BREASTFEEDINGCOUNSELLINGIN EMERGENCIESThis is a call to action for policy makers and other decision makers, donors,
humanitarian responders, community leaders and emergency-affected communities
to ensure that breastfeeding counselling is provided during emergencies, as isrequired by international standards of care.
Key message: Exclusive and continued breastfeeding is the single most effective intervention
for preventing deaths in children under five years.
Crises lead to disruptions. Emergencies (such as floods and conflict) are increasing in frequency
and severity. Access to food, shelter, safe water, sanitation, medical care and access to other basic
necessities required to keep children safe and nourished are commonly disrupted. Infants and young
children are particularly vulnerable; the younger the child, the more vulnerable they are.
Breastfeeding saves lives in emergenciesi. When systems are disrupted, breastfeeding continues tooffer nutrition security, hydration, comfort, connection, and protects babies from infectious disease.
Diarrhoea and respiratory tract infections are two of the most common causes of preventable deathsin emergencies. Estimates indicate that half of all cases of diarrhoea and one third of respiratory
tract infections could be avoided if all children were breastfedii . The lifesaving protection offered bybreastfeeding is strongest if children are fed as recommended by WHO and UNICEF. This includes
initiating breastfeeding within one hour of birth, breastfeeding exclusively (giving nothing else butbreastmilk, not even water) for the first six months of life and continuing to breastfeed up to twoyears and beyond.
Babies who are NOT breastfed are at the greatest risk of illness, malnutrition and death. The risks
to a child’s ability to survive and thrive are amplified in emergencies. Poor access to healthcare meansan otherwise treatable infection can become lethal. Babies who are fed infant formula are dependent
on safe water, a heat source, and a securesupply-chain for an expensive product that
It is estimated that improving breastfeeding
often cannot be hygienically prepared inpractices would save 820,000 children’s lives
an emergency setting. Emergencies renderthese babies highly vulnerable. They require each year and prevent an additional 20,000
urgent protection and intensive support.
maternal deaths from breast cancer globally iii .

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A CALL TO ACTION BREASTFEEDING COUNSELLING IN EMERGENCIESIMAGE: SAVE THE CHILDREN/EMNET DEREJEA CALL TO ACTION

Protecting and supporting breastfeeding is upholding the rights of women and childreniv. Yet justwhen it is needed the most, good breastfeeding practices are often eroded and undermined. Poorly
trained responders often damage a mother’s confidence by promoting misinformation or myths aboutbreastfeeding during emergencies. Dangerous donations of breastmilk substitutes (BMS) and other
Codev violations put both breastfed and non-breastfed children’s lives at risk. The support required tobreastfeed under difficult circumstances is often lacking. With appropriate support, almost all women
can breastfeed their babies. Stressed mothers can breastfeed. Milk supply (lactational capacity/output)
is unaffected by all but the most severe forms of malnutrition. However, women who breastfeed areoften concerned about the quantity and quality of their breastmilk. These concerns can be amplified
during emergencies. Breastfeeding mothers need urgent reassurance and skilled support to continue
to nurture, nourish, and protect their babies. Breastfeeding counselling is therefore listed as a priority
action in the Sphere Humanitarian Charter and Minimum Standards in Disaster Response.
Key message: Skilled breastfeeding counselling is a low cost, effective public health interventionvi andan imperative component of the package of interventions required to protect and support breastfeeding.

Effective counselling supports women to overcome challenges and to breastfeed successfully inemergencies. Compassionate and knowledgeable support from skilled breastfeeding counsellors playsa critical role in maintaining mothers’ confidence and wellbeing, solving breastfeeding difficulties
and strengthening caregiver-child attachment. A meta-analysis of individual counselling or group
education, immediate breastfeeding support at birth, and appropriate lactation management showedthat these interventions increased exclusive breastfeeding by 49% and any breastfeeding by 66%vii .
Counselling can support mothers to successfully initiate breastfeeding as recommended,even in emergencies.

