Reduction in prevalence of breastfeeding could occur due to limitations in provision and use of health services amid COVID-19 pandemic
The road to motherhood amid the novel coronavirus disease (COVID-19) pandemic was arduous for Soni Devi, 22, a resident of Uttar Pradesh’s Sonbhadra. She became a mother for the first time on April 30, 2020.
There was no ambulance service to take Soni to the healthcare centre when she went into labour amid the countrywide lockdown. After a couple of hours, as her family was preparing for the possibility of a home delivery, a grass roots level local non-profit partner of Child Rights and You (CRY) — Sonbhadra Vikas Samiti (SVS) — intervened. A few frantic phone calls later, a transport arrived.
Soni was rushed to the health sub-centre in the middle of the night and she delivered a healthy baby.
Post-delivery, she did not receive any advice on breastfeeding, as the auxiliary nurse midwife (ANM) at the facility was busy on COVID-19 duty elsewhere. Being a first-time mother, she could not give colostrum — the first milk due to absence of technical support / handholding by an ANM on the colostrum feeding procedure.
However, when Soni reached her village, CRY partner team (which provides interpersonal maternal and child counselling including the importance of exclusive breastfeeding through the counselling and monitoring centre) guided her on continued breastfeeding. But, by then, the opportunity of colostrum feeding was lost.
Unfortunately, there has not been much of public discourse on the impact of COVID-19 on maternal and child mortality in low-income and middle-income countries, and the potential consequences of disruptions to routine healthcare.
However, reduction in prevalence of breastfeeding could occur due to limitations in the provision and use of health services and disruptions to the enabling environment.
Lack of skilled health workers and increased reluctance by women to use healthcare system could lead to decrease in coverage of ante-natal care, post-natal care, and facility and community based lactation support and counselling.
According to National Family Health Survey (NFHS)-4 (2015-2016), only 41.6 per cent of children below three years were breastfed within one hour of birth; and 54.9 per cent children under six months of age were exclusively breastfed. The data is from pre-COVID times; the figures may drop further.
Not being able to provide colostrum is just one of the many challenges that lockdown has brought in for the new-born babies and their mothers.
Why is breastfeeding essential?
The first health benefit for the infant that comes to mind is their first shot at immunity and nutrition. The mother’s milk not only provides the right nutrients to build the foundation of a child’s healthy life, but also saves thousands of children. Breastfeeding reportedly plays a crucial role in prevention of sudden infant death syndrome.
While breastfeeding can do wonder to the infants, it is also beneficial for the lactating mothers: It averts development of cancer, diabetes, heart disease, osteoporosis and deaths in women.
Another grey area that is linked to nutrition of mothers is child marriage and early pregnancy. When young girls who are married off and become pregnant before they are bodies are fully matured may experience devastating health effects.
As complications from child birth are often deadly and their bodies aren’t prepared enough to handle them, the risk of maternal and new born death and morbidity shoots up.
Nutrition had become a far-fetched dream for lactating mothers belonging to the underprivileged groups during the lockdown.
According to NFHS-4 (2015-2016), at least 42.7 per cent of children aged six-eight months received solid or semi-solid food and breast milk, while 8.7 per cent breastfeeding children were receiving an adequate diet.
The percentage is likely to fall during COVID-19 times, thus impacting the survival and health of mothers and babies alike.
The pandemic has also raised concerns about whether mothers with COVID-19 can transmit the SARS-CoV-2 virus to their infant through breastfeeding. Accoridng to a recent study published in The Lancet Child & Adolescent Health Journal, mothers with COVID-19 infection are unlikely to pass the virus to the new born.
It stated that infected mothers can also breastfeed their babies and stay in the same room with their new borns safely, provided they use face covers and follow infection control protocols such as hand washing, etc. It also underlined that the sample size in the study was small to draw firm conclusions.
The World Health Organization (WHO) has highlighted that risk of COVID-19 infection is comparatively low in case of infants, and the infection is typically mild or asymptomatic in cases of contamination. But the consequences of not breastfeeding can be significant.
CRY and its non-profit partners have been providing Infant and Young Child Feeding training to mothers so that babies do not miss colostrum and exclusive breastfeeding. The state governments need to proactively share this information with mothers or get it disseminated via different channels.
The governments must take adequate measures to ensure that ANMs support new mothers post deliveries, while ensuring that quarantine centres have dedicated spaces for breastfeeding.
Busting myths around mother-child infection, providing adequate nutrition to generating awareness on breastfeeding, creating breastfeeding spaces within house / quarantine centres and delegating ANMs at health centres for deliveries — these are just some of the steps which crucial to address the challenges.
Children may not be the face of the pandemic at present, but if they are not breastfed, immunised or their health is not prioritised, many other infections apart from COVID-19 may weaken their health that are may cripple them.
It’s been a long battle to gradually change the societal mind-set around breastfeeding: It has taken effort, resources and finances. Let it not all go to waste.
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