SHIMLA: A study published by the UK based world’s leading independent medical journal “Lancet†has said that a new hope has emerged in the form of mother’s milk for rapidly reducing the infant mortality and improving child under nutrition in India. Breastfeeding promotion alone can reduce the infant mortality rate (IMR) by 11.6 percent in India where 57 infants out of 1000 die every year at birth. The highest IMR is in States like Uttar Pradesh (73), Chhattisgarh (71) and Madhya Pradesh (70) where as it is lowest in States like Kerala and Goa (15), Tamilnadu (30) and Himachal (36).
The new Lancet series reiterates that ‘promotion’ of breastfeeding and complementary feeding has to be scaled up to reach 99 percent coverage if we want a significant dent in IMR. However, it specifies that such promotion has to be ‘one to one individual counselling’ and ‘group counselling’, and not the traditional IEC campaigns. Correct counselling has the potential of increasing exclusive breastfeeding substantially during first 6 months. The new research points out that even if all other nutrition risks were addressed, a substantial number of child deaths still require interventions related to breastfeeding practices. 77 percent (1.06 million) child deaths attributable to suboptimal breastfeeding are due to non-exclusive breastfeeding during 0-6 months of life.
Breastfeeding Counselling is among three interventions found to have the greatest benefits. Predominant breastfeeding (breastfeeding plus water) increases the risk of child mortality 1.48 times as compared to exclusive breastfeeding. Partial breastfeeding (breast milk plus other milks or foods) increases the child mortality 2.8 times as compared to exclusive breastfeeding. The relative risk for prevalence of diarrhoea is 3 times higher and for pneumonia I 2.5 times higher for partial breastfeeding as compared to exclusive breastfeeding. With the exception of Chhattisgarh, the rest of the Indian states have extremely low rates of exclusive breastfeeding. The national average is close to 46.4 percent, with Haryana being lowest at 16.9 percent. Clearly, exclusive breastfeeding for a period of six months is not a practice among more than 20 million infants of the 26-27 million born each year.
Other recent epidemiological evidence suggests that beginning breastfeeding within first hour would have additional benefit with regard to mortality even in exclusively breastfed infants. The Lancet series reaffirms the recommendation to begin breastfeeding immediately after delivery. Given the high infant mortality and under nutrition, India needs a time bound action plan for each state with earmarked budgetary resources to scale up coverage of breastfeeding and complementary feeding promotion to 100 percent.
According to the editor of Lancet Series, Richard Horton, “the compelling logic of this scientific evidence is that governments need national plans to scale-up nutrition interventions, systems to monitor and evaluate those plans, and laws and policies to enhance the rights and status of women and children”.
Meanwhile the World Health Organisation (WHO) has also provided evidence that suggests breastfed babies were found to have a lower mean blood pressure and lower total cholesterol, reduced prevalence of overweight, obesity and type-2 diabetes in adulthood. Concerning obesity, WHO study found that breastfeeding was associated with a 22 percent reduction in the prevalence of overweight and obesity. For blood pressure, the effect of breastfeeding was less than those derived from other public health interventions targeted at adults, such as dietary advice, physical activity, salt restriction, and multiple risk factor interventions.
KY Singh is a political observer and a senior journalist with an interest in a diverse set of issues related to Himachal Pradesh and other mountain states. He lives in Shimla.
