Poonam Devi, 22, mother of two, lives in Bargaon village, Muzaffarpur district, Bihar. Her first child, a girl who is now four, was fed tinned milk instead of breast milk when she was born, because the family believed that to be better. The child kept falling ill. When Poonam Devi was pregnant with her second child, she and her mother-in-law both joined a Self-Help Group (SHG) run by Jeevika. They learnt that a newborn should be breastfed within an hour of her or his birth, and be nursed exclusively on breast milk for the first six months. That is exactly what they did when the second child was born. He is a nine-month old healthy boy today.
Breast milk is more than just food – it is an elixir tailored to the infant’s growth and developmental needs. The infant needs this elixir exclusively for a full six months – which means she cannot be fed anything else, not even a drop of water.
Ostensibly, the only person who can ensure this for the child is the mother. But while she shoulders all the responsibility, she often does not have the authority to take the decisions. Think about it: She must consciously decide to exclusivelybreastfeed her infant at least 2,000 times in the six months (presuming an approximate 10-12 feeds a day).
So, at least 10 times in a day, the mother not only has to nurse her baby, but very likely resist the strong advice of family members, and perhaps mixed information from the wider community. And all this while attending to the rest of her responsibilities in the household. This is a heavy burden to place on the shoulders of a young mother.
In India, analysis of breastfeeding trends shows that, over the last decade, the percentage of infants (under six months of age) who were exclusively breastfed in India increased from 46.4% to 54.9%. The national average, however, conceals variability across states – the rate in Bihar, for instance, has gone up, but it has fallen in neighbouring Uttar Pradesh.
One of the ways to increase exclusive breastfeeding, and help reduce infant mortality, is to create an enabling environment for the mothers. It is essential to recognise the fact that breastfeeding is not only the mother’s responsibility. A combined effort is required from the family, the community, Anganwadi workers, Asha workers and the medical staff in government and private hospitals. In Poonam Devi’s case, it was the SHG didi’s advice that convinced her mother-in-law about exclusive breastfeeding, as well as about a complementary diet of lentils, rice, vegetables, rotis, and eggs after the sixth month.
In routine immunisation, any contact with the health system is used to access the immunisation status of the child and provide any vaccines that the child was due but was not given. A similar practice could be followed to deliver age appropriate messages related to nutrition in the first two years of a child’s life. These messages are relevant during the first 1,000 days – the first two years – of the child and should not remain limited to only Asha and Anganwadi workers but encompass local doctors, elected members, teachers, SHG members, etc.
There are a number of government initiatives in place to encourage breastfeeding. The health and family welfare ministry has the Mother’s Absolute Affection programme to create awareness among service providers and caregivers on the benefits of breastfeeding. Pradhan Mantri Matru Vandana Yojana implemented by the women and child development ministry is a conditional cash transfer scheme for pregnant and lactating women of 19 years of age or above for the first live birth.
This yojana aims to provide conditions for safe delivery and good nutrition and feeding practices. Likewise Poshan Abhiyaan was launched in March 2018 to reduce stunting, under-nutrition, anaemia among young children, women and adolescent girls and reduce low birth weight. All of these are excellent initiatives.
Taking a page from the battle fought and won against polio, and the momentum we see around routine immunisation, infant nutrition needs to become a jan andolan, with district-specific action plans and strong monitoring and supervision. Only with successful implementation can we ensure that future generations are healthy and productive.
The article is originally published in Times of India on Aug 4, 2018