Managing Maternal Requests for Infant Formula in Emergencies: The Ethical Foundations of the Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE)

The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) outlines how nutritional support should be provided to the mothers and caregivers of infants in emergencies to maximize child health and survival. The OG-IFE outlines the necessity of ensuring support for breastfeeding mothers and the caregivers of infants who cannot be breastfed. It has strict and limited indications for providing infant formula, amongst which maternal preference to formula feed is not included. However, mothers who do not meet OG-IFE indications commonly request infant formula, and those to whom such requests are made can find it difficult to refuse them. This paper applies the ethical principles of beneficence, non-maleficence, health maximization, justice, and autonomy to the OG-IFE's preclusion of infant formula provision on the basis of maternal request. It presents an analysis weighing the possible negative and positive consequences of providing infant formula without and within the indications of the OG-IFE. It also describes how to mitigate against donations of infant formula, application of OG-IFE principles in high-resource settings, and how to respond to and support breastfeeding women who request infant formula and implement the OG-IFE regarding infant formula. Enabling governments, policy makers, humanitarians, health workers and donors to understand the ethical foundations of the OG-IFE regarding infant formula provision will assist in promoting good practice in disaster response and child health and survival.