ASSESSMENT OF STATUS OF INFANT AND YOUNG CHILD FEEDING 2006
District: Udhamsingh Nagar (State of Uttarakhand)
Written by Dr. Deeksha Sharma
Department of Women Empowerment Breastfeeding Promotion Network of and Child Development, Uttarakhand India (BPNI) D-47A, Sector-4, Defence Colony, Dehradun, Uttarakhand BP-33, Pitampura, Delhi – 110034 Tel: 0135-2714104, 2665274 Tel: 011-27343608, 42683059 Tel/Fax: 011-27343606 Fax: 0135-2714389 Email: [email protected] Website: www.bpni.org
Contents
Page No. Acronyms i Acknowledgements ii District profile iii Executive Summary 1 1. Introduction 3 2. Background 4 3. Objectives of the Study 8 4. Study Design, Data Collection and Analysis 9 5. Findings of the Quantitative Study 12 6. Findings of the Qualitative Data 24 7. Assessment of Infant and Young Child Feeding in the hospitals of 27 Udhamsingh nagar, Uttarakhand 8. Conclusion and Suggested Action Ideas 32 Annexures 1. Quantitative Survey on Infant and Young Child Feeding - I Questionnaires 2. Qualitative Survey on Infant and Young Child Feeding - Questionnaires V 3. Tenth Five Year Plan Goals 2003 – 2007 for Infant Feeding Practices XV 4. Definitions of Infant Feeding Behaviours XVI
PUBLISHED BY: Breastfeeding Promotion Network of India (BPNI) BP-33, Pitampura, Delhi – 110034 Tel: 011-27343608, 42683059 Tel/Fax: 011-27343606 Email: [email protected] Website: www.bpni.org
ABOUT BPNI The Breastfeeding Promotion Network of India (BPNI) is a registered, independent, non-profit, national organization that works towards protecting, promoting and supporting breastfeeding and appropriate complementary feeding of infants & young children. BPNI believes that breastfeeding is the right of all mothers and children. BPNI works through advocacy, social mobilization, information sharing, education, research, training and monitoring the company compliance with the IMS Act. BPNI does not accept funds or sponsorship of any kind from the companies producing infant milk substitutes, feeding bottles, related equipments, or infant foods (cereal foods).
Designed by: Amit Dahiya
Acronyms
ANM Auxiliary Nurse Midwives AWWs Anganwadi Workers BFHI Baby Friendly Hospital Initiative BPNI Breastfeeding Promotion Network of India CDPOs Child Development Project Officers DPO District Program officers DWCD Department of Women and Child Development EBF Exclusive Breastfeeding IMR Infant Mortality Rate IMS Act The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as amended in 2003 IYCF Infant and Young Child Feeding IEC Information, Education & Communication MPRs Monthly Progress Reports NFHS National Family Health Survey NGOs Non Government Organisations OBC Other Backward Castes SC Schedule Caste ST Schedule Tribes TBAs Trained Birth Attendants UNICEF United Nations Children’s Fund WHA World Health Assembly WHO World Health Organisation
i Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Acknowledgements
t the outset, I would like to offer my heartfelt thanks to Department of Women AEmpowerment & Child Development, who has given BPNI an opportunity to survey 13 districts during 2005-06.
Secondly, all the mothers and other respondents are entitled for our thankfulness, who patiently provided answers, and without whom this study could not have happened.
We deeply appreciate the role of District Program officers (DPO) of Udhamsingh nagar, who was involved in conducting the study. Dr. B.S. Nagi assisted with data collection, entry, tabulation, and analysis.
Mr P K Sudhir, Consultant, BPNI deserve special appreciation because of his keen interest and efforts to make this survey a success.
Dr Arun Gupta, Dr J P Dadhich and Dr. Jagdish C. Sobti provided the final comments; I am extremely thankful for their contribution.
Sincere thanks to Amit Dahiya for the design and layout - without his help the report would not have come out in this form.
Dr. Deeksha Sharma
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand ii District Profile
n the vicinity of the spectular Kumaon lies the district of Udham Singh Nagar which was a part Iof district Nainital before it gained the identity of a separate district in October 1995 The district was named in the memory of Late Shri Udham Singh who was a great freedom fighter and who killed General Dyre after the brutal Jaliyanwala Bagh massacre.
The district comprises of three main sub divisions Rudrapur, Kashipur and Khatima and is surrounded by the exotic Himalayan ranges. The tehsils in the district are Kashipur, Kichha, Khatima,Sitarganj. Bajpur and Garadpur are sub-tehsils. Whereas on the one hand, Udham Singh Nagar is basically an industrial district and many industry related professions are prevalant here, it is perfect example of 'Unity in Diversity' for which India is so widely known, on the other hand different cultures, religions and life styles are blended in absolute harmony.The fertile land lends itself to different forms of agriculture giving rise to agriculture related activities and industry making this land a green place which has resulted into prosperity all around. Pantnagar university is a leading temple of learning in the fields of agriculture and technology with one of the finest bulit university all around the world.
