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-2-

Initiation of breastfeeding within the first hour of birth
is the first and most vital steps towards reducing infant and
under five mortality, and the overwhelmingly high neonatal
mortality rate. We can save one million babies all over the
world by beginning with one action, one hour support and
one message: begin breastfeeding within one hour of birth.

Millennium Development Goal 4 (MDG-4) aims at
reducing under five child mortality by two third by 2015.
According to global data out of all 10.9 million under five
deaths, roughly 4 million babies die during the first month of
life. In Nepal this mean out of 30,000 newborn (up to 28 days)
deaths, 7,500 lives can be saved annually by this one act alone.

For millions of years babies have been breastfed. It’s
natural! A mother’s milk is ideal for her baby. It’s the best. In
fact, there is no substitution for mother’s milk. Breastfeeding
provides the best possible start of life, a foundation for fulfilling
the right of child.

Scientific research during the last four decades have
discovered that breastfeeding provide the ideal nutrition to
the baby, protects them against infection, allergy and asthma.
Exclusive breastfeeding during first six months promotes
physical, physiological, mental and physiological growth and
development.

Immediate breastfeeding is considered as the fourth
stage of labour. Early initiation of breastfeeding is beneficial
for both mother and baby. Suckling at breast benefits the
mother also because it stimulates the release of the hormone;
oxytocin, which helps in uterine contraction and prevents post
partum hemorrhage in the mother. Colostrum is important for
babies, as it is highly nutritious and rich in antibodies that
protect the newborn from various diseases. The early initiation
of breastfeeding also increases the bonding between the mother
and the baby. NDHS survey of 2006 states that only 35.4% of
babies were breastfed within one hour, so around 64.6% were
not breastfed within one hour in Nepal. Similarly only around
85% of the babies are breastfeed within 24 hours of birth so
15% of babies are not given breast milk even at 24 hours of
life. We can save the death of thousands of babies if we can
initiate breastfeeding within one hour. Similarly pre-lacteal
feeds will hamper the breastfeeding at the same time it will
expose the newborn to varieties of infection on different items
like ghee, glucose, plain water, ghuti etc. are used as pre-lacteal
feeds in Nepal. According to NDHS survey of 2006 the use of
pre-lacteal feeds in Nepal is 36.5%, which needs to be stopped
to save the newborn lives.

Exclusive breastfeeding is recommended for first six
months of life as it is uncontaminated and contains the entire
nutrients needed by the infant in the first six months of life. In
addition to the mother’s antibodies in the breast milk it provides

immunity to infant from different diseases. Breastfeeding can
save more lives of infants than many other intervention
strategies. Contrary to the National recommendation of
‘exclusive breastfeeding’ for the 6 months of life, according
to NDHS survey of 2006 only 53% of babies were exclusively
breastfeed till 6 months of age, a drop of 15% on 5 years
which was 68% in 2001 (NDHS). So there is urgent need to
stop this tendency to save infant deaths.

In Nepal legislature of breast milk substitute was passed
in 2051 SAARC code of breast milk substitute was developed
at Kathmandu meeting in 1995 which is considered to be one
of the best code on breast milk substitute in the world. But the
implementation of law has not been satisfactory as breast milk
substitute are freely available in the market, in spite of the
legislation monitoring, licensing and quality control of breast
milk substitute and sell is very weak or non existent. So there
is an urgent need of strengthening the initiating and evaluating
agencies to regulate the free sale of breast milk substitutes in
the country.

Provision was made in the law for creation of a high
level National Committee on promotion, protection and
support for breastfeeding with secretary of Health as the
chairperson with provision of four sub-committee a) BFHI,
b) Quality Control of breast milk substitute, c) Fellowship and
Research and d) Monitoring. This high level committee has
been authorized to appoint supervisors to monitor the overall
situation in breastfeeding. This in fact is almost non-functional.
Most of the Health professionals are not trained in
breastfeeding, hence they lack appropriate knowledge in
promotion, protection and support for breastfeeding. So we
need to activate this high level committee to improve the
breastfeeding situation in Nepal. Monitoring of the sale of
breast milk substitute should be done immediately with the
appointment of the supervisors as per provisions in the
legislation and due training should be given to all the health
professionals which in the long run will be of immense help in
reducing the infant mortality.

Government of Nepal recommends that the
breastfeeding should be initiated within one hour of birth,
exclusive breastfeeding for the first 6 months of life and
complementary foods should be given along with breast milk
after completion of 6 months and breast milk should be
continued till 2 years of age along with other foods. If such an
ambitions recommendation is to be successfully accomplished,
breastfeeding should be encouraged and supported, pre-natly,
peri-nataly and post-nataly. The message should be consistently
imparted by the policy makers, specialists, physicians, nurses,
dieticians, other health care providers, family, friends the
community and the media. Let us get united and speak in one
voice: for promotion, protection and support for breastfeeding.

Editorial

Breastfeeding: Within One Hour of Birth Can Save One Million Babies:
Shrestha PS1.
1. Prof. Prakash Sundar Shrestha, Department of Child Health. Institute of Medicine Maharajgunj, Kathmandu.


