Lactation failure

LACTATION FAILURE- URBAN & RURAL MOTHERS

DR.K.Sivakumar

INTRODUCTION

• Infant and young child feeding practices directly affect the nutritional status of children under two years, impacting child survival

• Child feeding practices are linked with knowledge of mother and socio-economic and cultural dimensions of the community

INFANT FEEDING PRACTICES IN INDIANFHS-3

• Although breast feeding after birth is nearly universal practice in India, very few children are put on breast feeding practice immediately after birth.

• Only 23.4 % of newborn babies were put on breast feeding within 1 hr.

• 37%- day one

• 63%-squeezed the first milk from breast discarded (colostrum) before they started breast feeding.

• Initiation of breast feeding is delayed and newborn is deprived of most nutritious feed and energy.

Optimal Infant Feeding practices includes

• Initiation of breastfeeding within one hour of birth.

• Exclusive breastfeeding up to six months of life.

• Continued breastfeeding for two years of life or beyond.

• Introduction of appropriate complementary feeding after 6 months of age.

Advantages of Breastfeeding

Breastmilk• Perfect nutrients• Easily digestible• Ready to serve• Protects against

infection• Protects against adult

onset diseases (diabetes, high blood pressure)

Breastfeeding• Helps bonding and

development• Helps in adequate growth

and development• Enhances brain & visual

development• Baby has higher

intelligence quotient• Prevents hypothermia

Advantages of Breastfeeding (contd.)

Mother• Reduces post delivery

bleeding and anemia• Delays next pregnancy• Protects breast and

ovarian cancer• Protects obesity and

shapes body• Convenient

Society• Eco-friendly • Human resource

development• Economic

development

Family Economic benefits

Less illnesses Family bonding

State of Infant and Young Child feeding in INDIA

3541.2

15.8

56.7

46.4

24.5 23.9

46.440.2

0

20

40

60

Initiation ofBreastfeeding within 1

hour of birth

Exclusive breastfeeding(0-6 months)

Complementary Feeding(6-9 months)

NFHS-2 (98-99) NFHS-3 (2005-06) DLHS-3 (2007-08)

Neonatal Mortality Risk by early infant feeding practices

1 1.16

2.55

3.57

0

0.5

1

1.5

2

2.5

3

3.5

4

Within one hour One hour to oneday

Day 2 Day 3

Timing of initiation of breastfeeding after birth

Infe

ctio

n sp

ecifi

c m

orta

lity

odd

ratio

Source: Edmond KM et al. Am J Clin Nutr 2007. 86:1126-31

Under-5 deaths preventable through universal coverage with individual interventions (2000)

India

*Breastfeeding: Exclusive for first 6 months and continued for 6 to 12 months Source: Jones et al. LANCET 2003;362:65-71

0% 2% 4% 6% 8% 10% 12% 14% 16% 18%

Breastfeeding*Complementary feeding

Clean deliveryHib vaccine

Clean water, sanitation, hygieneZinc

Vitamin AAntenatal steroids

Newborn temperature managementTetanus toxoid

Antibiotics fMeasles vaccine

Nivirapine and replacement feedingAntimalarial IPT in pregnancy

Inte

rven

tion

Percent

COMMON BARRIERS

BREAST FEEDINGFAILURE

INTERPERSONAL

INADEQUATE KNOWLEDGE

SOCIOECONOMIC STATUS MATERNAL AGE

MATERNAL EDUCATION LEVEL

MATERNAL WORKING STATUSPARITY

GESTATIONAL AGE

PLACE OF DELIVERY

TYPE OF DELIVERY

SOCIAL CUSTOMS

MODERNISATIONPSYCHOLOGICAL

HEALTH EDUCATION

SOCIOECONOMIC STATUS

• Socio economic status of the mothers had a significant association with duration of breast feeding

• Shorter duration was observed among the mothers with higher socioeconomic status

• prolonged duration among the lower socioeconomic class

• economically deprived mothers tended to breastfeed their babies for a longer period as compared to economically well-off mothers.

