Feeding in crisis. Exploring the provision of breastfeeding support during humanitarian emergencies

Establishing exclusive breastfeeding is crucial to decreases infants’ risk of morbidity and mortality and it is central for the treatment of malnutrition among infants aged less than six months (<6m). Yet, very little research has explored the feasibility, acceptability, and outcomes of breastfeeding support among mothers and infants <6m during humanitarian emergencies. The aim of this thesis was to increase knowledge about the provision of breastfeeding support during humanitarian emergencies. Three studies are included: Study I is a systematic review to compile and assess the characteristics and outcomes of reported interventions supporting the re-establishment of breastfeeding (i.e., relactation); Study II is a qualitative study to explore caregivers’ and health workers’ perceptions of breastfeeding practice, promotion, and support within a Medecins Sans Frontieres project in North-East Nigeria; and Study III describes the characteristics and treatment outcomes of malnourished infants <6m receiving breastfeeding support as part of their management in the same project. The success of relacatation interventions vary widely across contexts. Almost 80% of mother-infant pairs in reviewed studies re-started lactation after support interventions, but less than half achieved exclusive BF. Ralactation feasibility and outcomes during emergencies remain unstudied. The provision of BF support can be feasible and positively valued among populations affected by protracted humanitarian emergencies like North-East Nigeria, especially when associated to the management of malnutrition. Stabilization and recovery rates among malnourished infants <6m were acceptable in the humanitarian setting studied. Defaulting rates from ambulatory care need further attention. Future research should investigate most suitable approaches to support mothers with partially or non-breastfed infants <6m during humanitarian emergencies, while acknowledging maternal perspectives.