Infant Feeding in Emergencies – Resources for supporting families from #Ukraine #IYCFE

Infant Feeding in Emergencies – Resources for supporting families from #Ukraine #IYCFE

Our WBTi work has revealed that in the UK we have no national guidance on the support and feeding of infants and young children, or pregnant or breastfeeding mothers, during emergencies. There is currently a postcode lottery of Local Resilience Forums who include a few details in their advice to the public such as “Remember to pack formula and nappies for your baby”, but there is no national guidance for LRFs and local authorities that they should include infants and young children in their planning.

This page will serve as a repository for resources for those planning services and those providing feeding support for Ukrainian families with infants and young children.

Breastfeeding provides infants with food security, immune protection, and emotional comfort during disasters.
Basic priorities in an emergency:

1) Support new mothers to hold their babies skin to skin and begin breastfeeding within the first hour.

2) Support mothers who are breastfeeding, partially or fully breastfeeding, to continue breastfeeding and increase their milk supply if needed: provide access to skilled feeding support.

3) Protect infants who are not breastfed: Trained infant feeding / nutrition support teams from trusted NGOs like UNICEF will provide access to safe supplies of appropriate infant formula for babies that need it, and support with safe preparation under hazardous conditions.

4) Protect all infants: breastmilk substitutes and feeding equipment (infant formulas and other milks, bottles, teats, breast pumps and also donor human milk) will be provided by trusted NGOs like UNICEF; the public should AVOID sending donations of these into high risk settings, but send donations of funds to trusted NGOS instead. This will enable them to provide families with what is needed on the ground.

These organisations are members of the Infant Feeding in Emergencies Core Group and have created the international Operational Guidance on Infant Feeding in Emergencies. Please consider supporting their work with families with infants and young children.

We have collected links to infant feeding resources in Ukrainian, and also in the languages of countries housing refugee families, for breastfeeding helpers and aid workers in those countries.

Please send us any suggestions for additional resources

We have a few other resources not included here; please email us any enquiries.

NOTE: we will continue to add links and resources to this page, and these organisations are continuing to add further translations into more languages – please make sure that you clear your cache, or ‘refresh’ the page, each time you open any of these links to ensure that you find the most up to date page.

NOTE: We are providing these resources as a public service, but we cannot read the resources in other languages ourselves, so we cannot always vouch for the accuracy of the contents. Please have someone fluent in the language read it for you.

CONTACT: wbti@ukbreastfeeding.org

WHERE TO START? Watch this 4 minute introductory video from Save the Children

Aid worker or emergency planner? Short video here: how can you incorporate best practice into your support for Ukrainian families?

GET INFORMED: Read the first 25 pages of the Guidance for an overview of best practice.

Resources from the Global Breastfeeding Collective, led by WHO and UNICEF

It is important to continue breastfeeding if you are COVID positive: your milk can pass antibodies to your baby! More resources HERE.

UNICEF UK Baby Friendly resources

Guidance for local authorities on infant feeding during COVID19 (from BFI, First Steps Nutrition Trust, and NIFN). First line guidance for UK local authorities responsible for supporting families

The provision of formula in food banks (November 2020)

Statement on infant formula in food banks (November 2020) – signposting

See also the response to Question 11 on formula donations and distribution in their FAQ here

International humanitarian guidelines and operational guidance

Sphere Handbook

Operational Guidance on Infant feeding in Emergencies
for Emergency Relief Staff and Programme Managers

Available in numerous languages

Media Guide and Guide on writing/ talking about infant feeding in emergencies
These are extremely useful for humanitarian aid organisations and for the media in framing the situation

Guidance for helpers not trained in supporting infant feeding

This short leaflet was written for local authorities and those supporting Afghan refugee families but could be useful for those supporting Ukrainian refugees in the UK. It sets the context, lists some useful resources for parents, provides information about making up powdered infant formula correctly and describes useful actions in some possible scenarios.

Infant feeding support resources – multiple languages

Rapid Feeding Assessment Key Phrases in multiple languages (including Ukrainian, Russian, Romanian, Polish and English – scroll down the page)

Simple Points for Helpers – infant feeding in emergencies in multiple languages (including Ukrainian, Russian, Romanian, Polish and English – scroll down the page)


Pictorial counselling cards in many languages including Russian, adapted to include COVID19 recommendations. Some are full pictorial sets, while some are simply the translation matrix.

