Celebrating the final week of Hispanic Heritage Month

 ​​New Mexico Breastfeeding Task Force Deputy Director Monica Esparza, CLC and her 13-year-old daughter have started practicing Baile folklórico (Mexican folk dance) together to connect with their culture. The birth of Esparza’s daughter and subsequent WIC peer counselor position started her on her path to maternal child health advocacy. 

While searching for resources for her clients, Esparza networked with the New Mexico Breastfeeding Task Force (NMBTF), ultimately helping establish the Albuquerque chapter.  

An immigrant herself, Esparza’s experience navigating health systems inspired her to continue to help others face language barriers and other challenges to get the care they deserve.  

Identity erasure and revival  

From September 15 to October 15, we celebrate National Hispanic Heritage Month to honor the rich histories, cultural influences and contributions of Hispanics/Latinx in the United States.   Guest speaker Tecpaxochitl Mireya Gonzalez points out in the 2021 Nikki & Nikki LIVE: Celebrating Hispanic Heritage Month webinar that the term Hispanic is not accurate though and dismisses diversity. 

“What does it mean to be Hispanic?” Gonzalez poses. “There are a lot of nuances.”

Latinx are a diverse group with ancestry from 28 countries, USBC reports.

Photo by Elena Mozhvilo on Unsplash

To identify Spanish-speaking nations as the origin– an indicator of a colonized country– is to dismiss indigenous identities, “to dismiss all of our ancestry,” as Gonzalez puts it in the Nikki&Nikki discussion.  

It was breastfeeding/chestfeeding/bodyfeeding (the term Gonzalez uses) that allowed Indigenous People to be resilient through colonization, political injustices and other hardship.  

“We have these cultural practices that sustain us,” she says.  

Esparza says, “We are resilient, but we shouldn’t have to be.” 

“We are smart and we know how to solve our own problems,” she continues. “We need to make sure people listen and support us.”

Supporting diversity and cultural attachments 

In the webinar, Gonzalez details ways in which lactation care providers (LCPs) can best support a diverse group of people. 

First, questionnaires and intake forms should reflect diversity. Allow individuals to self identify.

Gonzalez explains that the CDC and the Census have allowed for the identification of Hispanic origin (which she acknowledges can be controversial because indigenous identity is not a subgroup; in fact, indigenous identity predates European invasion).

With this tweak in documentation, since 2009, there has been an 85 percent increase in the Native population, Gonzalez reports. There is dignity in this recognition, she says. 

LCPs can help individuals maintain their cultural attachments and build on their cultural values when identity is recognized. Birth, infant feeding and other cultural practices that were stolen, repackaged, and then resold back to Indigenous People can be restored. LCPs are uniquely situated to assist in this restoration of an entire food system and reclamation of health.  

This includes “re-indigenizing” agriculture– fueling pregnant bodies with pre colonial foods and feeding young children indigenous, complementary foods alongside breastfeeding.  

Secondly, Gonzalez urges trust-building. Create spaces where individuals feel seen and heard, ideally within the early prenatal period. Allow them to tell their stories, or help them to discover their stories. “Tell me about lactation in your lineage,” Gonzalez offers language for the LCP. Be aware that this transgenerational work can bring up trauma as birth and lactation often intersect with domestic abuse, sexual assault,  forced migration, etc. 

Esparza, too, emphasizes the value in building trust, listening and honoring stories and shares that these are the components that help her thrive as an LCP. 

Increasing representation in LCPs 

NMBTF offers a CLC scholarship program to those who self-identify as low income women of color throughout New Mexico in order to diversify the field of LCPs. The scholarship covers the online Lactation Counselor Training Course (LCTC) and the AALP exam. In its two years, the program has awarded 28 scholarships.

Photo by Laercio Cavalcanti on Unsplash

Since the LCTC has gone virtual, Esparza says that some of the participants have benefitted from the accessibility and self-paced nature of this platform; however, it has created barriers for some. In many rural areas in New Mexico, internet access is not always reliable. For those who speak English as a second language, a virtual platform requires a different learning process entirely, Esparza explains. 

