USE OF MILK POWDER IN EMERGENCIES OXFAM's POSITION
Never distribute milk powders alone as part of a dry ration
OXFAM does not support the distribution of dried milk powder to emergency affected populations as part of a general dry ration. This is because of the the risk of it being used as a breast milk substitute and the dangers associated with home preparation and consumption of reconstituted milk.
If infants and young children are given other milks in place of breastmilk, this reduces the infants demand for breastmilk, which in turn reduces the supply of mother's milk. Any reduction in breastfeeding means a significant loss of benefits to the child and mother from breastfeeding. In particular, 'the biological availability of nutrients from exceeds that from any substitute, and breastfeeding provides unique benefits to early physical, mental and emotional development that vield significant returns throughout life' (p5, WHO, 1997)
In addition, breastmilk protects children from infection and its consequences, as it passes on to the infant antibodies from the mother. Breastmilk has an important contraceptive effect, and enhances bonding, physical and emotional warmth, and care, which are all crucial for child survival. During emergencies, breastmilk may well be a young child's only sustainable source of food.
In contrast, reconstituted milk may be a source of foodbourne disease, as milk is an ideal environment for the rapid growth of bacteria. Bacteria multiply more rapidly in reconstituted milk than in the original water source. Infant feeding bottles are almost impossible to clean and sterilise in an emergency situation and so make a bad situation worse. The use of feeding bottles and reconstituted milk in an emergency context are likely to contribute to greater incidence of diarrhoea.
Although dried milk powder may not be distributed as a breastmilk substitute, in an emergency context where women are under great stress they may incorrectly perceive the milk powder as a useful supplement to their own breastmilk THIS IS FALSE AND POTENTIALLY DANGEROUS.
OXFAM's position against the distribution of milk powders as part of a dry ration in emergencies, is shared by the World Health Organization (WHO, 1995), the International Federation of the Red Cross and International Committee of the Red Cross (IFRC, 1989), UNICEF (1993) and UNHCR (1989).
Apart from contravening Oxfam's own policy position, the distribution of dried milk powder could be seen to violate the 1981 WHO International Code on the Marketing of Breastmilk Substitutes. Oxfam is currently supporting a UNICEF project that is independently monitoring the enforcement of this code (Interagency Group on Breastfeeding Monitoring, 1997). Oxfam actively campaigned for the WHO Code in the early eighties, and should continue to make every effort to ensure that it is endorsed, particularly in its own programmes.
Used correctly milk is a wonderful food. It is the indiscriminate distribution of milk powder that has such damaging consequences, particularly where it is perceived as an infant food. To quote an expert medical committee,
the most legitimate use of milk powder is as an ingredient in the preparation of special diets for severely malnourished patients of all ages over four months, for use under medical supervision. Those with mild or moderate malnutrition do not require these special diets and milk powder per se should never be indiscriminately sold or distributed as it discourages breastfeeding (Golden et al., 1997).
Milk powder can be used safely, by mixing with cereal flours and other ingredients to make porridge which is used in a 'wet' feeding programme, or alternatively can be used to make a porridge 'premix' for 'dry' distribution.
Developed in 1997
Alternatively if a breastmilk substitute is considered essential, for example, for an emergency affected population that is accustomed to bottle feeding (e,g. former Yugoslavia), they may be provided as long as certain measures are followed to ensure that: a) infants have to be fed on breastmilk substitutes (in other words there is no other available alternative) b) the supply is continued for as long as the infant concerned needs it, c) the supply is not used as a sales inducement (generic products should be used, not branded products. d) These measures are extracted from the 'The 1994 World Health Assembly Resolution on Infant and Young Child Nutrition (9th May, WHA 47.5). In addition, the World Health Assembly urged '..extreme caution, when planning, implementing or supporting emergency relief operations by protecting, promoting and supporting breastfeeding'.
The decision to use milk powder or any product that could be used as a breastmilk substitute, must therefore only be taken after a full investigation into infant feeding practices. This should include:
•an assessment of the impact of the emergency and emergency response on infant and young child feeding from the perspective of both women and children,
•identifying practical ways of actively protecting, promoting and supporting breastfeeding and other beneficial practices, which should form part of any subsequent programme.
Guidelines for such an assessment are given in Kathy Carters Practical Guidelines on infant Feeding in
Emergencies, 0~ 1996,
Helen Young,
Food and Nutrition Advisor, Oxfam Emergencies Department, Oxford
12 November, 1997
References
Carter, K, Feeding in emergencies for infants under 6 months, 0~ Oxford, 1996, April.
Golden, M et al. Milk aid and malnutrition Letter to the Lancet. 1997 Doe 11.
Interagency Group on Breastfeeding Monitoring. Cracking the Code Monitoring the International Code of Marketing of Breastmilk Substitutes. Geneva: WHO; 1997.
The Deputy High Commissioner. Policy for the Acceptance, Distribution and Use of Milk Products in Refugee Feeding Programmes. 1989 Jul 25.
UNICEF Nutrition Section. Distribution and Use of Breastmilk Substitutes in Emergencies: A Selection of Guidelines and Recommendations. New York: UNICEF; 1993 Jul.
WHO. International Code of Marketing Of Breastmilk Substitutes. Geneva: WHO; 198 1.
. The Management of Nutritional Emergencies in Large Populations (draft). Geneva: WHO; 1994.
Developed in 1997