People accept breastfeeding and its abundant benefits for mother-baby dyad, family, society, as well as the environment . Recent estimates suggest that optimal breastfeeding could prevent around 12% of child mortality under five years of age. But, initiation of breastfeeding within first hour of birth decreases neonatal deaths by 22%. An analysis in the United States found that if 90% of women breastfed exclusively for 6 months the country could save $13 billion in healthcare costs (Bartick et al, 2004).
|“If breastfeeding did not already exist, someone who invented it today would deserve a dual Nobel Prize in medicine and economics”. —Keith Hansen, the World Bank, The Lancet 2016|
Even then, globally, the rate of exclusive breastfeeding (EBF) is abysmal. The Global Breastfeeding Scorecard, which evaluated 194 nations, found that only 40% of children younger than 6 months are breastfed exclusively. According to POSHAN (Partnerships and Opportunities to Strengthen and Harmonize Actions for Nutrition in India, 2017), the proportion of infants in India, who were exclusively breastfed till 6 months, has increased from 46% to 55%. Prevalence of EBF ranges from 36% in Meghalaya, to 77% in Chhattisgarh. The disaggregated district-level data from the NFHS-4 highlighted that about one third of all the districts have EBF levels that are higher than 60 percent. Mandsaur in Madhya Pradesh has the highest rate with 95%.
Breastfeeding success is not the solitary responsibility of the mother. It also requires collective efforts from husband, family members, friends, health care practitioners (doctors, nurses, lactation consultants, nutritionists, etc) and society as a whole. Currently, a lot of efforts are being taken for implementation of various initiatives at the global and national level, to promote and support breastfeeding. The governing bodies are working towards strengthening current breastfeeding policies like the Baby friendly hospital initiative (BFHI), global strategy for Infant and young child feeding, International code of marketing of breast milk substitutes, etc.
Simultaneously, newer programmes are also being designed and implemented. Union Health Ministry of India in August 2016 has launched Mother’s Absolute Affection (MAA), a flagship program for enhancing optimal breastfeeding practices. A mobile application called ‘Stanpan Suraksha’ was also recently launched to keep a tab on the inappropriate promotion of baby food items.
As a lactation consultant with work experience of about ten years, I have inferred that majority of mothers genuinely wish to breastfeed. But, optimal milk production and successful breastfeeding is dependent on multiple factors.
Factors which positively affect breastfeeding rates:
- Mother’s education and awareness about the benefits of breastfeeding
- Support from the husband and extended family members
- Peer support
- Guidance from a lactation consultant
- Early initiation of breastfeeding
- General health status of the mother
- Mother’s self-confidence in her own ability to breastfeed
- Appropriate nutrition
Breastfeeding success is inversely proportional to:
- Myths regarding breastfeeding in the family
- Level of stress in the mothers
- Painful labour and delivery
- Problems with the breast like flat/inverted nipple, nipple soreness or cracks and engorgement.
Rate of Caesarean section is on the rise and often leads a hindrance in initiating breastfeeding early. Thus, mothers of preterm and sick babies who require NICU admissions find it difficult to establish breastfeeding if they do not receive correct guidance and training.
With modernization and western influence, over-dependence on artificial breast milk substitutes is increasing. More and more mothers are opting to pump breastmilk and bottle feeding their babies. Bottle feeding may also lead to breast refusal in babies, less frequent breastfeeding and increased stress in the mothers.
Worldwide approximately 60% of women of childbearing age are in the workforce. (ILO, 2007) Full-time employment of mothers outside their home causes negative influence on the duration of breastfeeding. The Maternity Benefit (Amendment) Act 2017 has increased the duration of paid maternity leave available for women employees from 12 weeks to 26 weeks. Research has also shown that such supportive state laws and lactation support from the employers correlate with higher rates.
Today we also have innumerable newer aids available in the market to support and facilitate breastfeeding.
There are variety of breast pumps for easy, convenient and painless milk expression, nipple formers and nipple shields for resolving issues of flat/inverted nipple and feeding/ nursing pillows to make the breastfeeding experience more comfortable. Cup feeders and other breastfeeding-friendly devices act as better substitutes for bottles. Special feeding equipment are also available for babies with special needs like cleft lip/ palate, preterm, low birth weight neonates and babies with chromosomal anomalies. After enough research, companies have introduced these products and these are boon for many mothers but they are also expensive. Additionally, it is mandatory to use them under the supervision and guidance of a lactation consultant for safety and optimal results.
Hospitals are now providing better lactation support with an increase in Baby-friendly hospitals. Additionally, more health care professionals are choosing to become Lactation Consultants. The slogan of World Breastfeeding Week (WBW) this year is “Breastfeeding: Foundation of Life”. In a world filled with inequality, crises, and poverty, breastfeeding is the foundation of lifelong good health for babies and mothers. Let us pledge to strengthen this foundation by coming together and contributing towards improving our country’s breastfeeding rates.