Breastfeeding is essential for infants’ growth and survival
Optimal breastfeeding practice decreases child death and contribute significantly to the long term health of children. In 2016, a Lancet series estimated that 823,000 deaths of children under five years could be prevented every year through optimal breastfeeding practices.
Optimal breastfeeding practices reduce hospitalization among children from diarrhea, respiratory infections, and otitis media illnesses.
Breast milk is the natural first food for babies, which provides all the energy and nutrients that the infant needs for the first 6 months of life. The World Health Organization (WHO) recommends that infants should be exclusively breastfed for the first six months, and for an additional 18 months or longer, to be breastfed along with complementary foods for the achievement of satisfactory growth and development.
Exclusive breastfeeding (EBF) is defined as giving breast milk to the infant, without any additional food or drink, not even water in the first 6 months of life, with the exception of vitamins, mineral supplements, or medicines. After six months, infants should receive nutritionally-adequate and safe complementary foods while continuing to be breastfed for up to two years of age or beyond.
In Bangladesh, infectious diseases, such as diarrhea and acute respiratory infections, are a cause of more than two-thirds of all deaths in children aged less than one year.
The importance of breastfeeding in the prevention of infectious diseases during infancy is well-documented. Breastmilk provides protection against pathogens by providing anti-bacterial and anti-viral substances that stimulate the infant’s immune system.
A meta-analysis of data from three developing countries showed that infants who were not breastfed had a six-fold greater risk of dying from infectious diseases in the first two months of life than those who were breastfed, and a similar protective effect of breastfeeding has been shown in studies of morbidity from infectious diseases.
Globally, only 35% the of infants worldwide were exclusively breastfed during their first four months of life. In Bangladesh, 55% percent of infants under the age of six months are exclusively breastfed. This proportion is lower than that reported in the 2011 BDHS (64%).
Between the 2007 BDHS and the 2011 BDHS, there was a sharp increase in exclusive breastfeeding, from 43% to 64%. Intensive mass media campaigns for several years preceding the 2011 survey could have impacted the status of mothers reporting on breastfeeding in 2011. The 2011 BDHS report and results dissemination discussed the increased level of breastfeeding.
Overall, 51% of children are breastfed within one hour after birth, and 89% are breastfed within one day. Rural children are more likely to be breastfed within one hour of birth compared with urban children (53% and 45%, respectively).
National Breastfeeding Policy and Action Plan -- 2015-2020 outlined five major action areas:
Legislation and policies regulating the marketing of breast milk substitutes;
Encouraging a breastfeeding policy in hospitals;
Training of health professionals;
Developing strategies for the promotion and support of breastfeeding in the community;
Setting targets, implementing and monitoring of the policy
The Global Strategy for Infant and Young Child Feeding states: “Appropriate evidence-based feeding practices are essential for attaining and maintaining proper nutrition and health.”
The latest scientific and epidemiological evidence has contributed to our understanding of the role of breastfeeding in the survival, growth, and development of a child, as well as the health and well-being of a mother in both developing as well as developed countries. Research has shown that exclusive breastfeeding provides immediate health benefits to the infant.
WHO has also published systematic reviews and meta-analyses regarding evidence on the long-term effects of breastfeeding and concludes that while modest, there are statistically significant long-term benefits from breastfeeding.
Lower blood pressure, lower total cholesterol, higher performance in intelligence tests, and a reduced incidence in excess weight and type-2 Diabetes Mellitus were found in subjects who had been breastfed. The magnitude of these effects was compared to other public health interventions, and it was found that especially for cholesterol levels and obesity, breastfeeding was similar if not more effective than dietary education and physical activity in later life.
The initiation of breastfeeding has some immediate and short-term effects on the mother by stimulating the release of oxytocin, which reduces the chance of post-partum hemorrhage through various pathways, while also delaying the return of ovulation, reducing the risks associated with having another pregnancy shortly after a previous one.
In the longer term, breastfeeding has been shown to help protect the mother from pre-menopausal breast cancer and ovarian cancer, osteoporosis, and coronary heart disease. Mothers who breastfeed also show an earlier return to pre-pregnancy weight.
Breastfeeding also contributes to maternal health immediately after the delivery because it helps reduce the risk of post-partum hemorrhage.
The decision to breastfeed and the ability to carry this out depend on a series of complex and often inter-related factors. These include cultural factors affecting feeding patterns and growth monitoring based on formula feeding.
