Science versus Traditions—who wins in exclusive breastfeeding practices in India?

16 Aug

Posted by: Aishwarya Sivaramakrishnan and Neel Nitin Karnik

Category: Public Health and Nutrition

Science versus Traditions—who wins in exclusive breastfeeding practices in India?

The World Health Organization (WHO) provides specific guidelines on exclusive breastfeeding and prescribes breastfeeding within the first hour of the baby’s birth and exclusive breastfeeding for the first six months of its life. This means that no other food or liquids must be administered, including water. This practice is considered one of the most effective ways to ensure infant health and prevent infant mortality. In addition to this, it is also healthy for new mothers to breastfeed, given how it can reduce the risk of having breast and ovarian cancer and high blood pressure.

However, tradition, which has a much stronger hold on people’s psyche, continues to win when newborns are fed substances such as water, honey, and cow’s milk alongside breastmilk in parts of India.

Over the years, the National Family Health Surveys have been tracking the progress toward making an indicator that measures whether EBF is practised. As we can see from the graph, a significant increase is visible in these practices.

This progress results from relentless efforts by frontline workers, such as ASHA, with the help of programs under the National Health Mission and POSHAN.

But what’s next?

The resources needed are in place and active, but how do we progress now that we live in a world afflicted by health emergencies such as the COVID-19 pandemic?

Evidence suggests that messages received by women from immediate family on EBF are powerful, and families play a crucial role in actualizing optimal EBF practices. Therefore, targeting these messages by addressing the issues associated with such traditions can help establish EBF as a standard practice.

Addressing problematic traditions can be challenging precisely because of the strong social and cultural acceptance gained after having been passed on over generations. But to dispel these beliefs, it is crucial to understand their origin and the way they manifest today.

Water feeding practices to avoid the feeling of thirst in the infant

It is commonly believed that, just like adults, infants feel thirst and therefore require water, especially during the summer months. However, breastmilk contains all the nutrients a newborn needs, which includes water to quench its thirst. Feeding newborns water can be harmful, especially since external sources can contain germs, which can weaken their immune system by causing diarrheal diseases.

Feeding honey to the infant for future prosperity

Indian traditions for a newborn often tend to revolve around bringing luck and fortune to the baby and its family, which is why feeding a newborn with honey is considered a good practice to ensure a prosperous life for the child. However, honey, like water, can harm a baby because it contains bacteria that have the ability to cause muscle weakness, with signs like poor sucking, a weak cry, constipation, and decreased muscle tone (floppiness).

Discarding colostrum because it is considered “bad”

Colostrum is the first form of breastmilk released right after giving birth and is nutrient-dense, high in antibodies and antioxidants to build an infant’s immune system. But because of its distinct yellow color, it is often perceived to be impure and is, therefore, discarded. Despite being incredibly nutritious for the newborn, the belief about it being “unclean and bad” for the newborn’s health continues to dictate breastfeeding practices.

These harmful practices continue to thrive, owing their establishment legitimacy to traditions and cultural beliefs. Furthermore, enforces of these traditions tend to be influential family figures.

In an Indian household, it is common for this kind of power to be held by the figure of the mother-in-law. In rural areas, where mobility continues to be an issue for women, venturing out of the house, especially when pregnant, poses a problem of living in an echo chamber where these traditions are emphasized and enforced regularly.

Given how rooted these cultural beliefs are, how do we go about dispelling them and increasing the adoption of EBF?

Technology can be a potential solution.

With increasing internet and smartphone penetration, information access is becoming democratized. Mobile health applications, such as BEST4Baby, can improve messaging effectiveness by supporting counselors in conducting six visits of messaging within the first month of birth. Audio-visual content on EBF-related information and answering common queries that mothers have can ensure that women can access quality and reliable information at their fingertips. This can help reduce their dependence on cultural beliefs and encourage adopting desirable practices. Popular social media platforms like Facebook and YouTube can also be harnessed to host EBF-related content that is informative and entertaining. The idea is to have easy access and impactful messaging to improve EBF practices.

However, merely providing timely information is not enough. Challenging these existing cultural beliefs around childcare to affect positive change is essential. Childcare has been considered women’s responsibility in India. As a result, most health-based messaging is aimed towards women – mothers, mothers-in-law, and other female family members, and not men.

Men play an influential role in household decision-making, which is why they can be made part of health messaging and counselling.

Although husbands might not provide specific health advice to their wives, they can be enabled to offer care-based messages. By including men in health counselling, they can have greater knowledge and awareness, thereby supporting and creating an enabling environment expecting members of their families with decisions around breastfeeding. This can also affect positive change in increasing men’s involvement in childcare and, in turn, support wider EBF adoption.