- Early initiation of breastfeeding has declined in 12 of 22 states: NFHS-5
- Exclusive breastfeeding has improved in 16 states and UTs, as per NFHS-5
- COVID-19 has made a dent in health and nutrition outcomes: Expert
New Delhi: Breastfeeding, also known as nursing, is the way of providing young infants with the essential nutrients required for their growth and development. WHO (World Health Organization) recommends initiating breastfeeding within the first hour of the birth of a child. However, the key findings of the fifth round of the National Family Health Survey (NFHS-5) conducted in 2019-20 for 22 states and Union Territories (UTs) included in phase-1 of the survey show a worrying trend in child feeding practices. A significant decline has been reported in children under three years of age who are breastfed within one hour of birth. NFHS-5 data shows that among the children surveyed, breastfeeding in the first hour of birth had shown a downward trend in 12 states and UTs out of 22. On World Breastfeeding Week (WBW) 2021 that aims to protect breastfeeding, NDTV speaks to Mini Varghese, Country Director, Nutrition International in India to understand the status of breastfeeding in India and ways to overcome the disruption of programmes and health services due to COVID-19.
The Impact Of COVID-19 On Health And Nutrition
Explaining the impact of COVID-19, Ms Varghese said,
It is an established fact that good nutrition is fundamental for a healthy and productive nation and its people. Despite this understanding, nutrition has been under-prioritised for a very long time. The COVID-19 crisis that started in early 2020 has made a dent in the health and nutrition outcomes that India was aiming to achieve, unwinding the hard-won development gains made over the past decade. The fear of COVID-19 infection coupled with disruption in health services and reduced purchasing power and supply chains disruption has been impacting the overall nutrition aspects of children and women especially.
Ms Varghese further says that the essential health services have been disrupted because of the closure of schools, village health and nutrition days and Anganwadi centers. There has been a decline in uptake for health services such as antenatal check-ups, institutional deliveries and counselling of pregnant women and weighing of children, she adds.
The Importance Of Early Initiation Of Breastfeeding
NFHS-5 data reflects that while there has been an improvement in institutional deliveries, early initiation of breastfeeding has fallen drastically. Among 22 states and UTs, Sikkim has reported the sharpest decline of 33.5 per cent in initiating breastfeeding within an hour of birth. Ms Varghese believes that there is a clear failure of enacting the recommended best practices. WHO (World Health Organization) recommends initiating breastfeeding within the first hour of the birth of a child.
Breastfeeding provides the ideal nutrition for optimal growth and development. It also has a protective impact on diseases including SARS-CoV-2. For mothers, it improves birth spacing, helps the uterus return to its pre-pregnancy size. Breastfeeding lowers the risk of certain cancers, including breast and ovarian and may reduce the risk of heart attack and stroke even long after giving birth. Therefore, it is important for us to promote breastfeeding within one hour in the institutional setting both in public and private. The first hour of the newborn should be considered as the golden hour to making sure that essential newborn care services including breastfeeding are provided to the babies, says Ms Varghese.
How To Protect And Promote Breastfeeding
WHO also recommends exclusive breastfeeding for the first six months after birth. The NFHS-5 data shows improvement in exclusive breastfeeding with 16 states and UTs reporting a rise. To further promote early initiation of breastfeeding, and exclusive breastfeeding for up to months, Ms Varghese suggests practising inclusion of a birth companion for the woman in the labour room, coupled with the ‘zero separation’ policy − which mandates the newborn to be put between the breast immediately after birth.
There is sufficient evidence to showcase that when breastfeeding is initiated within the institution and supported by the health care workers, there is a high likelihood of continuation of breastfeeding even at the home setting when they have been discharged from the health facility. The other thing to look into is the separation of low-birth weight or premature babies because of the special care that they require into the newborn intensive care units (NICU). While we focus on the survival of these babies it is also limiting the chances of breastfeeding. There are evidence on restructuring NICU as M-NICU (maternal and neonatal intensive care unit) to provide skin to skin contact and Kangaroo mother care services at the earliest to babies who need the most, says Ms Varghese.
To be able to continue exclusive breastfeeding beyond the four walls of the labour room, Ms Varghese highlights the need for an enabling environment and the support from the community and the family. To promote the same, she suggests two key interventions; first, counselling of pregnant women on the importance of breastfeeding.
This needs to be established in the antenatal care clinics so that they have adequate information to practice and they’re mentally prepared for that. Second, we need to capacitate the labour room staff to practice what they have learned and the other aspect is, retaining the trained staff within the labour room which is a challenge often in these health facilities, says Ms Varghese.
The expert is of the opinion that often healthcare workers fail to practice the learnings because there is no monitoring or they have not been adequately supported. Hence, it’s important to focus on them as well to improve overall services and essential newborn care including breastfeeding in our facilities.
Children are the future of the country and we must invest adequately to ensure that firm ground is there for their growth and development. Nutrition is fundamental. Nutrition is the foundation, and it cannot wait, says Ms Varghese.
NDTV – Dettol Banega Swasth India campaign is an extension of the five-year-old Banega Swachh India initiative helmed by Campaign Ambassador Amitabh Bachchan. It aims to spread awareness about critical health issues facing the country. In wake of the current COVID-19 pandemic, the need for WASH (Water, Sanitation and Hygiene) is reaffirmed as handwashing is one of the ways to prevent Coronavirus infection and other diseases. The campaign highlights the importance of nutrition and healthcare for women and children to prevent maternal and child mortality, fight malnutrition, stunting, wasting, anaemia and disease prevention through vaccines. Importance of programmes like Public Distribution System (PDS), Mid-day Meal Scheme, POSHAN Abhiyan and the role of Aganwadis and ASHA workers are also covered. Only a Swachh or clean India where toilets are used and open defecation free (ODF) status achieved as part of the Swachh Bharat Abhiyan launched by Prime Minister Narendra Modi in 2014, can eradicate diseases like diahorrea and become a Swasth or healthy India. The campaign will continue to cover issues like air pollution, waste management, plastic ban, manual scavenging and sanitation workers and menstrual hygiene.