This post was most recently updated on April 6th, 2017
There is a French translation of this article below.
This article edited 11/3/17 to add – we are not accusing the midwves of GSF of not supporting breastfeeding or believing that breastmilk is the safest manner to feed babies. We are, however, concerned that mothers who are using formula are not being appropriately supported. The comments from GSF under this article prove that they are struggling to understand the particular hygiene challenges mothers in camp face every day.
At the end of January 2017, after many attempts by the Breastfeeding Counsellors of Calais and Dunkirk Infant Feeding Team to encourage safe infant feeding practices in the Grande Synthe refugee camp, the midwives of Gynecologie Sans Frontieres finally shared their infant feeding guidance document. Strangely, it was not sent to the British Infant Feeding Team who had spent nearly a year and a half trying to support them, but to an English volunteer not involved with infant feeding, who instantly shared it with us. What follows are some quotes from this guidance and short explanations of why it is inappropriate.
“GSF recommends the use of bottles (either glass or polycarbonate) and silicone or rubber teats with variable flow. Start with a low flow so as not to overwhelm the infant by the sudden arrival of a large quantity of milk; and ensure that the teat is always full of milk, and not air. Thus we do not recomend [sic] the use of cup feeding which risks choking the infant.”
This directly contravenes accepted best practice in emergency conditions. (see page 39 of this UNHCR manual for staff working in emergency situations http://www.unhcr.org/45f6cb1f2.pdf )
The women in camp live in shelters with no running water, without readily available access to sterilisation facilities. This paragraph does not take into account how difficult it is to keep equipment like teats clean and bacteria-free in such conditions of privation. It also does not take into account evidence based practice and proven research that has found cup feeding to be a safe and appropriate way to feed infants, especially if they have to be artificially fed in conditions that are damp and dirty. Cups, with fewer nooks and crannies, are much easier to wash up effectively and thus harbour fewer bugs.
“Sterilisation is not recommended”
We understand this is mainstream advice in France, unlike in the UK where the Dept of Health recommend sterilising all baby feeding equipment. However, French advice for parents living in safe, clean homes cannot apply to mothers living in tiny, damp wooden sheds with no running water, electricity or often even anywhere to keep equipment off the floor. This is far from appropriate advice for a refugee/transit situation.
“The recommended drying method is leaving to dry upside-down in the atmosphere : a purpose-made stand is recommended.”
So where is this equipment then? And where are these facilities? They were not available in the old woman’s centre, which was burned down in January 2017. We are not aware that communal, secure, clean washing up facilities are being built into the new Woman’s Centre. Will the midwives be welcoming mothers into their clinic to wash up and air dry bottles? Even if that were the case, are mothers going to walk, possibly in the rain, after every single feed, perhaps for 10 mins from one end of the camp to the other? If we give each mother enough clean bottles to last a day, they are given away, swapped or sold.
“Bottled water can be used if it is clearly labelled ‘convient pour la préparation des aliments pour nourrisson’ (‘suitable for the preparation of infant milk formula’)
So, contrary to ALL safety guidelines all over the world, these midwives are telling mothers it is acceptable to make up powdered formula with cold water? In a meeting in January 2017, the idea was actually mooted that British formula may contain bacteria, which therefore needs to be killed by the addition of very hot (more than 70 degrees) water but that French formula was not so affected. (Actually all European formula comes from the same sources – most made in manufacturing plants in Ireland. All of it is potentially contaminated).
“In order to make up feed, tap-water is permissible, letting the tap run for a time (from 3 seconds to 2 minutes depending on the frequency of its use)”
Even in clean, middle-class homes in the UK, our mothers are told to boil the water! The running water in camp is most easily accessed in the toilet blocks. Toilets that are dirty, without good electric light and dangerous places at night. In fact women and children wear nappies at night to avoid having to go to the toilets and risk being attacked.
“Once opened, the water bottle should be reclosed and kept in a refrigerator for a maximum of 24 hours”
Again, we ask: where are these fridges? These refugees are living in shelters that are not much more than garden sheds.
“The preferred method of heating is to use a bain marie (placing the bottle in a pan of warm water).”
So, a non-sterilised bottle, containing formula that probably contains bacteria, sitting in a bowl of warm water for some time, while those bacteria multiply? Nice. While the baby cries in hunger waiting for the feed to warm up. We have had no answer to our question: why can’t donors be asked to provide ready-made up formula? It has been pasteurized, can be stored at room temperature and can be provided in small cartons that means the packaging is not open for long before it’s empty. Crucially, it can be fed to the child straight from the carton, making feeding quicker and easier.
“Follow-up milks are enriched with iron, essential fatty acids and vitamin D and the calcium:potassium ratio is more suitable for bone growth.”
