‘India can achieve better healthcare goals by promoting breastfeeding’

Dr Dharminder Nagar
Dr Dharminder Nagar

Despite definitive medical advances and India being recognised as one of the best countries in Asia for specialised tertiary care treatment, more than 1.2 million babies under five die every year. Half of these deaths occur in the first 28 days of life, neonatal period, writes Dr Dharminder Nagar, Managing Director, Paras Healthcare.

When the Australian Member of Parliament, ‘Larissa Waters’, breastfed her daughter inside parliament earlier this year while moving a Senate motion, she not only made history but also made a strong statement in favour of the practice – breastfeeding.

While the world applauded her, we Indians clapped too but it was just noise. If you we around our surroundings, they look devoid of any compassion or consideration for the breastfeeding mother or baby.

Despite definitive medical advances and India being recognised as one of the best countries in Asia for specialised tertiary care treatment, more than 1.2 million babies under five die every year. Half of these deaths occur in the first 28 days of life, neonatal period.

The important component that can reduce the burden and save numerous bundles of joy is simple – breastfeeding. Surprisingly, out of the 26 million babies born every year in India, only 8 million are breastfed in the first hour of their birth – the golden hour for babies that secure their future life and health. In fact the recent reports also highlight that only 46% of the babies were breastfed even in the first day of their birth. Our neighboring countries fared better and are far ahead with Sri Lanka at 75.8% and Bangladesh at 64%.

These statistics do make some things clear. We do have a problem, a problem becoming an abyss and the fact that we immediately need to act. The question is HOW? Who will bring the change? Is it awareness, reach, perception or infrastructure? Or perhaps all?

Given below are few recommendations to ensure that breastfeeding evolves into a right of every baby:

Knowledge & Education of Mothers is imperative: Pregnant women should be given proper guidance during their pregnancy about lactation and its immense importance, practical knowledge, proper feeding practices, pumps and dietary care. It is found that women who are given prior guidance are able to adopt better feeding practices and have better feeding experiences than those who have not been given such guidance. This can be done by both government as well as private players but a proper course to impart guidance should be charted out and public-private partnerships in this direction can go a long way in achieving better results. Private clinics can be roped in by the government and given incentives to provide guiding sessions to women including those from economically deprived background who may otherwise not come forward themselves to avail advice in this regard.

Be clear about the myths & superstitions associated with Breastfeeding: There are a lot of myths associated with breastfeeding in India and those need to be quelled. First time mothers even in urban India experience issues emanating from lack of knowledge. Since families are only getting nuclear, most women have nowhere to go to seek advice on best feeding practices. The fact has to be emphasised to would-be mothers that while breastfeeding might require greater effort from them given their busy schedules, it is the best choice for babies and is absolutely worth the effort. Babies who have been breastfed have better chances of surviving, lower chances of acquiring diseases, malnutrition and stunting. Apart from better bonding between mother and baby, breastfeeding also leads to improvement in cognitive performance and better educational achievements in the child.

Make mothers understand that breastfeeding is good for them too: It also needs to be emphasised that breastfeeding also holds health benefits for women. Women who breastfeed their babies for sufficiently long period of time have lower risk of breast cancer, ovarian cancer and type 2 diabetes.

Building enabling infrastructure: The India Newborn Action Plan (INAP) developed by Ministry of Health & Family Welfare in 2014 has been targeting a 90 per cent rate of initiation of breastfeeding within an hour of birth by 2025. To achieve these rates, there is a need for investing in creating an enabling environment for mothers, especially the working mothers.

Making workplaces friendly for breastfeeding: In Delhi, where the ratio of working women is higher, it was found by a survey that about 41% of mothers felt that their offices did not have any nursing facilities. Clearly, there is a need for making laws and regulations for building infrastructure that is conducive for mother to breastfeed their babies and maintain a proper feeding schedule. Developing crèches should also be considered and there should be laws for workplaces to have breastfeeding rooms.

Public places should mandatorily have breastfeeding rooms: Women in public places feel awkward in breastfeeding their new-born because of the public gaze. To overcome this problem, government has to come out with proper feeding rooms at public places. Inclusion in metros, railway stations, airports, shopping malls and restaurants is a must.

A case in point here can be how the Australian Parliament has been made a more friendly place to young mothers over the past few years and how Larisa Waters was able to breastfeed her baby inside the Parliament. The Australian Parliament, as it stands today in this regard, can be a good example and can be the way forward for India in many of its endeavours to promote breastfeeding practices.  We look forward to the day our parliament shall also be recognized for the same.

Setting up and promoting human milk bank: Setting up Human Milk bank is another way India can, without argument, make her babies stronger. The sad news was that despite its obvious advantages, such banks were non-existent in India until a few years ago. The good news in this regard is that there is some action now and some banks have come up. Even better news is that government is considering a network of banks across 661 newborn care units across the country. The banks collect, pasteurise and store milk and is used to feed babies who cannot be nursed by their mothers because the mothers are not producing their own milk for whatever reason. It is also given to those babies who sadly lose their mothers right after birth.India can learn from Brazil, another developing country like India, in this regard. In 2011, Brazil’s milk collection in its Milk Banks was 1,65,000 litres and was given to 1,70,000 babies. As many as 1,66,000 mothers were donating their milk to these banks. There is no reason why Indian cannot replicate that success. There has been only a start in India in this field, that too in metros. All we need is a strong will and push towards achieving this goal.

What can we do? 

The private sector can play a very important role in changing the mindset and leading a change in making breastfeeding a part of our lives.

• Private companies can come up for setting up milk banks, under proper policy framework by the government. The private sector will only augment government’s efforts in providing the ‘Liquid Gold’ to those babies who cannot have it from their own mothers.

• Ensure that just like fire exist norms and disability ramps in buildings, rooms for breastfeeding mothers are also built.

• We can be active participants in creating awareness about exclusive breastfeeding.

• We need to create importance about the importance and need of a specialised lactation counselor.

• We can set up breastfeeding rooms where mothers can comfortably feed their babies.

• We can also urge others to follow, remember every change just needs two players  – an initiator and a motivator.

We as healthcare providers also understand that it is a key responsibility of doctors to ensure they administer the right knowledge and guidance to new mothers to groom them towards this practice. The increasing of the maternity leave period to six months is a very welcome initiative that will most certainly boost the practice among working women. We must remember that investing in breastfeeding is the single biggest healthcare investment we can make towards improving child health in India. Let’s begin a revolution that our future generations can appreciate and live.