With these challenges in mind, Esparza hosts two study groups a month which offer an opportunity to review the material and provide peer-to-peer encouragement. 

NMBTF recently started a virtual breastfeeding support group, and Esparza says that LCTC participants sometimes join these meetings to interact with real-life infant feeding challenges in their own language. 

Esparza shares that LA Publishing provides some of their lactation education materials in Spanish. Health Education Associates, Inc. offers many of their materials in Spanish as well. And this month, Lactation Education Resources (LER) announced that their 95-hour course is now offered in Spanish

Author Michelle Hackney and Illustrator Mia Ortiz-Gandara created Mamas Leche, a bilingual children’s picture book, told from the infant’s perspective. You can find a reading of the story here.  The second book in their series, Brave and Strong,  imagines a premature baby’s journey into the world.

Looking ahead  

Without diminishing the importance of Spanish- language materials, Gonzalez shared with Nikki&Nikki participants her hope to see lactation education developed into indigenous languages.  

Esparza emphasizes the need to include BIPOC communities when policies are being drafted and legislation is being written so that everyone’s voice is heard, considered and amplified.  

Esparza’s work through NMBTF has generated strong collaborations with organizations that interact with families at all stages. The coalition partners with the Indigenous Community Doula Association, W.K. Kellogg Foundation, birth and justice organizations, Family Friendly New Mexico, and health care providers among others.  NMBTF is in the process of creating a lactation curriculum for home visitors to best serve families. Learn more about NMBTF’s success and future plans in their 2020 Annual Report available in English and Spanish.

Plus-Size Mamas Can Breastfeed: Don’t Let Weight-Bias, Shaming and Poor Advice Derail Your Efforts. You’ve Got This!

By Kathleen Kendall-Tackett 
Illustrations by Ken Tackett
PraeclarusPress.com

Bias against fat people remains the last socially acceptable prejudice. It’s in science, the world,  and in healthcare. Plus-size women encounter prejudice in almost every type of health  care setting, but for some reason, it seems particularly harsh in maternity care. Women are  bullied and shamed into doing things that are not healthy, such as a 15-pound weight gain  during their pregnancies or an unnecessary cesarean. What’s worse, many providers feel  justified when they act this way, claiming only to be concerned about the mother’s health.  When providers say, “It’s just not healthy,” they are often hiding baser feelings that have  little to do with the health of the mother and more to do with providers’ sense of aesthetics  (“it’s not attractive”), and even their sense of right or wrong (“fat = lazy, undisciplined, poor,  dumb, etc.”).  

The same thing happens in lactation care. Weight bias is rife. I’ve heard it in the way  providers talk about mothers and in conferences on “obese mothers.” Is it any surprise that  breastfeeding rates are lower among women with higher BMIs?  

You’ve most likely run into these judgments already. Don’t buy into it! That’s their problem,  not yours. Here are some of the myths you might run into. These myths are even in the  scientific literature.

Myths about Plus-Size Mothers and Breastfeeding 

Previous studies have found lower breastfeeding rates in plus-size mothers. The question is,  why? Weight-biased scientists have often hypothesized something like this; “If ‘obese mothers’ cannot breastfeed, it must be their fault.” Their “fatness” somehow made it impossible.  Research articles, published in generally decent journals, beat the tattoo of the fat-hating  culture. Although clinicians often repeat these myths, none of the problems they’ve identified have a shred of evidence to support them. Some of these would be funny if they weren’t  so poisonous. 

  1. Your nipple is too big.  

This one’s odd. Skinny women sometimes have larger nipples. Not a bit deal. Nipple size is  not related to weight.  

Workaround: Sometimes, a nipple can be too big in the early days, especially if your baby  was born small or a bit early. If your baby is having trouble, you may need to express for a few  days to give her a chance to catch up. Keep offering and keep expressing milk to establish  your milk production. Try some different positions. If it hurts, stop, and give it a bit longer.  It will happen. 