Our calls for the midwives to provide the evidence for this statement have been ignored. In fact, the World Health Organisation has maintained that these milks are nutritionally unnecessary and, in some instances, risky:
“In 1986, the World Health Assembly stated that “the practice being introduced in some countries of providing infants with specially formulated milks (so-called ‘follow-up milks’) is not necessary” 4 . The Organization further maintains that as well as being unnecessary, followup formula is unsuitable when used as a breast-milk replacement from six months of age onwards. Current formulations lead to higher protein intake and lower intake of essential fatty acids, iron, zinc and B vitamins than those recommended by WHO for adequate growth and development of infants and young children” http://www.who.int/nutrition/topics/WHO_brief_fufandcode_post_17July.pdf
All quotes from GSF Infant Feeding Guidance document sent to a volunteer on 30th Jan 2017.
In February 2017, the Calais and Dunkirk Infant Feeding Team received a reply from Gynecologie Sans Frontieres to our open letter calling for them to follow established, evidence-based Infant and Child Feeding in Emergencies protocols; guidelines that are followed by all established NGOs, Unicef and the World Health Organisation. The reply did not address any of our concerns or questions and included this worrying comment:
“Breastfeeding and artificial breast-feeding protocols were written by breastfeeding and infant nutrition specialists, certified IBCLC (International Board Certified Lactation Consultant).
What IBCLC, following her own ethics and Code of Conduct, could be involved in such inappropriate and potentially dangerous infant feeding guidance?
It is clear the midwives have no real idea of the conditions these families are living in. We wonder why they refuse to even look at the evidence we have provided them and we are aghast at their resistance to learning about Infant Feeding in Emergencies, leaving babies at risk on a daily basis.
We call on GSF to answer our concerns and justify their practices – practices that are in direct contradiction to absolutely every large NGO, governmental and health authority in the world. We also ask that they welcome support and help from infant feeding specialists who are happy to volunteer our time, skill and knowledge to support refugee mothers in Northern France.
We want to know why a small, almost unknown NGO has sole responsibility for women’s health in this refugee camp and why no one appears to be holding them accountable or auditing their work.
We want to know why the French government appears uninterested in this crisis or why they do not allow non-French NGOs to operate in camp.
Most of all, we want to know how anyone, whatever their nationality or job description, cannot try to put assumptions and bias aside and concentrate on the health and safety of the most fragile and vulnerable members of the human race; babies.
Calais and Dunkirk Infant Feeding Team, 1st March 2017
Can you help? By raising awareness or talking to someone who might be able to advocate for the mothers and babies in this camp? Or by helping with admin tasks, letter writing, or do you have experience working with NGOs? Perhaps you are a French breastfeeding supporter who could speak with GSF? If you have any ideas of where we can go from here, please do not hesitate to get in touch.
Alice Farina says
Hi! I’m French, living in the UK, and I’d like to help, is there anyone actually raising awareness in France ? I think it would be really beneficial to translate your articles and share them with French people, I don’t think anyone I know in France has any idea of what’s happening in Dunkirk… I can help translate if you want?
Maddie McMahon says
Hi Alice, feel free to translate and share with anyone you like! I too have a feeling this is not well known in France and attitudes towards baby feeding in French culture can be challenging, especially to refugees who come from countries with traditionally high breastfeeding rates.
Thank you for caring!
Maddie x
Jodine Chase says
Hi, Alice, we could use help over at SafelyFed.org too, check us out and join the team! Maddie and her crew are doing such good work, we are doing all we can to support them.
Andrea says
Hi there,I’m a midwife in UK and am sad ‘re this info I have read here. I agree with all your concerns ,not sure what I can do to help,been over to camp early Jan just after fire,and coming again end of march.
Love light and peace
doulamaddie says
Hi Andrea, we’d love to know who this IBCLC is, who apparently wrote the guidance, and whether she actually is a qualified IBCLC. We’d also love to understand why they think our recommendations are so dangerous and how they justify not following UNHCR guidance on infant feeding in emergencies. It would be great if you could try to talk to them about it! And you may wish to clarify if they require you to follow this infant feeding guidance while you are there, because that may clash with your personal and professional ethics. Thank you for all you are doing! xx
Autumn Brennan says
GSF are looking for Women’s Centre Coordinator and some one to run their Women’s refuge
http://gynsf.org/en/
Maybe working on the inside? Needs to be able to speak French
doulamaddie says
Thanks Autumn. If we could find someone it would be a great step forward. But if they are required to follow this infant feeding guidance it may cause quite a moral dilemma for any volunteer who knows anything about infant feeding.
