LACK OF FUND­ING FOR BREAST­FEED­ING SUP­PORT FAILS MOTH­ERS

The na­tion suf­fers.

Woman's Era - - Contents - Ramesh Ku­mar Raja

In­dia ranks 78 out of 97 na­tions when it comes to breast­feed­ing sup­port ser­vices.

About 15 mil­lion ba­bies out of 26 mil­lion born are not able to be­gin breast­feed­ing within one hour of birth even as 80% of women de­liver in health fa­cil­i­ties, says a new re­port that looks at poli­cies and pro­grammes to sup­port women. This is “putting them at higher risk of death and dis­ease and mak­ing them less likely to con­tinue breast­feed­ing,” say WHO and UNICEF.

The re­port ti­tled, Ar­rested De­vel­op­ment, the 5th Re­port of As­sess­ment of In­dia’s Pol­icy and Pro­grammes on Breast­feed­ing and In­fant and Young Child Feed­ing 2018 has been com­piled by a na­tional con­sor­tium of pub­lic health groups and agen­cies in­clud­ing govern­ment de­part­ments, AI­IMS and UNICEF, un­der the aegis of World Breast­feed­ing Trends ini­tia­tive (WBTI), and is based on con­sen­sus among sev­eral or­gan­i­sa­tions and feed­back from key pol­icy mak­ers of the Govern­ment of In­dia.

As per the WBTI, which pro­vides ob­jec­tive scor­ing, In­dia has scored 45 out of 100 on pol­icy and pro­grammes, ris­ing from 44 in 2015.

The re­port sug­gests weak as­sis­tance to women in re­mov­ing bar­ri­ers they face to op­ti­mally feed their ba­bies. This hap­pens in al­most ev­ery sec­tor con­cern­ing in­fant feed­ing in­clud­ing health, women and child, HIV, Na­tional Dis­as­ter Man­age­ment Author­ity (NDMA), Labour and re­lated oth­ers.

Out of 18.8 mil­lion women ex­clu­sively breast­feed­ing at less than two months, the num­bers nose­dive to 10.7 mil­lion at six months. Only 2 out of 5 ba­bies of 68 months be­gin with solid foods along with con­tin­ued breast­feed­ing, and only one out of 10 chil­dren 6-24 months old re­ceive the min­i­mum ac­cept­able diet

con­tain­ing a va­ri­ety from four food groups. The re­port finds that money spent on pro­tect­ing, pro­mot­ing and sup­port­ing breast­feed­ing is de­spair­ingly de­fi­cient than that rec­om­mended.

The Govern­ment of In­dia’s Na­tional Steer­ing Com­mit­tee on In­fant and Young Child Feed­ing in 2015 and 2017 de­cided in­ter alia to ap­point a lac­ta­tion/breast­feed­ing coun­sel­lor at all de­liv­ery points in the health fa­cil­i­ties; to ef­fec­tively en­force the IMS Act, and to reach out to all preg­nant women with in­for­ma­tion book­lets etc. Ac­cord­ing to Dr Vandana Prasad, “It is dis­ap­point­ing to see that the de­ci­sion is not backed by ac­tion and no sig­nif­i­cant fund­ing had been al­lo­cated. Sim­i­larly, PMVVY, the Govern­ment of In­dia’s scheme for im­prov­ing ma­ter­nal health and nu­tri­tion, could be quite use­ful if uni­ver­salised, for women who are strug­gling be­tween work and car­ing roles. How­ever, the in­equity in pro­vid­ing ma­ter­nity en­ti­tle­ments to women work­ing in the in­for­mal sec­tor con­tin­ues, with the re­cent amend­ments to the Ma­ter­nity Ben­e­fits Act, 2017 mak­ing no ar­range­ments for them.

MOTHER’S AB­SO­LUTE AF­FEC­TION

The MOHFW launched a pro­gramme, ‘Mother’s Ab­so­lute Af­fec­tion’ (MAA) that for the first time made an al­lo­ca­tion of Rs 4.5 lakh per dis­trict to pro­mote breast­feed­ing. That is only for health fa­cil­i­ties. In­dia falls short sig­nif­i­cantly in other ar­eas. The ICDS has not made any al­lo­ca­tion of money for this pur­pose, so are oth­ers like NACO or NDMA for en­sur­ing safer feed­ing. The re­port has coded three ar­eas in “Red” – i.e. na­tional co­or­di­na­tion and fund­ing, sup­port in health care sys­tem and in­fant feed­ing dur­ing emer­gen­cies. The Govern­ment of In­dia guide­lines on IYCF of MOWCD (2006) and MOHFW (2013) are not backed by ac­tion.

Says Dr Arun Gupta, “The crux is to put your money where your mouth is! The Govern­ment of In­dia will have to in­crease fund­ing for scal­ing up breast­feed­ing sup­port in­ter­ven­tions to reach all women. This money will be used to en­force the ex­ist­ing law to reg­u­late mar­ket­ing and pro­mo­tion of baby foods; to es­tab­lish skilled coun­selling and sup­port sys­tems in health fa­cil­i­ties, dur­ing dis­as­ters and in feed­ing sup­port in HIV sit­u­a­tions; es­tab­lish­ing men­tor­ing teams at block level and mother sup­port net­work at vil­lage level; ca­pac­ity build­ing; mon­i­tor­ing and eval­u­a­tion etc.”

