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TIME FOR A NATIONAL PROGRAM TO CURB DECLINING PRACTICE OF BREASTFEEDING

By Ramesh Raja
In Interview
September 14, 2015
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Who knows a child better than the mother? It is only she, who understands the predicament of her kid, right from the womb till the baby matures to be an adult. But nurturing a kid is not that easy. It begins with the most pertinent practice of ‘breastfeeding,’ which in fact, is a biological norm and also a true sustainable nectar providing exercise that almost all mothers have to go through on the planet. It’s a bond between a mother and child. Besides being a nutritional and preventive health package for infants, breastfeeding is also a very significant public health issue. Many parts of the world are still struggling with low rates of exclusive and continued breastfeeding. Women are not able to breastfeed successfully mainly because of lack of support from family and fast life, among many others. Also with modernization, the economic activity took over all priorities resulting in more and more women joining the workforce, which prevented them from breastfeeding.

Besides, baby food industry has created a huge market for the ‘infant formula’ and other baby foods as a substitute or complement to breastfeeding, using all sorts of persistent endorsement techniques to persuade parents. This led to the rise of formula feeding.

Breastfeeding Promotion Network of India (BPNI), a two decade old non-profit national organization works to reverse this unhealthy trend. Its aim is to protect, promote and support breastfeeding and appropriate complementary feeding of infants. Contributing through advocacy, social mobilization, information sharing, education, research, training and monitoring the companies compliance with the IMS Act, the organization is also the regional focal point in South Asia for the World Alliance for Breastfeeding Action (WABA) and regional coordinating office for International Baby Food Action Network (IBFAN), winner of the 1998 Right Livelihood Award (also known as the Alternative Nobel Prize). To discuss the novel work of the organization and its flagship campaign in India and abroad, Ramesh Kumar Raja talked to Dr Arun Gupta, the
co-founder of BPNI. A pediatrician by profession, Gupta gave up his lucrative private practice to promote the cause of breastfeeding. He also happens to be a member of Prime Minister’s Council of India’s Nutritional Challenges and Chairman of the global Breastfeeding Initiative for Child Survival (gBICS). Edited excerpts:

Dr Arun Gupta

Dr. Arun Gupta, Co-founder BPNI

The practice of breastfeeding seems to be on secular decline especially with the culture of women preferring office over child nursing. How do you look at this trend?

Work outside home is an increasing reality although women work at home all the time. It is the concept of caring society and recognition of the value of breastfeeding, which we are losing. Breastfeeding is protective for an infant’s health and development as 90 per cent of brain develops during the first two years. Breastfeeding provides the opportunity of bonding between mother and child apart from high nutritive value it has for brain development; formula industry is trying to make a copy of it. But formula feeding is associated with higher risk of disease among children and adults besides diabetes and obesity etc. Women must get all these information and guidance on breastfeeding such as exclusive breastfeeding for the first six months.

This is why every woman should get six months leave at least. Besides, work places should be breastfeeding-friendly with private rooms and crèches. Corporate sector is going to gain by this, as women who have their babies close to them will be more productive at work. Many IT corporates have announced maternity protection measures recently; more should follow. It is a long-term investment.

What is the importance of first breastfeeding after childbirth?

Beginning breastfeeding within one hour of childbirth is a global recommendation. It is because skin-to-skin contact during the first hour is so critical for emotional bonding as well as it initiates a good process of successful lactation. Over the first few days, thick milk called colostrums is rich in “live” cells and antibodies to protect the baby. Then, baby should receive exclusive breastfeeding for the first six months and timely and appropriate complementary feeding after six months along with continued breastfeeding till 2 years or beyond. Till six months breast milk is all that a baby needs. After six months baby needs some extra foods, home-made foods that family eats, slowly the quantity is increased to meet the growing demands of the baby.

In rural areas poor health is largely a common issue among the women, which in fact affects the biology of lactation. How can government help in this situation?

