Belonging in Two Families: Exploring Permanency Options for Children in Long-Term Out-of-Home Care in Australia

This report presents the findings of an online survey which investigated permanency options for children in out-of-home care in Australia. While there has been much public discussion surrounding long-term foster care, guardianship and adoption in Australia, there has not previously been any formal research considering stakeholder opinions on these legal frameworks. This research aimed to fill this gap by asking participants to share their views on the existing legal frameworks of long-term foster care, guardianship, and plenary open adoption, as well as the concept of simple open adoption

'Want to Help the Children? Help the Parents': Challenges and Solutions from the Babies and Young Children in the Black Summer (BiBS) Study

This report presents the findings of the Babies and Young Children in the Black Summer (BiBS) Study. It considers the experiences of caregivers of very young children (0-4 years) of the 2019-20 Black Summer Bushfires and of emergency responders that supported families with very young children in this and other emergencies. Recommendations are made to improve emergency planning and response to better support very young children and their caregivers in Australian disasters

Emergency preparedness for infant and young child feeding in emergencies (IYCF-E) : an Australian audit of emergency plans and guidance

BACKGROUND: Australia experiences a high incidence of natural emergencies and Australian governments have committed significant investment into emergency preparedness and response. Amongst the population groups most vulnerable to emergencies are infants and young children with their vulnerability centering around their specific food and fluid needs. For this reason, the World Health Assembly has urged all member states to develop and implement infant and young child feeding in emergency (IYCF-E) plans in line with international guidance. This study aimed to determine the degree to which Australia has complied with this direction by conducting an audit of Australian emergency plans and guidance. METHODS: Australian Federal, State/Territory and a sample of Local government emergency plans and guidance were located via web searches. Documents were searched for key words to identify content dealing with the needs of infants and young children. Plans and guidance were also searched for content dealing with the needs of animals as a comparison. RESULTS: While plans and guidance contained numerous pointers to the desirability of having plans that address IYCF-E, there was a dearth of planning at all levels of government for the needs of infants and young children. Guidance related to heat waves contained information that could prove dangerous to infants. No agency at Federal or State/Territory had designated responsibility for IYCF-E or children in general. This was in stark contrast to the situation of animals for which there was widespread and comprehensive planning at all levels of government with clear designation of organisational responsibility. CONCLUSIONS: Lack of planning for IYCF-E in Australia places infants and young children at serious risk of adverse health consequences in emergencies. Australian Federal, State/Territory and Local governments need to take action to ensure that IYCF-E plans and guidance are developed and deployed in line with international standards. The pathway to successful integration of animal welfare plans provides a method for a similar integration of IYCF-E plans. Government health authorities are best placed to lead and be responsible for IYCF-E in Australia. National governments internationally should similarly take action to ensure that their youngest, most vulnerable citizens are protected in emergencies

Mistakes from the HIV pandemic should inform the COVID-19 response for maternal and newborn care

Background: In an effort to prevent infants being infected with SARS-CoV-2, some governments, professional organisations, and health facilities are instituting policies that isolate newborns from their mothers and otherwise prevent or impede breastfeeding. Weighing of risks is necessary in policy development: Such policies are risky as was shown in the early response to the HIV pandemic where efforts to prevent mother to child transmission by replacing breastfeeding with infant formula feeding ultimately resulted in more infant deaths. In the COVID-19 pandemic, the risk of maternal SARS-CoV-2 transmission needs to be weighed against the protection skin-to-skin contact, maternal proximity, and breastfeeding affords infants. Conclusion: Policy makers and practitioners need to learn from the mistakes of the HIV pandemic and not undermine breastfeeding in the COVID-19 pandemic. It is clear that in order to maximise infant health and wellbeing, COVID-19 policies should support skin-to-skin contact, maternal proximity, and breastfeeding

Estimating the prevalence of exclusive breastfeeding with data from household surveys : measurement issues and options

The importance of breastfeeding for infant and maternal health is well established. The World Health Organization recommends that all infants be exclusively breastfed until they reach 6 months of age. The standard indicator to measure adherence to this criterion is the percentage of children aged 0–5 months who are currently being exclusively breastfed. This paper proposes supplementary measures that are easily calculated with existing survey data. First, for an accurate assessment of the WHO recommendation, we estimate the percentage of infants who are being exclusively breastfed at the exact age of 6 months. Second, an adjustment is proposed for prelacteal feeding. These two modifications, separately and in combination, are applied to data from 31 low-and middle-income countries that have participated in the Demographic and Health Surveys Program since 2015. There is considerable variation in the effects across countries. The modifications use existing data to provide a more accurate estimate than the standard indicator of the achievement of the exclusive breastfeeding until 6 months recommendation

