We Have the Act. Time to Create the Awareness

The provision of the Maternity Bill extending maternity leave to mothers The provisions of the bill will apply to all organizations that employ 10 or more persons and is expected to benefit over one million women working in the organized sector.

Given the majority that the ruling government enjoys, its passage in the Lok Sabha is guaranteed, after which the Labour Ministry will notify the changes.

As per the amendments, maternity leave for women in the private and public sector will be increased to 26 weeks as against the present 12 weeks. However, those who already have two or more children will get 12 weeks of leave only.

The bill also proposes 12 weeks maternity leave to mothers who have children through surrogates as well as working women who adopt a baby below the age of three months. The Act will also allow nursing mothers to work from home after the 26-week maternity leave ends, depending upon the nature of their job.

However, the real work starts now. While the provisions are a progressive measure, there needs to be awareness created for the benefits of this to come through. The period after birth is critical for both the mother and the child’s health and the root of the amended act lies towards preventing malnutrition. That is the primary purpose of the Act, which is not to be treated as a holiday.

Passing the Act has to go along with creating awareness about breastfeeding and other measures that are to be taken to secure the health of the child and the mother. There needs to be a well thought out policy to promote breastfeeding, which is still lacking in India. Various studies show that less than 25% mothers in India initiate breastfeeding in the first hour after birth.

The WHO says that initiation of breastfeeding within an hour after birth could bring Infant Mortality Rate by as much as 22%. Nearly 77% of child deaths worldwide are attributed to non-exclusive breastfeeding during 0-6 months of life.

Both the WHO and UNICEF recommend breastfeeding within an hour of birth, only breast milk for the first six months, and continued breastfeeding up to the age of two years, along with appropriate complementary food.

 

 

 

 

 

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Time to End the Shame Around Breastfeeding

Last week, protests were witnessed across Argentina by groups of women who breastfed their babies in public. They were agitating against the police’s move to throw out a mother from a square in Buenos Aires for nursing her infant in public.

Carrying signboards that said, “Nursing is not up for discussion” and “My breasts, My rights”, over 500 women took to the streets in different parts of the country demanding respect for mother’s rights.

Breastfeeding is a simple, no-cost intervention that boosts the health of children and women substantially, in rich and poor countries. Yet there is little awareness about this. And as we get set to observe World Breastfeeding Week (August 1-7) around the world, experts are calling for programs that encourage ideal breastfeeding practices.

Studies in The Lancet point out that increasing breastfeeding to optimum levels could save over 800, 000 lives every year, most of them children under six months. Also, nearly half of all diarrheal diseases and one-third of respiratory infections in children in low- and middle-income countries could be prevented.

Babies who get no breast milk at all are seven times more likely to die from infections than those who get some in their first six months.

Children who are breastfed also do better at intelligence tests, are less likely to be overweight and less likely to get diabetes later in life. The benefits to mothers are also huge. They show lower risk of developing breast and ovarian cancers.

The awareness is especially abysmal in low-income countries, like India. And it does not help that the government has not aggressively promoted breastfeeding. The focus on bringing down maternal and child deaths has been heavily directed towards promoting institutional deliveries, antenatal check-ups and neonatal care.

There are many barriers that come in the way of early breastfeeding in India and this helps explain why signs of childhood malnutrition like stunting (45%) and wasting (20%), that depend significantly on early breastfeeding, remain high.

According to studies, only one in four mothers are able to start breastfeeding within one hour of giving birth and less than half of all mothers are able to exclusively breastfeed their babies for the first six months after birth.

Supportive health-care systems, workplace interventions, counseling and educational programs are needed to improve breastfeeding. The government’s recent moves to bring changes to the Maternity Benefit Act of 1961 are welcome steps.

There is also a need to break the wider social shame that exists around breastfeeding in public, something the UN has also acknowledged by backing the social trend of belfies – mothers sharing pictures of themselves breastfeeding. It is a welcome step towards ending that stigma and spreading the word about the importance of a mother’s milk.

 

 

 

How Aahar is making a change: A community speaks

Approximately 50% of children under 5 years are malnourished in India. Nearly 39% are stunted, that is low in height for their age. And in the financial capital Mumbai, 26000 children die every year because of malnourishment.

