Breastfeeding: It's your right New research is constantly revealing even more clearly that it is not possible for infants and their mothers to achieve optimal health unless the conditions are created that allow women to practice exclusive breastfeeding for first six months and to continue breastfeeding, while providing adequate complementary foods, for two years and beyond. Breastfeeding is the right of the mother and it also makes a major contribution to the realization of the child’s right to food, health and care. In this context our aim is to create awareness about the fact that breastfeeding is a right for both mother and her child and to provide information regarding formal and legal mechanisms which exist nationally and at international level. There is also need to bring a change in the public thinking, so that this right of the mother and child is respected, protected, facilitated and fulfilled at household, community and government levels.1 Child’s Rights Every child has five rights,
For his survival, the child's mother is the first person who will give warmth, love and nutrition. But she can only fulfil rights of her child, if she gets support from the family, community and the government.
Women’s Rights Women’s Rights in relation to breastfeeding are as follows:
A woman has a pivotal role in society as a mother to breastfeed her baby. It is, therefore, important to discuss the women’s right in relation to breastfeeding. Breastfeeding provides a nutritionally balanced food for infants and acts in the same way as immunization by reducing the chances to get certain diseases such as diarrhoea, respiratory tract infections including pneumonia and ear infection and urinary tract infections.2 Breastfeeding contributes to every women’s right to health by reducing her risk of getting breast and ovarian cancer, iron deficiency anemia, uterine bleeding after delivery, multiple sclerosis, osteoporosis and hip fracture.2
Information on timing of complementary foods Introduction of complementary food is a crucial decision concerning infant health and nutrition.3,4 World-wide 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 sixth month of life. Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately six months. Normal growth was reported by Mathur and coworkers during first six months in 126 exclusive breastfed infants in a study conducted in 1985.5 Madhavapaddi and Ramachandran6 had reported that there was no difference in the growth of infants who were solely breastfed and infants who received supplements in addition to breastmilk upto 6 months of age. The American Academy of Pediatrics has recommended that infants be given only breastmilk till they are 6 months old.7 WHO/UNICEF publication Integrated Management of Childhood Illness (IMCA), has explicitly stated that “most babies do not need complementary foods before 6 months of age.8 The Indian Academy of Pediatrics (IAP)9 also agrees with the BPNI policy to exclusively breastfeed children for 6 months and to start complementary feeds afterwards from the family pot. Susrutra Samhita, (800 BC) the Indian book of Medicine has clearly mentioned about the complementary food that at the age of six months when teething occurs, the child should be given small and useful food. Children who are weaned early usually remains lean and thin. A randomised study in Honduras showed no growth advantage in breastfed children given complementary foods from 4 months even when the foods were of very high quality (Cohen et al, 1994).10 WHO’s review of complementary feeding gave evidence that foods given to breastfed infants from 4 months did not increase growth in most children (WHO/NUT/98.1).11 Subsequent to that publication, in another randomized study, low birth weight infants also did not show increased growth when given complementary foods between 4 and 6 months (Dewey et al 1999). Information on energy consumption from breast milk was recently compiled from 21 published studies conducted in developing countries.12 The mean breast milk intakes reported from these studies were 413, 379, and 346 kcal/day by children 6-8, 9-11 and 12-23 months of age, respectively. Children’s average energy needs are 688, 829 and 1096 kcal/day for the same age group. Thus the average amounts of energy required from complementary foods will be less in breastfed children, approximately 275, 450 and 750 kcal/day (Table 1). It will be cheaper to provide adequate nutrition to breastfed children from 6 months to 2 years. Onyango et al13 have reported that keeping the toddlers on the breast, with appropriate complementary feeding 5 times a day, will be, in most settings, the most feasible means of encouraging adequate growth upto two years. Based on 20 studies Aderson et al14 concluded that significantly higher levels of cognitive functions were seen in breastfed than in formula-fed children at 6-23 months of age and these differences were stable throughout childhood and upto at least 15 years. Low birth weight infants showed larger differences than did normal birth weight infants suggesting that premature infants derive more benefits in cognitive development from breast milk than do premature infants. Table1: Energy needs for breastfed infants
Maternity protection Maternity Protection15 is a precondition of genuine equality of opportunity and treatment for men and women. Working women need paid breaks and access to facilities for either breastfeeding the baby or expressing milk. However, in practice, women employed in various work environments face different obstacles in breastfeeding. For instance, maternity leave may be available to formally employed women but agricultural workers, domestics and women working in the informal sector/ industry are usually not covered by existing laws. Every where women should be provided with paid maternity leave. There should be no worry that she may loose her job or seniority if she takes maternity leave. Similarly, at workplace child care facilities must be provided and these should be safe and comfortable. (Table 2 Maternity leave).