HS says
Please try and get in touch with Nurture Project International. They might be in a position to offer support or advocacy on behalf of the women involved, at the very least they will know who to direct these concerns to. This is shocking.
doulamaddie says
Hello Hazel, are you part of NPI? So far we’ve heard NPI dont have the resources…and it’s difficult if only French NGOs are allowed to operate in camp…but it you think it worth a pow-wow with NPI we will of course get in touch again!
Helen says
This is just appalling. Thank you for all you are doing, and for helping to spread the rage. I am racking my brains for ways to be supportive other than just saying “great job!”.
Delphine says
Hi there. I am French, living in the UK and would like to offer my help, should you need support with translation of material. I have direct experience of breastfeeding and having had my babies in the UK I am very aware of the cultural differences between France and the UK wrt bottle vs breastfeeding (amd sterilisation, and follow on milk etc.). I hope you, somehow, manage to get the message accross and get your questions answered.
doulamaddie says
Hi Delphine, feel free to share the article whereever you like and to translate it. I’ve had lots of offers of translations, so the first one I receive I will add underneath this post. We are painfully aware of the cultural differences when it comes to infant feeding between the French and British health services and hitherto we have tried to be as sensitive as possible to these different approaches. Thank you so much for your support!
Laura says
I am happy to share the article with my friends in France to help raise awareness. This is absolutely ludicrous. How can this be allowed?
Alison Linnecar says
I have just shared this disturbing and distressing article with the International Baby Food Action Network, IBFAN, and the French-speaking members at IBFAN-GIFA in Geneva and in France. Many IBFAN colleagues are already working to support brastfeeding mothers in refugee camps in Europe or in Asia. So I requested them to find out more about the situation and asked these questions, and also provided the links below for wider sharing:
“Have these midwives never heard of Enterobacter/Cronobacter sakazakii or Salmonella? Do they not know that breastfeeding is the only feeding method in crisis situations – our IBFAN colleagues who are working with refugees use special mother-baby tents for relactation and support, see the photos in the brochure Climate Change and Health.
Here are some relevant publications on IBFAN’s websites in English and French:
http://www.gifa.org/
http://www.gifa.org/international/contaminants/
http://www.gifa.org/international/environnement-et-climat/
and on the IBFAN site there is more in English:
http://ibfan.org/infant-and-young-child-feeding-health-and-environmental-impacts
See also these specific sections on http://ibfan.org/contaminants-in-baby-foods
and the brochure on infant feeding in emergencies is here, with the various translations: http://ibfan.org/environmental-awareness
There is so much more on the websites about Bisphenol A and chemical contamination of infant and young child feeding products, including Endocrine Disrupting Chemicals. The European Commission is discussing criteria for identification of these chemicals, some of which are toxic to reproduction.
But however hard we try, we never seem to get this vital information out as widely as is so desperately needed in order to protect maternal, infant and young child health. ”
Can we also share some of these links on Facebook pages?”
We will contact UNHCR and the Emergency Nutrition Network who are the experts in emergency relief and disaster situations. The ENN is great and here is their website: http://www.ennonline.net/
I hope this helps.
Alison Linnecar
Convenor, IBFAN global working group on chemical and microbiological contamination of infant feeding products. See http://ibfan.org/infant-and-young-child-feeding-health-and-environmental-impacts
doulamaddie says
Thank you so much Alison! We are 3 lowly breastfeeding counsellors who have been working to raise awareness of this situation for mothers, without success. Finally we seem to be alerting the infant feeding community to the fact that the authorities in camp seem incapable of understanding why IYCFE best practice is so important. The volunteer midwives of GSF and volunteers in the Women’s Centre in the camp have been provided with many of the links you have kindly shared, together with labels for formula cartons in appropriate languages, breastfeeding support phrases translated into various useful languages and links to online IYCFE training. None of this appears to have been acted on.
Comments on the GSF facebook page today 3/3/17 seem to suggest that there is a deep lack of awareness. As you say, getting this vital information across sometimes feels next to impossible.
Alison Linnecar says
Thank you doulamaddie but I would never say that midwives are lowly – instead you are the real heroes. I am sure that the midwives of GSF are doing their level best in the most challenging circumstances. I have lived in France for almost 40 years and trying to breastfeed my 3 children here was a real uphill struggle, but it seemed to me that things were improving, even if slowly, thanks to the work of the French breastfeeding advocacy NGOs and to French midwives committed to the protection, promotion and support of optimal breastfeeding practices . One point I would like to make is that polycarbonate feeding bottles containing Bisphenol A, BPA, have been banned in the European Union since 2011 – and France has led the way in pushing for this ban and extending it to food contact materials for young children: http://ibfan.org/news-bisphenol-a-eu-ban-on-use-in-baby-bottles-enters-into-force-next-week
doulamaddie says
We are breastfeeding counsellors, not midwives, Alison.