  1. Your areola is too big.  

So what? Your baby doesn’t need to get the whole areola in her mouth. She only needs to  take enough in to get a deep latch, one that doesn’t hurt you and helps her transfer milk well. 

Workaround: While you  don’t need to worry about  “big areolas,” you do  need to pay attention to  whether your baby has a  deep latch. If your nipples  are sore and/or you don’t  hear audible swallowing,  have a lactation specialist  take a look. Many times, it  can be quite easily sorted  with skilled help. But it’s  better to get that help  sooner rather than later. 

  1. Your breasts will “crush” your infant.  

This is a particularly hateful myth. New mothers are already sensitive enough. Saying that  they will harm their infants with their bodies is the worst kind of fat-shaming, and it’s not  even close to true. 

Workaround: You’ve been handling your breasts since puberty. I’m sure you can figure  out a comfortable way for you and your baby to sit while nursing. Some mothers find that  a rolled-up washcloth under their breast takes some of the weight off the baby. The truth is  that many different positions can work. Feel free to experiment.  

Remember, this is your body and your baby. You don’t have to do it like anyone else. The  “right” position is the one that works. 

  1. You have no lap, so you won’t be able to use all the standard  positions. The no-lap argument is laughable. Lap  size depends on people’s height and body  shape. You can’t make a blanket statement  that supposedly includes all plus-size  women. For example, short women may  not use much space for the baby to be. Are  we going to say they can’t breastfeed? Or  course not! You also do not need to use all  the standard positions. That’s just silly. And since when do mothers breastfeed  from their laps?  

    Workaround: Biological Nurturing (laid back breastfeeding) is your friend here. By using it, you increase the ventral space area  where your baby can lie. Here’s a quick overview. 

    a) Sit comfortably and pretend like you are watching TV. It can be any angle you like.

b) Put your baby at what Dr. Suzanne Colson calls the “right address.” Your baby should  be face down on your body, letting gravity do the work to hold her in place. Scoot  the baby up so that your baby’s cheek is on your breast. From that position, you  should comfortably be able to see your baby’s face. 

c) Hang out and enjoy being close to your baby. When your baby gets hungry, she  will start bobbing her head towards your breast. Feel free to support your baby’s  movements and adjust yourself, your breasts, and your baby as needed. From this  position, babies tend to latch well and feed efficiently.  

d) Try different positions. Don’t feel like you have to do it the way that anyone else  does. Here is a link to her site so you can see this in action.

http://www.biologicalnurturing.com/video/bn3clip.html 

You can also purchase her book here. PraeclarusPress.com 

    1. “Obese women” have less of a prolactin response to suckling.

This myth is insidious  because it sounds  so scientific and so  sure, and it comes  from a particular  study (Rasmussen  & Kjolhede, 2004).  This study has gained  importance because  everyone cites it and  uses it for evidence  about why plus size women can’t  breastfeed. It’s even  on the exam we take  to become IBCLCs.  But here’s the thing:  this belief was a  hypothesis. The study  included only 17 mothers (some of whom were “overweight,” not “obese”). Tiny  sample. It’s interesting, but you can’t conclude much from it. Strike one. 

The researchers hypothesized that progesterone in adipose (fat) tissue suppress es prolactin, the hormone necessary for milk production. That wouldn’t be a good  thing. (Progesterone is another hormone that helps sustain pregnancy and drops to  low levels after birth.)  

Unfortunately, the data did not support their hypothesis. They only found the effect  of suppressed prolactin on day one but not on day two (so it could be anything, really, including a measurement error). Further, progesterone appeared to have no role  in this process whatsoever.  

So what does this mean? It means that this theory, in all its fat-shaming glory, was  not supported by the findings. What do you need to do about it? Absolutely nothing!  But do be aware that some of your providers may harbor this belief—mainly because  most have not read the actual study. 

