World Breastfeeding Week is celebrated in most parts of the world from 1 to 7 August. This year, the Week highlights the importance of providing support to breastfeeding families. Breastfeeding for the first few years of life protects children from infection, provides an ideal source of nutrients for growth and development of young children and is economical and safe. However, in many countries, including Bhutan, many mothers stop breastfeeding too soon and there are often pressures to switch to breast milk substitutes including infant formula, which can contribute to growth faltering, micronutrient malnutrition and can cause diarrhoea. Even when mothers are able to get off to a good start, all too often in the weeks or months after delivery there is a sharp decline in breastfeeding rates, and practices, particularly exclusive breastfeeding, as stated by the World Alliance for Breastfeeding Action (WABA). With changing times, societies change and various traditional support systems, such as family and community support system is less visible. However, support for mothers from a wider circle is needed, whether it is provided by trained health workers, community outreach, or from friends who are also mothers, and/or from fathers/partners and supportive workplace policy environment.
While most mothers in Bhutan breastfeed up to 2 years or more, the practice of exclusive breastfeeding – feeding only mother’s milk – for the first six months of the baby’s life remains a challenge. The Bhutan Multiple Indicator Survey (BMIS) 2010 shows that only 48.7 per cent of mothers practiced exclusive breastfeeding, that too only for the first five months. Working mothers often do not get a set rest period after giving birth to enable them to breastfed properly and needless to mention, maternal anaemia is a concern. In rural Bhutan, mothers are already up and working in the field less than a week after giving birth. This is often why many caregivers end up giving food other than breast milk, causing under-nutrition.
Under-nutrition is more than lack of food security. It exists even in food secure communities, sometimes caused by inadequate knowledge or traditional beliefs and practices related to infant feeding and hygiene. For example in the context of Bhutan, there exists traditional beliefs that one must feed butter to the new-born and in some communities that colostrum (the mother’s first milk) is considered bad for the baby. The effect of these beliefs is that babies are deprived of important nutrients in breast milk. The government promotes exclusive breastfeeding during the first six months of a baby’s life. But employed women are allowed only three months maternity leave after which they return to work. Maternity leave is even shorter for women working in the private sector. There is scientific evidence that children who do not receive the appropriate nutrition in early life, especially mothers’ milk, are not able to develop and grow properly.
The BMIS 2010 shows that 33.5 per cent of children in Bhutan suffer from stunting – an irreversible outcome of chronic nutritional deficiency during the first 1,000 days of a child’s life (the period from 9 months in the mother’s womb to 24 months after birth). The damage it causes to a child’s development is permanent. Studies have suggested better childhood nutrition could cut stunting by one-third and reduce health issues from diarrhoea and pneumonia. Breastfeeding helps mother and child to bond and enhances their interaction for cognitive and socio-economic development thus helping children to learn and earn more as adults propelling growth while reducing poverty and inequities.
“I did exclusive breastfeeding for three months. But thereafter I had to do mix feeding because I’m working and I stay far away from my work place,” says Nidup, a 25-year-old mother. SangayLhamu, 32-year-old mother of two says: “I bottle-fed both my children as I had to go to office.” This is a reality for most women who are employed. Working mothers, both in offices and in farms and market place, face challenges and need support to succeed at working and breastfeeding.
This is where the local community and the government can work together to step up efforts - by starting Mother Support or Peer Support groups to help mothers to establish and sustain breastfeeding; by establishing a network of local community support contacts for breastfeeding mothers that women can go to for help and support after giving birth. Government can create spaces for children and women at market places, at offices and at both formal/informal workspaces as an investment for future prosperity underpinning the importance of child-focused social protection systems. Societal support increases the mother’s confidence in her ability to breastfeed beyond the early weeks and months. Let us renew the promise to protect, support and promote breastfeeding by bringing breastfeeding support close to mothers as children deserve a healthy start in life.
Representative, UNICEF Bhutan