The Union Government should work on strengthening its Mothers Absolute Affection (MAA) programme, a unique initiative launched in 2016 in public, and mobilise the private sector hospitals to aspire to get accreditation for “Breastfeeding Friendly” health care, based on WHO’s ‘Ten Steps to Successful Breastfeeding’, says Dr. Arun Gupta.
The World Breastfeeding Week, marked during August 1-August 7 this year, has just passed us. Governments, non- government organisations and healthcare professionals have celebrated by organizing webinars and events to mobilize action in this regard. Providing education and necessary logistics’ support to mothers by catering to specific health requirements in the maternity care department was the theme for this year. Everyone had one question in mind; why the breastfeeding rate within an hour of birth in India was a dismal 41 per cent when nearly 90 per cent births are delivered in registered healthcare facilities.
To begin breastfeeding within an hour of birth is a public healthcare recommendation. The World Health Organisation, UNICEF and the Government of India have recommended this practice in order to improve the health of newly-born babies, reduce infant mortality, enhance mother-child bonding besides several other benefits for lactating mothers. Early breastfeeding helps achieve better results in the baby’s well-being during the first 2 years of life, and has been linked to reducing under- nutrition in children.
Early breastfeeding rate, which was 9 per cent in 1992, rose gradually to 41 per cent by year 2015. However, there has been no improvement in it over the last five years. This has been a constant source of worry for the Union Health Ministry, which during the first week of August this year, called a virtual meeting with experts for threadbare discussions on how to increase the rate of early breastfeeding in India.
Experts shared their views on how to better care and support for the mothers who have had caesarean deliveries as such cases are on the rise. They also have suggested measures for addressing low birth weight in babies and the unnecessary use of formula feeding in hospitals. Having worked in this domain over the last four decades, I also have some suggestions to offer, which I feel would help in improving the early and exclusive breastfeeding rate in the country. Let me first begin by differentiating the response in the public and the private sector hospitals.
Strengthening Action in Public Hospitals
I would like to first congratulate the Union Ministry of Health and Family Welfare, Government of India for having launched in year 2016 the Mothers Absolute Affection (MAA) programme, with an objective to improve breastfeeding practices in hospitals.
However, the Government has not yet evaluated the performance of the MAA programme since its inception. Review of the MAA programme is recommended to find answers to why there is no improvement in early breastfeeding rate over last five years.
If we want to progress quickly, the Ministry would need to strengthen the MAA programme by taking a string of measures. These include review of current training programme and the skill training of maternity healthcare staff on the basis of ‘Ten Steps to Successful Breastfeeding’, appointment of dedicated lactation support staff; monthly monitoring of the data on early breastfeeding within an hour of the birth, use of infant formula during hospital stay, and last but not the least, creation of governance structures, like a breastfeeding committee, comprising of 3-4 persons including nurses, pediatrician and obstetrician, under a nodal authority in all the maternity hospitals.
The committee may be mandated to review the data every month or on quarterly basis, with the objective of effecting necessary structural changes so as to provide requisite support to women before and after their delivery. This is an essential and non-negotiable step for making progress.
Further, to achieve sustainable success, the Union Government needs to consider a twin-pronged strategy that ensures recording of decisions on feeding of babies after taking the consent of mothers who wish to use infant formula at birth. Secondly, it should provide support to women during both vaginal and caesarean deliveries.
Why are these two steps necessary? A realtime mother Jincy Varghese from Mumbai put up a public petition “Stop feeding formula milk to newborns without the parent's consent #MyBabyMyDecision” five years back to show her discomfiture at the hospital’s decision to formula feed her baby without first taking her consent. More than 1,10,000 people have supported her petition.
Begin Action in the Private Sector Maternity Hospitals
Strategically, the Government of India should communicate and coordinate with private hospitals to fulfill the requirements of MAA programme in the maternity facilities as per WHO’s ‘Ten Steps to Successful Breastfeeding’. Private hospitals should in fact aspire get to their accreditation as “Breastfeeding-Friendly” institutions. Such a new initiative was launched in December last year with the objective of bringing a change in hospital practices.
Adoption of scientific measures and ushering in structural reforms in healthcare facilities is likely to deliver truly exciting results. Enabling every mother to begin breastfeeding within an hour of birth and to ensure direct skin-to-skin contact for the well-being of both the mother and the baby, is very much attainable. A mother who utilizes services of ‘Breastfeeding-Friendly’ accredited hospitals is more likely to be successful in breastfeeding her baby. This would also benefit the hospital by raising its popularity among public.
By working on these recommendations, the current statistics of early breastfeeding in hospitals can definitely be improved in India. The implementation of an action plan that seeks to attain at least 10 per cent growth in early breastfeeding rate each year in each hospital, and its monitoring at the highest government level would create favourable results for everyone.
(The writer is a paediatrician, Central Coordinator, Breastfeeding Promotion Network of India (BPNI) and Former Member PM’s Council on India’s Nutrition Challenges.)