Food security

What is food security?

Food security means having reliable access to enough healthy food to meet dietary needs and allow an active, healthy life. Breastfeeding provides that for babies. Poverty, unexpected changes in a family’s situation, and emergencies, large or small, can create challenges for food security and increase health risks. Infant formula feeding creates additional challenges for families who may already be in a difficult situation. It must be found, purchased, and safely prepared and stored, all of which can be challenging or impossible. In addition, infant formula cannot provide protection from the infections commonly seen in emergencies.

A) Describing food security

Breastfeeding gives babies food security (Carothers 2014; Prudhon 2017). That means having reliable access to enough affordable, healthy food to meet all their dietary needs and allow for an active, healthy life. (Salmon 2015; Venu 2017). Not having food security is associated with many negative effects on children and their families (CCP 2015).

There are many reasons for not having food security and these can be individual, local, or regional. They can also be global. Recently, the COVID-19 pandemic has decreased food security for many individuals around the world (Akseer 2020).

Unless stopped, climate change will decrease food security in the coming years (Myers 2017).

B) Infant formula-feeding decreases food security for babies

Infant formula is less likely than breastfeeding to provide food security.

1) Finding formula

Formula may be hard to obtain.

a) Effect of unsafe infant formula sales in China

There have been several times that large amounts of dangerous infant formula was sold in China, injuring and killing babies. In 2008, the deliberate contamination of infant formula with melamine made 300,000 babies sick and 54,000 were hospitalized.

Chinese citizens have become wary of infant formula made by Chinese companies. Many families far prefer to use imported infant formula. They pay high prices, and the practice has stimulated a variety of illegal activities such as thefts and the smuggling of formula into China. The high demand for formula in China has resulted in significant, periodic depletion of some supplies in Australia, Hong Kong, and elsewhere (Kent 2015). To avoid local shortages, Hong Kong has had restrictions on the export of infant formula from 2013.

b) Covid-19 pandemic

During the Covid-19 crisis, there have been many reports of infant formula hoarding, local shortages, profiteering, and theft. Sadly, such behaviour is inevitable in crises. 

c) Availability when travelling

Brands and types of formula can be somewhat different in different countries. This can be a problem when travelling as the baby may not easily tolerate a change.

2) Buying infant formula

Infant formula is expensive and families may be unable to afford regular purchases. This may result in the baby being underfed or malnourished as some families may resort to:

  • Diluting infant formula resulting in milk that is too watery and low in calories and other nutrients.
  • Substituting other unsafe milks or liquids.
  • Starting solid foods early.
  • Keeping the baby quiet with a pacifier.

3) Transportation

Before formula can be used, it must be transported from where it is obtained by caregivers and brought to the baby. This may involve walking, using public or private transportation, or driving. Transportation can be hampered by lack of money, weather, the poor health of caregivers, pandemics, and socio-political unrest.

4) Storing and safe preparation

Storing and preparation both require appropriate resources such as:

  • A cool place to store formula before preparing
  • Sterilized water for adding to formula
  • Sterilized bottles and nipples

C) The COVID-19 (coronavirus) pandemic

In addition to food security, breastfeeding during the COVID-19 pandemic can keep babies healthier. This allows families to avoid possibleCOVID-19 infection while seeing health-care providers or during hospitalization. This also reduces further strain on overburdened health-care systems.

Formula costs more and can cause more hardship for families whose income has been reduced.

Mothers who are infected with COVID-19 infections should continue to breastfeed while minimizing the risk of infection of the baby.

D) Describing emergencies

Emergencies can challenge food security, and those emergencies can be as local as in your own house or as broad as an entire geographic area.

A baby’s food security may be reduced by the following:

  • Running out of infant formula at home or while travelling
  • Lack of clean water
  • Lack of power
  • Lack of housing
  • Evacuations
  • Large-scale emergencies such as floods, snowstorms, hurricanes, tornadoes, fires, and earthquakes
  • Pandemics such as Covid-19
  • Refugee and war situations

Unless stopped, climate change will continue to increase the number of severe weather events and affect ever more families and is also likely to lead to more socio-political unrest.

E) Reasons to breastfeed in emergencies

Breastfeeding in emergencies can:

  • Protect children from infection.
  • Comfort children.
  • Provide safe, affordable nutrition.
  • Empower mothers.
  • Avoid the risks and challenges of infant formula-feeding.
  • Allow families to use their time and resources elsewhere.

During large-scale emergencies, babies and young children have the highest risk of illness and death. They face risks from diarrheal diseases, pneumonia, and underfeeding.

Overcrowding, food insecurity, unsafe water, poor sanitation, and overburdened health systems increase the risk of illness (Branca 2016).

Breastfeeding rates tend to decrease in these situations, making an already difficult situation worse (DeYoung 2018; ENN 2001). Guidelines have been developed to promote and support breastfeeding and minimize the risks these children face but are not always implemented (Rabbani 2020; IFE 2007).