The district is situated at 28-degree southeast, 30-degree north latitude, 78 degree and 81 degree east longitude of Kumaon. Nainital is to the north, Bijnour, Moradabad, Rampur to west, Bareilly, Pilibhit to south and district Champawat is in the east of this district. Southeast lies the border of Nepal. Reserved forest area lies at the borders of district Nainital and Champawat. The total district is Tarai. Water is available at the depth of 10 to 20 meters. Due to its special geographical structure the district is leader in agriculture in the country.
The area of the district is 3055 square km. It is divided into three parganas, 4 tehsils,2 sub tehsils. There are 669 revenue villages and 15 forest villages. Out of 669 villages 298 villages are in tehsils Kashipur, 159 in tehsil Kichha, 122 villages are in tehsil Sitarganj and 90 in tehsil Khatima. There are 7 blocks for development work. They are Jaspur, Kashipur, Bajpur, Gadarpur, Rudrapur, Sitarganj and Khatima. These 7 blocks are further divided into 27 Nyaya Panchayat and 326 village Panchayat. Urban area is divided into 8 Palika Parishad Jaspur, Kashipur, Bajpur, Gadarpur,. Rudrapur, Kichha, Sitarganj and Khatima and 7 Nagar Panchayat MahuaDabra, Mahuakheraganj, Kelakhera, Dineshpur, Sultanpur Patti and ShaktiGarh.
Population density of this district is 299 per square kilometer. In comparison with Uttarakhand 5.75 percent area is of Udham Singh Nagar. 9.8 percent schedule caste and 40.7 % schedule tribe of Uttarakhand reside in Udham Singh Nagar. According to the census of 1991, 39.3 percent are literate. In literate persons 66.7 % are male and 33.3 % are female. According to the 1991 census 153484 families live here. 102444 families are in rural area and 51040 are in urban area.
District At a Glance Item Unit Detail Total geographical Area Sq. Kms. 3055 Population 1. Male Lacks 4.91
2. Female “ 4.24
3. Total “ 9.15
iii Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Executive Summary
his survey on infant feeding practices in Udhamsingh nagar, district of Uttarakhand was Tassigned to BPNI by Department of Women Empowerment & Child development during the year 2005-06.
Assessment of infant and young child feeding practices in the community is the first step to improve the child nutrition and development. The survey helps in documenting the prevalent infant and young child feeding practices and also give insight where actions are required to improve the situation.
The findings of this survey are documented under three heads quantitative and qualitative aspect of infant feeding in the community and infant feeding practices in hospitals. The quantitative findings describe the prevalent IYCF practices and qualitative ones describe the reasons behind such practices in Udhamsingh nagar district of Uttarakhand.
Quantitative aspect of infant feeding in the community The infant feeding practices were found sub-optimal at every indicator like initiation of breastfeeding within 1 hr was found as low as 32%, Prelacteal feeding that is very harmful for newborn, was highly prevalent (76%) and exclusive breastfeeding for 6 months was found 33% in this district. No 4-6 months old children was found exclusively breastfeeding, this is of serious concern.
Qualitative aspect of infant feeding in the community 1. Prelacteal feeding is very much prevalent because the harmful effects of these are not informed to mothers during pregnancy and families. 2. Support and assistance at birth by health care providers was not available for early initiation of Breastfeeding. 3. Skilled-counseling on sufficiency of Exclusive breastfeeding to fulfill all needs of children for first 6 months was not given to these mothers. 4. Counseling on optimal Infant and Young Child feeding, at multiple opportunities, was not available to these families.
Infant feeding practices in hospitals 1. There is strong need to encourage hospitals to become baby friendly by practicing ‘ten steps of successful breastfeeding’. 2. There is urgent need to aware all health care staff IMS Act and making them responsible to monitor this Act in their health care facilities. 3. Breastfeeding should be discussed during antenatal visits of all mothers. Proper positioning, attachment and knowledge about how to express breast milk need to be explained to all mothers in the hospital.
Recommended strategies • Family level interventions are necessary to ensure early start and exclusive breastfeeding for this IYCF counseling must be delivered as “service’ in all child health programs through home visits/ multiple contacts and periodical monitoring of these services should be done. • Create breastfeeding support centers lead by Lady Supervisor in her circle after appropriate training is provided to them. They could in turn act as trainers of frontline workers.
1 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand • Early intervention in the health facility by ensuring ten steps to successful breastfeeding under Baby Friendly Hospital Initiative (BFHI). • Intensifying IEC activities on IYCF feeding counseling through print and electronic media, ensuring accuracy and in line with IMS Act. • Nutrition education should properly address the taboos and customs prevalent in the communities.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 2 1. Introduction
his report is a part of the survey on infant feeding practices in 13 districts of Uttarakhand Tassigned to BPNI by Department of Women Empowerment & Child development during the year 2005-06. This is the documentation of the findings of the quantitative and qualitative study of infant feeding practices for Udhamsingh nagar district in Uttarakhand. 1. In Phase I, quantitative data (percentage early initiation, exclusive breastfeeding, complementary feeding, prelacteal feeding) was collected by interviewing mothers of infants between the ages of 0 - 12 months. 2. During Phase II, qualitative data (barriers and opportunities for optimal infant feeding practices) was collected through in-depth interviews of mothers, pregnant women, mothers-in-law, health workers and father-in-law/husband. 3. Phase III or the last phase compile the data collected on infant feeding practices in the hospitals through interviews of doctors, nurse, store keeper, chemist shop owners and mothers delivered at hospitals.
