World

Procurement and use of breastmilk substitutes in humanitarian settings

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Executive summary

UNICEF is committed to supporting mothers to exclusively breastfeed their infants to 6 months of age and to continue breastfeeding to age 2 and beyond with appropriate complementary foods. Protection, promotion, and support for breastfeeding is central to all humanitarian programmes that include infant and young child feeding (IYCF) support. However, there are circumstances where infants cannot be breastfed. This guidance document outlines UNICEF’s commitments, guiding principles, and procedures for managing the procurement and use of breastmilk substitutes (BMS) for UNICEF staff working in humanitarian settings, where BMS are one component of humanitarian programmes to protect, promote and support infant feeding. This guidance is not intended to provide comprehensive programming guidance on infant feeding in emergencies.

This guidance confirms that UNICEF can act as the provider of first resort for BMS where procurement is warranted as part of an overall humanitarian response that supports optimal IYCF; as well as the provider of last resort for BMS, in line with its Cluster Lead Agency (CLA) accountabilities.

In every emergency, there will be infants who are not breastfed or who are partially breastfed. These infants are highly vulnerable and require urgent and targeted protection and support given their increased risk of morbidity and mortality.

Groups of concern 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 (e.g., medical conditions where it is recommended that a mother not breastfeed temporarily or permanently), and for whom wetnursing, relactation or receiving donor human milk is not feasible

  4. As a temporary measure, infants under 6 months of age who are mixed fed (breastfeeding plus BMS) while their mothers are supported to transition to exclusive breastfeeding.

These infants need to be fed an appropriate BMS in a safe and sustainable way, without jeopardizing breastfeeding practices in the remainder of the population.

As part of the UNICEF Core Commitments for Children in Humanitarian Action (CCCs), UNICEF has a key role to play in providing support in the preparedness and response efforts. As such, the procurement of breastmilk substitutes for infants in need is aligned with our commitments.

The decision to 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 6 months of age should be prioritized for support.

If there is a need to procure BMS in humanitarian contexts, UNICEF can act as the provider of first resort and procure BMS 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 Centre, Supply Division (SD)). This document provides a template for such a request. It also includes key messages for donors, fundraisers and the media.