Protecting breastfeeding in emergencies: a concept analysis to inform midwifery education and practice

In humanitarian emergencies, including natural disasters, armed conflict, famine, mass displacement, and disease outbreaks, breastfeeding is a lifesaving practice for mothers and infants. As a recognised human right, it provides safe nutrition and hydration without reliance on clean water, electricity, or external supplies. Breastfeeding protects against infection and malnutrition, supports maternal health, reduces stress through oxytocin release, strengthens bonding, and promotes resilience in unstable settings. Despite this, breastfeeding is frequently undermined by misconceptions, lack of privacy, inadequate support, and the uncontrolled distribution of breast-milk substitutes (BMS), often in violation of the International Code of Marketing of Breast-milk Substitutes. These practices increase the risks of diarrhoea, infection, malnutrition, and mortality where safe preparation cannot be ensured. Midwives are well positioned to protect breastfeeding in these contexts due to their role in continuity of care and expertise in physiological infant feeding. However, their contribution is often constrained by workforce shortages, exclusion from emergency planning, and insufficient preparation for infant and young child feeding in emergencies (IYCF-E). This paper presents a concept analysis of protecting breastfeeding in emergencies and identifies key educational attributes: of breast milk-based feeding; application of IYCF-E guidance (including OG-IFE, Sphere standards, and the International Code); provision of skilled, rights-based, culturally responsive support; prevention of harmful practices such as unsolicited BMS distribution; facilitation of protected mother and baby spaces; and adherence to ethical and humanitarian standards. Embedding these competencies within midwifery education is essential to prepare educators and students for proactive, midwife-led responses in crisis settings. Drawing on ABM (2024), OG-IFE, ICM guidance, and WHO frameworks, this paper argues for curriculum integration to strengthen maternal and infant survival, resilience, and rights protection in emergencies.