Breastfeeding is the first and best feeding option for infants

UNICEF and WHO recommend exclusive breastfeeding for the first 6 months of life followed by continued breastfeeding with adequate complementary foods for up to 2 years and beyond. Exclusive breastfeeding means no fluids other than breastmilk.

Other feeding options may be appropriate in certain circumstances: orphans, severely malnourished mothers, mothers choosing not to breastfeed, or temporarily not breastfeeding. These are:

• Expressed Breastmilk
• Wet-nursing*
• Generically packaged infant formula**
• Locally purchased branded formula**
• Stop gap home-made recipes

* The practice of wet-nursing may be unacceptable or inappropriate in situations of high HIV prevalence where testing, support, and counselling are not available

** Supplies of infant formula should preferably be generically labelled (without a brand name) in order to prevent the promotion of a particular brand. Instructions on the labels must be in languages which can be read by both the emergency field workers and the emergency affected population, in order to avoid confusion and mistakes in distribution and use.

For more information: Infant Feeding in Emergencies: Policy, Strategy and Practice. Report of the Ad Hoc Group on Infant Feeding in Emergencies, 1999. Available on-line http://www.ennonline.net and from Baby Milk Action's Virtual Shop.

 CODE COMPLIANCE, ALSO IN EMERGENCIES

To minimise the risks of artificial feeding and avoid commercial exploitation of crises, it is vital to implement the International Code of Marketing of Breast-milk Substitutes and relevant WHA Resolutions.

Recommended procedures:

• Donations of breastmilk substitutes, bottles, teats and commercial baby foods should be refused.

• If needed, breastmilk substitutes should be purchased by the organisations responsible for the nutrition programmes, based on a careful analysis and assessment of the situation at hand, and only after approval and together with the appointed emergency health/nutrition coordinating body and the most senior health/nutrition advisor at headquarter level.

• Purchased breastmilk substitutes should preferably be generically labelled (contact the local UNICEF office about obtaining of generically labelled formula).

• If breastmilk substitutes are distributed, their distribution and use should be carefully monitored and infant health followed up by trained health staff. Distribution should only be to infants with a clearly identified need, and for as long as the infants need them (until maximum 1 year age or until breastfeeding is re-established).

• Breastmilk substitutes should NEVER be part of a general distribution.

• Products should be labelled in accordance with the Code using correct language, instructions and messages, should comply with the standards Codex Alimentarius, and have a shelf life of at least one year from the date of distribution.

• Bottles and teats should NEVER be distributed, and their use should be discouraged. CUP FEEDING should be encouraged instead.

Summary of some key relevant WHA resolutions Resolution 1986 urges member states to: "ensure that the small amounts of breastmilk substitutes needed for the minority of infants who require them in maternity wards and hospitals are made available through the normal procurement channels and not through free or subsidised supplies." Emergencies: Resolution 1994: "In emergency relief operations, breastfeeding for infants should be protected, promoted and supported. Any donated supplies of breastmilk substitutes, or other products covered by the scope of the Code, may be given only under strict conditions: if the infant has to be fed with breastmilk substitutes, the supply is continued for as long as the infant concerned needs it, and the supply is not used as a sales inducement." Resolution 1996: "Member states are urged to ensure that complementary foods are not marketed for or used in ways that undermine exclusive and sustained breastfeeding."