Experts highlight importance of early initiation & exclusive breastfeeding during COVID-19 pandemic

New Delhi: On the occasion of World Breastfeeding Week (1st to 7th August) experts from Nutrition International, India highlight the importance of early initiation and exclusive breastfeeding during the COVID-19 pandemic. The theme this year is ‘Protecting Breastfeeding: Where Lies the Responsibility?’.

A mother’s breast milk is like a vaccination that nourishes the baby lifelong. It builds immunity and cognition, reduces the risk of stunting, and protects the baby from diseases and death. It is naturally fortified with nutrients and antibodies making it even more important in COVID-19 times to protect both babies and mothers. Despite strong evidence supporting its immediate and long-term health benefits, timely initiation and continued breastfeeding is not practised widely. Phase one of the NFHS 5, 2019-20 notes that despite improvements in the institutional deliveries, only 50 percent of newborns are breastfed within the first hour of birth, and this was the situation before the pandemic.

Since the COVID-19 outbreak, there has been a disruption of services provided at health sub-centres and Anganwadi Centres as well as a reduction in institutional deliveries, resulting in a decline in uptake of key services such as antenatal and postnatal care and counselling of pregnant and lactating women and weighing of children. With a lack of appropriate care support and counselling and the fear of infection, a unique set of challenges are emerging concerning fake news and myths such as breastmilk being a carrier of the COVID-19 virus, which discourage breastfeeding.

In addition, the high burden of care responsibilities on women who enact multiple roles within the household makes exclusive breastfeeding for the first six months challenging. Between completing domestic chores and working to supplement the family income, little attention is paid to the mother. Additional barriers such as inadequate maternity leave legislation, and unregulated and inappropriate marketing activities within the breast milk substitute industry, have today contributed to low rates of breastfeeding.

“With the persistent fear of the third wave of COVID-19 and vaccination for infant and young children still not in sight, it makes re-focusing on breastfeeding even more important”, says Mini Varghese, Nutrition International’s Country Director for India. Ensuring the implementation of breastfeeding within one hour of birth during all institutional deliveries will be an important step towards achieving the target. We need to identify barriers within the labour room and address them through capacity and infrastructure building to improve breastfeeding practices.

Speaking on this Anganwadi Worker, Nidhi Shrivastav from Datia District, Madya Pradesh shares, “There are many myths around breastfeeding for COVID-19 positive or recovering mothers. COVID-19 positive mothers who give birth refuse to breastfeed as they fear they’ll pass the infection onto their babies. However, we work on counselling these new mothers and their families on the lifesaving benefits of breastfeeding. We also encourage them to take precautions such as washing their hands, wearing masks and sanitizing surfaces for safe breastfeeding practices.” The need of the hour is targeted myth-busting for mothers and influencers in the family and community.

Despite breastfeeding being cost-effective, baby food companies continue to attack and replace breastfeeding with their products. Some major achievements made to counter this include the World Health Assembly (WHA) endorsing one of the most powerful tools to protect breastfeeding — the “International Code of Marketing of Breastmilk Substitutes” — recognizing that commercial marketing of baby foods is harmful to the health of infants. In India, the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 (IMS Act) bans all forms of promotion of foods marketed to children up to two years of age. Decades of relentless struggle of mothers, health professionals, public health experts, activists, against the corporate push for powdered milk formula, made this possible.

“While India has a law to protect breastfeeding, it needs action for enforcement”, says Mini Varghese. All the concerned stakeholders including professional associations need to come forward to support the government to ensure that the IMS Act is implemented in its true spirit. The ‘zero separation’ policy to promote early initiation of breastfeeding which mandates the newborn to be put between the breast immediately after delivery to maintain skin-to-skin care for the first few hours after birth, has been a critical first step towards the ‘right start’ of life. However, a long journey is still underway.

Varghese further recommends investing in two aspects of critical importance. Firstly, counselling of pregnant women and their families on early initiation and exclusive breastfeeding during every interaction with them. Secondly, capacity building of labour room and postnatal care ward staff and retaining them in these facilities. While the disruptions in services and counselling have highlighted the deficiencies in our health and nutrition services, they also present an opportunity to adopt new approaches.

Labour code legislations mandate the provision of creches at work-site facilities to enable working mothers to breastfeed their infant, without withdrawing from the labour market. Such practices require better implementation and advocacy so that babies are not deprived of breastmilk or mother care. It is also crucial to normalize breastfeeding in public spaces and action is needed to build this as a societal norm as well as develop infrastructure to support such practices.

There is a need to accelerate efforts to make sure that the gains achieved in the past decades aren’t lost. Children are the future and adequate investments in their health and nutrition need to be made to ensure a solid foundation for their growth and development.