The Real Reason for Lower Breastfeeding Rates  in Plus-Size Mothers 

Let’s go back to our original question.  Why do plus-size women breastfeed at  lower rates than women with lower BMIs?  The answer is one you might suspect. A  study of more than 19,000 women in the  U.S. found that plus-size mothers were significantly less likely to get the support that  we know they need to successfully breast feed (Kair & Colaizy, 2016). They were  less likely to have their babies with them  in the first hour, less likely to have skin to  skin time, and less likely to be instructed  on cue-based breastfeeding. Further, their  babies were less likely to room in and were  more likely to use pacifiers. They were  even less likely to get a handout listing breastfeeding resources in the community.  

There is no excuse for this. We (as a field) have spent years looking for ridiculous hormonal  explanations or looking at the mothers’ characteristics. While we have been pointing fingers at you, we should have noticed that three fingers are pointing back at us. 

Things to Watch For 

While you don’t have to believe the myths, there are a couple of things that may be related  to BMI, so they are important to watch for. 

  1. You may have more edema. 

This isn’t always true, but it can be, especially if you’ve had a lot of fluids during your delivery.  

Workaround: If you have engorgement or your breasts feel so full that your baby can’t  latch, use reverse-pressure softening to push some of the fluid away from your nipple and  areola. It’s important to breastfeed as much as you can during this time. Here’s a link to  show you how. 

http://www.breastfeedingonline.com/rps.shtml#sthash.XplY2f Ke.dpbs 

Engorgement is caused by your milk “coming to volume,” but also excess blood and fluid.  It’s important for you to address for your own comfort and because it can influence your  milk production. Breastfeed or express your milk frequently. Use some cool compresses  to comfort. You might also try some very gentle breast massage. The best expert on this is  lactation consultant Maya Bolman. You don’t need a deep massage. The lymph nodes are  near the skin. You just need enough so that they can help move excess fluid. Here’s a link for her site below. The first half is on hand expression, and the second part is on breast massage. https://player.vimeo.com/video/65196007 

  1. Watch out for the effects of insulin resistance. 

If you have a condition related to insulin resistance (e.g., polycystic ovarian syndrome  (PCOS) or type II diabetes), it’s important to keep it under good control. Excessive insulin  can affect the hormones necessary for lactation. If you are on medication to control excessive insulin, don’t stop. Exercise is your friend here. It’s good to have some gentle exercise  every day if you can. Put your baby in a sling or stroller and take a walk. If you’ve had a particularly carby meal, go take a walk. It will help a lot. 

Exercise will make it easier for you to breastfeed. The goal is not weight loss; it’s to use exercise as a way to control insulin. You may lose some weight too, but you will get major health  benefits even if you are not smaller. 

Conclusion 

If you are a breastfeeding mother, or want to be, what do you need to do? First, know that  you may not get the support you need from your providers. I wish that it was different, but  it’s important to acknowledge the landscape. Fortunately, knowledge is power. If you know  what you might run into, you can gather what you need for yourself. Find people you connect with and who will help you. I’m sorry that you will have to do it this way. You deserve  better. But you can make it work. 

Breastfeeding is your right.  Don’t let anyone tell you differently.  You’ll be amazing. 

 

Kathleen Kendall-Tackett, PhD, IBCLC, FAPA, is a health psychologist and international  board-certified lactation consultant. She lectures extensively across the U.S. and Canada, and  in 15 countries outside of North America. She became interested in the topic of weight bias in  maternity care after attending several conferences in a  row on the topic of “obese mothers.” They made her mad.  After being bumped off of a plane, she wrote a particularly  snarky piece for the Science and Sensibility blog called  “Weighing in on Obesity and Breastfeeding,” which lead  to many opportunities to speak on the topic. She served  on the U.S. Office of Women’s Health’s Taskforce on  Obesity and Trauma, and lectures frequently on the topic  of weight/BMI, trauma, and bias in healthcare providers.  Dr. Kendall-Tackett is the founding editor for Clinical  Lactation and served as Editor-in-Chief for 11 years.  She is also Editor-in-Chief of Psychological Trauma  and is currently serving her second term. She continues to  advocate for plus-size women in every setting that she is in.   You can find out more at www.kathleenkendall-tackett.com. 

