Dr. Shyam P Lohani

World Breastfeeding Week 2021 was celebrated amid different programmes throughout the world with the theme “Protect Breastfeeding: A Shared Responsibility” from 1- 7 August (WHO, 2021). Breast milk provides optimal nutrition for babies. It has the right amount of nutrients that are easily digested and is readily available. It has a healthy composition with unmatched immunological and anti-inflammatory properties that protect against numerous illnesses for both mothers and children.
Breastfeeding is one of the most effective means to improve child health and survival. However, according to the World Health Organisation (WHO), nearly two out of three infants are not exclusively breastfed for the recommended six months. Due to the continuation of benefits, the WHO recommends breastfeeding until two years old or longer. Health-related agencies and organisations recommend starting breastfeeding as early as one hour after birth for the greatest benefits. But surprisingly, only about 55 per cent of babies are breastfed within the first hour of their birth in Nepal (UNICEF, 2018).

Benefits
It takes two to six days for mature breast milk to begin to flow. Until then, colostrum which is nutrition concentrated pre-milk comprised of antibodies, growth factors, protein, fat, and white blood cells provides perfect nutrients for the baby. With vaginal birth for a first-time mom, it takes three to four days on average for milk to begin producing, while with cesarean section, it may take five to six days. Crying is the most common way that the baby is hungry. Other signs that the baby is hungry include licking their lips or sticking out their tongue, placing a hand in their mouth, moving their jaw, mouth, or head to look for the breast, opening mouth, fussiness, and sucking on things.
Breast milk provides the ideal nutrition for infants. Breast milk has a perfect composition of vitamins, protein, and fat that is needed for the baby to grow. Additionally, it contains those essentials in a form more easily digested than any of the infant formulae. Breastfed infants are more likely to gain the right weight as they grow older than become overweight in the future. Breast milk provides all the energy and nutrients required for the first months of life, provides up to half or more of the nutritional needs of children during the second half of the first year, and about one-third of nutritional needs during the second year of life.
It also helps psychologically as the bonding between mother and child is better when breastfed than formula-fed. There is also economic benefit as families save a considerable amount of money when breastfed. Studies have shown that breastfeeding can help reduce the prevalence of various illnesses and health conditions, which in turn results in lower healthcare costs. Breast-fed children also have fewer hospitalisations and trips to healthcare providers. The risk of hospitalisation in the first year of life for lower respiratory infection is more than 250 per cent higher among babies who are formula-fed than those who are exclusively breastfed at least for the first four months of their life (Bachrach et al, 2003).
Human milk is a natural and renewable food that provides a complete nutritional requirement for about the first six months of life. On the other hand, infant formula and other substitutes for human milk that requires packaging that ultimately is deposited in landfills as opposed to breast milk. Thus, breastfeeding has an environmental benefit.
Breast milk is composed of antibodies that help babies fight off viruses and bacteria. Breastfeeding has been shown to lower the risk of asthma or allergies. There has been sufficient information that babies who are breastfed exclusively for the first six months have fewer ear infections, respiratory illnesses, and episodes of diarrhea. It also reduces the risk of colds and infections, gut infections, intestinal tissue damage, allergic diseases, bowel diseases, sudden infant death syndrome, childhood leukemia and both types of diabetes.
Breastfeeding is recommended for most infants; however, it is contraindicated for a small number of women. Breastfeeding is not recommended for mothers with HIV, human T-cell lymphotropic virus type 1 or type 2, active untreated tuberculosis, and herpes simplex lesions on the breast. Infants with galactosemia should not be breastfed. However, correctly taken antiretroviral drugs can virtually eliminate the chances of HIV transmission through milk to the infants. Breastfeeding is also contraindicated if mothers use certain drugs or treatments such as illicit drugs, antimetabolites, chemotherapeutic agents, and radioactive isotope therapies.

Breast milk bank
Studies have shown that breastfed children perform better on intelligence tests. The benefits of breastfeeding even extend up to adulthood, with a substantially lower chance of obesity, cardiovascular disease, diabetes, and even some types of cancers. There are also health benefits for the mother owing to breastfeeding, as it lowers the risk of breast cancer, ovarian cancer, diabetes, hypertension, and heart disease.
Encouraging mothers to breastfeed needs a multidimensional approach such as better public policies like paid maternity leave, access to quality child care services, break time for working mothers, and a non-threatening location for expressing the milk. The importance of breast milk bank has been realised in Nepal and a milk bank is being considered to be open at Maternity Hospital in the capital and it is recommended that to extend it to all the hospitals in the major cities. It is urged to all the stakeholders that to protect, promote and support breastfeeding for the health of all women, children, families, and the nation. It is hoped that the provision of a counselor in each healthcare facility improves the adherence to the exclusive breastfeeding in the country.

(Prof. Lohani is the founder and academic director at Nobel College. lohanis@gmail.com)