PHA-Exch> Dismal breastfeeding rates hampering infant health

[Claudio Schuftan]

   From:    arun at ibfanasia.org
     <http://indiatogether.org/> <http://indiatogether.org/>

MOTHER AND CHILD
*Dismal breastfeeding rates hampering infant health
*Statistics are staggeringly in favour of breastfeeding, and surprising as
it may be, breastfeeding rates in India are dismal.
 <http://indiatogether.org/support/home.php><http://indiatogether.org/support/home.php>
*25 August 2008* - It is that time of year: posters are printed about the
benefits of breastfeeding, well-baby contests are held and bonnie, breastfed
babies are paraded as pictures of health. World Breastfeeding Week (August 1
to 7), with its Olympian theme of "Going for the Gold' this year had been a
hectic seven days with media messages and campaigns around the country.

However, the lack of a policy framework to promote breastfeeding, the
powerful supplementary foods lobby, the lack of support for mothers and
health workers under-prepared in human lactation, have meant that the
seven-day long push loses steam as the year rolls around.

In India only 24 percent of new mothers initiate breastfeeding in the hour
after birth, 46 percent breastfeed exclusively the first six months and  56
percent nurse beyond six months with the introduction of complementary food.
But nearly half of under 5 children are underweight.

The solution, according to World Health Organisation is as simple as it is
natural. Early initiation of breastfeeding, it says, within an hour after
birth could bring the IMR down by 22 percent. A January 2008 series on
Infant Mortality and Malnutrition that was published in medical journal *
Lancet* said nearly 77 per cent (1.06 million) child deaths attributable to
suboptimal breastfeeding are due to non-exclusive breastfeeding during 0-6
months of life.

Breastfeeding promotion alone contributes to 11 per cent reduction in IMR if
coverage of promotion is 99 per cent through one-to-one and group
counseling, and can avert 21.9 million Disability Adjusted Life Years at 3
years. With such staggering statistics lined up, we all need to give
breastfeeding an impetus. The solution is simple: promote breastfeeding by
committing money and resources.

*Unenforced law and misinformation
*
The main stumbling block is the lack of support for mothers from the family,
society, medical fraternity and also their work places. Mothers are often
asked to throw away immune-property-rich colostrum or the first milk. Older
women in the family, who dictate infant feeding practices for new mothers,
cite inadequate breastmilk supply and encourage mothers to switch to infant
milk substitutes.

Coupled with the aggressive promotion of these substitutes through surrogate
advertisements, breastfeeding rates continue to be low. Surprisingly, it is
not the law that is deficient, but its implementation and formation of
support structures.

Apart from benefits to the mother and child, economic value of breastfeeding
is quite high. According to 1998 BPNI estimate, the value of breast milk and
breastfeeding to this country of 24.4 million annual births, based on the
national breastfeeding patterns over a 2-year lactation period, was around
three times the national education budget then.

Using available data on lactating mothers, frequency of nursing per day in
both the exclusively breastfed group and those who had introduced
complementary food, the researchers indicated Indian mothers produced an
estimated total of 3944 million litres of breast milk. If this milk were to
be replaced by infant milk substitutes it would cost $3 billion.

Little wonder then that the Infant Milk Substitutes manufacturers have been
trying to sell their products. Surrogate advertising and sponsored medical
conferences were the norm till BPNI took on Food Products Major, Nestle, in
1994. Nestle products Cerelac and Lactogen were found to be violating
provisions for advertising, labelling and sponsoring medical events.

Nestle was put in the dock for promoting introduction of complementary food
Cerelac in the 4th month (after three months) while, at that point, the Act
proscribed marketing such food to those below 4 months and advertising
Cerelac. Nestle's Infant Milk Substitute Lactogen was also found to violate
labelling rules.

All that Nestle has done in the last 14 years is to intimidate and delay
court proceedings. The company had also filed a writ petition challenging
the key provisions of the Act, questioning its constitutional validity and
seeking a stay on the case, stating it is impossible to comply with the IMS
Act. But since then all their product labelling has complied with the Act.

