During emergencies, including natural disasters and armed conflict, breastfeeding is critically important. Breastfeeding provides reliable nutrition and protection against infectious diseases, without the need for clean water, feeding implements, electricity, or external supplies.
Key Information:
Protection, promotion, and support of breastfeeding should be an integral part of all emergency preparedness plans. Breastfeeding specialists should be part of plan development. Emergency protocols should include breastfeeding specialists among emergency relief personnel, provide culturally sensitive environments for breastfeeding, and prioritize caregivers of infants in food/water distribution. Emergency relief personnel should be aware that dehydration and missed feedings can impact milk production, but stress alone does not. Emergency support should focus on keeping mothers and infants together and providing private and/or protected spaces for mothers to breastfeed or express milk. Emergency support should also focus on rapidly identifying mothers with breastfeeding difficulties and breastfeeding mothers and infants who are separated, so their needs can be prioritized. Breastfeeding support should be available to all women experiencing difficulties, including those needing reassurance. Nonbreastfed infants should be identified as a priority group requiring support. Relactation, wet-nursing, and donor milk should be considered for nonbreastfed infants. No donations of commercial milk formula (CMF), feeding bottles or teats, or breast pumps should be accepted in emergencies. The distribution of CMF must be highly controlled, provided only when infants cannot be breastfed and accompanied by a comprehensive package of support.
Recommendations:
Protecting, promoting, and supporting breastfeeding should be included in all emergency preparedness planning and in training of personnel.
About ABM Position Statements:
The Academy of Breastfeeding Medicine empowers health professionals to provide safe, inclusive, patient-centered, and evidence-based care. Women and others who are pregnant and lactating identify with a broad spectrum of genders, pronouns, and terms for feeding and parenting. There are two reasons ABM’s use of gender-inclusive language may be transitional or inconsistent across protocols and position statements. First, gender-inclusive language is nuanced and evolving across languages, cultures, and countries. Second, foundational research has not adequately described the experiences of gender-diverse individuals. Therefore, ABM advocates for, and will strive to use, language that is as inclusive and accurate as possible within this framework.
VictoraCG, BahlR, BarrosAJ, et al.Breastfeeding in the 21st century: Epidemiology, mechanisms, and lifelong effect. Lancet, 2016; 387(10017):475–490.
2.
World Health Organization. Guiding principles for feeding infants and young children during emergencies. Geneva: World Health Organization; 2004.
3.
BruntonPJ, RussellJA, DouglasAJ. Adaptive responses of the maternal hypothalamic-pituitary-adrenal axis during pregnancy and lactation. J Neuroendocrinol, 2008; 20(6):764–776.
4.
Uvnäs MobergK. Oxytocin effects in mothers and infants during breastfeeding. Infant, 2013; 9:201–206.
5.
ModakA, RongheV, GomaseKP. The psychological benefits of breastfeeding: Fostering maternal well-being and child development. Cureus, 2023; 15(10):e46730.
6.
DeYoungSE, ChaseJ, BrancoMP, et al.The effect of mass evacuation on infant feeding: The case of the 2016 Fort McMurray wildfire. Matern Child Health J, 2018; 22(12):1826–1833.
7.
GribbleK, MarinelliKA, TomoriC, et al.Implications of the COVID-19 pandemic response for breastfeeding, maternal caregiving capacity and infant mental health. J Hum Lact, 2020:890334420949514.
8.
TasciB, Kuzlu AyyildizT. The calming effect of maternal breast milk odor on term infant: A randomized controlled trial. Breastfeed Med, 2020; 15(11):724–730.
9.
DoreaJG. Breastfeeding is an essential complement to vaccination. Acta Paediatr, 2009; 98(8):1244–1250.
10.
GribbleKD, McGrathM, MacLaineA, et al.Supporting breastfeeding in emergencies: Protecting women’s reproductive rights and maternal and infant health. Disasters, 2011; 35(4):720–738.
Intergovernmental Panel on Climate Change. Climate change 2022: Impacts, adaptation and vulnerabilities. Cambridge, UK; 2022.
13.
United Nations Children’s Fund (UNICEF). The climate-changed child: A children’s climate risk index supplement. New York: UNICEF; 2023.
14.
ØtsbyG, Aas RustadS, HelskogK. Children affected by armed conflict, 1990–2022. Oslo: Peace Research Institute Oslo (PRIO) and Save the Children; 2023.
15.
