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Monday, March 12, 2012

Why milk product donations shouldn't be allowed during disasters

In the 23 February 2012 edition of the Inquirer, a letter to the editor was sent by Corazon del Mundo, chair of Women Involved in Nation-Building, directing the readers' attention to the Sendong disaster and listing down reasons why donations of milk products should be allowed and be coursed through government agencies.  This letter was in response to the column by Rina Jimenez-David on milk and malnutrition where she wrote about the perils of donations of powdered formula or milk.   
This brings us to the problem of donations of powdered formula or milk, which are among the first and most common items sent in response to disasters. “In the confusion that surrounds emergencies, these products are often distributed in an uncontrolled way and used by mothers who would otherwise breastfeed their babies,” says Unicef, adding that indiscriminate use of donated milk “results in unnecessary illness and death for infants.”



Interestingly, the UNICEF does allow donations of milk coursed through the appropriate government agencies. 
Thus, Unicef appeals to the public who may want to donate milk to Sendong survivors not to give the milk directly to affected populations, but rather give the milk to the appropriate authority, such as the DOH, so that distribution of the milk can be carefully managed.

Let me quote my breast friend Velvet Escario-Roxas on why milk donations should not be allowed in times of emergencies:
The first ones to die in an emergency are bottlefed babies. That is a fact. Why? Because there are lost resources (no infant milk, no bottles, no water and if there is it's unsanitary etc etc) and bottlefed babies have very low immune system compared to breastfed children.
It really is in our law that donations of milk products during disasters is controlled by the government. The donations of artificial milk is not the first resort but the last resort (looking at the hierarchy of infant feeding) 
The danger of giving out artificial milk is that it undermines breastfeeding. The breastfeeding mothers would line up and ask for milk donations because of the mentality of "free" samples. Handing out artificial milk might be an easy way out but it is a very dangerous road to trek. 
Donations of milk products is not the solution. It just increases the risk of diarrhea, disease, malnutrition and death.Infant Formula = Not Sterile = Death 
The solution in times of disaster is to create a "breastfeeding support group during emergencies" to continue breastfeeding and to relactate mothers who are purely bottlefeeding. I am sure that there are possible wetnurses left and right. If there are expressed donor's breastmilk so much the better. Some cities in the Philippines have done this (during floods, fires, typhoons) and they have been successful.
It is in tons of scientific researches that breastfed babies will continue to thrive and live healthier lives even in the worst terrible disasters. That is why breastfeeding saves lives. 
The danger of giving out artificial milk is that it undermines breastfeeding. The breastfeeding mothers would line up and ask for milk donations because of the mentality of "free" samples. Handing out artificial milk might be an easy way out but it is a very dangerous road to trek. 
Donations of milk products is not the solution. It just increases the risk of diarrhea, disease, malnutrition and death.Infant Formula = Not Sterile = Death 
The solution in times of disaster is to create a "breastfeeding support group during emergencies" to continue breastfeeding and to relactate mothers who are purely bottlefeeding. I am sure that there are possible wetnurses left and right. If there are expressed donor's breastmilk so much the better. Some cities in the Philippines have done this (during floods, fires, typhoons) and they have been successful.It is in tons of scientific researches that breastfed babies will continue to thrive and live healthier lives even in the worst terrible disasters. That is why breastfeeding saves lives.
Meanwhile, here is what neonatologist, Dr. Mianne Silvestre has to say:
Allowing donations of artificial formula during disasters is fraught with grave danger that is well documented. The floods in CDO and Sendong were like a tsunami but probably worse. A study from India conducted by Adhisivam B., Srinivasan S., Soudarssanane M.B., Deepak Amalnath S. and Nirmal Kumar A. (and published in Indian Pediatrics, Aug 17, 2006) identified the problems related to feeding of children post tsunami in four villages in Pondicherry. Verbatim from their Summary - - "Data were collected from 100 randomly chosen families who had an Infant or a Young child below 3 years of age during Tsunami. Informants were the mothers. In the population studied, 30% mothers did not exclusively breast feed for 6 months; 58% bottle fed their children and 51% fed their infants with commercial formula. The occurrence of diarrhea was three times higher among children who were fed with free Breast milk substitutes (BMS) than in those who were not fed with the same. Those populations, wherein a pre-existing tradition of artificial feeding is present, infants are at further risk during a crisis situation like Tsunami. Breast feeding practices need strengthening even in routine conditions to tackle a disaster rather than intervention after the disaster." . . This data constitutes real harm not potential for harm, not conjecture.After the catastrophic floods in CDO and Iligan, came the earthquake in Negros? How about Infant Feeding in post- earthquake disasters? . . . Again the harm is documented and not just theoretical. . . Hipgrave DB, Assefa F, Winoto A, Sukotjo S. published their data from Yogyakarta and Central Java after the May 2006 earthquake there. This was published in the journal, Public Health Nutr. 2012 Feb;15(2):307-15. Epub 2011 Mar 23. . . Again, verbatim from their Abstract:OBJECTIVE:Distribution of breast milk substitutes (BMS) after the 2006 Yogyakarta earthquake was uncontrolled and widespread. We assessed the magnitude of BMS distribution after the earthquake, its impact on feeding practices and the association between consumption of infant formula and diarrhoea among infants and young children.DESIGN:One month after the earthquake, caregivers of 831 children aged 0-23 months were surveyed regarding receipt of unsolicited donations of BMS, and on recent child-feeding practices and diarrhoeal illness.SETTING:Community-level survey in an earthquake-affected district.SUBJECTS:Primary caregivers of surveyed children.RESULTS:In all, 75 % of households with an infant aged 0-5 months and 80 % of all households surveyed received donated infant formula; 76 % of all households received commercial porridge and 49 % received powdered milk. Only 32 % of 0-5-month-old infants had consumed formula before the earthquake, but 43 % had in the 24 h preceding the survey (P < 0·001). Consumption of all types of BMS was significantly higher among those who received donated commodities, regardless of age (P < 0·01). One-week diarrhoea incidence among those who received donated infant formula (25·4 %) was higher than among those who did not (11·5 %; relative risk = 2·12, 95 % CI = 1·34, 3·35). The rate of diarrhoea among those aged 12-23 months was around five times the pre-earthquake rate.CONCLUSIONS:There were strong associations between receipt of BMS and changes in feeding practices, and between receipt of infant formula and diarrhoea. Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies.

I find that the foregoing discussion already thoroughly presents why milk donations should not be freely allowed in times of disaster and won't be adding anything more.  

What do you think about milk donations during times of disaster?

2 comments:

Anne @ GreenEggs&Moms said...

Agree that breastfeeding support centers should be set-up ... hope we are capable of this when the next disaster comes around. We can barely get other procedures in place.

Carol - The Lazy Mama said...

I couldn't agree more. Breastfeeding support centers need to be setup in times of disasters AND also in any given day. People need to be informed. Milk donations may mean well but they don't know the dangers that it poses to children especially in an unsanitary environment.

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