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Breastfeeding and complementary feeding: importance, challenges and protection in emergencies

  • Page updated onApril 23, 2026
Infant and young child feeding
Text and photo: Bruno Abarca

The nutrition of infants and young children largely determines their health and nutritional status. However, there is limited adherence to the main recommendations for breastfeeding and complementary feeding.

In humanitarian contexts, the challenges of feeding young children are even greater, increasing the risk of acute malnutrition, chronic malnutrition, and infections. Therefore, humanitarian action must help to protect life-saving infant feeding and care practices.

Why breastfeeding and complementary feeding saves lives

Newborn babies have an innate sucking reflex, which often manifests just minutes after leaving the womb. This gives them immediate access to their first protective barrier against the risk of illness and death at their most vulnerable moment: breast milk (WHO, 2025)World Health Organization. (2025). Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals (2nd ed.). World Health Organization. https://www.who.int/publications/i/item/9789240113732.

It is recommended that breastfeeding be initiated within the first hour after birth and that exclusive breastfeeding be practiced for the first 6 months of life (without introducing additional liquids or foods). From that point on, the nutrient needs of children increase. Therefore, it is recommended that starting at six months of age, alongside breast milk (which should continue for at least two years), complementary feeding be gradually introduced.

Breastfeeding protects the lives of infants from the moment they are born

Breast milk is the best possible food and hydration for young children. Therefore, it is crucial for nutrition and physical and cognitive child development. It should always be done on demand, paying attention to the child’s needs, and offering the breast whenever they show hunger.

During the first days of the baby's life, breast milk is known as colostrum and is especially rich in nutrients. Over time, breast milk adapts its composition to always contain the right proportions of fats, proteins, carbohydrates, vitamins, minerals, and water that the baby needs.

Furthermore, the live cells, microorganisms, and bioactive factors contained in breast milk have a positive effect on the infant's innate immunity that no formula milk can replicate (Cacho & Lawrence, 2017)Cacho, N. T., & Lawrence, R. M. (2017). Innate immunity and breast milk. Frontiers in Immunology, 8, 584. https://doi.org/10.3389/fimmu.2017.00584. Thus, breast milk strengthens the newborn's chemical intestinal barriers against pathogens, helps compensate for the immaturity of epithelial cells and macrophages, contributes to establishing the gut microbiota and its symbiosis with the host, and enables the recognition and inactivation of pathogens. At the same time, it also helps control the inflammation that all these effects could produce. Moreover, there are other protective effects of breast milk that are not yet well understood, such as the possible contribution of the stem cells it contains to the regeneration of the infant's tissues and immune system. Thanks to all of this, breast milk reduces morbidity and mortality from diarrhoeal and respiratory infections.

Breastfeeding also has important positive effects on mothers who practice it: it reduces the risk of ovarian and breast cancer, facilitates spacing between pregnancies, helps with the loss of weight gained during pregnancy, and reduces the risk of diabetes, among other benefits.

Breastfeeding and complementary feeding should be continued after 6 months of age

At 6 months of age, children's nutritional demands increase. Breastfeeding should therefore continue while new foods are introduced. During this period there is an increased risk of acute and chronic malnutrition if complementary feeding is not adequate (USAID Advancing Nutrition, 2023)USAID Advancing Nutrition. (2023). Integrating complementary feeding in emergencies: A decision tool for concrete actions at each stage of the humanitarian program cycle. https://www.complementaryfeedingcollective.org/media/641/file/comp_feed_emer_decision_tool.pdf.pdf. Furthermore, this stage will be key to their development, as it is when future eating habits begin to be established.

Complementary feeding should be based on a diversified diet with products of different flavours and textures from all food groups. These include breast milk; cereals, roots, tubers, and plantains; legumes, nuts, and seeds; dairy products; meats; eggs; vitamin A-rich fruits and vegetables; and other fruits and vegetables. Each day, breast milk should be combined with at least 4 other different food groups. The introduction of foods should be done progressively, offering healthy and nutritious food. Furthermore, the child should be allowed to decide how much they eat, encouraging autonomy and self-regulation, without forcing or distracting them to eat (WHO, 2023)World Health Organization. (2023). WHO guideline for complementary feeding of infants and young children 6–23 months of age. World Health Organization. https://www.who.int/publications/i/item/9789240081864.

