Promoting Exclusive Breastfeeding; Bottom-up Approach To Tackle Nutritional Deficiency In Infancy

Thinking about breastfeeding a child during infancy might appear as ‘natural’ as breathing, almost instinctive across various species of mammals. However, its importance in ensuring the well-being of a child is often overlooked by humans. Moreover, various misconceptions and prevailing norms related to nutrition create problems, especially in India.

The first two years of human life are critical, where the growth and development of a child is determined by how much optimal feeding practices have been adhered to by parents and caregivers. This includes early initiation of breastfeeding within first hour of birth, exclusive breastfeeding for the first six months, introducing nutrition-rich complementary foods after six months of age along with continued breastfeeding up to 2 years of age. This is important to prevent potential long-term adverse consequences from poor nutrition.

As per the National Family Health Survey (2019-21) about one in three children under-5 years in India are stunted (height for age) and underweight (weight for age), and one in five are wasted (weight for height). India also carries one-third of the global burden of malnutrition.

Exclusive breastfeeding is the cornerstone of a child’s early development. Exclusive breastfeeding means that an infant should receive only breast milk and no other food items, be it liquid or solids, for the first six months. This includes even water! This is because breastmilk contains 88% water and is adequate to meet the infant’s requirements. It protects them against diarrhoea and common illnesses such as pneumonia, laying the foundation for long-term immunity. In fact, the World Health Organisation (WHO) recommends that infants should not be given water, as it carries the risk of water-borne diseases. There are exceptions like oral rehydration solution (ORS), vitamin syrups or drops, or medicines prescribed by the doctor. 

The importance of breastfeeding within the first hour of birth is well documented. Mother’s first milk contains a vital substance – colostrum or ‘liquid gold’ – that is rich in antibodies and nutrients. It establishes a newborn’s immune system, contains prebiotics that are essential for digestion, and aids in growth and development. 

This simple life-saving intervention is often not prioritised. In India, water, raw honey, and a range of liquids are given to infants right after birth. Items like raw honey are riddled with danger as it is high in sugar levels and may also carry various disease causing bacteria. In the country, only 42% children under-3 are breastfed within the first hour of birth, while 64% are exclusively breastfed under six months. 

Breastfeeding also benefits lactating mothers. A longer period of breastfeeding is associated with a reduced risk of breast cancer and ovarian cancer and also reduces risks of type-2 diabetes. Whereas, a shorter duration of breastfeeding increases the risk of postpartum depression. 

Our own experiences of working with marginalised communities in hard-to-reach pockets in India reveal socio-economic factors that impact feeding practices. Whenever access to Primary Health Care Centres (PHCs) and Frontline Health Workers is not available on a regular basis, families tend to revert to generational knowledge passed down by elders in the family or community for childcare. Poor availability of nutritional foods and the subsequent ill health of the mother only exacerbates the problem. This forces vulnerable families to switch to formula-based feeding early in infancy. They also revert to myths and perceptions of infants being thirsty during summer months, and begin feeding them with water. 

Mothers from marginalised communities also face additional gender-linked challenges. Lack of resources often forces them to re-join the workforce immediately after birthing a child, making it difficult for them to nourish their own bodies in order to be able to effectively breastfeed. Factors like lack of privacy in their workplaces and the burden of household chores also play a role. 

The government of India lays heavy emphasis on promoting exclusive breastfeeding through ASHA and other Frontline Health Workers. Policy interventions have improved feeding practices over the years. However, we could achieve more through a concerted bottom-up approach, in-turn accelerate the performance on nutritional indicators. For this, the role of community-based social organisations and leaders is critical, especially as breastfeeding is deeply personal and gender sensitive.

Community-led approaches have a proven and well-documented track record across developing countries in changing deeply entrenched nutritional practices and behaviours. Our own field experience of a project in Kandhamal District, Odisha shows this. Tribal community women trained by us led the change in their household’s and neighbourhood’s nutrition seeking behaviour, where their families have now started shifting consumption patterns to include more nutritious foods in their diet. These women have managed to create such an environment locally that their community members draw inspiration from each other to improve their practices, this is a factor that acts like a force-multiplier in such interventions.

Viksit Bharat also means Swasth Bharat. It is necessary that governments, social and even private sector players come together to promote such bottom-up interventions that keep the community in the centre of the program, work closely to transform exclusive breastfeeding practices, one household at a time. It is only by making the fight against malnutrition a Jan Andolan (people’s movement), with each stakeholder playing their role that we can accelerate the progress on key nutritional indicators for our mothers and children and achieve our SDG targets by 2030. 

Animesh Rai

Guest Author Senior Manager – Implementation Science, Vitamin Angels India.