Opinion: good planning and policy would allow us anticipate the needs of young babies during emergencies and ensure they're cared for
By Liz O'Sullivan and Aileen Kennedy, TU Dublin
Here's a list of recent emergencies which we've seen in Ireland: Covid-19, the fire in Wexford General Hospital, the arrival of large numbers of refugees from Ukraine and elsewhere, reports of homes being evacuated due to flooding, and electricity power outages. This quite diverse range of emergencies have something in common that may surprise many people. All threaten the nutritional security and the health and wellbeing of the youngest members of society.
Our youngest babies, those between 0 and 6 months old, rely solely on breast milk or infant formula. They have small bodies and a small store of nutrients, therefore anything that threatens their access to breast milk or infant formula is much more problematic than something that threatens access of an adult to a food source. Adults are adaptable, can source a variety of foods, or can live for a long time with no food. In fact, the Guinness World Record for longest survival without solid food is 382 days - not that this is something we’re recommending.
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From RTÉ 2fm's Jennifer Zamparelli show, Louise Lennox on why she decided to donate her breast milk
During emergencies, the youngest babies are most vulnerable, and most likely to become sick or die due to malnutrition. Breastfeeding can get disrupted due to lack of shelter or water and physical and mental stress on mothers and families. Formula feeding becomes additionally risky for multiple reasons, including unsanitary or unstable supplies of water and electricity.
When one thinks of an emergency, it's often major weather events, such as storms, landslides, hurricanes and floods. While some of these occur on a local or regional level in Ireland, we don’t (yet) see these types of emergencies impacting the whole country. We suspect this is the reason why Ireland has never developed an infant and young child feeding in emergencies preparedness plan, even though the WHO has urged all member states to do so. Ireland just wasn’t viewed as a country that experienced national emergencies.
That is, until March 2020. The Covid-19 pandemic has opened our eyes to the ways emergencies might impact infant nutrition in Ireland. A report published in 2022 by researchers from TU Dublin and Bainne Beatha, a parent-led breastfeeding advocacy group, highlighted that over 40% of participants were unable to get the in-person or medical breastfeeding support they needed during the pandemic and 30% felt the pandemic negatively impacted their breastfeeding experience.
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From RTÉ Radio 1's Drivetime, Dr Liz O'Sullivan on the TU Dublin research into breastfeeding and mother of two Petrina O'Halloran on her experience of breastfeeding support
Researchers from Trinity reported that some women viewed maternity restrictions imposed during the pandemic as a "blessing in disguise" because the number of visitors postpartum was limited. Others, however, described difficulty accessing breastfeeding support as daunting or frustrating, with some saying online help was "useless." The long-term impact of maternity care restrictions during the pandemic on breastfeeding rates in Ireland is still unknown.
Another potential cause for concern is there is just one Human Milk Bank on the island of Ireland. Located in Co. Fermanagh, it provides vital breast milk to the most vulnerable babies across the 27 neonatal units in the Republic of Ireland and Northern Ireland.
Mothers who are breastfeeding their own babies and have excess milk can donate some of their breast milk. This donor milk is provided to help small, premature, and sick babies survive and leave hospital more quickly. Donor breast milk is a precious source of nutrition, especially in an emergency, bridging the gap until a baby can receive its mother's own milk. The Milk Bank often publishes appeals for more donors, even outside of emergency contexts.
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From RTÉ Archives, Anne Marie Smyth reports for RTÉ News in 2018 on the breast milk bank in Co Fermanagh which provides milk for premature babies on the island
The strain placed on the service throughout the pandemic highlights another way infants in Ireland are vulnerable to emergencies. Although assurances are in place that the supply of breast milk to neonatal units in the Republic of Ireland will not be impacted by Brexit, anything else that impacts this service such as the flooding of the building, a major power outage or contamination of milk would have severe consequences for our smallest, sickest babies.
But it's not just breastfeeding that’s impacted during an emergency. Given that a large proportion of babies in Ireland are fed infant formula, they are vulnerable to emergencies too. An example of a recent emergency in the US was the widescale shortage of infant formula, which largely came about because of contamination in one of the biggest formula production plants in the country, which led to a mass recall of infant formula on the market.
Given that Ireland is a major global supplier of infant formula, we might not think that such a shortage would happen here. However, the composition of cow’s milk needs to be altered significantly to make it suitable for infants, including the addition of components such as fats, vitamins, and minerals, all components not manufactured in Ireland. This leaves us vulnerable to any emergency that could impact the global supply chain.
The best thing we can do to prepare for emergencies is provide appropriate protection, promotion and support now
While we may not be able to prevent—or even predict—future emergencies, we can better prepare for them. International guidance on infant and young child feeding in emergencies has been published. Researchers in TU Dublin, in collaboration with Queen's University Belfast, are currently developing a context-specific infant and young child feeding in emergencies draft preparedness plan for the island of Ireland, funded under the North-South Ireland Research Programme.
The most effective thing we can do to prepare for emergencies is provide appropriate protection, promotion and support of breastfeeding now. The more families that can be supported with breastfeeding, the better protected infants are during emergencies.
Dr Liz O'Sullivan is a Lecturer in Nutrition at the School of Biological, Health and Sports Sciences at TU Dublin. Dr Aileen Kennedy is a Lecturer in Dietetics at the School of Biological, Health and Sports Sciences at TU Dublin.
The views expressed here are those of the author and do not represent or reflect the views of RTÉ