References 

Kair, L. R., & Colaizy, T. T. (2016). Obese mothers have lower odds of experiencing  pro-breastfeeding hospital practices than mothers of normal weight: CDC Pregnancy Risk Assessment Monitoring System (PRAMS), 2004-2008. Maternal &  Child Health Journal, 20(3), 593-601.  

Rasmussen, K. M., & Kjolhede, C. L. (2004). Prepregnant overweight and obesity diminish the prolactin response to suckling in the first week postpartum. Pediatrics, 113,  e465-e471.  

This article is free to host, distribute, print, and share. 

Questions: ken@praeclaruspress.com 

PraeclarusPress.com

National Childhood Obesity Month: the links between infant feeding and obesity Part 2

In conjunction with National Childhood Obesity Month,  we are zeroing in on what obesity looks like in the U.S. and how infant and young child feeding (IYCF) and other perinatal factors influence the obesity epidemic. Here’s the next installment of  Our Milky Way’s roundup of contributors’ work relating to childhood obesity.

Photo credit: WIC Image Gallery

Picking back up with  Sylvia Metzger’s, MPH, MSN, RN, CNL, IBCLC, LCCE work, her  research has also informed us on how paternal health affects babies’ weight. “Every baby’s destiny can actually begin before conception, reflecting both the paternal and maternal health status,” Metzger explains.  “Dad’s lifestyle and health before conception actually matter, and can also pre-program a baby’s health trajectory.  It is not just the mom’s intrauterine environment.  Paternal obesity prior to conception, for example, can increase the incidence of obesity and metabolic disorders in offspring, independently from the maternal status.  But how much do we focus on fathers during preventative care visits?”

 

Dana Dabelea’s, MD, PhD work exploring gestational diabetes (GDM) has shown that GDM diagnosis increases the risk of diabetes and obesity in a mother’s offspring.  Dabelea and colleagues studied fuels that feed the growing baby – such as fats of various types and sugars- all of which come through the placenta and umbilical cord to nourish the fetus. “It turns out that fatter babies (measured with an instrument called the PedPod®) had mothers with higher glucose levels during pregnancy, even if these levels were still considered in the “normal” range,” she reports. “We followed the offspring and looked at what influence postnatal feeding had as well. It turns out that breast-feeding for at least 6 months largely reverses the effects of GDM on fatness in children.  I think this was exciting, since it meant that there are things that can be done very early in life that can reduce the later risk of obesity and diabetes….One additional thing of great interest – in studies of stem cells grown from the umbilical cords of these babies by my basic science colleagues, they have shown that obese mothers unknowingly ‘program’ these stem cells to be more likely to turn into fat cells than muscle or bone cells – some of the first human evidence of a possible pathway that changes how an infant responds to their environment.”

Photo by Jorge Salvador on Unsplash

 

Dabelea’s research illuminates epigenetic and racial disparity components too. The SEARCH for Diabetes in Youth study has shown diabetes to disproportionately affect minority children. Dabelea explains: “Type 1 diabetes (juvenile diabetes) is actually most common among non-Hispanic white youth, although recently we are seeing increasing trends in minority groups, especially Hispanics. There are several factors at work in type 2 diabetes, but we don’t yet know all of the story. First, a higher proportion of minority youth are overweight or obese, which is the major risk factor for later diabetes. Second, many of these are offspring of mothers who themselves have diabetes, GDM, or even just obesity as they enter pregnancy. Such women pass to their babies an increased susceptibility for obesity and diabetes, a phenomenon called the “vicious cycle” – where the risk of obesity and diabetes are passed to the next generation without involving genetics. Lack of breastfeeding, or only a short duration of breastfeeding likely also plays a role, since it appears that breastfeeding reduces both obesity and diabetes among offspring.”

