Santosh Jain Passi
Breastfeeding lays a sound foundation for healthy life during infancy/childhood as well as the later years of life. Every child needs to be provided adequate nutrition, care, protection, love and affection for his/her proper growth and development. As per WHO and UNICEF, breastfeeding must be initiated within the first hour of birth; and that colostrum (thick, yellowish and sticky but highly nutritious secretion) must be fed to the baby. Further, that the infant should be exclusively breastfed (only breast milk and no additional food or drink, not even water) for the first 6 months; breastfeeding should be on demand; use of bottles, teats or pacifiers prohibited; and after 6 months, she/he should be given age-appropriate complementary foods along with continued breastfeeding up till 2 years or beyond.
Nature’s precious gift – breast milk, is a perfect food for the baby for which there is no other substitute. It not only provides adequate amount of energy but also contains appropriate quantity/quality of proteins, fat, lactose,
minerals (esp. iron), vitamins and water as well as various health promoting components like lactoferrin, bifidus factor, enzymes and immune bodies (mainly immunoglobulin A).Above all, it is tailored to suit the baby’s needs. Free of contamination, it is easily available, economical, easy-to-digest which boosts the baby’s immunity and protects him/her from several infections. In fact, mother’s milk is the neonate’s first vaccine. Since breastfeeding reduces morbidity/mortality rates among children as well as the incidence of various NCDs during their later life, it helps in keeping the health-care cost under check. Further, breastfeeding fosters a rather close and interactive mother-&-child bond which greatly helps in emotional/psychological development of the infant; and thus, directly impacts his/her brain development. Not only this, breastfeeding confers several benefits to the mother too– it reduces post-partum bleeding as well as the risk of breast/ovarian cancer and anaemia. The incidence of overweight/obesity is comparatively less common among the mothers who breastfeed their babies. Breastfeeding is a means of natural contraception – it promotes family planning and child spacing.
Mother’s milk being the most suitable/complete food, breastfeeding should be continued even during the mother’s or the child’s sickness, unless medically contraindicated. Safe complementary foods should be introduced only after the age of 6 months to bridge the gap between the child’s nutritional needs and the nutrients provided through breast milk. During breastfeeding, it is advisable that the mother neither smokes nor consumes alcohol as it can be harmful – both for herself and the baby. In addition, care should be taken to maintain proper hygiene before & after breastfeeding. It is recommended that the child should be fed on demand or at least 8 times/day. It is imperative that every mother should know the appropriate technique of breastfeeding – how to feed, when to feed, how many times to feed with special emphasis on proper latching and various other aspects of breastfeeding.
Studies indicate that breastfeeding within an hour of birth alone can prevent nearly 20% of the neonatal deaths; and that the exclusively breastfed babies are at 11-15 times lowered risk of mortality due to diarrhoea/pneumonia. However, NFHS-4 data indicate that 41.6% children (aged <3 years) were breastfed within first hour of birth and 54.9% (aged <6 months) were exclusively breastfed; the respective figures in 2005-06 (NFHS-3) were 23.4% and 46.4%.The current scenario calls for raising awareness regarding the appropriate Infant and Young Child Feeding (IYCF) practices along with their effective implementation.
Since 1992, World Breastfeeding Week is being celebrated every year (1-7 August) in more than 170 countries for encouraging breastfeeding and, thus, improving child health. This year’s theme is Sustaining Breastfeeding Together which endorses the creation of an enabling environment for successful breastfeeding. It further aims to work collectively towards the common goal for achieving sustainable results. In 2016, World Alliance for Breastfeeding Action (WABA) initiated the journey towards Sustainable Development Goals (SDGs) by linking each goal with breastfeeding and multi-level partnerships including health-care advocates/activists, decision-makers along with political support and media. All governments have endorsed to prioritise the World Health Assembly’s global target for increasing the exclusive breastfeeding rates up to at least 50% by 2025.