The report provides not only the prevalent infant and young child feeding practices in Udhamsingh nagar, but also brings to light several reasons that help or hinder these practices. The report consists of a brief background, methodology, findings of the quantitative study in part-1, findings of qualitative study in part-2 and findings of in infant feeding practices in the hospitals part-3. Finally, it attempts to make recommendations for future action.
3 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 2. Background
n India, while the infant mortality rate (IMR) has shown decline there still remains the need Ito accelerate improvements in infant and neonatal survival to achieve Tenth Plan goal, to reduce IMR to 45 per 1000 live births by 2007 so as to reduce it further by 27 by 2012. Problems such as malnutrition in children, poor maternal and adolescent nutrition, gender discrimination, all continue to be major challenges.
Even today, every fourth infant born in India has low birth weight and every second young child is malnourished, reflecting inadequate caring practices related to health, hygiene, infant and young child feeding, psychosocial care, and discrimination for girls and women.
Inadequate infant and young child feeding practices contribute to the sharp increase in malnutrition – almost fourfold between the first few months of life and the completion of two years of age. Recently released UNICEF’s report card on nutrition, says that each year 600,000 under-5 child deaths could be averted in India if a handful of simple health interventions along with correct infant feeding were to be universally applied.1
It is estimated that worldwide 10.9 million children under five years of age die every year, of which 2.42 million deaths occur in India alone. The Global Strategy on Infant and Young Child Feeding2, adopted by World Health Assembly (WHA), recognizes that two-thirds of these deaths occur during the first year and is related to inappropriate infant feeding practices.
This statement is further strengthened by a research on accelerating child survival published in the Lancet, which clearly establishes that universal breastfeeding (exclusive breastfeeding for the first six months and continued breastfeeding for the next six months) is the single most effective child survival intervention – it reduces under-5 mortality by 13 to 16 percent. Adequate complementary feeding after six months could prevent an additional 6 percent of all such deaths. Extending the coverage of these two optimal infant and young child feeding practices to 90% could prevent 19% of all deaths among children under five3.
A recent study from rural Ghana reveals that 22% of neonatal deaths could be reduced if all mothers started to breastfeed within an hour of birth.4
Recently released WHO Child Growth Standards are based on the breastfed child, as the norm for growth and development. WHO reiterates that breastfed infants should be the standard for measuring healthy growth. While it is known that children fed on breast milk substitutes gain weight quickly compared with breastfed babies, such bonny babies face many health problems at a later stage.
The rationale behind promotion of optimal infant and young child feeding, especially breastfeeding, is not confined to its singular contribution to improved child survival and healthy growth. Optimal infant feeding also contributes to improved development outcomes and better active learning capacity in young children. The World Bank has produced a
1 UNICEF. (2006). Progress for Children. A report Card on nutrition; Number 4, May2006. UNICEF, New York. 2 WHO (2003), “The Global Strategy for Infant and Young Child feeding.”, WHO, Geneva 3 Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS and the Bellaagio Child Survival Study. Lancet, 362, July 5, 2003, 65-71 4 Karen M. Edmond, Charles Zandoh, Maria A. Quigley, Seeba Amenga-Etego, Seth Owusu-Agyei and Betty R. Kirkwood. Delayed Breastfeeding Initiation Increases Risk of Neonatal Mortality. Pediatrics, 2006;117;380-386 http://www.pediatrics.org/cgi/content/full/117/3/e380
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 4 comprehensive report on the importance of improved nutrition on the reduction of poverty. Central to the report’s recommendations is the firm statement that steps to prevent malnutrition MUST occur during pregnancy and the first 2 years of life.5
Scientific evidence is available that breast milk alone is the ideal nourishment for infants for the first six months of life, and their ’first immunization’. It contains all the nutrients, antibodies, hormones and antioxidants that an infant needs to thrive – the ‘nurture provided by nature’. It protects babies from diarrhoea and acute respiratory infections, stimulates their immune systems and thereby prevents and reduces malnutrition, morbidity and mortality in infants and young children.
Promotion of optimal infant and young child feeding practices is crucial for preventing malnutrition & early growth faltering; reducing infant and neonatal mortality and for promoting integrated early child development. Breastfeeding is a critical entry point for ensuring progressive fulfillment of children’s rights to survival, growth and development to full potential, without discrimination.
Breastfeeding also creates a strong bond between the mother and the child, stimulating development of all five senses of the child, providing emotional security and affection, with a lifelong impact on psychosocial development. New research also indicates that it confers cognitive benefits, thereby enhancing brain development and learning readiness. Responsive care and feeding is another way in which infants participate actively in their own development. The benefits of breastfeeding for maternal health, well-being and empowerment including those for birth spacing are also well established.
