By Anjali Bhardwaj, Asia Regional Manager, Adolescent and Women’s Health and Nutrition
The COVID-19 pandemic has precipitated a malnutrition crisis. At a time when the world needs resilience to disease the most, overwhelmed health systems, broken supply chains and reduced purchasing power have left millions around the world without the nutrition they need to build immunity. Further compounding this crisis, the spread of misinformation is undermining the work of health campaigns and positive nutrition practices adopted over the past decade, including one of the most critical for mothers and babies: breastfeeding.
A mother’s breastmilk acts as a baby’s first vaccine and is naturally fortified with lifesaving nutrients and antibodies that provide lifelong protection against infections and diseases. It improves infant health, immunity and cognition, reduces the risk of stunting, and increases survival rates. Breastfeeding is cost-effective and, if scaled up in 75 key countries, has the potential to save the lives of 823,000 children under five and prevent 20,000 women dying of breast cancer every year.1
Despite strong evidence supporting its immediate and long-term health benefits, timely initiation and continued breastfeeding is not practiced widely in many parts of the world. In Pakistan, mass media campaigns and national guidelines promoting the early initiation of breastfeeding exist, but only one in five babies are breastfed within the first hour after birth. In India, Bangladesh, Indonesia and the Philippines, exclusive breastfeeding (feeding only breastmilk for the first six months of life) rates range from 45% to 65%, much lower than necessary for a lifesaving universal practice. The reasons include lack of knowledge, time and support, to misinformation and easy availability of breastmilk substitutes.
The COVID-19 crisis has brought a new and unique set of challenges. Disrupted access to health services, including antenatal care (ANC) and interpersonal counselling, has meant that many women are not receiving critical health and nutrition information and support when they need it most. Preliminary data from India shows that ANC registrations decreased from 99% in January to 67% in March (the first month of the country’s lockdown). Confusion and misinformation, coupled with the fear of spread of the disease, also saw some health facilities inappropriately separating newborns from mothers and discouraging breastfeeding. In July, Nutrition International estimated that just a five percent reduction in breastfeeding could result in an additional 16,469 child deaths this year, across 129 low- and middle-income countries.
To aid breastfeeding and counter the spread of false information, UNICEF and WHO released the Global Breastfeeding Collective’s Call To Action during COVID-19, which includes important steps to protect the crucial practice of breastfeeding during the pandemic. Weighing the potential risks of COVID-19 infection against the risks of morbidity and mortality associated with not breastfeeding, mothers are advised to continue breastfeeding while taking care with hygiene.
To ensure that breastfeeding is protected, promoted and supported throughout the pandemic, service providers and hospital staff must be sensitized to the guidelines, so they are prepared and able to help mothers in initiating and sustaining breastfeeding. Support networks, both offline and online, where women are provided information, counselling and guidance for breastfeeding are an important outlet for mothers to access knowledge and find resources. Large-scale mass media campaigns can also be helpful in busting myths about breastfeeding in urban and rural communities. Case studies and testimonies from women who were COVID -19 positive but continued to breastfeed directly or through expressed milk can set a positive example and demonstrate the enormous benefits of breastfeeding.
Inclusion and engagement of husbands and other family members in creating a nurturing environment at home also plays a significant role in practicing and continuing breastfeeding. For this, it is imperative to educate families and communities about the nutritional needs of a lactating mother and the importance of sharing household responsibilities among other family members, so that the new mother can focus on her and the baby’s health.
Beyond homes and communities, an enabling policy environment can help women feel empowered to breastfeed. Countries that have implemented progressive policies and encouraged enabling changes, such as extended maternity and parental leave, have seen improvements in breastfeeding rates and associated decreases in infant morbidity and mortality.
Today, as global leaders work tirelessly on the COVID-19 response, it is crucial that we do not lose the hard-won development gains that we have made. As of late August 2020, 48 out of 127 countries across the world have experienced at least some disruptions in their breastfeeding protection and promotion programs. A long journey still lies ahead to promote breastfeeding and ensure that its reduced rates do not stay permanent. Given the current health crisis, this has never been more important – to ensure we overcome the virus now and to secure a healthy future for generations to come.
1 CG Victoria, R Bahl, AJB Barros, et. al. Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect. Lancet, 387 (2016), pp. 475- 490