Dabelea and colleagues conducted a pilot randomized controlled trial of obesity prevention among American Indian children aged 7 to 10, called Tribal Turning Point. They found that a combination of parent-child sessions aimed at behavioral motivation for change, along with a toolbox of community activities, cooking classes and fun things for kids to do, resulted in lower weight gain among the group that got the intervention. “This kind of work is aimed at helping stem the tide of the epidemic in the highest risk group – American Indians,” she says. “But counter forces are strong – an abundance of calories, often of poor quality, the ease with which we can live without much physical activity and potential environmental factors such as air pollution and endocrine disrupting chemicals, are all promoting dangerous levels of obesity.”

Source: United States Breastfeeding Committee.

 

More, recent research on childhood obesity: 

Exclusive breastfeeding can attenuate body-mass-index increase among genetically susceptible children: A longitudinal study from the ALSPAC cohort— This research shows that  exclusive breastfeeding (EBF) to five months has substantial effect in decreasing BMI among children at higher genetic risks. It suggests that interventions aimed at reducing the risks of overweight and obesity across the lifespan should start in very early childhood to be impactful, which makes EBF a key candidate intervention. 

Why and how human donor milk may curb obesity in preterm infants— This work explores why and how donor breast milk may be more beneficial than pre-term artificial milk. 

Childhood Obesity and Breastfeeding Rates in Pennsylvania Counties—Spatial Analysis of the Lactation Support Landscape— This work explores the inverse relationship between geographic access to professional Lactation support providers (LSPs) and childhood obesity in Pa. counties. 

National Childhood Obesity Month: the links between infant feeding and obesity Part 1

Photo credit: WIC Image Gallery

Worldwide, obesity has nearly tripled since 1975.  Anthropologist Daniel Sellen of the University of Toronto reminded participants at the “Nutrition and Nurture in Infancy and Childhood: Bio-Cultural Perspectives” conference that no country has yet managed to avoid the occurrence of childhood obesity. Sellen pointed out that 90 percent of countries experience the double burden of malnutrition; simultaneously experiencing inadequate food access and obesity.

This National Childhood Obesity Month, in two installments, let’s zero in on what obesity looks like in the U.S. and how infant and young child feeding (IYCF) and other perinatal factors influence the obesity epidemic. Here’s a round-up of Our Milky Way contributors’ work around childhood obesity. 

Breastfeeding socializes taste. As Penny Van Esterik, Professor Emerita, York University, Toronto and Adjunct Professor, University of Guelph pointed out in Breastfeeding: where healthy and sustainable food systems begin, infant feeding can set up children for the “industrial palate” contributing to the obesity pandemic.  Dr. Julie Mennella’s research on flavor learning has shown that sensory experiences, beginning early in life, can shape preferences. “Mothers who consume diets rich in healthy foods can get children off to a good start because flavors are transmitted from the maternal diet to amniotic fluid and mother’s milk, and breastfed infants are more accepting of these flavors,” Mennella writes in Ontogeny of taste preferences: basic biology and implications for health. “In contrast, infants fed formula learn to prefer its unique flavor profile and may have more difficulty initially accepting flavors not found in formula, such as those of fruit and vegetables.”

Photo credit: WIC Image Gallery

Healthy Children Project’s Cindy Turner-Maffei shared her notes from Nutrition During Pregnancy and Lactation: Exploring New Evidence – A Workshop. Specifically,  Kjersti Aagaard of Baylor College of Medicine reported on the impact of maternal diet on the developing infant microbiome. Turner-Maffei noted:

    • The diversity of vaginal microbes decreases in pregnancy. The neonate’s early biome looks very different than that of the vagina. 
    • The neonate’s microbiome may reflect the amount of fat in the mother’s diet. High fat diet (>35% of calories as fat) is more correlated with infant dysbiosis* than with maternal obesity. (This difference persists—it seems irreversible with dietary changes later.) [*dysbiosis=imbalance in the microbiome—a less than desirable microbial community]
    • We should stop focusing on treating obesity in pregnancy/lactation and focus instead on supporting dietary change. Within days of changing the diet (less added sugar and fat and more fiber), the mother’s metabolic markers and those in her milk change for the better. 
    • Similarly, “we must come to value nutrition over weight.” 
    • Encourage nutrient quality: “fresh from the source produce” is best. Address equity issues in access to fresh produce.
    • Today’s research does not show that giving probiotics in pregnancy protects mother or infant.
    • Fun fact: Did you know that “there are Pseudomonas species that can exist solely on caffeine”???!!!
Photo credit: WIC Image Gallery