National Plan of action for children, 2005 underlines India’s commitment for children manifested in several articles of the constitution dedicated to children. It also spells that the rights of child articulated in the constitution of India and the CRC should work in synchrony to ensure all rights to all children. Building on these provisions and in recognition to India’s commitment to the Millenium development Goals and the World Fit for Children, the state shall work to progressively extend these guarantees and protections to all children.
India has become one of the first countries in the world to update its legislation to protect, promote and support breastfeeding, in harmony with the new Global Strategy for Infant and Young Child Feeding. The enactment of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 (as Amended in 2003) is a major step forward in ensuring the best possible start in life for young children. This Act regulates marketing and supply of infant milk substitutes, feeding bottles and infant foods. It mandates that all mothers be empowered so that their infants receive exclusive breastfeeding for the first six months. Thereafter, they shall receive optimal complementary feeding, along with continued breastfeeding up to two years of age or beyond.
The National Guidelines for Infant & Young Child Feeding launched in 2004 and revised, updated in 2006, call for concrete action plans on optimal Infant and Young Child Feeding and lists responsibilities of several stake holders
2.1. Status of Infant & Young Child Feeding and 10th Five-Year Plan Goals for India In the major strategies to stated commitments of the tenth plan include recognition of the early childhood up to six years as critical for the development of children and prenatal to first
5 World Bank. (2006). Repositioning Nutrition as Central to Development: A Strategy for Large-Scale Action . http://siteresources.worldbank.org/NUTRITION/Resources/281846-1131636806329/NutritionStrategy.pdf
5 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand three years as the most crucial and vulnerable period in the life for laying the foundations for the achievement of full human development potential and cumulative life-long learning.
Data from NFHS -2 reflects that in India, 47.0 percent (percentage below -2 SD) children under the age 3 years are underweight.6 According to the NFHS-2, in India, breastfeeding within one hour was initiated in only 15.8 percent of infants, which reaches 37.1 percent within the first 24-hours; only 55.2 percent of children of 0-3 months and 27.3 percent of 4-6 months were exclusively breastfed. According to the Multiple Indicator Cluster Survey (MICS) 2000 of UNICEF India, the percentage of ‘true’ exclusively breastfed babies between 0-3 months is even lower (15.6 percent).
After the age of six months, introduction of complementary feeding with continued breastfeeding is critical for meeting the protein, energy, and micronutrient needs of the children. However according to NFHS-2, in India, it is delayed in the case of a substantial proportion of children. Only 33.5 percent of children (6-9 months old) who are breastfed consume solid or mushy foods.
Recommended Optimal Infant and Young Child Feeding Practices
Starting breastfeeding immediately after birth, preferably within one hour.
Exclusive breastfeeding for the first six months.
Continued breastfeeding for two years or beyond.
Introducing appropriate and adequate complementary feeding after 6 months.
The 10th Five Year Plan for India aims to:
• improve the initiation of breastfeeding within one hour from 15.8 percent to 50 percent. • improve exclusive breastfeeding during 0-6 months from 55.2 percent (at 0-3 months) to 80 percent • improve complementary feeding figures from the current level of 33.5 percent to 75 percent.
Such achievements are possible only with clear and comprehensive plans implemented seriously and in partnership with all those concerned or involved in infant feeding programmes including NGOs (See Fig 1).
6 International Institute for Population Sciences (2000), National Family Health Survey (NFHS–2): India (Mumbai: IIPS).
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 6 90% 80.0% 80% 75.0% 70% 55.2% 60% 50.0% 50% 40% 33.5% 30% 15.8% 20% 10% 0% Initiation of Breastfeeding Exclusive breastfeedong Complementary feeding within 1 hour (0-6 months) (6-9 months)
NFHS-2 Tenth Plan Goals
Note: NFHS 2 data for exclusive breastfeeding is for the 0-3 months period
Fig.1 Infant Feeding Practices: Tenth Plan goals for India
2.2. Making it Possible The evidence- The promotion of early and exclusive breastfeeding is a well-recognized acceleration strategy for child survival. Studies conducted the world over, have demonstrated that achieving high rates in exclusive breastfeeding are possible through effective counselling and support interventions.
Haider et al7 from Bangladesh demonstrated the feasibility of increasing exclusive breastfeeding through home-based community peer counsellors who were trained in counselling. The programme achieved 70 percent exclusive breastfeeding in five months.
In the study done in Haryana8, it was demonstrated that promotion of exclusive breastfeeding till the age of six months is feasible in a developing country through existing primary health- care services, and reduces the risk of diarrhoea and prevents growth faltering. The study also demonstrated that the incidence of exclusive breastfeeding at 3 months was higher in the intervention group (79 percent) as compared to the control group (48 percent).
An intervention study conducted by BPNI in Bhuj9 to promote breastfeeding through behaviour change communication strategy, demonstrated that the exclusive breastfeeding rate was 38.3 percent in the intervention group as compared to 1.7 percent in the control group. In another study from Bangladesh evidence was provided of remarkable reductions in infant mortality by 32 percent, with the increase in exclusive breastfeeding rates from 39 percent to 70 percent10.
Strategies- 1) Establishment of Lactation Clinic/ Breastfeeding support Centre 2) Mainstreaming IYCF counselling as ‘service delivery’ in all child health programs 3) Proper implementation of BFHI (Breastfeeding friendly hospital initiative) in health facilities (both in public and private). 4) Assistance and support at first hour of birth to initiate timely breastfeeding both at home or hospital.
