Supporting One of Haiti’s Most Important Natural Resources: Breast Milk

By Rose St. Fleur, M.D., FAAP

Haiti experienced a devastating earthquake in February 2010. Since then, we all have been working tirelessly to provide desperately needed medical assistance. The ongoing cholera epidemic is a testament to the many disturbing consequences of the earthquake on this beloved country. Maximizing Haiti’s resources in times of crisis is critical to effective support, and CRUDEM is expert at handling this task efficiently. Still, during times like this, we sometimes overlook one essential resource: a mother’s breast milk. The substantial positive impact of breastfeeding is immeasurable because breast milk, and the associated practices designed to support the breastfeeding mother, are crucial to infant survival.

Breast milk is beneficial for all babies. It contains billions of live antibodies to boost immune function, white blood cells to fight off infections, and antioxidants for cellular repair. Breast milk helps to reduce infant mortality from diseases such as upper respiratory infections, pneumonias, and diarrhea. For mothers, breast milk assists in reducing the risk of post partum depression and increases oxytocin, which can aid in stress adaptation. Breast milk carries critical importance in countries where access to consistent and complete health care is poor, as is the case in many parts of Haiti. During times of a natural disaster, when clean water availability is in jeopardy and disease spreads rapidly, breast milk can literally be a lifesaving fluid for children.

However, the breastfeeding mother is often vulnerable to changes during times of crisis. She may be encouraged to offer infant formula to her infant, not realizing the profound impression that this simple act holds for the health of her baby. When a mother breastfeeds, the suckling actions of the infant on the breast trains her body to produce more milk for her baby as it is being consumed. Up to 50% of human milk is produced at the same time the infant breastfeeds, stimulated by infant suckling alone. But, when a breastfeeding mother gives infant formula to her baby, her own milk supply is not stimulated by the nursing infant. As a result, her milk supply begins to decrease almost immediately. The mother becomes more and more unable to supply sufficient breast milk to her infant, so she begins a pattern of dependence on infant formula. This can be detrimental and even fatal to infants because infant formula does not supply the same protective effects that breast milk offers. We have already seen instances of this occurring in many parts of the world – the United Nations Children’s Fund (UNICEF) estimates that approximately 1.4 million children under five years of age die every year from suboptimal breastfeeding.

In addition to not providing her infants with essential nutrients for survival, the mother who must formula feed now faces the significant financial burden of purchasing formula, nipples and bottles. To make matters more difficult, infant formula must be stored in a clean, dry area – not easily done in tropical climates. A closed, sealed package of powdered infant formula is not sterile; any amount of handling easily contaminates the product even more. Finally, infant formula must be prepared using sterilized feeding equipment and clean water. This poses an additional challenge for the mother who does not have access to a reliable source of clean water for such purposes. Some forms of infant formula are “ready-to-feed,” meaning that mixing with water is necessary. However, these formulas are often the most expensive to purchase and the most difficult to find – not to mention that it still does not provide the unsurpassed protective benefits of breast milk.

he World Health Organization (WHO) has long recognized the benefits of breast milk on mothers and babies afflicted by natural disasters. Because breast milk is so vitally important for infants and young children, it calls for the protection, promotion, and support of breastfeeding through a list of interventions for health care settings called the “Ten Steps to Successful Breastfeeding.” These Ten Steps include practices such as initiating breastfeeding early in life (preferably within a half hour of birth,) ensuring that mothers and babies remain together as much as possible, and encouraging frequent breastfeeding (at least 8-12 times a day.)

The WHO also discourages practices that may threaten breastfeeding, such as the practice of injudicious infant formula distribution. In fact, the WHO has written a code of ethics – The International Code of Marketing of Breast Milk Substitutes – that addresses this concern. In it, the Code states “…[that] inappropriate feeding practices lead to infant malnutrition, morbidity and mortality in all countries, and that improper practices…can contribute to … major public health problems.”

What can we do to provide humanitarian relief in a manner that respects and upholds breastfeeding?
Here are some tips:

• The safest food for an infant, especially during times of crisis, is mother’s milk! In these situations, infants are at higher risk of imminent death from dehydration and infections than they are from other more chronic illnesses, even HIV. Never give infant formula to a child that is breastfeeding and growing well.

