In many parts of rural India, when a baby is born, there is an ingrained belief that the first breast milk, the vital colostrum, which is power-packed with nutrients and acts as a natural boost to a baby’s immune system, maybe indigest-ible or may harm the baby! And, sometimes due to lack of awareness of nipple care, mothers are also not able to start with breastfeeding.
On the contrary, India’s National Guidelines on Infant and Young Child Feeding, along with the WHO, highlight the importance of ‘breast-feeding within the first one hour of birth’ to give a baby, and its breast-feeding journey, the best start in life, and not only continue till six months of age but also support it, along with complementary feeding up to two years of age.
In India, effective implementation of rec-ommended infant feeding practices is yet to be achieved. According to the estimates by the National Family Health Survey (NFHS 5), only 41 per cent children were breast-fed within the first one hour of birth – and, in rural areas, it’s only 40 per cent.
Despite widespread knowledge and a culture that breast-feeding is vital to supporting growth rates of babies, which is maximum in their first year of life, infant feeding practices (both breast-feeding and complementary feeding), which have a major role in determining the nutritional status of a child later in life, leave much to be desired in a rural context. Even though the best efforts of ASHA workers, NGOs and CSR bodies are slowly creating awareness, the challenge lies in reaching the last mile, where taboos and myths prevail.
As a country saddled with a heavy burden of malnutrition, this warrants our attention. Breast-feeding is the fundamental right of each and every child. Early initiation of breast-feeding within one hour and exclusive breast-feeding for first six months are identified as key interventions to achieve SDGs, related to child malnutrition and mortality respectively.
Breast-feeding & malnutrition: The link between infant feeding and malnutrition has been well-established. A recent UNICEF evidence reveals that malnutrition has been responsible, both directly and indirectly, for 60 per cent of deaths among under-five-year-old children, annually – with over two thirds of these, associated with inappropriate feeding practices that occurred dur-ing the first year of life.
Only 35 per cent of infants worldwide are exclusively breast-fed during the first four months of life and complementary feeding begins either too early, or too late, combined with foods that are often nutritionally inadequate and unsafe. Poor feeding practices in infancy and early childhood, resulting in malnutrition, contribute to impaired cognitive and social development, poor school performance, and reduced productivity in later life – and are, therefore, a major threat to social and economic development as they are among the most serious obstacles to attaining and maintain-ing the health of this important, vulnerable age group.
Rural realities, on ground: But, in a complex coun-try like India, breast-feeding in rural areas is all too often shaped by the beliefs of a community, which are further influenced by social, cultural, and economic factors. Most mothers in the vil-lages, driven by necessity to get back to agricul-tural or labour work, entrust their little ones to elderly in-laws or parents – interrupting the reg-ularity of breast-feeding and introducing comple-mentary feeding too soon. And, sometimes, the ratio of breast-feeding and complementary feeding is imbalanced even for children up to two years of age, which invites malnutrition. Worse still, some mothers who don’t have support systems at home or when work is at its peak, are forced to carry their infants to the fields where they work, exposing them to potential infections and some-times neglect.
So, with the dire need for family incomes, a lack of support or access to information and changing societal norms, breast-feeding can all too often take a back seat in a rural woman’s life, leading to a loss of the many advantages that breast milk offers infants.
Breast milk is a natural, nutrient-rich source of nourishment for newborns, tailored to meet their specific needs and development. It provides essen-tial vitamins, minerals, antibodies, and enzymes, bolstering their immune systems and protecting them against various illnesses. Breast-feeding is associated with a reduced risk of infections, aller-gies, asthma, and sudden infant death syndrome (SIDS), among other health benefits. Furthermore, the act of breast-feeding fosters a unique bond between mother and child, enhancing emotional connections and building a sense of security.
But, appropriate breast-feeding practices depend on accurate information and support from the family, community and healthcare system – sometimes difficult to find in rural India.
Antenatal & prenatal care: There is a need to spe-cifically target expectant and new mothers on a monthly basis during their antenatal care (ANC) and postnatal care (PNC) phases, specifically mak-ing them aware of the nutrition and care to be taken. These interventions can address common misconceptions and challenges faced by mothers and involves educating young couples about the essential ways of breast-feeding, proper breast-feeding techniques and the prevention of infec-tions and illnesses. By addressing misconceptions and providing essential knowledge, mothers can be empowered to provide their infants with the best possible start in life.
Some of the key initiatives needed include: Awareness & guidance: Make mothers aware of the importance of not skipping breast-feeding ses-sions and provide them with guidance on how to manage their work and childcare responsibilities effectively.
Training: During the last trimester, emphasise nip-ple care and its importance, with measures to be practised just a few days before delivery. Train women on how to extract breast milk and feed with spoon and vati, discouraging them from reverting to bottle-feeding. Additionally, train-ing on crawling methods is of high importance of early and exclusive breast-feeding. This helps mothers to be mentally prepared and ready after delivery.
Maternal benefit schemes: Mothers need to be intro-duced to maternal benefit schemes that offer incentives for important milestones like child-birth, child vaccination and reaching six months of age. This helps balance the loss of income and enables the purchase of essential nutrition supple-ments for the child.
Diarrhoea management: Referrals via ASHA to health centres in each block have enabled children diagnosed with diarrhoea receive treatment. The mother stays with the child during this period for proper and supportive treatment of the child. Home visits & support: Home visits are a must to monitor the child’s health and provide advice to secondary caretakers on proper childcare practices.
MAA programme: Recognising the need to encour-age young mothers to take breast-feeding seriously, the government has initiated the MAA (Mother’s Absolute Affection) programme, which aims to strengthen the bond between mother and child and intensely focus on promotion of breast-feed-ing. The MAA programme can be further strength-ened, with grassroots workers reaching out to pregnant & lactating mothers with the appropri-ate government-provided guidelines.
Through these interventions, NGOs, CSR bod-ies and civil society can make a significant impact in supporting new mothers and ensuring that their infants receive the essential nutrition they need for healthy growth and development. But, there is more work to be done. Despite much prog-ress, there is a continued need to focus on mater-nal and new born care, with a focus on promoting proper breast-feeding practices and infant nutri-tion. As so many other social issues vie for our attention these days, it is vital that we do not for-get the importance of this, given the crucial role it plays in ensuring quality health and nutrition for the next generation.