Optimal Breastfeeding Saves Lives

Appropriate and optimal infant feeding is fundamentally important to assure adequate nutrition and growth during infancy. Optimal breastfeeding involves complementary feeding and overlapping practices of exclusive breastfeeding (breastmilk with no other foods or liquids) for the first six months of life, early initiation of breast-feeding as soon as a child is born, feeding colostrum, and avoiding prelacteal foods. In Nepal and elsewhere throughout South Asia, suboptimal infant feeding practices have been associated with undernutrition, reflected by stunting and wasting, and mortality. Practices such as early initiation of breastfeeding, avoiding prenatal feeds, assuring intake of colostrum, and maintaining exclusivity of breastfeeding in early infancy, represent critical exposures that benefit child growth and development. Exclusive breastfeeding up to six months of age and continued breastfeeding during the first and second years of life have been associated with increased linear growth and better cognitive development scores.

 Combat malnutrition

Breastfeeding is believed to benefit infants because breast milk provides a complete and balanced mix of essential nutrients for infants, including proteins, fats, and minerals, which are crucial for a baby’s growth and development. The nutrients in breast milk are highly bioavailable and easily digestible, which helps ensure that infants absorb the necessary nutrients efficiently. Breast milk, especially colostrum, contains antibodies and other immune factors that promote the development of the infant's gut and immune system and prevent pathogen invasion as it prevents the intake of pathogens in food or water. Apart from these, breastfeeding is cost-effective compared to formula feeding, making it more accessible in low-resource settings and thereby reducing the risk of malnutrition caused by economic factors. Regular breastfeeding supports appropriate weight gain and growth patterns, reducing the risk of undernutrition. Furthermore, exclusive breastfeeding promotes close maternal-infant bonding, which supports emotional well-being and encourages consistent feeding practices, further reducing the risk of malnutrition. Optimal breastfeeding is so critical that it could save the lives of over billions of children under the age of five years each year.

In 1990, WHO-UNICEF made a declaration known as the Innocenti Declaration. The declaration, which was created in Innocenti, Italy, aims to protect, promote, and provide support for breastfeeding. Infant and young child feeding is essential to physical and mental development and long-term health. Since then, UNICEF has provided clarification regarding the recommended period for exclusive breastfeeding. UNICEF’s latest recommendation with the World Health Assembly (WHA) and many other countries is to set a period of exclusive breastfeeding for 6 months.

Breast-feeding policy tends to be an emotive issue. International agencies recommend that mothers practice exclusive breastfeeding for the first six months of life, followed by a timely introduction of appropriate complementary foods. Early initiation of breastfeeding (i.e., within one hour of birth) is recommended as the first critical step to ensure children receive colostrum, the “first milk,” which is rich in nutrients and antibodies essential for rapid adaptation to postnatal life. Early suckling can also facilitate success with subsequent breastfeeding practices by stimulating the release of prolactin, enabling the mother to produce more milk. Concerns exist that, in Nepal, the prevalence of exclusive breastfeeding in early infancy may be in decline, as indicated by a slight reduction from about 70 to 66 per cent between consecutive National Demographic Health Surveys (NDHS) from 2011 to 2016. In South Asia, including Nepal, and in other regions, colostrum may often be discarded, despite the nutritional and immunological benefits it confers to newborns, and replaced by prelacteal feeds. Prelacteal feeding not only displaces breastmilk but also can disrupt the priming of the gastrointestinal tract and may introduce pathogens that increase the risk of illness. 

Consequent delay in establishing breastfeeding has been shown to predispose infants to a higher risk of mortality in a dose response. Exclusive breast-feeding up to six months followed by continued partial breast-feeding into the second year of life is essential to promote infant and child health and minimise the damage caused by the malnutrition-infection cycle.

Support for breastfeeding

The family plays a role in exclusive breastfeeding by supporting the mother to fulfil her nutrition by consuming nutritious foods, ensuring that the mother gets enough rest, and creating a calm and peaceful home atmosphere. UNICEF and WHO created the Global Breastfeeding Collective to rally political, legal, financial, and public support for breastfeeding. The Collective brings together implementers and donors from governments, philanthropies, international organisations, and civil society. The Collective’s vision is a world in which all mothers have the technical, financial, emotional, and public support they need to breastfeed.

WHO has formed the Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breastmilk Substitutes and Subsequent Relevant World Health Assembly Resolutions, also known as NetCode. The goal of NetCode is to protect and promote breastfeeding by ensuring that breastmilk substitutes are not marketed inappropriately. Specifically, NetCode is building the capacity of Member States and civil society to strengthen national Code legislation, continuously monitor adherence to the Code, and take action to stop all violations.

In addition, WHO and UNICEF have developed courses for training health workers to provide skilled support to breastfeeding mothers, help them overcome problems, and monitor the growth of children so they can identify early the risk of undernutrition or overweight/obesity.

There are ten steps in successful breastfeeding under the Baby Friendly Hospital Initiative (BFHI), which has covered a wide range of initiatives that can promote and protect breastfeeding and save the lives of children under five years from falling into malnutrition and its consequences.

(The author is a nutritionist associated with the College of Applied Food And Dairy Technology.)