Breastfeeding spaces have been beneficial for service receivers who can breastfeed their babies while visiting these offices. However, for those who work there, it's made little difference. Inadequate breastfeeding facilities and strict policies prohibiting children in workplace add to the difficulty
Ensuring every child receives the best start in life is of utmost importance. The significance of breastfeeding within the first hour after birth cannot be overstated. Studies have shown that newborns breastfed within the first hour have a significantly higher chance of survival. This practice also triggers the production of essential nutrients and antibodies, found in breastmilk, including the vital colostrum. Breast milk stands out as an affordable and effective means to protect newborns and infants from infections. Encouraging breastfeeding holds equal importance for mothers, as it plays a crucial role in preventing 20,000 annual deaths attributed to breast and ovarian cancer, while also acting as a natural contraceptive.
Research from Nepal's tertiary level hospitals reveals that a significant number of mothers were not practising exclusive breastfeeding because of limited time due to job commitments.
The government's target for SDG 3.2.1 is to reduce the under-five mortality rate to 27 deaths per 1,000 live births by 2022 and to 20 deaths per 1,000 live births by 2030, and that for SDG 3.2.2 is to reduce the neonatal mortality rate to 16 deaths per 1,000 live births by 2022 and to 12 deaths per 1,000 live births by 2030. Optimal infant and young child feeding (IYCF) practices are critical to the health and survival of young children. Recommended IYCF practices include early initiation of breastfeeding within the first hour of life, exclusively breastfeeding for the first six months of life and feeding children a diet that meets a minimum diversity. However, according to the Nepal Demographic and Health Survey 2022 report, exclusive breastfeeding among children age 0-5 months has fluctuated widely-declining to 56 per cent in 2022. Only 55 percent of children age 0-23 months were engaged in early initiation of breastfeeding.
Recognising these challenges, efforts have been made in Nepal to provide support to mothers from various sources, including family members, healthcare professionals, employers, and governments, and best practices adopted to ensure an environment that would support breastfeeding. One of them being, the government's attempt to facilitate breastfeeding in workplaces. While this is a good start, it definitely is not enough. Due to the mandatory policy, there breastfeeding spaces are available now but are not well managed. These spaces must meet hygiene requirements and have a hand washing facility, among others. Their utilisation is another major challenge.
Many working mothers find it difficult to breastfeed their child for many reasons. There is hardly any support for mothers in the informal sector. Even in the formal sector, one significant obstacle is the limited duration of paid leave, which often lasts less than 26 weeks (about 6 months). Workplaces could create an inclusive atmosphere where working mothers do not have to make a difficult choice between their professional pursuits and child care.
These breastfeeding spaces have been beneficial for service receivers who visit these offices for some time and can breastfeed their babies now. However, for the women who work there, it's made little difference. Inadequate breastfeeding facilities and strict policies prohibiting children in the workplace add to the difficulty. In the absence of child care facilities, mothers cannot bring their babies along. As a result, most women resort to formula substitutes in spite of the law prohibiting its sale and distribution.
The rising caesarean section rates in Nepal, which has risen by almost twofold from 4.6 per cent to 9 per cent (2011-2016), add to this woe by delayed breastfeeding compared to natural delivery, mostly due to medical conditions or knowledge and skills about different positions and postures for breastfeeding.
All these make human milk banks crucial in providing safe and nutritious alternatives for these infants. Nepal took a significant step in this direction by initiating its first milk bank, Amrit Kosh, in 2021. In Nepal, scaling and expanding the Amrit Kosh initiative to create a connected system of lactation management centres in public and private health centres could significantly decrease infant mortality rates, benefiting not only the estimated 80,000 preterm newborns but also offering vital support to other vulnerable infants. This pioneering endeavour aligns with Nepal's Multi-Sector Nutrition Plan (MSNP), aiming to enhance the nutritional well-being of mothers, adolescents and children across the nation. The mission aims to gather, pasteurise, assess and preserve human donated milk from nursing mothers, and distributing it to needy children in a safe manner.
These lactation management centres play a vital role in ensuring baby-friendly health systems, offering critical support to premature, low birth weight and other vulnerable infants when they need it most. By making human milk banks available within eligible healthcare institutions, numerous infant lives can be saved. It has also helped to sensitise working women towards the essential role of human milk for the infants and that their own milk can be stored and fed to the child following basic management guidelines. Furthermore, it enhances altruism and the pride of not just giving life to their own child but that their excess milk, if donated, can be a saviour for another little life, too.
However, creating a supportive environment for nursing mothers requires involvement from the entire ecosystem, comprising the family, health care system, workplaces and governments. The need is to set up a matrix of Comprehensive Lactation Management Centres, where the priority is early initiation of breastfeeding for one's own child and donation of surplus to save other lives. Finally, facilitating breastfeeding is the responsibility of everyone, which will not just help save lives but also aid in the growth of a healthy new generation.
Dr Mishra is Additional Secretary at the Ministry of Health and Population
A version of this article appears in the print on August 18, 2023, of The Himalayan Times.