Our government has initiated many programmes/schemes and interventions for promoting breastfeeding directly/indirectly which include:
A nationwide flagship programme – ‘MAA’ (Mothers’ Absolute Affection) has been implemented across the States/UTs since November 2016. It envisages improving the breastfeeding rates and child feeding practices among the masses. Under this, ASHAs are being incentivized for reaching all pregnant women and nursing mothers of young children (aged <2 years) for advocating optimal IYCF practices. Positioning of trained ANMs (at all sub-centres) and the health-care personnel (at all delivery points) is also being ensured for providing skilled support to nursing mothers, where necessary. The programme involves a comprehensive set of activities along with strong monitoring component for protecting, promoting and supporting breastfeeding/child feeding – both at the community and the facility level.
India Newborn Action Plan (INAP) aims at attaining single digit neonatal mortality rate by 2030 (five years ahead of the global target) and addresses prime interventions like pre-conception and antenatal care; care during labour/child birth; immediate new-born care; care of healthy and the small/sick new-borns as well as care beyond new-born survival. It is targeting at raising the rate of breastfeeding initiation (within 1st hour of birth) to 90% by 2025.
Maternity Benefit Programme (MWCD) provides cash incentive (Rs.6,000/-) to pregnant women/nursing mothers as a compensation for the wage loss as well as to facilitate breastfeeding during the first six months of life. Facility based new-born care, special new-born care units, new-born care corners, home based new-born care are some of the schemes dedicated to the mother-&-newborn dyads which can profoundly promote timely initiation of breastfeeding.
Since Nov 2016, the Pradhan Mantri Surakshit Matritva Abhiyan(MoHFW) aims to provide assured, comprehensive cost-free quality antenatal care to all pregnant women on the 9th of every month. This Abhiyan provides an excellent window of opportunity to highlight the benefits of breastfeeding as well as appropriate IYCF practices, especially the primi-gravida/the mothers-to-be!!
Mother and Child Tracking System (MoHFW) employs information technology for ensuring the delivery of full-spectrum healthcare/immunization services to pregnant women and children (aged <5 years). It is an innovative, web-based application to facilitate/monitor service delivery and establish a two-way communication between the service providers and the beneficiaries. In this context, it may be mentioned here that IYCF practices should also be tracked, monitored and facilitated so as to improve the timely initiation, exclusive breastfeeding, appropriate complementary feeding and continued breastfeeding practices.
The Union Minister for Health and Family Welfare, Sh. J.P. Nadda has said that breastfeeding is the natural cost effective intervention that should be promoted at all levels. To improve the IYCF indices, counselling strategies need to be strengthened through adequate resource allocation, capacity building and effective communication at all levels. For a collective action and lasting impact, midwives, nurses, physicians, nutritionists, public health advocates and community workers need to be trained effectively to promote, advocate and facilitate the adoption of optimal IYCF practices. The health facilities should have lactation counsellors/skilled assistance while at community level, trained peer counsellors/mother support groups can help the mothers to sustain breastfeeding. Pregnant women and adolescent girls need to be educated about the lactation process; and the girl child should be given an equal opportunity to adequate breastfeeding. For promoting breastfeeding, apart from having baby friendly hospitals, mothers should be entitled to flexible-extended leave benefits and necessary breaks as well as adequate breastfeeding rooms at the workplace. Recently, Tamil Nadu government has established nearly 300 centrally air-conditioned breastfeeding rooms in public places like bus terminals. Further, there is a need for effective implementation of the Infant Milk Substitutes (IMS) Act in every
*Dr Santosh Jain Passi – Public Health Nutrition Consultant; Former Director, Institute of Home Economics, University of Delhi
** Ms Akanksha Jain – Ph D Scholar, Amity University, Noida, Uttar Pradesh; Research Officer – Public Health Nutrition Division, LSTech Ventures Ltd, Gurgaon, Haryana, India
Views expressed in the article are author’s personal.