Supporting breastfeeding in humanitarian crises

Breastfeeding in emergencies can save lives, protecting infants from infectious diseases, diarrhea, and malnutrition.

Yet mothers often need help to begin and continue breastfeeding – especially when they’re in armed conflict zones or displaced by natural or climate-change disasters.

To that end, FLRF and The Centre for Global Child Health at The Hospital for Sick Children (SickKids) launched an initiative to strengthen breastfeeding support for mothers in humanitarian crisis settings. The goal is to create new resources – or standard operating procedures (SOPs) – that humanitarian workers can easily use to assist mothers to breastfeed.

The SOPs will be the first of their kind to feature:

Existing evidence-based guidance on breastfeeding in humanitarian crises
Real life input from mothers and humanitarian responders from different crisis scenarios
A range of practical ‘how to’ instructions, tailored for different crisis types

Project partner

The Centre for Global Child Health at The Hospital for Sick Children (SickKids)

Principal Investigator

Professor Zulfiqar A. Bhutta, Co-Director, Director of Research, SickKids Centre for Global Child Health: “Worldwide, millions of families are increasingly displaced or live in dangerous situations. Without targeted support, it can be extremely difficult for mothers to begin and continue breastfeeding. Clear evidence-informed actions for providing effective breastfeeding support are urgently needed and this project couldn’t be more timely in reaching that goal.”

A technical advisory group of humanitarian health and nutrition specialists will provide field expertise, including operational experience with humanitarian interventions. Their guidance will help ensure the SOPs can be integrated with existing humanitarian support structures.

Phase I objectives

Produce an updated literature review on all types of humanitarian crises – with a specific focus on conflict settings
Build corresponding crisis profiles reflecting impacts to breastfeeding, as well as displacements, injuries, and deaths according to specific timeframes
Compile breastfeeding experiences of mothers, families, and humanitarian workers
Examine the distribution and use of breastmilk substitutes in different humanitarian crisis settings
Develop first SOPs

Phase II – anticipated

When Phase I objectives are complete, the partners are planning a second phase to transform the SOPs into different formats that can be readily used in the field and disseminated for global adoption.

Background

The ‘Assessment and Operationalization of Breastfeeding Support Guidelines and Programs in Conflict and Humanitarian Settings’ project launched in 2025. It builds on an earlier project with the SickKids Centre for Global Child Health and The Aga Khan University, investigating successful breastfeeding interventions in conflict settings.

The current project is also built on a six-phase “operationalization approach” that FLRF is developing and testing with partners in Ghana and South Africa. The idea is to help put policies into operation.

Are you interested in learning more about operationalizing breastfeeding policies or becoming a co-sponsor? Please contact FLRF (kathrin.litwan@larsson-rosenquist.org).

Toker E, Keleş MG, Karakul A. Experience of Breastfeeding Mothers during the Earthquake of the Century: A Qualitative study. Disaster Medicine and Public Health Preparedness. 2025. https://doi.org/10.1017/dmp.2025.10080

Ferguson, S. In emergencies, breastfeeding keeps babies alive | UNICEF USA. (2024). UNICEF USA. https://www.unicefusa.org/stories/emergencies-breastfeeding-keeps-babies-alive

Rabbani, A., Padhani, Z. A., Siddiqui, F. A., Das, J. K., & Bhutta, Z. (2020). Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates. BMJ Open, 10(9), e036757. https://doi.org/10.1136/bmjopen-2020-036757

Mirzazada S, Padhani ZA, Jabeen S, Fatima M, Rizvi A, Ansari U, et al. Impact of conflict on maternal and child health service delivery: a country case study of Afghanistan. Confl Health. 2020;14(1):38. DOI: 10.1186/s13031-020-00285-x

Das JK, Padhani ZA, Jabeen S, Rizvi A, Ansari U, Fatima M, et al. Impact of conflict on maternal and child health service delivery - how and how not: a country case study of conflict affected areas of Pakistan. Confl Health. 2020;14(1):32. DOI: 10.1186/s13031-020-00271-3

Andersson N, Paredes-Solís S, Legorreta-Soberanis J, Cockcroft A, Sherr L. Breast-feeding in a complex emergency: four linked cross-sectional studies during the Bosnian conflict. Public HealthNutr. 2010;13(12):2097-2104.

