Infants less than six months of age who are not breastfed need urgent identification and targeted skilled support. The priority to feed these infants should be re-lactation. If this is not possible or when artificial feeding is recommended by skilled staff such as health providers or infant feeding counselors, breast-milk substitutes are necessary and must be accompanied by training on hygiene, preparation, and use to minimise their associated risks. Artificial feeding in an emergency carries high risks of malnutrition, illness, and death and is the last resort only when other safer options have first been fully explored.

Infant formula requires mass production by the dairy industry. As well as contributing to malnutrition and sickness in children, it leads to significant environmental impacts including plastic and other waste, and degradation of land and waterways. Pollution and environmental degradation intensify environmental health risks and create harmful living conditions. Pollution of the water, soil, and the air is a threat to human health and wellbeing and exacerbates poverty and inequality.

Women are usually responsible for feeding children and often also have the least control over household finances.

Air pollution
Soil pollution
Water pollution
Cultural acceptance
Impact on wellbeing / mental health
Water depletion

• Water sources and soil can be polluted by an accumulation of waste and leachates and spillages from piled wasted items. Piled waste often hosts disease vectors.
• Accumulation of packaging may result in blockage of drainage channels and watercourses and contamination of waters sources and end up in rivers, lakes, and the ocean.
• Air may be polluted by burning solid waste.
• Artificial feeding has high risks of malnutrition, illness, and death, and also spreads sickness through the environment.
• Pollution also affects animals and plants, degrading natural ecosystems and their ability to provide essential natural services and resources for society.
• Donations of BMS overwhelm waste management infrastructure.

• Procurement and distribution of nutritional items can have negative effects on the environment if activities are not well planned or the needs and behaviour of individuals and communities are not appropriately assessed. When delivered items do not match with the cultural particularities of affected communities, items may be unused and may be piled. Also, when items are used but the resulting waste is not properly managed by people accumulation of wastes can occur in places that have limited recycling capabilities and wasted items can be eliminated by open burning caused air pollution. Improper disposal and management of breastmilk substitute wastes can become a vector for disease to spread within communities. For example, ready-to-use infant formula in liquid form will have individual packaging, thus, increasing the amount of waste per user.
• Accumulation of packaging may result in blockage of drainage channels and watercourses and contamination of waters sources and end up in rivers, lakes, and the ocean.

• Refuse or return any donations of BMS.
• Support mothers to start or return to breastfeeding wherever possible.
• Bottles and teats should NEVER be used in a humanitarian emergency.
• Create plans for appropriate disposal, having the person who receives any BMS return the empty tin to the distribution point before collecting the next tin (this is recommended anyway to prevent misuse or selling of the product and to understand the use of the product in the home).

• Refuse to accept any donations of BMS and return any that are delivered to the country of origin, they are unsafe to use and cannot be disposed of effectively in low-income countries.
• Support mothers to start or return to breastfeeding wherever possible.
• Bottles and teats should NEVER be used in a humanitarian emergency regardless of whether they can be sterilized. Cups without lids (not sippy cups) can be used and recommended. Cups, however, are recommended over bottles and can be re-used rather than handing out disposable medicine cups, for example. Cups can be used from newborns, bottles are never necessary or recommended. Any bottles that are donated or confiscated should be returned, recycled, or buried to ensure they cannot be used. If a reusable cup is used for a child, which is possible, then this can be used for the child for the length of time that the child needs it, even after the age of five years old. It can then also be used by others in the family.

In South Sudan, Humanitarian agencies provided nutritional supplement feeding and found that over time waste was accumulating on land and in watercourses, causing pollution. Agencies responded by setting up feeding centers and removing packaging prior to distribution where possible; providing safe comfortable feeding areas and encouraging their use, followed by encouragement to return all waste packaging prior to leaving the feeding center.

• Number of BMS containers appropriately destroyed
• Number of BMS containers distributed
• Number of positive changes made to procurement processes to minimise their environmental impact.

• Prevention of environmental damage
• Mitigation of environmental damage

Time for assessment, support provision and management of donations.