Breastfeeding in times of war

In order to understand why there should be a significant focus on breastfeeding mothers in times of crisis, FairPlanet spoke with Andrea Poloková and Adela Boldižárová of MAMILA, a civic organisation that aims to support women throughout their breastfeeding journey.

With trained and certified lactation consultants, the NGO has been providing assistance and advice in Slovakia and 10 other European countries for twenty years. It came as no surprise, then, that their team quickly responded to the humanitarian crisis that followed the Russian invasion of Ukraine.  

“Solutions to breastfeeding problems tend not to be offered the way they should be in peaceful times, thus in the context of the war or other humanitarian crises, women often get even less help with breastfeeding,” explains Andrea Poloková, who leads MAMILA. 

According to data published in July by the UN International Organisation for Migration (IOM), about 6.1 millions Ukrainians left to seek shelter in other European countries and 6.6 millions Ukrainians relocated to safer territories within Ukraine. IOM estimates that 4 percent of internally displaced women in Ukraine are either pregnant or breastfeeding.

The United Nations Population Fund estimates that 265,000 Ukrainian women were pregnant in the early days of the Russian invasion, and at the time of publishing its report in April predicted that roughly 80,000 women will give birth in the following three months. 

In general, Ukrainian women and kids account for the largest demographic of refugees, and are thus among the most vulnerable. These numbers certainly raise questions as to what strategies should be applied to feed babies during times of emergency. The WHO, on its part, emphasises that breastfeeding is “one of the most effective ways to ensure child health and survival.

“Breastmilk is the ideal food for infants. It is safe, clean and contains antibodies which help protect against many common childhood illnesses.” 

The case of Iraq

Poloková of MAMILA noted that there are numerous studies delving into the issue of breastfeeding during humanitarian crises. Michael Malcolm, along with co-authors Vidya Diwakar and George Naufal, conducted a case study on Iraq and the question of breastfeeding during the prolonged conflict in the country.

The authors explain that there are certain undeniable variables that in emergency situations have an impact on breastfeeding mothers, the most common of which are mothers’ poor nutrition, access to clean drinking water and stress. They conclude, however, that the key determinant to whether a woman will breastfeed is the presence of medical and health professionals who can support her in breastfeeding. 

In the context of Iraq, the researchers reference a 2003 report by the Emergency Nutrition Network, which found that significant distributions of formula milk in 1996 by The World Food Programme was “a major contributing factor to infant malnutrition, morbidity and mortality,” and reduced breastfeeding rates, too. This resulted from insufficient instruction on formula-feeding (an entirely different process from breastfeeding), lack of access to clean water and the absence of certain enzymes and other components in formula milk that are found in breastmilk. 

“Alternative interventions like skilled breastfeeding support for conflict-affected mothers may provide more sustainable benefits and with fewer unintended consequences,” the researchers wrote. 

dispelling myths around breastfeeding

Back in March, two certified lactation consultants from MAMILA travelled to Vyšné Nemecké on the Slovak-Ukrainian border in order to assess the situation for breastfeeding Ukrainian refugee mothers. 

At that time, Vyšné Nemecké was one of three border crossings that faced an unprecedented influx of almost 370,000 Ukrainian refugees. As of 29 June, the Slovak Ministry of Interior granted 83,131 Ukrainians temporary protection status; of those, over 40,000 are women and about 33,000 are kids. Neither the Ministry of Interior nor other institutions collect data on how many of these women are either breastfeeding or due to give birth in Slovakia. 

It is widely believed that breastfeeding women lose milk when dealing with crisis or high levels of stress, but Poloková opposes this view, claiming that it “results from a lack of understanding of breastfeeding as a key moment in humanitarian crises, not to mention other contexts.” 

“Breastfeeding counselling is key given the possible unavailability of other feeding methods or the risks that these feeding methods imply,” she added.

As Poloková emphasised, breastfeeding may also give the mother a sense of control in unstable circumstances, as it has scientifically proven calming effects generated by a hormone called oxytocin, which is produced in both the mother's and the baby's body.

All the while, the risks associated with breastmilk substitutes are numerous. Not only may accessibility to formula itself be regularly curtailed in emergency situations, but access to clean drinking water and the hygienic preparation process could be limited too, Poloková explains. She identifies the inconsistent assistance of humanitarian agencies in safe feeding during the current crisis as one of the core issues, and suggests that agencies should follow international standardised practices defined by the WHO and listed in the Infant Feeding in Emergencies document. 

“Donations or supply of formula should be done through organisations that have  established a system for collection and distribution of the formula and only to infants who truly need it,” she said, stressing that “influence by commercial interest” must be prevented. 

Responding to the crisis at the border

From the onset of the conflict, professional lactation consultants in MAMILA  networked with humanitarian aid organisations that were helping Ukrainian refugees in Slovakia in order to reach as many refugee mothers as possible, and their lactation consultants still offer free support to Ukrainian women. 

Adela Boldižárová, a consultant stationed in the town of Košice, already assisted two Ukrainian refugee mothers with newborns. But the situation Boldižárová and her colleague encountered on the border made them focus their work on verbal discussion with mothers as opposed to immediately offering practical help. 

Yet despite the apparent difficulties that necessitate a different approach to counselling, Boldižárová believes they can keep helping mothers at the border, granted the appropriate conditions will be provided. “It would require some dedicated space [...] Each mother perceives her situation very personally; it is always an individual situation. Some mini-space where a mother could sit down and where she could put the baby down to give her some comfort.” 

Since the general situation at the border has changed, and the number of refugees crossing the border is decreasing, lactation consultants from MAMILA now focus on counselling Ukrainian mothers where they stetled in Slovakia.

Both of the Ukrainian mothers that Boldižárová met gave birth in Slovakia and have since returned to Ukraine.

Boldižárová tried to connect FairPlanet with the family that stayed in Košice for a while longer. Unfortunately, we were only able to exchange a few short messages, in which the Ukrainian mother wrote that it was very important for her that the child was fed with breastmilk and that the help she received made her “believe that everything will work out and [to] not give up.”

Image by Mirek Pruchnicki.