"The most difficult time for me was the first month after giving birth. According to city-based yoga therapist Dwee Chintan Pathak, whose child was born with mild jaundice that prevented the mother from breastfeeding in the first crucial hours after childbirth, "doctors and women from my family suggested to me many things about breastfeeding practises, but there was no one to teach me practically."
In less than six months, Diya Deepak Mathal, a 33-year-old domestic worker from Mumbai, was forced to resort to bottle-feeding her kids in order to resume work and stabilize the family's financial condition. Although she was able to breastfeed the infant, it was challenging to maintain exclusive breastfeeding for six months.
Colostrum, which is very nutritious and contains antibodies that shield the infant from illnesses, is found in a mother's initial breastmilk. It is advised that children be exclusively breastfed for the first six months of their lives, meaning they are only given breastmilk. This is because, according to the fifth National Health and Family Survey (NFHS), breastmilk contains all the nutrients children need in their first six months of life and is an uncontaminated nutritional source.
However, in contrast to Pathak's and Mathal's cases, a number of issues, including housework, the employment status of women, and a lack of an environment that is welcoming and supportive of nursing practises frequently dissuade new mothers from using exclusive breastfeeding. The average amount of time in India spent exclusively nursing is 3.9 months.
Women's Problems in the Informal Sector
While women working in the official sector are eligible to apply for paid maternity leaves, those working in the informal sector are not. As a result, it is challenging for them to provide their babies and themselves with the best care possible.
In such circumstances, women are required to quit their jobs or return to them in less than six months. Due to their socioeconomic circumstances, those who cannot afford to take a break find up juggling their employment, domestic duties, and child care at the expense of their own physical and emotional wellbeing.
Two months after giving birth to her second child in 2018, Mathal, who resides with her husband and two children, had to return to work. She would finish her morning chores after spending two to three hours working at one house early in the day. She would then go home to feed the baby. "Even though I was able to breastfeed the infant a few times a day, there were some days when I needed to use outside milk. Therefore, exclusive breastfeeding was never possible, she continues.
Anil Parmar, vice president of community investment at United Way Mumbai, an organisation that addresses health, education, and other community development issues, claims that it is extremely difficult for women who work as daily wage earners to find a private area where they can breastfeed in crowded conditions with little to no sanitation infrastructure.
The Pradhan Mantri Matru Vandana Yojana, according to Dr. Kavita Puranik, assistant manager - community investment, United Way Mumbai, offers women working in the informal sector a direct cash transfer of Rs. 5,000 to make up for lost pay and motivate them to seek out better treatment. While this helps in a limited way, it does not address the need for workplace breastfeeding assistance.
Responsibility isn't only a Woman's Job.
"The first relationship between the infant and the mother was broken off when the baby was not given to me after birth and was whisked away for hours. Furthermore, the transition to breastfeeding was completed after the baby received bottle feedings for the first 21 days. Later, the infant was unable to become used to sucking milk from the mother's breast, according to Pathak.
In order to start breastfeeding as soon as possible, Parmar claims that many medical and paramedical workers do not let moms feed the baby during the first hour of birth. Only 51% of Mumbai's children under the age of three were breastfed during the first hour, according to the NFHS-5.
Pathak's health was severely harmed by the protracted adoption of regular nursing habits, which occasionally resulted in reduced milk production and engorged breasts. According to NFHS, starting breastfeeding early strengthens the link between the mother and child, which promotes regular milk production. When Mathal's breast milk was insufficient to feed the infant throughout the day, packaged milk was also used as a substitute.
The University of Wisconsin-Project Madison's Poshan aims to inform and provide nutrition to women during pregnancy and the postpartum period. One of the community program put on by UWM to support pregnant moms is a baby shower ceremony.
While Pathak had her mother and mother-in-law to turn to for advice and support, many women may not have these resources and may be reluctant to ask for assistance because of embarrassment or a fear of safety.
"I believe that women should have a support system that can advise them on nursing when they are giving birth. This is incredibly important, but I think there's a problem," adds Pathak.
Pathak and Mathal emphasise the necessity for support from the male members of the immediate family beyond this time. This entails not only assisting with domestic tasks or making sure the mother gets enough sleep, but also offering the mother enough emotional support as she copes with hormonal changes that may be hurting her mental health.
Health facilitators work to close these healthcare gaps in the UWM community level programmes in Mumbai and counsel expectant parents early on about appropriate birth control methods, early nutrition, timely checkups, use of Iron Folic tablets, and the significance of exclusive breastfeeding practises.
Unresolved issues
One of the most pressing unmet needs of childbearing mothers in India is the absence of designated nursing locations in public and work settings. At the Bandra, Lokmanya Tilak, Chhatrapati Shivaji Maharaj, and Mumbai Central railway stations in Mumbai, one can find a baby-feeding room. Even while this is positive, there is a need to create more centers like this in other publicly accessible public areas and organizations.
Government, private, or daily wage employers' workplaces must provide enough nursing spaces and basic facilities. As Parmar points out, these facilities will be very helpful in assisting lactating women by providing flexible work hours to accommodate breastfeeding requirements. A lot also depends on the workplace policy and management's efforts to educate staff about reducing stigma associated with nursing mothers and developing a supportive, healthy, and secure workplace.
According to Parmar, "Measures needed are ensuring specialized breastfeeding counsellors at the hospital or educating the Accredited Social Health Activists and Auxiliary Nursing Midwives to provide counselling to new mothers well beyond delivery up to 3-4 months."
It is crucial to inform parents about exclusive breastfeeding from birth, complementary feeding techniques, the provision of food supplements and micronutrients for lactating mothers, the value of first milk, and the timing of natural weaning as many mothers switch to bottle-feeding due to a variety of factors.
Parmar also draws attention to the fact that the promotion of companies that provide alternatives for newborn milk has contributed to a fall in the practise of exclusive breastfeeding. "Exclusive breastfeeding has decreased as a result of a number of circumstances, including unethical advertising and aggressive infant milk substitute marketing by commercial businesses. The government ought to examine such actions and, where appropriate, take corrective action.”