Dramatic Increase of Exclusive Breastfeeding Leads to Improved Child Survival in Assam
By Angela Walker
DIBRUGARH, India, 15 June 2010 – Anganwadi Durowpadi Bedia takes her job very seriously as a community-based health worker on the Nahortoli Tea Estate in the northeast Indian state of Assam.
Every month she conducts meetings to teach new and expecting mothers about the importance of exclusive breastfeeding for six months and visits them in their homes to reinforce the lifesaving messages of proper health and nutrition for their babies.
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“Before the Aangawadi workers, even though the doctor was advising them to breastfeed, the mothers were still following their traditions of feeding goat’s milk to the babies and putting goat dung on the cord as medicine,” says Bedia, who herself was born and raised on the tea estate where her mother worked picking tea.
“I had seen many deaths near my house and in the labour lines. But from the time when I have joined here, continuously giving the messages about institutional deliveries, immunizing children and breastfeeding, we don’t see the same rate of deaths as before.”
Bedia speaks the local dialect of Sadri and helps reinforce messages being broadcast on TV and on the radio. Home visits help the whole family knows the importance of exclusive breastfeeding during the first six months of life, continued breastfeeding for twenty four months and the proper introduction of age appropriate and nutrient-dense complementary foods in the beginning of the seventh month.
Seeing the home environment also ensures that she can reinforce proper hygiene and the importance of washing hands with soap to keep both mothers and babies happy and healthy.
“Whenever we go on home visits we talk to all members of the family -- the parents, the grandparents, adolescent girls,” says this slightly built woman dressed simply but elegantly in a blue and red sari and pearl necklace with her thick hair piled on her head. “Other members of the family come to know. They have faith in what I am saying.”
An Innovative Partnership
Every year, two million Indian children die before their fifth birthday, most of them from preventable causes.
Only 46 percent of infants are exclusively breastfed. In Assam, a coordinated strategy led by the state government in partnership with UNICEF and local NGOs considerably increased the rate of exclusive breastfeeding in infants younger than six months.
In the last four years, over 1.7 million Assamese infants have been exclusively breastfed, protected against undernutrition and disease and given the best start in life.
"Unquestionable global evidence demonstrates that breastfeeding counseling and support is the most important child survival intervention" says Dr. Victor Aguayo, Chief Child Nutrition and Development Programme with UNICEF.
The strategy included harmonizing the messages used for the promotion of breastfeeding, building the capacity of village-based health and nutrition workers to counsel mothers and families and standardizing the tools they use to support breastfeeding.
They particularly wanted to change traditional perceptions about colostrum, which was considered “dirty milk” and usually expressed and discarded.
“We faced a lot of difficulties. They were not listening to us, and the infant mortality rate was very high,” Taulfrank says. “One team after another went to the community. It took time to convince them. Again and again the same messages were delivered, then they came to know and believe.”
Home Visits Yield Results
In each village, health and nutrition workers meet at the Anganwadi centre on a fixed day each month. They draw up a list of the women who are in their last trimester of pregnancy or nursing an infant and establish a schedule for home-visits. Each mother on the list is visited at her home three to four times a month.
“Now mothers understand how vital breast milk is to the health of their babies,” said Jeroo Master, the Chief of the UNICEF Assam office. “Having health and nutrition workers actively promoting breastfeeding at the village level will ensure each child has the best start possible in life.”
Monika Bedi named her one-and-a-half-month-old daughter Mohima, which means “Blessing.” Her husband, Motilal, works in the tea factory.
The young mother is dressed traditionally in sherbet hues of pink, orange and blue, a streak of orange vermillion decorating the part of her hair pulled back into a neat bun. Her house is tidy with keepsakes carefully arranged behind glass doors and a television covered in orange lace.
Her baby nestles in a blue blanket, her hair oiled and a streak of kohl on her forehead against the evil eye.
From her mother, Monika came to know the tradition of throwing away the first milk. The Anganwadi and ASHA workers, who she calls ‘baideo’ or ‘elder sister’, told her about the importance of colostrum and exclusive breastfeeding.
“I was not knowing before it is important, and it will be good for baby,” she says. “When they come and talk in our own language, I understand better. I feel comfortable with them. I feel more nervous with the doctor.”
Baby Mohima has grown from 3 kg 200 grams at birth to 4 kg 700 grams today and has suffered no bouts of diarrhoea. “I say mother’s milk is the best,” Monika says. “If you feed mother’s milk, the baby is very healthy.”
Breastfeeding After Resuming Work
Mothers who live and work in the tea communities are in special need of support as most of them resume work soon after childbirth. Grandmother Hasina Begum walks 30 minutes to take her seven-month old granddaughter, Sabnum, into the fields to be breastfed by her daughter, Salma.
The sounds of buzzing locusts can be heard in the hot, humid air as the baby suckles at her mother’s breast.
“The baidoes, they told me to feed the first milk,” Salma says. “I have fed my child the first yellow milk.”
Hasina feels it is worth the extra effort to bring her grandchild to her mother several times a day so that she can get the perfect start in life.
“She needs Mommy – mother’s milk is best,” she says.
For more information and interviews, please contact:
Angela Walker, Chief of Communication, UNICEF India
Geetanjali Master, Communication Specialist, UNICEF India
Alistair Gretarsson, Communication Specialist, UNICEF India