World Breastfeeding Week: As organisations work to improve better practices, formula administration remains a challenge

For 31-year-old Jincy Varghese, the delivery of her child was supposed to bring her joy, but fate had other ideas.

In a piece written in the Indian Express, Varghese, a resident of Panvel on the outskirts of Mumbai said that she developed gestational diabetes during pregnancy and as soon as her child was born, he was taken away to the Neonatal Intensive Care Unit of the hospital, where he was immediately administered formula instead of breastmilk.

Varghese has since written a petition in Change.org where she has written to Maharashtra CM Devendra Fadnavis to pass a law where private hospitals get the consent of the mother before feeding a new-born with formula.

Last month, the Delhi High Court sought the stand of the Centre, the Delhi government, and civic authorities on providing facilities that allowed mothers to breastfeed in public places. As World Breastfeeding Week ends today (August 7), the lack of public spaces in India for mothers to feed a new-born is still a societal issue that needs serious looking into.

Recently, Malayali women’s magazine Grihalakshmi was criticised after it depicted a model on its cover, breastfeeding a baby.

Societal pressure clubbed with money pumped in to increase formula consumption are the biggest challenges advocates of breastfeeding face across the world.

WHO and UNICEF had partnered to study breastfeeding patterns across the world. It was revealed that in India, the lack of breastfeeding has resulted in annual economic loss of $14billion due to child deaths and cognitive losses caused from poor practices. Globally, the 823 000 child deaths, 20 000 maternal deaths, and $302 billion in economic losses each year are stark reminders of the current reality. All of these, and more, could be prevented by scaling up breastfeeding.

The report also revealed that approximately three in five new-borns around the world waited more than 1 hour before being breastfed in 2017. Authors noted that although improvements have been made in the number of infants breasted in low- and middle-income countries — 37% in 2005 vs. 42% in 2017 — there is significant room for improvement.

India ranks 56th among the 76 countries that were analysed. 

Previous studies have demonstrated that beginning breastfeeding later than 1 hour after birth (2 to 23 hours) was associated with a 33% higher risk of mortality. Those who began breastfeeding at least 24 hours after birth more than doubled their risk of mortality. Neonates who begin breastfeeding later than 1 hour after birth are also at increased risk of infections, including a heightened risk of cough and breathing difficulties in the first months of life.

FORMULA VERSUS BREASTMILK

One of the biggest challenges faced by India is the debate of formula versus breastmilk. Dr Padmini Balagopal, a practicing lactation consultant says that one of the biggest problems is administration of formula instead of breast milk. “If every Maternity Hospital had a well-trained nursing staff who could help the new mother initiate successful breastfeeding before the mother leaves the Hospital and then, give that mother a number to call with any issues or problems, the dropout rate of breastfeeding could decrease dramatically,” she said while speaking to DNA.

Dr Padmini also explains the ill-effects of formula powder, which research shows can lead to potential cardiovascular disease and diabetes later in life. While addressing the global debate of breastfeeding in public, where several mothers - fearing societal pressure - have opted for formula instead of feeding their child, Dr Padmini says, "The answer to this is that pregnant mothers need adequate breastfeeding information and a preparatory tool kit of knowledge on the harmful effects of withholding breast milk and exposing the new babies to possible water contamination while mixing formula powder. The ignorance of the health, emotional and psychological benefits of breastfeeding and breast milk is what can result in pejorative comments like 'weird' and 'dirty’ for the natural process of breastfeeding."

Dr Swaroop N, who works with KHPT, a Pan-India healthcare non-profit organisation says that another challenge is the doctor. “From our experience in rural areas, women who deliver at facility would usually abide by doctors’ advice. Sick babies especially at the special new-born care units may not be able to directly breastfeed during the initial days of their life. Such babies need to be fed with the breast milk that has been expressed from their mothers. Instead of feeding the expressed breast milk some doctors find formula feed to be an easier alternative. This is an attitudinal problem and not a technical one,” he told DNA.

Promotion of any kind to 0-2 years of children of baby foods and feeding bottles is banned by the Infant Milk Substitutes Act. This act states that no person should advertise, promote or mislead people to believe that infant food, feeding bottles and infant milk substitutes are an acceptable replacement of mother's milk. No person can distribute or supply infant food, feeding bottles and infant milk substitutes, or contact any expecting mother or mother of an infant, or offer inducement in an attempt to sell or promote infant food, feeding bottles and infant milk substitutes. Section five states, no person shall donate or distribute infant food, feeding bottles and infant milk substitutes or any material regarding the same, except the health system. Violation of the act for the first time can lead to two-year imprisonment and a fine of Rs 1,000. Subsequent violations increase the fine up to Rs 5,000, and a jail period of five years. However, with the way formula is still sold, it appears that there is a greater need to amend this act to increase the punishment.

EASING THE PROCESS OF BREASTFEEDING

About 27% of all babies are born with low birth weight in India, said a 2014 report. Kangaroo Mother Care (KMC) comprised of skin-to-skin contact along with exclusive breastfeeding is proposed as a ‘game-changer’ for improved new born health among low birth weight new-borns.  It has also proven to improve bonding between mother and infant, reduce new born infections, lower stress levels and many other benefits.

Recently, Bill Gates, Chairperson of Bill and Melinda Gates Foundation wrote a detailed piece on KMC. "Combined with exclusive breastfeeding, this practice prevents neonatal deaths by regulating the baby’s temperature, accelerating weight gain, and reducing the risk of infections. What’s more, it encourages mother-infant bonding at a critical time of the child’s development," Gates wrote.  

The Gates Foundation and WHO have funded KHPT as one of seven global organisations to develop a model for implementing KMC at population level. “As on June 2018, programme monitoring data shows overall KMC initiation rate among the eligible cases as 71%. For the same period, around 30% practiced effective KMC (eight hours or more of skin to skin care and exclusive breastfeeding). Prolonged KMC hours is a challenge and it would take continuous efforts by the project team and Government to achieve better results. Before starting the intervention, the effective KMC percentage was less than 1%. We probably might end up around 40-50% of effective KMC by December 2018,” said Dr Swaroop.

Another interesting aspect about KMC is that the father can also hold the child close, and play a pivotal role in its development. Karnataka resident Virupaksha Gowda, who runs a provision store in Kanakagiri, along with nine other members of his family administered KMC to his new-born until the baby gained weight. 

ROAD AHEAD FOR INDIA

Varghese’s story may be an indicator of the intense battle breastfeeding campaigners have ahead of them to clamp down on the pharmaceutical companies that pump in money to encourage formula consumption, but this is where the government needs to actively involve itself and ensure India’s numbers in breastfeeding increase in the next five years. Furthermore, the government needs to actively promote the importance of KMC, which in turn will reduce the dependence on formula, thereby decreasing infant mortality rate.