7 Haider R, Ashworth A, Kadir I, Huttly SRA. Effect of community -based peer counsellors on exclusive breastfeeding practices in Dhaka, Bangladesh: a randomised controlled trial. Lancet 2000; 356: 1643-47 8 Bhandari N, Rajiv B, Sarmila M Jose M, Robert E B, Bhan M K. Effect of community-based promotion of exclusive breastfeeding on diarrhoeal illness and growth: a cluster randomized control trial. Lancet 2003; 361: 1418-1423. 9 Phatak A, et al. (2004)“Improving Infant & Young Child Feeding Practices in Calamity Struck Areas Using Counseling by Trained Anganwadi Workers” ; Journal of Indian Medical Association; (272/2005-06, to be published). 10 Arifeen S, Black RE et. al. Exclusive breastfeeding reduces acute respiratory infections and diarrhoea deaths among infants in Dhaka slums. Pediatrics, 2001:108: E.67
7 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 3. Objectives of the Study
his study was done in Udhamsingh nagar to assess current infant and young child feeding Tpractices across the district, to capture, in particular, the geographical and socio-cultural differences in breastfeeding practices.
The study had the following specific objectives:
• To assess the status of infant and young child feeding practices in Udhamsingh nagar district. • To understand the barriers to optimal infant feeding practices. • To investigate the knowledge and skills of health care providers and the support provided by them on infant feeding practices in hospitals.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 8 4. Study Design, Data Collection and Analysis
he interview schedules, guidelines for the in-depth interviews, guidelines for PRA T techniques, fieldwork strategy were prepared and discussed in the committee of the experts. These were finalized and pre-tested in the field, and in the light of the findings of the pretest, the same were revised.
4.1. Quantitative Study: Status of Infant and Young Child Feeding After completing the pilot survey in Udhamsingh nagar District, six teams of the investigators were made, two in one team. The teams were made purely on the basis of random selection.
Quantitative assessment with mothers of 0-9 months old children: Steps Adopted The study was conducted in both rural and urban areas of Udhamsingh nagar. First, Udhamsingh nagar district was divided into two parts, in one part, blocks were listed which were within 10 kilometers from the district headquarters, and in the second part the blocks were listed which were situated at a distance of more than 10 kilometers from the district headquarters.
A block was selected randomly from each part of district. From each of the selected block, a village was selected randomly from the list of villages in the block. This list was procured from the block headquarters by the investigators. Then a cluster of six villages was identified around the randomly selected village. The selected village was included in the cluster of six villages.
In the first selected village of each cluster, one house was selected at random. Then going from house to house, 30 mothers with children aged between 0-3 months were selected for interviews. Similarly, 30 mothers each were selected with children between the ages of 3-6 months as well as between 6-9 months. Thus, a total of 90 mothers were selected for interviews. In case the quota of 90 children in the three age strata was not completed, another adjoining village in the cluster was visited. This exercise was continued till the quota of 30 interviewee mothers (total of 90) in the three categories was completed.
A similar exercise was followed in the case of urban areas. In the block headquarters of the selected block, 6 wards/localities were randomly selected. The process followed was the same as for selecting respondents in the rural areas. Thus, there were 90 mothers interviewed from the urban areas of block headquarters.
The total numbers of interviews of mothers of three strata in the district was 180 (from the cluster of villages in two rural blocks and from the block headquarters).
The research team got the maximum cooperation and help from the ICDS directorate, govt. of Uttarakhand; CDPOs, and other concerned officials in the field.
Quantitative assessment with AWWs: Steps Adopted As Anganwadi workers (AWWs) have the duty to convey the right messages regarding infant feeding and mother-child health, it is must that this person, coming in direct contact of the mother, should have right knowledge and awareness regarding this issue. Therefore 12 AWWs per block (24 per district) were also enquired for their knowledge and awareness regarding infant feeding issues.
9 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand The requisite information from a district was collected as per the details given below:
Schedule Details Block-1 Block-2 Total Quantitative Data Mother having children - 0-3 month 30 30 60 Mother having children 3- 6 months 30 30 60 Mother having children 6-9 months 30 30 60 Anganwadi Workers 12 12 24 Qualitative Data In-depth interviews • Mother of infant of 0-6 months 4 4 8 • Pregnant women 4 4 8 • Mother-in-law 4 4 8 • Father-in-law/ Husband 4 4 8 • ANM/Others 4 4 8 PRA • Mothers of infants of 0-6 month 4 4 8 • Pregnant women 4 4 8 • Mothers-in-law 4 4 8 Hospitals At District Headquarters • Government 1 • Private 1
4.2. Qualitative Study: Status of Infant and Young Child Feeding The main aim of undertaking the qualitative study was to understand the barriers to optimal breastfeeding practices. The study helped to establish some of the positive factors on which health workers, community workers and communicators can build on the programs to motivate mothers and other stake holders (in the family and community) to promote optimal infant and young child feeding practices.
