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First-hour breast milk missed

Children born at health facilities in Bangladesh are less likely to get the crucial first-hour breast milk than those born at home, a survey has found.


The small amount of special milk called ‘colostrums’ that mothers produce during the first hour acts as a vaccine against infections in case of newborns, and the study shows it can cut under-one-month deaths by 31 percent.

But the latest Bangladesh Demographic and Health Survey (BDHS) showed that only 39 percent of babies born at health facilities got the vitalising colostrums compared to more than 50 percent of those born at home.

In the absence of investigations to identify the reason behind the low colostrums feeding at health facilities, experts blame lack of awareness and training among doctors, nurses and other health professionals.

Powdered milk companies are also being accused of violating laws to mislead hospital staff.

“The mother and baby are kept close to each other (after delivery),” Dr Kaosar Afsana, Director, BRAC’s Health Programme, told bdnews24.com. “In many hospitals they are kept separate after birth”.

Child specialists say the rising trend of surgical delivery means babies are less likely to get colostrums.

“But there is no reason why they can’t. The procedure (C-section) is being done with spinal anaesthesia. The mother remains awake,” child specialist Dr Khurshid Talukder told bdnews24.com.

He said, in his own hospital, babies are breast-fed soon after surgical delivery. “They suckle”.

Even premature babies or those with low birth weight who are unable to suckle are breastfed by extracting the milk. “That requires a greater degree of support from the hospital staff,” he said, pointing out that consequences could otherwise be ‘grave’.

His hospital recently admitted a two-and-a-half-month-old baby with ‘Kwashiorkor’, an acute form of protein-energy malnutrition.

The baby had been fed “formula milk after being born underweight”.

It was the mother's second child. She said she had successfully breastfed her first baby.

“The second baby weighed just two kg. As he could not suckle, they feed him formula milk. But if only someone was there to help him, the baby would not have suffered,” he said.

BRAC Health Director Dr Afsana said there was lack of coordinated training among health workers.

“Paediatricians work with child health. Obstetricians attend to deliveries at hospitals and are mostly concerned with the mother.

“In most cases, nurses take away the babies soon after they are delivered. But they are not adequately trained to take care”.

Dr Afsana said at Upazilla health facilities nurses mostly attend to deliveries with the help of ‘Ayas’ (female hospital staff). “But these nurses or Ayas do not know how to ensure the first-hour breastfeeding. They separate the baby from the mother soon after birth”.

According to her, even members of families were not aware of colostrums feeding. “Urban educated mothers do not know that newborns should be kept close to them."

“Even a section of doctors are sceptical about the idea that breastfeeding can be started almost in all situations,” said Dr Afsana, who is also the Secretary of the Civil Society Alliance for Scaling Up Nutrition in Bangladesh.

“Hospital staff are also being encouraged by the companies to provide babies with formula milk powder. Some doctors prescribe [formula milk] consciously or unconsciously,” she said.

The World Health Organisation (WHO) suggests children be exclusively breastfed, with no other liquid or solid food given to infants for the first six months.

It suggests homemade food from the seventh month along with breastfeeding for two years, a practice which a survey finds many families ignore.

Source - bdnews24.com