Declining breastfeeding in Nepal: Who is responsible?

 Declining breastfeeding in Nepal: Who is responsible?

It has been revealed that the rate of complete breastfeeding in Nepal has decreased from 70 percent in 2011 to 56 percent in 2022.

Breastfeeding is the most effective and evidence-based practice for infant health and nutrition. Mother's milk provides all the necessary nutrients and immunity to the baby. In addition to providing protection from various infections, it contributes significantly to physical, mental and intellectual development.

Breastfeeding is an important public health strategy to build the foundation of health, nutrition and immunity for babies at the beginning of life.

According to a recent report by the World Health Organization and UNICEF, only 47 percent of infants under 6 months of age worldwide are exclusively breastfed. The World Health Organization has set a global goal of increasing the rate of full breastfeeding to 60 percent by 2030.

Various reports including the Nepal Demographic and Health Survey have shown that there is still a challenge to continue breastfeeding in Nepal. According to the Nepal Demographic and Health Survey 2022, the rate of complete breastfeeding in Nepal is limited to 56 percent, this rate was 70 percent in 2011.

In Karnali and Sudurpaschim provinces of Nepal, the rate of complete breastfeeding is the highest at 74 percent, while the rate is the lowest in Bagmati province at 43 percent. This shows that breastfeeding promotion is not only a matter of giving knowledge to mothers, but also a matter of creating the necessary environment for breastfeeding.

Let us imagine the situation of a mother who wakes up in the morning, finishes her housework, breastfeeds her baby and gets ready to go to office. Some mothers are forced to work in the office while taking care of their children at home.

Those who do not have a suitable place to breastfeed in the office, lack of time and have to take on another responsibility after returning home.

On the other hand, some families may still not have enough mother's milk, the child needs more milk or food, and the idea that it is easier to feed from a bottle is affecting the breastfeeding practice.

So the only question is did the mother breastfeed or not? Not only that, have we given the mother the necessary environment to successfully breastfeed? The question is also important.

The first week of August is celebrated as World Breastfeeding Week as an opportunity to promote breastfeeding. The World Health Organization recommends exclusive breastfeeding for the first 6 months after birth, followed by continued breastfeeding for two years or more with appropriate complementary foods. But globally, the practice of full breastfeeding for 6 months has not yet reached the expected level, rather it seems to be decreasing.

Nepal is implementing remarkable policies, programs and plans for breastfeeding promotion. Breastfeeding has been prioritized through national nutrition strategy, multi-sectoral nutrition plan, breastfeeding counseling in health institutions, women's health volunteers and various nutrition programs. Establishment of breastfeeding place in public places, implementation of mother-infant and child-friendly hospital concept, establishment of human milk bank in charity obstetrics and gynecology hospital at Thapathali. The goal of establishing one human milk bank in all provinces has been advanced.

It is not appropriate to blame only the mother for the decrease in breastfeeding. Today, many Nepalese women are active in economic activities. There is an obligation to return to work soon after delivery. There is no provision for breastfeeding in the workplace. Long working hours and lack of child care centers make it difficult to continue breastfeeding. This challenge is serious especially for women working in the informal sector.

In order to help working mothers, the government is discussing about giving 180 days of maternity leave to match the 6 months required for full breastfeeding. However, it has not yet been decided whether this arrangement will be fully implemented. If the 180-day leave can be implemented effectively, it can significantly help the mother to fully breastfeed for the first 6 months. But vacation alone is not enough, a breastfeeding-friendly environment in the workplace, comfortable work arrangements and support from the employer are also necessary.

On the other hand, the role of the family is also very important. In Nepali society, the support given to mothers by grandmothers, husbands and other family members has a great impact on successful breastfeeding. But in some cases, it seems that problems are arising due to traditional beliefs, misconceptions and insufficient information.

There are still practices in the society such as feeding other milk instead of mother's milk to the child, throwing away the yellowed milk. Therefore, breastfeeding education is equally important for the promotion of breastfeeding not only for the mother but also for the whole family.

The increasing use of digital media and the impact of aggressive marketing is another important aspect of breastfeeding today. The increased availability and promotion of breast milk substitutes and other products, as well as bottle feeding materials, can affect some families. Although the Breast Milk Substitutes (Sales and Distribution Control) Act, 2049 is active in Nepal to control the unfair promotion of breastfeeding substitutes, its effective implementation and monitoring is still necessary.

Likewise, the role of the health system in promoting breastfeeding is equally important. Health institutions providing maternity services should strongly implement actions such as starting breastfeeding within the first hour of birth, solving breastfeeding problems, giving continuous counseling to mothers, and discouraging the use of breast milk substitutes. A lot of work is being done for breastfeeding promotion in various health institutions, but it is necessary to emphasize on effective implementation along with its continuation.

Therefore, in the present perspective, why is complete breastfeeding decreasing in Nepal? How much are we supporting mothers to make breastfeeding successful? There should be a question. Breastfeeding is not just a mother's personal responsibility; This is the result of family support, positive thinking of society, workplace facilities, support of health system and effective policies of the government. If we want to build a healthy and nourished generation in Nepal, it is necessary to understand breastfeeding not only as a mother's duty, but also as a shared responsibility for child rights, women's rights and public health.

The success of breastfeeding is not determined only by the will of the mother, it is determined by the support the mother receives, the behavior of the family, the facilities at the workplace and the commitment of the state. Therefore, promoting breastfeeding is not only about giving knowledge to the mother, but also about empowering the mother and creating the necessary environment for breastfeeding.