Breastfeeding in Emergency Situations
- Jul 27
- 6 min read
Introduction
In France, natural disasters are not a distant abstraction. Wildfires in the south, floods in the north and west, violent storms: every year, families are forced to evacuate their homes within minutes. Yet in the rush of an evacuation, infant feeding is rarely planned for. How can breastfeeding continue under stress? Should formula donations be accepted? What should go in an evacuation kit when there's a baby involved? This article brings together scientific data and international recommendations to help families and health professionals prepare.
Breastfeeding: a major asset in emergencies
In a crisis, access to safe drinking water, electricity, and clean equipment becomes uncertain.
In France, unlike in other countries, there are no official guidelines on infant feeding in emergency situations.
This is where breastfeeding becomes an asset for families. Breast milk is available without delay, at the right temperature, free of microbiological risk (and even protective), and tailored exactly to the baby's needs.
Epidemiological data support breastfeeding in these contexts. A 2014 European Commission analysis found that non-breastfed infants face a death risk 14 times higher in emergency settings.
During the Yogyakarta earthquake (Indonesia, 2006), the diarrhea rate among non-breastfed infants reached 25%, compared to just 12% among breastfed babies, in an environment where clean water access was compromised for the entire population.
For exclusively breastfed babies under 6 months, another reassuring fact: since breast milk is 88% water, they don't need extra water even in extreme heat. The Australian Breastfeeding Association (ABA) confirms this explicitly in its emergency guidance.
Stress disrupts breastfeeding, but doesn't stop it
It's one of the most widespread beliefs: "I got scared, and my milk dried up."
In reality, stress does not shut down milk production. What it disrupts is the let-down reflex: the oxytocin-driven mechanism that allows milk to "come down" and become available to the baby.
Adrenaline and cortisol released under stress temporarily interfere with oxytocin. The milk is there, but it doesn't flow easily. To the mother and those around her, this can look like the milk has disappeared, but it's a temporary and reversible situation.
The IFE Core Group (Infant Feeding in Emergencies Core Group), which develops international guidelines on infant feeding in emergencies, stresses this point in its Operational Guidance: creating a safe, calm, private space restores the let-down reflex within minutes.
Helen Gray, IBCLC lactation consultant and emergency response coordinator for the Lactation Consultants of Great Britain (LCGB), put it clearly during the 2022 Ukraine crisis: a crying baby may simply be expressing stress, not hunger.
Because of emotional co-regulation: if the mother is stressed during an evacuation, the child may cry and be difficult to soothe.
This observation aligns with IFE Group data: in crisis situations, normal infant behaviors (frequent waking, prolonged feeds) are often misread as a sign of insufficient milk, without considering other possible causes.
Finally, relactation is possible. Mothers who stopped breastfeeding following displacement or trauma have been able to resume it with qualified support. Relactation requires frequent breast stimulation and, in some cases, the use of a supplemental nursing system (at-breast supplementer) while milk supply builds back up. The IFE Core Group makes this a priority in its emergency response.
Formula donations: a well-meaning but flawed idea
Faced with images of displaced families with infants, the humanitarian instinct to send powdered formula is understandable. Yet it's a response that can prove dangerous, and one discouraged by all reference organizations: WHO, UNICEF, the IFE Group.
The reasons are numerous:
Preparing powdered infant formula requires safe drinking water (ideally at 70°C to kill bacteria, since formula powder is not sterile), sterilized bottles, and strict hygiene conditions :all resources in short supply during an emergency.
An untargeted donation of breast-milk substitutes can lead breastfeeding mothers to switch to formula out of fear of running out of milk, triggering a real drop in supply due to fewer feeds.
The Sichuan earthquake (China, 2008) became an emblematic example: breast-milk substitute manufacturers distributed their products en masse in disaster zones, using the crisis to expand their commercial presence, in defiance of public health recommendations.
This doesn't mean mothers who don't breastfeed should never be supported. The IFE Group is clear: targeted, organized support supervised by qualified health professionals is possible for infants who cannot be breastfed. It's uncontrolled donations that are the problem, not support itself.
Preparing an evacuation kit with a baby
The ABA recommends preparing a kit covering at least 3 days, assuming no access to running water, electricity, or gas. Contents vary depending on the feeding method.
For a mother who breastfeeds directly
A baby carrier or sling (supports closeness, skin-to-skin contact, discreet feeding)
10 to 20 liters of water for the mother (hydration and basic hygiene)
Non-perishable energy foods (cereal bars, dried fruit)
36 diapers, wipes, bibs, a small blanket
For a mother who expresses milk In addition to the above kit, learning to hand-express milk before an emergency occurs is strongly recommended by the ABA: without electricity, an electric breast pump becomes unusable.
