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m Successful Lactation in the Modern World: Is it Possible?
Successful Lactation in the Modern World: Is it Possible?
Dr. Priya H. Manihar1, Dr. Varun J. Wani2, Dr. Reena J. Wani3
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Abstract
Breastfeeding is a natural act, but it is also a learned behaviour. This year’s theme for World Breastfeeding Week 2022 is ‘Step up for breastfeeding: Educate and support.’ Organizations like Mumbai Breastfeeding Promotion Committee (MBPC) Mumbai Obstetric & Gynecological Society (MOGS) and Federation of Obstetrics & Gynecologic Societies of India (FOGSI) have been holding activities, webinars and competitions to focus on this important topic. This has been a wonderful way to partner with neonatologists, pediatricians, community medicine and mother support groups. The aim of all these activities is to highlight the physiological importance of breastfeeding, promote exclusive breastfeeding, and make the general population aware about its multiple benefits. This article provides a few key points for practicing physicians to impart knowledge of the evidence-based advantages of breastfeeding to their patients, friends and relatives. Keywords: breastfeeding, mother, infant, newborn, lactation, MBPC, COVID, HIV
“If I have seen further it is by standing on the shoulders of Giants.” - Sir Isaac Newton, 1675.
Breastfeeding is a natural act, but it is also a learned behaviour. Hospitals and health care practitioners should support all mothers to initiate breastfeeding as soon as possible after birth, within the first hour after delivery, and provide practical support to enable them to establish breastfeeding and manage common breastfeeding difficulties. Lactation support and management is a multidisciplinary team work of the healthcare providers including physicians, nurses, midwives, registered dieticians, public health professionals, scientists, lactation consultants, peer counsellors, and community health volunteers.[1] There is a dictum: ‘Breast is Best’. Each and everyone of us shares a common commitment of promotion of breastfeeding and thus safeguarding the lives of the people.[2]
India: Key Indicators
Azadi ka Amrit Mahotsav: India is celebrating its 75th Independence Day this year and National Surveys are reflecting many surprising changes in early initiation of breastfeeding as seen in Table 1.[3, 4]
As per NFHS-5, overall 63.7% children under the age of 6 months were exclusively breastfed as opposed to 54.9% reported in NFHS-4. Lakshadweep, Meghalaya, Andhra Pradesh and West Bengal showed the most improvement in early initiation, while Sikkim, Assam, Dadra & Nagar Haveli and Daman & Diu had the worst decline in early initiation of breastfeeding between the two surveys.[3, 4]
Global Reports [5]
As per the global reports, breastfeeding rates are too low in developed countries. It is found that only
1 Senior Resident, Dept of Community Medicine, LTMMC and GH, Sion, Mumbai. 2 Senior Resident, Dept of Community Medicine, LTMMC and GH, Sion, Mumbai. 3 Professor and Head, Dept of Obstetrics & Gynaecology, HBT Medical College & Dr RN Cooper Hospital, Mumbai. Corresponding Author: Dr. Varun J. Wani, Senior Resident, Dept of Community Medicine, LTMMC and GH, Sion, Mumbai. Email: varunwani93@gmail.com
Table 1: Changes in the early initiation of breastfeeding from NFHS 4 (2015-16) to NFHS 5 (2019-20) [3]
1 in 25 mothers are exclusively breastfeeding, unlike 1 in 5 in developing nations. Worldwide, 7.6 million babies each year are never breastfed as per UNICEF, 2018. Infants are more likely to be breastfed at least once in low- and middle-income countries. Countries like Bhutan, Madagascar and Peru have the highest nursing rates. Ireland, US and Spain have some of the lowest rates.
Interestingly, in less developed countries, breastfeeding duration is longer among the poorer mothers while in developed countries, it is the wealthy mothers who are more likely to nurse their child for a longer duration. Benefits of Lactation to the Mother[6]
1. Helps in better involution of uterus 2. Reduction in postpartum hemorrhage 3. Lactational amenorrhoea as a contraceptive to help in birth spacing 4. Risk reduction of ovarian cancer, breast cancer 5. Risk reduction of diabetes type 2, hypertension Benefits of Breastfeeding for the Hospital[7]
1. Warmer and calmer emotional environment 2. No nurseries, more hospital space 3. Fewer neonatal infections 4. Less staff time needed 5. Reduced risk of hospitalization and mortality Benefits of Breast Feeding to Families[8]
1. Healthy mother and baby for short term and long term 2. Lesser financial costs as breastfeeding is free 3. Decreased emotional stress caused by illness of the child and mother 4. Decreased medical care costs
COVID-19 Pandemic[9]
There were many myths and misconceptions especially during the first wave of the pandemic. We have all learnt and know that this virus is not transmitted via breastmilk.
Some general instructions were given to the breastfeeding mother who had COVID or its symptoms like fever, cough or difficulty in breathing such as: 1. Seek early medical care. 2. Wash hands thoroughly with soap and water. 3. Cover nose and mouth with a handkerchief. 4. Use mask and maintain cleanliness. 5. Continue breastfeeding with precautions to protect yourself and the infant from infections.
It is known that breastfeeding strengthens a child’s immune system, by directly transferring the antibodies from the mother; it improves survival and provides lifelong health benefits. Hence after initial hesitancy in the first wave, all organizations gave clear guidelines that unless mother or neonate is too sick, breastfeeding should be facilitated with proper infection prevention and control measures.[10, 11]
HIV and Breastfeeding[12]
1. HIV can pass from a mother to her child during pregnancy, labour or delivery, and also through breast milk. 2. The evidence on HIV and infant feeding shows that giving Anti-Retroviral Treatment (ART) to mothers living with HIV, significantly reduces the risk of transmission through breastfeeding and also im-
proves their health. 3. WHO now recommends that all people living with HIV, including pregnant women and lactating mothers living with HIV, take ART for life from when they first learn their infection status.
