Impact of the COVID-19 pandemic on infant feeding practices in the United States: Food insecurity, supply shortages and deleterious formula-feeding practices.

The coronavirus disease 2019 (COVID-19) pandemic increased food insecurity among US households, however, little is known about how infants, who rely primarily on human milk and/or infant formula, were impacted. We conducted an online survey with US caregivers of infants under 2 years of age (N = 319) to assess how the COVID-19 pandemic impacted breastfeeding, formula-feeding and household ability to obtain infant-feeding supplies and lactation support (68% mothers; 66% White; 8% living in poverty). We found that 31% of families who used infant formula indicated that they experienced various challenges in obtaining infant formula, citing the following top three reasons: the formula was sold out (20%), they had to travel to multiple stores (21%) or formula was too expensive (8%). In response, 33% of families who used formula reported resorting to deleterious formula-feeding practices such as diluting formula with extra water (11%) or cereal (10%), preparing smaller bottles (8%) or saving leftover mixed bottles for later (11%). Of the families who fed infants human milk, 53% reported feeding changes directly as a result of the pandemic, for example, 46% increased their provisioning of human milk due to perceived benefits for the infant's immune system (37%), ability to work remotely/stay home (31%), concerns about money (9%) or formula shortages (8%). Fifteen percent of families who fed human milk reported that they did not receive the lactation support they needed and 4.8% stopped breastfeeding. To protect infant food and nutrition security, our results underscore the need for policies to support breastfeeding and ensure equitable and reliable access to infant formula.

Knowledge and practice pattern of integrated child development services scheme supervisors (AWS) following capacity building and remote supportive supervision.

Background: Nutritional status of under-5 children in India is not promising and lags far behind the WHO Global Nutrition Targets. Although the Integrated Child Development Services has been continuously delivered through Anganwadi centers since 1975, the burden of malnutrition still persists. Objectives: This study was conducted to estimate the knowledge and practice pattern of Anganwadi supervisors and the effect of capacity building through remote supportive supervision during the COVID-19 pandemic in Assam, India. Methods: A cross-sectional before-after study using a mixed methods approach was used to evaluate the knowledge pattern and service delivery of supervisors from each district of Assam. For qualitative assessment, telephone depth interviews were conducted. Results: Knowledge of supervisors in the beginning was 83.43% which improved by 7.97% at the end of the study. The highest burden of SAM children was in Tinsukia and Barpeta districts. On mapping, most districts with lower burden of SAM had supervisors with higher knowledge levels on Infant and Young Child Feeding practices. Qualitative assessment revealed house-to-house visit for ensuring service delivery and use of online platforms and phone calls for counseling. However, community resistance and lack of transport stood as a main challenge. Conclusion: Supportive supervision done remotely during the pandemic to enhance the performance of health workforce was found effective.

Child undernutrition and associated factors among children 6-23 months old in largely food insecure areas of rural Ethiopia.

Child malnutrition is the leading public health problem in Sub-Saharan Africa, resulting in poor health and economic losses. Ethiopia has one of the highest child undernutrition rates in the world that occurs to multifaceted factors, including food insecurity. Thus, we performed a cross-sectional study to assess the prevalence and risk factors for child undernutrition in largely food insecure areas of Ethiopia. Data were collected from 354 mother-child pairs from the Siraro district. Both bivariate and multivariate logistic regression was used for statistical analysis. Variables with a P-value of <0⋅05 in multivariate analysis were used to detect statistical significance at a 95 % confidence level. About 67 % of households are food insecure. The prevalence of stunting wasting and underweight were 42⋅7, 9⋅9 and 27⋅7 %, respectively. Female gender, higher age of the child (12-23 months v. 6-11 months), living in a household with five or more siblings, not getting therapeutic zinc supplement at least once, inadequate diet diversity, lack of growth monitoring service, and maternal own income increases the likelihood of child undernutrition. It can be concluded that child undernutrition is a severe public health problem in the study area. Improving primary healthcare services related to zinc supplementation, growth monitoring and promotion, and improving infant and child feeding practices can be considered as a strategy to address the problem.

