Health

Early breastfeeding practices in India: Missing link with institutional deliveries

India has increased institutional delivery rates to reduce maternal mortality, neonatal mortality

 
By Sachin Kumar Jain
Last Updated: Wednesday 28 August 2019
Photo: Getty Images

Institutional deliveries do not guarantee early initiation of breastfeeding (colostrum), within an hour of child birth. Health institutions and service providers seem to be reluctant towards promoting early breastfeeding.

India has kept a clear focus on increasing institutional deliveries to reduce maternal mortality and neonatal mortality. Even though 80 per cent deliveries are now institutional in many states, the rate of early breastfeeding is between 30 per cent and 60 per cent, according to the fourth National Family Health Survey.

Huge disparities have been recorded within states. 

Maharashtra

In the state, 57 per cent newborns are breastfed within an hour of birth, while 90.3 per cent deliveries take place in institutions. In Gondiya district, which recorded 82.6 per cent institutional deliveries, 69.7 per cent newborns were breastfed within an hour of birth. Almost the same standards were maintained by Osmanabad and Chandrapur districts.

But in Bhandara district, early breastfeeding rate was only 32.6 per cent against 98.7 per cent institutional deliveries. Similarly, in Aurangabad, only 43.55 children received early breastfeeding, but 93.5 per cent deliveries took place in institutions.  

Uttar Pradesh

In India's most populous state, 67.8 per cent deliveries took place in institutions, yet it recorded the lowest early initiation of breastfeeding rates in the country — 25.4 per cent. In Mahoba district, 89.6 per cent deliveries are institutional, while only 46.65 per cent children were breastfed early.

In Lalitpur, 84.5 per cent children were born in institutions, yet only 41.4 per cent children received early breastfeeding. Meerut had 65.2 per cent deliveries in institutions, but only 12.5 per cent children were breastfed early. 

Madhya Pradesh 

The state has in the past years recorded high levels of neonatal and infant mortality, maternal mortality and malnutrition and thus has been in the public eye. The state has 80.8 per cent deliveries in institutions, but only 34.6 per cent children received early breastfeeding.

In Bhopal, 91.7 per cent deliveries are institutional, but only 16.9 per cent children are breastfed early. But in tribal-dominated Shahdol and Balaghat districts more than 50 per cent children are given breast milk early.

Rajasthan 

The desert state reported that 84 per cent deliveries are taking place in institutions, yet only 28.4 per cent newborns are breastfed within one hour of birth. Rajsamand district reported 84.7 per cent institutional deliveries, whereas only 13.1 per cent children were fed breast milk within an hour of birth.

Baran district, dominated by Saharias (a particularly vulnerable tribal group), reported 97 per cent institutional deliveries but only 45.2 per cent children were breastfed early.

Punjab

One of India's most prosperous states reported 90.5 per cent institutional deliveries. Yet, only 29.9 per cent of the newborns received breastfeed within an hour of birth. Gurdaspur district recorded 87.3 per cent deliveries in institutions, but only 19.1 per cent children under-3 years were breastfed within an hour of birth.

Mapping of institutional deliveries and early initiation of breastfeeding

Odisha

Odisha, on the other hand, was among states with the highest rate of early breastfeeding in the country. It had 85.4 per cent institutional deliveries and 69 per cent of the children were breastfed within an hour of birth.

Boudh (with 82.6 per cent institutional deliveries vs 89 per cent early breastfeeding rate), Balangir (87.1 per cent institutional deliveries vs 87.9 per cent early breastfeeding rate) and and Nuapada (84.7 per cent institutional deliveries vs 86.6 per cent early breastfeeding rate) were the districts where early initiation of breastfeeding was higher than the level of institutional deliveries. 

Meghalaya 

Among north-eastern states, Meghalaya had 51.4 per cent institutional deliveries, while 60.8 per cent children were breastfed within an hour of birth. Districts such as Ribhoi (77.9 per cent), West Khasi Hills (68.2 per cent) and West Garo Hills (66.5 per cent) recorded the highest number of breastfeeding within an hour of birth.

Mizoram

In Mizoram, 80.1 per cent deliveries are institutional and whopping 73.3 per cent children were fed with breast milk within an hour of birth. Saiha district with 60.6 per cent institutional deliveries recorded 87.2 per cent early breastfeeding rate, whereas it was 86.6 per cent in Mamit, where institutional deliveries was 58.75 per cent. Kolsib district, with 87.7 per cent institutional deliveries, 79.8 per cent children were breastfed early.

Kerala

In Kerala, 99.9 per cent deliveries are institutional and 63.3 per cent children are breastfed within one hour of birth. Districts such as Kottayam (81.4 per cent), Kannur (76.4 per cent) and Kozhikode (72.6 per cent) recorded highest rate of breastfeeding.

Early initiation of breastfeeding must be considered as one of the most urgent and non-negotiable indicator of a nation’s development. To achieve the United Nations-mandated Sustainable Development Goals (Goal 3.2) to end preventable deaths of newborns and children under-five, by 2030, a set of interventions are required to be followed. They include:

  1. Strict implementation of infant milk substitute, feeding bottles and infant foods (Regulation of Production, Supply and Distribution Act, 1992). There are evidences that infant milk substitute producers are trying to replace breast milk with packaged infant products in partnership with medical professionals and institutions.
  2. Efforts must be strengthened for outreach services under health and nutrition programmes.
  3. Amendment must be made in Pradhan Mantri Matru Vandana Yojan to ensure that all women, without any conditions, receive maternity entitlements that would compensate their labour and wages for a period of nine months.
  4. Sufficient allocation of budgets for supporting breastfeeding under National Health Mission, National Food Security Act, Integrated Child Development Services etc.
  5. Make sure that delivery points and health institutions do not de-motivate mothers and families towards early breastfeeding.
  6. Capacity building, respect and space of frontline workers — Accredited Social Health Activist or ASHAs and Anganwadi Workers.
  7. Sick newborn care units must be equipped with essential support for early initiation of breastfeeding.

Also read: Early breastfeeding practices in India: Backwardness cuts through social spectrum

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