Breastfeeding: Where are we now and what can we do better?

The health of a nation is often measured by its Maternal Mortality Rate (MMR) and Infant Mortality Rate (IMR). A key strategy in reducing IMR is successful breastfeeding, which has been shown to significantly enhance infant health and survival. Despite this, data from the National Family Health Survey (NFHS) reveals that only about 43 to 56 per cent of infants in India are successfully breastfed. Why does this dismal picture persist? It has been 18 years since I founded Cloudnine and my ultimate focus has been on providing comprehensive breastfeeding support for mothers. This year, the World Alliance for Breastfeeding Action (WABA) has chosen the slogan “Closing the Gap” for World Breastfeeding Week, aiming to bridge the gap between those who breastfeed and those who do not and I want to take this opportunity to share our approach and educate the public on what we are doing to “close the gap.” 

The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding along with appropriate complementary foods up to two years of age or beyond. 

According to the National Family Health Survey (NFHS-5) conducted in 2019-2021, the prevalence of exclusive breastfeeding for infants under six months in India is approximately 58 per cent. This represents an improvement from previous years but still falls short of the WHO target of 90 per cent and Cloudnine’s achievement of 95 per cent. Early initiation of breastfeeding within the first hour of birth is critical, yet only about 41 per cent of newborns in India receive this timely start. Several factors contribute to these suboptimal breastfeeding rates, including socio-cultural beliefs, lack of awareness, inadequate support systems, and economic pressures. For instance, traditional beliefs in some communities may promote the use of pre-lacteal feeds (feeding substances other than breast milk before breastfeeding is initiated), which can interfere with the establishment of successful breastfeeding practices.

Challenges faced by mothers

Indian mothers face numerous challenges when it comes to breastfeeding. These include:

1. Lack of awareness and education: Many mothers lack knowledge about the benefits of exclusive breastfeeding and the techniques for successful breastfeeding. Misinformation and myths about breastfeeding can discourage mothers from continuing breastfeeding or starting it early. 
2. Workplace challenges: For working mothers, especially those in the informal sector, the lack of maternity leave and breastfeeding-friendly workplace policies can severely impact their ability to breastfeed. Many workplaces do not provide adequate facilities for expressing and storing breast milk.
3. Healthcare system barriers: Healthcare providers often do not have the training to support breastfeeding mothers adequately. There is also a lack of standardised breastfeeding counselling services in many health facilities.
4. Economic and social pressures: In economically disadvantaged families, the need for mothers to return to work soon after childbirth can force them to abandon breastfeeding. Social pressures and the influence of aggressive marketing of breast milk substitutes also play a role.

Moving forward – Recommendations for Improvement – Closing the Gap

When we started Cloudnine 18 years ago – we had breastfeeding mothers only of 48 per cent. With continuous support and encouragement now for the past few years we have been having more than 95 per cent of mothers successfully breastfeeding at Cloudnine Group of hospitals. So “What did we do or what are doing right” to “Close the Gap”?

1. Strengthen awareness campaigns: Increase the reach and effectiveness of breastfeeding awareness campaigns, particularly in rural and underserved areas. These campaigns should address common myths and misconceptions about breastfeeding during the antenatal period. Sensitise mothers about the benefits of breastfeeding and encourage them to seek help for various problems like flat nipples, large breasts, and small breasts and discuss their concerns, and myths and allay their fears. Sensitise the treating Obstetricians/Healthcare providers to address this as a routine in their antenatal visits. 
2. Enhance training for healthcare providers: Implement comprehensive training programs for healthcare providers to ensure they can offer effective breastfeeding support and counselling. This includes training on the importance of early initiation and exclusive breastfeeding. Obstetricians should be sensitised to pro-actively explain, check the breasts and take corrective measures, if required, during antenatal check-ups.
3. Promote breastfeeding support: Enhance breastfeeding support during childbirth and in the hospital during the recovery phase. Golden hour breastfeeding should be encouraged to increase the chances of mothers to breastfeed. Ensure the mothers are successfully breastfeeding before discharge.
4. Address concerns of breast engorgement proactively. Prevent breast engorgement – by explaining what to do if it were to happen rather than waiting to happen. We have patented non-surgical management of breast abscess which helps a lot of mothers who develop engorgement and breast abscess.
5. Ensure trained lactation consultants are available round the clock – either by phone or by video consultation (could use WhatsApp video calls too) for new mothers for the first 2 weeks – a crucial period to seek help.
6. Community support systems: Develop and support community-based programs that provide peer support for breastfeeding mothers. These programs can create a supportive environment for mothers to share experiences and receive encouragement. In addition, hospitals should provide “reach out” nursing staff trained in Lactation support when required. 

The bigger picture in India

The primary issue in India is the scarcity of trained lactation consultants. Despite its vast population, India has fewer than 200 lactation consultants, compared to over 200 in a small country like New Zealand. This shortage is a significant barrier to providing the necessary hands-on support that mothers need. While many lectures and informational sessions are organised, as noted by WHO field workers, they are insufficient without practical, hands-on help. Active support should be provided during the antenatal, natal, and postnatal periods to ensure successful breastfeeding. Lectures alone will not encourage mothers to seek help; they need direct assistance and encouragement.

Breastfeeding is a critical component of infant health and survival, yet many mothers face significant challenges that prevent successful breastfeeding. At Cloudnine, we have demonstrated that with proper support and education, high breastfeeding rates are achievable. By addressing the gaps in support, increasing the number of trained lactation consultants, and providing hands-on assistance, we can improve breastfeeding rates and infant health outcomes across the country.

By working together to “close the gap,” we can ensure that more mothers and babies experience the benefits of successful breastfeeding, leading to a healthier future for all.

Reference:

Shazia Shadab, R. Kishore Kumar, Prakash Kini, Ruth Patterson, Surekha Sanjeev Managoli, Namitha Sachin. Dynamic taping: A promising non-surgical management technique for lactational breast abscess. Journal of Neonatology. 2024; Jan 12; 1-8.