World Breastfeeding Week: Doctors insist that a focus on educating communities on importance of exclusive breastfeeding is key.
Doctors insist there is a need to focus on educating mothers, communities, grandmothers, fathers on the importance of exclusive breastfeeding. (Wikimedia Commons)
It seems like lagging outreach efforts in rural Karnataka are hindering breastfeeding campaigns, as ASHA workers and medical officers reveal their struggles in reaching women effectively.
Startling statistics from the NFHS-5 survey highlight the disparity, showing a commendable 97 percent rate of institutional births in the state, but a dishearteningly low 49.1 percent of children under three years of age being breastfed within the critical first hour after birth.
Speaking to South First, one ASHA worker from North Karnataka, says, “Awareness on early breastfeeding practices is not enough. Despite several awareness campaigns and training insisted in hospitals, it is obviously not reaching many women.”
Speaking to South First, Dr Shalini VL, a physician who serves in Hassan district, says that several cultural beliefs continue to be formidable obstacles to early breastfeeding practices.
Several cultural belief continue to obstacles to early breastfeeding practices. (Wikimedia Commons)
“Despite proven benefits, cultural beliefs have become a hindrance to early breastfeeding initiation in the state. Despite continuous efforts from hospital staff, nurses, ASHA workers, and doctors, the deep-rooted beliefs and practices surrounding childbirth and child-rearing have been inadvertently hampering early breastfeeding practices,” Dr Shalini says.
According to her, one significant cultural belief is the notion that colostrum, the initial milk produced by mothers, is impure or harmful to the newborn.
“The colour of this milk is slightly yellowish/creamish, which the villagers think is pus and is bad for the baby. Hence, the practice of discarding colostrum — depriving infants of its rich nutrients and antibodies that protect against infections and diseases — is continuing even now,” she explains.
In many rural parts of Karnataka, even to this day, many cultures and communities feed honey and sugar water to infants as a practice as soon as the child is born.
“It is important to note that this practice is not recommended by health experts and paediatricians,” says Dr Devika Gunasheela, a gynaecologist and IVF expert at Gunasheela Hospitals in Bengaluru.
She adds, “Honey is dangerous for infants under the age of one year due to the risk of infant botulism, a rare but serious illness caused by a bacterium that can be present in honey.”
Donkeys are smuggled into Andhra Pradesh from Telangana, Maharashtra, Gujarat, and other states. (Creative Commons)
She says that despite warnings, even in private hospitals, family members get a gold ring dipped in honey or sugar water and feed the newborn even before breastfeeding.
Dr Shalini says that some communities follow the practice of naming the newborn immediately after birth. During this practice, honey is first fed to the baby and then they are named. It is only after this that the woman is allowed to feed the baby.
In some villages, feeding the newborn donkey’s milk is also still in practice. The belief is that this milk will help the child become intelligent in the future.
“Feeding anything other than breastmilk is not only unsafe, hygiene wise, but also deprives the child of nutrition,” says Dr Shalini.
Families refuse to listen to reason and stick to their harmful practices and beliefs. (Creative Commons)
Citing an incident that happened in one of the government hospitals in Hassan, Dr Shalini recalls a woman refusing to feed her baby within the first hour of birth. Despite coercion, she and her family insisted on waiting for a call from their village.
Dr Shalini says, “The staff there wondered what was happening and when the family was told the importance of feeding the mother’s first milk to the baby, they said that an old lady from the family had taken the first milk to the village where she would first feed it to ants, and only if the ants drink it and stay alive can the mother feed the baby.”
Such practices and beliefs are very strong within some communities and they refuse to listen to the staff, adds Dr Shalini. They are not aware that ants don’t drink milk. This shows that awareness on importance of breastfeeding is only confined to posters and pamphlets.
Focus on grandmothers, fathers in the community. (Wikimedia Commons)
“It must verbally reach every house in the village. ASHA workers and Anganwadi workers need to be trained on how to debunk the myths of these communities. These families need to be told about the consequences of not feeding the baby during the first hour after birth. Additionally, the benefits — not only for the baby but the mother too — should be explained well,” says Dr Shalini.
Doctors explain that pregnant women and their families, even during antenatal check-ups, must be told about the importance of breastfeeding for their babies and the new mother.
“It is important that government doctors and clinicians, ASHA workers, and Anganwadi workers develop programmes to educate fathers and grandmothers about the importance of breastfeeding, also strengthen programmes that provide mother-to-mother support and peer counselling programmes in hospitals and community healthcare settings,” says Dr Divya Jyoti NS, a gynaecologist and obstetrician from Bengaluru.
