Friday, February 28th, 2020

Breastfeeding : The Health Promoting and Life Saving Approach

img2014080101{ Written By - : Dr Santosh Jain Passi , Dr Vandana Sabharwal and Ms Akanksha Jain } For proper growth and development, every child needs to be provided adequate nutrition, proper care, love and affection, particularly during the early years of life. Breastfeeding lays the foundation for his/her healthy life not only during infancy/childhood, but during the later years too. Till six months of age, the baby needs just mother’s milk and nothing else; only the tonics or the medical supplements can be given to the child, as per the requirement. For the first six months of life, mother’s milk provides the infant with all the nutrients that are needed for his/her optimal growth and development. Therefore, the infant should beexclusively breastfed during the first six months i.e. the baby should be fed only the mother’s milk and nothing else, not even water. Apart from nutrition, another valuable contribution of exclusive breastfeeding is that it fosters constant positive interaction between the mother and the child which helps in the emotional and psychological development of the infant with a direct positive impact on his/her brain development. While breastfeeding boosts physical and mental growth of an infant; after the age of six months, feeding the child with adequate and safe complementary foods becomes necessary, so as to bridge the gap between the nutritional needs of the child and the nutrients provided through the breast-milk. Thus, early/timely initiation of breastfeeding and exclusive breastfeeding for the first six months coupled with complementary feeding (after the age of six months) along with continued breastfeeding are the cornerstones of child’s proper growth and development. If the children are healthy, the nation is healthy and this in turn results in improved productivity and economic growth of the country. Breastfeeding is a natural and cost-effective method of feeding the neonates, infants and toddlers. Compared to artificial/top feeding, breastfeeding is affordable and does not even disturb the household budget. Breastfeeding enhances mental development, promotes learning and, thus, helps in facilitating universal primary education. It can give every child a fair start in life, ruling out gender inequality. It reduces the chances of child mortality in the first year of life by nearly 13 percent. It also reduces the risk of next pregnancy; and thus, helps in increasing the inter-pregnancy interval (child spacing). The chances of HIV transmission from the infected mother to the child are lowered if the child is given just the breast-milk during the first six months of life. Breastfeeding helps in lowering the production of pharmaceutical, plastic and aluminum wastes and thus, ensures environmental sustainability. It also promotes community partnership by bringing people from different areas, disciplines, expertise and experiences to work towards the common goal. Globally, out of the 135 million babies born every year, 60 per cent do not receive optimal breastfeeding; and the price paid for suboptimal breastfeeding is massive. Apart from economics, suboptimal breastfeeding is associated with increased risk of infant/child mortality as well as infections and diseases affecting the psycho-social milieu of the community. On the other hand, in case of individuals who receive breast milk and are exclusive breastfed during the first six months of life, the odds of developing non communicable diseases like diabetes, cardio-vascular diseases, hypertension etc. are far lesser as compared to those who do not receive the breast milk or are not exclusively breast fed for the first six months of life. And, these dividends of optimal breastfeeding are conferred to the individuals even after the child grows i.e. during their middle age/old age. What a coincidence, breastfeeding and complementary feeding are linked to all the eight Millennium Development Goals (MDGs) which were set more than two decades back (1990) by the various governments and the United Nations for fighting poverty as well as for promoting sustainable development by 2015. Therefore, by protecting, promoting and supporting breastfeeding, each of us can contribute to the MDGs in a substantial way by ensuring good health of our children and, thus, an overall development of our nation. However, translating knowledge regarding appropriate breastfeeding and complementary feeding practices into adoption of these practices requires behavioural change among the mothers, their spouses, other family members particularly the mothers-in-law and thus, the community as a whole. Further, inculcating optimal breastfeeding and complementary feeding practices requires building up the mother’s confidence so that she can successfully breastfeed her baby. In addition, it is important that an enabling environment is created for the mother through a suitable back up support from the father/other family members, improved working conditions, as well as decreasing her household