Breast-feeding: The campaign enigma

Dr Md Shaheenul Haque (Rayhan)

IT is good to say good words, listen to good words and follow good-worded advice. But good themes may not meet the reality requirement always and if the slogans and advices do not come from realization of the reality then naturally those 'gospel's simply turn funny and sometimes even annoying.

One may say that who does not know that mother's breast-milk is the best food for the baby? And which mother does not want that her baby will grow healthy and stout? But this best informed intelligent and the very civilized human beings are indifferent to, or ignoring the knowledge! Where is the problem?

A recent study depicts that a baby can be deprived of mother's breast-milk grossly due to the following reasons:

Mother related causes (92%): Under nutrition, Associated diseases, Lack of health education, Inadequate birth spacing, Hormonal contraceptives, Psychological stretch, Cosmetic over-awareness, Outside job of the mother, Social taboos, Separation of the mother from the baby for any reason.

Baby related causes (07%): Congenital physical abnormalities, Digestive problem, Acute illness Psychological problems (rarely).

Other causes constitute only 01% of the problem.

In the context of Bangladesh the cause related picture of reduced breast-feeding comes in the following pattern:

In the solvent and elite society: Cosmetic over awareness, outside job of the mother, psychological stretch and hormonal contraceptives these four factors impart more than 95 per cent of the causes, depriving the babies of breast milk.

In the poor and uneducated society: Undernutrition, associated diseases, lack of health education and inadequate birth spacing play the major role in this regard (about 90%).

Baby related causes are almost the same in these two groups.

The picture clearly depicts that mothers hold the main responsibility of the problem in this regard and only three to four causes, those share the bigger chunk of the problem, if can be solved, it would no more be tough to encounter the whole problem. But unfortunately, for some unknown reasons, these very vital issues are ignored or consciously avoided and overlapped by some other practically less important issues. It is desirable that things should be more clearly versed in the public media that everyone can get a clearer picture and vague misunderstanding does not arise from any corner.

Now, let us look at the root from when, where and how the problem started first: After the Industrial Revolution in Europe and America, waves of material development not only employed men and women in direct work but also dragged in most of their usual time, energy, leisure and mental coolness in a very timed, typed, tight and tense pattern of lifestyle. Time was getting scarce and mental stretch was increasing day by day as an unavoidable adjuvant of the so-called 'developmental rat race'. Moreover, to reduce the expense, hazards and tension of life in the dream of prosperity, people stared birth control, especially with hormones which collaterally withered the breasts off milk.

Developmental tide took apart two of very vital factors for the natural breast-feeding practice: mother's time and mother's tensionless mind. During and after the Second World War, these anomalies increased manifold sharply. But then 'development' came forward to help the mothers and all concerned. Various types of 'artificial, formula food' with fringes of options and facilities to be set and fit with the running lifestyle came out to replace the breast milk. And mothers absorbed it rapidly in the culture getting nothing better in that prevailing situation.

During the late sixties and early seventies, when most of the major material problems of human life came to a system and apparent solution, health and social scientists came forth to review the natural breast-feeding issue. It was disclosed that nothing could be a better or even a suitable peer to the breast milk for a baby. It was also concluded that sound physical and mental development of a baby is largely shared by the natural breast-feeding. But when it was discovered, then already the arrow was on flight the culture of 'tinned baby food' had saturated the civilization in such a way that 'development' and 'the formula baby food' became inevitably tied with each other. Moreover, increasing cosmetic over-awareness of mothers pierced an extra nail on this practice. This was the picture in Europe, America and in many parts of the developing world in the late sixties. But social scientists did not stop there. They began trying to restore the natural breast feeding practice in the Third World countries where till then the waves of development did not sweep the tradition away. And they started the mission not excluding the developed ones too. It was quite evident that the time and scope to get a considerable success in this regard in the developed society was already passed too far to bring it back. So the only hope remained in the underdeveloped society.

Worldwide campaign for 'breast-feeding' started in full swing just in the early eighties when another problem flared up as a major health issue 'breast and uterine cancer', for which contraceptives, especially the hormones and the repeated wash out of the womb (menstrual regulation) were taken in count as two of the main causative factors. And also it put a question, whether an abnormal practice of less or no 'breast-feeding' can impart anything to the increasing incidence of breast and uterine cancers. Doctors and scientists failed to conclude anything clearly but ambiguously just opined that, obviously, any abnormal practice is supposed to fall in a natural imbalance everywhere including the body itself and can increase/increate problems. This unclear conclusion put the people, and usually the women in a serious confusion about the hormonal contraceptives and MR. But, suitable alternative was not available as it is not even now.

Again the doctors and the scientists were to bring the 'Breast Feed' agenda in the limelight as a considerable issue in this regard. It was placed like this, as breast-milk proved to be the best food for the baby and breast-feeding is a ubiquitous natural system and a natural contraceptive and as it is the best practice for the mother to maintain the natural homeostatic system of the body, mothers should not avoid the practice any more. All these words were made aiming the developed society. But, ironically when this campaign was launched in the developing countries, the words and the attitude were not much changed according to the need, necessity and the reality of the third world countries. As a result, this strategy of campaign gained very little, almost no success in Bangladesh like other developing countries. Now, as modern development follows the western pattern, we may predict that within this pattern we will have to go on the same trail...

But it is very sad to know that the conditions in western countries are not at all better than us. After all possible efforts, 'breast-feeding' could not literally be increased or even its withering could be stopped there in an effective manner till now.

If the situation is such then logically it can be predicted that in this race of the 'westernized development', dreaming a successful breast-feeding society is simply a utopia unless the basic problems are traced, intelligently considered and proper measures are taken accordingly, tallying with the loss and benefits of the modern developmental flow.

Anyway, our 'Breast-Feed' campaigners also are not proving their cordial attitude and intention in their activities. Let us see some example of their indefinite and confusing slogans those are randomly preached:

Slogan: "Only breast-milk is enough for the baby up to five months of the baby's age and nothing is needed as food for the baby up to this age, not even a drop of water except the mother's breast-milk."

Comment: While many factors of the mother and the baby are involved in the qualitative and quantitative sufficiency of breast-milk for the baby, including mother's nutrition, physical and mental state, scope to feed the baby, climate conditions and a lot of other factors, then this generalized suggestion can create serious misconception, sometimes enough to stage a dire situation for the baby and the family just by following this suggestion without considering other related factors. This slogan can be true only in case of a completely healthy mother.

Slogan: "Take more meat, fish, milk and vegetables your baby will enjoy a bonanza of breast-milk."

Comment: Although never it was suggested, how and from where one poor mother can manage those fabulous food for her, even after that the truth is that well nutrition of the mother does not ensure good lactation; because, many other factors are intricately involved in successful lactation. Medical Science evolved that at least four major factors are to be fulfilled for an adequately qualitative and quantitative breast-feeding: Well nutrition of the mother; Tension-free mental state of the mother; Absence of any related disease or drugs, which hamper the lactation; Desire, scope and physical ability of the mother to breast-feed her baby.

It is proved that lack of fulfilment of any one or more of these four points definitely hampers the qualitative and quantitative values of breast-milk.

These are the very basic truths in this regard that are to be coined first. But, do we see anything of them in the 'Breast-Feed' campaign? Can't we do anything better and fruitful? Anything relating with the reality and the practical circumstances? Do we really feel for us or just laundering the money of the 'big donors' in the name of 'Breast-Feed' campaign?

Dr Md Shaheenul Haque (Rayhan) is working with different NGOs in the related field.

Source: The Daily Star: July 6, 2001