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Iellamo A, Wong CM, Bilukha O, Smith JP, Ververs M, Gribble K, Walczak B, Wesolowska A, Al Samman S, O’Brien M, Brown AN, Stillman T, Thomas B. "I could not find the strength to resist the pressure of the medical staff, to refuse to give commercial milk formula": a qualitative study on effects of the war on Ukrainian women's infant feeding. Front Nutr 2024; 11:1225940. [PMID: 38826579 PMCID: PMC11140133 DOI: 10.3389/fnut.2024.1225940] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Accepted: 04/24/2024] [Indexed: 06/04/2024] Open
Abstract
Introduction During emergencies, breastfeeding protects infants by providing essential nutrients, food security, comfort, and protection and is a priority lifesaving intervention. On February 24, 2022, the war in Ukraine escalated, creating a humanitarian catastrophe. The war has resulted in death, injuries, and mass internal displacement of over 5 million people. A further 8.2 million people have taken refuge in neighboring countries, including Poland. Among those impacted are infants and young children and their mothers. We conducted a study to explore the infant feeding challenges and needs of Ukrainian women affected by the war. Methods We conducted a qualitative descriptive study involving in-depth interviews (IDIs) with 75 war-affected Ukrainian mothers who had at least one infant aged less than 12 months at the time of the interview. Eligible mothers were either (1) living as Ukrainian refugees in Poland, having crossed the border from Ukraine on or after February 24, 2022, when the war started (n = 30) or (2) living in Ukraine as internally displaced persons or as residents in the community (n = 45). All interviews were audio-recorded (either transcribed or had responses summarized as expanded notes) and analyzed using qualitative thematic analysis using a two-step rapid analysis process. Results Participants in Ukraine who wanted to initiate breastfeeding right after birth faced opposition from healthcare workers at maternity hospitals. Ukrainian refugees who gave birth in Poland faced language barriers when seeking breastfeeding support. Half of the participants in Ukraine received commercial milk formula (CMF) donations even if they said they did not need them. Most respondents stated that breastfeeding information and support were urgently needed. Conclusion Our data suggests that healthcare workers in Ukrainian maternity hospitals require additional training and motivation on delivering breastfeeding support. In addition, lactation consultants in maternity ward are needed in Ukraine, and interpretation support is needed for refugees to overcome language barriers. There is a need to control the indiscriminate donations of commercial milk formula and to ensure that complementary foods and commercial milk formula are available to those that need it. This study confirms the need for actions to ensure infant and young child feeding (IYCF) support is provided during emergencies.
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Affiliation(s)
| | | | - Oleg Bilukha
- Global Public Health Emergency Branch, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Julie P. Smith
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, NSW, Australia
| | - Mija Ververs
- Global Public Health Emergency Branch, Global Health Center, Centers for Disease Control and Prevention, Atlanta, GA, United States
| | - Karleen Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Bartłomiej Walczak
- Institute of Applied Social Sciences, University of Warsaw, Warsaw, Poland
| | - Aleksandra Wesolowska
- Laboratory of Human Milk and Lactation Research, Department of Medical Biology, Faculty of Health Sciences, Medical University of Warsaw, Warsaw, Poland
- Human Milk Bank Foundation, Warsaw, Poland
| | - Sura Al Samman
- Jordan Community Health and Nutrition Behavior Change Project, FHI 360 WAMERO, Amman, Jordan
| | - Michael O’Brien
- Crisis Response Unit, FHI 360, Washington, DC, United States
| | - Annette N. Brown
- Strategy and Innovation with Evidence Unit, FHI 360, Washington, DC, United States
| | | | - Blythe Thomas
- 1000 Days Initiative, FHI Solutions, Washington, DC, United States
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Hwang CH, Iellamo A, Ververs M. Barriers and challenges of infant feeding in disasters in middle- and high-income countries. Int Breastfeed J 2021; 16:62. [PMID: 34425848 PMCID: PMC8383418 DOI: 10.1186/s13006-021-00398-w] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2020] [Accepted: 06/08/2021] [Indexed: 11/10/2022] Open
Abstract
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.
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Affiliation(s)
- Cindy H Hwang
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | | | - Mija Ververs
- Johns Hopkins Bloomberg School of Public Health, Center for Humanitarian Health, Baltimore, MD, USA.
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