Reproductive Health

Rural Indians Spread the 'Breast is Best' Message

Thursday, October 17, 2013

More than half of the youngest children in the Indian state of Jharkhand are stunted by chronic malnutrition. UNICEF-trained breastfeeding counselors in several states are helping to change that in meetings with neighbors about the nutritional benefits of mother's milk.




Sumi Mardi
Counselor Sumi Mardi used her own example to change customs and promote breastfeeding.

Credit: Swapna Majumdar

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NEW DELHI (WOMENSENEWS)--Sumi Mardi was not surprised to find most children are sickly and undernourished in Bheetardari, a remote village in the tribal-dominated east Singhbhum district of the state of Jharkhand.

Over half of the state's youngest children--almost 57 percent of those under 5-- are stunted due to chronic nutrition deprivation, making it the second worst state in the country.

As a breastfeeding counselor, and someone who grew up and still lives in the area, Mardi knew that poor access to health care was compounded by a dearth of information about the importance of breastfeeding within the first hour of birth and its linkages to children's disease and death.

This month, three years after Mardi began counseling tribal villages in the district about the wonders of colostrum--mother's first milk, which provides natural immunities--more than 50 families in Bheetardari and its surrounding villages have stopped the traditional practice of giving honey and goat's milk to their newborns.

This is a big achievement for a community that, Mardi says, had never seen a motorized vehicle before last year.

"The pregnant tribal women, mostly uneducated, were unaware that children who were not breastfed had higher chances of undernourishment," Mardi told Women'seNews in an interview held in Delhi. "Since they had to go back to work soon after childbirth, they would feed them honey and water used to boil rice. They didn't realize by not breastfeeding immediately after childbirth they were contributing to the large number of stunted children in Jharkhand who are less than 5 years of age."

Mardi facilitates group counseling sessions with pregnant women and breastfeeding mothers in a local resource group that meets every month. Some of her health messages are woven into folk songs that the group sings together. Entertaining, educational videos developed by UNICEF, such as "Mother-in-Law Says So," are screened to facilitate community discussions.

Changing Customs

When she herself became pregnant Mardi used her own experience to show how customs could and should change. She told women about a relative who brought honey for her to give to her daughter soon after birth. "It was my mother-in-law, who became aware of the importance of breastfeeding because of my training, who asked her to take it back. This helped to make the women believe in the benefits of breastfeeding. Also, the fact that I am also a tribal, like them, made them more accepting."

Counselors such as Mardi are making a difference, sometimes between life and death, in remote villages in different states.

Trained by UNICEF to debunk myths on breastfeeding in the states of Madhya Pradesh, Gujarat, Jharkhand and Uttar Pradesh, the counselors from these regions have emerged in the last five years as community champions by taking breastfeeding support to mothers in hard-to-reach populations. Global evidence shows that more mothers breastfeed when they receive information, counseling and encouragement in their homes and communities.

In India, 300,000 babies die within 24 hours of birth annually, according to the 2013 State of the World's Mothers report, published by the Indian chapter of the child rights nonprofit Save the Children. The country also accounts for 29 percent of worldwide newborn deaths. Over 2.1 million children die annually before reaching their 5th birthday, with the majority of these deaths occurring during the first 28 days after birth.

Breastfeeding also benefits mothers, with links to faster weight loss after pregnancy, protection from breast and ovarian cancers and possible reduction in the risks of hip fractures, osteoporosis and type 2 diabetes.

"Breastfeeding immediately after childbirth is important because it benefits both the mother and the child," Dr. Victor Aguayo, chief of UNICEF India's Child Nutrition and Development Program, said in an interview held in Delhi. "But poor feeding practices in the initial phase in a newborn's life contribute to malnutrition."

Global evidence shows that starting breastfeeding in the first hour after birth can reduce the risk of newborn death by up to 22 percent by averting deaths related to sepsis, pneumonia, diarrhea and hypothermia. Evidence also shows that children who are exclusively breastfed are 14 times more likely to survive the first six months of life than non-breastfed children.

Less Chances for Girls

If the newborn happens to be a girl, chances are she won't be breastfed, said Mrina Pande, an author and feminist. "Daughters are discriminated against, especially if she is the second or third daughter. She is not breastfed because she is seen as a burden. They are expected to survive on water or honey."

But this is changing. Uzma Qureshi, another breastfeeding counselor working in a district hospital in the central Indian state of Madhya Pradesh, has persuaded over 100 families to adopt the practice. Madhya Pradesh tops the list of Indian states for newborn deaths within seven days of their birth.

One of the 50 breastfeeding counselors posted at each district hospital in the state by the government, Qureshi reaches out to every mother on each bed with a simple message: colostrum saves lives.

"I have prevented more than 100 families from following the traditional practice of giving honey, water or cow's milk to their newborns immediately after they were born. I have been able to convince the families that mother's milk is every child's right and ensured that every child gets it" she said.

Qureshi also has to convince husbands. In addition to the health benefits of breastfeeding, she found that explaining the economic benefits of breastfeeding often clinched the argument. "Since they want to give the baby cow's milk, I tell them they would have to spend money to buy it. Mother's milk is not just free of cost, it's also the best for the child. The thought of saving money wins over many husbands. As long as they are convinced that breastfeeding is the best thing for their child, it doesn't really matter which strategy works."

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