Australian foster carers' views and concerns regarding maternal drug use and the safety of breastmilk

Parental substance misuse and mental health issues are major factors associated with infant placement into out-of-home care. Such placements may result in disruption and/or cessation of breastfeeding. Provision of breastmilk to infants in out-of-home care (OOHC) is desirable in terms of infant health and development, and also in supporting maternal caregiving. However, little is known about how breastfeeding is supported for infants in out-of-home care. This study used an online survey to explore the facilitation of breastfeeding in the context of OOHC and foster carers’ management of expressed breastmilk (EBM). Foster carers were generally open to the idea of maternal breastfeeding and infants in their care receiving EBM from their mothers. However, the majority of respondents expressed concern regarding the safety of EBM for infant consumption due to the possibility of harmful substances in the milk. Concerns regarding the safety of handling EBM were also prevalent. These concerns caused foster carers to discard EBM. Findings suggest foster carers’ may lack knowledge related to maternal substance use and breastmilk. Better integration between health care and social service systems, where the voices of mothers, foster carers and child protection workers are heard, is necessary to develop solutions enabling infants living in OOHC access to their mother’s breastmilk

'A better alternative' : why women use peer-to-peer shared milk

The process by which women came to use internet-facilitated peer-to-peer shared milk was explored via a written questionnaire administered to 41 peer milk recipients from five countries. Respondents were universally unable to provide some or all of the milk their infants required. Twenty-nine dyads had a medical condition that could have affected their ability to breastfeed. Many respondents had had great difficulty in finding health workers who could assist them with their breastfeeding challenges. Before obtaining peer-shared milk, respondents had tried to increase their own milk supply, used infant formula or sought donor milk from personal contacts. Health workers dealing with breastfeeding women require greater training in the recognition and treatment of conditions that adversely affect breastfeeding including a physiological incapacity to fully breastfeed. Peer-to-peer milk recipients appear to be very satisfied with the solution milk sharing provides to their problem of being unable to fully breastfeed their infants

Perception and management of risk in Internet based peer-to-peer milk-sharing

The perception and management of the risks of peer-to-peer milk sharing was explored via a written questionnaire administered to 97 peer milk donors and 41 peer milk recipients who were recruited via Facebook. All recipients’ respondents were aware that there were risks associated with using peer-shared milk and took action to mitigate these risks; however, their knowledge and risk mitigation was incomplete. Recipient respondents were well informed as to the risks involved in artificial feeding and this contributed to their decision to prefer peer-shared milk. Many donor respondents did not follow guidelines for safe milk expression. Many respondents had not discussed milk sharing with a health provider. It is recommended that health providers be proactive in providing education to minimise the risks of peer-to-peer milk sharing. This is the first study to examine the views and practices of Internet-facilitated peer-to-peer milk sharing and provides insight that may improve the safety of the practice

Peer-to-peer milk donors' and recipients' experiences and perceptions of donor milk banks

Objective: To explore the intersection of peer-to-peer milk sharing and donor milk banks. Methods: A descriptive survey design containing closed and open-ended questions was used to examine women's perceptions of peer-to-peer milk sharing and milk banking. Closed-ended questions were analyzed using descriptive statistics and conventional qualitative content analysis was used to analyze open-ended responses. Setting: Participants were recruited via the Facebook sites of two online milk-sharing networks (Human Milk 4 Human Babies and Eats on Feet). Participants: Ninety-eight milk donors and 41 milk recipients who had donated or received breast milk in an arrangement that was facilitated via the Internet. Results: One half of donor recipients could not donate to a milk bank because there were no banks local to them or they did not qualify as donors. Other respondents did not donate to a milk bank because they viewed the process as difficult, had philosophical objections to milk banking, or had a philosophical attraction to peer sharing. Most donor respondents felt it was important to know the circumstances of their milk recipients. No recipient respondents had obtained milk from a milk bank; it was recognized that they would not qualify for banked milk or that banked milk was cost prohibitive. Conclusion: Peer-to-peer milk donors and recipients may differ from milk bank donors and recipients in significant ways. Cooperation between milk banks and peer sharing networks could benefit both groups

Supporting the most vulnerable through appropriate infant and young child feeding in emergencies

The past decade or so has seen a growing awareness among those involved in supporting breastfeeding that emergencies place infants and young children at particular risk. Increasingly, experts in infant feeding in nonemergency contexts have sought to be involved in advocating for and supporting the needs of infants and young children in emergency situations. With this growing interest, as well as greater frequency of emergencies throughout the world, there is a need for increased knowledge among International Board Certified Lactation Consultants (IBCLCs) and others about what helps, and what doesn’t, in infant and young child feeding in emergencies (IYCF-E)