While it is critical that women’s health and nutrition be given utmost importance, the state of nutrition of mother is not related to lactation performance. Government of India has a crucial role to play here, not only to ensure food security for women but also to provide caring health workers to counsel mothers both in rural and urban areas, as lactation performance depends on two hormones, one ‘Prolactin’, which makes milk, and the other ‘Oxytocin’ that makes the milk flow from breast to the baby. Both are initiated by sucking of the baby, the key is sucking. Oxytocin flow depends on state of mind of the mother, it depresses if she is not confident, has pain, doubts, anxiety etc. What you need is “confidence building measure” rather than information shoots. For this, you need well-trained and caring health workers. This knowledge and skill is lacking. Currently, what we are doing is a bit of lip service, gains can rapidly fall off. It is this factor that calls for a special training of workers and government’s attention must be drawn to it.

How far is it fair to promote the ‘commercialization of baby food’ at a time when the child mortality rate refuses to die down?

It is not at all fair to promote

baby foods. In fact, there is a law in the country that bans all kind of promotion of baby foods, meant for children under the age of two. It also bans baby food industries’ sponsorship of conferences of doctors or any incentives for them. Companies continue to break the law. It is recognized that promotion of commercial baby foods actually undermines breastfeeding and cause morbidity and mortality. The government needs to be very strict in enforcing this law that was enacted in 1992.

What is the impact of breastfeeding on IQ and long-term health and development?

It is shown by scientific studies that higher the breastfeeding, better the IQ (intelligence quotient). Recent studies also reveal that it enhances the earning ability at 30 years. It is also known that Pneumonia and Diarrohea are more in children who are sub-optimally fed, means not exclusively breastfed for the first six months. WHO has analyzed that breastfeeding is effective in the long term in reducing obesity, diabetes and blood pressure.

Awareness level of breastfeeding is still not up to the mark. What should be done to improve it?

Government of India should run a national program with an objective to enhance rates of breastfeeding an infants, which have been static for 20 years. Each state should take this on a war-footing to put in place a “breastfeeding counselor” for a population of 5000. They should be women and be able to provide ‘one-to-one’ counseling. Additionally, adequate maternity leave, supportive work environments for day care, and crèches are essential. The government should earmark a “budget” for programs related to protection, promotion and support of breastfeeding and infant feeding. Above all, strict enforcement of the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 is critical.

Is there a governance issue linked to breastfeeding?

Yes, there is clearly one. According to a recent assessment of India’s policy and programs done by us, there is no policy, no plan of action and no budget attached to it. Government of India has a National Breastfeeding Committee but it rests on the website of Government of India. If this begins working, things can change. This committee can coordinate multi-sector actions which are required in all states. Several policy areas such as maternity protection, enforcing the law to protect breastfeeding from aggressive promotion of baby foods, health system support to women, and breastfeeding during disasters etc. in need of urgent attention. Breastfeeding rates can go up only if we invest in multiple policies and programs; we have to make a beginning from somewhere.

Could you share with our readers how BPNI is associated with the cause of breastfeeding and its achievements?

We are involved in advocacy of better policies and imparting skill training to health workers. The major achievements are the IMS Act in 1992 and Amendment Act 2003, as well as Cable TV Regulation Act banning promotion of baby foods, bottles etc. The Mid Term Assessment of 11th Five Year Plan recognized this gap and we hope that the 12th Five Year Plan would address this issue. BPNI is consulted in many child health and nutrition committees of Government of India. BPNI carries out an India assessment of policy and programs every three years using World Breastfeeding Trends Initiative (WBTI) tools in line with Global Strategy for Infant and young child feeding. BPNI has developed a skill-training program for health workers that combines all kinds of skills required for breastfeeding counselling or growth monitoring.

BPNI monitors the law enacted for regulating the marketing of baby foods. BPNI advocates for sustainable solutions to child malnutrition through comprehensive food based approaches, not through market product based ad hoc solutions. BPNI has clear ethical policy on conflict of interest for its own funding and does not accept funds from companies manufacturing baby foods, feeding bottles etc. and from organizations/industry having conflict of interest.  BPNI raises conflict of interest concerns in policy and programs at all levels.