In India, 1.2m children aged 0–59 months die each year, with an estimated 58% of these deaths occuring during the neonatal period. A meta-analysis of three large trials conducted in Ghana, India and Nepal found that initiation of breastfeeding was associated with a 44% lower risk of neonatal mortality
Writing in BMJ Global Health in a paper funded by the UNICEF Regional Office for South Asia, the authors note that a multipronged strategy in India has led to an increase in the rates of early breastfeeding from 24.5% in 2006 to 44.6% in 2014.
“Importantly, in the seven states with the highest burden of neonatal mortality, the combined rate of early initiation of breastfeeding increased from 12.5% in 2006 to 34.4% in 2014 (ie, a 2.7-fold increase) with an average annual rate of increase of 21.8%,” the paper states.
“This evidence seems to indicate that focused strategies, effective capacity-building initiatives, strong partnerships, vibrant community-based action, and strategic mass media communication contributed to double/triple the rate of early initiation of breast feeding.”
However, the report also makes clear there is considerable room for further improvement.
They point out that despite 81.1% of deliveries in 2014 being attended by a skilled health provider, only 44.6% of newborns were breast fed within one hour of birth, “indicating that rates of early initiation of breastfeeding could double if all newborns delivered by a health provider were breast fed within one hour of birth.”
The report also points out that breastfeeding initiation can be particularly delayed for infants born by caesarean section.
India's National Family Health Survey 2015 shows that, in states such as Andhra Pradesh and Telangana, where 92% of deliveries are attended by skilled health providers, there are high rates of caesarean deliveries (40% in Andhra Pradesh and 58% in Telangana). This is in turn associated with low rates of early initiation of breastfeeding (37% in Telangana and 40% in Andhra Pradesh).
“Furthermore, prospective cohort studies in India have shown that infants born by caesarean section were almost four times less likely to initiate breastfeeding within one hour of birth than infants born by vaginal delivery. However, global evidence suggests that, in the presence of adequate support, a caesarean section is not necessarily a barrier to timely initiation of breast feeding,” the researchers note.
The report concludes there is an urgent need to continue to strengthen national and state policies, hospital and maternity practices, and the knowledge and skills of birth attendant to support the early initiation of breastfeeding.
“Both public and private sector providers need to reach out to mothers, families and communities with one unequivocal message: early initiation of breastfeeding saves lives,” it adds.
Source: BMJ Global Health
“Early initiation of breast feeding on the rise in India”
Authors: Víctor M Aguayo, et al.