Infant Feeding flyer for families in transit (including English, Ukrainian, Polish, Russian, updated for COVID19). Developed by the volunteer team from Infant Feeding Support for Refugee Children/ Safely Fed

Posters and booklets in Ukrainian hosted by the Lithuanian IBCLC Association

Pictorial book about breastfeeding (no words) from La Leche League Netherlands. The PDF is free to use for all. Printing and sharing is allowed, as long as the original file (including credits) is unaltered. Price listed on website is for printed version.

Breastfeeding resources in multiple languages including Ukrainian, Romanian, Russian. (From the Missouri Department of Health and Senior Services, USA)

Breastfeeding Matters – A Guide to Breastfeeding for Women and their Families (from best Start, Ontario Canada) can be downloaded free in Russian and other languages

Translations of key phrases, breastfeeding infographics in many languages, and more: Safely Fed European resources

La Leche League International: Variety of resources and infographics in infant feeding in emergencies translated into multiple languages – most are directed at mothers and parents

Global Health Media: Videos on childbirth and breastfeeding topics.

Infant Feeding in Emergencies Social Media resources:

Infant Feeding Support for Refugee Children Facebook Page: Memes/ graphics in multiple languages, with appropriate captions

La Leche League International Facebook page: Memes/ graphics in multiple languages, aimed at mothers and parents

Safely Fed UK Facebook page – volunteers welcome to create graphics in Canva and to monitor the page! Contact WBTi UK: wbti@ukbreastfeeding.org

For policy makers, emergency planners, media and humanitarian aid workers

Policy resources, media guide, training materials: Infant Feeding in Emergencies Core Group

IYCFE Hub: global hub of resources

Background information on breastfeeding in Ukraine: WBTi 2015 Ukraine Assessment Report

Policy resources, translations of key phrases, and more: Safely Fed European resources

Please do contact us if you are interested in volunteering or have some useful resources to share!!

CONTACT: wbti@ukbreastfeeding.org

Helen Gray MPhil IBCLC is Joint Coordinator of the WBTI UK Steering Team, and Policy and Advocacy Lead at Lactation Consultants of Great Britain. Her research interests include human rights and infant and young child feeding in emergencies.

Protecting babies in emergencies

Protecting babies in emergencies

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.

 

There is no UK government plan

The World Health Assembly (Resolution 63/2010) has recommended that all countries implement existing global guidelines on infant feeding during emergencies, including specific operational guidance to help relief agencies protect infant nutrition and minimise risk of infection. Although there is national guidance on care of animals during emergencies, a recent World Breastfeeding Trends Initiative (WBTi) report found that there are no UK-wide or national strategies addressing infant and young child feeding during a disaster. Scotland is the only part of the UK that has a named lead on infant feeding in emergencies. Emergency planning and response is devolved to local authorities; because there is no guidance on the protection of families with infants there is no way to ensure that local strategies consider infant nutrition as part of emergency response.

 

Risks for formula fed babies

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

Gribble IYCFE liquid photo 13006_2011_Article_127_Fig2_HTML
Emergency supplies required to care for and feed a formula fed baby for one week in a developed country, using read-to-feed milk. From Gribble & Berry 2011 “Emergency Preparedness for those who care for infants in developed country contexts.” International Breastfeeding Journal /2011 6:16

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.

Donations Balham Mosque
Donations of clothing, bedding, toys, food and water, London, June 2017. Photo Credit: @balhammosque

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.

 

What’s been done so far?

International guidelines for protecting infants in disasters and emergencies are available.  There is a need to adapt these to a UK context, where, beyond the early weeks, many babies are fully or partially formula fed and which includes a rich mix of cultures and nationalities with different feeding practices.

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. [UNICEF UK Baby Friendly Initiative has produced guidance for Local Authorities on infant feeding during the COVID pandemic]

[See also Preventing inappropriate donations during emergencies 2021 from the Infant Feeding in Emergencies Core Group: https://www.ennonline.net/ifecoregroupinfographicseries

 

Preventing inappropriate donations during emergencies 2021. From the Infant Feeding Core Group https://www.ennonline.net/attachments/4050/Preventing-and-Managing-Inappropriate-Donations.pdf

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.
  • DO ensure that parents are aware of guidance on sterilisation of bottles and teats and how to prepare any powdered formula safely and have access to facilities to carry this out, to reduce the risk of contamination. Liquid ready-to-feed formula may be needed if suitable preparation facilities are not available.

What is needed now?

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.