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Table 1 Summary of components of food security for infants and young children and indicators

From: Food security for infants and young children: an opportunity for breastfeeding policy?

Food security term Infant feeding system
Breastfeeding and wet-nursing 1 Expressed breast milk Breast milk substitutes (BMS)
Appropriateness WHO/UNICEF Global Strategy for Infant and Young Child Feeding (2003) –breastfeeding most preferred of 4 options. Suitability of wet-nursing depends on circumstances. Health of mother/wet-nurse. WHO/UNICEF Global Strategy for Infant and Young Child Feeding (2003) –suitability of milk from mother or donor depends on circumstances. Health of donor. WHO/UNICEF Global Strategy for Infant and Young Child Feeding (2003) –suitability of BMS depends on circumstances. Compliance with composition, food safety and labelling standards for infant food3.
Availability Rate of exclusive breastfeeding at 6 months. Continued breastfeeding for up to two years of age or beyond. Prevalence of wet nursing. Location and support of breast milk banks and milk sharing. Transport and handling cold chain. Retail outlets, including pharmacies, or rarely on prescription-only4. Local or imported brands.
   Feeding equipment and sterilization. Clean water, feeding equipment and sterilization.
Accessibility Economic and social policies that facilitate proximity between breastfeeding dyad: BFHI2; Maternity leave; Breastfeeding-friendly childcare; Breastfeeding-friendly work place. Acceptance of wet-nursing. Donor and recipient must meet eligibility criteria for breast milk banks, milk sharing sites and social networks. Access to some milk banks may be on prescription only. Retail outlets, including pharmacies, or on prescription-only4. Policies that separate mother and child. Regulation of marketing of BMS.
Affordability Economic and social support for time, labour and opportunity cost to breastfeed. Financial, gift or social remuneration of wet-nurse. Costs may include shipping, compensation or payment to milk bank or donor. Breast pump, feeding equipment and sterilization, storage and transport costs. Requires financial payment. Retail cost of powdered or liquid infant formula varies with location and whether domestic or imported product used. Feeding equipment and sterilization costs.
Utilization 100% if milk production and intake regulated by breastfeeding dyad. Wastage in handling, storage, distribution and feeding. Diversion from food chain. Reduces consumption of breast milk. Wastage in BMS supply chain, manufacturing, distribution and feeding.
Stability High rates of exclusive breastfeeding and proximity of breastfeeding dyad required. Stable in emergencies, unless relief disrupts breastfeeding. e.g. by supply of BMS. Variation in supply not investigated. Expressing milk may increase supply of breast milk. Unstable in emergencies. Feeding breast milk substitutes decreases supply of breast milk. Market access, including free trade agreements. Unstable supply and added risks in emergencies. May be oversupply of BMS as emergency relief.
  1. 1. Wet-nursing includes cross-nursing arrangements.
  2. 2. WHO/UNICEF Baby-friendly Hospital Initiative (BFHI).
  3. 3. Codex Alimentarius standards relevant to infant foods.
  4. 4. WHO International Code of Marketing of Breast-milk Substitutes (1981) and resolutions.