Evidence from a small number of hospitals certified as breastfeeding-friendly reveals that changes in hospital policy can significantly increase the rate of breastfeeding initiation within one hour of birth. This holds true regardless of whether the birth is vaginal or via caesarean section, suggesting a path to improve India’s low breastfeeding rates, as reported by the latest National Family Health Survey.

While institutional deliveries in India rose from 79% to 89% between 2015-16 and 2019-21, the proportion of newborns breastfed within an hour saw only a marginal increase, moving from 41.6% to 41.8%. The “Ten Steps to Successful Breastfeeding,” established by the World Health Organization (WHO) and UNICEF as part of the Baby-Friendly Hospital Initiative (BFHI), serve as the basis for creating breastfeeding-friendly environments in hospitals. Despite only 40 hospitals in India volunteering for this certification, improvements in breastfeeding initiation in these facilities underscore the impact of the ten steps, even among caesarean births, which studies show can hinder breastfeeding initiation rates.

The Southern Command’s Command Hospital in Maharashtra, after becoming breastfeeding-friendly certified, increased the rate of breastfeeding initiation within an hour to nearly universal levels. For caesarean births, the initiation rate jumped from 65% to 99.7%, and for vaginal births, it increased from 97.7% to 100%. Similarly, Sitaram Bhartia Institute of Science and Research achieved notable improvements after implementing the ten steps required for certification: breastfeeding within an hour after caesarean delivery rose from 40.7% to 75%, while rates for vaginal deliveries improved from 87.6% to 89.5%.

Starting breastfeeding within the first hour provides the newborn with colostrum, a thick, nutrient-rich, yellowish milk filled with antibodies that bolster the baby’s immunity against infections. Health experts consider this first feeding crucial for neonatal health. According to Dr. Arun Gupta, from the Breastfeeding Promotion Network of India (BPNI), which leads efforts to encourage hospitals to become breastfeeding-friendly, “Breastfeeding has immense short- and long-term health benefits for newborn babies and infants. Exclusive breastfeeding for the first six months of life significantly reduces the risk of infant mortality.” Dr. Gupta also highlighted that certified hospitals have nearly universal success in ensuring babies are breastfed within an hour of birth.

The WHO and UNICEF’s “Ten Steps” include a series of actions to support breastfeeding from the antenatal period onward. This protocol entails discussing the significance of breastfeeding with pregnant women and their families, establishing a clear breastfeeding policy communicated to staff and patients, training staff with sufficient knowledge and skills to support breastfeeding, enabling immediate and uninterrupted skin-to-skin contact after birth, and ensuring breastfed newborns are not given any other food or fluids unless medically necessary.

The impact of these steps is well-documented. “A systematic review of 58 studies on maternity and newborn care published in 2016 demonstrated clearly that adherence to the Ten Steps impacts early initiation of breastfeeding immediately after birth, exclusive breastfeeding, and total duration of breastfeeding,” according to the WHO. This evidence reinforces the need for hospitals to adopt breastfeeding-friendly policies to ensure optimal maternal and infant health.

(Input from various sources)

(Rehash/Yash Kamble/MSM)