Emergency planning and guidance for infant and young child feeding in emergencies (IYCF-E): Analysis of U.S. state policy in relation to global standards

Climate-related disasters are increasing in frequency and severity, compounding inequities, and threatening safe infant feeding. Without adequate planning, emergencies disrupt breastfeeding and create conditions for unsafe formula feeding, risking infant disease and death. Breastfeeding ensures food security and disease protection but requires structured planning to be adequately supported. U.S. federal frameworks have not adopted global infant and young child feeding in emergencies (IYCF-E) guidance, leaving states with varied approaches. This cross-sectional comparative policy analysis study examines IYCF-E integration across U.S. state emergency planning and guidance in relation to global guidance. Publicly accessible materials from state Departments of Emergency Management (DEM) and Health and Human Services (DHHS), including Emergency Operations Plans (EOPs) and public-facing guidance were evaluated by two independent investigators using the World Breastfeeding Trends Initiative (WBTi) Indicator 9 assessment and an 11-item rubric assessing basic preparedness elements, drawn from global operational IYCF-E guidance (OG-IFE). U.S. state EOPs lacked alignment with global guidance (mean score=0). Only 12 of 46 available EOPs (26%) mentioned infant feeding; none included guidance for breastfeeding support, safe formula preparation, or donation management. Across 100 state departments, only 26% fulfilled at least one Basic Element. More comprehensive resources appeared in public-facing DHHS and WIC materials than in DEM documents. Misalignment between global guidance and state preparedness risks preventable breastfeeding cessation, unsafe formula feeding, infant disease, and deepening inequities. While federal legislative changes are essential to enhance alignment, there is an urgent need and important opportunity for states to implement global IYCF-E guidance and improve climate resilience.