Why India needs more breast milk and less Cerelac

Igor Golovnov / 123rf
18 August, 2014

Between 1 August and 7 August, the World Health Organization, along with several partners, celebrated World Breastfeeding Week with awareness campaigns, photography contests and other initiatives. Though the global event is in its twenty-third year, in India it received little endorsement or coverage.

This is a pity, since India is committed to helping achieve the United Nations’ Millenium Development Goals (MDG), among which is the reduction of child mortality (number of deaths per 1000 live births in the first five years of life) by two-thirds by 2015, with the year 1990 as the baseline. And promoting breastfeeding could be key in this effort—UNICEF points out that even in cases where the mother is malnourished, with proper support and counseling, breastfeeding can usually continue.

According to WHO, the two diseases that are most responsible for infant mortality in the developing world are diarrhoea and pneumonia, which respectively contribute to 55 and 53 percent of infant deaths within the first year of life. These are inextricably linked to poor breastfeeding practices in the first six months of life. Breast milk gives an infant a steady supply of white blood cells, antibodies, lymphocytes, vitamins and easy-to-digest carbohydrates and fat, all of which help it build resistance from external infection during its most vulnerable initial months.

A recent Lancet report found that an exclusively breastfed baby is 14 times more likely to survive the first year of birth compared to one that is not breastfed at all. And according to WHO, early initiation of breastfeeding, within an hour after birth, could bring infant mortality rates down by 22 percent.

India’s infant mortality rates have still not fallen to what would be required to meet the MDG. UNICEF’s 2012 data showed India’s under-five mortality rate to be 56, compared to 126 in 1990. To meet the MDG, India will need to lower this to 42, but the Breastfeeding Promotion Network of India (BPNI) estimates that by 2015, there will still be 50 infant deaths per 1000 births.

Given that we are falling short, India’s continued dismal infant feeding practices are worrying. According to the third National Family Health Survey (2005–2006) data, only one in four women breastfeed within one hour of giving birth, and less than one in two women exclusively breastfeed for the first six months, as recommended by the government of India.

Our distaste begins with the colostrum, the mother’s first milk, which is yellowish and sticky, and serves as the baby’s first important immunisation—a concentrated shot of antibodies and immunoglobulin A, which coats the lining of immature intestines, preventing germs from leaking through. Many rural and tribal families in India throw away the colostrum, believing it to be “dirty milk.”

Doctors in India are also culpable: a WHO study in 2011 found that one in five deliveries in India are through C-sections; the resulting use of painkillers during the first hour after birth often delays the activation of breast milk. Thus, doctors bottle-feed babies with formula and other substitutes, which leave the baby confused and slow to latch on when the mother is ready to nurse. Particularly troubling is the fact that in more than 60 percent of the hospitals where these C-sections took place, the study found that they were performed for financial gains, rather than reasons of health.

Apart from the low rates of women breastfeeding immediately after giving birth, large numbers of women are not exclusively breastfeeding even afterwards, during the first six months. After speaking to several mothers, two common reasons I heard were that they were not able to generate enough breast milk, and that they were constrained by the limited 12-week maternity leave that most workplaces offer—as per the guidelines of the International Labour Organization—after which they need to get back to work, usually with no facility of an office crèche to keep their babies in close quarters.

In many countries, the former challenge has been dealt with innovatively. A series of Facebook groups, named “Human Milk 4 Human Babies,” located in cities around the world—many in the United States, but also in Malaysia, Indonesia and Singapore—connects mothers who have an oversupply of breast milk with mothers who need breast milk for their infants. A friend of mine in Singapore who approached one such advertiser visited her home feeling awkward only to find that all the women who had come to have their infants nursed—or had come with cups to collect milk for their infants at home—were perfectly at ease with the arrangement.

As for the challenges of the workplace, the concept of on-site daycares at offices is popular in the west, but not very common in India. This is something that needs more attention at a policy level, given the growing number of women entering the workforce—insights could be gleaned from countries such as Norway and Sweden, which have implemented initiatives that address these concerns, such as paid combined leave for both parents.

Lalita Iyer, a former journalist and the author of I’m Pregnant, Not Terminally Ill You Idiot! wrote in her book about the issues new mothers face at their workplaces:

Most companies treat motherhood as some sort of hobby or incurable disease the woman has suddenly developed and not as a natural progression of single to married to pregnant to mother.

She also wrote:

The fact is most companies don’t know how to deal with the ‘strange’ needs of new mothers. Of having to nurse. Or expressing milk. Or bringing their baby to work. Or being excused for an hour in the afternoon so they can go home or to the day-care and check on their babies. There’s all this talk about really not wanting to lose you, but then, they aren’t exactly doing anything to make it easy for you either.

Given these difficulties, many women with enough breast milk and no latching problems, will incorporate other food, such as Cerelac or Lactogen, into the baby’s diet. This is often done at the advice of their healthcare practitioners. On a recent trip to the pediatrician, I was informed that my nine-month-old girl was becoming underweight, and had to be fed solids every three hours. The pediatrician also dissuaded me from breastfeeding. “Keep it to the minimum,” he said. “The child needs to put on weight, and breast milk will not allow for that.”

Dr JP Dadhich, the national coordinator of the BPNI feels that this is a misconception. “It is true that culturally Indians think being chubby is a sign of good health,” he said. “But we need to go by the defined WHO weight growth standard charts. What is seen as chubby or cute could be above normal and actually unhealthy. Breastfed babies have normal growth pattern and their growth acts as a norm for monitoring the growth of infants.”

He also pointed out that companies such as Nestle have had a tenuous relationship with the law when it comes to promoting their baby food products. “According to the act, promoting in any manner including any sort of advertisements, or giving any sort of an incentive to increase sale of infant milk substitutes and foods for infants below two years of age would be violating the act,” he said. This year, Nestle released a video during Breastfeeding Week, promoting breastfeeding. But there was no missing the massive logo in the background as cartoon babies rapped about the benefits of breastfeeding.

Even if mothers dodge marketing spiel and commit to breastfeeding, they have to deal with the negative cultural attitudes towards it. This begins at home, with aunts and uncles who enquire how much you feed, and if you have too much or too little milk, and what you eat to make more, and when you plan to stop—to which if you say anything more than one year, you’re greeted with raised, disapproving eyebrows.

It extends to lecherous gazes in the public sphere, with the taxi driver adjusting his rear view mirror to get a better view, or the train attendant who peeks between the curtains of your AC compartment as you feed. Personally, I’ve found the best thing to do is carry on, and even fiercely return stares. The health of my child is at stake—so what if a few strangers get a “free show”? After all, the fact that the question of breastfeeding in India is still relegated to the private realm is a major obstacle in tackling it as a health issue, unlike in some other parts of the world where it is a fiercely debated, if far from settled, question.