Soudamini Rout, 32, from Gop, in Odisha’s Puri district, has just given birth to her third child at Bhubaneswar’s Capital Hospital, the largest public hospital in the city. Although she had breastfed her two earlier babies, it was often a challenging experience.
Now, after the birth of her third baby, Rout is being counselled for the first time on the importance of exclusive breastfeeding. “My first baby was born at home and although my sister-in-law guided me on how to breastfeed initially, it was difficult. The baby just wouldn’t suck and I soon developed an abscess in one of my breasts after which I stopped,” she recalls. When the second baby arrived, she breastfed for two months and then started formula feeds. The doctor she consulted advised her to continue breastfeeding but did not insist on her doing it exclusively. Today, she knows better but is filled with reservations, “I feel my breast milk is not enough for the baby,” she states hesitatingly.
Odisha’s infant mortality rate (IMR) at 65 per 1000 live births, is the second highest in the country, and the majority of infant deaths takes place in the first month of the child’s life. In such a context, the practice of early and exclusive breastfeeding for the first six months of an infant’s life assumes critical importance, with research having established that this practice could reduce under-five child deaths by about 16 per cent in India. Exclusive breastfeeding not only prevents infections, particularly diarrhoeal ones, in the child, it also helps in preventing anaemia as breast milk has the best bioavailable iron. Yet, Odisha has a long way to go on this front: According to the National Family Health Survey-3 (NFHS-3), only 37 per cent of mothers in the state practice it.
“There is no resistance to breastfeeding in Odisha, but the concern is more about practicing exclusive breastfeeding for the first six months and starting correct and appropriate complementary feeding after that,” says Dr Lingaraj Pradhan, a specialist paediatrician at Capital Hospital.
A study on breastfeeding and weaning practices among mothers attending the Immunization and Health Guidance clinic by the Department of Community Medicine, SCB Medical College, Cuttack, revealed that prelacteal feed was given by 37.4 per cent of mothers. Of them, 32.5 per cent had given artificial milk, 22.5 per cent had given boiled water and 20 per cent had given honey.
As for exclusive breastfeeding, the study pointed out that just 49.5 per cent mothers breastfed up to four months, while only 13.1 per cent breastfed for six months. Some 14.1 per cent mothers had not breastfed exclusively. Among the reasons cited for this were scanty milk, workplace pressures and ill health. The major supplementary feeds among non-exclusive breastfeeding cases were boiled water, animal milk, powder milk and honey.
Health experts warn that in an environment with no access to clean water and where there is poor personal hygiene, feeding water and other fluids is harmful and exposes babies to early infections, to which they can easily succumb.
But there was one encouraging trend in the study: A high percentage of mothers (92.5 per cent) had given colostrum – the first milk that contains important nutrients. However, the District Level Household Survey-3 (DLHS-3, 2007-08) on Child Feeding Practices in Odisha also revealed that only 63.7 per cent of children below three years in the state were breastfed within one hour of birth. The levels vary considerably between districts. While 82 per cent children under three were breastfed within an hour of birth in the coastal district of Bhadrak, the figure is only 40.1 per cent in the western Bargarh district.
The percentage of children aged from six to 35 months who were exclusively breastfed is low in Odisha – 42.6 per cent – with the figure dipping in certain pockets. For instance, in the industrialised district of Anugul, only 24.4 per cent of mothers could exclusively breastfeed for six months.
Says Sourav Bhattacharjee, Nutrition Specialist, UNICEF, Odisha, “Colostrum is vital for a newborn but it is not enough. Early initiation of breastfeeding is a must for both the newborn and the mother – it prevents the baby from developing hypoglycaemia and assists in the adequate secretion of milk. It also helps to develop a bond between mother and baby.”
Delayed initiation of breastfeeding deprives newborns of a concentrated source of anti-infective properties, Vitamin A and proteins. Early breastfeeding also lowers the mother’s risk for excess postpartum bleeding and anaemia, boosting her immune system. Given this, the UNICEF in Odisha is supporting essential nutrition programmes focusing primarily on the first two years of life, including the promotion of early and exclusive breastfeeding and timely complementary feeding. Understanding the need for maternal support to the mother for breastfeeding and complementary feeding, the World Food Programme is also investing in enhancing capacities of the grassroots functionaries in infant and young child feeding counselling.
There is also a gender bias is terms of breastfeeding. According to a study on Feeding Practices Versus Nutritional Status of Infants in a Rural Integrated Child Development Services (ICDS) block of Odisha, a significantly higher percentage of male infants were breastfed in comparison to female infants, who were breastfed for a decidedly shorter time period. A fact that Dr Pradhan confirms.
If exclusive breastfeeding is critical, so also is introduction of complementary foods at the right time. According to Dr Pradhan, the term “weaning”, which was used earlier, is somewhat misleading, “Weaning means going off something, but we are not advocating that mothers stop breastfeeding. The additional food is never at the cost of breast milk.”
But there’s another challenge: The quality and quantity of weaning foods. “Traditional home-cooked foods are best for growing babies but cultural practices prevent mothers from introducing them,” observes Dr Pradhan. A baby over six months is given only a limited number of cereals, and other appropriate foods, like rice, vegetables and fruits, are introduced only after a year once the Annaprasana – a ceremony where solid food, especially rice, is first introduced – has taken place. Though ideally by the time they are one, babies should be eating what the rest of the family eats.
Dr Geeta Pattnaik, a state government doctor who has served in many rural areas, reveals that semolina or rice flakes are the usual weaning foods in the hinterland, but their consistency is a matter of concern. She says, “Babies are generally given watered down food which may not have the required nutrition. Some would rather give powdered biscuits mixed with milk than, say, boiled papaya and lentil soup, which are easily available and more nutritious.”
The state government is trying to do more. It has begun to observe a Nutrition Day for the management of severely malnourished children. Complementary feeding practices are being encouraged and hospital-based health workers (yashodas) are being trained to advice new mothers on best practices. In partnership with UNICEF and the Odisha Voluntary Health Association (OVHA) – a federation of health NGOs – the government recently launched ‘Surakhya’, an initiative that spreads awareness among mothers about breastfeeding with the focus, initially, on seven out of the state’s 30 districts, where infant feeding practices are poor.
“Just counselling the mother on breastfeeding and complementary feeding is not enough. We need to provide them with the required support,” says Bhattacharjee. According to him, the time for generalised messages is over. Odisha’s mothers now need appropriate IEC (Information, Education, Communication) and on spot support.
But there is no denying that the scenario is slowly changing. The NFHS-3 figures indicate that under-nutrition among children in Odisha has registered a decline over the past few years. However, given the state’s tragic history in terms of child deaths, its high levels of disparity and poverty, there can be no slackening on the effort to secure healthier lives for Odisha’s Generation Next.