in major disasters. Local authorities and relief agencies require national guidance to develop local strategies so that we can all be better prepared.
Heather Trickey is a Research Associate based in DECIPHer, Cardiff University. Her research focuses on public health policy and parents, particularly Infant Feeding Policy.
Helen Gray is Joint Coordinator of the World Breastfeeding Trends (WBTi) UK Working Group.