Breastfeeding and humanitarian emergencies: the experiences of pregnant and lactating women during the earthquake in Abruzzo, Italy.

BACKGROUND: Emergencies have a great impact on infant and young child feeding. Despite the evidence, the recommended feeding practices are often not implemented in the emergency response, undermining infant and maternal health. The aim of this study was to explore the experiences of pregnant and lactating women during the earthquake emergency that occurred in L'Aquila on 6 April 2009. METHODS: The study design was qualitative descriptive. Data were collected by individual semi-structured interviews, investigating the mother's experiences of pregnancy, childbirth, breastfeeding, infant formula or complementary feeding during the emergency and the post emergency phase. Data analysis was categorical and was performed by using N-Vivo software. RESULTS: Six women who were pregnant at the time of the earthquake were interviewed in January 2010. In addition to the essential needs of pregnant and lactating women, such as those related to the emergency shelters conditions, the main findings emerged from this study were: the reconfiguration of relationships and the central role of partners and family support; the need of spaces for sharing experiences and practices with other mothers; the lack of breastfeeding support after the hospital discharge; the inappropriate donations and distribution of Breast Milk Substitutes. CONCLUSIONS: During and after L'Aquila earthquake, several aspects of infant and young child feeding did not comply with standard practices and recommendations. The response system appeared not always able to address the specific needs of pregnant and lactating women. It is urgent to develop management plans, policies and procedures and provide communication, sensitization, and training on infant and young child feeding at all levels and sectors of the emergency response.

The Philippines' snapshot situation of pregnancy-related and child feeding practices during the COVID-19 pandemic.

Background: Maternal, infant and young child health and nutrition are affected during the COVID-19 pandemic. Aim: This study aimed to present the snapshot situation of maternal health practices of pregnant women including infant and young child feeding (IYCF) practices of children under two during the COVID-19 pandemic. Methods: A rapid nutrition assessment survey (RNAS) was conducted through phone interview in nine selected areas from November 3 to December 3, 2020. A multi-stage sampling design was employed in the selection of areas with low, medium, and high risk categories across the islands of Luzon, Visayas, and Mindanao in the Philippines. A total of 792 mother-child pairs, and 148 pregnant women were covered. Results: Majority (84.5%) of pregnant women availed pre-natal check-ups, 82.4% of them had micronutrient supplements, of which 20.5% took IFA tablets. Almost 60.0% of children under two were currently breastfed during the pandemic, with 60.8% of infants less than 6 months receiving breastmilk exclusively. Appropriate complementary feeding practices based on this study were not drastically affected by the COVID-19 pandemic. However, access to pregnancy-related information, along with breastfeeding and complementary feeding messages and advice were disrupted during the community lockdown. Conclusion: Although maternal and child feeding practices were unchanged, innovative delivery of community health and nutrition services such as tele-visits by midwives, and community health workers are some of the ways to move forward in improving the health and nutrition of women and children in the wake of the pandemic and during subsequent waves.

Infant and young child feeding during natural disasters: A systematic integrative literature review.

BACKGROUND: As climate change worsens, the frequency and intensity of natural disasters continues to increase. These extreme weather events particularly affect the physical and mental health of vulnerable groups such as mothers and infants. From low-income to high income countries, poorly organised disaster response can negatively impact infant and young child feeding practices. AIM: To examine challenges and supportive strategies for infant and young child feeding during natural disasters to inform further research and guide disaster recommendations and practice. METHODS: A comprehensive search strategy explored the electronic databases PubMed, CINAHL and Cochrane Library. Screening, data extraction and analysis were conducted using Covidence. Quality assessment was conducted using the Mixed Methods Appraisal Tool (MMAT). Studies were analysed using thematic analysis. FINDINGS: This review included 13 studies (4 mixed methods, 1 critical ethnography, 2 quasi-experimental studies, 4 descriptive studies, 1 qualitative study, 1 evidence gap map analysis). Breastfeeding facilitators during natural disaster contexts are privacy for breastfeeding, community and family support, adaptation of professional breastfeeding support to the local context and pre-existing breastfeeding practice. Breastfeeding challenges during natural disasters include decreased breastfeeding self-efficacy, lack of knowledge and resources and over-reliance on formula baby milks. Formula baby milk feeding challenges during natural disasters are the lack of access to resources required for hygienic formula baby milk preparation as well as the lack of availability of formula baby milk in some contexts. CONCLUSION: This systematic integrative review demonstrates that interventions which facilitate optimal infant and young child feeding in natural disaster contexts must be culturally and socially appropriate; increasing women's knowledge of optimal breastfeeding and safe formula baby milk feeding practices as well as breastfeeding self-efficacy.

