Controversies aside, mother’s milk remains an untapped elixir

The cover page of the Malayalam magazine Grihalakshmi, with a picture of a woman breastfeeding a baby, has triggered debates and a legal case, but statistics on breastfeeding practices across the country stare one in the face.
Only two out of five women initiate the practice within the first hour of childbirth and half the number of mothers don’t follow the World Health Organisation (WHO)-recommended exclusive breastfeeding for first six months, shows the fourth edition of the National Family Health Survey released by the Union ministry of health and family welfare early this year.

As breastfeeding comes with a large number of benefits for the mother and the child, its high prevalence is considered an important public health goal. Officials say they have seen an increase in breastfeeding practices compared to the past decade, when less than a quarter of women initiated the practice early and a little more than two in five fed their newborns up to six months.

Global reports put India among five largest emerging economies — China, Indonesia, Mexico and Nigera — where investment in breastfeeding is significantly low leading to economic loss of $14 billion due to child deaths and cognitive losses caused by poor breastfeeding practices. Reports by WHO and Unicef in 2017 concluded that more than 2 lakh children died across these countries because of inadequate breastfeeding.

While the Centre has extended maternity leave for women from 12 weeks to 26 weeks, hospitals often sensitise expecting mothers about best practices. "We begin talking to women about the benefits of breastfeeding during their ante-natal check-ups. In fact, in most of these sessions we include mother-in-laws," says Chennai-based lactation consultant Rekha Sudarshan. "We tell them that breastfeeding the baby from the first hour of birth, ensures that the child receives the rich colostrum which provides it immunity against several diseases," she said.

The practices vary widely across Indian states. The 2015-2016 survey showed that only 54.9% of women in India exclusively breastfeed their children for six months. The incidence is 4% higher in rural areas compared to urban areas. However, incidence of feeding practices in the first hour is at least 7% higher in urban areas with 41.5% of women initiating ‘first milk’ practice. Studies have shown that putting children to the breast in the first hour after delivery contracts the uterus and reduces risks of postpartum haemorrhage.

Among states, while more than 70% of women in Goa begin feeding the babies within an hour, only 60% of them feed their babies exclusively for six months. In states like Uttar Pradesh, only one in five women feed in first hour although two in five exclusively breastfeed babies for six months.

Doctors and women’s right activists say a number of factors including lack of adequate maternity leave in several work places prevent women from exclusive breastfeeding. Many women say they feel uncomfortable with alternatives like breast pump. "I tried expressing breast milk and storing it in the refrigerator, but my maid and relatives at home did not want to feed that to my baby. When I return home my child didn’t take the bottle because she wanted me," said R S Madhumitha, a 27-year-old techie who gave birth two months ago. She admits that words of her gynaecologist and paediatrician keep echoing in her ears, yet she chose baby food when she had to return to work last week.

Although many doctors admit they don’t push the mothers too much, what makes the situation worse is the drop in the number of children being given breast milk along with solid and semi-solid food in the six to eight months age group. There has also been a drastic drop in the number of women feeding their babies a combination of these foods across all states. The national average has dropped from 52.6% in 2005-2006 to 42.7% in 2015-2016. "We tell women that breastfeeding helps in bonding with the child better and reduces breast cancer risks, besides improving the child’s health. But we will have to keep doing it to encourage our women," says senior gynaecologist Dr N Palaniappan, who heads the safe motherhood committee at The Federation of Obstetric and Gynecological Societies of India.