As a lactation specialist, I understand that we need to use evidenced based research to inform and guide practice everyday. Although each mom and baby dyad I see is its own independent unit, there is a bigger effect on the greater national and global society of early initiation of breastfeeding within the first hour and exclusive breastfeeding for the first 6 months. Breastfeeding is both a personal choice and a public health initiative. Early this year, the Lancet released a series about the impact of breastfeeding globally. One of the most shocking statistics states, “The scaling up of breastfeeding can prevent an estimated 823,000 child deaths every year” (Lancet BF Series, Jan 30 2016). Recently UNICEF also shared this statistic, "The longer breastfeeding is delayed, the higher the risk of death in the first month of life. Delaying breastfeeding by 2-23 hours after birth increases the risk of dying in the first 28 days of life by 40 per cent. Delaying it by 24 hours or more increases that risk to 80 per cent" (http://www.unicef.org/media/media_92038.html). Breastfeeding, therefore saves lives and gives babies the best start to life.
This is not the current situation in my local practice. Each week, I visit maternity centres and complete home visits in my local community. Very few women are attempting to breastfeeding in the first hour, let alone the first days. Even if a mother's wish is to exclusively breastfeed, her child will almost definitely be given top feed while in the hospital. After returning back home after 24 to 36 hours, she finds herself without confidence, unable to latch her own child, and believing that her milk is not enough. This is an epidemic problem throughout India. Women face multiple barriers when it comes to breastfeeding their own child in the first hour and first days of life. Whether she is lacking in knowledge and confidence herself or hearing voices from family members and medical staff that her milk is not enough, her nipples are too small too big or strange, or that she is too tired to eat, a mother must fight for the opportunity to give her baby the best start.
So with the knowledge that breastfeeding with mother's own milk in the first hours and days is the best start for the baby, but the current problem of top feed being given in all levels of society, where do we go from here? The Lancet study concludes, “Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women and society. To realize these gains, political support and financial investment are needed to protect, promote and support breastfeeding” (Lancet BF Series, Jan 30 2016). How do we protect, promote and support breastfeeding better here in India? Dr. Arun Gupta from BPNI shares, “Breastfeeding and its success depends on hormonal control particularly the flow of the mother’s milk which depends on her state of mind. If there is any doubt planted in her mind about her ability to lactate, it is unlikely that she will succeed. Therefore health workers or care providers have to play a vital role in building up the confidence of new mothers. However, such support is rarely forthcoming. If a woman complains of “not enough milk” she is usually asked to buy a formula feed rather than helped to gain confidence” (Gupta "Manipulation by Assistance: Undermining Breastfeeding,” Sept 6 2008). From health workers to family members, we need to help our mothers our mothers succeed. Confidence building is the best way to support a mother in breastfeeding. Most times, her milk is more than enough. Also, there needs to be scaling up of the breastfeeding support profession. With skilled lactation care, women will receive proper guidance and support in the beginning days and when challenges arrive. Changes are happening in India, but I hope we can look back in five and ten years and see a drastic transformation of the breastfeeding rates in India to ensure a better future for all children.