"I know what's best for my baby"

Breastfeeding

by Shanika Sriyananda in New Delhi

In this era which we witness vast improvement in technology and enjoy the electronic wonders in every segment, we still hear shocking news of millions of infants dying without a drop of milk, pricking the hearts of millions.

Tiny tots like walking skeletons are still screaming for a grain of rice. Amidst the gloomy picture of these unfortunate children, the countries in which they are born, boasts of several achievements including excellent economic growth, novel inventions and increase in health indicators.

However, it was shocking to hear that over 1.4 billion babies in the South Asian region die before they could complete the first month of their arrival in this world. And... another 2.2 million babies leave same world between the ages of two to 12 months. The main killer is the infant and young child malnutrition, which is mainly due to inappropriate feeding practices.

So...what are the ways to reduce infant mortality.

The answer is simple but the benefits derived from it are long-term. It is the BREASTFEEDING which every mother is encouraged to do to make their children healthy.

Is it the responsibility solely to be borne by the mothers "No, not only the mothers but there is a great need to receive support from the family as well as the community, to continue breast feeding the infants", Dr. Arun Gupta, the Regional Coordinator of the South Asia Breastfeeding Partners Forum said.

According to Dr. Gupta, improving breastfeeding practice needs behavioural change, something that does not happen spontaneously and without encouragement. " This requires a shift in thinking from 'food based' approaches towards 'family based' feeding behaviour", he said.

The prominent paedatricians and high governmental and NGO officials from the South Asian countries - Afganistan, Bhutan, India,Maldives,Nepal,Pakistan and Sri Lanka - who took part in the Forum which was held under the theme of 'Save babies: Support women to breastfeed', highlighted the need for universalising optimal breastfeeding practices - beginning breastfeeding within an hour, exclusive breastfeeding for the first six months and continue breastfeeding for two years or beyond along with adequate and appropriate complementary feeding.

The Millennium Development Goals (MDGs) target to reduce deaths of Under five years olds by a two third by 2015 but the experts stressed the need of setting up new time frame for the SARRC countries prior to the MDGs time frame, as the world's highest number of infant deaths in the world are recorded in this region.

"So the region needs to scale up the action on breastfeeding faster. But this cannot be achieved if women are not supported to breastfeed optimally. If women have to practise optimal breastfeeding, they need support from all stakeholders - the father, family, the community and the State.

It is time to create a new world for children and their mothers, where women can breastfeed successfully in an atmosphere of love, caring and sharing to have a healthy child population", they stressed.

"South Asia which has about 1.4 billion people, has the highest number of Under-five deaths and Under-five children who are underweight. Out of total 146 million Under-five underweight children 70 million are in the South Asia and they are unlikely to achieve their full growth and potential development", Dr. Gupta said adding that early breastfeeding within one hour and exclusive brastfeeding for the first six months is the key to tackle infant malnutrition and also the survival of infants and young children.

Dr. Gupta said that despite the known advantages of breastfeeding there are long-term advantages over artificial feeding.

Its benefits for mothers and children for long-term outcomes of adult health, reducing obesity, neonatal infections, diarrhoea and respiratory illnesses. Malnutrition impairs mental and physical development in kids and makes them more susceptical to illnesses.

According to the World Health Organization (WHO)'s infant feeding guidelines recommend that infants should begin breast feeding within one hour, be exclusively breastfed for the first six months of life to achieve optimal nutrition, survival, growth and development.

Thereafter, to meet their evolving nutritional requirements, infants should receive appropriate and adequate complementary feeding while breastfeeding continues for up to two years of age or beyond. These interventions are critical to infant and young child mortality.

Citing an example Dr. Gupta said that Lancet series on child survival and alter newborn survival showed that 13% to 15% of under-five deaths in resource poor countries could be prevented through achievement of 90% coverage with exclusive breastfeeding alone. And additional 6% could be prevented with appropriate complementary feeding.

He said that half of diarrhoea deaths are attributed to sub optimal breastfeeding and global ecological risk assessment of deaths and years of life lost due to suboptimal breastfeeding among children in the developing world revealed that attributable fractions for deaths due to diarrhoeal disease and lower respiratory tract infections are 55% and 53%, respectively, for the first six months of infancy, 20% and 18% for the second six months, and are 20% for all-cause deaths in the second year of life.

The authors concluded that globally, as many as over 1.45 million lives (117 million years of life) are lost due to suboptimal breastfeeding in developing countries. This WHO Study further justifies focus on nutrition interventions being mainstreamed.

He also said that beginning breastfeeding within first hour cuts newborn deaths by 22% and a study carried out in Ghana clearly showed, for the first time in the world, an association between timing of breastfeeding and newborn survival.

The study showed that 22% of all neonatal deaths could be prevented if all women could initiate breastfeeding within one hour of birth. Further analysis now suggests that this figure could be as high as 31%.

