Step Up For Breastfeeding: Educate And Support

The biggest myth related to breastfeeding is that the mother is solely responsible for breastfeeding the child. Even though challenging, the antenatal phase of pregnancy is probably not the only difficult phase in a mother's life. To nurture an infant comes with its challenges, and breastfeeding is one of them, especially for an inexperienced mother with no social support.

What are the difficulties faced by women while breastfeeding?

Breastfeeding is a deeply emotional journey for many mothers, a perspective that we often overlook. It's not always a smooth ride; most women encounter challenges during this period, be it physical or emotional.

Fear, sadness, anger, and concern are typical emotional stages a feeding mother experiences. Poor milk production, a commonly reported problem, often results in a loss of confidence and self-doubt, further reducing breast milk production.

This experience is often different from what one would have expected. Prenatal counselling helps in demystifying breastfeeding but does not always lead to improved knowledge and a better breastfeeding experience.

Sore nipples, inadequate milk production, breast engorgement and infection of the breasts are some of the common physical problems associated with breastfeeding. Addressing both physical and mental difficulties is highly important, as these often lead to mothers stopping exclusive breastfeeding and beginning formula.

The scandalous formula feeds

The scandalous history of formula feeds is well-known. Nestle risked the lives of millions of children for profit. Poor people's desire to Westernize helped companies get mothers from third-world countries hooked on formula feeds. The company linked formula feeds to the most desirable but unrealistic outcomes. Initially, free samples of this unhealthy and expensive 'baby-killer' were distributed. 

As it was expensive, poor mothers often diluted it with water before feeding the child. Doing this not only deprives the children of essential nutrients but also puts them at a higher risk of developing infections. This product, which Nestle advertised as being better than breast milk, soon gained popularity but led to the death of millions of children. 

Formula-feed companies continue to mislead mothers and fill them with self-doubt. They use powerful marketing techniques to reach millions of people and fool them into believing formula feeding is better for their children. As breast milk production involves a complex neurological pathway, the emotions of fear, concern, and guilt affect it. These emotions further reduce milk production, which forms a vicious cycle and pushes mothers toward artificial feeds. 

Breastfeeding vs formula feeds

Whether breast milk is better than formula feed has been an age-old discussion. Breast milk is better for the child, which is 'nature's perfect food'. Breastfeeding is beneficial not only for the child but also for the mother. 

It protects the child from diseases like type 1 diabetes, ear infections, obesity, high cholesterol, cancer(leukaemia, lymphoma), and diarrhoea. It is free and easily accessible and makes your child smarter by promoting brain development (the secret of ‘Sharma ji ka beta’). It also protects the mother from breast and ovarian cancer, heart disease, and diabetes.

Some mothers, however, choose formula feed as it is more convenient than breast milk. Formula feeding allows time flexibility and enables the partner to feed the child. But is formula feeding healthy for the child?

Use of formula feeds in early infancy has a 2.5 times higher risk of making the child unhealthy and malnourished. An early switch to formula feeding increases a child's risk of developing severe health conditions like necrotizing enterocolitis(a life-threatening disease of the intestines). It is also associated with a higher risk of developing chronic conditions like diabetes and asthma.

Investment in breastfeeding is significantly low in India. In India, only 50% of newborns get breast milk within the first hour of birth, and only 55% get exclusive breastfeeding for the first six months of life. 

Formula feeds are not only expensive but also result in more kids getting hospitalized due to related complications. Poor breastfeeding practices lead to child deaths and cognitive losses, which result in an economic loss of $14 billion per year!! India currently spends only Rs 10 per child to maintain adherence to good breastfeeding practices. Promoting good breastfeeding practices would thus result in direct and indirect economic gains for the country.

Formula feed, even though known to be worse than breast milk, is indicated in certain health conditions related to the mother and the child. Infants suffering from specific genetic disorders (like galactosemia and MSUD) can not tolerate breast milk and, therefore, require specific artificial feeds. Infants with low birth weight require additional nutrition besides breast milk, given through formula feeds. In certain maternal conditions like active herpes infection, consumption of certain drugs or severe illness that prevents the mother from breastfeeding, one can give formula feeds.

Setting up breast milk banks could be argued to be a possible solution. However, ethical malpractice becomes a cause for concern. More than 80 non-profit breast milk banks are in the country, but the recently approved sale of breast milk for profit has raised many eyebrows. It opens up a window for exploitation and could lead to a scandalous blast from the past.

Breastfeeding in public: a challenge for all mothers

One advantage of formula feeding is that one can feed babies in public. According to a survey in India, only 6% of mothers could find designated public areas to nurse their children. Due to the lack of designated places, 81% of the surveyed women felt uncomfortable breastfeeding in public, the most significant barriers being hygiene and awkward stares.

Social stigma is a pervasive issue, not just in India but globally. Women from all corners of the world have expressed feelings of embarrassment when breastfeeding in public, often feeling judged by others. These adverse experiences are mainly due to the sexualization of breasts in our society, overshadowing their primary role as a child's source of nourishment. 

Even though many countries have addressed this issue and made attempts to reduce the social stigma associated with breastfeeding, a lot of work still needs to be done, especially in India. A breastfeeding room, which should be part of the construction plan of public places and buildings, is not currently included in the National Building Code of India (NBC) 2016, a comprehensive building code. 

Impact of social support on breastfeeding

Postpartum depression decreases milk production and affects the nourishment of the child. Due to cultural and personal inexperience, mothers usually find themselves alone in such scenarios. Studies have shown that social support not only helps in fighting depression but also improves breastfeeding practices and even breastmilk production. A study showed that support from the mother, father and husband was associated with early initiation of breastfeeding and prevented pre-lacteal feeds(any food except mother's milk provided to a newborn before initiating breastfeeding, a practice harmful to the baby).

A study done in Thailand found that training mothers and grandmothers helped improve breastfeeding practices. Informational, instrumental, and emotional support is necessary to promote good breastfeeding practices. Breastfeeding knowledge still needs to improve in our community, with only half the women aware of good breastfeeding practices. This study highlights the supportive role of the community in breastfeeding. Contrary to belief, breastfeeding is not a mother's responsibility alone.

Is traditional support better than online support?

The COVID pandemic has significantly increased the acceptability of remotely provided care, even breastfeeding support. Some consider online support more accessible than real-life support. Not only can it be accessed at convenient times, but it also helps maintain anonymity for those affected by the social stigma. But does online support have the same impact as traditional in-person support?

A study showed that online support groups affect breastfeeding practices similarly to traditional support. It is better than no support at all. Therefore, one should opt for online support when no other option exists. This study, however, did not compare the impact of online vs. traditional support on women's mental health and satisfaction.

To conclude, poor breastfeeding practices are a substantial public health problem in India. We need to enable breastfeeding by empowering women with knowledge and social support. As a supportive community, we can improve the acceptance of healthy breastfeeding practices, leading India to a healthier tomorrow.

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Edited by Christianez Ratna Kiruba

Image by Janvi Bokoliya