?Some years ago, I was involved in an attempt to stop a group of well-intentioned women from donating formula milk to Laventille, so that "the poor children could have something to eat."
Nothing I said or did could change their minds and the formula duly arrived in the Laventille Health Centre where it contributed to that year's outbreak of gastro. A side-effect of this move would have been a decline in the number of children being breastfed, something that is seen, to the delight of those with money invested in formula companies, whenever formula is introduced into a culture as an emergency short-term measure. Until about five years ago, it used to be mandatory for NGOs sending supplies to disaster areas to beg, in the first instance, for formula. Paediatricians have long known that this is a recipe for further disaster but it has taken many years and deaths for this lesson to be learned by official and non-official organisations. It has still to be recognised in civil society but the recent earthquake disaster in Haiti has brought the problem into focus in the Americas. Unicef, WHO and the World Food Programme have just made an official statement that donations of formula to Haiti are not appropriate.
Breastfeeding is the norm in Haiti and Unicef data shows that 87 per cent of babies are breastfeeding at ages six-nine months and 35 per cent are breastfeeding at ages 20-23 months. This is why their infant and child mortality rates are not worse. It might be of interest for us to reflect on the strength of Haitian women who in the midst of poverty and hardship, the like we have not seen in this country for years, are able to maintain this relationship with their children and do it while working full-time. Special concerns in countries like Haiti (even without an emergency of this magnitude) include lack of transportation, vulnerability to storms and flooding/mudslides, rough terrain that makes travel difficult, and lack of resources like electricity and clean water. In an emergency, these issues are compounded.�After a disaster, when long-term recovery is underway, the worst thing to have to deal with is a breastfeeding culture that suddenly became a formula-feeding society. The repercussions on mortality and morbidity could take generations to overcome.
Breastfeeding is an infant's first line of defence in any situation and more so in a disaster. For the many orphaned, injured, and ill babies in Haiti, direct breastfeeding is the only feasible option. Mothers therefore need support and encouragement to breastfeed their babies to the point that if a mother has ceased breastfeeding, it is critical to offer her the opportunity to restart or "relactate." Feed the mother to feed the baby is the new cry. Breastfeeding is so important that even if a child is motherless or separated from his mother, other mothers can be asked to step in to share their milk by breastfeeding the baby. Breastfeeding saves lives by being the perfect food with anti-infective properties to protect a baby from the germs that cause diarrhoea, pneumonia, and other diseases that are rampant in a contaminated environment. It also delivers perfect nutrition when food sources are scarce, including water. It is the perfect delivery system, always available, always clean, it constantly replaces itself, provides warmth, is loving, and allows for the important skin contact that lowers stress levels for both the baby and the mother. There are a number of problems with using formula in a disaster but, above all, it increases the infant death rate. In the 2004 tsunami in Indonesia, a breastfeeding culture, 72 per cent of families were given formula which resulted in an outbreak of diarrhoea and deaths among the formula-fed infants.
Even in the best, most hygienic conditions, artificially-fed babies are five times more likely to suffer diarrhoeal diseases. In unsanitary, crowded conditions, the lack of safe water and the lack of facilities to sterilise feeding bottles and prepare formula safely and correctly (soap, a stove, fuel to boil water, clean measuring cups, refrigeration) means that artificially-fed infants are more than 20 times more likely to die from diarrhoea and other infectious diseases than infants who are exclusively breastfed. Formula feeding requires intensive support from aid agencies, diverting them from their most important tasks of providing relief. It creates dependency and contributes to undernutrition. When a mother feeds her baby formula, she produces less milk. What happens when the donated formula runs out? If the family cannot purchase formula, they water down whatever is left or introduce cheaper but inadequate milks like condensed milk with the resulting malnutrition, diarrhoea and death. Donating formula seems on the surface to be a good way to help out, but there are many unintended consequences. Formula is a recipe for disaster in an emergency situation. If you want to do something, donate funds to relief organisations that can, in turn, acquire supplies as needed to meet the specific, identified needs on the ground.