Although almost 90% of deliveries in India now happen in health facilities, only 42% of babies are breastfed within the first hour of birth, indicating poor support for breastfeeding in hospitals. Over 60% of child births happen in government facilities, but barely half a dozen government hospitals have been accredited as breastfeeding friendly despite the evidence that making hospitals breastfeeding friendly helps improve breastfeeding rates. However, all the armed forces hospitals providing maternal and child care are being accredited as Breastfeeding Friendly Hospitals through an initiative started by Lt Gen Daljit Singh, who recently retired from the post of the Director General of the Armed Forces Medical Services (AFMS). In an interview to TOI, he explained why this was an important initiative and how it has improved exclusive breastfeeding by changing practices in the hospitals.
How many of the armed forces hospitals have been accredited as breastfeeding friendly?
Of 150 peacetime hospitals, 110 have maternal and paediatric services with about 23,000-25,000 births annually. Sixteen have been accredited as breastfeeding friendly hospitals and eight are awaiting external evaluation to get certified. Over 70 hospitals under various zonal commands are at various stages of being accredited.
How did you get interested in making armed forces’ hospitals breastfeeding friendly?
I am a neonatologist, but my interest in the issue started in my undergraduate days when my thesis was on breastfeeding in low birthweight babies. My thesis showed that it is sufficient to exclusively breastfeed even low birthweight babies to ensure that they get adequate nutrition. After graduation, I was posted to the Command Hospital in Bangalore, which was certified as a breastfeeding friendly hospital in 1998. So, my initiation was in a place where I saw exclusive breastfeeding in practice, and I realised its importance early on. Though I have exited most service groups after retiring, I have remained a part of the breastfeeding friendly hospitals initiative (BFHI) group as it is an issue close to my heart. We have regular meetings to review our progress.
What is the role of neonatologists in protecting breastfeeding?
When I specialised in neonatology, I found that when it came to pre-term babies or low birthweight, there was a bias among neonatologists towards giving them formula feeds. There was no confusion about full term babies as everyone knew breast milk was best for babies. But when it came to preterm babies, neonatologists felt that there were nutrients missing in breastmilk that formula could provide or that breastmilk was inadequate. The practice of keeping babies separate from the mother in a neonatal intensive care unit (NICU) would also lead to the mother producing less milk. To support the mother in lactation and to continue to support her till the baby comes out of the neonatal ICU, some initiative is required on the part of the neonatologists. Then came the fear of HIV, Hepatitis C infection and again neonatologists pushed to give preterm babies formula. You need neonatologists to be converted to breastfeeding. Without consistent effort on the part of neonatologists, babies lose out on their mothers’ milk and fall to formula feeding.
What extra investments and efforts are needed to make hospitals breastfeeding friendly?
You need to invest in two things—the assessment fee, about Rs 30,000 and in the training of lactation counsellors, Rs 20,000. It is not a lot of money but those heading a hospital will always ask where they would find the money for these. As the director general, I could reassure them that we had enough funds and make the funds available. We need to raise awareness and create a sense of mission in everyone involved— nurses posted in the delivery rooms and post-natal wards, the obstetricians and gynaecologists, who are the first point of contact for mothers when they come for antenatal check-ups, neonatologists and lactation counsellors.
Has the certifying of hospitals made a difference?
Once accredited, we have to submit data on various indicators of a breastfeeding friendly hospital every six months and that makes us collect data and track progress. After the accreditation of R&R Hospital, which is our biggest, skin-to-skin contact with mother and breastfeeding within the first hour of birth has been ensured for all babies born there. Similarly in the Command Hospital in Maharashtra, after being accredited and certified as breastfeeding friendly, initiation of breastfeeding within an hour of birth went up from 65% to 99.7% of babies delivered through C-section and from 97.7% to 100% for normal deliveries. Now, we are reviewing the progress of all accredited hospitals in helping mothers to achieve exclusive breastfeeding for the first six months.
How can baby food companies’ efforts to influence doctors and health workers be tackled?
Company fellows come with free this and that. They are mostly multinational companies, and they will go to any length to sustain their business. You can keep them out only if it is done with a sense of mission among doctors, nurses and paramedics to ensure that no wrong practices are implemented. It is easier to enforce these in the armed forces as there are fewer vested interests and we don’t need company support to hold conferences. We also have strict rules on hospital entry and so we can easily restrict their entry.
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