The microbiome comes into play in Sylvia Metzger’s, MPH, MSN, RN, CNL, IBCLC, LCCE work with The Human Microbiome Project— a National Institute of Health initiative with the goal to study microbiota. “We have plenty, almost 5 pounds of our body weight,” Metzger points out. Microbiota have a shockingly significant impact on human health and disease. “Our gut microbiota work for us really hard,” Metzger continues.  “They [affect] our immunity, metabolism, endocrine system, and even our neural pathways.  I had no idea that an obese patient can have very different gut bacteria than a lean counterpart, and that these microbiota can epigenetically influence the patient’s metabolism.  The wrong bacteria can literally reprogram our metabolism towards obesity.  I look forward to learning more about how to feed our microbiota right – for now, my understanding is that they love to munch on prebiotics… Breastmilk serves as an excellent prebiotic and is full of human milk oligosaccharides, which can, for example, decrease the risk of necrotizing enterocolitis, a devastating condition affecting predominantly premature infants.  The therapeutic potential in treating illness with underlying dysbiosis through manipulation of the enteric microbiome, which would also include autoimmune conditions (Crohn’s, diabetes type I) may be tremendous.

Stay tuned for Part 2 next week.

National Preparedness Month: the U.S.’s deficit in Infant and Young Child Feeding preparedness during emergencies

Photo by Mika Baumeister on Unsplash

 The editors of more than 200 health journals worldwide just released  ​​Call for Emergency Action to Limit Global Temperature Increases, Restore Biodiversity, and Protect Health ahead of The United Nations General Assembly this month. The authors urge critical action to curb global temperature increases in an effort to  “halt the destruction of nature, and protect health.” 

This  piece details how hotter temperatures are taxing public health systems:

“…Hurricane Ida caused dozens of deaths across several states from flash flooding and other impacts. With the power grid down, some died from carbon monoxide poisoning caused by using generators. In the aftermath of the storm in Jefferson Parish in Louisiana, local officials have been working to provide transportation for those who need dialysis and other medical care. Earlier this summer, hundreds died in a record-breaking heat wave in the Pacific Northwest… Wildfire smoke, increasingly clogging skies with dangerous levels of air pollution, causes spikes in emergency room visits.” 

Many of the current humanitarian crises are related to the climate crisis.  It’s driving human displacement which comes with a multitude of consequences. More on that here

Photo by Adrien Taylor on Unsplash
“While filming a climate change documentary called Thirty Million for the United Nations, I was blown away by the beauty of the Bangladeshi people — both in their character and appearance. Bangladesh faces losing 18% of its land, displacing thirty million people, with one metre sea-level rise. At the end of Ramadan every year, the country has one of the world’s largest internal migrations of people going from the cities to their home villages to celebrate the holiday. This type of migration may soon become across borders as climate change makes life difficult in this stunning country.”

Recent hurricane related power outages and water safety issues bring the importance of Infant and Young Child Feeding (IYCF) during emergencies to the forefront.  

“Breastfeeding provides food security for infants and young children specifically in emergency situations,” as noted in IBFAN and BPNI’s Formula for Disaster. “Economic hardship, conflicts and calamities cause disruption, deprivation and severe stress for families, especially for mothers and their children. During such emergency situations, optimal breastfeeding is a lifeline to ensure survival, food and affection for infants and young children, in addition to providing anti-infective agents to protect against disease.”

Threats exasperated by the climate crisis have become the frequent reality for so many families and yet, our nation is abysmally prepared, especially for those with young children.