It is especially important that the diet includes daily consumption of fruits, vegetables, and animal products such as meat, fish, and eggs. Frequent consumption of legumes, seeds, and nuts is also essential, especially if vegetables and animal products are scarce in the diet, and always in a format that poses no choking risk. Starchy staple foods (potatoes, white bread, pasta, white rice, corn, etc.), although very common, should be minimized. They lack proteins and important micronutrients such as iron, zinc, or vitamin B12. Dairy products should also be part of the diet, although the best option is breast milk. Conversely, foods high in sugar, sweeteners, salt, and trans fats should be avoided.

Millions of children are not getting the nutrition they need

Infant and young child feeding (IYCF) is globally deficient

Although the benefits of breastfeeding are widely documented, actual practice falls well short of recommendations. For example, waiting more than one hour to initiate breastfeeding increases mortality in the following 28 days of life by 30%, and waiting more than one day doubles the risk of mortality. However, only 48% of newborns practise early initiation of breastfeeding (UNICEF & WHO, 2018)UNICEF & WHO. (2018). Capture the moment: Early initiation of breastfeeding — the best start for every newborn. UNICEF. https://www.unicef.org/reports/capture-moment. Similarly, only 44% of these children receive exclusive breastfeeding during their first 6 months of life. The other 56% either do not breastfeed at all or introduce other foods or liquids (such as water or formula milk) (Nutrition International & Alive and Thrive, 2022)Nutrition International & Alive and Thrive. (2022). The cost of not breastfeeding: Global advocacy brief (2022 update). https://www.aliveandthrive.org/en/resources/the-cost-of-not-breastfeeding-global-advocacy-brief-2022-update. Finally, only 59% of children continue to receive some breast milk between 12 and 24 months of life.

Actual complementary feeding practice also falls well short of recommendations. Only 34% of children between 6 and 23 months of age have a diet with the recommended minimum diversity of 5 food groups per day. Likewise, only one in two children of this age receives complementary feeding at least 4 times a day. Overall, it is estimated that only 21% follow a minimum acceptable diet (UNICEF, 2024)UNICEF. (2024). Diets. UNICEF Data. https://data.unicef.org/topic/nutrition/diets/.

Infant and young child feeding
UNICEF, 2024

Infant and young child feeding (IYCF) problems have serious consequences

When feeding of infants and young children is inadequate, they cannot meet their nutritional needs. As a result, their risk of malnutrition increases, including acute malnutrition, micronutrient deficiencies, and stunting. Furthermore, these children become much more vulnerable to infections. Today it is estimated that inadequate breastfeeding practices cause 420,000 child deaths every year from diarrhoea and pneumonia (Nutrition International & Alive and Thrive, 2022)Nutrition International & Alive and Thrive. (2022). The cost of not breastfeeding: Global advocacy brief (2022 update). https://www.aliveandthrive.org/en/resources/the-cost-of-not-breastfeeding-global-advocacy-brief-2022-update.

The consequences, however, go far beyond this, also affecting maternal health and the economy of the most vulnerable families. The lack of breastfeeding is also attributed to more than 90,000 maternal deaths from type 2 diabetes and cancer, over 4.5 million annual cases of childhood obesity, the loss of up to 5% (Latin America) or 23% (Sub-Saharan Africa) of the income for families purchasing formula milk, and over $500 billion in global economic losses due to cognitive delays, mortality, and healthcare costs.

How to promote breastfeeding?

Breastfeeding promotion is critical to improving overall infant and young child feeding (IYFCF) practices. It is not only about initiating breastfeeding, but also about making it a positive experience that feeds back. 

Promoting exclusive breastfeeding and its continuation is a public health priority

When breastfeeding is a positive experience, its practice reinforces itself. Similarly, when it is not established or carried out correctly, its practice becomes increasingly difficult. For example, when exclusive breastfeeding is replaced by formula milk or accompanied by the premature introduction of other foods or liquids, several negative effects occur. First, the use of these other foods results in a lower intake of breast milk, which is much more nutritious and has more protective effects than any other alternative. Additionally, the baby's demand for breast milk decreases, along with the sucking stimulus, and ultimately, milk production diminishes. Without support, mothers facing this situation may be forced to rely entirely on the substitutes for breast milk that initiated the problem.

