In answer to the question about whether or not there are experts that do
promote breastfeeding in emergency conditions, yes there most certainly
are!!! I used to work nonemergency conditions to develop nutrition programs
for a blindness prevention organization that would be locally sustainable
rather than short term food distribution.  The primary focus was to prevent
nutritional blindness by improving vitamin A intake.  In reality, we were
actually focusing on preventing a much larger problem than the blindness.
Improving vitamin A status reduces childhood mortality rates in areas of
vitamin A deficiency by up to 34%.  It doesn't take a rocket scientist to
figure out that colostrum and breast milk are absolutely crucial sources of
vitamin A for infants that have not yet weaned.  So this was a big part of
our strategies and that of other NGOs that focus on developing programs
that are locally sustainable. Breastfeeding promotion is a huge component
of most international nutrition programs, though as other have posted (e.g.
Pamela Morrison on the situation in Zimbabwe) HIV and fear of transmission,
rather than a rational look at HIV-free survival rates for infants has
taken a tremendous toll.

Although I did not directly work on refugee programs, I did work with the
nongovernmental organizations (NGOs) that did do this type of work all the
time. It depends very much on the NGO how well they focused on
breastfeeding promotion as a component.  The better NGOs do hire an expert
that has an MPH with an emphasis in nutrition, or an RD, MS or PhD in
nutrition. I have not run across many IBCLC's doing this type of work
because these program often focus more on food and peripherally on the
breastfeeding. The UNHCR (United Nations High Commission on Refugees),
uncless they have radically changed their policies in the 5 years that I
have been sliding out of international work, did have policies that support
breastfeeding in emergency conditions.

Unfortunately, the press tends to be extremely ignorant about these
issues.  I still remember beating my head against the wall during the first
Gulf War over the reports of bombing the baby milk factories.  I remember
spending quite a bit of time explaining to a CNN reporter about why this
was probably a good thing to have happened given the lack of sanitation in
the refugee conditions in Iraq - all to no avail.  I also had the
misfortune to sit through a CNN interview (about Somalia) where they seemed
to be more interested in finding out whether the refugee expert partook of
the local stimulant and asked about osteoporosis (what a nonsequetir for an
emergency setting) than in reporting anything substantial about nutrition.

Best, Susan Burger, PhD, MHS, IBCLC, RLC

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