Academic journal article Bulletin of the World Health Organization

Protecting and Improving Breastfeeding Practices during a Major Emergency: Lessons Learnt from the Baby Tents in Haiti/Proteger et Ameliorer Les Pratiques D'allaitement Maternel Au Cours D'une Situation D'urgence Majeure: Les Lecons Tirees Des Rentes Pour Bebes En Haiti/Proteger Y Mejorar Las Practicas De la Lactancia Materna En Casos De Emergencias Graves: Lecciones Aprendidas En Las Tiendas Para Bebes En Haiti

Academic journal article Bulletin of the World Health Organization

Protecting and Improving Breastfeeding Practices during a Major Emergency: Lessons Learnt from the Baby Tents in Haiti/Proteger et Ameliorer Les Pratiques D'allaitement Maternel Au Cours D'une Situation D'urgence Majeure: Les Lecons Tirees Des Rentes Pour Bebes En Haiti/Proteger Y Mejorar Las Practicas De la Lactancia Materna En Casos De Emergencias Graves: Lecciones Aprendidas En Las Tiendas Para Bebes En Haiti

Article excerpt

Background

On 12 January 2010, an earthquake measuring 7.3 on the Richter scale hit Haiti. Its epicentre was close to Port-au-Prince, the capital city. Overall, about 3 million people, or 30% of the country's population, were affected--half of them children. Approximately 300 000 people were killed and another 300 000 were injured. (1) The earthquake destroyed homes and forced 1.5 million people into displacement. (2) Many of these people took up residence in one of the country's 1555 crowded camps for internally displaced persons. (3) Port-au-Prince, where the majority of the camps were established, was already home to a poor population with little access to basic social services. The rate of exclusive breastfeeding (21.7%) in the city was the lowest in the country even before the earthquake and there was fear that breastfeeding practices would be further jeopardized during the emergency)

The humanitarian response to the crisis was fast and multifaceted. In collaboration with local and international nongovernmental organizations (NGOs), the Haitian health ministry and the United Nations Children's Fund (UNICEF) established baby tents (points de conseils en nutrition pour bebes [infant nutrition counselling units]) throughout the areas affected by the earthquake (the cities of Port-au-Prince, Jacmel, Leogane, Petit Goave and Gonaive). Similar smaller initiatives, described elsewhere, had been launched in Bosnia, Kenya, the Philippines and the United Republic of Tanzania in response to various types of emergencies. (5,6) These initiatives helped to inform Haiti's response, but Haiti's baby tent programme was the world's largest coordinated response of its kind in an emergency context.

In this article we describe Haiti's baby tent strategy, the results achieved, the challenges encountered and some potential ways to address these challenges. We also discuss certain recommended features of future emergency programmes in support of infant and young child feeding.

Context

Before the earthquake

According to empirical evidence, 19% of all deaths among children younger than 5 years in the developing world could be prevented through appropriate infant and young child feeding practices. (7) In Haiti, implementation of the infant and young child feeding practices recommended by the World Health Organization (WHO) and UNICEF was hindered by certain circumstances and beliefs. (8-10) For example, infants were often separated from their working mothers during the day and some people felt that the first milk was "dirty" and harmful to neonates. According to the 2005-2006 Demographic and Health Survey, 44% of Haitian mothers initiated breastfeeding immediately after birth and 41% of infants less than 6 months old were exclusively breastfed. Of infants in this age group, another 23.7% were prematurely given liquid, semi-solid and solid foods of suboptimal quality. (11)

After the earthquake

Haiti's health ministry and nutrition partners (UNICEF, WHO, the United Nations World Food Programme and various NGOs) feared that harsh living conditions in the camps for displaced persons would lead to the abandonment of appropriate infant and child feeding practices. They also realized that infants whose mothers had died or were missing would need to be fed and cared for. There were also fears that a flood of donated infant formula and milk products would lead to the uncontrolled distribution of these products and to increased rates of diarrhoea and death among infants as a result of unhygienic bottle feeding practices. Haiti had been a recipient of donations of all kinds from the United States of America for decades. In the weeks immediately after the earthquake, Haiti received infant feeding products from different countries in enormous quantities, in violation of the International Code on the Marketing of Breast Milk Substitutes, which restricts the marketing of breast-milk substitutes to protect breastfeeding. …

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