Promoting breastfeeding is not simply a matter of explaining its benefits. It is necessary to ensure that choosing breastfeeding becomes the most advantageous, convenient, and easy option for mothers to adopt and sustain, as they are the ones who must make and continue this decision (ENN & IFE Core Group, 2021)Emergency Nutrition Network & Infant Feeding in Emergencies Core Group. (2021). Operational guidance on breastfeeding counselling in emergencies. https://www.ennonline.net/resource/ife/operational-guidance-breastfeeding-counselling-emergencies. It must also be perceived as the best option by their partners and families, who must support mothers. For this reason, it is necessary to address this goal from health centres and hospitals, but also from the community and public health policies, and always from a gender equity perspective.

Breastfeeding promotion from health services

The information that mothers, their families, and their communities have about breastfeeding will largely determine the decisions they make about the feeding and care of their future children. For this reason, breastfeeding promotion must begin as soon as pregnancy is known and continue through childbirth and the postpartum period (WHO, 2017)World Health Organization. (2017). Guideline: Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services. World Health Organization. https://www.who.int/publications/i/item/9789241550086.

Antenatal follow-up consultations are a key opportunity. These can be complemented with additional activities such as childbirth preparation and newborn care classes. The information provided during this period should cover the importance and benefits of breastfeeding for the health of the baby and the mother, and for the family's finances. It should also address techniques and skills for successful breastfeeding, the challenges and difficulties that may arise, how to overcome them, and the support services available to make breastfeeding a positive experience.

The moment of birth is also fundamental. Generally, just a little assistance is enough for a newborn to begin breastfeeding easily within the first hour of life. From that moment on, it is the baby's own sucking that stimulates the release of maternal prolactin and the immediate production of milk. It is therefore important to place the baby on the mother with skin-to-skin contact. This also promotes a wonderful emotional bond, proper temperature regulation, and the transfer of protective bacteria to the newborn. Alongside this, the mother should be guided and given additional advice to ensure a good latch, exclusive on-demand breastfeeding should be recommended, the risks of using bottles should be explained, and the baby and mother should be kept in the same room. Healthcare institutions must have adequate policies and trained staff to ensure compliance with all of these measures (WHO, 2018)WHO & UNICEF. (2018). Implementation guidance: Protecting, promoting, and supporting breastfeeding in facilities providing maternity and newborn services — the revised Baby-friendly Hospital Initiative 2018. World Health Organization. https://www.who.int/publications/i/item/9789241513807.

Breastfeeding promotion in the community

After discharge and throughout the entire duration of breastfeeding, mothers, their partners, and families should have access to some form of additional support to resolve any doubts that may arise over time. This also helps to address rumours and contradictory messages they receive from other information sources (ENN & IFE Core Group, 2021)Emergency Nutrition Network & Infant Feeding in Emergencies Core Group. (2021). Operational guidance on breastfeeding counselling in emergencies. https://www.ennonline.net/resource/ife/operational-guidance-breastfeeding-counselling-emergencies.

The creation of support groups and networks among mothers and families going through a similar life stage can be very helpful in identifying and properly overcoming difficulties. Examples of difficulties include the self-perception of producing insufficient milk or of insufficient quality, or the incorrect interpretation of normal baby behaviors as signs of a problem. Some issues, which are easy to prevent or address, often lead to the introduction of supplements or artificial formulas, and to the premature and definitive cessation of breastfeeding and its benefits.

Promotion of breastfeeding through public policies

Promoting breastfeeding cannot be confined to the family and community sphere. It makes no sense to promote breastfeeding within the family and health facilities if the mother's work overload or return to paid employment prevents her from maintaining breastfeeding as she would wish, or if she continuously receives messages urging her to stop breastfeeding through every possible communication channel (WHO & UNICEF, 2022)World Health Organization & UNICEF. (2022). How the marketing of formula milk influences our decisions on infant feeding. World Health Organization. https://www.who.int/publications/i/item/9789240044609.

