Breastfeeding is a normal way to feed an infant and is critical for women's and child health, survival, nutrition and development. Not only because infants and young children are vulnerable but the criticality is in the fact that brain develops almost entirely during the first two years of life. This is the time when breastfeeding helps with touch and visual interactions responsible for better development. It leads to development of IQ in children, which thereby imparts better education, performance in the workplace and lifetime.
The WHO and UNICEF recommend breastfeeding to be initiated within one hour of birth, exclusive breastfeeding (with no other foods or liquids) for the first six months of life, and continued breastfeeding with complementary feeding (breastfeeding with other age-appropriate foods) until 24 months of age and beyond.
Breastfeeding and optimal infant and young child feeding help prevent child malnutrition - both under nutrition and obesity. Other than protecting children from common childhood illnesses, it has the potential to reduce non-communicable diseases like type 2 diabetes and cancers. This is nourishment for life (Food necessary for growth, health and good condition)
There are many barriers to create an enabling and supportive environment for women to optimally feed babies. For Exclusive Breast Feeding (EBF) these barriers arise during the prenatal period, first day after birth and in the first 6 months. Similarly, there are barriers for good complementary feeding with continued breastfeeding after 6 months.
WBTi (World Breastfeeding Trends Initiative) is a worldwide programme and 9 countries have reported by June 2018. Globally, India ranks at 78 and has not shown a significant improvement in 5 rounds of assessment since 2005. India scored a meager 44/100 in 2015 and 45/100 in 2018.
In 2012, the World Health Assembly Resolution 65.6 endorsed a Comprehensive implementation plan on maternal, infant and young child nutrition, which specified six global nutrition targets for 2025. The aim of the fifth target is to increase the rate of exclusive breastfeeding in the first 6 months up from 38% in 2012 to at least 50% by 2025. Tamil Nadu Exclusive Breastfeeding rate is 44% and by 2025 expecting it to rise up to 60%.
Barriers for Exclusive Breastfeeding
Our ancestors had breastfed their kids to 4-5 years .This era is witnessing steady increase in lactation failures, lower breastfeeding rates, and breast & nipple Issues etc. What is the reason behind this? Is there a problem with the mother and child or is it about the change in society.
Currently pregnant mother’s weight gain is on an increased pattern where high nutrition and less physical work and mental stress lead to weaker muscles and joints and sudden weight gain post delivery makes it difficult to handle babies. Sitting hours together and feeding will get to the issue of arm and back pain and adding to this sleepless nights giving more stress to the mother.
Brassieres play a crucial role in breastfeeding and it’s important to use the right kind of brassieres. Padded brassieres may lead to flattening of the nipples which leads to difficulty in latching the baby to the breast. Wearing comfortable brassieres and seeing to the eversion of the nipple and cleaning the breast and wearing proper clothing is an important aspect for exclusive breastfeeding.
The present generation mothers have completely different expectation towards motherhood as compared to earlier generations. A new mother has to sit and feed for hours together which means no sleep and no social life for the mother. The present generation expects a protocol or time schedule on how much milk to feed the baby, the hours of sleep their baby needs and much more. But there is no protocol to breastfeed a baby, what works for one baby will not work for another and the baby’s need keeps changing.
This makes the moms clueless with questions like am I feeding the baby properly?, how do I know that I breastfed to my baby's satisfaction, why does my baby keep crying even after feeding? Also lot of advises from friends and family members lead to confusion and a stage of depression. Prenatal preparation by the mother along with the family is the answer to all this problems.
When a mother with her family members, spouse, grand moms are educated on the challenges post delivery, it helps the situation better as each family member can contribute and make the overall procedure easy for the mother and enjoy the whole process as a family.
During the fourth trimester babies do feel as if they are still in the womb so they are expected to be warm and cozy with the heart beat sound. This can be done only through breastfeeds, the more the baby is in arms the more comfortable they are. In this case, fathers can also help by providing Kangaroo Mother Care where they place the baby skin to skin. The entire family needs to sit together and work out a schedule on taking care of the baby so that everyone gets enough breaks and no one is stressed through the process and the mother also gets equal rest.
Currently most mothers take their post delivery leaves during their maternity period itself due to medical reasons such as cervical stitches, low lying placenta and more. This leads to only limited leave available post pregnancy during which they will prepare themselves on joining back to work by starting bottle and formula milk. Due to financial scrutiny and compulsion of keeping up the career, mothers do think of the future requirement of the family than the present need.
Providing adequate knowledge to raise awareness of exclusive breast feeding and increased involvement of health care providers in enhancing knowledge through antenatal and postnatal care will be the best approaches to increase Exclusive Breastfeeding Practice. It is also important that we identify cultural believes and practices that support infant and young child feeding and use them to promote exclusive breastfeeding. Policy makers should consider promotion of infant-friendly work environment among employers and the establishment of work-site crèches to promote exclusive breastfeeding.
Dr Jayashree Jayakrishnan Is a Lactation Consultant, Fortis Malar Hospital, Chennai