Abstract
Dear Editor:
I
I am a biomedical scientist working in India having a special interest in Health Systems Research. I was delighted to read the article as it spoke about strengthening health care system for providing breastfeeding support to the mothers. I have experience in working with lactating mothers in rural Indian setting, who actually are in need of support from trained health care professionals about the correct infant feeding practices. India has come up a long way in many aspects of maternal and child health care. We have done fair enough for ensuring minimum antenatal care (four ANCs) to the pregnant mothers from 37% (2005–06) to 51.2% (2015–16), 2 postbirth following them for routine immunization. But somehow, we are almost stuck to the rate of exclusive breastfeeding (EBF) for the first 6 months of infant's life.
In Indian setting, the accredited social health activists, auxiliary nurse and midwives, and anganwadi workers are those who provide the basic ANC to pregnant mothers. Even immediate postnatal care up to 42 days of postpartum period is also part of their assignments. Despite having structure in place, perceived increment in public awareness regarding benefits of EBF, we are still struggling. The Outpatient Breastfeeding Champion (OBC) 3 is a clinically focused platform that definitely needs to be in place, but the sociocultural economic determinants of duration of EBF are the most important to be focused on in the present day scenario for most of the low- and middle-income countries (LMICs). 4 Majority of the LMICs have a health system structure in place that provides basic ANC. 4 The question is why can't we try to strike a balance in the clinical and sociocultural economic issues that deters the EBF practices. Our national program has a window of counseling the expectant mothers while giving ANC. We definitely need to have a clinical platform to improve the competency of the care providers to address the clinical issues related to breastfeeding, but at the same time we need to explore further how we can address the important other nonclinical factors influencing it. Many investigators around the globe have explored this issue, but mostly in quantitative manner, and we all know parents' education level turned to be one of the major determinants of failure of EBF practices. The current embedded counseling sessions within the maternal and child health program are focused only on the pregnant mother, whereas globally studies conducted in developing country like ours have explored the role of fathers and the role of influential family members in deciding/maximizing duration of EBF in the backdrop of the females having less power for making decisions on such important issues. 5 Unfortunately, these important pieces of evidence lack programmatic translation, and hence the policy makers now need to look at the diverse options encompassing the other significant determinants to increase the current rate of EBF for the first 6 months from the current 54.9%. 2
As a health system researcher, I would support to have a clinical platform for skill building of care providers, but more necessarily we need to have activities within the existing health care delivery structure focused toward skill building of expectant mothers, their husbands, and influential family members for optimizing the duration of EBF. It may sound easier to have a program like OBC in the system, but we need to prioritize among the possibilities to improve infant feeding outcome in harmonization with the infant and young children feeding initiative.