Breastfeeding will not only remove the burden of generational malnutrition but also prevent occurrence of cancer in mothers
When Dr Shruti Kamdi (pictured on left), a transfusion specialist at a leading Mumbai hospital, had her first child, she struggled to nurse her baby as she was unable to secrete enough milk. Admitted to a private hospital, she was put on medication to increase breast milk. But that didn’t help much. And four months after the delivery, she had to put her baby on breast milk substitutes (BMS).
Not wanting to take any chances during her second pregnancy, Dr Kamdi tried traditional fixes and ate fenugreek laddoos to increase milk. She also brought stimulation pumps for lactation. But all her attempts failed and the doctors advised her to spoon-feed the baby. After three months of her delivery, she came in contact with Dr Rupal Dalal at the Shrimati Malati Dhanukar Maa aur Shishu Poshan Kendra in Mahalaxmi through a WhatsApp group. She went to the centre and was advised about correct breastfeeding techniques.
“I went there to learn about the types of complementary feeds (food to be given after six months); instead I was told that even surrogate mothers produce milk with some medical help. It was inspiring for me. After that I completely stopped formula feed and only breastfed my second child,” says Dr Kamdi. She admits that she did not know of such techniques during her first pregnancy. She is also surprised that none of her doctors advised the breast crawl (done immediately after baby’s birth) or kangaroo mother care (where baby is put on mother’s breast), which may help in lactation. “Despite having enough milk, it is frustrating to deny your child health benefits of breast milk. There is no concern for lactation [in hospitals]. Instead the focus is on surgeries, treating diseases and therapeutics,” she says. Her husband, a pediatric anesthetist, was also unaware of such lactation techniques.
Recounting her second delivery in a Mumbai hospital, former Palghar Zila Parishad CEO Nidhi Chaudhari says that she was advised to breastfeed her baby but she was not successful in lactating. Dr Dalal advised her and pointed her to some YouTube videos. She learned the techniques. “While working on malnutrition in Palghar I realised that breastfeeding is critical. At that time I never knew that I will plan a second child. The cradle position and posture are critical in initiation of breastfeeding and later continuing with the flow, expressing breast milk and retaining it for the child. The baby must be laid on mothers’ breast as soon as it is born and breastfed even if its weight is coming down, which happens initially. Mother’s milk is healthy, hygienic, ensures immunity and the baby gets all the required nutrition. It is like demand and supply where the more you feed your baby the more you generate,” she says.
“There is no awareness on colostrum, which is very healthy for the baby. Babies cannot digest protein-rich cow milk. Once the child is delivered they [hospitals] don’t bother. Every hospital must have a lactation consultant,” adds Chaudhari.
The above examples are of educated urban women, where one of them is a doctor. One can only imagine the plight of poor and uneducated mothers who suffer not only due to their lack of knowledge but also lack of a clean and hygienic environment before and post delivery.
According to the findings of National Family Health Survey (NFHS) 4, only 9.6 percent of children get minimum adequate diet from 6 months to 23 months of age and only 54.9 percent children under 6 months get exclusive breast milk. In terms of children in different wealth quintiles, 22 percent of richest children, up to 30 percent of middle class and upper middle class children in India, are malnourished.
Says Dr Rupal Dalal, paediatrician and a former consultant with department of health and women and child development, Maharashtra, who has extensively worked on malnutrition and infant and young child feeding, “Since the 1960s when most mothers starting formula feeds (milk substitutes), the wisdom of our grandmothers is long forgotten. Formula feeds have hygiene issues and require boiled water. Slum women use contaminated water for formula feed which leads to diarrhoea and slow death of the child. Besides, formula feeds are processed and loaded with sugar and make children sick. Any first-time mother who walked into our clinic was predominantly nipple latching. Lack of knowledge on correct breastfeeding technique on part of mothers, wrong notions and misinformation coupled with total lack of support in the hospital and direct push of formula feed, lactation consultants pushing for nipple shields and breast pumps make breastfeeding difficult.”
To bridge this gap, Dr Dalal along with her team of expert volunteers and IIT-B has been counseling mothers on nutrition, lactation and complementary feeding through Maa aur Shishu Poshan Abhiyan. The project has several Spoken Tutorial videos and a toll-free helpline (1800 200 2098) was started recently.
Prohibitions under Infant Milk Substitutes (IMS) Act
- Nobody should advertise the distribution, sale or supply of infant milk substitutes or feeding bottles.
- Nobody should give an impression that feeding of infant milk substitutes is equivalent to mother’s milk.
- Nobody should take part in the sale of infant milk substitutes or feeding bottles or infant foods.
- No container or label shall have pictures of an infant or woman or both.
- Infants milk substitutes shall not be displayed outside maternity and children hospitals.
