Protecting the lives of babies

Rahim, one-year-old baby of Sokhina Khatun, resident of Kotagram village in Abhoynagar upazila of Jessore, was getting weaker day by day. The baby has been suffering from different health problems. A health worker (nutrition) of BRAC one day visited his house, detected the problems and advised his mother to give her baby breast milk and provide other nutritious foods. The baby started showing improvement after his mother complied with the advice.

BRAC sources said the baby's mother did not breastfeed him properly during the first six months of his birth mainly due to ignorance, which weakened his health. The mother admitted that she fed her child with artificial milk.

"We do not like to buy baby food of multinational companies, but some companies compel the poor mothers to buy the artificial food," she said.

There are several reasons for not breastfeeding babies. Ignorance is the main reason. Though breastfeeding is essential for maintaining the good health of newborns, many babies have been deprived of the breastfeeding in Abhoynagar upazila.

Aggressive marketing of some baby food companies creates a difficult situation for breastfeeding. To increase the breastfeeding rate further is a challenge as mothers still face certain problems.

Residents of Abhoynagar upazila said that some companies distribute formula milk samples free to hospitals and maternity wards. Mothers are later compelled to buy the formula.

Another mother, Farzana Akhter, 38, resident of Kotagram village of the upazila, said many poor mothers feed their babies artificial milk due to their ignorance. As a result, infants receive inadequate nutrition. She said that BRAC health workers are working in the area to raise awareness on necessity of breastfeeding.

Health experts said there is no alternative to breastfeeding for normal growth of children, terming breastfeeding a right of infants. So, health professionals have to provide optimum support and encouragement to mothers for breastfeeding. It was found that many shops in Abhoynagar upazila are selling artificial powder milk, packet and canned milk as baby food flouting the government rules. Most of the shop owners are unaware of the ban of selling the baby food. They said they are selling it as local people came to their shop seeking baby food. However, some of them know that there is no substitute to breast milk.

The same picture was found in other parts of the country where artificial baby food is available violating the BMS (Breast Milk Substitutes) Code. Abhoynagar Thana Health Complex sources said they are campaigning to highlight the importance of breastfeeding.

According to clause 3 of Breast Milk Substitutes (Regulation of Marketing) Ordinance, 1984, no person shall make, exhibit, distribute, circulate, display or publish any advertisement regarding breast milk substitute and promote the use of any breast milk substitute or implying or designed to create the belief or impression that breast milk substitute is equivalent or superior to breast milk feeding.

Clause-4 says: "No person shall promote any breast-milk substitute either by advertisement or by offering or giving any gift, prize, discount coupon, or other free items or by any other means".

However, a section of companies are selling and promoting breast milk substitutes flouting the rule, said Bangladesh Breastfeeding Foundation (BBF). According to BBF, the BMS Code is being violated mainly due to lack of awareness and monitoring.

Institute of Public Health (IPH), which is entrusted with the responsibility of enforcing the BMS Code, said massive public awareness about the breastfeeding can help enforce the BMS Code.  

"We can save millions of lives and increase economic opportunity by improving feeding practices and nutrition for infants and young children. Good nutrition is necessary for people to live a healthy and productive life, and is critical to securing long-term social and economic development goals - such as the Millennium Development Goals", said IPH.

Three essential feeding practices during the first 24 months of life can prevent the impact of poor nutrition that last a lifetime: Exclusive breastfeeding for the first six months (180 days), washing hands with soap before preparing food and feeding young children and beginning with the seventh month of life (from six through 23 months of age) feeding babies and children a variety of healthy foods (preferably homemade) in sufficient quantities, along with continued breastfeeding.

While breastfeeding has traditionally been a universal practice in Bangladesh, only about 40% of mothers exclusively breastfeed their babies for up to six months (BDHS 2007). This has led to malnourished children growing up with weakened immune systems, stunted growth, increased risks of severe infectious diseases, and damaged physical, mental, and brain development.

According to WHO, nearly a million newborns die every year in WHO's South-East Asia Region that include Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Republic of Korea, Sri Lanka, Thailand and Timor-Leste. Many of the children can be saved by early and exclusive breastfeeding.

Evidence shows that breast milk is the best food for newborns and infants, providing all the nutrients they need for their healthy growth and development. It protects newborns and infants from common childhood illnesses - such as diarrhoea and pneumonia. It protects the mothers too.

Experts call for taking necessary steps for ensuring breastfeeding. Dr Raisul Haque, Programme Coordinator of BRAC Health Nutrition and Population Programme (HNPP), said under the BRAC's nutrition project 'Alive & Thrive (Community Component)' being implemented since June 2009 across the country, they are trying to solving the nutrition problem of babies (aged 0-2 years). Under the programme, mothers of those babies are advised by the BRAC workers through counselling to give only breast milk to their babies till six months and must continue breastfeeding along other with home-made sufficient nutritious foods, including protein till two years. If the rule is ignored, the babies may fall to health problem.

About the violation of the BMS Code, Dr Raisul said the Code should be strengthened more for checking the violation. "BRAC is carrying out awareness raising programme so that the BMS Code is not violated. I called on all concerned for enforcement of the BMS Code", said Dr Raisul.

BBF has urged healthcare providers to play an important role in assisting mothers and their families to promote breastfeeding so that all infants get growth and development. Breastfeeding within one hour of childbirth and exclusive breastfeeding for the first six months is a key factor for the survival of an infant, said Dr SK Roy, Chairperson of BBF. "We have to work together to build a happy, healthy and prosperous Bangladesh for the future generation," Roy said.

BBF sources said starting breastfeeding within 1st hour of birth of child reduces 31 per cent newborn deaths. Exclusive breastfeeding until six months could cut child deaths by 13 per cent. Because mother's milk is easier for babies to digest and contains all the nutrients, calories which need to grow.

Existing laws and policies must continue to be implemented and enforced, including laws against the promotion of infant formula and in support of clean and uncontaminated food. The government has ratified the International Breast Milk Substitutes (BMS) Code and formulated national laws in the mid-1980s that have curbed BMS market control, but progress is still needed to improve the enforcement of this code.

The writer is a freelance journalist. Her e-mail address is: [email protected]