International Column: Effects of Humanitarian Emergencies on Newborn and Infants' Health in Pakistan

Sociocultural Factors Affecting Breastfeeding Practices of Mothers During Natural Disasters: A Critical Ethnography in Rural Pakistan

Natural disasters affect the health and well-being of mothers with young children. During natural disasters, this population is at risk of discontinuation of their breastfeeding practices. Pakistan is a middle-income country that is susceptible to natural disasters. This study intended to examine sociocultural factors that shape the breastfeeding experiences and practices of internally displaced mothers in Pakistan. This critical ethnographic study was undertaken in disaster-affected villages of Chitral, Pakistan. Data were collected utilizing multiple methods, including in-depth interviews with 18 internally displaced mothers and field observations. Multiple sociocultural factors were identified as either barriers or facilitators to these mothers' capacities to breastfeed their children. Informal support, formal support, breastfeeding culture, and spiritual practices facilitated displaced mothers to sustain their breastfeeding practices. On the other hand, lack of privacy, cultural beliefs, practices and expectations, covert oppression, and lack of healthcare support served as barriers to the breastfeeding practices of displaced mothers.

Barriers and challenges of infant feeding in disasters in middle- and high-income countries

BACKGROUND

Global evidence from the past 35 years confirmed the protective effect of breastfeeding and supported the guidance to protect, promote, and support breastfeeding practices, particularly in natural disaster and conflict settings. This study aimed to summarize the difficulties faced by disaster responders and mothers for optimal infant feeding during disasters in middle and high-income countries.

METHODS

A scoping literature review was conducted by searching databases for peer-reviewed literature and grey literature published between January 2010 and December 2018 that focused on infant feeding in the aftermath of disasters. Only disasters that occurred in middle or high-income countries as defined by the World Bank for the 2018 fiscal year were included.

RESULTS

The study found that a major challenge faced by organizations establishing infant feeding in emergencies (IFE) programs is the violation of The International Code of Marketing of Breastmilk Substitutes by other aid organizations and governments, such as acceptance of donated infant formula and untargeted distribution of formula. Additionally, many disaster responders were unfamiliar with IFE protocols. Mothers faced other barriers to breastfeed their infants during disasters. They often lacked privacy or spaces conducive to breastfeeding. Limited fluid and energy intake, stress, and exhaustion also deterred mothers from breastfeeding. Many challenges for responders and barriers mothers face for optimal infant feeding practices persist despite existing guidelines.

CONCLUSIONS

The findings of this study reveal the lack of IFE preparedness and response capacity in middle and high-income countries, and the need for governments and aid organizations to adapt guidelines and establish policies and programs to support infant feeding in emergencies.

A Policy Brief on Promotion, Protection, and Support of Breastfeeding Practices During Disaster and Displacement

Introduction

During natural disaster a sudden increase in infant mortality and morbidity rates are reported. Breastfeeding practices are essential to prevent malnutrition-related mortalities among infants during disaster and displacement.

Methods

Findings from the undertaken critical ethnographic study in the disaster relief camps of Chitral, Pakistan, were referred to identify need-based policies to promote, protect, and support breastfeeding among displaced mothers.

Policy Implications

The study identified the need for strategic policies at sociocultural, economic, and geopolitical levels to support breastfeeding and save lives of young children during natural disasters.

Conclusion

This article will facilitate clinicians, healthcare providers, and national and international agencies to recognize gaps in the existing policies and services targeting breastfeeding mothers during disaster and displacement.

Breastfeeding in Disaster Relief Camps: An Integrative Review of Literature

Breastfeeding is the safest mode of infant feeding during disasters and displacement. Although challenges associated with breastfeeding during humanitarian emergencies are global, they are particularly problematic in low- and middle-income countries such as Pakistan. To examine the factors that affect breastfeeding practices of displaced mothers in disaster relief camps, an integrative review of literature was undertaken. The review suggests that the breastfeeding experiences, behaviors, and practices of displaced mothers are shaped by a combination of gender-based, sociocultural, economic, and geopolitical factors. A thorough understanding of these factors will assist nurses and other stakeholders to improve breastfeeding practices and decrease child deaths in disaster relief camps.