Bridging the Knowledge Gap: Protecting Mothers and Babies During Ebola Outbreaks

Breastfeeding is essential for child health, as emphasized by the World Health Organization (WHO) and UNICEF, both of which recommend exclusive breastfeeding for the first six months of a child’s life. This practice is widely recognized for its significant health benefits, helping to protect infants against infections and providing them with the necessary nutrients for proper growth and development. The WHO also advocates for continued breastfeeding up to two years or more, alongside complementary foods, to ensure optimal development.

However, in the event of infectious disease emergencies, such as an Ebola outbreak, the act of breastfeeding faces potential risks. Ebola is an infectious virus that can be transmitted through bodily fluids, and though the virus is predominantly transmitted through blood, vomit, or other body fluids, it has the potential to be passed through breast milk as well, though this is not well-understood. Consequently, during Ebola outbreaks, mothers are often faced with difficult decisions regarding whether to continue breastfeeding or to separate from their infants for their safety. This uncertainty arises from significant knowledge gaps about the interaction between the Ebola virus and breast milk, as well as the safety of breastfeeding during an outbreak.

Threat to Mothers and Babies During Ebola Outbreaks

Ebola, characterized by symptoms such as fever, fatigue, headache, sore throat, muscle pain, and later more severe symptoms like vomiting, diarrhea, rash, and bleeding, presents a high risk of death. Pregnant women and infants are at particularly high risk. In countries where breastfeeding is essential for infant survival, the consequences of an Ebola outbreak can be devastating, as it often leads to abrupt and sometimes unsafe discontinuation of breastfeeding.

Breastmilk contains a myriad of protective elements, such as antibodies and immune system boosters, that help babies fight infections. When breastfeeding is discontinued, particularly when babies are switched to infant formula or other substitutes, they lose out on these crucial protections. This makes them more vulnerable to diseases and increases their likelihood of severe illness or even death. This risk is particularly concerning in countries where the need for breastfeeding is high due to poor access to clean water or medical services.

Lack of Knowledge and Research on Ebola and Breastfeeding

The situation becomes more dire due to the lack of research regarding Ebola’s interaction with breast milk and the safety of breastfeeding during an Ebola outbreak. While the virus is known to spread through close contact, the potential for breast milk to be a medium for the virus is not well established. This creates confusion and, at times, a reactive approach to handling breastfeeding during an outbreak, often based on limited or low-quality evidence.

In a recent paper published in The Lancet Global Health, experts called attention to the critical knowledge gaps surrounding Ebola and breastfeeding. The research emphasized the urgent need for comprehensive studies to fill these gaps. While the WHO has provided some guidelines for breastfeeding during Ebola outbreaks, these recommendations are often based more on expert opinions than on empirical research. As a result, mothers may be instructed to discontinue breastfeeding, which may not always be in the best interest of the baby, especially if both mother and baby are infected.

The key unanswered questions in this area include:

1. Is breast milk infectious during an Ebola infection?: While it is known that Ebola can be transmitted through bodily fluids, there is little data on whether breast milk can carry the virus.
2. Can expressed breast milk be safely treated?: There is uncertainty about whether breast milk, if expressed, can be treated to eliminate the virus and made safe for consumption by the infant.
3. Should mothers continue breastfeeding if both they and their infants are infected with Ebola?: It remains unclear whether continuing breastfeeding would benefit the infant even in cases where both mother and baby are infected.
4. Can vaccination of mothers against Ebola protect breastfed infants?: Another major question is whether vaccination of mothers helps prevent transmission of Ebola to infants via breast milk.
5. What are the risks for infants when their mothers are infected with Ebola?: There is insufficient information on how an infant’s health might be impacted if the mother is infected but breastfeeding continues.

These knowledge gaps can lead to decisions that may inadvertently harm both mothers and infants. For instance, mothers may refuse vaccination due to fears that it could harm their babies, not realizing that this decision leaves them vulnerable to Ebola. On the other hand, mothers who choose to stop breastfeeding might expose their babies to increased risks of other infections, thereby endangering their health.

A Plan for Addressing the Knowledge Gaps

To address these critical gaps in knowledge, a roadmap for research on Ebola and breastfeeding has been proposed. This plan includes several key research questions that need to be answered and outlines the types of studies needed to provide clarity and guidance. It also emphasizes the importance of including diverse groups of breastfeeding women in research, such as those who are recovering from Ebola, those vaccinated against Ebola, and those living in Ebola-affected communities.

Such research is vital to ensure that decisions regarding breastfeeding during Ebola outbreaks are based on solid evidence, not just on assumptions or fear. The roadmap for research advocates for the inclusion of vaccine recipients, mothers infected with Ebola, those recovering from Ebola, and mothers with no symptoms but still infected. Research also needs to examine the general population of breastfeeding mothers in areas affected by Ebola, so that they too can be provided with proper guidance and support.

The Need for Action

Despite the urgent need for research, little has been done to investigate the safety of breastfeeding during an Ebola outbreak. As highlighted by the authors of the study, women and children have long been neglected in Ebola research, with more attention being paid to other aspects of the disease, such as its transmission via semen. For too long, there has been a lack of proper research into the interaction between Ebola and breast milk, which has left mothers and babies without clear guidelines on how to navigate these challenging situations.

It is time for governments, pharmaceutical companies, and health organizations to take responsibility and act. With the help of research, it will be possible to provide mothers with the information they need to make informed decisions about breastfeeding during an outbreak. This research must be conducted proactively, with plans and approvals put in place before outbreaks occur, so that data can be gathered efficiently and effectively when the next outbreak strikes.

Closing the Female Data Gap

The lack of research into breastfeeding during Ebola outbreaks is a part of a broader issue known as the “female data gap,” which refers to the underrepresentation of women’s health issues in scientific research. This gap is not only present in the context of Ebola but also affects many aspects of healthcare. Women’s bodies, experiences, and needs have historically been ignored or overlooked in medical research, leaving them without the support and care they need.

The Universal Declaration of Human Rights clearly states that motherhood and childhood are entitled to special care and assistance. This is a right that must be upheld. Mothers deserve the best available guidance and care, especially during emergencies like Ebola outbreaks. As highlighted by the authors of the study, more research is not just a matter of scientific curiosity; it is a moral imperative. Women and children have the right to be protected, supported, and informed.

Breastfeeding plays a vital role in child health, and during infectious disease emergencies like Ebola outbreaks, it is crucial to understand the potential risks and benefits of continuing breastfeeding. The lack of research on the subject has left many mothers without the proper information needed to make decisions that could save lives. To ensure that mothers and babies are not put at unnecessary risk, more research must be conducted to determine the safety of breastfeeding during Ebola outbreaks. This research must be a priority for governments, health organizations, and researchers, as it has the potential to protect millions of mothers and babies in the future.