According to PAGASA, the Philippines is visited by an average of 20 typhoons yearly. These typhoons bring about massive flooding that often leads to the displacement of hundreds of thousands, if not millions of Filipinos. Evacuation centers are soon crowded with people – many of them infants and young children. Calls are made for relief goods, and every other person who is safe and dry does his/her part to help. That is the Filipino spirit of bayanihan, after all.
Almost every call for donations will include a request for infant formula or powdered milk. Before I learned anything about infant feeding in emergencies, I thought that was only natural – there are numerous babies out there after all and they need to eat. Just like well-intentioned doctors, health care workers, relief work volunteers, I was upset by the notion that people would ban formula donations. Do we just allow babies to starve then?
Now that the country is in the midst of heavy rains and significant flooding, we are again inundated by calls for relief goods including infant formula. And again there are reminders that infant formula donations are banned by law. Before we go up in arms, let me explain why this is so.
INFANT FORMULA CAUSES MORE HARM THAN GOOD IN EMERGENCIES
Safely feeding an infant with formula requires 1) access to a constant supply of formula 2) access to clean water 3) access to heating implements (proper preparation of formula requires heating of water to a certain temperature) 4) ability to clean feeding implements.
As we know, evacuation centers are often crowded and have very limited water supply. Any available water is likely to be contaminated. Using this water to mix formula leads to diarrhea which in situations like this, often leads to death.
When infant formula is included in every relief pack given out, it is made available even to mothers who are successfully breastfeeding. Why is this a problem? Mothers who are breastfeeding and displaced due to an emergency are often made to believe that the ‘stress’ from the emergency affects their ability to breastfeed; that their breast milk becomes insufficient and inadequate. They then end up giving formula to their healthy breastfed child. The truth is that breastfeeding is especially protective in disaster situations. A mother’s breast milk will contain the same amount of calories, with the right proportion of protein and fat, regardless of the mother’s nutritional status. With breastfeeding there is no need to provide water, so exposure to deadly bacteria and contaminants is avoided.
How about the mothers who are mix-feeding or those who are formula feeding? How will their babies survive without access to formula? The safest approach for mothers who are breastfeeding to any degree is to support them so they return to breastfeeding exclusively. Mothers who have just recently weaned can be taught to relactate. Wet-nursing (having other breastfeeding mothers feed babies that are not their own) is another alternative to be considered. Some (very few) babies will need access to formula, and it is important that formula administration is supervised to ensure it is being done properly. The Philippine government has an established Infant and Young Child Feeding Protocol for identifying those infants that are formula-dependent and monitoring their feedings. The government is responsible for acquiring the needed formula and has the proper channels for doing so. It is important that formula be administered only to those who absolutely need it, and only under correct supervision, because unsupervised formula feeding often leads to diarrhea, which is the largest cause of death in these situations.
How about powdered milk for older children? Can we distribute that? Distributing any type of milk powder to the general public is not a good idea. Why? Because mothers will use this as infant formula, which is bad because 1) it isn’t suited for consumption by children younger than 1 and 2) it again exposes the infant to illness from contaminated water.
After the massive flooding from Typhoon Ondoy, LATCH in cooperation with other breastfeeding support organizations partnered with UNICEF to perform relief/support missions in evacuation centers. We visited various centers all over the metro and at each center, gathered the mothers together to find out how they were feeding their babies. Many mothers were breastfeeding exclusively, and the majority of mothers were breastfeeding to some degree. We asked the mothers who were using infant formula where they would get the water to mix it from. The answer? ‘We try to buy bottled water but we can only get a little at a time. So we use the rain water from the gutters. But people also use that for bathing and washing things, so if that runs out, we take water from the portalets.‘ Asked how they clean their bottles and you can guess the answer – in the gutters and using water from portable toilets. So though well-intentioned donors provide infant formula with the intent of helping, the fact is that this practice doesn’t help at all and only endangers infants all the more.
We also joined UNICEF in the call for breast milk donations. Donor milk was brought to PGH for pasteurization and then taken with us to be given to babies who were not being breastfed and had no access to breast milk. To our pleasant surprise, because the majority of mothers were breastfeeding, very few babies needed milk. We were able to leave enough for the babies who were previously formula-dependent, and those whose mothers needed assistance with relactation.
HOW CAN THE PUBLIC HELP?
Breastfeeding mothers are able to provide adequate nutrition to their babies, even when they themselves are undernourished. But this is at the expense of their own body’s needs (the body is designed to meet the infant’s needs first). We can help support and protect babies by first feeding their mothers. Provide hot meals and calorie-dense foods so that mothers have a good source of nutrition. Prioritize breastfeeding mothers in the distribution of goods. Do not include infant formula or powdered milk in relief goods. If you are able, provide breastfeeding education and support to nursing mothers so they can continue to breastfeed during this challenging time.
For more detailed information, here is a guide to Infant and Young Child Feeding in Emergencies, as well as a Guide for The Public, both published by the Emergency Nutrition Network.