Breastfeeding is critical for a child’s health. The World Health Organization (WHO) and UNICEF recommend that babies should be breastfed within the first hour after birth, exclusively breastfed for the first six months, and continue breastfeeding alongside other foods for up to two years or longer.
However, during infectious disease emergencies like Ebola, breastfeeding can become a significant concern. In some cases, diseases can be transmitted to the baby through close contact or, in rare instances, via breast milk. There is also the potential risk of harming infants when their mothers are treated with medication or vaccinated during outbreaks.
But separating mothers from their babies or stopping breastfeeding carries its own risks.
The Threat to Mothers and Babies
Ebola is a deadly virus that spreads easily and is often fatal. The disease begins with symptoms such as fever, muscle pain, headache, sore throat, and fatigue. This is followed by vomiting, diarrhea, rashes, and sometimes, bleeding. Pregnant women and infants are particularly vulnerable.
Ebola outbreaks usually occur in countries where breastfeeding is essential for child survival, including several African nations. For example, Uganda declared an Ebola outbreak on January 30, 2025, marking the latest in a series of epidemics.
Breast milk provides essential nutrients and antibodies that help protect babies from infections and support their immune systems. When mothers stop breastfeeding, babies lose this crucial protection, increasing their risk of serious illness.
Weighing Protection Against Harm
When faced with an outbreak, it is vital to understand what actions will protect both mothers and their babies. Recommendations on breastfeeding during infectious disease outbreaks must carefully consider the risks of the disease, medical treatments, and the dangers of stopping breastfeeding altogether.
The WHO has released guidelines on how to care for breastfeeding mothers and their infants when one or both are infected with Ebola. However, these guidelines are based on limited evidence and mostly reflect expert opinions rather than research-based knowledge.
Sadly, research into Ebola’s effects on breastfeeding has been limited. While there is significant data on the virus’s impact on semen, little is known about its potential presence in breast milk.
A recent paper published in The Lancet Global Health calls for urgent research into the relationship between Ebola and breastfeeding, with the goal of better protecting mothers and babies.
Unanswered Questions
There are still many unknowns about how Ebola affects breastfeeding:
- We know that Ebola spreads through close contact, so breastfeeding could pose a risk if either the mother or the baby is infected.
- It is unclear whether Ebola can be transmitted through breast milk, and if it can, how long it remains infectious.
- We don’t know if expressed breast milk can be treated to make it safe for the baby.
- It is unknown whether it is better for a baby if the mother continues breastfeeding if both are infected with Ebola.
- We also don’t know if vaccinating mothers against Ebola could help protect their breastfed infants.
This lack of knowledge creates confusion and leads to decisions that may put mothers and babies at greater risk. For instance, mothers might refuse the Ebola vaccine out of concern it could harm their baby, but this leaves them vulnerable to the virus. Alternatively, they may choose to stop breastfeeding after being vaccinated, which exposes the baby to other serious illnesses.
Separating mothers and babies who both have Ebola and stopping breastfeeding could lower their chances of survival.
The Need for Action
For years, there have been calls for more research into Ebola and breastfeeding, but progress has been slow. It is unacceptable that women and children are deprived of breastfeeding because the necessary research has not been conducted.
Drawing on our experience providing medical care during Ebola outbreaks and developing guidelines for breastfeeding mothers in emergencies, we have developed a plan to address this research gap.
In our paper, we outline key groups of breastfeeding mothers who need to be included in research:
- Vaccine recipients
- Mothers who are ill with Ebola
- Mothers recovering from Ebola
- Mothers infected with Ebola but not showing symptoms
- The broader community of breastfeeding mothers in Ebola-affected regions
Only through targeted research can we ensure that mothers and babies receive the care and protection they deserve during Ebola outbreaks.
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