The recently released India Report of the World Breast Feeding Trends Initiative (WBTi) 2008, highlights the role of breast feeding in ensuring child health and reducing infant and child mortality. India has an infant mortality rate of 55 per 1000 li ve births (SRS 2008) which accounts for 72 per cent of the country’s under-five mortality rate. Breast feeding is the most important intervention to prevent newborn infections, diarrhoea and pneumonia, which cause child deaths in the month after birth till the end of the first year of life. Initial breast feeding in the first hour after birth and exclusive breast feeding in the first six months after birth can go a long way in preventing most neonatal and infant deaths in India. Save the Children UK’s Report on Saving Children’s Lives (2008) points out that infants who are exclusively breast fed for the first six months after birth are ten times less likely to die of diarrhoea and 15 times less likely to die of pneumonia.
Early breastfeeding within one hour of birth has huge implication on the success of exclusive breastfeeding later and on newborn infections and mortality. It helps better temperature control of the newborn baby and enhances bonding between the mother and the baby.
Very low rate
Yet, India’s early breast feeding initiation rate is among the worst at less than a quarter of mothers i.e. just 24.5 per cent. In states such as Bihar and Uttar Pradesh the rate of initial breast feeding within one hour of delivery is as a low as 3.7 per cent and 7.2 per cent. At the same time most states of the North Eastern region, Kerala, Tamil Nadu, Maharashtra, Goa and Orissa have initial breast feeding rates which vary from 51 per cent to 66 per cent. On the whole initial breast feeding rates have increased from the abysmally low level of 16 per cent in 1997-98; though this is no reason to boast as the current rate is still too low. Mothers give pre-lacteal liquids such as non breast milk, water, sugar or glucose water, honey etc. While the first breast milk is highly nutritious and carries antibodies that protect the child from diseases, pre-lacteal liquids and feeds are harmful and contribute to diarrhoea in the newborn.
Exclusive breastfeeding is another area where India is performing poorly. Only 46.4per cent of Indian mothers practise exclusive breast feeding. Both initial breast feeding and exclusive breast feeding requires behaviour change from the existing socio-cultural practices, which impede them. Lack of proper information about the life-saving value of these two practices needs to be countered with widespread awareness building campaigns not only through the media but through direct grassroots contact and counselling. Baby food producers who promote their products also prevent the spread of exclusive breast feeding in society. Awareness building has to address this issue also.
Women need support at the work place in the form of intervals during work and crèches to engage in breast feeding. The informal sector, which accounts for vast majority of the Indian labour force, needs to take measures that would allow mothers and babies to be together for the first six months. Improving exclusive breastfeeding would be a critical input to check the rise in malnutrition.
The Global Strategy for Infant and Young Child Feeding recommend that babies continue to be breastfed for two years of age or beyond along with adequate and appropriate complementary foods starting after six months of age. Median duration of breastfeeding (which includes exclusive breast feeding in the first six months and breast feeding with other complementary foods) is appreciably high in India. Bottle-feeding, which is considered as a modern method of feeding, is cutting into even the existing quantum of breast feeding. Awareness needs to be built on the ill effects of bottle feeding such as difficulty in maintaining the bottle clean and the ‘nipple confusion’ it causes resulting in the child refusing breast milk.
Babies should be fed soft and mashed food at least 3-5 times a day. Between 1997-98 and 2005-06 complementary feeding rates in India have improved from 35 per cent to 56 per cent. On the one hand it leaves still a long way to go; on the other hand it is equally important to enhance the quality of complementary food and cleanliness in providing it. The WBTi report also calls for support to food insecure populations to procure food. In addition to such support counselling should be also provided to make adequate and appropriate foods at home.
Analysing the policies and programmes the report calls for a set policy changes. One of them is to give policy status to the National Guidelines for Infant Young Child Feeding and implementing it with budget support. Another recommendation is to effectively implement the ban on promotion of infant milk substitutes as per the IMS Act, by preventing the indirect promotional tactics of baby food manufacturers. The report also recommends the extension of the maternity benefit to the informal sector, which employs the vast majority of Indian women. In this connection it also supports a planned implementation of the 11th Plan initiative to nationally extend the Muthulakshmi Reddy Scheme of Tamil Nadu, which provides financial support of Rs.6000 to mothers Below Poverty Line. This scheme helps mothers in the informal sector who do not have maternity benefits to be with their babies in the initial months after birth; rather than going for work out of economic compulsions. The report also calls for setting up crèches in the NREGA work sites as outlined in the National Rural Employment Guarantee Act and for the expansion of the Rajiv Gandhi crèche scheme.
In view of the life saving importance of breast feeding, the National Rural Health Mission (NRHM) and the Integrated Child Development Services (ICDS) should take up a sustained nation-wide campaign to dispel the socio-cultural inhibitions attached to initial and exclusive breast feeding.
(The author works with Save the Children, New Delhi.)