Yes, I agree midwives are wonderful and it’s brilliant that the GSF sagefemmes are volunteering. The ones I met were lovely and obviously caring. I hate having to expose these out dated attitudes to infant feeding, but, like you, I am committed to ensuring babies are safely fed.
GSF says
On several occasions you have criticized Gynecology without Borders for breastfeeding in migrant camps.
We want to clarify several elements without controversy.
– GSF volunteers are all professional perinatal specialists with between 5 and 12 years of university studies.
– Breastfeeding and artificial breast-feeding protocols were written by breastfeeding and infant nutrition specialists, certified IBCLC (International Board Certified Lactation Consultant).
– The protocols are regularly updated to adapt to the specific characteristics of the Linière camp.
– GSF, recognized and partner of the French National Colleges of Midwives and Gynecologists Obstetricians;Is perfectly legitimate to provide in France, obstetric gynecology care and make education to maternity, parenting, and breastfeeding.
Given all these elements, we invite you to reconsider your requests. We assure you that our practices are reflected, validated, and orchestrated by qualified professionals, with respect for autonomy, with maximum safety and hygiene for children and women.
Cordially
doulamaddie says
Respectful thanks yet again for this response that you are copying everywhere. Unfortunately, it doesn’t answer any of our questions. We are only humbly asking for clarification of why you feel you do not need to follow international best practice for Infant and Young Child Feeding in Emergency or Transit situations. You sent out a guidance document, from which I quote that is not evidence-based. We thought qualified midwives were under an obligation to follow evidence-based guidance and to commit to continuous learning?
We met with some of you in January and had a positive meeting. We are struggling to understand why we cannot have a conversation about this matter. As you can see from today, there are many many experts in the field of infant feeding who are worried and would like to engage with you about this. Continually copying this letter of your everywhere is not helping us understand each other and find a cordial resolution. Kind regards, Maddie
GSF says
Les conditions sont totalement différentes que celles décrites dans l’article incriminant GSF.
Les recommandations de l’UNICEF sont valables dans les pays où les conditions sanitaires sont plus défavorables qu’en France. Si nous avions le moindre doute sur le risque bactérien nous adapterions notre procédure. Ce n’est pas le cas pour l’instant. Bien que les conditions de vie soient très dures pour les réfugiés, nous n’avons pas en France (jusqu’à présent) de risque infectieux de dysenterie, de choléra, etc. comme en Haïti par exemple.
En effet dans les situations de crise quand l’eau n’est pas potable, quand les boites sont stockées ouvertes etc… Les risques infectieux sont importants. Et les recommandations des organismes internationaux sont alors adaptées.
Nous ne sommes pas dans des conditions très insalubres, l’eau est potable. En France l’eau du robinet est potable. Les recommandations françaises sont en parfaite adéquation avec les recommandations que nous préconisons à GSF. Nous n’avons eu aucun cas de maladie infectieuse secondaire à l’ingestion d’eau sur le camp.
Dans le camp de la Linière :
l’eau du robinet est potable,
le stockage des boites est dans un endroit sec au Health Center,
nous disposons de suffisamment de boites de lait pour ne pas avoir à le couper
il y a de quoi faire chauffer de l’eau dans le camp.
Nos conseils sont justement adaptés à la réalité du terrain. Ils sont faisables. C’est pour cela que nous recommandons l’usage de biberons …. Ci-après un extrait de nos recommandations, tirées des normes d’hygiène de l’autorité sanitaire française :
« Concernant le nettoyage des biberons, nous préconisons de le nettoyer rapidement après la tétée pour éviter toute incrustation propice à la prolifération bactérienne. Un nettoyage soigneux peut être conseillé par immersion en utilisant un détergent afin de décrocher les particules collées sur les parois, des goupillons sont utiles dans cette opération. L’ensemble est alors rincé puis mis à sécher. Une désinfection par stérilisation n’est pas préconisée. Le stockage du matériel nettoyé à l’air libre en position de séchage sur un présentoir dédié aux biberons est préconisé. Pour la reconstitution des biberons, l’utilisation de l’eau courante du robinet est possible, la recueillir froide quelques temps après avoir fait couler celle-ci (3 secondes ou 2 minutes pour un robinet d’usage fréquent ou non). Pour l’eau minérale ou de source, elle doit porter l’allégation« convient pour la préparation des aliments pour nourrisson » Une bouteille ouverte, destinée à l’alimentation du nouveau-né, doit être ensuite fermée et conservée au réfrigérateur pendant 24h maximum, l’eau doit être non ou peu fluorée ( inf 0.3mg/l). Il faut préparer le biberon en extemporané et le donner dans l’heure, au-delà il convient de le jeter par risque de contamination bactérienne. Le chauffage au bain marie est préférable. »
Quand le Women Center a brûlé, nous avons accueilli provisoirement au Health Center les femmes et enfants. Actuellement le Women Center est parfaitement fonctionnel. Nous distribuons le lait et prodiguons les conseils ci-dessus.