• If you have an infant that is not growing well, first assess the level of malnutrition and dehydration, and offer breast milk as much as possible. This may be done by teaching the mother to express her milk using her hands.

• Promote breast milk production by keeping mothers and infants together as much as possible, and encouraging the act of “skin-to-skin” as much as possible. This means having the nude infant (except the diaper) in contact against mother’s bare chest, covering both with additional fabric for modesty. Research has shown that skin-to-skin behaviors increase growth rates in infants and breast milk volumes in mothers.

• Optimize mother’s nutritional status as much as possible so that she can make as much breast milk as her body will allow. Ensure proper hydration, vitamin supplementation, and caloric intake for the mother.

• Be aware that infants born in developed countries like United States are often larger due to overnutrition. A baby that appears small to the untrained eye may be, in fact, of normal size. Always use WHO-endorsed growth charts to measure an infant’s weight, height, and head circumference. Do not use a growth chart from a formula-endorsed company since they are usually inaccurate.

Finally, maintain a constant awareness of the sustainability of your intervention, especially in regards to breastfeeding. In keeping with the spirit of CRUDEM’s mission, we help to develop “a healthier Haiti, one dignified life at a time” by empowering the Haitian mother to maximize her most precious resource to her child: her own lifesaving milk. To the mother who has lost so much, this may be the only lasting gift she has to give.

Rose St. Fleur, MD, FAAP is a member of the Academy of Breastfeeding Medicine and the Breastfeeding Coordinator, American Academy of Pediatrics, New Jersey Chapter. Dr. St. Fleur is a Pediatrics Generalist and Clinical Assistant Professor, at Jersey Shore University Medical Center, Affiliate of University of Medicine and Dentistry of New Jersey-Robert Wood Johnson Medical School in Neptune, NJ. She received her M.D. from University of Rochester School of Medicine and Dentistry, Rochester, NY. and was Chief Resident, Department of Pediatrics at Winthrop-University Hospital, Mineola, NY.

A longtime medical volunteer at HSC, Dr. St. Fleur had the opportunity to serve in Milot, following the 2010 earthquake, with her husband who is an anesthesiologist. The couple lives in Jackson, NJ with their two children, aged 4 ½ and 11 ½ months. In addition to her passionate advocacy of breastfeeding education and promotion, Dr. St. Fleur enjoys reading and traveling.

 


 
References:
Eidelman, A, et al. Policy Statement: Breastfeeding and the Use of Human Milk. Pediatrics March 2012 129(3): e827-41.

Heinrichs, M et al. effects of suckling on hypothalamic-pituitary-adrenal axis responses to psychological stress in postpartum lactating women. Journal of Clinical Endocrinology and Metabolism 2001 86(10): 4798-804.

Groer, MW et al. Postpartum stress: current concepts and the possible protective role of breastfeeding. Journal of Obstetric and Gynecologic Neonatal Nursing 2002 31:411-17.

Stanford School of Medicine: Hand Expression of Breast Milk. Available, with video, at: http://newborns.stanford.edu/Breastfeeding/HandExpression.html

Mikiel-Kostrya, et al. Effect of early skin-to-skin contact after delivery on duration of breastfeeding: a prospective cohort study. Acta Pediatrica 2002 91(12): 1301-6.

UNICEF: Infant Nutrition and Child Feeding. Available at: http://www.unicef.org/nutrition/index_breastfeeding.html

World Health Organization: The WHO Child Growth Standards. Available at: http://www.who.int/childgrowth/standards/en/

The World Health Organization. International Code of Marketing of Breast Milk Substitutes (1981). Available at: http://www.who.int/nutrition/publications/code_english.pdf

UNICEF: International Code of Marketing of Breast Milk Substitutes. Available at: http://www.unicef.org/nutrition/index_24805.html

The United States Breastfeeding Committee: Breastfeeding and Emergencies. Available at: http://www.usbreastfeeding.org/Communities/BreastfeedingandEmergencies/tabid/193/Default.aspx