Exclusive Breastfeeding? Yes. Effective Breastfeeding? No. What to do?

An IAS officer writes about a project that’s improving weight gain among babies in Nandurbar district of Maharashtra

Minal Karanwal | May 27, 2022


#ICDS   #bureaucracy   #Nandurbar   #Maharashtra   #malnutrition   #nutrition   #healthcare   #Health  


Our hearts almost skipped a beat when we heard community health officer (CHO) Dr. Sandeep Kakuste’s success story with baby Pinki Lakhan Patil, who was born underweight in a brick kiln. Pinki weighed 1.7 kg at birth. As she was on exclusive breastfeed she could not have gained weight by any other method. However following the techniques of ‘Health Spoken Tutorials’ of IIT Bombay, Pinki gradually gained weight and weighed 2.5 kg in 14 days – a weight gain of 800 grams within a fortnight. CHO Dr Rakesh Patil says that never in his career of seven years has he seen weight gain due to breastfeeding at this pace.
 
Nandurbar has an exclusive breastfeeding rate of 86.6%. (The breastfeeding rate is an indicator that measures if the child has had breastmilk exclusively in the first six months of its life). Going by this mathematical figure, it would mean that in 0-6-month-old babies, incidence of underweight/wasting/stunting would be proportionately less in the district as children only drink their mother’s milk and nothing else.
 
Yet as per NFHS-5 data, Nandurbar’s stunting, wasting and underweight indicators remain very high. As many as 57.2% children are underweight, 45.8% are stunted and 30.7% wasted. This means that the high exclusive breastfeeding rate is not translating into reduced malnutrition amongst children.
 
Speaking of breastfeeding, to a layperson like me the only image and explanation that conjured up is that of a mother holding her child to her breast, until I came across Health Spoken Tutorials that can be easily termed ‘mechanical engineering’ on the phenomenon of breastfeeding. These tutorials helped us simplify the ‘hold and latch’ in a manner so effective that we started getting positive and good results with corresponding proportionate weight gain in children.
 
In field when I saw ‘cradle hold’ practices with a child’s head often tilted towards the mother, I wondered if we as grownups could ever drink water in a similar manner from a glass or a bottle with our head tilted sideways. In nipple feeding, I have often seen the mother holding her child to her breast as she continues to do farm work.
 
It is plain logic that the child should be held to the breast in a manner that makes it easiest for the child to drink milk. The idea of ‘milk transfer’ from the mother’s breast to the child is central to breastfeeding. The idea of a ‘correct latch’ of the child on the mother’s breast is also central to breastfeeding.
 
During my visits to the district hospital I saw many babies low on energy and crying and many concerned mothers would complain, “Ye doodh nahi pi raha hai.” This made me curious as to why the hungry child was resisting drinking the mother’s milk.
 
The tendency more often is to blame the beneficiary for their handicaps – illiteracy, ignorance and poverty. I have often heard comments like “Mata khud hi bachche ka bhala nahi chahti” or “Yeh log itne bachche kar lete hai ki sab pe dhyan nahi dete”.
 
The question that comes to mind is: Are we really helping these mothers with an easier and effective technique or are we only justifying our own incompetencies?
 
The mothers that Dr Kakuste and Dr Patil helped were so elated to see weight gain in their children that they stuck to the Tutorials’ new skill of breastfeeding by following it to a tee.
 
These Health Spoken Tutorials not only presented to us a different hold or a new technique, but also gave us clear analogies as to why we need to be convinced with these instructions. For example, we came to know that a simple extension in the neck of the child during breastfeeding helps in the swallow process, just as we extend our necks while we drink water. We also came to know that complete alignment of the child towards a mother’s breast increases its comfort as it drinks its mother’s milk.
 
The logic behind each idea and micromanaged breakdown of the ‘hold’ only helped us to push these techniques wide and deep into the health systems and as well as ICDS which so far we believed only doctors could understand. Our ASHA tais and Anganwadi sevikas absorbed these tutorials.
 
Talking of weight gain in a child between 0-6 months of age, the only input we have is that of the mother’s milk. We do not quantify it because we haven’t been able to store this on a larger scale. For example, when we look at growth velocities in Nandurbar we find it very normal for a child of 0-6 months of age to have a monthly weight gain of 300-350 gram. This essentially translates to nearly 10-12 gram per day.
 
While the National Nutrition Mission guidelines recommend 28 grams weight gain per day, the Health Spoken Tutorials have helped us achieve weight gain of 35-40 gram and even 50 grams per day.
 
What did we learn here? That while the mothers of these hungry babies have been taught about exclusive breastfeeding for the first six months, they do not know effective breastfeeding. Hungry tummies of these small babies all around us, who cannot speak, get overshadowed in the helplessness of the mothers to transfer their milk to their stomachs.
 
We thank Dr Rupal Dalal of Health Spoken Tutorials, IIT Bombay, and Dr Devaji Patil for helping us lay down the implementation framework. We offer our appreciation and gratitude to Nandurbar collector Manisha Khatri for being a solid anchor in supporting this project.
 
Minal Karanwal, Sub Divisional Officer, Project Officer, Nandurbar district (Maharashtra), is 2019 batch IAS officer.

 

Comments

 

Other News

NCP’s Ajit Pawar is LoP in Maharashtra assembly

After the Bharatiya Janta Party orchestrated rebellion in the Shiv Sena partly led by Eknath Shinde who took away with him a majority of MLAs, the Eknath Shinde-BJP government proved majority in the state assembly floor test, crossing  the midway mark (144) getting 164 votes in their favour. The Natio

Why sanitation should matter to you

How many times a day do you flush the toilet? This number is probably between five and eight times for an average person. How many times a day do you spare a thought towards what happens to the human waste after you flush it away? The answer to this is likely to be close to zero for most people.

Who is Eknath Shinde, the auto driver who became CM?

Hailing from Satara district of Maharashtra, Eknath Sambhaji Shinde had to leave his education midway to financially support his family. He worked as an auto rickshaw driver, a lorry driver and also said to have worked in a brewery before he came in contact with Anand Dighe, Shiv Sena’s Thane unit pr

Metro 3 car shed to stay at Aarey, say new CM Shinde

Former Maharashtra chief minister Davendra Fadnavis stunned all at a press conference Thursday and named Eknath Shinde, the rebel MLA from Shiv Sena, as the next chief minister. Though Fadnavis said he would stay out of the government, a few hours later the BJP leadership announced he would be the deputy c

Uddhav Thackeray resigns as chief minister of Maharashtra

Minutes after the Supreme Court ordered a floor test on Wednesday night, Uddhav Thackeray in a televised address resigned as the chief minister of Maharashtra and also as a member of legislative council (MLC). He later drove down to Raj Bhavan and tendered his resignation to the governor Bhagat Singh Koshi

Gig workforce expected to expand to 2.35 crore by 2029-30

The gig economy has arrived in India, as the Covid-19 pandemic has propelled a flexibility of employment. As many as 77 lakh workers were engaged in the gig economy, constituting 2.6% of the non-agricultural workforce or 1.5% of the total workforce in India. The gig workforce is expected to expand to 2.35

Visionary Talk: Sanjay Pandey, Mumbai Police Commissioner with Kailashnath Adhikari, MD, Governance Now


Archives

Current Issue

Opinion

Facebook    Twitter    Google Plus    Linkedin    Subscribe Newsletter

Twitter