As Ukrainian families flee Russian brutality, women, children and especially infants are vulnerable to another scourge of war: disease and hunger. Health experts advocate breastfeeding over infant formula to keep babies healthy in the midst of bombardment and displacement.
On Feb. 24, when Russia’s missiles first struck Ukraine’s capital of Kiev, Mariia Ismahulova and her daughter Amina, 16 months, and son Marat, 4 years old, fled underground to escape missile strikes. The next day Russian tanks rolled in, and Ismahulova, the children and husband Alex Ismahulov drove 500 kilometers south to the city of Dnipro to take refuge with relatives. The Russian war machine lumbered behind them. From then on, the wailing of air raid sirens dictated life for Ismahulova and her family, sending them scurrying day and night into underground bunkers. For those first few terrifying days, Ismahulova, who was breastfeeding, was “so under stress that I couldn’t eat. It felt like my breasts were empty and daughter was always crying.”
Stress hormones can interfere with the oxytocin hormone pathway that releases milk, causing mothers to mistakenly believe they can no longer lactate, says Helen Gray, the London-based policy and advocacy lead at Lactation Consultants of Great Britain. This is temporary and doesn’t affect the body’s ability to make milk, she says. Although tempting in such cases, babies shouldn’t be switched to infant formula, which can undermine breastfeeding by reducing a mother’s milk supply, according to Gray. To get milk flowing again, mothers should be provided with “a safe and private space where they can focus on their baby.”
Breastfeeding is important for several reasons—especially in a war zone. First, it provides food security. When people are holed up in underground bunkers to escape missile strikes, or on the road seeking sanctuary in a nearby country via car or on foot, “wherever that mother goes, the milk is going with her,” said Gray. Second, breastfeeding contains antibodies preventing both upper respiratory and gastrointestinal diseases.
A weepy baby may simply be expressing stress, not hunger, says Gray, noting that online mommy networks are peppered with concerns like: “I haven’t been able to sleep for three days and I’m super stressed and my baby’s crying and fussing. Is my milk drying up?” Stressed babies feed constantly and are “clingy and crying and wanting mum all the time.”
Gray points to the research of Dr. Karleen Gribble, a professor in the School of Nursing and Midwifery at Western Sydney University, who writes that, in emergencies, infant formula should be treated like a medicine rather than food. She also advocates that international support for babies should be provided in the form of money—not infant formula.
In a 2021 article in Maternal & Child Nutrition, Gribble explains that that the immature immune systems of infants and toddlers leaves them vulnerable to diarrhea and respiratory tract infections. In low- and middle-income countries, babies who aren’t breastfed make up 72 percent of infant hospitalizations. In this context, “infants who are not breastfed are eight times more likely to die than their exclusively breastfed counterparts,” Gribble wrote.
UNICEF, Global Nutrition Cluster and IFE Core Group released a joint statement March 8 warning that Ukrainian families with infants and toddlers are especially at risk of falling ill due to unhygienic conditions. Gray explains that powdered infant formula must be reconstituted with boiling water that is allowed to cool to 70 degrees Celsius in order to kill microorganisms.
Bottles and teats must also be sterilized by boiling and prep surfaces disinfected, according to World Health Organization (WHO) standards. In crowded bunkers or refugee centers, it is impossible to create sterile environments, says Gray. Nonetheless, some babies must be formula fed because their mothers aren’t around to breastfeed, or are missing or killed. In such cases, extra care must be taken in preparing the formula.
Ismahulova says it has been impossible to maintain hygiene standards in many parts of Ukraine, especially where Russian forces have cut electricity and water lines, forcing people to melt snow for drinking. Should a baby become sick, medical help may not be available. The Red Cross is reporting increasingly severe shortages of food, medical supplies and fuel—especially in places like Mariupol, where the Russian Air Force, which bombed a maternity hospital on March 9, killing mothers and babies, continues its onslaught of the port city.
The privations of war are taking a toll. One of Ismahulova’s friends fell “extremely ill” after hiding with her 4-year-old daughter in a freezing underground parking lot. Another friend, Anastasiia Zodorozhnaia, 29, came under Russian sniper fire outside Kiev while in a three-car convoy. All the vehicles displayed white flags and signs with the Russian word “Deti,” meaning “children aboard.”
As Zodorozhnaia and her family drove past a copse of trees in a farm field, Russian bullets ripped into the vehicle’s engine and tire. Zodorozhnaia flung her body over her 2-year-old daughter Dasha to protect her, says Ismahulova, who translated for her friend. Despite the flat tire and damaged engine, “by some miracle” Zodorozhnaia’s family made it to safety.
Ismahulova read a text message from another mother pleading for help for her 1-year-old daughter. “She is ill for a week. Temperature is high all the time. Strong cough. Maybe somebody has some medicine, please! Antibiotics! The girl is dying!” Her social media feed “is full of such horrible texts,” said Ismahulova, who was interviewed while hiding in a closet, her dark-haired children beside her on mattresses, asleep.
Ismahulova hoped that, this night, they wouldn’t awake screaming from nightmares. “No one knows what will happen in the next minute,” said the 29-year-old English teacher, who dozes fitfully while awaiting the next air raid siren. “We wake up the kids and run. I hate these moments.”
Ismahulova is also worried about the safety of two other friends, both of whom are nearing their due date: One is nine months along, while the other is eight months. Gray says it will be crucial for these newborns to breastfeed within the first hour after birth.
This will ensure that the babies obtain colostrum, bolstering their immune systems and protecting against disease, especially if the moms give birth outside a sterile hospital setting. Postpartum breastfeeding also helps the mother as the oxytocin that is released causes uterine contractions, helping prevent excess bleeding, according to Gray. “It can save women’s lives” while keeping them “more calm. That’s really good for their mental health.”
Lioredana Ciofu of Romania helps run ParentIS, an NGO that supports parents and promotes breastfeeding by connecting clients with lactation consultants. Romania, which borders Ukraine to the south, has been providing sanctuary to about 8,000 Ukrainians a day since Feb. 27, says Ciofu. ParentIS staff and the consultants are on hand to support mothers and infant with baby items like slings, wraps and diapers. One of the top requests has been baby formula says Ciofu, pointing to Ukraine’s low breastfeeding rate, which is less than 20 percent.
Well-meaning donors have sent “boxes and boxes” of formula, Ciofu said. “All of these donations of formula have put a lot of pressure on mothers to use them.” However, the overcrowding—Ciofu points to one refugee centre along the Ukrainian border where there are 80 people in one room—means there isn’t a safe place to prepare formula, therefore creating a “high risk of disease.” If mothers have to use formula, it should only be the ready-to-feed premixed liquid kind, she says.
Ciofu and the lactation consultants are trying to encourage Ukrainian mothers, who arrive in Romania in a state of shock, to follow WHO recommendations and increase lactation and decrease formula if they have been reliant upon this feeding method. This transition period can be difficult, with infants crying as the mother’s body adjusts to producing more milk, Ciofu says.
War is brutal on women and children. Since the start of the Russo-Ukrainian war Feb. 24, more than 10 million Ukrainians—many of them children—have fled the country, reports UNICEF. Scores of children have been killed and many more are injured. “Every single minute, 55 children have fled their country. A Ukrainian child has become a refugee almost every single second since the start of the war,” according to UNICEF.
Mothers like Ismahulova and Zodorozhnaia are living these chilling statistics. They wait in fear for more Russian bombs to drop, while trying desperately to keep their children safe and fed in the midst of diminishing food and water supplies. Ismahulova especially dreads the dark. “Nights are difficult. Russians do their worst things during the night.”