Expert Speak- Power Of Early Initiation Of Breastfeeding- Bihar Point Of View

ExpertSpeak

Author:

Dr Nigam Prakash Narain,

Retd. Professor and Head (Paediatrics) Patna Medical College and Hospital

Vice President, Central Indian Academy of Paediatrics (IAP), 2020

Introduction

Breastfeeding is recognized as the optimal form of infant nutrition for the first six months. Although it is widely known to enhance survival and support ideal growth and development including cognitive development; only two out of five new-borns globally are breastfed within the first hour of birth and only 2 out of 5 infants (< 6 months) are breastfed exclusively for six months[1]. Failing to breastfeed optimally translates into real costs in human life, quality of life, and national economic outcomes.

In India, only 42% of the children are breastfed in the first hour of life and the prevalence of exclusive breastfeeding in children below the age of six months is 55%, which means that at least 1,09,62,022 children each year are not receiving the recommendation nutrition in the critical first six months of life. According to the recent findings of the National Family Health Survey-5(NFHS-5), the state of Bihar has witnessed a considerable drop in the early initiation of breastfeeding (EIBF) despite major improvement in institutional delivery from 63.8% in NFHS 4 to76% in NFHS 5. This trend has been a major concern as EIBF ensures that the infant receives the colostrum which is the first milk rich in protective factors and acts as the first vaccination for the child. However, the survey results in Bihar showed improvement in exclusive breastfeeding from 53.4% in NFHS-4 to 58.9% in NFHS 5. 

The scenario is a matter of concern for the Government and all the stakeholders working towards improving breastfeeding esp. EIBF in the state. The opportunity for increased institutional deliveries must be maximized by strengthening both the counseling skills of Front-Line Workers (FLWs) and the skills of facility-based providers in facilitating EIBF and improving the awareness among the mother and the family.

Fighting the persistent misinformation and myths around colostrum

At this point, it is important to continue to address the myths and misinformation around EIBF. There are persistent social beliefs and misconceptions that the first milk is considered unhealthy and unhygienic and is replaced with honey for newborns. Some people follow some rituals before giving the mother’s first milk to the newborn. Hence, it is pertinent to generate awareness and change the social norms around the significance of EIBF for a newborn; colostrum does not only give the most vital and boosts immunity nutrients, but EIBF including colostrum feeding also prevents the baby to develop hypothermia and improvises mother-child bonding.

Breastfeeding is best for preterm/low birthweight (LBW) infant

Prematurity and term small for gestational age (SGA) are leading causes of neonatal deaths in India and globally. In 2019-20 (NFHS 5), the low birthweight (LBW) burden in India continues to remain high at 18%.  WHO recommends all LBW infants, irrespective of their gestational age, be fed breastmilk. Clinically stable LBW infants should be put to breast as soon as possible after birth and be exclusively breastfed for 6 months. Early and exclusive Breastfeeding is especially important in preterm infants because human milk appears to have a protective effect on the immature gut and decreases the risk of necrotizing enterocolitis. Many preterm and term SGA infants may have difficulties feeding directly from the breast or direct feeding may not be sufficient to fulfill their needs. In such a situation, mothers should be counseled and supported to express milk for their infants, and expressed breast milk can be fed through a feeding tube, spoon, paladai, or cup. When in very unfortunate scenarios mother’s milk is not available (due to illness, or death), pasteurized donor human milk needs to be made available through functional human milk banks. 

Multi-stakeholder collaborative efforts to improve EIBF rates in Bihar using quality improvement approaches

Under the leadership of the Department of Health and Family Welfare, the Government of Bihar leading medical colleges and hospitals in Bihar with technical support from  Alive & Thrive and UNICEF undertook capacity enhancement of doctors and nurses in implementing optimal breastfeeding interventions especially for ensuring EIBF in both vaginal and C-section deliveries using a Point of Care Quality Improvement (POCQI) approach in 2019 -20 which resulted in a sustained increase in EIBF rates in both vaginal and C-section deliveries, adoption of zero separation policy for mother & newborn and increased counseling and support to mothers & family at the medical college hospitals like Patna Medical College ensuring near 100% EIBF in all vaginal deliveries and Anugraha Narayan Magadh Medical College, Gaya achieving and sustaining over 90% EIBF rates in non-complicated C-sections. This effort has now been scaled to all eleven government medical colleges in Bihar. Selected medical colleges are currently providing capacity-building and mentoring support to district hospitals in their catchment districts to improve breastfeeding interventions using a POCQI approach. The district hospitals are showing improvements in EIBF practices of facilitating immediate skin-to-skin contact and initiation of breastfeeding immediately following Caesarean section and vaginal delivery with Muzaffarpur District Hospital achieving over 90% EIBF rate from a zero level in non-complicated C-section during November 21 – May 2022.

Conclusion

Concerted and collective efforts to protect, promote and support optimal early and exclusive breastfeeding for improving the survival and well-being of children and mothers are the need of the hour.  Greater commitment and systems strengthening approach with a focus on quality is needed towards scaling up implementation efforts with quality, continuity, intensity, and equity to enable and empower women to breastfeed within the first hour of giving birth, giving their children the strongest start to life and continuing exclusive breastfeeding for first six months of life.

[1] UNICEF WHO. Capture the Moment—Early initiation of breastfeeding: The best start for every newborn. New York: UNICEF. 2018; Unicef, WHO. Global Breastfeeding Scorecard: Increasing commitment to breastfeeding through funding and improved policies and programs. New York: 2019.

[1] UNICEF WHO. Capture the Moment—Early initiation of breastfeeding: The best start for every newborn. New York: UNICEF. 2018; Unicef, WHO. Global Breastfeeding Scorecard: Increasing commitment to breastfeeding through funding and improved policies and programs. New York: 2019.