Ensuring Early Initiation of Breastfeeding to Save lives

Early initiation of breastfeeding goes a long way to improving an infant’s and mother’s health and reducing the risk of mortality.

This year’s theme surrounding the breastfeeding week— “Step up for breastfeeding: Educate and Support”—focuses on building support systems in marginalized settings to promote breastfeeding practices. Articulating both behavioural adherences as well service provision requirements, this theme argues for collaborative engagement of multiple partners to ensure the lifesaving intervention of breastfeeding.

India has one of the highest infant mortality rates (30 deaths per 1000 live births, SRS 2022) and neonatal mortality rate (20 death per 1000 live births, WHO 2020). Most neonatal deaths (75%) occur during the first week of life. In 2019, about 50% of newborns died within the first 24 hours.

This can be attributed to various factors such as poor healthcare service delivery, childhood illnesses, poor healthcare access, and sub-optimal breastfeeding interventions. The World Health Organisation (WHO) suggests that breastfeeding is one of the most effective ways to ensure the health and survival of the child. Literature shows that newborns who began breastfeeding between 2 and 23 hours after birth had a 33% greater risk of dying than those who began breastfeeding within one hour of birth.

Exclusive breastfeeding (EBF) is the practice of giving an infant breast milk for the first six months of life, with no other food or water added and is the cornerstone of optimum infant nutrition. On the other hand, Early Initiation of Breastfeeding (EIBF) is defined as the initiation of breastfeeding within 1 hour of delivery. While the priority focus remains on EBF, EIBF should not be neglected.

Recent NFHS data suggests that only 41.6% of the children initiated breastfeeding within 1 hour of life, suggesting that a majority of the newborn are missing the colostrum (first thick yellow milk) within the golden hour. This is also disturbing because close to 90% of deliveries are conducted in health facilities. This delay affects cognitive development, child growth, and natural immunity. The slower pace of improvement in EIBF rates can be associated with behavioural and health service delivery factors. Some of these are:

• Feeding baby prelacteal: It is a common practice among elders to feed the baby with honey as soon as they are born. Furthermore, health professionals also give newborns specific liquids such as sugar water or infant formula. All these delay a newborn’s first critical contact with its mother. Such practices continue to be prevalent in both home-based and facility deliveries.

• Lower EIBF rates in private health facilities: With a high number of mothers going to private health facilities for delivery, their lower EIBF compared to public facilities is a cause of concern. This suggests a binding implementation of the EIBF protocol in private healthcare facilities to ensure the newborn’s well-being.

• Rise in elective C-sections: In India, caesarean section rates have more than doubled between 2015 and 2019, increasing from 17.2% to 21.5%(NFHS-5). This has been associated with the limited practice of early initiation of breastfeeding. Global evidence also suggests that early initiation rates are significantly lower among newborns delivered by caesarean section.

• Gaps in the quality of care provided to mothers and newborns: An important part of delivery care is the support provided by skilled birth attendants for breastfeeding. A recent large-scale study in UP suggests that only 50% of the mothers received support in breastfeeding. This aligns with the system’s limitation in terms of human resources, as in many cases, babies are separated from their mothers immediately after birth and guidance from health workers is limited.

• Limited system’s focus on the support systems for mothers: NFHS-5 data shows that 90.2% of pregnant couples received advice on breastfeeding, but only 60.4% of fathers could recall someone explaining its importance to them. This limits the partner’s support in breastfeeding for mothers and children.

These challenges, while restricting EIBF, affect both child development and maternal health. To mitigate these challenges, systemic and behavioural interventions are required, including but not limited to improving breastfeeding counselling during pregnancy, breastfeeding support post-delivery, and building community networks to support the early initiation of breastfeeding.

Increased focus on such issues will ensure health benefits and strengthen India’s economic development. The modelling tool developed by Alive and Thrive shows that the total economic cost to India incurred due to not breastfeeding is estimated to be around $14,458 million each year, costing our GDP by 0.7%.

The pandemic has made us realize the importance of good health. We must rethink our health actions and step up for breastfeeding to help mothers and children achieve adequate nutrition for a healthier and safer tomorrow.

Shubham Gupta – Senior Manager, Sambodhi