it would first need a counselling dialogue with the mother to find out why she wants BMS? Is it prestige, a perceived more modern behaviour, a perception of not enough milk, not enough milk, or afraid of not having enough milk, sexual tabous, sharing infant care or planned absence of the BF mother.........

Further the insistance of mothers to get BMS is linked to the fact that the promotion of BMS is very overwhelming and imprints mothers/ parents and their environment!

It would help to have unbranded "unattractive" packages to distribute!

There is a need correcting the myths on BMS and clear information on breastfeeding and breastmilk to happen at the best befor the demand for BMS is there: "Breastfeeding has often been described as cost free.1 It is not free. Breastfeeding requires investment to overcome the sociopolitical barriers that exist in many countries2,3 through the eff ective approaches and practices described in the second paper of the Lancet Breastfeeding Series.4 As shown in the fi rst Series paper, infants, children, and mothers who do not breastfeed experience an increased risk of mortality and morbidity.5 Breastfeeding is nutritionally, immunologically, neurologically, endocrino logically, economically, and ecologically superior to breastmilk substitutes (BMS), and does not require quality control of manufacture, transport, storage, and feeding mechanisms." Quote from: https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)00103-3/fulltext

In order to address the questions, first of all, we should have to consider the type of emergency, location, context of the displacement such as the socio-economic, culture, religion and educational backgrounds. As an IYCF counselor working within an IYCF-E response, our approach responding to an emergency in developing and devloped countries vary. During complex emergency response especially in developing countries basic availability and accessibility of services such as: Health and Nutrition, food, WASH, Shelter, education and livelihood are ill served. Thus, requests for BMS from ineligible caregivers is huge, literally if the BMS provision is at food distribution site with other relief commodities and if the market value for BMS is high. However, if the provision of BMS is supported by Health/Nutritionst at Health facilities and or BFHI with strong HEALTH related SBCC then caregivers will realise the eligibility criteria and give up their requests with know-how effectively.

Hi Daniel,

I agree with you that having health/medical organisations/staff in charge of BMS distributions is a great help in terms of enabling distributions that are ethical and in line with the OG-IFE. 

I think that it is very helpful for emergency responders and organisations to know why mothers and other caregivers are requesting infant formula and for counsellors to use this knowledge in their work. Exploring why women are requesting infant formula is therefore critically important. In many instances it will be because they believe that they do not have sufficient breastmilk for the infant and in most instances this will not be true. Helping women through counselling to accurately assess their situation can remove any need to refuse providing infant formula. Other reasons for request such as wanting to obtain a high value product for resale or where the request comes from an aspiration to formula feed, will need a different counselling response.

Hi. I appreciate Daniel's and Karleen's suggestions about how caregivers who request infant formula need to be handled. We need to be very careful that in addition to appropriately counselling the caregiver, identifying her conserns and reason for the request in an empathetic manner, practical assessment of her ability to breastfeed adequately or not, is provided by skilled breastfeeding counsellors. I have come across 3 main reasons for requesting infant formula in such cases; 1) anxiety, stress/depression because of the disaster, displacement from home and/or loss of lives/livestock, household goods,  2)  perception of or actual insufficient milk as a result of the above, and 3) lack of privacy to breastfeed at shelters. There is a 4th reason, which we may not like to accept, which is is that many requesters/recipients of the infant formula (or other baby food), want to get these so as to sell them in the market (I have seen packets of RUTF openly on sale in markets).