When breastfeeding by the mother is compromised in emergencies, consideration can be given to using a wet nurse (a woman who breastfeeds another’s child) to feed the baby and prevent the use of infant formula (Angood 2017; Burrell 2020; Gribble 2018; Kent 2018). When recommending the use of a wet nurse, health-care providers need to ensure that:

  • There is no reason for the mother not to share her milk.
  • Breastfeeding a second baby will not affect her health.
  • Her own baby is growing well.

F) The risks of infant formula-feeding in emergencies

Infant formula-feeding during emergencies is often difficult for mothers and extremely dangerous for babies and young children (WHO 2004).

1) Using ready-to-use infant formula

Infant formula used in emergencies should be ready-to-use and stored in single portions.

The challenges of using such infant formula in an emergency may include: 

  • Finding infant formula that the baby can tolerate.
  • Paying for infant formula.
  • Getting clean water to sterilize feeding tools such as bottles and nipples.
  • Accessing heat or power to sterilize feeding tools and to warm infant formula before use.
  • Storing infant formula.
  • Difficulty transporting large numbers of heavy containers of infant formula.

2) Additional challenges of using liquid concentrate or powdered infant formula

Mothers and babies in emergencies face additional challenges if ready-to-use infant formula is not available and they are forced to use liquid concentrate or powder. Preparation and use of these products include:

  • Obtaining clean water to prepare infant formula.
  • Accessing heat or power to sterilize water used for infant formula preparation.
  • Reading directions on how to prepare infant formula (Wallace 2016).
  • Avoiding mixing errors.
  • Storing prepared infant formula.

References

Angood C. Operational Guidance on Infant Feeding in Emergencies (OG-IFE) version 3.0, 2017

Akseer N, Kandru G, Keats EC, et al. COVID-19 pandemic and mitigation strategies: implications for maternal and child health and nutrition. Am J Clin Nutr. 2020 Aug 1;112(2):251-256

Burrell A, Kueter AM, Ariful S, et al. Appropriate Infant and Young Child Feeding Practices in an Emergency for Non-Breastfed Infants Under Six Months: The Rohingya Experience [published online ahead of print, 2020 Mar 13]. J Hum Lact. 2020;890334420906838

Branca F, Schultink W. Breastfeeding in emergencies: a question of survival. Geneva: WHO; 2016 May 20 [cited Oct 15, 2019]

Carothers C, Gribble K. Infant and Young Child Feeding in Emergencies. JHL 2014;30(3):272-5 

COUNCIL ON COMMUNITY PEDIATRICS; COMMITTEE ON NUTRITION (CCPCN). Promoting Food Security for All Children. Pediatrics. 2015 Nov;136(5):e1431-8

DeYoung SE, Chase J, Branco MP, et al. The Effect of Mass Evacuation on Infant Feeding: The Case of the 2016 Fort McMurray Wildfire. Matern Child Health J. 2018 Jul 27

Emergency Nutrition Network (ENN). Infant Feeding in Emergencies; Module 1
for emergency relief staff. Manual for orientation, reading and reference. Emergency Nutrition Network 2001 Mar

Gribble K. Supporting the Most Vulnerable Through Appropriate Infant and Young Child Feeding in Emergencies. J Hum Lact. 2018;34(1):40‐46 

Infant and Young Child Feeding in Emergencies (IFE) Core Group. Infant and Young Child Feeding in Emergencies; Operational Guidance for Emergency Relief Staff and Programme Managers. Oxford: IFE Core Group; Version 2.1 – February 2007

Kent G. Global infant formula: monitoring and regulating the impacts to protect human health. Int Breastfeed J. 2015 Feb 23;10:6

Kent G. Wet Nursing in Emergencies. World Nutrition 2018; 9(3):314-323

Prudhon C, Benelli P, Maclaine A, et al. Informing infant and young child feeding programming in humanitarian emergencies: An evidence map of reviews including low and middle income countries. Matern Child Nutr. 2017 Jul 3 

Rabbani A, Padhani ZA, A Siddiqui F, et al. Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates. BMJ Open. 2020 Sep 13;10(9):e036757

Salmon L. Food security for infants and young children: an opportunity for breastfeeding policy? Int Breastfeed J. 2015 Feb 23;10:7
 
Venu I, van den Heuvel M, Wong JP, et al. The breastfeeding paradox: Relevance for household food insecurity. Paediatr Child Health. 2017 Jul;22(4):180-183
 
Wallace LS, Rosenstein PF, Gal N. Readability and Content Characteristics of Powdered Infant Formula Instructions in the United States. Matern Child Health J. 2016 Apr;20(4):889-94
 
World Health Organization (WHO). Guiding principles for feeding infants and young children during emergencies. Geneva: World Health Organization; 2004