By Dr Shagufta Kazi
Nutrition has been recognized, to be one of the most important determinants of health and is an important indicator of human development affecting the lives of individuals & families, productivity and ultimately National development. The scientific evidence revealed that maternal and child nutrition especially during the first two years of life is critical for survival, physical and mental development, learning capacities and has a lasting lifelong impact on the health of people.
Addressing the nutritional needs of infants and young children is one of the most promising means to improve our key indicators related to child health and development. Optimal infant and young child feeding includes early initiation of breast feeding within an hour, exclusive breastfeeding for the first six months of life followed by adequate complementary feeding and continued breastfeeding after six months to two years and beyond.
The country is facing the double burden of malnutrition. On one side there are high levels of undernutrition and micronutrient deficiencies in children and women. On the other side is the emerging problem of diet related chronic diseases like obesity, diabetes, hypertension, cardiovascular diseases etc. Optimal infant and young child feeding holds promise to prevent and alleviate both the undernutrition among children as well as diet related chronic diseases in later life including obesity.
To be successful in breastfeeding, women need practical help and support from all quarter’s especially health care providers. This means, women need accurate information about the optimal ‘ Breastfeeding’ and infant young child feeding. The Lancet in 2008 provided unequivocal scientific evidence that Breastfeeding promotion could work through ‘one to one’ or group counseling and no other method like mass media promotion are effective in increasing early and exclusive Breastfeeding rates. Health workers need to build mother’s confidence to increase breast milk flow and milk transfer from breast to baby’s mouth when she has feeling of not enough mik, assist her to initiate breastfeeding within one hour, assist in proper sucking position to allow effective sucking that will help in preventing breast problems like sore nipples and engorgement, solve problems if they do arise , answer any questions if mothers have, counsel mothers and familles on adequate and appropriate complementary feeding. Ideally all health care providers should acquire such skills. Unfortunately, most health care providers and family level frontline workers have barely acquire these skills in counseling and management of breastfeeding either during pre-service or in-service training. There is an urgent need for mother support from health professionals and institutions so as to ensure rational feeding practices like early contact between mother and the child soon after birth, exclusive Breastfeeding, rooming-in, abandoning the practice of giving prelacteal feeds, offering correct advice.
I have been working as a lactation counsellor in the valley since 2017 after completing my certification course. The problems faced by Breastfeeding mothers are many. Different group of mothers face different problems. Be it a working mother, or stay home mother, be it them from rural or urban areas, educated or visa versa, they face problems. Breastfeeding itself is a journey, which needs proper guidance and support. Lack of awareness and knowledge makes it tougher, if mothers don’t get mental support from family or the society they land up putting their babies on bottle feeds. Which exposes the babies to various illnesses.
You may hear someone say: “Breastfeeding is natural-why should a woman need help?” Certainly some mothers are very lucky. They breastfeed their babies without any difficulty. But many women need help at the beginning-especially with their first baby, and especially if they are very young. Many women need help to continue breastfeeding, especially if they work away from home, or if the baby seems to cry a lot.
Two recent studies in India have shown that many women now use artificial feeds of one kind or another from an early age. These may be cow’s milk, formula, diluted cereals, glucose water, or plain water. The practice is common all over the country. In some areas it is traditional to give early supplements, especially if the baby cries. The majority of women continue to breastfeed partially at the same time, and this must prevent some of the worst effects of artificial feeding. But early supplements are an important cause of diarrhoea and breastfeeding failure. The result of their widespread unchecked use is likely to be that more and more women stop breastfeeding early.
If you ask women why they give up breastfeeding, or why they introduce supplements early, they give many different answers, such as, “I did not have enough milk”; or “the baby refused to suckle.” However, though the women themselves do not know it, these are not the real causes of their difficulties.
The women do not really lack milk. They may be anxious and lack confidence that their milk is by itself enough for their baby. Sometimes the baby is not suckling in a good position. Some mothers lack enthusiasm to really try.
The underlying causes of their difficulties are: Lack of support from close female relatives, Delivering their baby in hospital and not receiving proper support at hospitals, The pressures of modern urban life. Lack of support from other women close to them
In traditional society, there were always experienced women nearby help a new young mother. These might include her own mother, or woman in the neighbourhood helped her to breastfeed the baby. It would be someone that she knew and could trust. But in modern society, and especially in towns, there is often no help nearby.
Sometimes a woman’s mother or mother-in-law is there to help, or she has other friends nearby, but they encourage her to give the baby artificial feeds, especially if they bottle fed their own children. Other family members too may encourage a woman to bottle feed, for example if they think that the baby cries too much.
Giving proper guidance plays a key role in reducing the top feeds.
Breastfeeding helps in increasing the spacing between the child births and in reducing the risk of breast and ovarian cancer in a Breastfeeding mother is now well established. Knowing the importance of Breastfeeding, it should be protected, promoted and supported. There is a beautiful and useful government program MAA ( mothers absolute affection) which helps health care professionals knowing the importance of Breastfeeding and practising in the system.
According to a research published in NDTV , India is a signatory to the target set by the World Health Assembly to increase the rate of exclusive breastfeeding in the first six months up to at least 50% by 2025.
the government needs to promote breastfeeding in a big way. At the same time, it is important to create awareness about the benefits of breastfeeding, as well as initiate steps to improve breastfeeding practices.
Firstly, there is an acute need for more lactation counselors. Secondly, there is a need to ensure that women working in the informal sector get adequate pay during maternity leave. Thirdly, separate spaces for breastfeeding are needed in offices, restaurants, malls, railway stations etc. so that women can breastfeed even when they are not at home. Fourthly, the Ministry of Health and Family Welfare should the implement Baby Friendly Hospital Initiative on a priority basis. Fifthly, the government must come down heavily on companies violating the Infant Milk Substitutes, Feeding Bottles and Infant Foods Regulation of Production, Supply and Distribution Act, 1992 and Amendment Act 2003. Sixthly, better data, especially at the state level is important because at the moment there are some districts for which there is no data. Lastly, effective implementation and monitoring of all government initiatives to support exclusive breastfeeding is a must.
Overall, breast feeding has been found to promote a healthier lifestyle for the child and the mother and I feel that everyone should consider the important research that has been done and consider breast feeding their infants to help decrease the risk of certain illnesses their child may come about in the near future. It’s a cheep health boost that society has accepted and instead of turning to formula, give breast feeding a chance and see what it can do for you.
(Dr Shagufta Kazi is a breast feeding counsellor. She is a practicing doctor since 2008.)