Source: breast feeding-practices,problems&prospects Ms. Sunita Reddy et al (6*)

INADEQUATE KNOWLEDGE

• All mothers knew that they had to breast feed their babies, but they did not have adequate knowledge about the appropriate way of breastfeeding.

• 10% knew that they have to initiate breast feeding within ½ hour of birth

• 10% had idea on hazards of prelacteal feed

Source: RN Chaudhary et al(2*)

• 25% had idea on importance of colostrum• 15% knew the meaning of exclusive breast

feeding• The impact of knowledge about breastfeeding

practice, i.e., (duration of breastfeeding, proper techniques, proper time of weaning) is poorly understood.

Source: RN Chaudhary et al(2*)

INTERPERSONAL

• Mother, Mother-in-law, Husband, Peer group are the most influential persons in decision-making about breast-feeding

• Misguidance & lack of support is one of the major contribution to breast-feeding failure

• Family relationships can play a significant role particularly in sustaining breastfeeding

Source : R.Haider et al(7*) "International Breastfeeding Journal."

MATERNAL AGE

• Age of the mother had a significant positive effect on the duration of breast feeding

• Mothers above 30 years had lower exclusive breastfeeding rates compared to younger mothers, similarly teen mothers had lower rates

• mothers in twenties were more likely to breast feed for 6 months than their older counterparts

Source: al-Nasser AN et al (5*)

MATERNAL EDUCATION LEVEL

• Educational status of the mothers was inversely associated with duration of breast feeding

• As educational status increased the duration of breast feeding decreased

• 25% of mothers who had studied up to college level & more had not practiced exclusive breast feeding

Source : Mrs. Rama ram et al & Kar et al (3*,4*) Ms. Sunita Reddy (6*)

• Prolonged duration was observed among illiterate mothers

• educated mothers tend to discontinue breastfeeding earlier than their illiterate counterparts

• Literacy status had little effect on continuation of breast feeding for more than six months

Source : Mrs. Rama ram et al & Kar et al (3*,4*) Ms. Sunita Reddy (6*)

MATERNAL WORKING STATUS• Working mothers have been observed to find it

difficult to breastfeed their infants and wean them quite early

• Mother's work status played a significant role in the early termination of breastfeeding.

• Returning to work has been identified as a factor that influences breastfeeding duration and was cited as the most common reason for breastfeeding cessation by mothers

• Mothers working more than 20 hours per week post-partum was associated with a shorter duration of breastfeeding

• lack of workplace facilities

PARITY

• Parity also significantly affected duration of breast feeding in a positive manner

• Primigravidas mothers did not breast feed exclusively compared to of the Multiparous

• Second & third born babies had higher rates than first borns.

• Mothers with previous breastfeeding experience had a greater duration of breastfeeding than mothers with no previous breastfeeding experience.

PLACE OF DELIVERY

• Place of delivery was found to influence initiation of breastfeeding practices

• Mothers who delivered their babies at health facilities were found to initiate breastfeeding on time & feed exclusively compared to home deliveries.

• This might be due to proper counseling and guidance of health workers for breastfeeding initiation and continuation.

TYPE OF DELIVERY

• Type of delivery also significantly affected duration of breast feeding.

• It is found that mothers having cesarean deliveries were less likely to breastfeed at 6 months compared to mothers with normal vaginal deliveries

• The reason may be due to mothers having cesarean section experience more complication, pain, prolonged recovery, fatigue, discomfort, stress and anxiety.

TABOO’s• Social custom of rural India is that the early breast milk is the

witch's milk • There is no secretion of milk in first three days• Colostrum as something indigestible and not good for baby’s

health• Size of the breast influences the amount of the milk production• Believed that breastfeeding affects a woman's posture and

makes them lose their charm and figure• Consider it indecent and embarrassing to use their breast as a

source of nutrients to their babies.

