Right to Information, Mothers and Children

Today few people will deny that breastfeeding is best for both, mother and child and there does not exist a substitute for breastmilk. A breastfed infant, wherever in this world, gets the best possible start in life. Infant food manufacturers have tried to imitate breastmilk, but no company has ever managed to make milk for babies that matches the mother’s own milk, I am sure they cannot !

Human milk is unique and superior to all other milks, it is the gold standard for infant feeding and is species specific. The breastfed infant is the reference or model against which all alternate-feeding methods must be measured with regard to growth, development, health and all other short and long-term outcomes. Research has shown that human milk and breastfeeding of infants provide advantages to the infant with regard to health and development and growth. It significantly decreases risk for a number of acute and chronic diseases whether that infant lives in developed or not so developed world.

Despite all the advantages of breastfeeding ; social factors, health care practices and commercial promotion have caused a serious decline in breastfeeding. Reasons for this decline illustrate problems such as insufficient community support for women, lack of support at workplace, lack of maternity leave in private and unorganized sector, lack of breastfeeding breaks during working hours, lack of crèches, misinformation by infant food and milk manufacturers, and lack of up-to-date knowledge and skills of health professionals and nurses. The real causes of these problems should be tackled by providing mothers with adequate support and by providing up-to-date, unbiased information to health care professionals and the general public. Information plays a crucial role. The

Convention for the Rights of the Child (CRC), ratified by the Government of India, requires nations to take appropriate measures to ensure the right of every child to the enjoyment of the highest attainable standard of health. Article 24 spells out that “States Parties recognize the right of the child to enjoyment of highest attainable health.... and shall take appropriate measures to combat disease and malnutrition” and ensure that all sectors of society, particularly parents, “have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding...” Supporting parents in the use of basic knowledge of appropriate child nutrition means not only ensuring access to accurate, unbiased information, but also providing protection against misinformation. Information should come from the Government and not from manufacturers of infant foods, bottles or teats because that could be biased.

Creating new needs for special formulas for mothers

Some companies have launched special products and new needs are being created, for example, special formulas for pregnant or lactating women. Here women are made to believe that they need these products to have a healthy pregnancy and enable them to breastfeed adequately.

Examples are:

A special food Horlicks (by SKB) is promoted as “ Mothers Horlicks- The special nourisher for pregnant and breastfeeding mothers”. Similarly Pramilac (by Abbot) is promoted as “ specially fortified nutrition supplement for optimum result”. Company recommends “ use throughout pregnancy and lactation”. Such information undermines mothers’ inherent ability to breastfeed her baby. As lactation performance does depend on mother's confidence, if she doubts her ability to produce enough breastmilk, milk flow decreases due to decrease in Oxytocin, a hormone that controls milk flow and is dependent on mother's confidence only. This makes another addition to a large number of women already nurturing a universal opinion of “not enough milk” much to the appeal of those manufacturing infant formulas.

Information about exclusive breastfeeding should reach women best during pregnancy, and health care sector needs to take its share of responsibility to provide that information. This should be up-to-date and correct. For this governments have the responsibility to update the information base of health care personnel including grassroot workers, with regard to infant feeding.

Information on Timing of Complementary Foods

The IMS Act defines complementary foods to be used . The International Code of Marketing of Breast Milk Substitutes and all subsequent World Health Assembly after the age of 4 months Resolutions prescribe exclusive breastfeeding for about six months.

Recently, a renowned international body on child health, the American Academy of Pediatrics reviewed this important issue and in a policy statement recommended that Infants be given only breastmilk till they are six months old.¹

Timing of complementary foods is, therefore, a crucial decision concerning infant health and nutrition. Do we need to reconsider that solid complementary food be given only at six months and earlier only in case there is real growth faltering ? In any case it should not happen before the age of four months.

Research evidence of why complementary foods should be added when child is 6 months of age

Worldwide research shows that for the vast majority of infants, there is no physiological or biological reason to recommend the introduction of complementary foods before the end of the sixth month of life.

Infant growth and nutrition

Recent studies show that the introduction of complementary foods before the age of 6 months neither enhances growth nor nutritional status of infants and that these foods replace breastmilk in breastfed infants.² Breastfed infants self-regulate their total energy intake when other foods are introduced. Therefore, there is no advantage of introducing these foods before 6 months. There is, however, a distinct disadvantage if the child is exposed to increased pathogenic contamination.³ Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first six months after birth⁴ . Malnutrition among young children can be greatly reduced by educating parents regarding the preparation of safe and adequate local weaning foods. It is more sustainable than reliance on often expensive, processed foods. Early introduction of complementary foods can lead to malnutrition and more importantly decreases mother's milk production⁵ due to decreased Prolactin, a hormone, which is responsible for milk production, depends on suckling stimulation by the baby.

Mother’s fertility:

Exclusive breastfeeding for 6 months not only reduces the risk of diseases for children, but also provides 98% protection against pregnancy for mothers who don’t return menstruation in six months.⁶

Infant health:

Exclusively breastfed babies were less likely to experience diarrhea and respiratory illness with the relative increasing age for those given solid foods.⁷

Allergies:

To reduce the risk of allergies in young children parents are recommended to introduce complementary foods no sooner than 6 months.⁸

However, unethical marketing practices by the companies who do not adopt the important WHO Resolutions or the recommendations of international bodies or the National measures, gives them an opportunity to make their own decisions on when to introduce complementary feeding. Though the advertising of infant foods is restricted in the Indian Law to protect breastfeeding, " Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992" (IMS Act), but the companies go all out to advertise cereal foods in many ways and sometimes without even mentioning the right age of starting these foods.