EXAMPLEIn the Philippines, the roll out of an Essential Intrapartum and Newborn Care (EINC) training
package in the aftermath of Typhoon Haiyan resulted in an increase in rates of early initiation ofbreastfeeding from 50% to 86% at three months post trainingix .
Counselling can mitigate against the impact of dangerous donations during emergencies.

EXAMPLEIn Yogyakarta and Central Java, following the earthquake in 2006, women who received
counselling on breastfeeding were more likely to continue breastfeeding despite receiving
BMS donationsx, xi .
Counselling facilitates access to breastmilk for non-breastfed babies and can reduce the risks babies
who are dependent on infant formula face in emergencies. It is imperative that those involved with
infant feeding support in an emergency rapidly explore safer feeding alternatives for BMS-dependentbabies in accordance with global guidance and standards and informed by cultural context andindividual circumstances. The options in order of priority arexii:
1. restarting breastfeeding (relactation)
2. donor human milk (ideally temporarily while breastfeeding is re-established)
3. facilitating breastfeeding by a woman other than the child’s biological mother (ideally temporarilyuntil breastfeeding is re-established)
4. supporting safer breastmilk substitute feeding as part of a comprehensive package of support(ideally temporarily until a safer option can be secured)Counselling plays a vital role in making safer alternatives available to these highly vulnerable children.

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A CALL TO ACTION BREASTFEEDING COUNSELLING IN EMERGENCIESDespite the perceived difficulty of establishing breastfeeding counselling services in emergencies,
experiences have shown that it is possible to establish or to re-establish breastfeeding counsellingand improve breastfeeding practices, even in the midst of a crisis.

EXAMPLEIn Haiti, following the devastating earthquake in 2010, baby tents where mothers could
breastfeed comfortably and be supported by trained counsellors and their peers wereestablished and rapidly scaled up. Appropriate breastfeeding practices remained undisrupted.
Of the 30% of younger babies who were reportedly fed breastmilk plus other foods or liquids
at the time of the earthquake, 10% moved to exclusive breastfeedingviii .

CALL TO ACTION
Women are 2.5 times more likely to breastfeed when breastfeeding is protected, promoted,
and supportedxiii . Families, communities, health workers, aid workers, policy makers and otherdecision makers have a collective responsibility to protect, promote and support breastfeeding
to strengthen the growth and future trajectory of the next generation.
We call on decision-makers to:Invest resources in routine programmes to improve breastfeeding as a crucial component ofemergency preparedness. Strengthen breastfeeding practices in non-emergency times to lowerbabies’ vulnerability during emergencies and to foster individual-, family-, and communityresilience to emergencies. Foster positive social norms towards breastfeeding. Improveaccess to skilled breastfeeding counsellingxiv. Ensure BMS industry regulations are upheldxv.
Demonstrate political will to protect and support breastfeeding to save both lives and money.

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34I nclude adequate provisions for breastfeeding counselling in emergency preparedness plansand policies. In order to reach the global target of increasing exclusive breastfeeding rates toat least 50% by 2025 and achieve Sustainable Development Goals related to nutrition, childhealth, maternal health, and education by 2030, breastfeeding counselling must be supported
from the onset of an emergency as outlined in the Operational Guidance: How to implement
WHO’s breastfeeding counselling guidelines in humanitarian settingsxvi . Provisions for various
scenarios, including public health emergencies, must include adequate funding as well asadequate organisational and human resources.
 nsure that breastfeeding counselling is a component of the minimum package ofE
humanitarian health and nutrition services. A package of breastfeeding protection, promotion,and support interventions, policies and programmes that include breastfeeding counselling andwhich are designed to support mothers at household, community, and facility level will have thegreatest impact. This package should prioritise the most vulnerable, including babies, mothers
and other caregivers in need of immediate support and those at increased risk of developing
breastfeeding difficulties or engaging in inappropriate practices.
I dentify and document breastfeeding counselling interventions in emergencies to trackprogress, learn, and inform scale up in emergency settings.

This brief was developed by the IFE Core Group, led by the Emergency Nutrition Network (ENN) on behalf ofthe World Health Organisation to complement the following guidance: ENN, IFE Core Group, 2021. OperationalGuidance: Breastfeeding Counselling In Emergencies. For complementary advocacy materials, refer to the Global
Breastfeeding Collective Advocacy Toolkit.

