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Post a reply: HOW to respond to requests for BMS from caregivers who are ineligible for BMS Support

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Dear colleagues, 

I am seeking training materials, experiences, approaches/techniques and your recommendations on HOW, as an IYCF Counsellor, to respond to requests for infant formula from emergency-affected mothers/caregivers who are NOT eligible to receive infant formula/BMS according to pre-established eligibility criteria? 

Put another way, as an IYCF Counsellor working within an IYCF-E Response that includes the targeted and controlled provision of BMS to eligible caregivers of BMS-dependent infants, HOW DO I REFUSE an ineligible caregiver in a way that is effective, compassionate,  respectful and minimises caregiver stress? 

WHAT should an IYCF Counsellor say, do and/or take into consideration?

Your responses will be used to inform the development of content for a new Training for Frontline Workers: MHPSS-INFORMED INFANT FEEDING COUNSELLING IN EMERGENCIES. The training will include a module on how to navigate tricky/complex issues which IYCF Counsellors commonly encounter during emergencies e.g., dealing with requests for infant formula from breastfeeding women who are ineligible for BMS Support. (Note that past refusals have reportedly resulted in camp riots/protests, taking of BMS by force and threats against health workers - while evidently part of a wider communication/sensitisation challenge, it does highlight the importance of IYCF Counsellors responding  appropriately).   Ethics  and WHY breastfeeding mothers request BMS during emergencies will be covered, in addition to the "how to" guidance in question here. 

This question is being posed with the understanding that providing infant formula to facilitate maternal choice when it is likely to cause significant harm is not kind or ethical  (Gribble, 2014). To allow for a focused discussion, please note that I am currently not seeking inputs on whether infant formula should be provided to all emergency-affected mothers who request it or not. 

With thanks to Dr. Karleen Gribble and Dr. Aunchalee Palmquist, whose insightful paper on Facilitators of good and poor practice in distribution of infant formula in the 2014–2016 refugee crisis in Europe inspired this question: "Crucially, frontline aid providers, including medical personnel and those providing nutrition support, need to be equipped with infant feeding counselling skills so they are able to appropriately support and assist mothers and caregivers requesting infant formula, including those who are refused. Strategies used in medicine to prevent inappropriate prescription of medications that can cause harm when dispensed improperly may be instructive (Wells & Cronk, 2020; Wyse et al., 2019)."

With many thanks in advance,


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