As per the World Bank es­ti­mates, In­dia would need to spend about Rs 320 per child born, roughly Rs 1 crore per dis­trict per year. Spend­ing this much has the po­ten­tial to pre­vent 99,000 child deaths due to di­ar­rhoea and pneu­mo­nia each year. It is likely to im­pact the In­dian econ­omy too, by sav­ing In­dia US $7 bil­lion spent on health­care costs due to in­ap­pro­pri­ate/sub-op­ti­mal feed­ing, and an ad­di­tional US $7 bil­lion lost due to de­creased pro­duc­tiv­ity each year, says the re­port. This is equiv­a­lent to se­cur­ing 14 mis­sile shields for In­dia.

Other than health ben­e­fits to chil­dren, breast­feed­ing also re­duces the risk of breast and ovar­ian can­cer in the moth­ers and pro­tects the baby from risks of fu­ture obe­sity and di­a­betes in chil­dren. In spite of

THE GOVERN­MENT OF IN­DIA’S NA­TIONAL STEER­ING COM­MIT­TEE ON IN­FANT AND YOUNG CHILD FEED­ING IN 2015 AND 2017 DE­CIDED IN­TER ALIA TO AP­POINT A LAC­TA­TION/BREAST­FEED­ING COUN­SEL­LOR AT ALL DE­LIV­ERY POINTS IN THE HEALTH FA­CIL­I­TIES; TO EF­FEC­TIVELY EN­FORCE THE IMS ACT, AND TO REACH OUT TO ALL PREG­NANT WOMEN WITH IN­FOR­MA­TION BOOK­LETS.

these ben­e­fits, In­dia’s pol­icy and pro­grammes fail moth­ers, as the re­port sug­gests.

Women con­tinue to face bar­ri­ers such as per­cep­tions of 'not enough milk', breast con­di­tions like sore nip­ples, engorgement and mastitis, in­tro­duc­tion of in­fant for­mula, Caesarean sec­tion de­liv­ery, as lack of sup­port at work places. All these are com­mon rea­sons for women to give up breast­feed­ing.

ENGORGED BREASTS

Far­iha Mat­loob, a breast­feed­ing coun­sel­lor her­self and a mother of a nine-month-old child re­cently faced breast­feed­ing is­sues dur­ing her de­liv­ery at a pri­vate hos­pi­tal in east Delhi. While nar­rat­ing her story to BPNI, Mat­loob said, “Be­ing a knowl­edge­able and aware woman, I still failed in ex­clu­sively breast­feed­ing my child af­ter my Caesarean sec­tion be­cause I did not get the re­quired sup­port from the hos­pi­tal staff. I couldn't breast­feed my child on the sec­ond day that led to engorged breasts. This re­sulted in the in­tro­duc­tion of for­mula, some­thing I never imag­ined. If I had prac­ti­cal sup­port dur­ing that time this could have been pre­vented.”

The health fa­cil­i­ties and com­mu­nity plat­forms do not have skilled teams that could pre­vent or solve prob­lems women strug­gle with. A sur­vey of 1,000 moth­ers by the breast­feed­ing sup­port group for In­dian moth­ers in 2016 also found that in­fants of about half of them were in­tro­duced to for­mula at birth and 2/3rd moth­ers/fam­i­lies were not even con­sulted.

The re­port sug­gests that a team at block level to men­tor and train com­mu­nity work­ers can bridge the gaps, cit­ing an ex­am­ple of the Lal­it­pur pro­ject cater­ing to all fam­i­lies, where ex­tremely pos­i­tive re­sults be­gan fad­ing when fund­ing was cut af­ter 2012. Lal­it­pur dis­trict is still bet­ter than oth­ers in Ut­tar Pradesh.

Prof HPS Sachdev, a se­nior pae­di­a­tri­cian and clin­i­cal epi­demi­ol­o­gist who was a part of the as­sess­ment team, said, “It is dis­ap­point­ing that the 5th re­port is no dif­fer­ent from the pre­vi­ous four re­ports since 2005. This sug­gests lack of mis­sion­ary zeal and co­or­di­nated multi-sec­tor re­sponse, which could be fol­lowed by states.”

Many neigh­bour­ing coun­tries like Afghanistan, Bangladesh and Sri Lanka have moved ahead of In­dia (7th out of 8 SAARC na­tions) on pol­icy scores and in­creased breast­feed­ing rates. Bangladesh, with a pop­u­la­tion of 16 crore al­lo­cated 13 mil­lion dol­lars for a 5year-plan on in­fant and young child feed­ing re­cently. Scot­land, smaller than HP, has in­creased its fund­ing to 4.3 mil­lion pounds an­nu­ally. “What is hold­ing In­dia back,” asks Dr Gupta.

The re­port sug­gests that the prime min­ster holds the key to kick­start­ing a scheme to save ba­bies through pro­tec­tion, pro­mo­tion and sup­port of breast­feed­ing, ad­dress­ing all in­ter­ven­tions re­quired. On the oc­ca­sion of the re­lease of the 5th re­port, BPNI launched a cam­paign, “Breast­feed­ing – Nour­ish­ment For Life”, which is to muster vol­un­teers across In­dia who will of­fer ac­cu­rate in­for­ma­tion and emo­tional sup­port to breast­feed­ing women. We

WOMEN CON­TINUE TO FACE BAR­RI­ERS SUCH AS PER­CEP­TIONS OF 'NOT ENOUGH MILK', BREAST CON­DI­TIONS LIKE SORE NIP­PLES, ENGORGEMENT AND MASTITIS, IN­TRO­DUC­TION OF IN­FANT FOR­MULA, CAESAREAN SEC­TION DE­LIV­ERY, AS LACK OF SUP­PORT AT WORK PLACES. ALL THESE ARE COM­MON REA­SONS FOR WOMEN TO GIVE UP BREAST­FEED­ING.

Bless my mom. Mom is ev­ery­thing to me.

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