World Breastfeeding Week 2022: Why exclusive breastfeeding is still difficult for many mothers

"The first one month post childbirth was the toughest phase for me. Doctors and women from my family suggested me many things about breastfeeding practices, but, there was no one to teach me practically," says city-based yoga-therapist Dwee Chintan Pathak, whose child was diagnosed with mild jaundice at the time of birth, which disallowed the mother from breastfeeding in the first crucial hours after childbirth.

Diya Deepak Mathal, a 33-year-old domestic worker from Mumbai, had to resort to bottle-feeding her children in less than six months in order to resume work to stabilise the financial situation at home. While she could manage breastfeeding the baby, it was difficult to ensure exclusive breastfeeding for six months.

The first breastmilk of a mother contains colostrum, which is highly nutritious and has antibodies that protect the newborn from diseases. According to the fifth National Health and Family Survey (NFHS), breastmilk contains all of the nutrients needed by children in the first six months of life and is an uncontaminated nutritional source, which is why it is recommended that children be exclusively breastfed in the first six months of their life; that is, they are given nothing but breastmilk.

However, similar to Pathak's and Mathal's case, a number of factors such as household chores, employment conditions of women and a lack of inclusive and supportive environment encouraging breastfeeding practices often discourage a new mother from practicing exclusive breastfeeding. In India, the median duration of exclusive breastfeeding is 3.9 months.

Challenges faced by women in the informal sector

While women in the formal sector are eligible to apply for paid maternity leaves, those engaged in informal work are not covered under such maternity benefits, thus, making it difficult for them to ensure optimum care of their newborns and themselves.

In such situations, women are forced to resume work in less than six months or leave the job. Those who cannot afford to take a break due to their socio-economic conditions end up juggling between their work, household chores and taking care of their baby at the cost of their own physical and mental health.

Mathal, who stays with her husband and two children, had to resume work two months after the delivery of her second child in 2018. After working at one house for two to three hours early in the morning, she would return home to feed the baby and then continue completing her chores for the day. "Though I could breastfeed the baby a couple of times in a day, there were days when I had to depend on outside milk. So, it was never possible to practice exclusive breastfeeding," she adds.

Anil Parmar, vice President, community investment, United Way Mumbai, an organisation focusing on health, education and other development concerns of communities, says, for women working as a daily wager in cramped conditions with limited or no sanitation infrastructure, it is nearly impossible to find a safe space for breastfeeding.

According to Dr. Kavita Puranik, assistant manager - community investment, United Way Mumbai, the Pradhan Mantri Matru Vandana Yojana, provides women in the informal sector with a direct cash transfer of Rs. 5,000 to compensate for loss of wages and encourage her to seek better healthcare. While this supports to some extent, it does not cater to need of breastfeeding support at workplace.

Not just woman's responsibility

"The baby was not given to me post-childbirth and was taken away for hours, thus, cutting off the first interaction of the infant with the mother. Further, bottle-feeding the baby for the first 21 days completely transitioned the breastfeeding process. The child was later unable to adapt to suckling milk from the mother's breast," says Pathak.

According to Parmar, many medical and paramedical personnel do not allow mothers to feed the child within the first hour of the birth, which is crucial for early initiation of breastfeeding. According to the NFHS-5, in Mumbai, only 51 percent of the children less than three years were breastfed within the first hour.

A considerable delay in adopting regular breastfeeding practices greatly impacted Pathak's health leading to engorged breasts and sometimes, lower production of milk. According to NFHS, early initiation of breastfeeding enhances the bond between the mother and infant leading to regular production of milk. In Mathal's case too, packaged milk became an alternative when the breast milk was not sufficient to feed the baby through the day.

Project Poshan of UWM aims at educating and providing nutrition to women during pregnancy and post-pregnancy period. A baby shower ceremony is one of the community programmes organised by UWM to group counsel expectant mothers. Photo Courtesy: United Way Mumbai

While Pathak could learn to tackle such dire situations with the guidance of her mother and mother-in-law in her house, there are many women who lack such support and may not always reach out for help due to stigma or lack of security.

"I feel women should get a support system, who can guide them about breastfeeding during their delivery. This is very crucial, but I feel it's lacking," says Pathak.

Pathak and Mathal stress on the need for support from immediate family members, including men, after this period. This not only includes helping with household chores or ensuring enough rest for the mother, but also, providing adequate emotional support to help the mother deal with hormonal changes affecting her mental health.

In the UWM community level programmes in Mumbai, health facilitators work to tackle such gaps in healthcare and provide early counselling to expectant couples on proper birth control methods, early nutrition, timely checkups, usage of Iron Folic tablets and the importance of exclusive breastfeeding practices.

Unaddressed concerns

Lack of designated breastfeeding spaces in public places and in workplace areas is one of the major underserved needs of child-bearing women in India. In Mumbai, one can find a baby-feeding room at Bandra, Lokmanya Tilak Terminus, Chhatrapati Shivaji Maharaj Terminus and Mumbai Central railway stations. While this is encouraging, there is also a need to develop more such centres in other easily accessible public spaces and institutions.

Workplaces, government, private or those employing daily wage earners, must dedicate adequate breastfeeding spaces with basic amenities. Such facilities, as Parmar notes, will go a long way in supporting lactating mothers with flexible work schedules to accommodate breastfeeding requirements. A lot also depends on the workplace policy and the management's efforts to sensitising employees to tackle stigma related to breastfeeding employees and create a supportive, healthy and safe work environment.

When it comes to accessibility to healthcare services and guidance during childbirth, Parmar suggests, "Measures needed are ensuring dedicated breastfeeding counsellors at the hospital or training of the Accredited Social Health Activists and Auxiliary Nursing Mid-wives to provide counselling to new mothers well beyond delivery up to 3-4 months."

As many mothers switch to bottle-feeding and wean off the baby from breastmilk due to multiple reasons, it is important to educate the parents about exclusive breastfeeding from birth, complementary feeding strategies, provision of food supplements and micronutrients for lactating mothers, the importance of first milk and time of natural weaning.

Parmar also highlights that promotion of brands providing infant milk substitutes have also caused a decline in exclusive breastfeeding practices. "There has been a decline in exclusive breastfeeding due to various factors, including unethical advertising and aggressive promotion of infant milk substitutes by commercial industries. The government should review such activities and take remedial action wherever necessary."

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