Despite institutional delivery being as high as nearly 79% nationally, the number of children in India breastfed within one hour of birth is less than 42% — near 43% in urban areas and 41% in rural India, according to the National Family Health Survey 4 (NFHS-4) data released a few days ago. The Janani Suraksha Yojana — cash incentives to pregnant women to attend antenatal clinics and opt for institutional deliveries — has led to a sharp increase in institutional delivery (from 39% in 2005-06 to 79% in 2015-16) and near doubling of children breastfed within one hour of birth in the last 10 years.
Breastfeeding babies soon after birth can prevent a significant number of neonatal deaths — about 20% newborn deaths and 13% under-five deaths, according to C.K. Mishra, Secretary, Ministry of Health and Family Welfare.
Improvements all around
At 99.9% in both urban and rural areas, Kerala has the highest institutional births in the country. Tamil Nadu is a close second with 99.2% institutional births in urban areas and 98.7% in rural areas. Yet, Kerala and Tamil Nadu do not fare greatly when it comes to initiating breastfeeding within one hour of birth. At 64%, Kerala is well below Goa’s average of 73%. Similarly, Maharashtra with 90% institutional deliveries has 57.5% for early initiation of breastfeeding compared to Tamil Nadu’s nearly 55%.
Bihar has shown the most improvement in initiating breastfeeding within one hour of birth — from 4% in 2005-06 to 35% in 2015-16. Though Uttar Pradesh has improved its performance, it is still about half of the national average — 7.2% in 2005-06 to 25% in 2015-16. Other States that have shown good improvement on this front are Haryana, Jharkhand, Madhya Pradesh, Punjab and Rajasthan.
Similarly, all States have registered an improvement in the case of exclusive breastfeeding of children under age six months. While Goa has shown a dramatic increase from 17.7% in 2005-06 to nearly 61% in 2015-16, Chhattisgarh has witnessed a drop from 82% to 77%.
Barriers to breastfeeding
“You need dedicated people who can counsel mothers on the need to breastfeed within one hour of delivery. There are socio-cultural barriers too,” says Dr. Ajay Khera, Deputy Commissioner and Head of Child Health, Ministry of Health and Family Welfare. “It is to overcome these that the government launched the MAA — Mother’s Absolute Affection — programme in August last year. Under the programme, there are special efforts to create community awareness and promotion of breastfeeding, capacity building and skilling of healthcare providers at all delivery points in the country.”
According to Dr. Sutapa B. Negi from the Indian Institute of Public Health, Delhi, early initiation of breastfeeding becomes difficult in the case of babies delivered through caesarean section, babies born preterm and low-birth-weight (less than 2.5 kg) babies. “Caesarean deliveries account for 10-15% and nearly 20% babies have low birth weight while 15% are born preterm,” says Dr. Khera.
According to NFHS-4 data, the national average for babies delivered by caesarean section is 28%, which is more than three times the 2005-06 figure of 8.5%.
While percentages may varying from one State to another, there is not much difference in the rate of breastfeeding within one hour of birth among rural and urban population. Except for a few States like Andhra Pradesh, Bihar, Gujarat and Tamil Nadu, rural areas have slightly higher percentage of babies being breastfed within one born of birth than their urban counterparts. “This implies that the need for support regarding breastfeeding is universal,” Mr. Mishra said last year during the inauguration of the MAA programme.
prasad.ravindranath@thehindu.co.in
