By Sarah DeYoung

Implications for Public Health

Designating a safe, quiet, and private space can help ensure that women are able to continue breastfeeding while in shelters. Shelters should also provide supplies and space for sanitary formula preparation for mothers who require additional options.

Disaster evacuations can pose feeding difficulties for the mothers of infants and young children in shelters, but these challenges can be mitigated—often with increased awareness and knowledge, some logistical thinking, and a little space.

Although many women choose to breastfeed their children, our research has found that caregivers often report significant challenges when attempting to continue to breastfeed after disaster evacuations. The issue appears to occur within and outside of the United States. For instance, mothers who fled the Fort McMurray Wildfire in Canada and mothers forced to relocate after the 2015 Gorkha earthquake in Nepal reported that issues such as stress and uncontrolled distribution of formula did not support breastfeeding.

These challenges can be rooted in more than one cause and overlap with social and behavioral complexities. Some mothers and volunteers mistakenly believe that breastmilk will dry up after a disaster or other high-stress events, or—in some cultural belief systems—that it might be cursed because of the hazard. Others think that if their own nutrition is compromised while sheltering, it can adversely affect the nutrition of the breastmilk. Some have been separated from their support systems. And some simply need access to space and supplies, such as clean bottles or privacy for breastfeeding, for safe infant feeding.

Caregivers who feed children formula also reported challenges in shelters after evacuation. For instance, in the Fort McMurray Wildfire study, respondents cited limited availability of nutritious and appropriate food for toddlers, private space, and specific types of formula among the problems they faced when feeding.

A few simple steps in shelter preparation can make it possible to avoid adding to the public health burden after disasters—and to help the parents and caregivers of infants and young children in the process. Some helpful measures include:

  • Provide medical assessments of pregnant women, new mothers, infants, and toddlers as they arrive at shelters.

  • Provide a safe, quiet, and private space specifically for breastfeeding.

  • Keep families together.

  • Reassure mothers that they can continue to breastfeed.

  • Provide instructions, clean water, and space for sanitary preparation for families that use infant formula. Be prepared to supply those families with specific (e.g., milk-free or soy-free) formulas during protracted events.

  • Ensure that pregnant women and lactating mothers have extra hydration. If possible, provide additional nutritious food as well.

  • Provide space and supplies to bathe and diaper infants and small children.

  • Plan for differences between cultures. Cultural practices may influence daily routines such as cooking, sleeping, and other activities.

  • Provide culturally appropriate food for young children who are transitioning to solid food.

  • Ensure mothers have mental health support by screening for postpartum depression, anxiety, and posttraumatic stress disorder among evacuees and families seeking shelter. Provide on-site services and concrete actions for follow-up care.

When public health practitioners and emergency managers work together to implement straightforward guidelines , they can meet infant feeding needs in shelters. Access to maternal and reproductive health care should be fundamental in planning for mass care during and after disasters.

This article originally appeared in the Research Counts Children and Disasters Special Collection series on June11, 2019. This is an updated version.

Suggested Tools

Pregnant Women in Disasters and Emergencies: Health Information Guide
Disaster Information Management Resource Center
Collection of articles related to pregnant women’s health in disasters.

Infant and Young Child Feeding in Emergencies
United Nations High Commissioner for Refugees
Comprehensive manual on infant feeding in disasters and emergencies.

Food Safety for Infants After a Disaster
Centers for Disease Control and Prevention
Guidelines for safe infant feeding practices after a disaster.

For a list of all the tools included in this special collection, visit the Mass Sheltering Tool Index. A list of further readings are also available.