Mass Media Needs Sensitization on Health Issues as an Indian TV Serial Anupama Inappropriately Endorses Prelacteal Feed

Movies and Television (TV) serials have a great impact on their audiences in any society across the globe, particularly those serials that have a huge fan following and the lead characters in these famous serials are nothing short of celebrities in real life. Millions of people just wait for the next episode of these famous serials with great anxiety. The lifestyle, clothes, attitude, behavior, culture, and so on of the characters in the serial influence the mindset of the audience at a very large scale.

Recently, in India, a serial named Anupama is being aired currently on StarPlus channel. This serial is one of the most popular TV serials among masses and have one of the highest television rating point (TRP) across all channels. ¹ In a recent episode of the same serial, it was shown that a baby was born in the hospital. The main lead of the serial, a women named Anupama, visited the hospital along with the grandparents and other family members to meet the mother and the newborn baby. They entered the ward where the mother and the baby were lying on a bed. The great grandmother picked up a small bottle from her bag and Anupama, the main lead, very happily gave it to the baby. All others present there asked her about its content. Then Anupama told them that its ghutti, a prelacteal feed, and it has to be given to the baby after birth and it is a practice to give it to newborn babies. ² Whatever shown in this serial as mentioned earlier has been contrary to the current breastfeeding recommendations.

Breastfeeding is one of the most effective ways to ensure child health and survival. The health professionals all across the globe discourage the use of prelacteal food and promote exclusive breastfeeding where nothing, even water, is to be given to the baby after birth till 6 months of age. Prelacteal feeding is the practices of giving any substances other than breast milk given to newborns before start of breastfeeding, usually in the first 3 days of life. ³ Honey, sugar, jaggery (brown sugar from sugar cane), sugar-juice, goat's milk, cow's milk, ghee (refined butter), infant formula, rose water, boiled water and clean water, and ghutti (herbal paste) are the common prelacteal foods usually given to newborns. These prelacteals may be prepared with herbs such as cumin, cardamom, nutmeg, asafetida, caraway, and cinnamon. ⁴

Despite having insignificant nutrient and protective values and bearing the risk of introducing contaminants in the newborn, giving prelacteal feeding remains a major cultural practice in the South Asian countries. ⁵ Prelacteal feeding deprives an infant the nutrients that it needs in the first 6 months of life that would be obtained by exclusive breastfeeding and discourage newborns from initiating breastfeeding. It is also associated with increased morbidity and mortality among newborn.^6,7 In a study from India, it has been observed that about 94% families in a particular district had given milk other than breast milk to their newborn as prelacteal feed. ⁸ Similarly, in a study from Himachal Pradesh in India, the prevalence of prelacteal feeding observed was 49.5%. ⁹ A study from Nigeria observed that large proportions of both medical and nonmedically trained health care workers stated that they routinely gave prelacteal feeds. ¹⁰

Prelacteals are often provided due to various misconceptions among people such as that it helps clear the babies' throat/bowel. Some believe prelacteals are a necessary substitute for colostrum or the colostrum is too heavy for the newborn to digest, and so on. Many other studies have also reported “insufficient milk supply” as a reason for providing prelacteals. ⁴ The choice of prelacteals may vary according to a caste, religion, or family. In many places in India, prelacteals to a newborn is given as a ritual whereby the person administering the prelacteals holds a respectful status within the family or community and it is thought that the child will be having the personality similar to the person giving prelacteal, and the same fact could seen in the serial Anupama too where this fact has been endosrsed.^2,4

But all this is against the medical advice regarding exclusive breastfeeding. The Government of India and other international health agencies also promote exclusive breastfeeding. ¹¹ This kind of endorsement of prelacteal in this serial named Anupama is against this medical advice and is nothing short of a hindrance in promotion of exclusive breastfeeding activities. With a very high TRP and millions of fan following, this kind of message percolates very deep into the society and could influence millions of families toward giving prelacteals.

There is no doubt that media influence masses directly or indirectly at a large scale. ¹² Many important health issues were brought in public domain and discussion by media thus highlighting its importance in public health policy making. But there were instances too where films and serials have shown many medical and health issues in poor light with lot of misinformation, distorted facts, and thus spreading false knowledge. This leads to practices that bring ill health to the families.

The scriptwriters in films and TV serials need to have their homework done properly and get some serious research done. It would be better if they could talk to some nearby qualified medical professionals regarding any health-related issues and their relation with the customs and culture of the society as well as the medical recommendations for the same. So there is a need of some mechanism where the script should be discussed with a medical professional beforehand whenever there is a scene discussing/showing hospital, health matters, health-related customs, and so on, so that proper, genuine, scientific, and appropriate information reaches the masses.

Training sessions for sensitization in very basic epidemiology and biostatistics, public health intervention, public health structure, national health programs, and health reporting in relation to breastfeeding issues for directors, scriptwriters, and editors for mass media such as cinema, TV channels, and news channels could be a significant tool for better dealing with health issues in media. ¹² The medical associations in every country should come forward and conduct sensitization workshops for media personnel at national, state, and district levels involving their state and district chapters across the country. Regular workshops on these topics will help in sensitizing media in the long run. ¹²

A small scientific document/module local in layman's language could be prepared by the medical professional associations for mass media, which could have information related to common health issues routinely shown in cinema and TV serials, and this document could be made available free with easy accessibility to media personnel as a ready reference. A mechanism of special medical information desk through e-mail for answering queries on health issues including breastfeeding could be evolved where any media personnel/scriptwriter could contact a medical association for any health query related to their stories.

The university curriculum of mass media courses as well as courses of school of drama and films could be more inclusive with introduction of modules related to health issues so that the budding journalists, scriptwriters, directors, actors, and so on could be sensitized about the importance of better health reporting and dealing with issues involving public health. Medical professionals could be involved as guest faculties for taking few lectures/workshops in these colleges and universities imparting these courses. The possibility of a small new course such as Medical Experts in Mass Media could be explored.

Finally, in case of this particular serial Anupama, where there is an issue of not observing exclusive breastfeeding by the family, it would have been better if the scriptwriter had shown that the elderly grandparents were insisting on use of honey as prelacteals, but the main character Anupama resisting them and guiding them for exclusive breastfeeding. That would have been a very strong message across the masses in every corner of the country and would have been a milestone in promotion of exclusive breastfeeding.