WBW & Role of Organizations
On the occasion of World Breast Feeding Week (WBW) 2021, Mumbai Breastfeeding Promotion Committee (MBPC) under leadership of President 2019-22 -Dr. Reena Wani, organized “WBW-2021” inaugural program on 3rd August 2021 as a hybrid event due to COVID concerns. The theme for WBW 2021 was “Protect breastfeeding- a shared responsibility”. The highlights of the event were Release of Breastfeeding training Module ‘Breastfeeding: A precious Bond’,and prize distribution for street-play and poster competitions. A copy of this training module was distributed to all colleges along with pen-drive containing powerpoint presentations of the chapters for training of doctors and healthcare workers.A partnership with other state and national organizations in such activities helps to spread awareness, and reinforce positive mes-
Figure 1: Prize winning poster (junior category) in MOGS
WBW 2022 Competition. (Source: Dr. Sayli Wankhedkar) sages for this cause.
This year’s theme for WBW 2022 is ‘Step up for breastfeeding: Educate and support.’ This time too, MBPC held various competitions and also added a quiz and slogan competition for breastfeeding. Other organizations like Mumbai Obstetric & Gynecological Society (MOGS) and Federation of Obstetrics & Gynecologic Societies of India (FOGSI) have been partnering with MBPC down the years, and also holding their own activities, webinars and competitions to focus on this important topic. This has been a wonderful way to partner with neonatologists, pediatricians, community medicine and mother support groups.
Key Points for Practitioners
1. Parents giving birth should be supported to breastfeed through early initiation of skin-to-skin contact and frequent breastfeeding, with skilled lactation support readily available in maternity care facilities. 2. There are continued benefits from breastfeeding beyond 1 year, and up to 2 years especially in the mother. Hence most organizations now support continued breastfeeding until 2 years or beyond, as mutually desired by mother and child. 3. WHO recommends implementation of the ‘Ten
Steps to Successful Breastfeeding’ specified in the
Baby-Friendly Hospital Initiative, some being: • Skin-to-skin contact between mother and baby immediately after birth and initiation of breastfeeding within the first hour of life. • Breastfeeding on demand (that is, as often as the child wants, day and night). • Rooming-in (allowing mothers and infants to remain together 24 hours a day). • Not giving babies additional food or drink, even water, unless medically necessary.
Conclusion
Emphasis on starting breastfeeding to the child within an hour of birth, exclusive breastfeeding for first 6 months of life and on completion of 6 months give complementary feeding to the child should be made by education toeach and every mother as well as the family for a brighter tomorrow. One person cannot reach everyone, but every person can reach someone, which may add up together to reach everyone!
‘Let us all take the Pledge to Promote Support Protect Breastfeeding!’
Acknowledgements
We thank the Presidents and team members of MBPC, MOGS, FOGSI, BPNI and other organizations working together for this important cause, and all participants in the various activities conducted for the promotion of breastfeeding.
References:
1. Campbell S. Core Curriculum for Interdisciplinary Lactation
Care: Jones and Bartlett Learning. 2019:4-6. 2. Park K. Textbook of Preventive and Social Medicine. 25th Edition:
Banarasidas Bhanot Publishers, 2019:614. 3. National Family Health Survey (NFHS-4). 2015-2016. Indian ministry of Health and Family Welfare. International Institute for Population Sciences. 4. National Family Health Survey (NFHS-5). 2015-2016. Indian ministry of Health and Family Welfare. International Institute for Population Sciences. 5. UNICEF. Breastfeeding: a mother’s gift, for every child.
UNICEF; 2018. Accessed on 2022 Aug 11. Available from: https://www.unicef.org/media/48046/file/UNICEF_
Breastfeeding_A_Mothers_Gift_for_Every_Child.pdf 6. Lutter CK, Lutter R. F et al and early childhood undernutrition, mortality, and lifelong health. Science. 2012;337(6101):1495-9. 7. Horta BL, Victora CG. A systematic review on the benefits of breastfeeding on diarrhoea and pneumonia mortality. World
Health Organization. 2013. 8. Tiruneh GT, Shiferaw CB, Worku A. Effectiveness and costeffectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low-andmiddle-income countries: a systematic review and metaanalysis. BMC pregnancy and childbirth. 2019;19(1):1-9. 9. Lubbe W, Botha E, Niela-Vilen H, Reimers P. Breastfeeding during the COVID-19 pandemic–a literature review for clinical practice. International Breastfeeding Journal. 2020;15(1):19. 10. BPNI. COVID-19 and Breastfeeding Update. 2020 May.
Accessed on 2022 Aug 11. Available from https://www.bpni.org/wp-content/uploads/2020/05/Update-on-COVID-19and-Breastfeeding.pdf 11. World Health Organization 2020. Breastfeeding and
COVID-19: Scientific brief. 2020 June. Accessed on 2022
Aug 11. Available from https://apps.who.int/iris/handle/10665/332639 12. Yadav P, Wani RJ, Shirodkar S. Impact of Changed
HIVTesting Strategy in PPTCT Programme at Tertiary
Hospital. Indian Jnl of Applied Research.2021;11(4).DOI : 10.36106/ijar.
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