Feldman-WinterL, VanT, VaradiD, et al.Academy of Breastfeeding Medicine Position Statement: Breastfeeding as a basic human right. Breastfeed Med, 2022; 17(8):633–634.
16.
SriramanNK, EvansAE, LawrenceR, et al.Academy of Breastfeeding Medicine’s Board of Directors. Academy of Breastfeeding Medicine’s 2017 Position Statement on informal breast milk sharing for the term healthy infant. Breastfeed Med, 2018; 13(1):2–4.
17.
BartickM, Hernandez-AguilarMT, WightN, et al.ABM Clinical Protocol #35: Supporting breastfeeding during maternal or child hospitalization. Breastfeed Med, 2021; 16(9):664–674.
18.
ZimmermanD, BartickM, Feldman-WinterL, et al.Academy of Breastfeeding Medicine. ABM Clinical Protocol #37: Physiological infant care—Managing nighttime breastfeeding in young infants. Breastfeed Med, 2023; 18(3):159–168.
19.
Hoyt-AustinAE, KairLR, LarsonIA, et al.Academy of Breastfeeding Medicine. Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for birth hospitalization discharge of breastfeeding dyads, Revised 2022. Breastfeed Med, 2022; 17(3):197–206.
20.
VanguriS, Rogers-McQuadeH, SriramanNK, Academy of Breastfeeding Medicine. ABM Clinical Protocol #14: Breastfeeding-friendly physician’s office—Optimizing care for infants and children. Breastfeed Med, 2021; 16(3):175–184.
21.
World Health Organization/UNICEF. WHO/UNICEF Global Strategy for Infant and Young Child Feeding. Geneva: World Health Organization; 2003.
22.
Emergency Nutrition Network (ENN), IBFAN-GIFA, Fondation Terre des homes, et al.Infant feeding in emergencies, Module 2 Version 1.1 for health and nutrition workers in emergency situations. Oxford, UK: ENN; 2007.
23.
IFE Core Group. Infant and young child feeding in emergencies: Operational guidance for emergency relief staff and programme managers, version 3.0. Kidlington, UK: UNICEF; 2017.
24.
World Health Assembly. Sixty-third World Health Assembly WHA6323: Infant and young child nutrition. Geneva: World Health Organization; 2010.
Infant and Young Child Feeding in Emergencies (IFE) Core Group, Emergency Nutrition Network (ENN), ModigellI, Shaker BerbarkiL, McGrathM. Operational guidance: Breastfeeding counselling in emergencies. Kidlington, UK: ENN; 2021.
27.
SummersA, BilukhaOO. Suboptimal infant and young child feeding practices among internally displaced persons during conflict in eastern Ukraine. Public Health Nutr, 2018; 21(5):917–926.
28.
Amat CamachoN, CharaA, BriskinE, et al.Promoting and supporting breastfeeding in a protracted emergency setting—Caregivers’ and health workers’ perceptions from North-East Nigeria. Front Public Health, 2023; 11:1077068.
29.
GribbleK, HamrosiM, TawlaS. “Want to help the children? Help the parents”: Challenges and solutions from the Babies and Young Children in the Black Summer (BiBS) Study. Sydney: Australian Breastfeeding Association and Western Sydney University; 2023.
30.
UedaT, YokoyamaY, IraharaM, et al.Influence of psychological stress on suckling-induced pulsatile oxytocin release. Obstet Gynecol, 1994; 84(2):259–262.
31.
NagelEM, HowlandMA, PandoC, et al.Maternal psychological distress and lactation and breastfeeding outcomes: A narrative review. Clin Ther, 2022; 44(2):215–227.
32.
PereiraJ, VickersK, AtkinsonL, et al.Parenting stress mediates between maternal maltreatment history and maternal sensitivity in a community sample. Child Abuse Negl, 2012; 36(5):433–437.
33.
DörnemannJ, KellyAH. “It is me who eats, to nourish him”: A mixed-method study of breastfeeding in post-earthquake Haiti. Matern Child Nutr, 2013; 9(1):74–89.
34.
DozioE, Le RochK, BizouerneC. Baby-friendly spaces: An intervention for pregnant and lactating women and their infants in Cameroon. Intervention Journal, 2020; 18(1):78–84.
35.
Ratnayake MudiyanselageS, DavisD, KurzE, et al.Infant and young child feeding during natural disasters: A systematic integrative literature review. Women Birth, 2022; 35(6):524–531.
36.