Nous sommes dans des conditions difficiles mais GSF est là pour aider les femmes à vivre dignement. Les conditions d’hygiène sont nettement supérieures à celles existant dans les pays en voie de développement où il n’y a pas d’eau potable, ni rien.
Nos procédures de terrain sont adaptées à la situation réelle pour la faisabilité. Nous partons des recommandations reconnues de tous et pour le bien être des patientes et de leur enfants, nous aménageons en fonction des caractéristiques du terrain une “procédure de terrain”, que nous échangeons volontiers avec les acteurs présents sur le terrain : autres associations, autorités sanitaires, mairie de Grande Synthe, etc.
Pour les bouteilles d’eau ouvertes quand nous ne pouvons pas les conserver, elles ne sont plus utilisées pour les biberons. Une bouteille ouverte, destinée à l’alimentation du nouveau-né, doit être ensuite fermée et conservée au réfrigérateur pendant 24h maximum, l’eau doit être non ou peu fluorée (inf 0.3mg/l). Il faut préparer le biberon en extemporané et le donner dans l’heure, au-delà il convient de le jeter par risque de contamination bactérienne.
Il n’y a pas besoin de frigo sauf pour garder les bouteilles d’eau pour entamées. À partir du moment où on n’utilise pas les bouteilles d’eau entamées pour les biberons, le frigo n’est pas utile.
Le chauffage au bain marie est préférable. Il est possible dans le camp de chauffer l’eau et de faire la cuisine.
Nous chauffons au bain marie les biberons. Ci-après nos recommandations validées par les autorités sanitaires françaises et adaptées aux conditions du camp. « Pour la reconstitution des biberons, l’utilisation de l’eau courante du robinet est possible, la recueillir froide quelques temps après avoir fait couler celle-ci (3 secondes ou 2 minutes pour un robinet d’usage fréquent ou non). Pour l’eau minérale ou de source, elle doit porter l’allégation« convient pour la préparation des aliments pour nourrisson ».
Nous n’avons eu aucune infection bactérienne chez les femmes et enfants depuis 15 mois en suivant les recommandations françaises d’hygiène.
GSF says
traduct by google
The conditions are totally different than those described in the incriminating article GSF.
The recommendations of UNICEF are valid in countries where health conditions are more unfavorable than in France. If we had any doubt about the bacterial risk we would adapt our procedure. This is not the case at present. Although living conditions are very harsh for refugees, we do not have in France (until now) an infectious risk of dysentery, cholera, etc. As in Haiti for example.
Indeed in crisis situations when water is not drinkable, when the boxes are stored open etc … The infectious risks are important. And the recommendations of international organizations are then adapted.
We are not in very unsanitary conditions, the water is drinkable. In France tap water is drinkable. The French recommendations are in perfect harmony with the recommendations we recommend to GSF. We had no case of infectious disease secondary to the ingestion of water on the camp.
In the Linière camp:
tap water is drinkable,
the storage boxes are in a dry place at the Health Center,
we have enough milk cans so we do not have to cut it
there is enough to heat water in the camp.
Our advice is precisely adapted to the reality on the ground. They are feasible. This is why we recommend the use of baby bottles …. Here is an excerpt of our recommendations, drawn from the hygiene standards of the French health authority:
“Regarding the cleaning of the feeding bottles, we recommend to clean it quickly after feeding to avoid any incrustation conducive to bacterial proliferation. Careful cleaning can be advised by immersion using a detergent to unhook particles sticking to the walls, and brushes are useful in this operation. The whole is then rinsed and then dried. Disinfection by sterilization is not recommended. The storage of equipment cleaned in the open air in drying position on a display dedicated to baby bottles is recommended. For the reconstitution of the bottles, the use of tap water is possible, collect it cold some time after sinking it (3 seconds or 2 minutes for a tap of frequent use or not). For mineral or spring water, it must bear the claim “suitable for the preparation of infant food”. An open bottle intended for infant feeding must then be closed and stored in the refrigerator for a maximum of 24 hours , The water must be non-fluorinated (inf 0.3mg / l). It is necessary to prepare the bottle in extemporaneous and to give it within the hour, beyond it it is necessary to throw it by risk of bacterial contamination. Heating in a water bath is preferable. ”
When the Women Center burned, we temporarily welcomed the women and children to the Health Center. Currently the Women Center is fully functional. We distribute the milk and provide the advice above.
