Falastine’s infant son wouldn’t stop crying. The one-month-old cried as his exhausted mother tended the goats on the rocky slopes of Al Dhale’e governorate in Yemen. He cried as she harvested vegetables and collected water from the well. And he cried as his father worked as an agricultural laborer, seldom bringing home enough money to feed the family of five.
22-year-old Falastine suspected the cause of her baby’s tears: she was struggling to produce enough breast milk to feed him. In Yemen, about 2.4 million pregnant and lactating women and 5 million children under five will require treatment for acute malnutrition in 2024, according to OCHA, while an estimated 17.6 million people are severely food insecure—meaning that they have run out of food and sometimes go days without eating. Mothers like Falastine often go hungry so that their families can eat a little extra. However, if mothers don’t get enough food for themselves, their babies also suffer the consequences.
“Starting to breastfeed within an hour of delivering a baby, and then continuing to give them only breast milk for the first six months of their life is absolutely critical,” says Sibida George, Global Nutrition Advisor at International Medical Corps. “Breast milk is an essential source of nutrients. But more than that, it also provides a combination of beneficial antibodies that kickstart babies’ immune systems and help them fight diseases.”
If babies don’t get enough breast milk in their early lives, it can lead to a range of problems, including malnutrition, illnesses and even death. If they survive their childhoods, underfed children can suffer from developmental issues and health complications that continue into later life.
Unfortunately, exclusive breastfeeding is rare in Yemen: only 20% of Yemeni babies are exclusively breastfed in the first six months of their lives. In rural areas, many babies aren’t breastfed in the first hour of birth, as recommended, in part because of a cultural practice of giving water to babies instead. This can have devastating consequences; a baby that isn’t breastfed within an hour of birth is 40% more likely to die before they are one month old, according to UNICEF. If they aren’t breastfed for the first 24 hours, this risk of death rises to 80%. It’s no coincidence that Yemen is among the countries with the highest infant mortality rates in the world, with an estimated 44.6 deaths per 1,000 live births—nine times higher than that of the United States.
“In rural areas in particular, women don’t always know that breastfeeding exclusively from birth to six months, and then practicing complementary feeding by slowly introducing solid food, is so essential for their babies’ health,” says Sibida.
“However, lack of awareness is just one aspect of the problem,” she continues. “Sub-optimal nutrition among mothers can make them too weak to breastfeed their babies. Because contraception use is low and mothers often have large families, poor nutrition can increase the strain on their bodies and make breastfeeding even harder—especially if they have multiple children within a short time. Plus, many families can’t access healthcare services because of poverty and displacement by the conflict, which means that if they have breastfeeding troubles, they’re cut off from support.”
Falastine lives in Al Dhale’e governorate, where food, clean water and healthcare services are scarce and malnutrition is widespread. Many of the governorate’s residents have fled the conflict and live in camps for internally displaced persons (IDPs), where poor living conditions mean that outbreaks of diseases and diarrhea are common. Many of the governorate’s children have not received recommended vaccinations. In places like this, effective breastfeeding gives many babies the best chance of survival.
Falastine went to the health facility nearest to her village, which is one of the many health facilities in Al Dhale’e supported by International Medical Corps. When she arrived complaining of breastfeeding difficulties and her son’s constant crying, the doctor sent her directly to the nutrition team. Measuring her mid-upper arm circumference confirmed their suspicions: Falastine was suffering from moderate acute malnutrition. She wasn’t getting sufficient nutrients and calories for herself—or for her baby.
The nutrition worker enrolled Falastine in a targeted supplementary feeding program, prescribing a wheat-soya blend to supplement her food and give her the energy to breastfeed. He referred her to the infant and young-child feeding (IYCF) team, who talked to her about the most effective breastfeeding positions and how to ensure that her baby got adequate breast milk so he wouldn’t be at risk of malnutrition, too. Finally, he referred Falastine to the reproductive health department for help with family planning.
Their interventions worked. Falastine’s health quickly improved, and her production of breast milk increased as she recovered from moderate acute malnutrition. After a few months of treatment, the team declared Falastine and her son healthy and ready to be discharged from the program, promising to stay updated on both mother’s and baby’s nutritional status.
Conflict has left about half of Yemen’s health facilities nonfunctional and has caused Al Dhale’e governorate’s health infrastructure to fall into ruin. And though Falastine was lucky to live close to the International Medical Corps-supported health center, accessing healthcare is far more challenging for the people of remote villages and IDP camps. In these hard-to-reach corners of the governorate, people seldom have access to safe water, let alone healthcare services. The residents also tend not to have vehicles to travel to health centers; in extreme circumstances, they are forced to make long journeys through the mountains using donkeys.
So International Medical Corps travels to them, sending mobile medical teams into the most isolated parts of the governorate to provide medical consultations, vaccinations, nutrition check-ups and IYCF advice. For World Breastfeeding Week 2024, we launched a major campaign in the remotest corners of the governorate, providing awareness-raising and educational sessions about the benefits of exclusive breastfeeding, as well as door-to-door advice sessions for mothers with infants under six months.
“Our health workers and volunteers provide IYCF guidance all year round,” says Sibida, “but this year’s World Breastfeeding Week—with the theme ‘Closing the Gap: Breastfeeding Support for All’—was a special opportunity to highlight the importance of breastfeeding support to the mothers who most need it. This includes the ones who are otherwise cut off from healthcare services and whose children are particularly at risk of malnutrition and disease.”
35-year-old Ekhtear’s family is one of the 23 families living in the Al Jeef IDP camp, which is nestled in the mountains of Al Hussein district. She has lived there for five years, arriving after the violent conflict forced her to leave her home in Qa’atabah. With seven children to care for, including a newborn, she’s come to trust the mobile medical team, and looks forward to its visits to her camp.
When the health workers visited her home during World Breastfeeding Week, Ekhtear proudly shared that she had followed their advice to breastfeed within the first hour of her youngest son’s birth, and planned to continue practicing exclusive breastfeeding for the first six months, as recommended. After answering her questions, the team offered her extensive guidance about when to feed during the days and nights, and how to get a nutritious diet and proper hydration to enable her to produce enough milk.
“The advice I received has made a real difference in our lives,” Ekhtear said. “Thanks to the guidance and support I received from the mobile team during my pregnancy and after, I’ve been able to raise my children using the basic resources available to us.”
Last year, International Medical Corps supported eight hospitals, 28 primary healthcare facilities and six medical mobile teams to provide crucial healthcare services across Yemen, reaching more than 291,000 people. We also provided IYCF feeding counseling to more than 35,000 Yemeni mothers, helping them give their children the healthiest start in life.
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