The qualitative study was based on in-depth interviews. The information gathered from in- depth interviews is of great help in designing interventions to improve knowledge, attitude and practice related to optimal infant feeding practices.
The following issues were covered by the in-depth interviews:
• Knowledge of appropriate breastfeeding practices, for example, initiation, colostrum feeding, exclusive breastfeeding and introduction of complementary feeding (mothers of infants, pregnant women and mothers-in-law); • Exact practices adopted for the infants and reasons for adoption of both favourable as well as unfavourable infant feeding practices; • Visualizing factors which can be used as a starting point to promote healthy feeding practices; • Identifying factors, which will generate or strengthen community and familial support for mothers to adopt appropriate breastfeeding practices • Perception of all key stakeholders at the community level-TBAs, influential women, women’s groups or forums etc. which can be targeted for the promotion of optimal infant and young child feeding practices at the community and family level were covered.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 10 In-depth Interviews: Steps Adopted In depth interviews were conducted with 40 respondents per district (20 respondents per block) for qualitative survey. In this way per block following number of respondents were interviewed: Nursing mother (with infant 0 – 6 months) : 4 Pregnant women : 4 Mothers– in – law : 4 Father-in-law/Husband : 4 Community workers : 4
Participatory Rapid Appraisal (PRA) : Steps Adopted This is a way of carrying out a survey that can lead to a high level of participation by local people. It is used to find out about the service needs of a local community by including the community in research, analysis of the issues, and planning for the future.
The main reasons for following a particular infant feeding practice were enlisted. 24 respondents per district (4 respondents per block) were included for this qualitative survey. In this way per block following number of respondents were interviewed: • Mothers of infants of 0-6 month • Pregnant women • Mothers-in-law
4.3. Infant feeding practices in hospitals A systematic monitoring of the Infant feeding practices in hospitals was undertaken to understand the implementation of the ‘Ten steps of Successful Breastfeeding’. This study helped to understand the hospital practices in support of optimal breastfeeding, health staffs skill in solving problems of breastfeeding. The data for this study was collected through interviews with doctors in hospital, nurses, store keepers, chemists and mothers delivered at hospitals. For every district 2 hospitals were assessed i.e. 1 government and 1 private.
The following persons were interviewed: 1. Doctors in hospital : 1 2. Nurses : 1 3. Store keeper : 1 4. Chemist Shop : 1 5. Mothers delivered at hospitals : 2
4.4. Data Analysis All completed schedules for quantitative and qualitative data on infant feeding practices in community and hospitals, were collected at BPNI National Secretariat, New Delhi, where data entry and analysis has been done district-wise and all districts together to get a feel of the state perspective. This report gives the findings for the district of Udhamsingh nagar.
11 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 5. Findings of the Quantitative Study
Section-I: Quantitative data collection from the Mothers
5.1. Breastfeeding practices at a glance in the district of US Nagar The summary findings of the quantitative data collected regarding infant feeding practices in district of US Nagar are presented in Table 5.1.1.
Table 5.1.1: Breastfeeding practices at a glance in the district Breastfeeding practices Percentage (%)
Percent of initiation of BF within 1 hour 32
Percent of initiation of BF within 1-4 hour 59
Percent of giving pre-lacteal feed 76
Percent of Exclusive Breastfeeding 0-3 months 67
Percent of Exclusive Breastfeeding 4-6 months 0
Percent of Exclusive Breastfeeding 0-6 months (Simple Average) 33
Percent of Complementary Feeding 6-9 months 98
Commonest pre-lacteal food given to new born Honey
Initiation of BF within 1 hour of birth Exclusive breastfeeding 0-6 months
32% 33.0%
Percentage of Complementary Feeding (6- 9 months)
98.0%
59% of the children received breastfeeding between 1-4 hrs of the birth and in 32% of the children initiation of breastfeeding was done within 1 hr.
Prelacteal feed was given in 76% of the children and commonest pre-lacteal food given to new born was honey.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 12 Exclusively breastfeeding rate was 67% for 0-3 months in US nagar, which got reduced drastically during 4-6 months as no children in this age group was exclusively breastfed. Thus exclusively breastfeeding rate for 0-6 months age group was only 33% in US nagar.
Timely complementary feeding was given to 98% of these children.
5.1.2. Socio-demographic Characteristics of the Respondents The Socio-demographic characteristics of the respondents are described in Table 5.1.2. Data was collected from 180 respondents.
Table 5.1.2: Socio-demographic Characteristics of the Mothers Characteristics Number Percentage Age Upto 20 years 20 11.1 21-25 years 73 40.6 Above 25 years 87 48.3 Education Illiterate 84 46.7 Just literate/No formal education 13 7.2 Upto Primary 37 20.6 Upto Middle 20 11.1 Upto Higher Secondary 17 9.4 Upto Graduation 09 5.0 Post-Graduation & above 00 0.0 Working outside the house Yes 56 31.1 No 124 68.9 Religion Hindu 149 82.8 Muslim 19 10.6 Other 12 6.7 Caste SC 15 8.3 ST 43 23.9 OBC 89 49.4 Other 33 18.3 Sex of Index Child Male 106 58.9 Female 74 41.1
In this area 48% of the mothers having 0-3 old children were above 25 years of age and 41% were between 21-25 years of age.
