[MUSIC] So let's start with infant feeding in the context of humanitarian crisis caused by natural disasters or conflict. In this module, I will first illustrate by infant feeding matters in a disaster context, I will do that with some concrete examples. Then I will discuss some of the basics and recommendations around infant feeding, and why safe and appropriate infant feeding is so important. I will also demonstrate that with some research findings, and I will show you how breast feeding practices differ across the world, and identify some countries at risk for infant survival if a disaster strikes. After that, I discuss the so-called warning signs, what to look out for in an emergency in relation to infant feeding. Then I discuss some approaches and programs addressing infant feeding in a disaster setting, I will speak about when to use so-called BMS, breast milk substitutes, for instance, infant formula, then some barriers and challenges mothers face and responders face. Lastly, I will direct you towards some essential resources in case you will ever be involved in preparedness or response in such settings. So let's start. I want to give you some concrete examples, so you understand perhaps better, why infant feeding matters when a disaster occurs? Imagine the following scenario, we are in a country in the Middle East, 35% of all infants are bottle-fed. Bottle-feeding is seen as a symbol of wealth and breast feeding is done but not at large scale, the conflict starts and bombings destroy water piping systems. What can you expect to see happening? So we have situation now here where safe drinking water is a problem, people have difficulties in preparing infant formula in a safe way, infant formula might be difficult to obtain, for instance, transport might be hampered by conflict. The question is, what will people start using instead of infant formula? Maybe people use unclean water, or goat or cow's milk that is not suitable for infants under six months, or the milk is perhaps not boiled or worse people use coffee cream and it looks like milk, but often has no milk in it. Well, the results are predictable, the infant has a high likelihood to get a diarrheal disease, and, or acute malnutrition, certainly his or her life is at stake if no appropriate solution is offered quickly. Another example, maybe you remember the migrant crisis in Europe in 2015, when thousands of people fled conflict and made very difficult journeys over land and oversee, imagine you have an infant with you in this context. Where would you be able to breastfeed this infant and if you don't breastfeed but depend on infant formula, where do you get this and how will you prepare it? In both previous examples, both caregivers as well as humanitarian practitioners scratched their heads to find the best solutions for those involved, and it wasn't easy. Let me tell you first something more general on what happens in a disaster related to this age group and their caregivers. So what happens in a disaster? Depending on the disaster and context, one or more of the following will apply, in a disaster setting there's often breakdown of usual networks of family and friends that support mothers who have difficulty breastfeeding. A disaster causes stress and disruption of daily routines, this poses new challenges for breastfeeding women. Imagine you have just lost your home, or your son is missing, or a friend or husband has just been killed, that causes an enormous amount of stress for a mother who is trying to feed her infant. Health workers who are trained in breastfeeding counseling and lactation management are often redeployed to direct emergency response activities or are affected by emergencies themselves. And that leaves mothers with nobody to turn to for help, during displacement caused by a disaster it's difficult for mothers to find comfortable private places to breastfeed. As I already Illustrated with my examples, access to safe and appropriate infant formula and water might be a problem because of a disaster. This is especially an issue in middle and high-income countries where generally a higher number of parents provide infant formula, and where breastfeeding rates are overall lower. It is not hard to imagine that if a mother dies or is injured, for instance, in a tsunami or earthquake, or if there is a separation of breastfeeding mothers from infants, the health and nutrition of the infants are immediately at risk. On the other hand, in a disaster setting, sometimes, there is a distribution of infant formula, and if that is uncontrolled this is a problem. I hear you asking, why that would be? Well, I will explain, distributions of infant formula to women that normally breastfeed might discourage women to continue breastfeeding, or what if you have distributions of formula with labels that people cannot read? How would they know how to use it? Perhaps people will dilute the formula too much, or too little, which can cause malnutrition or can have a negative impact on the child's kidneys. And maybe that particular product is not suitable for infants under six months but rather for older children, or what if reparation conditions are not hygienic? The infant most likely will get diarrhea with the risk of dehydration and infection. I want to illustrate a damage that can be done by uncontrolled distributions of infant formula, you might remember the 2006 earthquake and following tsunami that affected Yogyakarta in Indonesia. There was a lot of infant formula distributed to children, many of which were exclusively breastfeeding before the earthquake. Here you see on the slide the proportion of children under two years with diarrhea who received donated infant formula, compared to those that did not receive the donations. The rate of diarrhea in children under two years who had received donation was more than double than that of the children who had not received it. The study stated that there were strong associations between the received of infant formula and changes in feeding practices, but also between the receipt of infant formula and diarrhea. This study done by UNICEF, concluded that uncontrolled distribution of infant formula exacerbates the risk of diarrhea amongst infants and young children in emergencies. So I hope you understand with this introduction that when a disaster strikes emergency responders should immediately take action to safeguard the well-being of it of the infants. Also, there is not much time to waste, infants cannot wait a day to be fed.