responsibilities, so that the nursing mother can devote enough time towards the breastfeeding activity. In case the mother suffers from breast-milk insufficiency or she is not able to breastfeed the baby properly, then she should seek counseling from medical practitioners/peers, so that lactation failure does not occur and rather the process is re-established at its full swing. In case of working mothers, adequate maternity benefits and unhindered grant of extended leave (as and when required) is rather important. In this regard, government’s initiative of child-care leave is an excellent move; however, the beneficiaries should use this facility judiciously. No doubt, breastfeeding rates are not up to the mark among the rural/urban poor mothers whose vulnerability is associated with poverty, ignorance, and social discrimination and gender inequalities. The likelihood of breastfeeding cessation or sub-optimal breastfeeding practices is even greater in mothers who are literate, working outside home and fall under high/extremely high wealth categories. The set of problems are, however, different for the affluent elite society. Most of the mothers intentionally discontinue exclusive breastfeeding earlier than six months because they feel that prolonged breastfeeding could adversely affect their own health as well as  they would have to remain  bound to their child. Many of these mothers also have the apprehensions that they are not able to produce enough milk for their baby. This perceived breast-milk insufficiency leads to an early introduction of milk supplements/ breast-milk substitutes; thereby changing the maternal role and infant care patterns. All this happens due to the complexities of fast moving modern life rather than insufficient breast milk production in reality. Researchers throughout the world have proved that majority of the mothers are able to produce enough milk for their baby and the feeling of not-enough milk is often triggered due to numerous reasons like partial breastfeeding from one breast, improper positioning of the baby at the breast, dryness of the nipples or long gaps between two breastfeeding episodes. Moreover, the parents/mothers get wrongly influenced by the fancy advertisements of commercially produced infant milks/ infant foods and their dependency on breast milk substitutes increases at the cost of breastfeeding. The preference for these commercial infant formulae is sometimes driven by the doctor’s endorsements too, as some of them continue to recommend these foods claiming that the commercial infant milks/foods would be able to provide better nutrition to their baby. Additionally, the changing lifestyles and an increasing number of working mothers who want to succeed in their profession, impulsively push them to look for convenient infant feeding options. Here is a note of caution for the educated elite! Remember…… adopting optimal breastfeeding and complementary feeding is an investment in your child’s nutritional well-being, physical growth as well as psychological, cognitive emotional and social development; and thus, his/her holistic personality development for the lifetime. The mothers need to be highly motivated to sustain optimal infant feeding practices. Minor day-to-day problems like breast milk insufficiency, busy work schedules need to be resolved through innovative strategies which can be implemented as per the need. In addition, adequate support from the father and the other family members is very important. Psychological and social well-being of the mother as well as adequate mother-child interaction has a great impact on lactational performance of the mother. Therefore, it is imperative that the mother is provided the right kind of environment, particularly tension-free atmosphere, so that she can successfully breastfeed the baby. The commercially publicized practices should not be followed blindly; the choices need to be made only after proper understanding of the implications. Only in unavoidable circumstances, the drastic action like shift from breastfeeding to replacement feeding can be taken, when there is no other choice; elsewise, breastfeeding should be the best approach. There is no one magic bullet that can resolve all the breastfeeding related issues/problems. Let us make our best efforts to foster a society where all women are able to breastfeed their babies; and all babies can have access to adequate quantities of human milk…… Timely initiation of breastfeeding, exclusively breastfeeding till six months; and thereafter complementary feeding coupled with continued breastfeeding till two years or beyond can protect children from a number of infections and diseases like diarrhoea, dysentery and pneumonia as well as reduce the risk of mortality!!! ******* * Dr Santosh Jain Passi, Former  Director, Institute of Home Economics (University of Delhi) ** Dr Vandana Sabharwal, Assistant Professor, Institute of Home Economics (University of Delhi) ***Ms Akanksha Jain, Research Associate - PHN, LSTech Ventures Pvt. Ltd (Gurgaon)



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