For a woman not short on travel options, Melinda Gates, co-chair of the $42.3 billion Bill and Melinda Gates Foundation, spends an inordinate amount of time on the roads less travelled. Her goal is to meet women and adolescents in underserved communities to help the Foundation identify effective strategies to lower global inequities in gender, health, education and wealth.
Breastfeeding newborns for six months after birth is one such foolproof method to save lives, yet less than half of the 26 million babies born in India each year are exclusively breastfed during this critical period. At the end of breast-feeding promotion week, Melinda Gates, 50, discusses Hindustan Times what makes breastfeeding a miracle investment in newborn and child health.
Why is promoting breastfeeding so critical?
Every year, millions of children die in the critical 1,000 day period between their mother's pregnancy and their second birthday. Malnutrition is the underlying cause for nearly half of all under-5 child deaths. And many of these deaths can be averted through breastfeeding - starting within one hour of the baby's birth, breastfeeding exclusively for the first six months and then continuing for at least two years.
What's the biggest hurdle in promoting breastfeeding worldwide and specifically in India?
There are many hurdles, starting at the health facility. Many mothers do not get the counselling and information required to begin breastfeeding. Many working mothers globally and in India - across sections - are often forced to choose between breastfeeding and getting back to work. There also are misconceptions on supplementing breastfeeding with other food items and a lack of awareness of the benefits of exclusive breastfeeding. These have led to children missing out on good nutrition during early and critical periods of growth.
Is there data to show exclusive breastfeeding increases child survival?
Yes, absolutely. Breast milk is the "gold standard" for infant nutrition and by delivering antibodies from the mother it helps build an infant's immunity. Improved breastfeeding could save 8,00,000 children annually - including 2,50,000 child deaths caused by pneumonia and diarrhoea. Research shows that breastfed children are 14 times more likely to survive than non-breastfed children and that breastfeeding plays a significant role in their development as well. The Lancet Series on Child Survival has identified optimal breastfeeding as the single most important child survival intervention.
Our Foundation recently announced an increase in our support to scale-up effective nutrition interventions and develop new solutions to cut child and maternal mortality. In India, we estimate that doubling exclusive breastfeeding of children in their first six months could save 1,36,000 lives every year - and even more if breastfeeding is continued up to two years.
What initiatives has the BMGF taken to encourage breastfeeding in India?
Our work at the Foundation, and in the states of Bihar and Uttar Pradesh in partnership with the state governments, focuses on broader continuum of care for the newborns to reduce mortality. Breastfeeding is an integral part of this continuum and we work with communities, institutional partners, self-help groups and frontline workers to deliver the messages on breastfeeding.
Young mothers often do not have much say in infant care. Do you involve the family?
As a mother of three children, I believe that empowering women and girls is important. In the Indian context, while there are certain challenges that continue to exist, I believe that things are changing. In my interactions with self-help groups, women have always shown a keen interest in discussing issues like healthcare, nutritious food, and education. They are eager to make lives better for themselves and their families.
Three in four pregnant and lactating mothers in India are anaemic. How can families be encouraged to look after new mothers?
India has, in fact, nurtured its children well in recent times and this would not have been possible if there was no movement in the direction of nurturing mothers. A generation ago, 3.3 million Indian children under the age of five died. That number is down to 1.3 million today. The central and state governments are making investments and pursuing policies to continue this lifesaving trend.
Women working at the community level play a huge role. Do you have a champion?
When I spoke to a group of women in Shivgarh, Rai Bareili, nearly every one of them had experienced the pain of losing a child. But when I asked who had lost a child in the last year, hardly anyone raised their hand. I always think about that moment, because it was such incredible proof that progress is possible. Because of these women's efforts, more children are surviving.
What are the three most scalable solutions to meet Millennium Development Goals (MDGs) on maternal health?
The global community is now looking at the next global development framework - the Sustainable Development Goals (SDGs). With focus on newborn health, we are optimistic that it is possible to bring down the global newborn mortality rate to 1.2% by 2030. Simple, early interventions like drying the baby completely after birth to prevent hypothermia, breastfeeding within the first hour and exclusively for the first six months and practising kangaroo care can make a massive difference in preventing this massive burden.