Countries facing the highest standing humanitarian risk also tend to have the lowest rates of exclusive breastfeeding, even after accounting for national income, according to an exploratory cross-national ecological study published in Conflict and Health. The finding suggests that the nations most likely to experience emergencies may already have the largest share of infants missing out on breastfeeding’s protective benefits before any crisis begins.
The scale of the underlying problem is considerable. An estimated 252 million people needed humanitarian assistance in mid-2026, and breastfeeding is described as lifesaving precisely because emergencies disrupt safe water, health services and supply chains. Globally, only 47 percent of infants under six months are exclusively breastfed, and the 2026 global investment case estimates that suboptimal breastfeeding contributes to about 383,000 premature child deaths and US$339 billion in economic losses each year. The Operational Guidance on Infant and Young Child Feeding in Emergencies frames breastfeeding protection across preparedness, response and recovery phases.
The study, led by Alessandro Iellamo, set out to examine whether higher standing humanitarian risk is associated with lower exclusive breastfeeding once income is taken into account. It used an exploratory cross-sectional design drawing on 135 of 196 countries, 17,574 children in 15 Demographic and Health Surveys, and 114 administrative units across seven Sahel countries. Humanitarian risk was measured with the Index for Risk Management (INFORM) Risk score, which ranges from 0 to 10, with a score of 5.4 or above classified as high risk.
The primary analysis used an income-adjusted partial Spearman correlation, while inference from the Demographic and Health Survey data relied on a two-stage country-level estimator. Sensitivity analyses examined timing, health-system capacity, region, fragility and acute-crisis indicators to test how robust the association was to different analytical choices.
After continuous-income adjustment, higher humanitarian risk was associated with lower exclusive breastfeeding, with a correlation coefficient of −0.22 and a 95 percent confidence interval of −0.39 to −0.03, and a false-discovery-rate q value of 0.021. Among low- and lower-middle-income countries, median exclusive breastfeeding was 44.1 percent in high-risk countries compared with 53.8 percent in lower-risk countries, a shift of −9.4 percentage points with a 95 percent confidence interval of −17.0 to −0.6.
The association persisted after adjustment for health-system capacity and region, and was concentrated in sub-Saharan Africa. However, the authors report that it was non-significant when using categorical or survey-year income, or when using standardised survey estimates only, underscoring how sensitive the result is to analytical specification. The study’s conclusions explicitly describe the association as exploratory and specification-sensitive.
In an exploratory decomposition of the INFORM Risk components, the largest associations were found for institutional capacity, with a correlation of −0.36, lack of coping capacity at −0.25, and human hazard or conflict at −0.24, all of which survived multiple-comparison correction. This pattern points to weak coping capacity and conflict-related risk as the dimensions most strongly linked to lower exclusive breastfeeding at the national level.
The subnational and survey-level evidence was less conclusive. Results from the Demographic and Health Surveys were inverse but imprecise, with a two-stage odds ratio of 0.718 and a 95 percent confidence interval of 0.492 to 1.045, meaning the confidence interval included the possibility of no association. No consistent inverse within-country association was detected, indicating that the pattern observed across nations did not reliably appear within individual countries.
The authors conclude that, at similar national income, high-risk countries had lower exclusive breastfeeding, and that countries most likely to face emergencies may already have more infants without the protection of exclusive breastfeeding and systems less able to sustain support for it. Consistent with existing guidance, they suggest that breastfeeding protection and support should be treated as core lifesaving investments in emergency preparedness and response. As an ecological, exploratory analysis, the study identifies associations at the population level rather than establishing causal effects for individual mothers and infants, and the authors note that the published version is subject to further edits as a shared early-access article.
Subject of Research: The association between national humanitarian risk and exclusive breastfeeding rates
Article Title: Humanitarian risk and exclusive breastfeeding: an exploratory cross-national ecological study with DHS and subnational triangulation
Article References: Iellamo, A. (2026). Humanitarian risk and exclusive breastfeeding: an exploratory cross-national ecological study with DHS and subnational triangulation. Conflict and Health. https://doi.org/10.1186/s13031-026-00852-8
Image Credits: AI Generated
DOI: 10.1186/s13031-026-00852-8
Keywords: exclusive breastfeeding, humanitarian risk, INFORM Risk index, Demographic and Health Surveys, conflict and health, emergency preparedness, infant and young child feeding, sub-Saharan Africa, coping capacity, global health, cross-national study, Humanitarian
News Source: Courtney Benton. (October 28, 2026). High-risk humanitarian countries show lower exclusive breastfeeding rates. Scienmag.
