Reasons NOT to Send Formula or Breastmilk to Haiti or other Disaster Locations

Letter from Dr. Carlos González Rodríguez, Pediatrician, Barcelona, Spain
Founder of the Asociación Catalana Pro Lactancia Materna.
Member of the La Leche League International
Advisory Board Evaluator for the UNICEF Baby Friendly Hospital Initiative
Since 1992, Dr. Carlos González Rodríguez has taught more than 100 breastfeeding courses to health care providers. This English translation is provided by Jeanette Panchula, IBCLC in CA

Despite the turmoil around, Renante Taris breastfeeds her son, Erikson, comforting him in this gentle mothering manner like nothing else can. Renante and her toddler are at a hospital in Port-au-Prince, Haiti.
Photo by Jae C. Hong.

The donations of formula for bottle feeding in times of catastrophe such as war, earthquake and floods, are very dangerous. In fact, they are not donations, but instead free samples - it is the means by which formula companies compete to create new markets. If you pay attention to the news, you will frequently hear how an airplane has departed loaded with FORMULA - rarely will you hear of a plane loaded with beans or noodles. That is because the companies that sell noodles and beans, unless they have an especially generous director, have no commercial interest in making donations. While the country in question is in ruins, it is unable to pay for food; when they overcome the catastrophe they will eat their own beans grown in their own country, or their own noodles made in by local enterprises.

On the other hand, if in a third world country you can take over lactation, you get millions of women to abandon breastfeeding and millions of doctors and nurses will learn the "advantages" of bottle feeding, which without a doubt is wonderful because Non-Governmental Organization (NGO) “X” gave it to us as a gift, then you have a captive market that will be worth millions because that milk is not manufactured in the country and it must be imported, and if used to brand Z, they will probably continue to buy brand Z.

Years ago a request was made that donations be given with just a white label stating "milk for babies" with no brand, but of course the manufacturers refused. In addition, the manufacturer saves on transport by giving the free samples to an NGO – serious NGOs no longer accept them, but at times one will - or a government accepts them and THEY pay for the transport. And the real market, let us not fool ourselves, is in the third world. In Spain only 500,000 babies are born a year. In Indonesia, more than 5 million and in India 25 million. There are many more clients, although some will die on the way, and will only buy their milk for a week, and dilute it so that it will last...

Some years ago, at the end of the war in Sarajevo, I met a Bosnian pediatrician in a meeting. He had suffered real hunger and was very thin, and during the meals he would pick up the smallest piece of bread that would fall on the tablecloth and eat it. He explained to us how at the beginning of the war, infant mortality rose horribly, as they were flooded with free samples.

Of course, not all the professionals are knowledgeable about breastfeeding, as happens here. Many began to recommend "a little help" thinking the mothers, "stressed" by the war, would have NO milk, or wanted to help the poorly-nourished mothers by reducing the "load" of having to breastfeed. With no drinking water nor gas to boil it (as occurs also in Gaza today), when the explosions destroyed the water system and feces floods the lower floors, the death rate was enormous.

It fell upon the more knowledgeable pediatricians who went to UNICEF and called a meeting of the NGO's in the area, getting them to agree to not distribute any more free donations, and also provided their personnel with education on breastfeeding in emergencies...[which is available on-line from UNICEF now] in a few months, while the war continued, they were able to have a higher rate of breastfeeding and a lower infant mortality than prior to the war.

Of course some children need artificial milk in times of war; but for these few formula can be found without enormous loads of free samples. And those children, in those conditions, have such a high death rate that we can no longer think "the mother is free to decide if she wants to breastfeed or formula-feed."

In these conditions we must do everything we can to promote relactation even if it has been months since the mother breastfed, or find a wet-nurse. And sadly, it is not difficult to find them - because babies are weaker than adults - and in any catastrophe there are more mothers without babies than there are babies without mothers.

Emma Kwasnica, lactivist and breastfeeding supporter reminds those wishing to help Haitian babies and toddlers: "Sending donated artificial milk (and even donated breastmilk) to Haitian babies ultimately prevents them from getting breastmilk at their own mothers' breast, the impact of which is NOT benign. Breastfeeding is the single most effective way to ensure the health and survival of babies in any disaster zone. Please don't send milk. Send your money to an aid agency with experience in supporting lactation/re-lactation/cross-nursing on the ground (AFASS-type relief efforts)."