It is not in the interest of the manufacturers to clearly spell out the age of introduction of complementary foods as it would affect the number of users. There is a thin line between “information” and “promotion”. It may be important to answer the question whether infant food and milk manufacturers should be allowed to be involved in health and nutrition information or whether this should be the responsibility of the Government only through its National Breastfeeding Committee.

The National Measures

The National Guidelines on Infant Feeding⁹ issued by the Department of Women and Child Development , Ministry of Human Resource Development, Government of India, recognize the need of appropriate complementary foods in addition to breastfeeding after 4-6 months and clearly stress on the need of home made foods and avoid commercial weaning foods; the Indian Academy of Pediatrics endorsed these guidelines.

Government of India has taken some positive initiatives recently to increase maternity leave from 90 to 135 days and paternity leave of 15 days. A National Breastfeeding Committee has been set up to coordinate, integrate, organize and advise about breastfeeding programs. The IMS Act was enacted in 1992 and came into force on August 1, 1993.

How companies violate national and international measures

The IMS Act is violated by more than one manufacturer. They sometimes fail to recognize the spirit behind the IMS Act and the International code. Infant foods are advertised even though these advertisements are not in accordance with the the IMS Act. New ways of promotion and advertisement have been used. Recently Zee TV a and Nestle jointly sponsored -The Mothers’ Day, 10th May, 1998 and a popular movie Ram Lakhan was sponsored by Cerelac. Cerelac advertisement was shown innumerable times on that day but mostly violating the norms set in the IMS Act. This company has cleverly promoted Cerelac brand to be used from 4th month ( p©És eghus ls ) in their earlier promotion campaign in 1994. This must have easily added millions of extra mothers to this product, that is what a company wants ! Now Farex is advertised in print media and through calenders for health care system, without age being clearly mentioned. The warning with Cerelac advertisements on TV is transmitted in such a short time , you can't even make it still to see what is written. Manufacturers have started recommending different ages for different varieties of Cerelac, the brand and logo and appearances are similar, which people sometimes can't even read. It is nothing but confusing.That shows widespread disregard or scant respect of the letter and spirit of the IMS Act. A clear policy is nedded for such a promotion. Again, the big quetion is who should be responsible?

Companies have been sponsoring doctors' meetings in disguise of CME prgrams but what does it amount to? Bottles are sold with incentives, electronic and print media hardly pay attention to the advertising clause of the IMS Act while putting advertisements of infant foods as editorial section and advertisement sections are in different aresa, who should own this responsibility? Some companies even fail to completely follow the labeling requirements of the law to protect and promote breastfeeding in India. It calls for an urgent and legitimate action by the Government to protect the right to information and make available complete, unbiased and accurate information to mothers to make appropriate decisions.

The National Breastfeeding Committee, the policy makers and parliamentarians could play a vital role and all such products to be consumed by babies under two years should be considered for banning of advertising. Breastfeeding is the best for mother and child and should be protected and promoted, as it is a woman’s right to be able to breastfeed and a child’s right to be breastfed.

References

1.Breastfeeding and Use of Human Milk, Work Group on Breastfeeding, American Academy of Pediatrics, Pediatrics 100 : 1035-1039,1997.

2.Ann CH, Maclean WC : Growth of the Exclusively Breastfed Infant. Am J Clin Nutrition 33:183-192,1980

3.Heining MJ et al. Intake and Growth of Breast-Fed and Formula-Fed Infants in Relation to the Timing of Introduction of Complementary Foods: The DARLING Study. Acta Paediatr Scand. 82:999-1006, 1993

4.Cohen RJ et al. Effects of Age of Introduction of Complementary Foods on Infant Breast Milk Intake, Total Energy Intake, and Growth: A Randomized Intervention Study in Honduras. The Lancet ,344: 288-293, 1994

5.Malek M A et al . Effects of Training of Mothers on Weaning and Supplementary Food in Rural Bangladesh. Journal of Child Health, 10:134-137, 1986.

6.Consensus Statement. Breastfeeding as a Family Planning Method, The Lancet, Nov. 19: 1204-1205, 1988.

7.Brown KH et al. Infant Feeding Practices and Their Relationship with Diarrheal and Other Diseases. Pediatrics, 83:31-40, 1989.

8.Halken S et al. Effects of an Allergy Prevention Programme on Incidence of Atopic Symptoms in Infancy. Ann Allergy, 47:545-553,1992.

9. National Guidelines on Infant Feeding,Food and Nutrition Board, Department of Women and Child Development, Government of India. Dr. Arun Gupta MD National Coordinator Breastfeeding Promotion Network of India (BPNI) South Asia Representative International Baby Food Action Network (IBFAN) Senior Consultant Pediatrician Jaipur Golden Hospital, Delhi.

Dr. Arun Gupta MD
National Coordinator
Breastfeeding Promotion Network of India (BPNI)
South Asia Representative
International Baby Food Action Network (IBFAN)
Senior Consultant Pediatrician
Jaipur Golden Hospital, Delhi.