HiraniSAA, RichterS, SalamiB, et al.Sociocultural factors affecting breastfeeding practices of mothers during natural disasters: A critical ethnography in rural Pakistan. Glob Qual Nurs Res, 2023; 10:23333936221148808.
37.
CallaghanWM, RasmussenSA, JamiesonDJ, et al.Health concerns of women and infants in times of natural disasters: Lessons learned from Hurricane Katrina. Matern Child Health J, 2007; 11(4):307–311.
HwangCH, IellamoA, VerversM. Barriers and challenges of infant feeding in disasters in middle- and high-income countries. Int Breastfeed J, 2021; 16(1):62.
40.
IellamoA, Misa WongC, BilukhaO, et al.“I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula”: A qualitative study on effects of the war on Ukrainian women’s infant feeding. Front Nutr, 2024; 11:1225940.
41.
GribbleKD, PalmquistAEL. “We make a mistake with shoes [that’s no problem] but … not with baby milk”: Facilitators of good and poor practice in distribution of infant formula in the 2014–2016 refugee crisis in Europe. Matern Child Nutr, 2022; 18(1):e13282.
42.
KentJC, PrimeDK, GarbinCP. Principles for maintaining or increasing breast milk production. J Obstet Gynecol Neonatal Nurs, 2012; 41(1):114–121.
43.
IFE Core Group. Planning and managing articial feeding interventions during emergencies. Kidlington, UK: ENN; 2021.
44.
World Health Organization. Relactation: Review of experience and recommendations for practice. Geneva: World Health Organization; 1998.
45.
BanapurmathCR, BanapurmathS, KesareeN. Successful induced non-puerperal lactation in surrogate mothers. Indian J Pediatr, 1993; 60(5):639–643.
46.
GribbleKD. The influence of context on the success of adoptive breastfeeding: Developing countries and the West. Breastfeed Rev, 2004; 12(1):5–13.
47.
Amat CamachoN, von SchreebJ, Della CorteF, et al.Interventions to support the re-establishment of breastfeeding and their application in humanitarian settings: A systematic review. Matern Child Nutr, 2023; 19(1):e13440.
48.
IFE Core Group. Infant Feeding in Emergencies (IFE) Module 2, Version 1.1 (2007), Additional information: Part 6 Relactation. Kidlington, UK; IFE Core Group; 2007.
49.
PhillipsV. Relactation in mothers of children over 12 months. J Trop Pediatr, 1993; 39(1):45–48.
50.
GribbleK. Formula feeding in emergencies. In: PreedyVr, WatsonRR, ZiibadiS., eds. Handbook of dietary and nutritional aspects of bottle feeding. Wageningen, The Netherlands: Wageningen Academic Publishers; 2014.
51.
SmithJP, IellamoA. Wet nursing and donor human milk sharing in emergencies and disasters: A review. Breastfeeding Rev, 2020; 28(3):7–23.
52.
AbdelrahmmanK, BorgB, MihrsrahiS, et al.Facilitators and barriers of wet nursing from antiquity to the present: A narrative review with implications for emergencies. Breastfeed Med, 2024; 19(3).
53.
ModigellI, Emergency Nutrition Network (ENN). Lessons learned from initiating infant and young child feeding in emergencies programming for the Ukrainian response. Kidlington, UK: ENN; 2023.
54.
GribbleKD. Media messages and the needs of infants and young children after Cyclone Nargis and the WenChuan earthquake. Disasters, 2013; 37(1):80–100.
55.
Camiling-AlfonsoR, CapiliDIS, ReyesKAV, et al.Contributing to the Infant and Young Child Feeding in Emergencies (IYCF-E) response in the Philippines: A local NGO perspective. Field Exchange, 2015; 96. Available fromwww.ennonline.net/fex/50/iycfphilippines
56.
AlHreasyFA. Non-maternal nursing in the Muslim community: A health perspective review. J. Clinical Neonatology, 2018; 7(4):191–197.
57.
World Health Organization. WHO guideline for complementary feeding of infants and young children 6–23 months of age. Geneva: World Health Organization; 2023.
58.
MowlZK, LeFevreA, VerversM. A comparison of total cost estimates between exclusive breast-feeding and breast milk substitute usage in humanitarian contexts. Public Health Nutr, 2023; 26(12):3162–3172.
59.
HipgraveDB, AssefaF, WinotoA, et al.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 Nutr, 2012; 15(2):307–315.
60.
ArveloW, KimA, CreekT, et al.Case-control study to determine risk factors for diarrhea among children during a large outbreak in a country with a high prevalence of HIV infection. Int J Infect Dis, 2010; 14(11):e1002-1007–e1007.