Dr. Carlos González Rodríguez' original letter en Español:

Las donaciones de leche para el biberón en casos de catástrofe (guerra, terremoto, inundación...) son sumamente peligrosas. En realidad no son donaciones, sino muestras gratuitas: es el medio por el que las empresas lácteas compiten para hacerse con nuevos mercados. Si estás atento a las noticias, muchas veces habrás oído cómo ha salido un avión cargado de leche... raramente oirás de un avión cargado de macarrones o lentejas.

Porque las empresas que venden macarrones o lentejas, fuera de que alguna en concreto tenga un director especialmente generoso o solidario, no tienen un interés comercial en hacer una donación. Mientras el país en cuestión esté en ruinas, no pagarán por la comida; cuando superen la catástrofe, se comerán sus propias lentejas cultivadas en su país, o sus propios macarrones
fabricados por empresas locales. En cambio, si en un país del tercer mundo consigues cargarte la lactancia, consigues que millones de madres abandonen la lactancia y millones de médicos y enfermeras aprendan las ventajas del biberón, que sin duda es buenísimo porque la asociación X nos lo regalaba para ayudarnos, luego tendrás un mercado cautivo que valdrá millones, porque esa leche no se fabrica en el país y la tendrán que importar, y acostumbrados a la marca Z probablemente seguirán comprando la marca Z.

Hace años pidieron que los donativos fueran con una etiqueta blanca, "leche para bebés", sin marca, y los fabricantes, claro, no quisieron. Además, muchas veces la empresa fabricante se ahorra el transporte: se limita a entregarle las muestras gratuitas a una ONG (por suerte las ONG serias ya no las aceptan, pero a veces encuentras a un primo), o a un gobierno, y estos pagan los portes. Y el mercado de la lactancia, no nos engañemos, está en el tercer mundo. En España sólo nacen menos de 500.000 niños al año; en Indonesia más de 5 millones, en la India más de 25 millones... Son muchos más clientes, aunque algunos se mueran por el camino, aunque sólo se compren una lata de leche por semana y la diluyan para que dure...

Hace unos años, acababa de terminar la guerra de Sarajevo, conocí a unpediatra bosnio en un congreso. Había pasado hambre, estaba delgadísimo, y en las comidas recogía hasta la más minúscula miga de pan que cayera en el mantel y se la comía. Nos explicó como al principio de la guerra la mortalidad infantil aumentó espectacularmente, porque fueron inundados con muestras gratuitas. Claro, no todos los profesionales tienen buena formación sobre lactancia, igual que pasa aquí. Muchos empezaron a recomendar "ayuditas", pensaban que las madres, "estresadas" por la guerra, no tendrían leche, o que al quitarle a una madre mal alimentada la pesada "carga" de tener que dar el pecho le hacías un favor. Sin agua potable ni gas para hervirla (lo mismo que ocurre ahora en Gaza), cuando las explosiones destruyen las alcantarillas y la mierda inunda las plantas bajas... la mortalidad fue enorme. Tuvieron que ser los pediatras más concienciados los que fueran a quejarse a UNICEF, que convocó una reunión de todas las ONG sobre el terreno, acordaron no distribuir más donaciones, realizaron cursos para el personal... en pocos meses, mientras la guerra continuaba, habían conseguido tasas de lactancia materna más altas y una mortalidad infantil más baja que antes de la guerra.

Por supuesto algunos niños necesitan leche artificial en las guerras; pero para esos pocos ya se consigue leche sin necesidad de espectaculares cargamentos de muestras. Y esos niños, en esas condiciones, tienen un riesgo de muerte tan alto que ya no vale aquello de "la madre es libre para
decidir, y si ha elegido la lactancia artificial...".En esas condiciones hay que hacer todo lo posible para que la madre relacte, aunque lleve meses sin dar el pecho, o para encontrar una nodriza. Y tristemente eso no es muy difícil, porque los bebés son más frágiles que los adultos: en cualquier catástrofe hay más madres sin bebé que bebés sin madre.

Publications:
• Mi niño no me come (1999)
• Bésame mucho, cómo criar a tus hijos con amor (2003)
• Manual práctico de lactancia materna (2004)
• Un regalo para toda la vida, guía de la lactancia materna (2006)