We are in difficult conditions but GSF is there to help women live with dignity. Hygiene conditions are much higher than those in developing countries where there is no drinking water or nothing.
Our field procedures are tailored to the actual situation for feasibility. We start from the recommendations recognized by all and for the welfare of patients and their children, we adapt according to the characteristics of the terrain a “field procedure”, which we gladly exchange with the actors present on the ground: other associations, authorities The town hall of Grande Synthe, etc.
For open water bottles when we can not keep them, they are no longer used for baby bottles. An open bottle intended for infant feeding should then be closed and kept in the refrigerator for a maximum of 24 hours, the water should be non-fluorinated or not very fluorinated (inf 0.3mg / l). It is necessary to prepare the bottle in extemporaneous and to give it within the hour, beyond it it is necessary to throw it by risk of bacterial contamination.
There is no need for a fridge except to keep the bottles of water open. Once bottles of water are not used for bottles, the fridge is not useful.
Heating in a water bath is preferable. It is possible in the camp to heat the water and cook.
We heat the bottles with baby bottles. Hereafter our recommendations validated by the French health authorities and adapted to the conditions of the camp. “For the reconstitution of the bottles, the use of tap water is possible, collect it cold some time after sinking it (3 seconds or 2 minutes for a tap of frequent use or not). For mineral or spring water, it must bear the claim “suitable for the preparation of infant food”.
We have had no bacterial infection in women and children for 15 months following the French hygiene recommendations.
Caroline says
Hello everybody, i am a french widwife living in Africa. I am very happy to discover your breastfeeeding organisation ande as i can see there is à lot of articles i need to read about breastfeeeding, thank u for link. I used to work in Liberia, Tunisie, North soudan, 6 years with foreigners in France and 4 months ago i Was working in Greece with afgans and syrians women. I read in a post That there is sometimes cultural Gap between french and english approches concernant breastfeeeding. … Why not? But the most important thing for me isuis ” What do the women want????” In Greece few months ago women refuse exclusive breastfeeeding for newborn. …What can we do exept support i them in their choices and helping them with good advice concerning bottle feeding . I agree breastfeeeding is the Best in crisis situation but even in the worst refugees camp in sudan some women do not want exclusive breastfeeeding. And i read upper That refugees Côme from countries with high rate of breastfeeeding. … are we sure about this? Witch country, witch women? It is sad to read That ngos have difficulties working together and i hope u will find à Way to sit around a table together. Good Luck and i am sure aller of u are doing a great job!
Caroline says
Sorry for my english, i wrote from my phone and it s not easy!
Sophie Messager says
GSF: la presence d’eau potable ne change rien au fait ques des bacteries potentiellement mortelles pour les nouveau nes peuvent etre presentes dans les preparations de lait infantiles en poudre (comme le Enterobacter sakazakii, qui peut causer une entérocolite nécrosante mortelle chez un nouveau ne). Ces bacteries sont presentes dans la preparation en poudre parce que la facon dont les lait infantiles sont produits ne permet pas de les eliminer, donc ces bacteries sont presentes dans le lait en poudre AVANT que la boite de lait en poudre soit ouverte. C’est la raison pour laquelle il est recommande par l’OMS de preparer les biberons avec de l’eau chaufee au minimum de 70 degres (pour detruires ces bacteries presentes dans le lait en poudre). Voir ce rapport http://nosobase.chu-lyon.fr/recommandations/invs/2006_infections_e_sakazakii_invs.pdf.
J’ai personellement visite le camp de la Liniere en Novembre 2016 avec l’equipe de nutrition infantile. Les conditions du camps de permettent pas de preparer le lait en poudre de cette facon.
Vos recommendations actuelles sont inadequates, ne refletent pas les dernieres donnees scientifiques, et mettent la sante des nourrisons du camps en danger.
Presenter commen argument le fait que votre personel a des annees d’experience de formation medicale et scientifique n’est certainement pas une reponse correcte, et certainement pas une excuse pour l’ignorance.
Dr Sophie Messager, Cambridge
English translation
GSF: The presence of drinking water does not alter the fact that potentially fatal bacteria are present in powdered infant formula (such as Enterobacter sakazakii, which can cause fatal necrotizing enterocolitis in a newborn). The reason such bacteria can be present in powdered formula is due to the manufacturing process of formula, so they are present in the power BEFORE the tin of powder is even open. For this reason, it is recommended by the WHO to prepare baby bottles with hot water of a temperature of at least 70 degrees (to destroy these bacteria present in milk powder). See this report http://nosobase.chu-lyon.fr/recommandations/invs/2006_infections_e_sakazakii_invs.pdf.
