A Cry for Infant Feeding Support in Humanitarian Response Efforts

For decades, infant formula has been perceived as the easiest way for mothers to support their infants during times of crisis and emergency. But that’s far from reality. Every mother’s situation is different, and her needs and the needs of her infant can be nuanced and complex.

The war in Ukraine and other conflicts and emergencies have led to the deterioration of breastfeeding and nutrition practices, resulting in lasting health impacts.

More than 247,000 babies were born to women living in Ukraine in the first nine months after Russia invaded the country, according to Save the Children. And children are bearing the brunt of the war, losing parents, experiencing displacement, missing school, being injured—the list goes on. What is underreported or absent from coverage is the real need for nutrition support for mothers, their infants, and young children.

The span of a thousand days, from pregnancy to a child’s second birthday, lays the cornerstone for the years ahead. How well or poorly mothers and children are nourished and cared for during this critical period profoundly impacts a child’s ability to grow, learn, and thrive. Within these initial thousand days, the groundwork for a child’s lifelong well-being is established.

Because research on breastfeeding in conflict zones is scarce, in September 2022, FHI 360 staff sought to better understand the health and nutrition needs of mothers and infants by interviewing 75 mothers and 12 lactation consultants, both in Ukraine and in relocation centers for displaced Ukrainians in Poland, about their experiences related to infant feeding. About one-third of the mothers said they had received no infant feeding support in Ukraine or Poland.

“Such support [is] sorely lacking,” one refugee said. “All pregnant Ukrainian women found themselves in a situation where they had to give birth not where they had planned. Not with relatives, but in a foreign country, left alone. Either you can help yourself, or you can’t. And in such a state, realizing you are a refugee, it was very difficult that we did not receive that support and correct consultation or advice, which were very necessary.”

Nearly 70% of the women interviewed said the war directly affected their child-feeding practices. While they may have wanted to breastfeed or even started to do so, they could not find lactation support. Their fears and stress affected their milk supply, and without the right support, they stopped breastfeeding. As a result, the use of infant formula increased. And given the unstable conditions, these mothers do not have reliable supplies or ways to keep bottles clean.

The use of infant formula is critical in times of fragility, such as in Ukraine; however, various factors — including cost, availability and safe preparation — make relying on formula donations a fraught way of sustaining infant health. Some mothers were also concerned about the quality of food they receive for their infants, but they have been unable to find or afford anything else.

Lactation consultants and displacement center staff said they received an overwhelming supply of formula, which was distributed even to women who did not want or need it. In addition, clean water was not always available to prepare formula or to wash and sanitize bottles, and the brands of formula that were provided frequently changed.

And there is another critical factor: Giving precedence to formula overlooks the valuable role of breastfeeding and breast milk.

Globally endorsed evidence describes the vast and long-lasting positive effects of breastfeeding on children, their mothers, economies, and the environment. Breastfeeding provides infants with complete nutrition — no additional food or water is needed in the first six months.

Armed with anecdotal evidence and firsthand interviews, we feel confident in saying the Ukraine war has only exacerbated the vulnerability that women and their infants experience — and that the humanitarian response is not adequately filling the gaps.

As repercussions of the war continue to be felt, FHI 360 is calling on the humanitarian system — which includes donors, the United Nations, international and national agencies, government agencies engaged in the response, and civil society — to close the gaps in infant feeding support and to protect the health of women and their children by providing lactation support and ensuring access to safe and a nutritionally adequate diet for children ages 6 to 23 months.

If the humanitarian system addresses infant feeding issues and promotes safe child-feeding practices, we will minimize the lifelong effects of displacement and war — not just in Ukraine but in all rapid-onset emergencies.

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Alessandro Iellamo is the senior emergency nutrition adviser for FHI 360 supporting and a maternal, infant and young child nutrition specialist. He has extensive expertise in nutrition and infant and young child feeding policies and practices, particularly in emergencies, the WHO International Code, BFHI, the Operational Guidance for Infant and Young Child Feeding in Emergencies and other global tools.

Nadra Franklin, PhD, MPH serves as the managing director of FHI Solutions. Franklin has more than 30 years of international development experience and has worked at FHI 360 since 1999. Prior to joining FHI 360, Franklin led the U.S. Agency for International Development’s global Micronutrient and Child Blindness Project and was acting director of the Center for Nutrition.