President’s Corner – Breastfeeding Mitigates a Disaster

BREASTFEEDING MEDICINE
Volume 8, Number 3, 2013
ª Mary Ann Liebert, Inc.
DOI: 10.1089/bfm.2013.9989

PRESIDENT’S CORNER

Arthur I. Eidelman
Holocaust Memorial Day, or as it is called in Israel and worldwide ‘‘Yom Hashoah,’’ is a combination of the most depressing sadness, as we memorialize the 6,000,000 murdered victims of Nazi Germany and their European collaborators, and, paradoxically, a celebration of those individuals who somehow survived the horrors of mass murder and ethnic cleansing. The realization that 1.5 million infants and children were singled out for elimination by the Nazis so as to prevent the chances of a historical continuity of the European Jewish community is somehow counterbalanced by the miraculous stories of infants surviving, especially in the most unlikely circumstances and conditions.

This past Yom Hashoah (April 8, 2013) I had the opportunity to view a documentary entitled ‘‘Geboren in KZ’’ (‘‘Born in a Concentration Camp,’’ a film by Eva Gruberova and Martina Gawaz for GDR Television), which recounts the unbelievable story of seven infants who were born in 1945 in the Dachau, Germany, concentration camp. The fact that the mothers of these infants were able to conceal their pregnancies and reach term without being detected in and of itself defies comprehension, for as we know the policy of the Nazis was to send any woman diagnosed as pregnant directly to the crematorium. Some of the women even escaped detection and ‘‘selection’’ for death by the infamous Dr. Josef Mengele in
Auschwitz before being transferred to Dachau. No less miraculous so was their ability to maintain a minimal degree of nutrition to sustain their pregnancy until term or near term. Months later, when Dachau was liberated by the U.S. Army, the GIs to their astonishment discovered among the 30,000 survivors of the camp seven mothers and their seven infants ranging in age from 1 to 6 months (three boys and four girls).
To their wonderment they found that the infants were relatively thriving with few if any discernible medical problems. The film documents visually the U.S. Army’s surprise and the images of the healthy infants. Almost in passing, when they asked how the babies survived the unbearable conditions in the concentration camp, the answer they received was simply that the infants were breastfed, with two of the mothers acting as wet nurses to supplement those mothers whose milk supply was marginal. Not only did all the infants survive, after liberation they grew normally, ultimately married, and raised their own families, truly a testimony to their fortune in defying their presumed proscribed fate and the Nazis’ nefarious plan for a final solution to the Jewish problem.

And yes, they were breastfed successfully and thus survived the most disastrous medical and nutritional condition imaginable. The infants’ survival once again provides evidence of what should be axiomatic for all those who have been charged with the responsibility for organizing our communities for potential disasters, what is termed ‘‘disaster preparedness response and recovery.’’ As clearly stated in the ABM Statement entitled ‘‘Position on Breastfeeding’’1: ‘‘In situations of disaster or food insecurity, infants who are not breastfed have a markedly higher risk of infant mortality and morbidity from infectious diseases.’’ This conclusion was confirmed in a recent published study2 that analyzed the effect
of breastmilk substitutes and the incidence of diarrhea in infants after the 2006 earthquake in Java. The authors concluded that ‘‘there were strong associations between receipt of breast milk substitutes and changes in feeding practices and between receipt of infant formula and diarrhea. Uncontrollable distribution of infant formula exacerbates the risk of diarrhea among infants and young children in emergencies.’’

It should be clear that the key word in this quote is ‘‘uncontrollable,’’ meaning the non-medically indicated distribution of formula frequently by well-meaning non-governmental organizations that are insufficiently sophisticated or versed to understand that their actions are counterproductive for infant health. No less so are the actions of the formula companies’ distribution policies, which reflect at time marketing opportunities rather than legitimate public health needs. Binns et al.3 emphasized this in their recent article entitled ‘‘Ethical Issues in Infant Feeding After Disasters,’’ which summarized the issues in two pithy sentences: ‘‘Mothers who are injured or short of food can still continue breastfeeding and don’t need formula’’ and ‘‘Where formula must be used, health workers need to follow the highest ethical standards to avoid promoting infant formula to vulnerable communities in the post recovery phase.’’

Gribble4 further highlighted and extended this concern regarding the inappropriate behavior of formula companies and public health officials to the frequent detrimental role of the media, particularly in its encouraging harmful aid in the form of infant formula and in reporting incorrectly that stress5 interferes with the success of breastfeeding. Gribble,4 in analyzing the consequences of the 2008 earthquake in China and the cyclones in Myanmar, described the successful activities of an interagency called the Infant and Young Child Feeding in Emergencies (IYCF-E), which developed an ‘‘Operational Guidance for Emergency Relief Staff and Programme Managers.’’6 The Guidance functioned in part on the following principles that served as a basis for the actions of both the agencies and media communications:
1. ‘‘Babies fed anything other than breast milk are particularly vulnerable in emergencies.’’
2. ‘‘Use of infant formula or other milk products is dangerous in emergencies and should be avoided.’’
3. ‘‘The way to help babies survive in an emergency is to help their mothers continue breastfeeding.’’
4. ‘‘Donations of infant formula are not needed and are unhelpful.’’
5. ‘‘Aid organizations need help from media immediately after the start of the emergency to prevent arrival of
donations of infant formula.’’

Natural disasters are inevitable and part of the realities and vagaries of living on earth. Our role as caretakers is to prepare for them and not compound their consequences by disrupting the natural order of infant feeding (e.g., breastfeeding and the use of human milk). It is hoped that we will not need another round of evidence from manmade disasters such as the Holocaust of World War II to convince us that survival even in the most deprived circumstances is dependent on maintaining that maternal–infant dyadic breastfeeding nurturing relationship. Those infants who were born into the horrors of the Nazi camps and survived proved it, and that should be enough to convince the doubters. The lessons of the Holocaust are many, and we are charged to remember those who went through that hell and their message of hope for future generations.

References
1. Academy of Breastfeeding Medicine Board of Directors. Position on breastfeeding. Breastfeed Med 2008;3:267–270.
2. Hipgrave DB, Assefa F, Winoto A, et al. Donated breast milk substitutes and incidence of diarrhea among infants and young children after the May 2006 earthquake in Yogyakarta and Central Java. Public Health Nutr 2012;15:307–315.
3. Binns CW, Lee KK, Tang L, et al. Ethical issues in infant feeding after disasters. Asia Pac J Public Health 201;24:672–680.
4. Gribble KD. Media messages and the needs of infants and young children after Cyclone Nargis and the WenChuan earthquake. Disaster 2013;37:80–100.
5. Hill PD. Psychological distress and milk volume in lactating mothers. West J Nurs Res 2005;27:676–693.
6. IFE Core Group. Infant and Young Child Feeding in Emergencies: Operational Guidance for Emergency Relief Staff and Programme Managers version 2.1 February 2007. http://www.ennonline.net/pool/files/ife/ops-guidance-2-1-english-010307-with-addendum.pdf (accessed April 11, 2013).
—Arthur I. Eidelman, MD, FABM, FAAP
President, Academy of Breastfeeding Medicine
PRESIDENT’S CORNER 345