Old Tricks, New Opportunities: How Companies Violate the International Code of Marketing of Breast-Milk Substitutes and Undermine Maternal and Child Health during the COVID-19 Pandemic.

Breastfeeding is critical to maternal and child health and survival, and the benefits persist until later in life. Inappropriate marketing of breastmilk substitutes (BMS), feeding bottles, and teats threatens the enabling environment of breastfeeding, and exacerbates child mortality, morbidity, and malnutrition, especially in the context of COVID-19. These tactics also violate the International Code of Marketing of Breast-Milk Substitutes. This study identified marketing tactics of BMS companies since the start of the COVID-19 pandemic by reviewing promotional materials and activities from 9 companies in 14 countries, and the official Code reporting data from the Philippines. Eight qualitative themes emerged that indicate companies are capitalizing on fear related to COVID-19 by using health claims and misinformation about breastfeeding. Other promotional tactics such as donations and services were used to harness the public sentiment of hope and solidarity. Past studies show that these tactics are not new, but the pandemic has provided a new entry point, helped along by the unprecedented boom in digital marketing. There was a sharp increase of reported violations in the Philippines since the pandemic: 291 during the first months of the outbreak compared with 70 in all of 2019, corroborating the thematic findings. A lack of public awareness about the harm of donations and inadequate Code implementation and enforcement have exacerbated these problems. Proposed immediate action includes using monitoring findings to inform World Health Assembly (WHA) actions, targeted enforcement, and addressing misinformation about breastfeeding in the context of COVID-19. Longer-term action includes holding social media platforms accountable, raising public awareness on the Code, and mobilizing community monitoring.

Shared decision-making for infant feeding and care during the coronavirus disease 2019 pandemic.

Despite decades of research establishing the importance of breastfeeding, skin-to-skin contact and mother-infant closeness, the response to the coronavirus disease 2019 (COVID-19) pandemic has underscored the hidden assumption that these practices can be dispensed with no consequences to mother or child. This article aims to support shared decision-making process for infant feeding and care with parents and health care providers during the unprecedented times of the pandemic. It proposes a structure and rationale to guide the process that includes (1) discussing with parents evidence-based information and the different options to feed and care for an infant and young child in the context of the pandemic as well as their potential benefits, risks and scientific uncertainties; (2) helping parents to recognize the sensitive nature of the decisions and to clarify the value they place on the different options to feed and care for their infant or young child; and (3) providing guidance and support needed to make and implement their decisions. A shared decision-making process will help parents navigate complex feeding and care decisions for their child as we face the different stages of the COVID-19 pandemic.

Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care.

BACKGROUND: In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. WEIGHING OF RISKS IS NECESSARY IN POLICY DEVELOPMENT: Such policies are risky as was shown in the early response to the HIV pandemic where efforts to prevent mother to child transmission by replacing breastfeeding with infant formula feeding ultimately resulted in more infant deaths. In the COVID-19 pandemic, the risk of maternal SARS-CoV-2 transmission needs to be weighed against the protection skin-to-skin contact, maternal proximity, and breastfeeding affords infants. CONCLUSION: Policy makers and practitioners need to learn from the mistakes of the HIV pandemic and not undermine breastfeeding in the COVID-19 pandemic. It is clear that in order to maximise infant health and wellbeing, COVID-19 policies should support skin-to-skin contact, maternal proximity, and breastfeeding.