24 to 27 single-use plastic cups (for feeding expressed milk without a bottle)
Soap and water for handwashing
A backup plan to use the milk immediately if no refrigeration is available
In case of power outage: frozen milk reserves in the freezer
For a mother who feeds powdered infant formula
One unopened container of infant formula (check the expiration date every 3 months)
12 to 14 small bottles of mineral water (250 ml) for preparation
15 additional liters of water for surface and hand hygiene
24 to 27 single-use sterilized bottles OR paper cups (one per feed)
Soap, paper towels, disinfecting wipes
Important ABA note: if sterilizing bottles is not possible, using a cup is preferable to an unsterilized bottle.
In case of a power outage affecting breast milk reserves
Milk that has thawed but still contains ice crystals can be put back in the freezer.
Options during a power outage:
Try to find neighbors with a working freezer, or
Avoid opening the freezer door
If the freezer is full, it keeps food safe for 48 hours. If it's half full, that drops to 24 hours. For a refrigerator, it's 4 hours.
A cooler filled with your milk, surrounded by newspaper and blue ice packs, is another option.
When power returns, check your milk: if it has started to liquefy but ice crystals remain, it can be refrozen. If it is completely liquid but still cold, put it in the refrigerator and use it within 24 hours.
Sources: CDC, Kellymom, ABM Protocol 8 (2017)
What Australian and British guidance adds
Australia's ABA recommendations, developed in part through the Bushfire Emergencies Project, are among the most detailed in the world on this topic. They emphasize one central message: evacuate early with an infant, before the emergency becomes critical, because evacuation centers are often overcrowded and poorly suited to babies' specific needs.
For families with infants over 6 months old, in an extreme crisis where preparing infant formula is genuinely impossible, the ABA notes that long-life whole cow's milk can be used as a very short-term temporary solution.
On the British side, the response to the Ukraine crisis highlighted the concrete role IBCLCs play during mass displacement. The Lactation Consultants of Great Britain (LCGB) and the World Breastfeeding Trends Initiative (WBTi) UK coordinated an integrated response: networking professionals, resources in multiple languages, and online support groups available 24/7. Helen Gray emphasizes that specialized clinical support, not formula donations, is what truly protects infants in emergency contexts.
A powerful lesson emerged from the Ukrainian experience: infant and young child feeding in emergencies (IYCF-E) was initially underestimated in the international response. It was only through the mobilization of lactation professionals that this dimension was integrated into humanitarian priorities.
The role of health professionals in emergencies
Midwives, pediatric nurses, and IBCLC lactation consultants have a specific role to play before, during, and after a crisis.
Before: inform families about preparing an evacuation kit and reassure them about how resilient lactation is under stress.
During: identify breastfeeding mothers within shelter facilities, create or flag calm spaces for feeding, offer relactation support if needed.
After: support families who temporarily stopped breastfeeding and wish to resume.
The role of informal milk sharing also deserves mention. In some situations, a breastfeeding mother from the community can feed an infant whose own mother is temporarily unable to breastfeed. This age-old practice, guided by common sense and mutual trust, can save lives. It does not replace professional support, but it is one of the human resources available.
The IFE Group also recommends giving priority to breastfeeding mothers in emergency aid systems (for food rations, water access, and housing )since their own nutritional needs directly affect their infant's health.
Conclusion: breastfeeding as an anchor in times of crisis
Beyond its nutritional and immune value, breastfeeding serves a function often underestimated in emergencies: it maintains the bond between mother and baby, regulates stress for both, and provides continuity amid total disruption. Oxytocin released during feeding lowers maternal anxiety. Skin-to-skin contact regulates the baby's temperature and stabilizes vital signs. Breastfeeding is, in effect, a tool for emotional regulation.
Preparing for an emergency also means preparing your breastfeeding relationship to withstand it. It starts with knowing how to hand-express milk, having a well-adapted evacuation kit, and understanding that stress does not make milk disappear. Scientific data and past crisis experience converge on the same message: supporting breastfeeding in emergencies means protecting the most vulnerable infants.
Sources and references
Élise Armoiry for IPA / info-allaitement.org :"Infant Nutrition and Emergency Situations"
IFE Core Group (Infant Feeding in Emergencies Core Group) : Operational Guidance on IYCF-E v3.0, 2017
Australian Breastfeeding Association (ABA): Bushfire Emergencies Project, breastfeeding.asn.au/disaster-support
Lactation Consultants of Great Britain (LCGB) : lcgb.org/resources/infant-and-young-child-feeding-in-emergencies-iycf-e
UNICEF / IFE Core Group: recommendations on breast-milk substitute donations in emergencies
Academy of Breastfeeding Medicine Position statement. Breasfeeding in emergencies. 2024. https://abm.memberclicks.net/assets/DOCUMENTS/bartick-et-al-2024-academy-of-breastfeeding-medicine-position-statement-breastfeeding-in-emergencies.pdf
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