Table 2: Status of Maternity Leave in India
Family planning and population control For family planning and population control, breastfeeding is cost effective and safe method.
What Breastfeeding Does
At what Cost
Consider mother and child as one unit. Give due respect, opportunity, facility, education, nutrition and medical care to women so that breastfeeding becomes a normal norm for 2 years and beyond. Support new mothers. Ensure that they receive support and take rest while recovering from delivery, adjusting to a new baby and learning to breastfeed. Convince employers to create a supportive environment for breastfeeding mothers in the workplace and provide paid maternity leave, and paid breaks and facilities for breastfeeding or expressing milk. Monitor baby food industry compliance with the IMS Act entitled “ The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992”, and report violations to relevant government authorities, Central Social Welfare Board (CSWB), Indian Council for Child Welfare (ICCW), Association for Consumer Action on Safety and Health (ACASH) or Breastfeeding Promotion Network of India (BPNI).16 Health practitioners every where have an important part to play in promoting and supporting exclusive breastfeeding.
References
Dr. G.P. Mathur
India sets yet another example to protect breastfeeding by implementing the Cable Television Act Information and Broadcasting Ministry of India sets an example to protect breastfeeding through prohibition of direct or indirect promotion of Infant Milk Substitutes, Infant Foods or Feeding Bottles through an amendment to the Cable Television Networks [Regulation] 1995, Act and the Rules that came to effect on 8th September, 2000. By amending this Act and including Infant Milk Substitutes, Feeding Bottles and Infant Foods, the Information and Broadcasting Ministry has created a history and deserves a big applause.
What you could do: Now you contact your cable operator to stop these advertisements. As a subscriber if you come across any violations through the cable service you should also report to the authorised officer of your area (District Magistrate, or Sub-divisional Magistrate, or Commissioner of Police).The reporting information should include:1. Name and Place of the Cable Operator, 2.Name of the Programme, 3.Duration and Time, 4. Date, Month, Year.
Indian Law Institute organizes Right of the Child to Mother's Milk and the IMS Act A symposium on "Right of the child to Mother’s Milk and the IMS Act" was organized on 28th September at the Indian Law Institute, New Delhi. The participants included advocates, NGO’s, journalists and BPNI members. Mr Murali Bhandare senior advocate inaugurated and presided oner the function. He said there is no substitute to mother’s milk. Dr. Arun Gupta National Coordinator BPNI, spoke at length on the activities of BPNI and its role in monitoring the violations of IMS Act. He informed that a case on violation of IMS Act against Nestle is pending in the court for the last six years. At this stage Mr. Bhandare interrupted and said that legal battle is a lengthy battle. However, with advocacy BPNI could achieve success in stoppage of some violations of IMS Act. Mrs. Geeta Luthra, Advocate Supreme Court advised to issue "Show Cause Notice" to those who are responsible for violations of the IMS Act. Dr.Deepti Gulati, Consultant World Food Programme emphasized the importance and advantages of breast milk for infants and young children. Dr. G.P.Mathur from BPNI reported more than 25 violations of IMS Act during the year 1999- 2000 and also showed different types of violations. Participants took active interest and asked many queries which were replied by the speakers. Prof. [Mrs].S.K.Verma, Director of the Indian Law Institute, after welcoming the chief guest and participants, discussed the need of IMS Act in view of the declining trends of breastfeeding. Prof. Sadique Jilani Syeed assisted in organizing the function.
BPNI participation in International Conference on Early Childhood Care for Survival, Groth and Development at Hotel Ashoka, New Delhi In order to facilitate the development of the new India strategy for Early Childhood Care for survival, growth and development, in state specific settings, the Department of Women and Child Development, in collaboration with NIPCCD and UNICEF had organized a 3 day national conference, from 3rd to 5th October, 2000, with participation of national and international resource scientists and practioners. Dr Arun Gupta, Dr Jagdish C Sobti and Dr G P Mathur attended the conference. Dr Arun Gupta presented the paper entitled "Nutrition: An entry point for early childhood care".