Participants of the WBTi Assessment Workshop, April 2016

The World Breastfeeding Trends Initiative (WBTi)–an international tracking, assessment and monitoring system for national implementation of the Global Strategy on Infant and Young Child Feeding (IYCF)– scored the United States zero out of 10 for Infant feeding during Emergencies.  

WBTi uses the following criteria for assessment: 

  • The country has a comprehensive policy on infant and young child feeding that includes infant feeding in emergencies and contains all basic elements included in the IFE Operational Guidance
  • Person (s) tasked to coordinate and implement the above policy/strategy/guidance have been appointed at the national and sub national levels
    1. The health and nutrition emergency preparedness and response plan based on the global recommendation includes:  Basic and technical interventions to create an enabling environment for breastfeeding, including counselling by appropriately skill trained counsellors, and support for relactation and wet-nursing
    2. Measures to protect, promote and support appropriate and complementary feeding practices
    3. Measures to protect and support the non-breast-fed infants 
    4. Space for IYCF counselling support services
    5. Measures to minimize the risks of artificial feeding, including an endorsed Joint statement on avoidance of donations of breastmilk substitutes, bottles and teats, and standard procedures for handling unsolicited donations, and minimize the risk of formula feeding, procurement management and use of any infant formula and BMS, in accordance with the global recommendations on emergencies
    6. Indicators, and recording and reporting tools exist to closely monitor and evaluate the emergency response in the context of feeding of infants and young children.
  • Adequate financial and human resources have been allocated for implementation of the emergency preparedness and response plan on IYCF
  • Appropriate orientation and training material on infant and young child feeding in emergencies has been integrated into pre-service and inservice training for emergency management and relevant health care personnel
  • Orientation and training is taking place as per the national plan on emergency preparedness and response is aligned with the global recommendations ( at the national and sub-national levels)
Photo by John Middelkoop on Unsplash

The United States does not meet any of these criteria. 

“Ironically, some [U.S.] states and territories have well-elaborated plans for the care and feeding of household pets in shelters, but none for infants and young children,” Healthy Children Project’s Cindy Turner-Maffei points out. 

Research by Cindy H. Hwang, et al found that in all of the emergency situations they studied in middle and high income countries, The International Code of Marketing of Breastmilk Substitutes was violated.  

The authors report: “Donated and distributed infant formula was often labeled … without adequate preparation guidance. Infant formula was repeatedly distributed as part of the standardized assistance package regardless of mothers’ infant feeding practices. The uncontrolled distribution of donated infant formula not only undermined good breastfeeding practices and efforts of mothers, but also increased the health risk to infants. Mothers often had no access to electricity, gas, safe water, and necessary infant feeding supplies to hygienically prepare infant formula.” 

Breastmilk substitute (BMS) companies are known to exploit emergency situations exacerbating child mortality, morbidity, and malnutrition. Authors of Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic detail this behavior in the context of the current pandemic.  

Different from the U.S.’s preparedness deficit, WBTi congratulates Bangladesh on achieving “green” status, ranking them number one for supporting healthy infant feeding globally.

Photo by Theodore Goutas on Unsplash

Bangladesh scored 10 out of 10 on Infant Feeding during Emergencies. Find the country’s full report here. Other countries that have achieved high scores in IYCF During Emergencies include the Philippines, Sri Lanka, Afghanistan, Bolivia, and Nepal.  

During National Preparedness Month, individuals, families and communities are urged to take a week-by-week stepwise approach to prepare for disasters: Make A Plan, Build A Kit, Low-Cost, No-Cost Preparedness, Teach Youth About Preparedness.   Authors Karleen D. Gribble and Nina J. Berry offer detailed information on what emergency preparedness entails for breastfed and formula fed infants in Emergency preparedness for those who care for infants in developed country contexts.  Individuals can take action with USBC’s online tool in order to influence policymakers to integrate IYCF into future emergency preparedness and response efforts. 

Find general information about breastfeeding during emergencies and more action tools on USBC’s Infant and Young Child Feeding in Emergencies page