Almost half (47%) of the mothers in this group were illiterate and most of the rest were either educated upto primary or middle level.
31% of the mothers were found working outside home.
83% of these mothers was Hindu and 11% were muslim. Half of these mothers were OBC, 24% ST and 18% from other caste. 59% of the mothers were having male and 41% female children
13 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 5.1.3. Utilization of Health Care Services
Table 5.1.3 : Utilization of Health Care Services Variable Number Percentage Had antenatal checkup 177 98.3 Place of delivery - Home 157 87.2 - PHC 23 12.8 - Govt Hospital 00 0.0 - Pvt. Hospital 00 0.0 Type of delivery - Normal 174 96.7 - Caesarian 02 1.1 - Forceps 04 2.2 Check up done by - Doctor 13 7.3 - ANM/Nurse 76 42.9 - Dai 53 29.9 - Other 35 19.8 In this area 98% of the women having 0-3 old children have received antenatal check-up.
Here 87% of the mothers were delivered at home and rest 13% in PHC.
97% of the mothers were having normal delivery.
Check up of 43% of mothers was done by ANM/Nurse and 30% of women received their check-up from dai (traditional birth attendant) however almost 20% of women received check-up by others.
5.1.4. Breastfeeding Practices
5.1.4.1. Initiation of Breastfeeding
100%
80%
59.4% 60%
40% 31.7% Percentages
20% 8.9%
0% Within 1 hour 1-4 hours More than 4 hours
Fig 2: Initiation of Breastfeeding In 59% of the children breastfeeding initiation was done between 1-4 hrs while in 32% breastfeeding was initiated within 1 hr after birth.
Nine percent of mothers have initiated breastfeeding more than 4 hrs after birth.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 14 5.1.4.2. Pre-Lacteal Feeds Given to the New Born
No 24% Yes 76%
Fig 3: Pre-Lacteal Feeds Given to the New Born
In this population of US nagar prelacteal feeding was given in 76% of the children and in 24% of children it was not given.
5.1.4.3. Exclusive Breastfeeding-
100.0% 100%
80% 66.7% 66.7% 60% 33.3% 33.3% 40%
Percentages 20% 0.0% 0% 0-3 months 4-6 months 0-6 months Age Group
Exclusive Breastfeeding Artificial Feeding
Fig. 4: Status of exclusive breastfeeding among 0-6 months
Exclusive breastfeeding was done in only 67% of the 0-3 months age children, while no children of 4-6 months age group was found receiving exclusive breastfeeding. This whole scenario made the percentage of exclusively breastfed children in 0-6 months age group to 33%.
100%
80% 76.7% 60%
40% 40.0% 30% 26.7% 23% 20% 0.0% 3.3% 0% 0% 0% 0.0% 0.0% 0.0% Breastmilk + plain Breastfeeding + Breastfeeding + Breastmilk + solid water Other feedings plain water + other feedings
0-3 months 4-6 months 0-6 months
Fig. 5: Type of supplementary feeding among 0-6 months
15 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand When the type of supplementary feed was analyzed according to the age group of children it was found that water was given with breastfeeding in 30% of 0-3 months old while other feeding were also given with water and breastfeeding in 77% of 4-6 months old children.
5.1.4.4. Bottle-feeding Forty four percent of the children were found getting bottle-feeding.
No 56.1%
Yes 43.9%
Fig 6: Bottle –feeding
5.1.4.5. Continued Breastfeeding
More than 24 months Less than 18 15.0% months 8.9%
18 - 24 months 76.1%
Fig. 7: Plan to continue breastfeeding
Seventy six percent of the mothers have responded expected duration of continuation of breastfeeding to be 18-24 months and 15% said continuation for more than 24 months of age.
5.1.4.6 Frequency of Breastfeeding and Night Feeding Breastfeeding continuation in night is a good practice as this maintains the production and flow of mother’s milk. Here in this population 97% of the mothers were giving night feeds to their infants.
Frequency of breastfeeding more than 5 times in a day is a recommended practice but in this population 88% of the mothers were found practicing breastfeeding to their children more than 5 times in a day.
When the feeding frequency of more than 5 times was analysed with the age group of the child a reduction in feeding frequency of 7-9 months old children was observed.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 16 0-3 months children 33.3%
4-6 months children 31.1%
7-9 months children 23.3%
Breastfeeding more than 5 times during 87.7% the day time
0% 20% 40% 60% 80% 100%
Fig. 8: Frequency of Breastfeeding during the day and night
5.1.4.7 Complementary Feeding
100.0% 100.0% 100.00% 100%
80% 69.2%
60%
38.5% 40% 23.1% 20% 7.70% 7.7% 7.7% 0.0% 0% Others tea/coffee Plain water cola Mother’s milk (mushy) food gripe water, ghutti Solid or semi-solid Powder / tineed milk fruit juice, pepsi, coco Cow/Goat/Bufallo milk Sweetened water with sugar/gur/glucose/honey
Fig: 9: Complementary Feeding Practices: Age 6-9 Months
The food items received by 6-9 months old children were enquired and it was found that all of 6-9 months children were receiving mother’s milk and water. 69% of them were receiving cow/goat/buffalo milk as well and gripe water/ghutti was given in 39%.