61.
CreekTL, KimA, LuL, et al.Hospitalization and mortality among primarily nonbreastfed children during a large outbreak of diarrhea and malnutrition in Botswana, 2006. J Acquir Immune Defic Syndr, 2010; 53(1):14–19.
62.
World Health Organization. International Code of Marketing of Breast-Milk Substitutes. Geneva: World Health Organization; 1981.
United Nations Children’s Fund (UNICEF). Procurement and use of breastmilk substitutes in humanitarian settings version 2.0. New York: United Nations Childrens Fund; 2021.
65.
GribbleK, FernandesC. Considerations regarding the use of infant formula products in Infant and Young Child Feeding in Emergencies (ICYF-E). WN, 2018; 9(3):261–283.
66.
World Health Organization, Food and Agriculture Organization of the United Nations. Safe preparation, storage, and handling of powdered infant formula: Guidelines. Geneva: World Health Organization; 2007.
67.
IFE Core Group. Infant feeding in emergencies: Module 2 version 1.1. Kidlington, UK: IFE Core Group; 2007.
68.
Nurul FadjriahR, Ummu SalamahA, JafarN, et al.Practice of exclusive breastfeeding at evacuation site post-earthquake in Palu City, Indonesia. Medico-Legal Update, 2020; 20(2).
69.
SulaimanZ, MohamadN, IsmailTA, et al.Infant feeding concerns in times of natural disaster: Lessons learned from the 2014 flood in Kelantan, Malaysia. Asia Pac J Clin Nutr, 2016; 25(3):625–630.
70.
MirMohamadaliIeM, Khani JazaniR, SohrabizadehS, et al.Barriers to breastfeeding in disasters in the context of Iran. Prehosp Disaster Med, 2019; 34(1):20–24.
71.
BinnsCW, LeeMK, TangL, et al.Ethical issues in infant feeding after disasters. Asia Pac J Public Health, 2012; 24(4):672–680.
72.
HiraniSAA, RichterS, SalamiBO, et al.Breastfeeding in disaster relief camps: An integrative review of literature. ANS Adv Nurs Sci, 2019; 42(2):E1–E12.
73.
World Health Organization. Scope and impact of digital marketing strategies for promoting breast milk substitutes. Geneva: World Health Organization; 2022. Licence: CC BY-NC-SA 3.0 IGO.
74.
RollinsN, PiwozE, BakerP, et al.Marketing of commercial milk formula: A system to capture parents, communities, science, and policy. Lancet, 2023; 401(10375):486–502.
75.
World Health Organization, United Nations Children’s Fund (UNICEF). How the marketing of formula milk influences our decisions on infant feeding. Geneva: World Health Organization and the United Nations Childrens Fund; 2022. Licence: CC BY-NC-SA 3.0 IGO.
76.
BartleC. Infant feeding in emergencies: Reflections on the Christchurch earthquake. Midwifery News, 2011(61):31–32.
77.
TheurichMA, HumphreysAL, GosselinLB, et al.Food safety considerations for commercial complementary foods from global operational guidance on infant and young child feeding in emergencies. Nutr Rev, 2019; 77(5):350–362.
78.
IFE Core Group. Preventing and managing inappropriate donations: Breastmilk substitutes and other prohibited products—A guide for emergency relief staff, donors, and governments. Kidlington, UK: Emergency Nutrition Network (ENN); 2021.
79.
TarrantM, LokKY, FongDY, et al.Effect on baby-friendly hospital steps when hospitals implement a policy to pay for infant formula. J Hum Lact May 2016; 32(2):238–249.
80.
PalmquistA, GribbleK. Gender, displacement, and infant and young child feeding in emergencies. In: RileyN, BrunsonJ., eds. International handbook of gender and demographic processes. Thousand Oaks, CA: Sage; 2017.
World Health Organization. Guidance on ending the inappropriate promotion of foods for infants and young children: Implementation manual. Geneva: World Health Organization; 2017.
83.
BilginDD, KarabayirN. Infant and young child feeding in emergencies: A narrative review. Turk Arch Pediatr, 2024; 59(2):135–143.
84.
Editorial Staff. Mothers and babies benefit from a place of their own: Two success stories. BFHI News: The Baby-Friendly Hospital Initiative Newsletter. Sept/Oct 1999.
85.
Action Contre la Faim. Baby friendly spaces—Holistic approach for pregnant, lactating women and their very young children in emergency. Paris: Action Contre la Faim; 2014.
