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

  • Page updated onJune 29, 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 suckling reflex, which often manifests within minutes of leaving the womb. This gives them immediate access to their first line of protection against the risk of disease and death at their most vulnerable moment: breast milk (WHO, 2025).

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 living 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). Breast milk reinforces the chemical barriers of the newborn's intestine against pathogens, helps compensate for the immaturity of epithelial cells and macrophages, contributes to establishing the intestinal microbiota and its symbiosis with the host, and enables the recognition and inactivation of pathogens. At the same time, it helps control the inflammation that all these effects could produce. Moreover, there are other protective effects of breast milk that we do not yet fully understand, 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, the nutritional demands of infants increase. For this reason, breastfeeding must 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). Furthermore, this stage will be crucial for their development, as it is the time 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; meat; 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 groups. The introduction of foods should be done progressively, offering healthy and nutritious food. It is also important to let the child decide how much they eat, encouraging autonomy and self-regulation, without forcing or distracting them to eat (WHO, 2023).

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 well documented, actual practice falls far 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 a day doubles the risk of mortality. However, only 48% of newborns practise early initiation of breastfeeding (UNICEF & WHO, 2018). Similarly, only 44% of these children receive exclusive breastfeeding during their first 6 months of life. The other 56% either do not practise breastfeeding or introduce other foods or liquids (such as water or formula milk) (Nutrition International & Alive and Thrive, 2022). Finally, only 59% of children continue to receive some breast milk between 12 and 24 months of life.

Actual complementary feeding also falls far short of what is recommended. Only 34% of children between 6 and 23 months of age have a diet with the minimum recommended 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 considered that only 21% follow a minimally acceptable diet (UNICEF, 2024).

Infant and young child feeding
UNICEF, 2024

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

When feeding of young children and infants is inadequate, they cannot meet their nutritional needs. As a result, their risk of malnutrition increases, including acute malnutrition, micronutrient deficiencies and growth stunting. Furthermore, these children become far more vulnerable to infections. It is currently estimated that poor breastfeeding practices cause 420,000 child deaths per year from diarrhoea and pneumonia (Nutrition International & Alive and Thrive, 2022).

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 maintain, as they are the ones who must make and sustain this decision (ENN & IFE Core Group, 2021). It must also be seen as the best option by their partners and families, who must support mothers. For this reason, it is necessary to address this objective 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, 2017a).

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 crucial. Generally, a little assistance is all that is needed for a newborn to begin breastfeeding easily within the first hour of life. From that moment on, it is the infant's own suckling 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 on achieving a good latch, exclusive on-demand breastfeeding should be recommended, the risks of bottle use should be explained, and the baby and mother should be kept in the same room. Healthcare institutions must have appropriate policies and trained staff to ensure compliance with all these measures (WHO & UNICEF, 2018).

Breastfeeding promotion in the community

After discharge and throughout the entire duration of breastfeeding, mothers, their partners and families must be able to count on some form of additional support to resolve any doubts that arise over time. This also helps to address rumours or contradictory messages received from other information sources (ENN & IFE Core Group, 2021).

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

The promotion of breastfeeding cannot be confined to the family and community sphere. There is no point in promoting breastfeeding within the family and healthcare settings if the mother's excessive workload or her return to paid employment prevents her from maintaining breastfeeding as she would wish, or if she constantly receives messages encouraging her to stop breastfeeding through every possible communication channel (WHO & UNICEF, 2022).

Society is permeated by aggressive messages from the breast milk substitute industry (WHO et al., 2022). These companies frequently violate the International Code of Marketing of Breast-milk Substitutes (in existence since 1981) and exploit the fears of mothers and caregivers. These substitutes carry a significant financial cost for families and furthermore fail to be an adequate replacement for breast milk (which has unique properties that cannot be artificially replicated). However, the companies that market them have no qualms about distorting information about their benefits while simultaneously generating doubts and mistrust about breast milk among the population. In this way, the formula milk and breast milk substitute industry generates $55 billion 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). 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). Support networks and community structures also break down. As a consequence, 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

It is common in humanitarian emergencies for there to be unsolicited donations of breast milk substitutes, coming from unethical companies and from well-intentioned but poorly informed acts of solidarity (WHO, 2017b). These donations contribute to increasing the 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).

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 economic assistance (through cash or vouchers) for caregivers, and protection of babies who depend exclusively on formula milk (UNICEF, 2021). The latter must be done with great care, minimising the risk of infections and avoiding threats to breastfeeding in other families (IFE Core Group, 2021). In addition, coordination is needed to monitor and control unsolicited donations of breast milk substitutes (IFE Core Group, 2017).

On occasion it may be necessary to offer multiple micronutrient supplements (which do not displace other foods from the diet). 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).

The creation of community spaces to support infant and young child feeding (Baby-Friendly Spaces or Supportive Spaces for Infant and Young Child Feeding in Emergencies) is also a common priority action (GTAM, 2020). 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 infant feeding and childcare practices, on demand and with privacy. For this reason, they are also an excellent means of providing psychological first aid, facilitating referrals to other available protection and assistance services, and extending psychosocial support, with the understanding that the wellbeing of caregivers and infants is inseparable (IFE Core Group et al., 2026). These spaces are also suitable for hosting 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). Other humanitarian sectors must also prioritise the needs of the mothers and fathers of the youngest children, thereby creating a protective and positive environment for their care and feeding.

References

Nutrition

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How to cite this page

Abarca, B. (June 29, 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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