Each year about 0.76 million babies in India die in the neonatal period, constituting 29% of the global share, and nearly 3.5 million babies are born premature, constituting about 25% of the global burden.
But how will breastfeeding help?
It is estimated that initiation of breastfeeding within an hour of birth can prevent around 33% of these deaths. A quarter of a million neonatal deaths in the country are, therefore, preventable.
For babies who are born premature, with low birth weight, or are malnourished, breastfeeding gives the best start and can play a vital role in setting the wheels in motion for a well-nourished childhood.
Breastfeeding: a powerful but under-utilized intervention
In India, only 41% newborns receive breast milk within the first hour of their life and only 55% are exclusively breastfed for six months. In countries like India, the chances of a non-breastfed baby dying are six times more than those who are breastfed.
In premature babies, breast milk reduces the chances of sepsis and necrotizing enterocolitis, improves feeding tolerance, and reduces length of their stay in NICU (intensive care unit for neonates). Feeding them, however, is accompanied by additional challenges, including prolonged separation from mothers as babies are admitted in NICU; delayed or lack of lactation in mothers; lack of supportive staff, infrastructure and systems in hospitals to help express, store, and transport mother’s milk to the admitted baby etc.
A study by PATH and Lokmanya Tilak Municipal Medical College, Mumbai found that mothers whose babies were in NICU were stressed and anxious due to separation from their babies, and remained largely unaware about how to breastfeed, experienced pain in expressing milk, and had little privacy and support in the hospital and at home for breastfeeding.
In such cases, babies miss out on breast milk and often end up be ing fed formula milk or cow’s milk, which can cause sepsis, infection, and even lead to death. Additionally, a lot of babies are unable to breastfeed for reasons such as mother’s illness or death, abandonment, or delay in milk production.
It is for such situations, when babies have no access to their mother’s milk, that short- or long-term donor human milk from a human milk bank becomes a lifesaving alternative. Human milk bank is a facility which collects, processes, tests, stores, and feeds safe donor milk to vulnerable babies.
Ensuring universal access to human milk
Saving lives of infants with the use of donor human milk is a timeless practice. Countries in North America and Europe established human milk banks in the early 20th century. The United Kingdom established its first human milk bank in the 1930s and Brazil in the 1940s. The Brazilian Human Milk Bank Network which has won international acclaim is the largest in the world. It has helped achieve a single digit neonatal and infant mortality rate, in addition to saving the country an estimated $540 million annually through improved neonatal health outcomes.
India established Asia’s first human milk bank in as far back as 1989. Despite this, their growth has remained slow because of lack of awareness among the medical community, absence of standardized guidelines, and lack of lactation counsellors. The past few years, however, have seen an improvement in the government’s commitment, and collaboration among health care workers. India now has over fifty operational milk banks, but falls terribly short in meeting the huge unmet need for donor breast milk.
Ensuring that every baby, especially those born premature, receive human milk is one of the easiest and most effective steps to improve their health. The launch of the national guidelines on human milk banking/lactation management in public health facilities in 2017 was a step in the right direction. These guidelines propose to establish Comprehensive Lactation Management Centres which provide breastfeeding and milk expression support to mothers, encourage skin-to-skin contact between mother and baby, and provide safe donor milk to babies unable to receive mother’s milk.
Governments across India are working towards scaling up these centres. For successful expansion, there is a need to build capacities of the health care providers to improve awareness on breastfeeding; have dedicated staff for lactation counselling; have a breastfeeding-friendly environment with special focus on mothers whose babies are in the NICU; and have policies in hospitals that support early rooming-in of mothers and babies to allow mother’s milk to reach her baby or to provide donor milk to those vulnerable babies who cannot be breastfed.
Scaling-up lactation management centres will benefit 14.26 million mother-baby dyads at public facilities and 10.47 million mother-baby dyads at private facilities with improved newborn nutrition and care practices.
Since India continues to have the highest number of births globally, including babies born with low birth weight or premature, ensuring access to cost-effective and lifesaving interventions is essential to reducing neonatal deaths. Systematic implementation of the national guidelines will help us move towards a health system that prioritizes care of premature infants, which will not only improve survival rates but also lead to better long-term health of children, the future of New India.