The world’s fastest growing economy that ranks 131 on the Human Development Index may witness a million child deaths this year, mostly due to preventable causes. Over 10 million children who survive every year will have stunted growth and development that will cripple their human potential and diminish their economic productivity for the rest of their lives. It is impossible to give wings to the rising aspirations of a nation without breaking the shackles of this vicious intergenerational cycle. A remarkably simple, non-discriminatory, ubiquitously available, zero-tech intervention holds the key. It is called breastfeeding
We are a nation with deep aspirations drawn both from our civilisational heritage and our contemporary desire to be respected as an emerging superpower on the global stage. Growing economic stature, unprecedented IT prowess and breakthroughs in space explorations have fuelled our ambition. They have also propagated a false assurance that technological advancements alone can leapfrog a country of 1.4 billion people into the elite club of developed nations while circumventing foundational investments in nurturing its human potential. It is an exercise in self-deception and imperils the present and future generations.
The world’s fastest growing economy that ranks 131 on the Human Development Index may witness a million child deaths this year, mostly due to preventable causes. Over 10 million children who survive every year will have stunted growth and development that will cripple their human potential and diminish their economic productivity for the rest of their lives. The population that we refer to as our current demographic dividend in all likelihood suffered similar insults two decades ago as those children have grown into adults with diminished capabilities, albeit elevated aspirations. There is a high likelihood that they will also give birth to stunted children — perpetuating a vicious cycle of poverty, poor brain development and low economic productivity.
It is impossible to give wings to the rising aspirations of a nation without breaking the shackles of this vicious intergenerational cycle. A remarkably simple, non-discriminatory, ubiquitously available, zero-tech intervention holds the key. It is called breastfeeding. Breastfeeding is the single most powerful intervention with the largest impact on child mortality and plays a critical role in fostering healthy brain development.
Breast milk is not just an excellent source of nutrition customised for babies’ needs, it protects them from life-threatening illnesses like diarrhoea and pneumonia, and importantly fosters a nurturing relationship between the mother and the baby that scaffolds healthy brain development. For mothers, it also reduces their risk of acquiring breast and ovarian cancers. Universalising adoption of adequate breastfeeding will reduce child deaths by a fifth, raise our collective cognitive potential by 30 million IQ points, and add Rs 1 trillion every year to the economy.
Breastfeeding holds the key to nurturing a smart nation. Yet, despite four decades of relentless campaigns, less than half of our babies are initiated to breastfeeding within the critical first hour of birth. In States such as UP, this number drops to a quarter. So what makes this simple intervention so challenging to deliver? At the heart of the problem are deeply entrenched cultural norms that are not amenable to change through existing breastfeeding promotion strategies.
A behaviour change intervention study that we conducted in Shivgarh, UP, and published in the Lancet in 2008 recorded a five-fold increase in early initiation of breastfeeding from 15 per cent to 70 per cent, near universal adoption of Kangaroo Care and unprecedented reduction in newborn mortality by 54 per cent within just 16 months. There were several drivers of behaviour change that provide valuable insights to inform breastfeeding promotion programmes.
Existing behaviour change strategies are based on information-centric and unidirectional communication messages typically designed by experts with a mental model that is blind to existing cultural norms and their underlying beliefs, completely rejecting them as superstition. These are consequently met with a rejection and silent rebellion by communities who are steadfast in their trust in the effectiveness of age-old traditions. The neuroscience of behaviour change warns us that directly attacking deeply-held beliefs is the most effective way of reinforcing them. We, therefore, introduced Kangaroo Care — a novel behaviour that did not compete with existing cultural beliefs. It provided an alternate pathway for early initiation of breastfeeding by bringing the mother and the newborn in close physical contact and experience tangible, almost miraculous benefits such as spontaneous milk let-down, dispelling a deeply held myth that lactation only begins on the third day of birth.
Further, we found that interactions that lead to behaviour change need to have four essential components: desirability, believability, learnability and do-ability. Desirability is about appealing to the heart, kindling an emotional response that provides the motivational impetus for change. Believability is about providing evidence of benefit that aligns with their rational framework of cause and effect. Learnability is about packaging new knowledge into bite-sized capsules of digestible information, for example through use of analogies and storytelling in a culture where knowledge has traditionally been transmitted through an oral tradition. Do-ability is about building the skills, capabilities and support systems for the desired change to fructify.
Finally, we need to recognise, appreciate and respect the pivotal role of mothers in nurturing India into a smart nation. Their deep commitment to the wellbeing of their newborns can neither be challenged nor surpassed. We need to radically shift our view of them from being passive beneficiaries of Government schemes to the most effective providers of health and nourishment for their children and our future. Therefore they need to be engaged not as end users but as partners — “bhaagidaars” for the nation to maximise its human possibilities.
(The writers are global health researchers and founders of Community Empowerment Lab)