Adding here a few points to the exploration on why baby gets bottle feeds without serious efforts to breast feed . This is in the Indian context, butI am certain , it applies to many developing countries .
Among the several reasons why mothers give up breastfeeding in favour of the bottle , (both in the families that live on daily wages less than $3/- and those earning a little above ,$150/- p.m.), these are the ones that
emerged important in FGD discussions in the community I work in :
1. Topping the list
Grandparents of the baby are important players (in both the Hospital delivered babies and the home-delivered ones).
a) The elders do not see a baby's cry as a cue to feed-on-demand schedule, but consider that a baby cries because mother's milk is insufficient .So, out of tender feelings for the newborn , a very well- meaning grandma organises for the bottle and the infant feed from a shop close by and tells
the mother to breastfeed (supplement) as well.
(Needless to say that by the third day , the mother will begin lactating less if the baby is inclined to not put in the efforts to suck after finding the bottle feeds flow easily).
b) Many mothers in the informal sector have to go back to work soon and with bottle feeding ,it becomes easy to divide the task of feeding amongst the elderly family members and the younger ones - not unusually, a sister who is out of school.
(Maternity leave for 6 months is a luxury in even the formal work sectors and the few mothers availing it are informed parents and those who can work from home).
2)
As for most babies delivered in the hospital setting, the nurses in the obstetric unit are so overworked that they have no time to counsel the mother , except at the time of discharge. The Staff, including ANMs have
the knowledge but counselling is variable in different hospital settings. Not every baby gets to be counselled by a pediatrician at discharge.
( I would initially be surprised that the mother was allowed to bottle feed while in the hospital and the discharge slip has the advice to breastfeed).
At every well- baby visit for immunisation, the advice is repeated but it is already late ( and may even be seen as redundant if the baby is gaining weight adequately). Anybody who has studied the physiology of establishment of suckling patterns will understand why advice delayed is an opportunity denied . There is a great need to advice even before delivery.
3)
The surrogate advertisements in all media continue . A picture of a bonny baby smiling so sweetly at the sight of a happy mother holding out the bottle is attractive enough for the fathers to shell out money from their
lean wallets to get home the tin offered by the friendly neighborhood shopkeeper.
There is no need for a prescription for this in any country, I guess.
There are , of course, all other reasons that the group has already discussed. Personally, I feel there is a need for a multi-pronged approach.
From health laws at the National level to contextual health promotion and several layers of targeted measures across all settings and for all SES strata to reduce the demand side, there is much to do even as the
professional bodies are fighting the giants of the food industry.
One thing that was common to all the mothers we spoke to :
*Every mother wants to breastfeed her baby*.
Thanks and regards,
Sunanda
P.S.
Mothers of children with special needs ( many of whom have feeding problems associated with neurodevelopmental Impairments) also come with a complaint of poor suck in the child and are willing to put the child to breast for frequent small feeds when we advise to keep up the efforts for a few weeks at least.
CHIFA profile: Sunanda Kolli Reddy is a Developmental Paediatrician from New Delhi, India, with a special interest in Early Child Care and Development of children with neurodevelopmental problems in underserved communities. She is actively involved in health promotion, community-based research, care provider training for promoting abilities of children with special needs, through the various programmes of Centre for Applied Research and Education on Neurodevelopmental Impairments and Disability-related Health Initiatives (CARENIDHI), which she heads (www.carenidhi.org). Her work in the community settings to widen the disability-in-development model of CBR encompasses the wider determinants of health and human capabilities and issues which impact the lives of the poor. She combines her experience in developmental paediatrics with the core work of CARENIDHI's grassroots convergence programmes in partnership with groups working in the area of Implementation research and policy.
