The Hidden Struggle of Infant Feeding After Helene

For weeks after Hurricane Helene tore through western North Carolina in September 2024, new mothers faced an agonizing dilemma in trying to feed their infants. Extended power outages made it difficult to safely pump and store breast milk, and while boxes of powdered infant formula rolled in from well-meaning donors, few households had access to the clean water necessary to prepare it. 

It was just one of many crises confronted by residents in the path of the Category 4 storm, which caused 107 deaths in the state and left thousands of people without electricity or running water for months. But it set the stage for an unheralded rescue effort. 

Just days after the storm, volunteers from Breastfeed Durham and the North Carolina Breastfeeding Coalition began setting up stations where nursing mothers could pick up donated breast milk. The community groups formed the SAFE Infant Feeding Team, which worked over the next several weeks to distribute safe feeding kits and coordinate deliveries of milk and formula. 

Those efforts reflect a growing recognition that most mothers don’t want to abandon breastfeeding, even in the wake of disaster, says Aunchalee Palmquist, Ph.D., an associate professor at the Duke Global Health Institute and an International Board certified lactation consultant. 

“It’s a common misperception that women living in disaster-affected areas Cannot – or no longer want -- to breastfeed,” says Palmquist, who is documenting community volunteers’ work to support breastfeeding after the hurricane.

With support from DGHI and the Trinity College of Arts and Sciences, Palmquist asked volunteers and residents who participated in post-disaster breastfeeding efforts to share photos from their experience. She hopes to create a Photovoice exhibit showcasing their stories and archiving the community response to Hurricane Helene. As a medical anthropologist, Palmquist is primarily interested in documenting their efforts as part of the process of recovery and healing from the storm. But she also wants to advocate for policies that help all parents secure sound nutrition for their infants in times of crisis. 

“The message we are trying to promote is that disaster response shouldn't only be about managing formula,” she says, “that breastfed infants and people who are breastfeeding their babies also deserve to have support and interventions that are tailored to their needs too.”

Finding Support Through Milk Sharing

The benefits of breastfeeding are well documented, including promotion of a strong immune system for the baby and reduced risks of invasive breast and ovarian cancers, type 2 diabetes and high blood pressure for the mother, according to the U.S. Centers for Disease Control and Prevention (CDC). But while 85 percent of mothers in the U.S. initiate breastfeeding, only 28 percent are still exclusively breastfeeding at six months. Some mothers abandon breastfeeding due to lack of milk supply or physical problems, but other barriers – such as a lack of lactation support or inadequate work accommodations – cause many to quit before they want to, says Palmquist. 

Palmquist knows those struggles from her own experience as a young mother while a postdoctoral fellow at Yale University. “I had my first baby then and breastfeeding wasn’t super easy for me,” she recalls. “I was alone, we didn’t know anybody. And I became pregnant again when my first baby was about ten months old. I started doing a lot of online research on nursing while pregnant and tandem nursing.” 

During that time, she stumbled across internet-based milk sharing communities, and the idea, which was fairly new at the time, fascinated her. She applied for and received funding from the Wenner-Gren Foundation to conduct an multi-year ethnographic study aimed at understanding the experiences of parents participating in internet-based milk sharing communities. 

At the time, media stories tended to regard milk sharing suspiciously, citing concerns about infectious diseases or contaminants that could be passed through shared milk. But in her research, Palmquist found most communities took steps to ensure safety, including pasteurizing milk at home and at shared banks. Her team tested milk from the freezers of donors and recipients and found no significant difference in their bacterial profiles.

 “My goal was to illustrate all the different ways people come to milk sharing,” Palmquist says. The practice of milk sharing “speaks to our evolutionary history as humans who cooperatively take care of mothers and infants.”

Undeterred by Crisis

Over time, Palmquist grew interested in how that care is extended in times of crisis. In 2015, while on the faculty at the University of North Carolina-Chapel Hill, she led an ethnographic study examining how successful international aid workers were in providing pregnancy and breastfeeding support to Syrian refugees living in makeshift camps in Greece and France.

“We found that there were some organizations who were familiar with best practices for post-disaster maternal and child health, and they were trying to do the best that they could, but it was really difficult circumstances,” she says. “These were displaced persons who were living in tents at the harbor in Athens, in a field next to a gas station, who had very little support most times and who had experienced very traumatic events.”

For another project in 2014, Palmquist and collaborators at UNC visited five camps for internally displaced persons throughout the Kurdistan region of Iraq and interviewed approximately 30 women about their experiences with pregnancy and breastfeeding. Their findings, published in a March 2026 issue of the International Breastfeeding Journal, described a strong preference among mothers to breastfeed their infants despite the significant obstacles and lack of support services provided in the camps. 

“We found with this population that almost everybody really wanted to breastfeed,” said Palmquist. “And when they weren’t able to, it was because of a traumatic experience during birth, lack of hygienic conditions, or a lack of social support, particularly if they had other children they were caring for.”

Preparing for the Next Disaster

Palmquist says you can see that same determination among mothers in western North Carolina – and among the community volunteers who rallied around them to help in the wake of Helene. But while community support is critical, she says it needs to be accompanied by stronger practices and policies that recognize the unique vulnerabilities of infants during disasters.

A year before Helene hit western North Carolina, the CDC did publish a toolkit for feeding infants in emergencies, which offers guidelines for how emergency responders can support parents’ needs. The toolkit includes printable handouts on safe cleaning of infant feeding equipment and other resources, but it lacks specific guidance on implementing its recommendations, Palmquist notes. For example, the guide does not address how to support families who are not able to reach shelters, which left Helene responders needing to improvise. Some hiked or rode on horses to locate families in areas where roads were impassable, she says. 

Since Helene, the SAFE Infant Feeding Team has continued its work, offering workshops to help families and responders plan strategies for infant feeding during future emergencies. The group has set a goal to work with every North Carolina county on infant feeding preparedness in the next year. 

It’s a positive step, but one Palmquist hopes isn’t the last along the path to supporting breastfeeding mothers in times of crisis. “There is a role for community volunteering in response to disasters, but it really should be part of the state’s disaster response structure to have these things in place,” she says.