Development of this brief was supported by funding to ENN from WHO and Irish Aid. August 2021.

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A CALL TO ACTION BREASTFEEDING COUNSELLING IN EMERGENCIES

Referencesi	UNICEF and WHO (2017). Global Breastfeeding Collective.
Breastfeeding in Emergency Situations.

ii

 ictora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton,V
S., Krasevec, J., ... & Group, T. L. B. S. (2016). Breastfeedingin the 21st century: epidemiology, mechanisms, and lifelong
effect. The Lancet, 387(10017), 475-490.

iii

 ictora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton,V
S., Krasevec, J., ... & Group, T. L. B. S. (2016). Breastfeedingin the 21st century: epidemiology, mechanisms, and lifelong
effect. The Lancet, 387(10017), 475-490.

iv

 ribble K.D., McGrath M., MacLaine A. & Lhotska L. (2011).
GSupporting breastfeeding in emergencies: protecting
women's reproductive rights and maternal and infant health.
Disasters 35, 720-738.

v

 orld Health Organisation (1981). International Code ofW
Marketing of Breastmilk Substitutes and subsequent relevant
World Health Assembly resolutions (the Code)vi

 cFadden, A., Siebelt, L., Marshall, J.L. et al. CounsellingM
interventions to enable women to initiate and continue
breastfeeding: a systematic review and meta-analysis. IntBreastfeed J 14, 42 (2019).

vii

 ollins NC, Bhandari N, Hajeebhoy N, et al. Why invest, andR
what it will take to improve breastfeeding practices?. Lancet.
2016;387(10017):491-504.

viii

 yoya MA, Golden K, Ngnie-Teta I, et al. Protecting andA
improving breastfeeding practices during a major emergency:
lessons learnt from the baby tents in Haiti. Bull World HealthOrgan. 2013;91(8):612‐617.

ix

 astillo, M. S., Corsino, M. A., Calibo, A. P., Zeck, W., Capili, D.
CS., Andrade, L. C., . . . Silvestre, M. A. (2016). Turning disaster
into an opportunity for quality improvement in essential
intrapartum and newborn care services in the Philippines: Pre
to post training assessments. BioMed Research International,
2016, 1–9.

x ipgrave, D. B., Assefa, F., Winoto, A., & Sukotjo, S. (2012).
H
Donated breast milk substitutes and incidence of diarrhoea
among infants and young children after the May 2006
earthquake in Yogyakarta and Central Java. Public Health
Nutrition, 15(2), 307-315.

xi

 ssefa, F., Sukotjo, S., Winoto, A., & Hipgrave, D. (2008).
A
Increased diarrhea following infant formula distribution
in 2006 earthquake response in Indonesia: evidence andactions. Field Exchange 34, 29.

xii

I FE Core Group (2017). Infant and Young Child Feeding inEmergencies: Operational Guidance for Emergency Relief
Staff and Programme Managers. Version 3.

xiii

 ictora, C. G., Bahl, R., Barros, A. J., França, G. V., Horton,VS., Krasevec, J., ... & Group, T. L. B. S. (2016). Breastfeedingin the 21st century: epidemiology, mechanisms, and lifelong
effect. The Lancet, 387(10017), 475-490.

xiv

 NICEF and WHO (2019). Global Breastfeeding Collective.
UImproving Access to Skilled Breastfeeding Counselling.

xv

 orld Health Organisation (1981) International Code ofW
Marketing of Breastmilk Substitutes and subsequent relevant
World Health Assembly resolutions (the Code)xvi

 NN, IFE Core Group (2021). Operational Guidance:
E
Breastfeeding Counselling In Emergencies.

ENN
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Kidlington, Oxfordshire, OX5 2DN
Tel: +44 (0)1865 372340 | office@ennonline.net | www.ennonline.net

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A CALL TO ACTION BREASTFEEDING COUNSELLING IN EMERGENCIES