Society is permeated by aggressive marketing messages from the breast-milk substitutes industry (WHO et al., 2022)WHO, UNICEF, & International Baby Food Action Network. (2022). Marketing of breast-milk substitutes: National implementation of the international code, status report 2022. World Health Organization. https://www.who.int/publications-detail-redirect/9789240048799. These companies frequently violate the International Code of Marketing of Breast-milk Substitutes (in place since 1981) and exploit the fears of mothers and caregivers. These substitutes represent a significant financial cost to families and furthermore fail to be an adequate replacement for breast milk (which has unique properties that cannot be artificially replicated). Yet the companies that market them have no hesitation in distorting information about their benefits while generating public doubt and distrust towards breast milk. The formula milk and breast-milk substitutes industry thus generates 55 billion dollars in annual profit.

Exposure to formula milk marketing
WHO and UNICEF, 2022.

Governments and authorities must develop and implement gender-sensitive labor and public health policies that promote breastfeeding. These policies should, for example, allow for flexible work schedules that accommodate the care and feeding of infants. They should also facilitate and promote the shared responsibility of partners in this regard, as well as encourage messages consistent with these policies that increase their social acceptability. Furthermore, public policies must regulate the advertising and marketing practices of breast milk substitutes, in line with the International Code and breastfeeding recommendations.

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Challenges for infant and young child feeding in emergencies (IYCF-E)

Breastfeeding more difficult for mothers affected by humanitarian crisis

During humanitarian crises, mothers and caregivers face additional difficulties in providing their children with the nutrition they need.

On one hand, as a result of conflicts, climate events, and displacement, mothers who wish to breastfeed their children may find themselves physically, mentally, and emotionally exhausted (UNICEF & IFE Core Group, 2025)UNICEF & Infant Feeding in Emergencies Core Group. (2025). Technical and operational guidance for increasing access to breastmilk through wet nursing in emergency settings. UNICEF. https://knowledge.unicef.org/resource/technical-operational-guidance-increasing-access-breastmilk-through-wet-nursing-emergencies. In the conditions in which they live, there may be no safe spaces where families can care for and play with their young children, nor privacy to offer on-demand breastfeeding (Dall'Oglio et al., 2020)Dall'Oglio, I., Marchetti, F., Mascolo, R., Amadio, P., Gawronski, O., Clemente, M., Dotta, A., Ferro, F., Garofalo, A., Salvatori, G., Tarantino, A., Tiozzo, E., & Giusti, A. (2020). Breastfeeding protection, promotion, and support in humanitarian emergencies: A systematic review of literature. Journal of Human Lactation, 36(4), 687–698. https://doi.org/10.1177/0890334419900151. Support networks and community structures also break down. As a result, and especially if they are not prioritised in humanitarian assistance, mothers and caregivers may find themselves alone, without support, and without the capacity to feed and care for their young children.

On the other hand, during these crises, access to health services, information, and support regarding breastfeeding and infant feeding becomes difficult. This complicates the early initiation of breastfeeding and turns minor difficulties in its practice into insurmountable problems and obstacles.

Unsolicited donations of breastmilk substitutes are a huge risk

In humanitarian emergencies, it is common for unsolicited donations of breast-milk substitutes to arrive, coming from unethical companies and from well-intentioned but poorly informed solidarity actions (WHO, 2017)World Health Organization. (2017). The international code of marketing of breast-milk substitutes: Frequently asked questions (WHO/NMH/NHD/17.1). World Health Organization. https://www.who.int/publications/i/item/WHO-NMH-NHD-17.1. These donations contribute to increasing risks for infant and young child feeding, by forcing the interruption of breast milk production and creating a total dependence on formula milk (UNICEF, 2023)(UNICEF, 2023).

The negative effects of using formula milk multiply during a humanitarian crisis. Not only does it increase the risk of malnutrition at a time of maximum vulnerability, but it also heightens the danger of disease and death from diarrhea and dehydration, especially when clean water and means to maintain hygiene of the utensils used to prepare and offer formula milk are scarce.