86.
Hargest-SladeAC, GribbleKD. Shaken but not broken: Supporting breastfeeding women after the 2011 Christchurch New Zealand earthquake. Breastfeed Rev, 2015; 23(3):7–13.
87.
AbeSK, BalogunOO, OtaE, et al.Supplementation with multiple micronutrients for breastfeeding women for improving outcomes for the mother and baby. Cochrane Database Syst Rev, 2016; 2(2):CD010647.
88.
BalogunOO, O’SullivanEJ, McFaddenA, et al.Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev, 2016; 11(11):CD001688.
World Health Organization. Guideline: Protecting, promoting, and supporting breastfeeding in facilities: Providing maternity and newborn services. Geneva: World Health Organization; 2017.
91.
NelanMM, PentaS, WachtendorfT. Avoiding the “Second Disaster” of unwanted donations. International J of Mass Emergencies and Disasters, 2022; 40(3):223–225.
92.
MoossaviS, SepehriS, RobertsonB, et al.Composition and variation of the human milk microbiota are influenced by maternal and early-life factors. Cell Host Microbe, 2019; 25(2):324–335.e324.
93.
GribbleK, PetersonM, BrownD. Emergency preparedness for Infant and Young Child Feeding in Emergencies (IYCF-E): An Australian audit of emergency plans and guidance. BMC Public Health, 2019; 19(1):1278.
94.
Zakarija-GrkovićI, CattaneoA, BettinelliME, et al.Are our babies off to a healthy start? The state of implementation of the Global Strategy for Infant and Young Child Feeding in Europe. Int Breastfeed J, 2020; 15(1):51.
95.
GuptaA, NalubangaB, TrejosM, et al.Making a difference: An evaluation report of the World Breastfeeding Trends Initiative (WBTi) in moblising national actions on IYCF. Delhi: WBTi Global Secreiariat, BNPI; 2020.
96.
PrudhonC, BenelliP, MaclaineA, et al.Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries. Matern Child Nutr, 2018; 14(1).
97.
BeyeneT, ZoskyGR, GibsonPG, et al.The impact of the 2019/2020 Australian landscape fires on infant feeding and contaminants in breast milk in women with asthma. Int Breastfeed J, 2023; 18(1):13.
98.
BenginHG, ScherbaumV, HormannE, et al.Breastfeeding after earthquakes. Birth, 2010; 37(3):264–265.
99.
RabbaniA, PadhaniZA, FAS, et al.Systematic review of infant and young child feeding practices in conflict areas: What the evidence advocates. BMJ Open, 2020; 10(9):e036757.
100.
IFE Core Group Sub-Working Group on IYCF-E in the Context of Chemical Biological, Radiological, and Nuclear Threats. Guidance note: Infant and young child feeding in the first three days after nuclear power plant accident. Kidlington, UK: UNICEF and Irish Aid; 2023.
HaiekLN, LeDrewM, CharetteC, et al.Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic. Matern Child Nutr, 2021; 17(2):e13129.
106.
GribbleK, MathisenR, VerversMT, et al.Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care. Int Breastfeed J, 2020; 15(1):67.
107.
RollinsN, MinckasN, JehanF, et al.A public health approach for deciding policy on infant feeding and mother–infant contact in the context of COVID-19. Lancet Glob Health, 2021; 9(4):e552–e557.
108.
GribbleK, CashinJ, MarinelliK, et al.First do no harm overlooked: Analysis of COVID-19 clinical guidance for maternal and newborn care from 101 countries shows breastfeeding widely undermined. Front Nutr, 2022; 9:1049610.
109.
PartC, FilippiV, CresswellJA, et al.How do high ambient temperatures affect infant feeding practices? A prospective cohort study of postpartum women in Bobo-Dioulasso, Burkina Faso. BMJ Open, 2022; 12(10):e061297.
110.
United Nations Children’s Fund (UNICEF). Protecting children from heat stress: A technical note. New York: UNICEF; 2023.
111.
CerceoE, SaxerK, GrossmanL, et al.The climate crisis and breastfeeding: Opportunities for resilience. J Hum Lact, 2024; 40(1):33–50.
112.
IFE Core Group Sub-Working Group on IYCF-E in the Context of Chemical Biological Radiological and Nuclear Threats. Chemical, biological, radiological, and nuclear threats in wartime situation: The impact on breastfeeding safety and infant/young child feeding practices. Kidlington, UK: UNICEF; 2023.
