1. Role of Breastfeeding & Complementary Feeding in controlling Child Anemia Dr. Anchita Patil USAID/India IAPSM Conference, 2010-11 In absentia presented by: Dr. A. K. Gupta State Coordinator UP USAID Micronutrient Project

2. IAPSM 2010 NFHS-3 reports are worrying … Anemia rates in children 6-35 months India: 78.9% Jharkhand: 78.2% UP: 85.0% Kerala: 56.1%

3. IAPSM 2010 The story starts with the mother’s nutritional status Low iron reserves in mother Reduced iron transferred to fetus New Born starts life without adequate iron stores. Overall malnutrition in mother (usually linked with IDA) LBW baby

4. IAPSM 2010 Till of age … Iron Stores from mother (delayed cord clamping) Exclusive breastfeeding for six months Enough to maintain the iron stores for the baby 6 months

5. IAPSM 2010 How does BF work against child anemia? Low iron content, but high bioavailability (50%) Vitamin A in Breast Milk helps in iron transport and metabolism. Reduced infections, especially diarrhea prevents losses / impaired absorption. Animal milk consumption  gut lesions  blood losses

6. IAPSM 2010 Beyond six months … Infant needs increase 6 -12 months, Recommended Daily Allowance for Fe: 11mg/day ( 0.8 mg of Absorbed Fe) Breast-milk not enough Complementary Feeding initiated + Iron Supplementation

7. IAPSM 2010 How does CF work for child anemia (Complementary Feeding) Adds-on to low quantity / better bio-availability Fe in Mother’s milk. Improve overall nutrition Increased availability of absorption facilitators.

8. IAPSM 2010 Complementary Feeding Balanced energy - dense diet Foods with heme iron Avoid tea / coffee (absorption inhibitors) Fortified foods Continue breast feeding

9. IAPSM 2010 Breastfeeding Myths If it’s so simple, why aren’t women doing it? Myth 1: Breastfeeding is simple Reality: Breastfeeding is natural, not easy!!

10. IAPSM 2010 Not enough milk PERCEIVED PROBLEM Breasts don't seem full Baby cries soon after feeding EXPLANATION Genuine lactation failure – an extremely rare event Babies have variable hunger cycles Attachment / position Baby cry has other causes Reassure: weight gain, urine frequency. More sucking produces more milk. wah!!!!

11. IAPSM 2010 Artificial feeding PERCEIVED PROBLEM Bottle feeding is easier Formula IMS as good as breast-milk EXPLANATION Bottle-feeding has huge issues related to increased infections and nipple confusion The “processes” related to bottle feeding (cleaning regime, preparing formula) is more difficult. Formula milk has no antibodies, enzymes etc. and does not vary with feed duration, age of baby, season etc.

12. IAPSM 2010 Breastfeeding is consuming PERCEIVED PROBLEM A breast-feeding mother is home-bound. Babies should be bottle-fed at night to avoid disturbing the mother EXPLANATION A breastfeeding mother is free, as she is her baby’s food!! Night feeds increase baby’s satiety levels and therefore sound sleep at night Most babies develop their own rhythm soon and will sleep for longer periods in the night.

13. IAPSM 2010 Breastfeeding myths If education is the answer, why are breastfeeding rates lower in the “educated” women? Myth 2: Informing women about the benefits of breastfeeding will ensure appropriate behavior change Reality: A “supportive environment” is essential to ensure “compliance” to IYCF guidelines.

14. IAPSM 2010 Working women PROBLEM Women need to join work often as soon as a few weeks after delivery Pumping does not maintain milk supply as well as suckling does POTENTIAL SOLUTION Maternity break for at least 6 months (investing in the future) Improved work-place policies Research for viable options …..

15. IAPSM 2010 Family and community support POTENTIAL SOLUTION Health care providers need intense training Stronger implementation of IMS Act Counseling of family along with mother Breastfeeding should be a social norm PROBLEM Absence of comfort has a negative psychological effect on mother with detrimental impact on milk production and flow Health care providers promote formula

16. IAPSM 2010 Complementary Feeding Myths Reality: Complementary feeding / responsive feeding is an art and science both. It can be and needs to be taught to the caregivers. Myth 1: Complementary feeding is learnt by trial and error

17. IAPSM 2010 Complementary Feeding myths Myth 2: Complementary feeding is meant to replace breast milk as amount of breast-milk reduces after six months Reality: Complementary feeding is not “weaning-off” the breast, but adding on to breast-milk Breast milk production does not reduce after 6 months; baby’s requirements overshoot the supply.

18. IAPSM 2010 Complementary feeding myths Reality Babies may start off life with low iron stores Child’s requirement (per kg weight) is much more than adults. More difficult if foods have less bioavailability iron therefore more food bulk needed. Supplementation is almost always necessary. Myth 3: If complementary feeding is given in adequate amounts, it has enough iron to meet the child’s needs

19. IAPSM 2010 Iron Deficiency Anemia in children - a complex issue Maternal nutritional status, determines birth weight and iron stores Period of exclusive breastfeeding Age of Complementary feeding (increased iron requirement vs. risk of infections) Dietary diversity in complementary food

20. IAPSM 2010 Breast-milk is magic. Understand it.