I personally visited the Liniere camp in November 2016 with the Infant Feeding Team. The camp conditions do not allow powdered milk to be prepared in this way.
Your current recommendations are inadequate, do not reflect the latest scientific data, and put the health of the camp’s infants at risk. Claiming that you have many years of scientific training isn’t an excuse for ignorance. I urge you to review your policy.
Dr. Sophie Messager, Cambridge
Sophie Messager says
Voici le lien sur la preparation des laits en poudre a la maison, fournie par l’OMS http://www.who.int/foodsafety/publications/micro/PIF_Bottle_fr.pdf?ua=1
GSF says
Nous nettoyons les biberons sans les stériliser
Nous chauffons au bain marie le lait artificiel
Nous respectons les normes françaises en les adaptant aux conditions du camp.
Sophie Messager says
Pourrions nous essayer d’avoir un vrai dialogue au lieu de repeter les memes raisons pour justifier un choix malheureux? Les normes francaises sont inadequates (du a la presence des bacteries comme le enterobacter Sakazakii). L’ANSES a d’ailleurs un document qui precise que “Toutes les préparations en poudre destinées aux nourrissons ou aux jeunes enfants ou aux personnes âgées, y compris les préparations à des fins médicales spéciales, y compris les additifs ajoutés à ces préparations sont des produits à risque. Seules les préparations liquides stériles sont des produits sûrs.”
https://www.anses.fr/en/system/files/MIC2000sa0003Fi.pdf.
Alors pourquoi ne pas utiliser uniquement des laits deja reconstitues (et donc steriles) dans le camp de la Liniere? Et surtout, pourquoi rejeter le soutien a l’allaitement propose par l’equipe de benevoles anglaise?
English version:Could we try to have a real dialogue instead of repeating the same reasons to justify an unfortunate choice? French standards are inadequate (due to the presence of bacteria such as enterobacter Sakazakii). ANSES also has a document which states that “All powdered preparations for infants or young children or the elderly, including preparations for special medical purposes, including additives added to such preparations, are risky products, only sterile liquid preparations are safe products. ”
https://www.anses.fr/en/system/files/MIC2000sa0003Fi.pdf.
So why not use only milks already reconstituted (and thus sterile) in the camp of the Liniere? And most importantly, why reject breastfeeding support from the English Volunteer Team?
GSF says
votre document date de 2007
nous suivons les recommandations de l’ANSES
GSF says
https://www.anses.fr/fr/system/files/MIC2000sa0003Fi.pdf
martina says
And, I’d like to add that to preserve, improve and protect breastfeeding should be the 1st goal without any doubt for any people evidence-based-working with mothers
I work in Italy with high and middle class women, so could I be justified to suggest bottles and formula?
Breastfeeding is always to promote, everywhere in the world, not only but expecially in emergencies.
What are the reasons for those suggestions, if no any ONG or professionals working for moms and babies health tells differently?
Martina Carabetta, LLLL, IBCLC
GSF says
Nous faisons la promotion de l’allaitement maternel avant tout. Nous respectons le choix des femmes d’allaiter ou de ne pas allaiter. Pour l’allaitement artificiel nous donnons soit du lait en bouteille quand nous en avons, si les patientes l’acceptent; soit nous donnons du lait en poudre si les patientes le souhaitent.
We promote breastfeeding first and foremost. We respect the choice of women to breastfeed or not to breastfeed. For artificial breastfeeding we give either bottled milk when we have it, if the patients accept it; Or we give powdered milk if the patients wish.
UK-NGO says
Dear Infant Feeding Team. Having worked for many years in the field of humanitarian and development aid including IYCF-E, your concerns are highly valid. Also being a mother of three small children I am keenly aware of the difficulties of maintaining sanitary and hygiene standards and that is with the luxury of all mod con’s on tap i.e. gas cooker, a kettle and a microwave in my kitchen. Where GFS state: The French recommendations are in perfect harmony with the recommendations we recommend to GSF, I’m afraid the conditions in the camp are far from those of a normal French homestead and thus clearly substantiate why specialized guidelines should be being used.
Just to pick one argument by way of illustration, although there are many – the argument that water is ‘drinkable’ or potable and thus the implication that it is ok for reconstitution of powdered infant formulas bears no relevance to infants. Potable water stands for older children or adults with a fully functioning immune system, but not for a small infant. Similarly, the guidance that teets/bottles should be cleaned quickly after feeding to avoid bacterial contamination is simply untenable in such conditions throughout the night.