An epidemiologic evidence of a causal association between early breastfeeding and infection specific mortality in the newborn infants published recently in the American Journal of Clinical Nutrition showed that those newborns in Ghana, who initiated breastfeeding within 1 hour, were less likely to die of neonatal sepsis than those who didn't.

Risk of infection deaths increased with increasing delay in initiation of breastfeeding from one hour to seven days overall late initiation (after day 1) was associated with a 2.6-fold risk.

Additionally, partial breastfeeding during first month was associated with a 5.7-fold adjusted risk of death as a result of infectious disease after adjusting with the effect of early breastfeeding. That means early as well as exclusive breastfeeding both are significantly associated with reduced infection-specific neonatal mortality in young infants.

WHO provides clear evidence of optimal breastfeeding and its links to adult health and IQ (2007).

Another WHO systematic meta-analysis conducted to assess the association between breastfeeding and blood pressure, diabetes and related indicators, serum cholesterol, overweight and obesity, and intellectual performance has found that who were breastfed experienced lower mean blood pressure and a higher performance in intelligence tests.

Prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. All effects were statistically significant but for some outcomes their magnitude was relatively modest.

Dr. Gupta said that the exclusive breatfeeding can cut down HIV transmission rates from HIV positive women to their offspring by half. The new intervention cohort study from South Africa, assessed the HIV-1 transmission risks and survival associated with exclusive breastfeeding and other types of infant feeding in HIV positive women.

Risk of acquisition of infection at six months of age via exclusive breastfeeding was 4.04%. Breasted infants who received some solids had 11 times higher risk infection and if other milk or formula is given along with breastfeeding the risk could almost double.

The study showed that HIV free infant survival was much higher in exclusively breastfed children at 3 months.

According to WHO about two-thirds of all child deaths occur during infancy, and related to sub optimal feeding practices.

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A correct attachment is crucial to success

The trick to successful breastfeeding is getting the baby to suckle in correct position at the breast or 'latch on' well. This way it helps effective transfer of mother's milk from a mother to her baby.

The baby should take enough of areola (the brownish area around the nipple) into the mouth for maximizing milk transfer. This is essential because breastmilk is stored in ducts under areola. A correctly attached baby takes the nipple as well as the areola inside the mouth and uses suction to pull out the breast tissue to form a teat.

This stimulates production of two hormones. One, prolactin that is responsible for milk secretion from the glands, and two oxytocin, which makes milk flow from ducts in the breast into the baby's mouth.

Therefore, effective suckling is what controls the whole process of milk production and milk transfer. As the baby sucks and takes out milk, the breasts start making more milk. More suckling makes more milk.

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How does it benefit baby and the mother?

It ensures the intake of first milk from the breast, which is thick and yellowish in colour (colostrum), as the first feed which provides protection against infection (called first immunization of the baby), the other benefits are:

* Early initiation builds on the baby's innate reflexes. Babies who start breastfeeding at this time continue to breastfeed exclusively and thus adopt optimal feeding practices later.

* The baby learns to recognise his/her mother's smell.

* The baby is calmer and his/her breathing and heart rate are steadier.

* The process of emotional bonding starts.

* The mother's body helps to keep the baby warm, especially important for small and low birth weight babies and saving them from hypothermia, one of the important causes of deaths.

* The mother's body produces the hormone oxytocin and the flow of milk is enhanced.

* The mother's commensal (normal) bacteria start colonizing the baby's skin and gut, which helps to protect the baby against the harmful bacteria in the environment.

* Early initiation of breastfeeding has also been shown to help reduce post-partum bleeding, a major cause of maternal mortality in developing countries.

Take the advantage of feeding the baby with colostrum

Colostrum, the sticky, yellowish-white milk is available for first 3-5 days and is eventually replaced by mature milk. It has high levels of antibodies, vitamin A, vitamin K and other protective factors, and thus is called babies' first immunization.

Although colostrum is secreted in small quantities (30-90 ml), it is sufficient to meet the energy requirements of normal newborns during the first few days of life. Thus, in the first few days the requirement of the baby is little and is met by even a few minutes of suckling at the breast.

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What is the magical milk...

* Mother's milk is complete nutrition for the baby from birth upto 4-6 months. No other milk, food or drink is required.

* Babies should start to breastfeed within 1/2 to 1 hour of birth. They should get colostrum - the yellowish milk during first 2-3 days. Nothing should be given before the first breastfeed.

* Bottlefeeding is unnecessary and even harmful for babies. It is the leading cause of diarrhoea in babies.

* Mother can continue breastfeeding during sickness without any harm to the baby.

* Commercial milks are always inferior to mother's milk.

* Solid foods should be introduced after 4 months but not later than 6 months of age.

* Breastfeeding should be continued well into the second year of life.

* Practically all mothers can successfully breastfeed their babies.