In the face of strong lobby, the government has failed to meet the targets
had set itself for the 10th five year plan ending 2007 vis-a-vis
breastfeeding (50 per cent initiating breastfeeding, 70 per cent exclusive
breastfeeding for 6 months and 75 per cent complementary foods with
breastfeeding till two years). And to the activists in BPNI, it is clearly
the case of lack of information, of support, lack of skills among health
workers in an institutional delivery and finally social taboos devaluing
breastfeeding.

The activists are none too happy with the budgetary allocation for or
implementation of the National Guidelines for Infant and Young Child
Nutrition that the Department of Women and Children formulated. While the
document proposes use of locally prepared food, the Ministry is now pushing
packaged, fortified food caving into the pressure from the industry.
Contracting reduction of malnutrition to private players would only
jeopardise the mission, they say.

Another aspect of breastfeeding support is mother-to-mother groups. The
efforts have been sketchy and are often NGO-driven in both urban and rural
India; their success depending more on the commitment of their leaders. But
there are positive examples too.

*Positive stories and the fightback*

While it seems like so much is going wrong with breastfeeding, positive
stories emerge from urban and rural areas. Many natural leaders help women
overcome their breastfeeding difficulties.

Breastfeeding is a learned skill, and many find they have learned it the
wrong way in the hospitals. The staff give formula or water in a bottle and
send breastfeeding downhill by causing nipple confusion. C-sections are very
common and mothers are often not helped to establish breastfeeding
immediately. When they return home, they are exposed to more taboos and
misinformation and many seek help as late as 5 months after delivery.

Listing out the benefits,  breastfeeding offers health as well as emotional
benefits to infants and mothers. The baby gets protected against allergies,
bonding between mother and child contributes to reduction in postpartum
depression, gives mother a rest from the reproductive cycle through
lactational amenorrhoea, which has many benefits: no anaemia, fatigue,
protects against breast cancer, makes baby feel secure, and gives the baby
the safest and the perfect food for full development as nature intended.

Talking to mothers over phone and visiting them in their homes by volunteers
can right the wrongs.

Stay at home mothers who have been wrongly guided by their families and
women from even second-tier cities, where breastfeeding rates are higher,
end up calling for help.


The greatest challenge has been in trying to convince women that the
colostrum produced on days 1, 2 and 3 after delivery have immunological
properties and should be given to children, instead of being thrown away as
milk gone bad.

The recent focus on breastfeeding has meant the staff are trained in
detecting poor breastfeeding practices like a bad latch, bad positioning,
poor weight gain in babies and help women optimally breastfeed and introduce
complementary foods.

*Workplace changes needed for returning mothers*

However, with agriculture taking a backseat and growing ubranisation has
meant most of the efforts of health workers get diluted. Daily wage earners,
be it agricultural labourers or construction workers, traditionally take
their children to work place and breastfeed on demand. Increasing
contractualisation of labour has meant employment practices that are not
mother - and child-friendly.

This phenomenon is equally seen in urban organised sectors. Employers be it
the state or private institutions often do not offer a maternity leave with
benefits in excess of the minimum 6 weeks prescribed under Maternity
Benefits laws.

Experience elsewhere have shown that security net measures for women like
long paid maternity leave have helped women breastfeed exclusively and
longer. In Norway, approximately 97 per cent of women breastfeed when
leaving hospital, 80 per cent are breastfeeding at 3 months and 20 per cent
beyond 12 months, reports the World Health Organisation. The government's
family policies ensured that women are entitled to a maternity leave of 42
weeks with full pay or 52 weeks with 80 percent of the salary and nursing
breaks of at least 1 hour on their return to work.

These are the setbacks to breastfeeding that need tackling working with the
government. The government needs to recognise breastfeeding as food security
for infants and recognise 0 - 6 months as entities in planning. Optimal
feeding of infants and young children should be declared a part of poverty
reduction and adequate funds provided in central and state plans to promote
breastfeeding.
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