While doctors advocate for more awareness, the World Health Organisation (WHO) and UNICEF together introduced the Baby Friendly Hospital Initiative (BFHI) by outlining “Ten Steps to Successful Breastfeeding”. The primary aim of this initiative was to enhance breastfeeding practices in hospitals offering maternity services.
Hospital staff, ASHA workers, and Anganwadi workers play a major role in promoting exclusive breastfeeding. (Wikimedia Common)
In 2016, the Union Ministry of Health and Family Welfare launched the Mothers Absolute Affection (MAA) programme, dedicated to revitalising efforts to safeguard, promote, and support breastfeeding practices in public hospitals.
The Breastfeeding Promotion Network of India (BPNI), a national professional organisation working on protection, promotion, and support of breastfeeding for the last 31 years, partnered with WHO India — under the technical guidance of the Union government — to develop, test, and validate self-assessment and external assessment tools for the MAA programme.
This will assess how well a hospital is implementing the MAA programme or the Ten Steps initiative, and also validates and provides accreditation.
“However, the programme was to be tried only in private hospitals, along with the Association of Healthcare Providers — India (AHPI). However, over 100 hospitals from different states have expressed interest and 17 hospitals have already acquired accreditation. In Telangana, it was seen that some of the public hospitals also showed interest. Also, the accreditation and the tag of ‘Breastfeeding Friendly Hospital’ is gaining traction and is showing good results too,” claims Dr Arun Gupta, Founder and Central Coordinator, BPNI.
BPNI recently wrote a letter addressed to the Health Minister of Karnataka Dinesh Gundu Rao, proposing the breastfeeding-friendly accreditation of maternity hospitals to increase early breastfeeding rates in Karnataka.
The letter proposed a partnership with BPNI for public hospitals having maternity services.
“Data from NFHS-5 clearly shows that institutional births in South Indian states have gone up, but these same states still lag behind in early breastfeeding practices,” Dr Gupta tells South First.
Here are the numbers across the southern states:
Kerala: 66.7 percent: Early breastfeeding practices; 99.8 percent: Institutional births
Tamil Nadu: 60.2 percent: Early breastfeeding practices; 99.6 percent: Institutional births
Andhra Pradesh: 52 percent: Early breastfeeding practices; 96.5 percent: Institutional births
Telangana: 37.1 percent: Early breastfeeding practices; 97 percent: Institutional births
Karnataka: 49.1 percent: Early breastfeeding practices; 97 percent: Institutional births
Dr Gupta adds, “We even noticed the gap in breastfeeding within one hour in vaginal birth vs Cesarean section births is also very large. Once the hospitals sign up with BPNI, these aspects improve drastically as we ensure awareness at all levels.”
Meanwhile, Dr Shalini insists that while awareness about the importance of breastmilk should be passed on to breastfeeding women, they should also be taught how to feed the child.
Babies not fed through the night could become hypoglycaemic. (Creative Commons)
She says that it should be made mandatory that at least two to three feeds should be done in the hospital, in front of the staff, to assess if the mother has understood the positions of breastfeeding.
She also insists that they must be educated about the baby going into hypoglycaemia when not fed through the night, possibly leading to death.
“In many villages that I have worked, women, especially girls who become mothers at a young age, are tired from handling the child through the day. They dose off at night, without waking the baby to feed. Many babies do not cry. But this can lead to hypoglycaemia in the baby and they may even die. So feeding every two to three hours from both the breasts is important,” she says.
Dr Shalini adds that prolactin hormone, which helps in producing milk in the mother, is very active during the night. The more the baby suckles, the more the lactation increases in the mother.
Another aspect of breastfeeding that women are not taught is the importance of burping after feeding.
Burping is important after breastfeeding. (Creative Commons)
“Many times, in the morning, new mothers hand over the baby to elders in the family to be burped. But during the night, many don’t do that. This can lead to aspiration and the baby could die. If you look at the statistics of infant deaths, 30 percent of them would be due to milk aspiration,” she adds.
Doctors opine that ASHA and Anganwadi workers play a major role in training the new mothers. They insists that these workers, during their home visits, should speak about the importance of exclusive breastfeeding for the first six months. They should also ensure that they watch the new mothers feed to know if they are doing it right.
They also opine that the Village Health Sanitation & Nutrition Committee meets — that are attended by expecting mothers, pregnant women, and postpartum women — should be used as an opportunity to discuss the importance of breastfeeding and also feeding within the first hour of birth, irrespective of the type of birth (vaginal or C-section).
(World Breastfeeding Week is observed annually from 1-7 August and is supported by WHO, UNICEF, and many Ministries of Health and civil society partners.)
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