Truths Behind Rejection of Formula Donations During and After Emergency Situations

(I wrote this article last 22 November 2013 with the hope that some bigger syndication will publish it... wellm they didn't so I am claiming it back for my blog. This was a reaction to all the debate going on about formula donations post-Yolanda, one that even reached international forums)

Babies and children are top priority when disaster strikes. When natural calamities end up displacing hundreds of people, one of the first calls to go out or be offered is formula milk donations.

Two weeks ago, the Visayan region of the Philippines was hit by what is touted to be the strongest typhoon ever recorded in human history. The storm surge that came along with it killed thousands and leveled several areas, stripping people of their homes, schools, churches and hospitals. Hundreds of thousands of people scattered over several provinces are left without food and shelter and yet, why are formula donations being banned by the government?

There are several inter-related truths that provide rationale for this particular policy:

1. Most mothers start out breastfeeding their children. Based on experience over several strong typhoons, most that end up in evacuation centers are either breastfed and mix-fed. Few babies below the age of six months are completely formula dependent. Thus, the need for formula donations is not high and one the government can certainly address.

2. Studies show that 50% of formula fed babies run the risk of requiring hospital treatment in emergency situations, mostly due to ill-prepared formula that will be inevitable in shelters where clean water, sterile equipment and a steady supply of the formula are hard to come by. Usually, evacuees are deluged with donations in the first few days but are left wanting in the weeks, maybe even months, to come. The reality is that mothers sometimes end up preparing formula using rain or portalet water or diluting it so much that it causes water intoxication in their babies. Most people have not made the connection that formula is called precisely that because it has to be prepared a certain way for it to be beneficial.

3. Getting mix-feeding mothers to relactate, new mothers to exclusively breastfeed, and parents to wean their toddlers/preschoolers off formula/bottle feeding reduces the risks posed by ill-prepared formula. The simple act of giving milk using cups instead of feeding bottles or getting toddlers eating more solids are more practical and sustainable strategies in emergency situations.

4. There is a system in place that allows formula fed babies to get formula at evacuation centers and temporary shelters. These babies are neither forgotten nor allowed to die. Hopefully, those identified to have no other option but formula will also be monitored. However, when more mothers exclusively breastfeed, the few formula-dependent babies left can be better provided for with age-appropriate milk and other resources and information necessary to ensure safe formulation.

5. Resources are a challenge post-calamity, even if a family does not end up in an evacuation center. Communication lines may be down for a while. Water pipes busted. Supplies like gas or milk may be out of stock. In tent cities, clean water is often scarce and a family might not be able to get enough to wash and sterilize feeding bottles, what more have enough to prepare formula with. Congestion may also increase the level of humidity, expediting milk spoilage.

6. There is no wisdom in providing hundreds of cans of milk, or including a box of milk per prepacked baby kit to all families in an evacuation center since formula has to be age-appropriate and only babies under age 1 truly rely on milk as their main source of nourishment. Unfortunately, if formula is given to a breastfeeding family, they will use it, even if they were already breastfeeding successfully. If powdered milk is given to each family, they will use it, even if they were not milk drinkers previously. Such has been the indoctrination  of some societies, like ours, that people actually think formula is a safer, better food for their baby. For some, it is even a status symbol.

7. For the same price per can, private citizens or organizations could be providing one to three days worth of food and water to families in calamity zones and temporary shelters. The percentage of infants is always very low (and again, most that stay in evacuation centers are breastfed to some degree) so it is more practical to channel funds to feeding all members of a family, instead of just one, or providing them with shelter, clothes, medicines, etc. It also makes no sense for centers to be flooded with free formula while families struggle to get drinking water, cook their food or clothe themselves.

8. Returning to their homes or relocation may be a long time coming for evacuees which will pose challenges for the parents and the government to sustain formula feeding. At best, the average Filipino family can barely sustain the cost of formula for a whole year. Imagine how much worse it would be for families left with nothing and no clear prospects for the future.

9. Thanks to a growing number of breastfeeding advocates, the Milk Code is being observed better and better in the Philippines. Unfortunately, this has not stopped milk companies from offering free milk through hospitals and clinics. Milk companies are also known to freely distribute samples by the can in schools, conferences and the like. This surely suggests that should the government not have the budget to purchase formula for the few babies per center that need it, our leaders can still appeal to these companies to provide the milk because they can afford to give them freely. Private citizens and organizations, out of concern for babies, need not spend for them at all.  Unfortunately though, milk companies in the country seem to have a problem with donating unbranded cans to the Department of Health (per Milk Code stipulation) as well as taking on the task, even if they can afford it, of providing free milk indefinitely for evacuees that need it.

10. Formula feeding eats up resources in already compromised living arrangements. It eats up gas and water that could be used for cooking. It requires soap (or salt). It is a monthly expense. It takes up space and requires light (as proven by a mom who mistakenly used gasoline in preparing her baby's milk, accidentally killing her child). And because formula feeding increases risks for certain diseases (diarrhea, ear infection, allergies) that living in a shelter compounds, there will also be medical costs and it may even cost lives. Add to this again the burden of spending so much to provide for one member of the family while leaving the others malnourished and it becomes a vicious cycle of health issues.

11. Donations are hard to manage, track and properly distribute in our country over an average typhoon, what more a catastrophe that wiped out entire areas. Pre-packaged baby kits with a formula in each bag will have to be repacked, otherwise other babies will be put at risk. All formula cans would have to come with the necessary accessories, otherwise, it will put babies at risk. Prevention by banning formula donations reduces logistics nightmares, public health issues and loss of lives for the government.

12. 16,000 children age five and below are estimated to die every year in the country from diseases that are linked to formula feeding. This number will surely rise when measures are not taken to control formula feeding (especially in cases when babies are beyond age 1) and closely monitor formula distribution in shelters.

13. The ban on milk donations is not about breastfeeding being superior to formula feeding. It is about the greater good in a time of chaos and limited resources. Breastfeeding and formula feeding are also not just feeding issues, but during war and calamities, both become bigger public health issues.

14. The people who will be left in evacuation centers are the truly marginalized ones, without family or friends who can take them in. Post-Yolanda, we are looking at thousands of families. Not only will they be short of funds (which will challenge again the sustainability of formula feeding), they will have limited options. Some of these families also have multiple children of varying ages where it becomes all the more critical that fewer or none will be reliant on powdered milk for sustenance and nutrition. This references to the growing trend of milk-dependent toddlers/preschoolers when eating solids is most beneficial for them.

15. The difference with calls for breast milk donations and milk letting drives is that the breastfeeding groups behind these ensure that donated breast milk is not compromised (cold chain project) as opposed to the usual unmonitored distribution of formula without the necessary paraphernalia and information. Donated breast milk is also pasteurized and given through the use of cups, which makes it safer than formula. Perhaps, because breast milk donation is very personal in nature, its advocates take more care in making sure nothing gets wasted, as opposed to a general donation of formula wherein cans might be left under the heat of the sun or water used in formulation might be dirty. Donor milk is also not distributed indiscriminately because the goal is always to ensure safe and sustainable feeding so its recipients usually are moms in the process of relactation or babies who have been separated from their mothers.

The government and concerned agencies are just looking out for these children and their families for the short and long-term. The international standards are rigid because it has been proven time and again in emergency situations all over the world that indiscriminate formula donations just create problems and cost lives.

Now, people who really want to help these babies can send cash donations instead to trusted agencies or send food, care and emergency shelter kits for their families. Let us relieve the parents of some of their immediate worries and burdens, so that they can care for their children better. And may these truths reassure everyone that this stance the Philippine government has taken is a good one.