Friday, December 1, 2006

By Gyan Pathak

Had the mothers of our country taken enough care to breastfeed their newly born babies, over 15 per cent of 24 lakh child deaths every year could have been averted, especially if optimal breastfeeding practices were scaled up to 90 per cent, says the State of the World Breastfeeding, India Report Card - 2006.

The report has recently been released by International Baby Food Action Network, Asia-Pacific. As for the South Asia, over 3.7 million children die every year before they reach five years of age. Of these, 2.2 million children die before they reach their first birthday. Foeticide of female children and other killings of born and unborn children are obviously not included in this data.

Reading this report on breastfeeding practices in India reveals that more than 11 lakh babies die during first month of life, and another 5 lakh during two to 12 months of age. It is happening despite the fact that 22 per cent of all neonatal deaths could be reduced if breastfeeding is initiated within one hour of birth by all mothers.

According to the assessment made during the year 2005 - 06, only 15.8 per cent of the mothers breastfeed their babies within an hour of birth of their babies. Newly born children need exclusive breastfeeding for the first six months, but only 46.9 per cent of the mothers do that. Resorting to bottle feeding the children below the age of six months is 13.7 per cent while complementary feeding practices are prevalent for 35 per cent of the children in the age group of 6 - 9 months. Indian mothers are good at only in median duration of breastfeeding the babies of 0 - 17 months. Our average mothers continue breastfeeding until 25.4 months.

India may be the biggest and strongest country in South Asia, however, in good breastfeeding practices it scored only 68 marks out of 150. It ranks sixth among eight South Asian countries, the report says. No country in South Asia has best practices, however, Sri Lanka and Bangladesh have somewhat better practices ranking first and second in the region. The Maldives ranks third, Pakistan fourth, Nepal fifth, and having scored equal marks Afghanistan and Bhutan ranked seventh.

India scored zero marks in maternity protection that concerns paid maternity leave, paid breastfeeding break, national legislation encouraging work site accommodation for breastfeeding and/or childcare and ratification of ILO resolution in this regard.
Another area where India scored zero is “infant feeding during emergencies”. There is no concern in India regarding policies and programmes on infant and young child feeding in emergencies and even awareness materials in emergencies integrated into pre-service and in-service training for emergency management.

Other areas where the situations are somewhat alarming includes Health and Nutrition care that scored only 3.5 and Infant feeding and HIV that scored only three. Health and nutrition care concerns health provider school and pre-service education programmes, standards and guidelines for mother-friendly childbirth procedures, in-service training programmes. Infant feeding and HIV concerns policies and programmes to address infant feeding and HIV issues and on-going monitoring of effects of interventions on infant feeding practices and health outcomes for mothers and infants.

Even the majority of our hospitals are not baby friendly and the initiatives taken so far scored only 4.5 out of 10 marks. Percentage of baby friendly hospitals, training, standard monitoring, assessment and reassessment systems are at yellow mark indicating the dangers in this area.

We even lagged behind in “information support” that scored only four marks, “National policy, programmes and coordination”, “Community outreach” and “Monitoring and Evaluation” scored five marks each.

Evidence has shown that under nutrition among infants underlies the majority of deaths, making optimal infant and young child feeding crucial to any strategy to reduce child mortality. As most of the deaths occur in the first year of life, we have to devise emergency measures on priority basis.

It is needed more so because, legally speaking, a child unborn or born, has also a fundamental right to life or survive. Causing their death, intentionally or negligently is certainly homicide. Let us always keep this in mind while devising plans and policies, and after making necessary framework, let us vigorously implement them.#