Celebrating World Breastfeeding Week amidst the Covid-19 pandemic
Breastfeeding is a lifesaving strategy that has evidence-based benefits and a positive impact on child health and survival.
During these challenging times of the pandemic, mothers across the world have voiced many fears, most of them unfounded, about the effects of breastfeeding. Among these are, can I breastfeed my baby if I am Covid-19 positive? Will the virus get transmitted through my milk? Frontline health workers, who are sometimes the only source of health information for vulnerable communities living in remote areas, need to be trained about counselling mothers about ideal breast-feeding practices amidst the pandemic. They need to be able to effectively use interpersonal communication to best inform Covid-19-positive mothers about breastfeeding? What precautions do lactating mothers need to take?
Benefits of breastfeeding
According to a joint statement released by UNICEF Executive Director and WHO Director-General, this year's world breastfeeding week under its theme ‘Protect Breastfeeding: A Shared Responsibility’, is a time to revisit the commitment to eliminate child malnutrition, made at the start of this year, by prioritizing breastfeeding-friendly environments for mothers and babies.
Breast milk provides complete nutrition to newborns and infants, and holds many benefits for the mother-child dyad. It protects children against many common childhood illnesses including diarrhoea and pneumonia; breastfed children have better immune systems, better vision, perform better in intelligence tests, are less likely to be obese or overweight and are less prone to non-communicable diseases later in life. Mothers who breastfeed their infants are healthier both physically and emotionally, have increased self-esteem and confidence and have lower risk of ovarian and breast cancer and other non-communicable diseases like diabetes and hypertension.
Colostrum, the first milk, is considered equivalent to the first immunisation for the baby. The nutrients in breast milk are easily digestible; it is rich in antioxidants and enzymes; it has immunity-boosting properties with live antibodies that protect the baby from infection. Breastfeeding creates an emotional bond between the mother and baby which is crucial for the psycho-social development of the infant.
Exclusive breastfeeding during the pandemic
Despite the proven benefits of this lifesaving practice and progress made in the last four decades, breastfeeding is suboptimal across the globe. According to a recent comprehensive national nutrition survey (CNNS), in India, only 58% of the infants below six months are exclusively breastfed till 6 months. While efforts have been made to increase the level of exclusive breastfeeding through several strategies under the national programmes and policies including POSHAN Abhiyaan, the pandemic has proved to be a severe setback to all our efforts. Though several state governments, civil society organisations and other policy advocacy groups proactively took up the task of revitalising interventions to promote exclusive breastfeeding amidst the pandemic, multi-pronged strategies are needed to promote exclusive breastfeeding that has a direct impact on child health and survival. According to a joint statement released by UNICEF Executive Director and WHO Director-General on the occasion of World Breastfeeding Week under its theme ‘Protect Breastfeeding: A Shared Responsibility’ there is a need to revisit our commitments on prioritising breastfeeding-friendly environments for mothers and babies that was made at the start of this year, This includes:
1) Ensuring the International Code of Marketing of Breastmilk Substitutes – established to protect mothers from aggressive marketing practices by the baby food industry – is fully implemented by governments, health workers and industry.
2) Ensuring that the health care workers have the resources and information they need to effectively support mothers to breastfeed, implement the Baby-friendly Hospital Initiative, and guidelines on breastfeeding counselling.
3) Ensuring that employers allow women the time and space they need to breastfeed; including paid parental leave with longer maternity leave; safe places for breastfeeding in the workplace; access to affordable and good-quality childcare; and universal child benefits and adequate wages, as recommended by UNICEF.
Is it safe for a mother with Covid-19 infection to breastfeed her baby?
A reasonable way to look at breastfeeding and Covid-19 infection is to weigh the potential risks of transmitting the virus from mother to infant while breastfeeding against the risk of sickness and mortality associated with not breastfeeding the infant and by inappropriate use of animal milk or formula milk and preventing the protective effect of skin-to-skin contact that is facilitated by breastfeeding. Since there is no evidence so far that the virus is transmitted through breastfeeding, WHO recommends that mothers with suspected or confirmed Covid-19 infection should be encouraged to initiate or continue to breastfeed. Efforts should be made to counsel the mothers that the benefits of breastfeeding substantially outweigh the potential risk of transmission of the virus. However, it is important that the mothers should follow general infection-control measures. Close contact between mother and baby while breastfeeding is perhaps the main risk. In case the mother coughs or sneezes, the droplets which are infected with the virus may infect the baby. Therefore, during breastfeeding, a Covid-19-positive mother should wear a mask and practise respiratory hygiene. She should replace masks as soon as they become damp, dispose of masks immediately; not reuse a mask; not touch the front of the mask but untie it from behind. She should wash her hands (for 40 seconds) before each feeding session. Routine disinfection and cleaning of surfaces is essential.
If the Covid-19-positive mother is too unwell to breastfeed, she needs to be supported to safely provide her breast milk to her baby by expressing her milk or using human donor milk. While expressing milk, proper hand hygiene must be maintained. The expressed breast milk should be fed to the newborn by a healthy caregiver.
What should the frontline health care workers do to promote breastfeeding among Covid-19 mothers
The frontline workers should be trained and sensitised to support Covid-19-positive women to breastfeed their infants. They should build their confidence while counselling them about breastfeeding during the ANC check-ups, provide appropriate support during child birth and help them with early initiation of breastfeeding while following general infection control measures and provide counselling on exclusive breastfeeding during the first six months. They should continue to support exclusive breastfeeding for six months, followed by continued breastfeeding with complementary foods for up to two years and beyond using appropriate resources and information on breastfeeding, complementary feeding and infection control measures.
(The piece has been authored by Dr Suparna Ghosh-Jerath, Professor and Head, Community Nutrition)