Breastfeeding

Breastfeeding contributes to emotional and psychological development of infants. Breastfeeding is Key to healthy life and one of the most critical interventions which can help bring down infant mortality. The constitutional mandate for breast feeding is provided under Article 42 of the constitution of India which says that the State shall make provision for securing just and humane conditions of work and for maternity relief. Dalai Lama also said that our very first act after birth is to suck our mother’s milk. This is an act of affection, of compassion. Without that act, we cannot survive. “

               The first week of August is globally marked as World Breast feeding week to promote, protect and support breastfeeding. This year the theme is ‘Breastfeeding: A Winning Goal - for Life!’ highlighting that achieving the Millennium Development Goals requires more early, exclusive and continued breastfeeding. Breastfeeding can contribute to each of the MDGs in a substantial way. Breastfeeding is key to the MDGs which focus on eradicating extreme poverty and hunger.  Breastfeeding provide high quality nutrients and adequate energy, and can help prevent hunger and malnutrition. It is a natural and low-cost way of feeding babies and children.

               Early initiation of breastfeeding within one hour, exclusive breastfeeding till six months of age and appropriate complementary feeding after six months with continued breastfeeding till at least two years can help bring down under infant and under five mortality rate. The World Health Organization and UNICEF recommends early  initiation of breastfeeding within the first hour after the birth; exclusive breastfeeding for the first six months; and continued breastfeeding for two years or more, together with safe, nutritionally adequate, age appropriate, responsive complementary feeding   aftersixth month.

                    Breast milk provides appropriate concentrations of almost all the nutrients for infants. During the first few days after delivery, the mother produces colostrums, a thin yellowish fluid, and rich in protein and antibodies that provide immunity to the baby at the time of birth.  Colostrum also helps the newborn's digestive system to grow and function properly. Mother’s milk comprises of various components such as anti-microbial factors, digestive enzymes and growth modulators that promote the infant’s growth and development. Breastfeeding is one of the most effective interventions for child survival particularly to address morbidity and mortality related to three major conditions i.e. neonatal infections, diarrhoea and pneumonia. Breastfeeding has a protective effect against childhood obesity and lowers the risk of several chronic conditions including asthma, diabetes and heart disease, in adult life and thus contributes to long-term benefits. It has been found to have direct positive impact on brain development. Breastfeeding has many health benefits for the mother too. It reduces anemia. Obesity is less common among nursing mothers as it helps the mother to regain her normal figure. It is protective against breast and ovarian cancers. It also helps in spacing pregnancies as breastfeeding is the effective contraceptive.

                    The increased availability of infant milk substitutes in the market has lead to extensive promotions by the infant food manufacturing companies, through advertisements, free samples, gifts to mothers and health workers to convince them that bottle feeding is as good as breastfeeding. This undermines breastfeeding in many ways and has contributed to the decline of breastfeeding rates.To prohibit this and promote breastfeeding there exists the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 (The IMS Act) which  came into force on August 1, 1993. The Act aims to prohibit the promotion of infant foods, infant milk substitutes and feeding bottles.

                    The Act Prohibits the advertisement of infant milk substitutes and feeding bottles to" ensure that no impression is given that feeding of these products is equivalent to, or better than, breastfeeding. It Prohibits providing free samples and gifts to pregnant women, mothers of infants and members of the families, donation of free or subsided supplies of products for health care institutions and prohibits incentives and gifts to health workers and also display of posters at health care facilities / hospitals /health centers. The act also prohibits any contact of employers manufacturing and distributing company with pregnant women, even for providing educational material to them. The Act also prescribes that all labels of IMS /Infant food, must say in English and local, languages that breastfeeding is the best. Also, the labels must not have pictures of infants or women or phrases designed to increase the sale of the product. There is also MATERNITY BENEFIT ACT, 1961 to regulate the employment of women for certain period before and after child-birth and to provide for maternity benefit and certain other benefits.

                        Some of the possible reasons for suboptimal breastfeeding are primarily lack of proper information to mothers, lack of counseling on feeding of infants, unawareness about health care support, inability of the health care providers to help mothers experiencing breastfeeding difficulty and lack of proper support structures at the community and work place for working women. Besides this practice of mixed feeding, or giving other liquids and/or foods together with breast milk to infants under 6 months of age, poses risks to an infant’s health because it can increase the chance of their getting diarrhea and other infectious diseases. Giving water or other liquids can also cause the supply of breast milk to decrease as the baby sucks less at the breast.  Babies do not need liquids other than breast milk, not even water; in the first 6 months as breast milk contains all the water a baby needs.

                 To overcome these challenges there is need to focus onInformation, Education and Communication  approaches including the use of electronic ; TV, radio, video , print medium including posters, counseling cards, flip charts, manuals, newspapers, magazines, effective use of Social media, interpersonal  communication and community activities to motivate mothers, families and the community to promote breastfeeding. Community based strategy must involve peer counseling on the one hand and Print and electronic media to disseminate the message to the people on the other hand.  This shall facilitate skilled peer counseling and also help in removing mistaken beliefs and blind faiths such asColostrum is not good or even dangerous for babies.  The facilitators of peer counseling are Medical officers, Staff Nurses, ASHAs, AWWs, skilled Mother support groups, traditional birth attendant/an active mother from the village, Spouse, Family Members and also People at Work. This includes individual or group counseling and home visits to ensure counseling services at all levels. This should be available for all members of the family who exert important influence on infant feeding behaviour including the father and the grandmother of the baby.

                      Each child deserves the best possible start in life, thus there is a need to educate not only pregnant women and mothers of infants but also each member of her family about the benefits of breastfeeding. This is not only responsibility of the state but also duty of the society to facilitate breastfeeding.

* Pooja  P. Vardhan is Asst Director PIB Indore .