42%
Of children born in the last 5 years were breastfed within one hour of birth
38.4%
Children under 5 are stunted
20%
Of the children from richest families in India are malnourished
Up to 30%
Of middle-class and upper-middle-class children are malnourished
Source: NFHS 4
The 10-minute tutorial videos give step-by-step guidance for the nutrition of pregnant or lactating mothers and babies, breastfeeding and complementary feeding in the first 1,000 days. The videos are managed by a computer engineering team of IIT-B led by professor Kannan Moudgalya. The videos are available on Health Spoken Tutorial channel on YouTube in English, Marathi, Hindi, Gujarati, Tamil and Konkani languages on 12 different topics about mother and child’s nutrition in the first 1,000 days. The videos will soon be available in 22 languages covering 45 topics. The videos can be downloaded and accessed offline.
“After the success of our spoken tutorials on other projects we wanted to expand into health training, particularly breastfeeding skills due to shortage of trained people on lactation. These videos will enormously empower millions of parents, health workers, doctors, nurses, nutritionists by imparting life-enriching knowledge that can drastically reduce infant mortality. The videos on breastfeeding have received excellent results. We guarantee that these videos are suitable for self learning,” says professor Moudgalya.
The first 1,000 days, i.e., from conception to two years of age, are critical for a baby and correct nutrition can decide the baby’s health by reducing infection, risk of chronic conditions like diabetes and heart diseases, increase immunity, brain health with better memory, concentration, and judgment. Moreover, breast milk reduces the chances of breast and ovarian cancers in mothers.
“Mothers lack support at birth for breastfeeding in the hospital and at home. Right from the stage of pregnancy, mothers need to be trained in correct breastfeeding techniques. If the mother knows skills of breastfeeding before going into delivery, she is empowered. It has to be part of the curriculum of medical and nursing colleges and even undergraduate studies as these are life skills,” says Dr Dalal.
India has 1 crore severely malnourished children under the age of five. Lack of knowledge on nutrition is the major reason for malnutrition, which results in infant mortality and has an adverse economic impact, reveals NFHS 4. Poor nutrition leads to loss of IQ by several points, thereby drastically reducing a person’s intelligence. Malnutrition consequences are cyclic in nature; a stunted girl child at two years will give birth to low weight baby and takes two-three generations to combat stunting in future generations. If not tackled within this period the damage is irreversible. Maternal health experts Governance Now spoke to said that focused attention on maternal care (pre and post delivery) and child care with exclusive breastfeeding for the first six months and appropriate complementary feeding subsequently alone will bring down the severity of malnutrition.
But there is one more problem to deal with. Recently, Nestlé was under the scanner after Breastfeeding Promotion Network of India (BPNI) alleged that the Swiss food giant had organised an industry-supported meeting intended to influence doctors into prescribing their baby food in India. Acting on the complaint, the ministry of health and family welfare (MoHFW), which is responsible for promoting breastfeeding in India, forwarded the matter to the union ministry of women and child development (MoWCD). Nestlé has denied these allegations.
As per BPNI, Nestle violated the Infant Milk Substitutes (IMS), Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 (see box on pg 41). The IMS Act, with the 2002 amendment, aims to protect and promote breastfeeding and proper use of infant foods. Nestlé is not alone; many baby food companies align with hospitals and doctors to promote their supplements.
Dr Arun Gupta, central coordinator, BPNI, says that over the last 25 years it has been observed that India sells approximately 27,000 tons of baby milk annually for children below three years, out of which 10,000 tonnes annually is consumed by babies under 6 months at a time when breastfeeding is critically recommended. On average, a baby in India during first six months consumes one can of powder milk.
“The reason for this could be that India is producing a large amount of animal milk. In my opinion, powder milk consumption should reduce. For some children, if they are denied breast milk, it is a question of life and death as it reduces risks of pneumonia and diarrhoea. New evidence is increasingly saying that breast milk decreases obesity and diabetes in children. Besides a large number of other health benefits, there are psychological and emotion benefits,” he says.
“With almost 40 percent babies born in private hospitals, baby food companies are building relationships with the healthcare sector and the practice of introducing formula feeds at the time of birth is rampant. This sends a strong signal to the families about necessity of baby foods,” adds Dr Gupta.
Moreover, for working mothers, who are juggling office and home, baby foods offer an easy option. The Maternity Benefits (Amendment) Act, 2017, which offers 26 weeks paid maternity leave, was implemented only two years ago. And the Act is restricted to the organised sector only. Also, according to a survey conducted by Teamlease Services, the Act may hinder the entry of new women into the workforce as it will cause an estimated job loss of 11 lakh to 18 lakh in 2018-19 for women.
A right combination of laws, infrastructure, and correct attitudes can increase the awareness around breastfeeding and bring down malnutrition.
geetanjali@governancenow.com
(This article appears in the February 28, 2019 edition)
