LACK OF FUNDING FOR BREASTFEEDING SUPPORT FAILS MOTHERS
The nation suffers.
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.
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.