HEALTH EDUCATION

• Mothers who received breast-feeding counseling and support from the time of their babies' birth had significantly greater rates of breast-feeding initiation, exclusivity, and duration of total breastfeeding than those who did not

• Attending prenatal counseling appears to be associated with breastfeeding initiation & continuation

PSYCHOLOGICAL

• Women who were under stress and anxiety failed to breastfeed for long.

• Postpartum depression begin as soon as three to four days after delivery and can affect decision and ability to breastfeed

• Insufficient milk syndrome• Mother’s intention to breastfeed can influence

breastfeeding duration

• Mothers who intend to breastfeed for greater lengths of time tend to breastfeed for longer than mothers who intend to breastfeed for less time

• It was found that mothers with intention to breastfeed for less than 4 months was a risk factor for early discontinuation of breastfeeding.

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BREAST FEEDING PROBLEMS

Retracted nipple Cracked nipple Engorged breastMastitisInsufficient breast milkMaternal medications

How to overcome this problems

Breastfeeding Initiatives

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Baby Friendly Hospitals Initiatives(BFHI)

1. Helping the mother initiate breast-feeding within the first hour of birth in normal delivery and 4 hrs following caesarean section.

2. Encourage breast feeding on demand.

3. Allow mothers & infants to remain together 24 hrs a day ,except for medical reasons.

4. Give new born infants no food or drink, other than breast-milk unless medically indicated; exclusive breast feeding should be promoted till 4-6 month of age.

5. No advertisement, promotional material or free products for infant feeding should be allowed.

6. Show mother how to breast feed, and how to maintain lactation even if she is seperated from her infant.

7. Give no artificial teats, pacifiers, dummies or soothers to breast feeding infants.

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8. Encourage mothers to assist each other and to develop breast feeding supporting groups.

9. Inform all pregnant women about benefits and management of breastfeeding

10. Train all the health care staffs in the skills necessory to implement this policy.

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National guidelines on infant & young child feeding(2004)

• Intensify nutrition &health education to improve

infant & child feeding and caring practices so as to:

(a) bring down the prevalence of under-weight

children under 3yrs from current level of 47%-40% ;

(b) reduce prevalence of severe under nutrition in

children in the 0-6yrs age group by 50%

• Enhance early institution of breast feeding (colostrum

feeding) from the current level of 15.8%-50%.

• Enhance the breast feeding rate for the first 6 month from the current rate of 55.2%( for 0-3 months) to 80% .

• Enhance the complementary feeding rate at 6 months from the current level of 33.5% -75%.

Breastfeeding Promotion Network Of India ( BPNI)

• Registered, independent, non-profit, national organization located at New Delhi

• Working towards protecting, promoting and supporting breastfeeding

• BPNI believes “ Breast feeding is the right of all mothers and children”

• Main goal is to empower all lactating mother to practice exclusive breastfeeding up to six months and continued breastfeeding upto two years and along with introduction of appropriate complementary feeding after 6 months of age.

World Breastfeeding Week• World Breastfeeding Week

(WBW) is an annual celebration which is being held every year from the 1st to 7th August.

• Being organized by WABA, WHO and UNICEF

• Goal is to promote exclusive breastfeeding for the first six months of life.

• This year's World Breastfeeding Week (WBW) theme, 'BREASTFEEDING SUPPORT: CLOSE TO MOTHERS'

REFERENCES

1. NFHS-2 AND 32. Knowledge and practice of mothers regarding

breast feeding: a hospital based study, RN Chaudhary et al

3. Mrs Rama Ram et al: Breast feeding practices in rural Darjeeling.IJCM, 2000; 25 (2);79 – 82

4. Kar M, De R: Breast feeding practices – impression from an Urban Community ,Indian Jour. Of Public Health, 1991; 35 (4): 93 -5

5. A retrospective study of factors affecting breast feeding practices in a rural community of Saudi Arabia, al-Nasser AN, Bamgboye EA, Alburno MK.

6. Breast feeding-practices ,problems & prospects Ms. Sunita Reddy

7. Reasons for failure of breast-feeding counselling: mother’s perspectives in Bangladesh,R.Haider et al

8. Worldbreastfeedingweek.org

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