Aahar, which means food, is a program that combines home-based and facility-based care to reach out to a large number of vulnerable children in need of monitoring. In order to make maximum impact, it reaches out to mothers when they are pregnant and  addresses nutrition and feeding practices throughout the first 1,000 days of child’s life. The program was launched in Dharavi, Mumbai’s largest slum colony in 2012 by NGO SNEHA, and works in partnership with the Centre’s Integrated Child Development Scheme, the Municipal Corporation of Mumbai and the Lokmanya Tilak Municipal General Hospital.DSC_0395

This week SNEHA will felicitate the many champions that help Aahar make a difference. A series of events will be held to honour the dedication and commitment of mothers, the municipal staff and community workers.

 

Here are some of those voices:

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Mukesh Kumar Jaiswal

Mukesh Kumar Jaiswal, 25

“I was 21 years old when I got married and I have two young children. My children used to fall sick very often when they were babies and my wife and I struggled to cope. We gave them whatever was cooked in the house, sometimes we fed them chips and biscuits. It was only when my youngest was nearly 6 months old when we realised that what they eat makes a substantial difference to their health. This was after SNEHA workers came to our area and held camps. They talked about the importance of breastfeeding and immunisation and it made a big difference to our children’s well-being and those in the neighbourhood as well. 

It is not like children don’t fall sick now. They do but not as often as they used to. We not only feed our children green vegetables, dal and fruits, but we eat healthy too”

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Renuka Kadam

Renuka Kadam, Community Organizer, SNEHA

“I started working in Dharavi 4 years ago and it was initially very hard to convince the families here to change their habits. They did not understand the importance of eating green vegetables, fruits and protein. We received a lot of support from the local anganwadi where these women would gather. Gradually they started to trust us and attend our sessions.

There was no awareness of the importance of breastfeeding. Most women would not nurse their babies due to misconceptions and myths so we had to work a lot on that aspect. They did not understand how important it is to take adequate rest, eat regular, nutritious meals while pregnant or take vitamins and supplements so their babies are healthy. They are so busy taking care of their families that they forget to look after themselves. They forget to eat. So we draw a clock on a sheet of paper and mark out the hours when they should eat. 

We hold camps twice a month when babies are weighed and their growth is recorded in charts. As the mothers see the improvement they are convinced. We also advice them about spacing babies and the various contraceptive methods.

From the time we started Aahar, there has been a big improvement in baseline indicators. But the challenge remains. Dharavi is home to a large migrant population so we have to monitor constantly”.

 

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Sangeeta Gupta

Sangeeta Gupta, 30

“I have three children and earlier I would never bother too much about what I fed them. If I could cook a meal I would. Otherwise I would give them some money so they could eat chips or biscuits. After SNEHA’s camps I have changed. I always give them a dabba for school with vegetables and roti or rice. I have seen what a major difference it has made to my children’s health”.

 

Breastfeeding: Promotes a smarter, healthier, equal world

The lives of over 800, 000 children and 20 000 mothers could be saved each year with universal breastfeeding says a new series by the respected medical journal The Lancet.

Breastfeeding leads to fewer infections, enhanced IQ, probable protection against obesity and diabetes, even breast cancer prevention in mothers, says the series which has been hailed as the most in-depth analysis done so far into the health and economic benefits that breastfeeding can lead to. It also highlights that breastfeeding leads to economic savings of 300 billion dollars

The data published is based on analysis led by scientists at the Federal University of Pelotas in Brazil who looked at data from previous research.

Reporting on the findings, The Independent,  a UK daily, quotes the study head Professor Cesar Victora as saying, “There is a widespread misconception that breast milk can be replaced with artificial products without detrimental consequences…. The decision not to breastfeed has major long-term negative effects on the health, nutrition and development of children and on women’s health.”

However, globally, only 37% of children under the age of six months are exclusively breastfed in low and middle-income countries.

Women avoid or stop breastfeeding due to many reasons ranging from medical, cultural, and psychological, to physical discomfort. Turning to formula milk, which is heavily pushed by multinational companies and many hospitals, becomes a convenient option.

There is a need to create a supportive environment for a mother who is breastfeeding says Dr Armida Fernandez, Founder, SNEHA. This includes addressing the many myths and misconceptions that are still widely prevalent.

“Mothers, and this includes women from poor backgrounds, want to breastfeed their babies. But if their baby keeps crying, and this happens due to many reasons, they feel it’s because they are not producing enough milk and so they resort to formula or diluted cow’s milk leading to malnutrition”, says Dr Fernandez.

