Nutrition
Even after decades of doctors’ recommendations and government campaigns for raising awareness, not all Indian mothers are following the exclusive breastfeeding guideline.

Only 54.9 % children under the age of six months have been exclusively breastfed, according to the latest National Health and Family Survey (NHFS-4). For the healthy growth of a child, it is necessary that the child be breastfed and consume no other solid or liquid food until the infant completes six months. The numbers have, however, improved substantially from a 46.4 % in NHFS-3.

The latest survey also shows that 56% of the rural children below six months were exclusively breastfed, while it was only 52.1% amongst urban children.

Individual states were also surveyed under NHFS. Among the South Indian states, Tamil Nadu has reported the least compliance with 48.3% children who have been exclusively breastfed till six months. This is as against 34.1 per cent in the previous survey.

This is followed by Kerala that reports just 53.3 % children, Karnataka has 54.2, Telangana 56.8 and Andhra Pradesh reported the highest at 71.1 % children being breastfed exclusively.

Medical professionals explain there could be several factors that pushes the breastfeeding percentage down; It includes lack of designated places for women to feed the child, minimal understanding of the concept and family pressure. In addition, infant feed formulations available in the market and projected as healthy alternative could also discourage breastfeeding.

It maybe noticed here that the trends in Kerala and Karnataka have shown a decline in the numbers while the others have fared better.

Why is this worrisome?

The first nutrition that any child is exposed to comes from the breast milk. Even as several other market products claim to match the nutrition in breast milk, it cannot be used as a equivalent replacement. Dr Yogesh Gupta, paediatrician, Fortis Hospitals says that breast milk has all the necessary ingredients in the right proportion. “From the amount of glucose, fat, carbohydrates or proteins, it is (well) balanced. Formula milk or other food supplements are no match to this,” he explains.

Besides, breast milk is also rich in antibodies and enzymes that offer a child protection against several diseases. “When breastfed, the child tends to acquire immunity from the mother. Studies have found that children who are exclusively breastfed also gain weight better, have higher IQ, better immunity and are less prone to allergies and infection,” explains Dr Gupta.

The myth about colostrum

NHFS-4 has also found that  only 41% of children are breastfed within the first hour of birth. This means a lost opportunity to give the child colostrum (the first secretion after birth, rich in antibodies).

Dr Gupta says people believe in myths and first give the child honey. In rural areas, some communities believe that feeding the child the first milk or colostrum could cause harm. It is also called witch’s milk. “It is actually ‘liquid gold’ for the baby. It is rich in fat and antibodies helps immunity coats the gastro-intestinal system of the baby. When the baby is out of womb, it is attacked from outside by several factors. It is Colostrum that offers protection,” he says.

“Feeding the child anything but breast milk puts it at a high risk of contracting infections and also brings down immunity substantially,” Dr Gupta adds.

Challenges

Dr Supraja Chandrasekar, paediatrician, People Tree Hospitals in Bengaluru talks about the change in mindset over the years. She says earlier, if a mother could not breastfeed the child or seemed unable to produce enough milk to support the child, there were minimal options before her. “The family would make efforts to pacify her, boost her confidence, ensure she is provided more nutrition and doctors would counsel her. At most, she would be prescribed medications to help lactate better,” she says.

Previously, when the country saw several joint families, the chances that the child was put to the breast was higher as the families would have several lactating mothers willing to offer foster care. However, with single families, that could be another challenge that the mothers face.

The scenario, however, has changed over decades with the introduction of several products in the market. “Formula milk is catching up fast. There are so many alternative feeds available in the market. The moment the baby cries, it is assumed that the amount of milk produced by the mother is insufficient and the family starts considering alternatives,” she adds. “The child could cry for other reasons as well. It could just be the heat or maybe general discomfort. In several cases, even doctors prescribe formula milk without much effort. The hand just goes to the prescription.”

This leads to complications. Dr Supraja explains that once the child starts to feel satisfied with an external source, exclusive breastfeeding would not be possible.

“The bottled milk (becomes) an easier option for the child. It does not involve suckling and hence, the child finds comfort. Over a period, this would also mean that the breast milk produced itself would genuinely come down. Also, the child would prefer formula milk as it is sweeter,” she says.

What’s ore, families often believe that washing the bottle with hot water can sterilize it. “That is untrue. It has to be boiled well in hot water. Failing to do this puts a child at an increased risk of diarrhoea,” she warns.

Maternity leaves

Another concern is that women do not get sufficient maternity leave.  Dr Supraja explains, “In many cases, it is just about three months. In such cases, women do not realise the importance of expressing breast milk into a bottle and switch over to cow’s milk instead,” she says. Women can explore options such as using a breast pump to express milk and store in a safe container.

Sufficient quantity

A thought that the milk produced by the mother is insufficient for the child is a common misconception. “If a child has six to eight wet nappies a day, it is good enough indication to know that the child is getting enough feed. There is nothing to worry unless a doctor specifically finds some shortcomings,” she said.

Ideally, the child ought to be exclusively breastfed for six months. Other options could be explored from seven months of age and it is ideal to, however, continue breastfeeding for upto two years, she recommends.

Campaigns

Under the flagship National Health Mission of the Ministry of Health and Family Welfare, the government is working on improving breastfeeding practices. A yearlong ‘MAA’ (Mothers’ Absolute Affection) Programme was launched nationwide in August 2016. A set of guidelines have been laid down for the implementation of the programme at ground level. Besides this, advertisements to promote the concept are also played on television channels and radio shows.

A paper published jointly by the Associated Chambers of Commerce and Industry of India (ASSOCHAM) and Ernst and Young says India presently has 50% of the world’s undernourished children. The report outlines that India has lost nearly 4% of its GDP to malnutrition. Given the role exclusive breastfeeding plays in ensuring adequate nutrition of infants, this is a critical area for the government and citizens to get together and act.

Challenges Involved for lactating mothers

No specified zones in public spaces for breastfeeding

Insufficient maternity leaves

Lack of family support and guidance

Myths about the quantity being inadequate

Traditional practices of feeding the child cow’s milk with honey