August 20, 2021
Exclusive breastfeeding (EBF) has important benefits for both the mother and child. The first 1000 days (between conception and a child’s second birthday) provides a unique period of opportunity for optimum child growth and development and also establishes the foundations for good health across the life course. Essential components of infant and young child feeding practices (IYCF) include timely initiation of breastfeeding, exclusive breastfeeding (EBF) for the first 6 months of life and continued breastfeeding until the child is 2 years of age. EBF (defined as the practice of only giving an infant breast milk for the first 6 months of life, with no other food or water added) is the cornerstone of optimum infant nutrition.
Notably, EBF reduces the risk of the infant to experience diarrhea diseases, upper respiratory tract infections, obesity in later life and EBF could improve the neurocognitive functions of the child. The neonate has an immature immune system and colostrum, a powerful immune booster, protects infants from infections by means of bioactive factors and secretory IgA antibodies. Breast milk with its abundant source of immunoglobulins, lactoferrin, lysozyme and cytokines play an important role in absorbing and engulfing harmful micro-organisms and targeting specific bacteria and providing protection by regulating the immune response. Human milk oligosaccharides, abundant in human milk, shape the microbiome, provide probiotics and modulate the developing immune system also displaying anti-adhesive effects for bacterial antigens. All the above are compelling reasons for every infant to receive only breast milk and preferably their own mothers’ milk. However, despite these obvious benefits and numerous recognized advantages of appropriate feeding practices, the rates of EBF in India is seen to be depleting, especially among working mothers.
In India, exclusive breastfeeding is inadequate as only 55% of babies are exclusively breastfed (0-6 months) and 41% are able to begin breastfeeding within an hour of birth. According to a new study on the cost of not breastfeeding and an accompanying tool, annually, inadequate breastfeeding results in 100,000 preventable child deaths (mainly due to diarrhea and pneumonia), 34.7 Million cases of diarrhea, 2.4 Million cases of pneumonia, and 40,382 cases of obesity in India. Health impact on mothers is more than 7000 cases of breast cancer, 1700 of ovarian cancer and 87000 of type- 2 diabetes.
Exclusive breastfeeding among children 0–6 months of age was widely practiced in most states in the first month of life. However, EBF declined with each additional month and by the time infants are 6 months of age, exclusive breastfeeding rates were low. The proportion of infants exclusively breastfed was significantly greater in rural areas than those from urban place of residence. The rate of EBF in India continues to be sub-optimal with no appreciable gains in the last 13 years. The factors identified with non-compliance of EBF were living in urban areas, shorter birth intervals and belonging to higher wealth index.
The COVID-19 pandemic is creating global disruption, causing markets to plummet and generating many questions in every area of life-health care sector in particular. Since March 18th, 2020, the WHO recommends that women with COVID-19 can breastfeed if they wish to do so, based on the idea that through breastmilk the babies would get antibodies and anti-infective factors that help protect newborns from getting infections. The WHO encourages women to breastfeed or to continue breastfeeding following certain recommendations and precautions. Despite the COVID-19 pandemic, the international organizations continue to promote breastfeeding.
The best way to promote successful breastfeeding, is to ensure that the mother-infant dyad is kept together, and skin-to-skin contact is supported and encouraged. Skin-to-skin is the safest and best transition for mothers and their infants to a new life together. Skin-to-skin also increases blood glucose levels 75–90 min after birth, improves cardiorespiratory stability and significantly reduces stress levels in the infant and mother. Keeping mother and infant together can reduce birth stress and even prevent neurodevelopmental disorders in the infant. The smell, touch and voice of the mother naturally calms the infant.
EBF needs to be supported through an integrated approach meeting the different needs, regions and especially in states with high neonatal mortality rates where these practices are deficient. Several successful intervention models and strategies to promote EBF have been evaluated and there is a need to scale-up and implement the most appropriate and culturally acceptable ones to universalize optimal infant feeding practices. In addition, providing maternity entitlements to women would actualize the rights of mothers and infants to breastfeed.