Borrel A, Taylor A, McGrath M, Seal A, Hormann E, Phelps L et al. From Policy to Practice: Challenges in Infant Feeding in Emergencies During the Balkan Crisis. Disasters. 2001;25(2):149-163.

Campbell S. Global challenges in protecting and promoting breastfeeding. Prim Health Care. 2008;18(1):41-48.

McGrath M, Seal A, Taylor A. Infant feeding indicators for use in emergencies: an analysis of current recommendations and practice. Public Health Nutr. 2002;5(03).

Toole M, Waldman R. The public health aspects of complex emergencies and refugee situations. AnnuRev Public Health. 1997;18(1):283-312.

Webb P, Boyd E, Pee S, Lenters L, Bloem M, Schultink W. Nutrition in emergencies: Do we know whatworks?. Food Policy. 2014;49:33-40.

Young H, Borrel A, Holland D, Salama P. Public nutrition in complex emergencies. The Lancet. 2004;364(9448):1899-1909.

Publications from previous project

Singh NS, Ataullahjan A, Ndiaye K, Das JK, Wise PH, Altare C, et al. Delivering health interventions to women, children, and adolescents in conflict settings: what have we learned from ten country case studies? The Lancet. 2021 Jan 24;397(10273):533–42.

Kamali M, Munyuzangabo M, Siddiqui FJ, Gaffey MF, Meteke S, Als D, et al. Delivering mental health and psychosocial support interventions to women and children in conflict settings: a systematic review: BMJ Global Health 2020;5:e002014.

Jain RP, Meteke S, Gaffey MF, Kamali M, Munyuzangabo M, Als D, et al. Delivering trauma and rehabilitation interventions to women and children in conflict settings: a systematic review: BMJ Global Health 2020;5:e001980.

Meteke S, Stefopulos M, Als D, Gaffey MF, Kamali M, Siddiqui FJ, et al. Delivering infectious disease interventions to women and children in conflict settings: a systematic review: BMJ Global Health 2020;5:e001967.

Shah S, Munyuzangabo M, Gaffey MF, Kamali M, Jain RP, Als D, et al. Delivering non-communicable disease interventions to women and children in conflict settings: a systematic review: BMJ Global Health 2020;5:e002047.

Das JK, Padhani ZA, Jabeen S, Rizvi A, Ansari U, Fatima M, et al. Impact of conflict on maternal and child health service delivery – how and how not: a country case study of conflict affected areas of Pakistan. Confl Health 14, 32 (2020). https://doi.org/10.1186/s13031-020-00271-3

Als D, Meteke S, Stefopulos M, Gaffey M, Kamali M, Munyuzangabo M, et al. Delivering water, sanitation and hygiene interventions to women and children in conflict settings: a systematic review: BMJ Global Health 2020;5:e002064.

Munyuzangabo M, Khalifa DS, Gaffey MF, Kamali M, Siddiqui FJ, Meteke S, et al. Delivery of sexual and reproductive health interventions in conflict settings: a systematic review: BMJ Global Health 2020;5:e002206.

Rabbani A, Padhani ZA, Siddiqui FA, Das JK, Bhutta ZA. Systematic review of infant and young child feeding practices in conflict areas: what the evidence advocates. BMJ Open 2020;10:e036757. doi: 10.1136/bmjopen-2020-036757

Bhutta ZA, Gaffey MF, Blanchet K, Waldman R, Abbasi K. Protecting women and children in conflict settings BMJ 2019; 364 :l1095 doi:10.1136/bmj.l1095

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