Dr Arun Gupta, Regional Coordinator of International Baby Food Action Network (IBFAN) Asia, and Member, Prime Minister’s Council on India’s Nutrition Challenges, shares valuable insights on the importance of breastfeeding in improving maternal and infant health indices in the country, in an interaction with Lakshmipriya Nair
How important is breastfeeding in maternal and child health?
Breastfeeding is too important as far as mother and child health is concerned. A baby who is breastfed within one hour has 2.6 times lesser chance of newborn infection and deaths during this period. Exclusive breastfeeding during the first six months reduces diarrhoea, respiratory infections, and undernutrition making it the number one intervention for child health and survival. Exclusive breastfeeding also reduces risk of hospitalisation in diarrhea and pneumonia cases. There is concrete evidence that breastfeeding also provides protection against obesity, and adult diseases such as diabetes, hypertension, and malignancies. For mothers, breastfeeding provides protection against ovarian and breast cancer. Exclusive breastfeeding is important for birth spacing too.
Can breastfeeding play a role in meeting the MDG goals?
Certainly breastfeeding can play a role, if coverage is scaled up to 90 per cent or more for three indicators: early initiation of breastfeeding within one hour, exclusive breastfeeding for the first six months and adequate and appropriate complementary feeding with continued breastfeeding for two years or beyond.
As much as 22 per cent newborn mortality can be cut down for example if all mothers were enabled to breastfeed within an hour of birth. Further breastfeeding exclusively reduces diarrhea mortality by 10 times and pneumonia mortality by 15 times in children 6-23 months of age. More recent evidence points on that breastfeeding also leads to higher earning capacity later in life through increasing IQ, educational attainment with increasing breastfeeding duration
As per WHO statistics, India lags behind in breastfeeding. Why is it so?
Recent World Breastfeeding Trends Initiative (WBTi), policy assessment has revealed that India lacks a clear policy, plan of action and budget for interventions on breastfeeding. Lack of coordinated response reduces the priority it needs. There are several policy areas needing urgent attention such as maternity protection, enforcing the law to protect breastfeeding from aggressive promotion of baby foods, health system support to women and breastfeeding during disasters etc. to mention a few. Breastfeeding rates can go up only if we invest in policy and programmes.
What are the major challenges to tackle?
Aggressive promotion of baby foods through the health systems pushes mothers to adopt artificial feeding. Lack of maternity protection measures for majority of women especially in the unorganised sector and in the private sector who have to combine work and breastfeeding is a major challenge. Health system being unsupportive to mothers at time of birth or later to ensure exclusivity of breastfeeding pushes women to adopt unwanted harmful practices. Confusing messages from several quarters in the absence of state interventions and lack of proper information on risks of formula feeding makes good feeding choices a huge challenge.
What are the steps to better our breastfeeding stats?
Government of India should ‘move’ the existing national committee on breastfeeding and develop a plan of action for five years at least with assured funding. Policy and programmes should be reviewed every three years. Some one should review the plan every six months. Data on three indicators of breastfeeding should be reviewed annually from every State; if US can do it, why can’t we? The most recent Government of India’s Rapid Survey of Children data shows mere 44 per cent mothers are able to breastfeed within one hour. Is it not a gross failure of our health system support towards mothers, a system, which claims that 78 per cent mothers deliver in institutions. Exclusive breastfeeding rate at 64 per cent is an improvement from NFHS 3 data but complementary feeding rate at 50 per cent is a fall from NFHS-3. What we need to do is rapidly scale up coverage of these three indicators to nearly universal. Who is looking at these?
How does BPNI work with the government and other agencies like UNICEF?
The Breastfeeding Promotion Network of India (BPNI) was founded in 1991, to protect promote and support breastfeeding in India. It works with government and UNICEF like agencies through advocacy. BPNI carries out an India assessment of policy and programmes every three years using World Breastfeeding Trends Initiative (WBTi) tools, in line with Global Strategy for infant and young child feeding. BPNI has also developed a world-class four-in-one skill-training programme for health workers that combines all kinds of skills required on breastfeeding counselling or growth monitoring. BPNI advocates for such training to be mainstreamed. BPNI also helps in monitoring the law enacted for regulating the marketing of baby foods and feeding bottles. BPNI advocates for sustainable solutions to child malnutrition through comprehensive food based approaches not through market product based ad hoc solutions. BPNI has a clear ethical policy on conflict of interest for its own funding and does not accept funds from the companies manufacturing baby foods, feeding bottles etc., and from organisations/ industry having conflict of interest. BPNI raises conflict of interest concerns in policy and programmes at all levels.