Mother’s milk is the ideal nutritionally perfect food for newborns and infants. It is like nectar for the infant and is aptly called the first vaccine that can be given to the child. During the initial post natal phase, breast milk is in the form of yellow viscous milk or colostrums which is packed with antibodies (immune globulins), and give the child an integral immunity against various diseases, including acute respiratory infections and diarrhoea. Breast milk is also rich in proteins, has enzymatic activity that prevents the growth of bacteria and viruses, and fulfils all the nutritional requirements of the new born for the first six months. It is safe, easy to digest, is readily available and very affordable. Thus breastfeeding is the cheapest and most effective way to ensure a child’s health and survival.
Exclusive breast feeding implies that the child should be only, and only, on mother's milk from first hour of birth up to a minimum of six months, without any other supplement like water, honey, gripe water or any top feed. If only every infant were exclusively breastfed during the first six months of life, an estimated 1.5 million human lives would be saved every year on this earth. Elaborating on the merits of breast feeding, Dr Amita Pandey, Associate Professor of Obstetrics and Gynaecology, King George’s Medical University (KGMU) says, “I work in a government hospital and the only feeding modality that is advocated in our setup is exclusive breast feeding (no water, sugar, gripe water, honey, or coconut water) during the first 6 months of life. We let the mother start feeding the baby as early as within 10 minutes of delivery. We put the baby, cord and all, on the mother’s abdomen, and it crawls up and starts suckling. This early suckling also helps in the delivery of the placenta and the membrane.”
Ironically, Aakanksha, mother of a one month old baby (delivered through a caesarean section in a private nursing home) told that as she did not lactate immediately after the delivery, the doctor allowed her to feed her baby on formula milk through an unsterilized cup and spoon for the first two days. Later she switched on to breast feeding the child. Similarly, another young mother Veena said that though she was breastfeeding her infant daughter, she had given her water too. She was unaware of the harms of letting the baby drink water along with mother’s milk. However, Prerna, the proud mother of a week old caesarean infant is strictly exclusively breastfeeding her son and is determined to continue with it for the next 6 months.
According to Dr Neelam Singh, Consultant Obstetrician and Gynaecologist, “Not only the doctor, but everyone who converses with a new mother-- the nurse, attendant and her family members--has a distinct role to play. The doctor’s responsibility is to assure the mother that she can give her child complete nutrition by exclusive breastfeeding and to ensure that breastfeeding is started early. The paramedical staff should educate her about the benefits of breastfeeding and help her continue with it. The family’s role is to support her and take good care of her food and nourishment.”
Despite the medical fraternity vouching for the efficacy of mother’s milk, less than 40% of infants below six months of age are exclusively breastfed worldwide. In the state of Uttar Pradesh, only 17.7% of the children aged 6-35 months are exclusively breastfed for the first six months. In UP alone, which has the dubious distinction of having the highest infant, neonatal as well as under five mortality rate in India, around 70,000 child deaths can be prevented every year if adequate breast feeding practices are followed and children receive only breast milk for the first 6 months of their life.
Bottle feeding is taken as a sign of modernity in urban as well as rural Indian households, with scant regard for the level of hygiene required. It is not uncommon to find even poor women resorting to bottle feeding their child with goat or cow milk. Adding fuel to fire are the glamorous advertisements of infant formula milk and baby food, showing suggestive models of chubby, smiling babies, to entrap the modern urbanite mother and tempt her to formula-feed her child instead of her own milk. Infant formula milk may at times meet the nutrient requirements but it does not have the immune globulins. Also, the level of hygiene demanded by bottle-feeding is very hard to meet especially in a country like India. This predisposes the child to more infection. Moreover maternal and infant bonding, which is crucial to the emotional development of the child, cannot be provided by these foods. Bottle feeds and formula milk can never be a replacement for breast milk.
A reason commonly cited by new mothers for not breast feeding is that they are not able to produce enough milk in the first few days, forcing them to put the baby on top feed. Ramdulari, the mother of a 6 years old TB patient, is one of such large numbers of undernourished Indian mothers who did not breastfeed her son due to the unfounded fear of insufficient lactation, thus making him a weakling prone to infections. Dr Amita Pandey strongly contends that whatever colostrums the mother produces during the first few days, are enough nutrition for the baby. A full term baby has enough glycogen stored in her to help her sustain for the initial two days. Moreover, if the baby is put to breast, the mother is bound to lactate eventually. It is like a cyclic process—put the baby to breast, there is a cyclic release of hormones, and the mother’s milk production increases. The more is the baby put to breast, the more would be the milk production. Only in extremely rare cases where sufficient breast milk is not produced, or if the mother is suffering from some serious ailment, does the doctor allow top feed.
Sometimes working mothers, who have to leave their baby home for long hours after a few weeks of delivery, either stop breast feeding the child early and/or ensure that the child has at least one top feed. They feel that if the child is not initiated into top feed from the beginning, she will not accept it later and thus create problems. It should be made mandatory for the employer to ensure that the workplace environment and working conditions are baby friendly Рsix months maternity leave; flexible working hours that allow the mother to breastfeed her baby in a separate feeding room; and/or cr̬che facility.
In the chaos of ignorance about the benefits of breastfeed, there are some sane voices of mothers like Kalpana, which are worth emulating. Kalpana, who recently delivered her second child at a private nursing home, says, “I exclusively breastfed my first child during the first six months, right after my caesarean delivery. Since I had to join my workplace only after three months of maternity leave, I made use of the breast pump to store my breast milk for 3-4 hours, which helped me to exclusively breastfeed him for more than 6 months.”
Lack of education and awareness about the benefits of breast feed among the masses prevents many mothers from exclusively breast feeding their baby. Sometimes misplaced notions about spoiling their figure prevent young mothers from breast feeding. The truth is that suckling of milk does not deform the shape of the breast. Rather, breast feeding brings the mother back to her normal physical shape much faster, than if she does not breast feed the child. Traditional norms sometimes go against exclusive breastfeeding. In many families it is considered auspicious to give goat milk to the infant or a drop of honey, or even gripe water. And if the mother is a working woman, she may resort to top feeds for her convenience.
Dr Arun Gupta, Regional Coordinator International Baby Food Action Network (IBFAN), Asia would like the Central and State governments to have their plan of action and budget allocation for promoting breast feeding, based on gaps which exist in current policy and programmes, in order to live up to this year’s theme of ‘Understanding The Past, Planning For The Future’.
It would make good sense to include nutrition education, with special emphasis on infant feeding practices, as part of the school/college curriculum so that adolescents understand the medical benefits of mother’s milk and dispel the myths associated with breastfeeding. We should promote breast feeding and good nutrition for women in both rural and urban areas. Working mothers should be made aware of the utility of breast pumps. Breast milk is the child's natural immunity and she should not be deprived of it.
(The author is the Managing Editor of Citizen News Service (CNS). She is a J2J Fellow of National Press Foundation (NPF) USA. She has worked earlier with State Planning Institute, UP and taught physics at India's prestigious Loreto Convent. She also authored a book on childhood TB (2012), co-authored a book (translated in three languages) "Voices from the field on childhood pneumonia" and a report on Hepatitis C and HIV treatment access issues in 2011. Email: shobha@citizen-news.org, website: http://www.citizen-news.org)
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