If there are any code violoations that need reporting, please use the below link.
http://ibfan.org/code-watch-form
GSF says
Merci de nous donner vos arguments pour dire que nous violons les bonnes pratiques et en même temps les solutions que vous proposez que nous puissions vous répondre à nouveau car cela a déjà été fait au dessus.
Gynécologie Sans Frontières
Bindi Borg says
Hi Maddie and all
Very sorry to hear this. The guidelines that should be followed in a refugee camp setting are:
– In French: http://files.ennonline.net/attachments/121/ops-guidance-french-sept-07.pdf
– In English: http://files.ennonline.net/attachments/1001/ops-guidance-2-1-english-010307-with-addendum.pdf
There is no question on this – a refugee camp falls under an emergency setting and the usual (non-emergency, French national) guidelines do not apply.
However, it is also worrying to hear these old “mother’s choice” excuses trotted out. In my experience, even in countries where breastfeeding is the norm (for example, I am currently working in Cameroon), most NGO staff and even most medical practitioners are not equipped to protect and promote breastfeeding, and to provide breastfeeding support, despite their 5-12 years of study. This is either because breastfeeding is not adequately covered in those courses or because those medical practitioners do not have the time to spend supporting women to breastfeed.
This is why your work is vital, so please don’t lose heart! Please contact me directly so that we can discuss how I can be of assistance. I speak French and will be in France in August, so may be able to assist in person?
Bon courage.
bindi
GSF says
Bonjour
Nous ne savons pas si vous êtes sourdes ou si vous ne comprenez pas le français, mais nous allons vous redire une dernière fois nos réponses :
1/ nous favorisons tout le temps l’allaitement maternel
2/ nous essayons d’orienter vers l’allaitement maternel et nous les accompagnons avec des professionnels
3/ nos professionnels sont compétents pour accompagner l’allaitement maternel, beaucoup travaillent dans des services labellisés IHAB (qui favorise l’allaitement maternel)
4/ nous refusons d’imposer notre volonté aux femmes (comme nous l’avons vu faire par des Doulas dans le camps de Grande Synthe)
5/ nous respectons le choix des femmes d’allaiter ou de ne pas allaiter si malgré les informations elles choisissent de ne pas allaiter
6/ les conditions de préparation du lait maternisé sont conformes au règles des comités d’hygiène.
Vous ne pouvez raconter n’importe quoi et diffuser de fausses informations nous concernant, sans que nous prenions des mesures face à ces assertions diffamatoires. En particulier quand vous remettez en cause :
1/ les compétences de nos professionnels en allaitement
2/ l’hygiène de nos professionnels
qui accepteraient de prendre le risque de tuer des nourrissons par négligence.
Vos dires ont été remonté aux niveau national au niveau de la commission nationale de la naissance.
Merci d’en prendre compte et de cesser cette discussion.
GSF
doulamaddie says
I am posting the English translation of the above comment by GSF for the benefit of my non-French speaking readers. I will make a couple of points and then switch off commenting on this thread because I think this conversation is clearly not getting us anywhere.
Hello
We do not know if you are deaf or you do not understand French, but we will repeat our answers for the last time:
1 / We always favor breastfeeding
2 / we try to orient towards breastfeeding and we accompany them with professionals
3 / our professionals are competent to accompany breastfeeding, many work in services labeled IHAB (which promotes breastfeeding)
4) We refuse to impose our will on women (as we have seen done by Doulas in the Grande Synthe camp)
5 / we respect the choice of women to breastfeed or not to breastfeed if despite the information they choose not to breastfeed
6 / the conditions for the preparation of the formula are in accordance with the rules of the hygiene committees.
You can not say whatever you want and disseminate false information about us without taking action against these defamatory assertions. Especially when you question:
1 / the skills of our breastfeeding professionals
2 / the hygiene of our professionals
Who would take the risk of killing infants through negligence.
Your statements have been raised at the national level at the level of the national commission of birth.
Please take this into account and stop this discussion.
GSF
Maddie’s reply: NO doulas have been providing infant feeding support in camp. We visited as registered, qualified Breastfeeding Counsellors and Peer Supporters. We provide information to support mothers in making informed choices. We do not coerce and it is inflammatory and unjust to accuse us of such behaviour.
We are not having this conversation for fun. We support the work of GSF and want to be friends. We wish to help, not hinder. If there are babies and children in camp, the moral duty of any volunteers is to follow best practice guidelines for infant feeding. We have no evidence that this is currently the case. Until we have it proved otherwise, we will continue to campaign for Infant and Young Child Feeding in Emergencies measures to be followed. This does not involve dictating feeding choice to mothers, but is does mean making sure all staff and all parents understand the risks and benefits of each choice.
We call on GSF to work with relevant agencies to ensure best practice. The safety of mothers and babies should be top priority.