Ten out of 19 states and union territories surveyed as part of the National Family Health Survey-5 (2019-20) of the Union ministry of health and family welfare show a decline in the percentage of under-3 rural kids breastfed within one hour of their birth.
Rural Sikkim tops this list and has recorded the highest decline in the percentage of such babies. From 68.9 per cent in the National Family Health Survey-4 (NFHS) of 2015-16, the figure of under-3 rural kids breastfed within one hour of their birth has dropped by half to 33.1 per cent in 2019-20. In the same period, between 2015-16 and 2019-20, rural Mizoram has also registered a decline in such kids from 73.9 per cent to 58.6 per cent.
Other states that have recorded a drop in under-3 rural kids breastfed within one hour of their birth include Assam, Karnataka, Tripura, Goa, Gujarat, etc.
Meanwhile, at 30.5 per cent, rural Bihar has the lowest percentage of under-3 kids breastfed within an hour of their birth. This means every seventh child born in rural Bihar is not breastfed within an hour of her/his birth.
“Nobody cares about early breastfeeding. We have around seventy six per cent institutional deliveries in Bihar. Still, early breastfeeding is a missed opportunity,” Neelmani, who works with Social Action Research Centre, a non-profit working on health and welfare of women in Bihar, told Gaon Connection.
Whereas a large number of states have reported a decline in breastfeeding within one hour of the birth, some states have also registered a progress. From 61.3 per cent in 2015-16, under-3 rural kids breastfed within one hour of their birth has increased to 79.9 per cent in 2019-20 in Meghalaya. In the same period, such cases have increased from 46.6 per cent to 55.9 per cent in Jammu & Kashmir.
The World Health Organization (WHO) recommends all mothers should be supported to initiate breastfeeding as soon as possible after birth, within the first hour after delivery. Provision of mother’s breast milk to infants within one hour of birth is referred to as “early initiation of breastfeeding” and ensures that the infant receives the colostrum, or “first milk”, which is rich in protective factors.
A 2009 report of the WHO, Infant and Young Child Feeding, point out that infants who are not breastfed are six to 10 times more likely to die in the first months of life than infants who are breastfed. Diarrhoea and pneumonia are more common and more severe in children who are artificially fed, and are responsible for many of these deaths.
Rising number of rural kids not being breastfed within an hour of their birth is a matter of grave concern as 35 per cent under-5 kids in rural India are stunted, 33 per cent under-5 kids are underweight, and 17 per cent are wasted.
According to Rupal Dalal, a Mumbai -based paediatrician, apart from preventing infants from infectious diseases and reducing neonatal mortality there are other impacts of colostrum or the first milk. “When you breastfeed a child within an hour, the child will have its first stool right away. Babies who don’t pass their stool in a day or two are at a high risk of developing severe physiologic jaundice,” she told Gaon Connection.
Health experts believe rural women lack awareness around the importance of breastfeeding her new-born within an hour of birth. “Lack of awareness among rural women about breastfeeding is a big issue. They should be informed about the importance of early breastfeeding before they become mothers,” Santanu Bag, a Kolkata-based paediatrician consultant told Gaon Connection.
Can rising C-sec deliveries be blamed?
The recent National Family Health Survey-5 (2019-20) has also recorded a jump in Caesarean section (C-sec) births in rural India. Telangana tops the list with over 58 per cent rural births in the state (both public and private facilities) as C-sec deliveries. Meanwhile, 84 per cent of deliveries in West Bengal’s private rural facilities are C-sec.
According to public health experts, the type of delivery also affects breastfeeding within an hour of the childbirth.
A 2019 study, ‘National and rural-urban prevalence and determinants of early initiation of breastfeeding in India’, published in BMC Public Health, found only 41.5 per cent of Indian mothers initiated breastfeeding within one hour post-birth. “Birthing through caesarean, receiving delivery assistance from non-health professionals and residing in rural areas of the Central region were associated with delayed EIBF [early initiation of breast feeding] in all populations,” reads the study.
“Type of the delivery also affects early initiation of breastfeeding. If a woman undergoes Caesarean delivery, she needs additional support to breastfeed her child as she cannot sit at that time,” said Bag.
Dalal informed that during labour pains and a vaginal delivery, the pregnant woman’s hormones change. “This is when you start lactating. But in C-section, which takes around ten minutes in case of emergency, a mother does not go through that process which boosts lactation,” she told Gaon Connection.
“Doctors feel that as the new mother is on anaesthesia and other medication, she will not be able to produce milk and they start formula feeding the newborn,” she added.
Take the case of 24-year-old Asiya Ishfaq Mir, a resident of Pahroo village in Budgam district of Jammu and Kashmir. When she visited a private health facility, she was suggested a C-sec delivery. “When I went to a private hospital, I was asked to get operated. But I refused. I finally went to a government hospital, didn’t undergo any complications, and had normal delivery,” Mir told Gaon Connection, who became a mother last month. “I was also able to feed my baby within an hour after my delivery,” she added.
According to Dalal, there is a lot of influence of companies who manufacture and sell infant milk substitutes, commonly known as formula milk. Although India has a law to address the issue, the problem remains. The Infant Milk Substitute Act, 1992, prohibits any food being marketed or otherwise represented as a partial or total replacement for mother’s milk, or employs directly or indirectly any method of encouraging any person to purchase or use infant milk substitute, feeding bottle or infant food.
“We have a breastfeeding promotion network in India, which has been asking the government to ensure each and every hospital in urban and rural India should protect babies from infant milk substitutes. But not a single hospital has done this,” lamented Dalal.
“If you visit primary health centres, and district hospitals in Bihar, you will see most of the families come prepared with pre-lacteal, such as cow milk, to feed children. Almost all staff in the labour room are trained but still they do not sensitise women or promote breastfeeding,” said Neelmani.
According to him, apart from the healthcare staff, father and other members of the families should promote breastfeeding within an hour of birth in the labour room. “We focus on mothers, the target groups, but we also need to focus on secondary groups, such as the mother-in-law and father of the baby. They should ask service providers to promote breastfeeding. Regular nudging of labour staff is required,” he said.
Between 2015-16 and 2019-20, West Bengal saw an improvement in under-3 rural kids breastfed within one hour of their birth. The percentage has increased from 47.1 per cent to 59 per cent. But Bag believes 59 per cent is not a very good figure.
Besides C-section, another reason why rural women fail to breastfeed new-borns is their inability to produce milk even when they undergo vaginal delivery. In such a case, the role of ASHA (accredited social health activist) workers and ANMs (auxiliary nurse midwife) becomes significant.
“Generally, women produce almost thrice the quantity of milk a child could even consume. But there are some cases where women say they are not able to produce milk,” Preeti Singh, an ANM based in Lucknow, Uttar Pradesh, told Gaon Connection. “We teach the young mother how to breastfeed new-borns in the labour room so that there is no delay in feeding the baby,” she added.
“Rural women fear that their body will disfigure because of breastfeeding. Many times they do not breastfeed because of this fear. But that is not the case. Breastfeeding has several health benefits for mothers too,” informed Neelmani.
The WHO’s 2009 report shows breastfeeding has both short and long-term benefits for the mother as well. The risk of postpartum haemorrhage may be reduced by breastfeeding immediately after delivery, and there is increasing evidence that the risk of breast and ovarian cancer is less among women who breastfed.
