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Guidance on provision and use of breast-milk substitutes in humanitarian settings, UNICEF 2018

This guidance document is intended for internal use by UNICEF staff
working in humanitarian settings, who are requested to support the
procurement and/or distribution of breastmilk substitutes (BMS). This
guidance is not intended to provide comprehensive programming guidance
on infant feeding in emergencies but focuses on the procurement and use of
BMS. It was developed in tandem with Supply Directive CF/SD/2018-01.
Breastfeeding is the biological norm and the best way to feed infants under
six months of age. After six months, breastfeeding should be continued
together with complementary feeding up to the age of two years or
beyond. UNICEF is committed, as per the Core Commitments for Children
in humanitarian action, to protect, promote and support breastfeeding in
emergencies.

However, there are infants and young children who cannot be breastfed, or
are partially breastfed, for a longer or shorter period of time. These include:
1) Infants and young children who were orphaned or whose mother has
been absent for a long period of time either before the humanitarian
situation or in the course of the humanitarian situation and for
whom wet-nursing, relactation or receiving donor human milk is not
feasible;
2) Infants and young children whose mother is present and who were
not breastfed before the time the humanitarian situation or in the
course of the humanitarian situation regardless of the reason, and for
whom wet-nursing, relactation or receiving donor human milk is not
feasible;
3) Situations where the mother and/or infant has a medical condition
for which breastfeeding is not possible, and for whom wet-nursing,
relactation or receiving donor human milk is not feasible; and
4) Infants under the age of 6 months who are mixed fed (breastfeeding
plus BMS) and whose mother is being supported to transition to
exclusive breastfeeding.

These infants and young children need to be fed an appropriate BMS in
a safe and sustainable way, without jeopardising breastfeeding in the
remainder of the population. The BMS that carries the lowest risk for
contamination in humanitarian settings is ready-to-use infant formula
(RUIF), which should be provided with a feeding cup.
The decision to accept, procure, use or distribute BMS in a humanitarian
emergency must be made by informed, technical personnel in consultation
with the agency responsible for cluster or sector coordination, lead technical
agencies involved in the response, and governed by strict criteria. When
resources are limited, infants under six months of age should receive
priority for support.
If there is a need to procure BMS, UNICEF will act as the provider of last
resort, whether or not the Cluster has been activated. The procurement
needs to be done in accordance with global and UNICEF guidelines. Offices
that are considering the procurement and distribution of BMS need to seek
agreement from UNICEF Headquarters in New York (Nutrition Section,
Programme Division) and Copenhagen (Medicines and Nutrition Center
(MNC), Supply Division (SD)). This document provides a template for
such a request. It also includes key messages for donors, fundraisers and
the media.

Organization(s): 
United Nations Children's Fund
Cluster(s)/Sector(s): 
Original Publication Date: 
14 Jun 2018
Document type: 
Handbook or Manual
Theme(s): 
Infant and Young Child Feeding
Coordination hub(s): 
Regional Office for Latin America and the Caribbean (ROLAC)