BPNI strategic planning meeting: Infant and young child feeding on 24-25 June 2000 To discuss the issues in depth and suggest actions and strategies for next five years for implementation and suggestions to relevant Governments, BPNI and other NGO’s, a 2 days meeting on 24 and 25 June, 2000 was arranged by BPNI at IMA House, Delhi. BPNI has established six task forces and an advisory council.
The six task forces are:
National Technical Committee on Child Health (NTCCH) Dr Arun Gupta, National Coordinator of the BPNI, an appointed member of the committee, attended the meeting.The first meeting of the National Technical Committee on Child Health was held under the chairpersonship of Shri. A. R. Nanda, Secretary (FW) on 18th September, 2000, at New Delhi. Dr Arun Gupta, stressed that unless malnutrition is effectively tackled other interventions may not achieve optimal results. He also suggested a greater coordination between activities of Department of Women and Child Development and Family Welfare. Shri Nanda expressed the view that the committee should meet once every quarter. He advised that details of the studies being conducted by ICMR and those mentioned by other members may be made available to the Department of Family Welfare for dissemination to all members of NTCCH. In future during the meetings, success stories may be presented by NGO’s.
World Breastfeeding Week (1-7 August 2001) Breastfeeding: It's Your Right
The Breastfeeding Promotion Network of India (BPNI) organises World Breastfeeding Week (WBW) to increase social mobilization for optimal breastfeeding and reach out to all sections of society. BPNI is a coalition of members, an umbrella organisation in which State and City Coordinators and its members participate fully. WBW is certainly one of the most visible strategies to achieve the goals of the World Summit for Children and is now steadily gaining ground, with more and more groups becoming involved in its activities. Past themes of WBW include 1992-1996; the BFHI, Making the Act Work, Mother-friendly workplaces, Breastfeeding: Empowering Women, breastfeeding - A Community Responsibility and Breastfeeding: Nature’s Way, Breastfeeding-The Best Investment and Breastfeeding-Education for Life. This year’s theme was selected as Breastfeeding: It’s Your Right. As on the past this year also action folders were produced for use by BPNI members, in organising a multitude of events to bring the message home. WBW activities provide a prime example of how information can be circulated to all segments of society.
Through the 200 City Coordinators, State Coordinators, State BPNIs, more than 2000 members. Rotary Clubs, Inner Wheel Clubs, Lions Club, and other NGOs who are interested and involved on the issue all over the country BPNI has played a key role to fulfil the activities on World Breastfeeding Week. BPNI had supplied action materials around the country for the celebration and people have benefited out of this. From every corner we have received the response and it is very much encouraging. BPNI provided inputs into observation of World Breastfeeding Week in the country through Department of Women and Child Development, ICDS centres, Nutrition Centres, Medical health personnel, Rotarians, ESI Hospitals and clinics, Military and Army headquarters, etc.
BPNI also provided inputs into observation of World Breastfeeding Week to various NGOs in the country that was also involved in the celebration in a big way. The group conducted quiz competition, poster and slogan competition, essay competition, among the students in the schools and colleges alongwith teaching/learning activity about breastfeeding to make them fully aware of the issue.
Members of BPNI were involved in different hospitals and community for talk and orientation programme on the issue.
BPNI also interacted with print and electronic media. Three press release were issued from the BPNI office. Zee TV and Doordarshan covered the issue during the week at different times with features.
Sensitization of Parliamentarians and release of Advocacy kit Sensitization Meet for the Parliamentarians on Breastfeeding held on the occasion of World Breastfeeding Week to uphold breastfeeding as the most important human right both for the baby and the mother. This meeting is organised by Government of India, Department of Women and Child Development. During the meeting a Parliamentarian Advocacy Kit on Breastfeeding is being released jointly by GOI-BPNI-UNICEF.
Report of the Special programmes in the country on the event Indian Academy of Pediatrics (IAP): All branches of IAP in the country celebrated the World Breastfeeding Week with very innovative ideas. From most of the places we have received reports of celebration of WBW.
Rotary Club and Inner Wheel Club: Rotary and Inner Wheel clubs have taken this issue as part of their activities and during the week they have undertaken lot of activities with the help of BPNI’s action folder and other materials specially in the South India area.
Display of banners and posters: The banners containing information of breastfeeding week celebration were fixed at various points. Various types of posters and slogans highlighting the advantages and promoting breastfeeding in English and Hindi and other local languages.
Jessy George
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