By Dr Rohayati Taib of the Department of Paediatrics,
RIPAS Hospital
Breastfeeding helps to bring mother and baby closer.
Each year, a total of 10.9 million children under the age of five will die
worldwide. The majority of deaths occur below the age of one and 40 per cent
will occur in the newborn period. In total, it is estimated that four million
babies will die annually in the developing world, particularly in Sub-Saharan
Africa, before they reach the age of one.
Almost all of the four million newborn deaths are due to preventable causes. The
majority of them are attributable to infections such as diarrhoea, septicaemia,
meningitis and pneumonia. Most deaths occur at home. There is now clear evidence
that early initiation of breastfeeding would be protective and will have a
substantial impact in reducing this staggering statistic.
According to the World Health Organisation, in the Global Strategy for Infant
and Young Child Feeding, two-thirds of under-five deaths that occur in infancy
are most related to poor feeding practices. Breastfeeding is a key to child
survival. As many as 1.45 million lives are lost globally due to the sub-optimal
breastfeeding practices in cutting down childhood deaths worldwide was
recognised and published in the Lancet series on child and newborn survival in
2003 and 2004. The authors concluded that 13 per cent to 15 per cent of all
child deaths could be reduced if coverage levels of breastfeeding are increased
to near universal.
Breastfeeding in the first hour of live could save almost one million babies'
lives each year. Last year, Paediatrics published evidence proving that early
breastfeeding has an impact in reducing mortality in the newborn period. This
research was funded by the Department for International Development (DFID).
It showed that if mothers start breastfeeding within one hour of birth, 22 per
cent of babies who die in the first 28 days, the equivalent to almost one
million newborn each year, could be saved. If breastfeeding starts on the first
day then 16 per cent of lives could be saved. The likelihood of death increases
significantly each day the start of breastfeeding is further delayed.
Babies who were fed only breastmilk were four times less likely to die than
those who were also fed other milk or solids, confirming the health benefits of
exclusive breastfeeding in the first month.
This is the first study of its kind to assess the effect on newborn survival
rates of when mothers start to breastfeed. It was carried out by Kintampo Health
Research Centre in Ghana and the London School of Hygiene and Tropical Medicine
and was funded by DFID. The analysis was based on 10,947 breastfeeding babies
born between July 2003 and June 2004 in Ghana who survived to the the second
day.
The First Hour: Early Initiation of Breastfeeding
The first hour after birth is an exciting and exhilarating experience for both
mother and child. Early skin-to-skin contact and the opportunity to suckle
within the first hour are important. The baby who is in close contact with its
mother can suckle when there are signs of readiness such as the suckling
movements. Close contact in itself does not necessarily result in immediate
suckling. Mothers require support for both suckling and contact, both acts so
closely interrelated.
The suckling reflex of the newborn is at its strongest 20-30 minutes after
birth, which diminishes if the infant is not fed, only to reappear almost 40
hours later. This may be called 'the fourth stage of labour', which includes
putting the baby to breast after birth and ensuring the intake of colostrum by
the neonate. The ideal time for early initiation of breastfeeding has been
suggested right from birth in the delivery suite to within one hour after
delivery.
Mechanisms by which early breastfeeding can save newborn lives
There are several mechanisms by which early initiation of breastfeeding could
reduce the risk of death in the newborn infant:
- Early human milk (Colostrum) is rich in a variety of immune and non-immune
components that are important for early gut growth and resistance to infection
- Early feeding with non-human milk proteins (for example, animal milk) may
severely disrupt normal gut function
- Lack of feeding in the first hours or days of life may disrupt metabolic
functions and cause acid build-up (acidosis) and low glucose (hypoglycaemia)
- Mothers who suckle their babies shortly after birth have a greater chance of
successfully establishing and sustaining breastfeeding throughout infancy
- Promotion of warmth and protection may reduce the risk of death from
hypothermia
Other benefits
Early breastfeeding has a physiological effect on the uterus as well, causing it
to contract. This is due to a hormone called oxytocin, which is released when a
baby suckles or in response to hand stimulation by the baby, causing uterine
contraction as well as milk ejection. Oxytocin is known to play a role in
bonding and reduction in postpartum bleeding. Postpartum bleeding is a major
problem that jeopardises maternal health and its prevention can save a mother's
life through early breastfeeding.
World Breastfeeding Week 2007
World leaders at the United Nations Millennium Summit in September 2000 agreed
on a critical goal to reduce deaths of under-five children by two thirds, but
this may be unattainable without halving newborn deaths which now comprise 40
per cent of all under-five deaths. The promotion of early initiation of
breastfeeding has the potential to make a major contribution to tackling the
millennium development goal for child mortality. In global terms, over one
million lives would be saved if all newborns younger than one month were
breastfed within the first hour of life.
This year's World Breastfeeding Week (August 1-7) calls upon policy makers,
health workers, families and community members to ensure conducive conditions
for mothers and babies to start breastfeeding during the first hour of birth.
The evidence is clear and in abundance: Breastfeeding saves lives. It is a
solution that does not need costly medicine. - Courtesy of the Ministry of
Health Public Awareness Programme)