Other factors include the effect of the media, including the portrayal of bottle feeding as the norm and as safe. National factors, such as insufficient education of health professionals, lack of education in schools, and the lack of supportive environments outside the home and in the workplace come into play.
The existence of a national policy guaranteeing breastfeeding breaks, until a child is at least six months old, was associated with significantly higher rates of exclusive breastfeeding.
Although many women are aware that breastfeeding is the best source of nutrition for the baby, they are not aware of specific benefits, such as protection against diarrhea. Many people, including health professionals, erroneously believe that infant formula and breast milk are equivalent in terms of health benefits.
Following the National Nutrition Policy (2015) and other policy goals and targets, 2nd National Plan of Action on Nutrition sets the following targets and indicators by 2025 for reducing various forms of malnutrition:
Increase the initiation of breastfeeding in the first hour of life to 80%;
Increase the rate of exclusive breastfeeding to 70% in infants younger than 6 months of age;
Increase the rate of continued breastfeeding in children aged 20 to 23 months to >95%;
Increase the proportion of children aged 6 to 23 months receiving a minimum acceptable diet to more than 40%;
Reduce the rate of low birth weight to 16%;
Reduce stunting to 25% among under-5 children;
Reduce wasting to less than 8% among under-5 children;
To promote breastfeeding practices at the community level, Save the Children-led Suchana program, funded by the DFID and EU, is closely working with pregnant and lactating women and children under two years of age. The program aims to achieve significant reduction in the incidence of stunting among children under two years of age in Sylhet and Moulvibazar districts of Sylhet Division.
Interpersonal communication is one of the key methods for supporting behaviour change and optimal IYCF practice, as has been found effective in previous trials in Bangladesh.
Suchana is conducting household counselling on a regular basis for assessing the practice and counselling mothers and family members on optimal practice, which includes importance of ANC and PNC, supporting on optimal breastfeeding practices (positioning, attachment, etc), and mothers with children 6-23 months on complementary feeding, dietary diversity of PLW, continue breast milk caring for children up to two years of age, care of sick children, personal and environmental hygiene, and WASH as appropriate.
Suchana is promoting early initiation of breastfeeding within the first hour after the birth, exclusive breastfeeding for the first six months, and continued breastfeeding for two years or more, together with safe, nutritionally adequate, age-appropriate, responsive complementary feeding starting in the sixth month by courtyard sessions, household-level counselling, GMP session, and mass communication (pala gaan, community theater, day observance etc).
Some short-term benefits of breast feeding include:
Reduced risk of illness due to contaminated water, which under some conditions can occur with formula. Breast milk is a source of lactose and essential fatty acids that help a baby’s brain grow and develop
Fewer cases of ear infections, gastrointestinal infections, bacterial meningitis, urinary tract infections, late-onset sepsis in pre-term babies, and more
Encourages skin-to-skin contact and nurturing, working to soothe and comfort the infant
Colostrum -- the first milk produced at birth -- contains high amounts of carbohydrates, protein, and antibodies, and it has yet to be replicated as formula
Releases the “love” hormone, oxytocin, in the mother, which improves the bonding between mother and baby. The release of oxytocin after birth also aids in contracting the uterus to prevent post-partum hemorrhage and reduce the uterus to pre-pregnancy size. Milk production helps with post-partum weight loss.
Some long-term benefits of breast feeding are:
Breastfeeding as an infant can lead to higher IQ, especially if breastfed exclusively and for a longer period of time;
Babies who are breastfed have a lower risk of obesity later in life;
Children and adults who were breastfed have a lower rate of food allergies, asthma, eczema, Celiac disease, and type I and type II diabetes, among others;
Breastfeeding mothers have lower rates of ovarian, breast, and endometrial cancer;
Women who breastfeed may have higher bone density and lower rates of osteoporosis later in life
Breastfeeding is about more than simply providing a child food; the data shows it is a vital way to help ensure a child develops to her/his full potential. During the 1,000-day window from a mother’s pregnancy to her child’s second birthday, breastfeeding is central in giving kids the right start to life, building the foundation for a healthy and prosperous future.
The mother benefits. The child benefits. Entire countries benefit when their children are healthy and strong. When breastfeeding is encouraged and supported, we all win.
Fatema Kaniz is Technical Manager of Nutrition, Suchana program, Save the Children in Bangladesh.