She believes that doctors need to aggressively and consciously encourage breastfeeding.

“I find many doctors do not support it at all. The moment the baby is a little underweight they tell the mother to start a top feed. “ Dr Fernandez suggest that health centres and clinics must have counsellors on their staff who actively encourage women to breastfeed.

Currently India is still some distance away from reaching its targets on improving infant nutrition as per an assessment report by the Breastfeeding Promotion Network of India (BPNI) and Public Health Resource Network (PHRN) published in late 2015.

The report says that nearly 15 million babies, who comprise of 55% of newborns in India annually, are deprived of optimal feeding practices in their first year after birth.

The assessment also points to gaps in policies and programmes outlined for enhancing breastfeeding rates. Countries like Afghanistan, Bangladesh and Sri Lanka fare better than India in comparison.

Aggressive promotion of baby foods by companies, lack of support to women in the family and at work places, inadequate healthcare support, and weak overall policy and programmes were some of the reasons identified as responsible for lack of improvement in infant and young child feeding practice indicators.

 

Lessons in Breastfeeding

Doctor Turuk answering questions from the audience
Doctor Turuk answering questions from the audience

What to do when breast milk dries out? Can the child be fed when the mother is sick? Is maalish good for the baby? Can we put oil in the child’s ears and nose?

Doctors from BYL Nair hospital were flooded with questions from about 100 mothers, some of them even pregnant. The programme was organised at Buddha Vihar hall at  Govandi by SNEHA in collaboration with the BYL Nair Hospital, Mumbai Central. This is one of the many programmes SNEHA has organised for World Breastfeeding week starting August 1.

The audience were shown a short film too which extolled the benefits of breastfeeding in the first half hour of birth and six months exclusively.

The audience is shown a short film on the benefits of breastfeeding
The audience is shown a short film on the benefits of breastfeeding

“The first thick milk (colostrum) is like a vaccine for your child. Please do not throw it away. The child needs no water either. The breast milk has 80% water,”said Dr Mahendra Chavan after the doctors enacted a play before the audience.

One woman asked why her breast milk just dried out. She said that her mother-in-law insisted on feeding her daughter honey for three days after birth, and after three days she could not generate any milk. Her daughter only drank milk from the bottle.

The doctors explained that for the milk to generate the child has to suckle the breast, which sends a signal to the brain that milk has to be made. “If you do not feed the child for the first three days, it will be very difficult for the body to generate milk. The more you feed the child, more milk is generated,”said community development officer, Anjali Parande.

Nair hopsital doctors enacting a play
Nair hopsital doctors enacting a play

The doctors also showed a chart with the dos and don’ts to the audience. “Using the bottle is responsible for many infections. The nipple too. The child spits it out and picks it again and feeds on it,”said Parande.

Dr Alka Turuk demonstrated the right way to breastfeed the baby and ensure that mothers do not suffer back pain. She also demonstrated the right way to express milk. She also explained the importance of using contraception after the baby so that there is a three-year gap between first baby and the next. “It is important to breastfeed the baby. This is possible only if there is a three year gap between two babies,” said Dr Turuk.

The SNEHA staffers and doctors asked the women to spread the word. “We have come here so that at least your generation can mend the errors made by the earlier generations. Please spread the message with your friends and sisters,” said Parande.

Promoting breastfeeding

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On the occasion of World Breastfeeding Week, SNEHA organised three rallies at Dharavi on August 2. All the 79 community organisers, and others who work with the Aahar project of SNEHA, came out in support of the message. Nearly 150 people attended the rallies

“We spread the message of breastfeeding in the rallies. We told women that it is very important to breastfeed the first half hour of birth, and then exclusively for the first six months. There were some women from the community too who came and asked us questions. Our staffers counselled them on the issue, “said Dr Ganesh Mane, programme co-ordinator, Aahar.

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The rallies had the support of our civic officials, and especially the doctors of Lokmanya Tilak Municipal General Hospital. In fact, Dr Alka Jadhav, professor of department of Paediatrics, with Dr Neeta Naik at LTMG Hospital, Mr Nandepalli, an ex-corporator from BMC, and Mr Gaikwad, CDPO, Dharavi block inaugurated the three rallies.