Donations are also not permanent or guaranteed. When donations become scarce or inaccessible, the production of breast milk has already decreased. Therefore, families find themselves without the financial means to acquire a product inferior to breast milk that is extremely expensive, putting their children at risk.

How to protect breastfeeding and infant feeding in emergencies

Humanitarian action in emergencies must include actions such as support for assisted delivery and early initiation of breastfeeding, food or financial assistance (through cash or vouchers) to caregivers, and protection of babies who depend exclusively on formula milk (UNICEF, 2021)UNICEF. (2021). Procurement and use of breastmilk substitutes in humanitarian settings (Version 2.0). https://www.unicef.org/documents/procurement-and-use-breastmilk-substitutes-humanitarian-settings. The latter must be done with great care, minimising the risk of infections and avoiding threatening breastfeeding in other families (IFE Core Group, 2021)Infant Feeding in Emergencies Core Group. (2021). Planning and managing artificial feeding interventions during emergencies: A guide for decision makers and programmers working in emergency preparedness and response (Infographic). Emergency Nutrition Network. https://www.ennonline.net/ifecoregroupinfographicseries. In addition, coordination is needed to monitor and control unsolicited donations of breast-milk substitutes (IFE Core Group, 2017)Infant Feeding in Emergencies Core Group. (2017). Infant and young child feeding in emergencies: Operational guidance for emergency relief staff and programme managers (Version 3.0). Emergency Nutrition Network. https://www.ennonline.net/resource/ife/operational-guidance-infant-feeding-emergencies-og-ife-version-30-oct-2017.

It may sometimes be necessary to offer multiple micronutrient supplements (which do not displace other foods from the diet). Nutritional supplements in the form of small-quantity lipid-based nutrient supplements (SQ-LNS) may also be used when there is food insecurity and significant nutritional deficiencies. If families are already consuming flour- and cereal-based foods (wheat, maize, or rice), these can be mixed with soya and fortified with micronutrients (WHO, 2025)World Health Organization. (2025). Infant and young child feeding: Model chapter for textbooks for medical students and allied health professionals (2nd ed.). World Health Organization. https://www.who.int/publications/i/item/9789240113732.

The creation of community support spaces for infant and young child feeding (known as Baby-Friendly Spaces or Supportive Spaces for Infant and Young Child Feeding in Emergencies) is also a common priority action (GTAM, 2020)Global Technical Assistance Mechanism for Nutrition. (2020, September). Supportive spaces for infant and young child feeding in emergencies (Technical brief). https://www.ennonline.net/supportivespacesiycfetechbrief2020. These are safe spaces located in displaced or highly vulnerable communities, designed for the exclusive access of pregnant women and mothers of children under 2 years of age, as well as fathers on occasion. They offer specialist advice on feeding and infant care practices, available on demand and with privacy. They therefore also serve as an excellent channel for providing psychological first aid, facilitating referrals to other available protection and assistance services, and extending psychosocial support, recognising that the wellbeing of caregivers and infants is inseparable (IFE Core Group et al., 2026)Infant Feeding in Emergencies Core Group, MAMI Global Network, & Global Nutrition Cluster. (2026, February 11). Integrating mental health and psychosocial support (MHPSS) into IYCF-E – Webinar. YouTube. https://www.youtube.com/watch?v=sozon9mfGFE. These spaces are also suitable for carrying out scheduled educational activities and mutual support among people who need new positive social connections.

In any case, it is important to understand that the protection of infant feeding in emergencies is not the exclusive responsibility of the nutrition sector (UNHCR & Save the Children, 2018)UNHCR & Save the Children. (2018). Infant and young child feeding in refugee situations: A multi-sectoral framework for action. https://www.unhcr.org/media/infant-and-young-child-feeding-refugee-situations-multi-sectoral-framework-action. Other humanitarian sectors must also prioritise the needs of mothers and fathers of the youngest children, thereby creating a protective and positive environment for their care and feeding.

References

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How to cite this page

Abarca, B. (April 23, 2026). Breastfeeding and complementary feeding: importance, challenges and protection in emergencies. Salud Everywhere. https://saludeverywhere.com/en/health-in-humanitarian-crises/infant-and-young-child-feeding/

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