Timely supplementation of solid and mushy food were found in all of these children.
5.1.5 Effect of other Factors on Infant Feeding Practices 5.1.5.1 Effect of Education, Caste of Mother and Sex of Index Child on Initiation of Breastfeeding Table 5.1.5.1 shows that more of literate (40%) mothers were timely initiating breastfeeding within 1 hour than their illiterate (23%) counterparts. Timely initiation was low in OBC than their counterparts. However timely initiation was same in children irrespective of their sex .
17 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 5.1.5.2. Effect of Education, Caste of Mother and Sex of Index Child on Pre-lacteal Feeds Given Incidence of giving pre-lacteal feeds was more prevalent in illiterate (87.0 percent) than in literate counterparts (66.0 percent) as shown in Tables 5.1.5.1. Prelacteal feeding was prevalent in all caste but lower percentage of OBC mothers were found giving this than their counterparts. In the studied population 78% of male children and 72% of female children were getting prelacteal feeding.
5.1.5.3: Effect of Education, Caste of Mother and Sex of Index Child on Frequency of Breastfeeding Breastfeeding more than 5 times during the day and night feeding was found prevalent in both illiterate and literate mothers. This was the trend in a larger portion of mothers irrespective of their caste. Almost similar trend was found in children of both sexes. (Table- 5.1.5.3).
Table 5.1.5.1: Breastfeeding practices by education of mother Indicators Illiterate (N=84) Literate (N= 96) No. % No. % Initiation of breastfeeding − Within 1 hour 19 22.6 38 39.6 − 1-4 hours 58 69.0 49 51.0 − 5-12 hours 06 7.1 03 3.1 − 13-24 hours 00 0.0 03 3.1 − More than 24 hours 01 1.2 03 3.1 Pr-lacteal feed given 73 86.9 63 65.6 Breastfeeding more than 5 times during the day time 3 86.9 85 88.5 Breastfeeding during the night 80 95.2 95 99.0 Note: Figures in parenthesis are the percentages.
Table 5.1.5.2: Breastfeeding practices by caste Indicators SC OBC OTHER (N= 15) (N= 43) (N=89) No % No % No % Initiation of breastfeeding − Within 1 hour 03 20.0 12 2.9 22 24.7 − 1-4 hours 11 73.3 28 65.1 57 64.0 − 5-12 hours 01 6.7 00 0.0 08 9.0 − 13-24 hours 00 0.0 01 2.3 02 2.2 − More than 24 hours 00 0.0 02 4.7 00 0.0 Pr-lacteal feed given 12 80.0 26 60.5 77 86.5 Breastfeeding more than 5 times during the day time 13 86.7 37 86.0 80 89.9 Breastfeeding during the night 15 100.0 43 100.0 85 95.5 Note: Figures in parenthesis are the percentages.
Table 5.1.5.3: Breastfeeding practices by sex of index child Indicators Male (N= 106) Female (N= 74) No. % No. % Initiation of breastfeeding − Within 1 hour 34 32.1 23 31.1 − 1-4 hours 62 58.5 45 60.8 − 5-12 hours 05 4.7 04 5.4 − 13-24 hours 02 1.9 01 1.4 − More than 24 hours 03 2.8 01 1.4 Pr-lacteal feed given 83 78.3 53 71.6 Breastfeeding more than 5 times during the day time 94 88.7 64 86.5 Breastfeeding during the night 101 95.3 74 100.0 Note: Figures in parenthesis are the percentages.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 18
5.1.5.4. Effect of Age, Education and Caste of Mother, and Sex of the Index Child on Exclusive Breastfeeding
Tables 5.1.5.4- 5.1.5.7 provide data on effect of these factors on exclusive breastfeeding.
• Exclusive breastfeeding by the age of the mother With increasing age percentage of mothers exclusively breastfeeding their children also got increased but not significantly. (Table 5.1.5.4).
• Exclusive breastfeeding by education of the mother Almost similar percentage of mothers was found exclusively breastfeeding irrespective of their education. (Table 5.1.5.5)
Table 5.1.5.4: Exclusive breastfeeding and supplementary feeding to children in the age group of 0-6 months by age of mother
Exclusive breastfeeding & Upto 20 yrs 21-25 yrs Above 25 yrs supplementary feeding practices (N= 17) (N= 48) (N= 55) No. % No. % No. % Exclusive breastfeeding 05 29.4 16 33.3 19 34.5
Breastmilk + plain water 04 23.5 11 22.9 17 30.9 Breastmilk + other feedings 00 0.0 00 0.0 00 0.0 Breastmilk + plain water + other feedings 08 47.1 21 43.8 19 34.5 Breastmilk + solid 00 0.0 00 0.0 00 0.0 Note: Figures in parenthesis are the percentages.
Table 5.1.5.5: Exclusive breastfeeding and supplementary feeding to children in the age group of 0-6 months by education of mother Exclusive breastfeeding and Illiterate (N= 53) Literate (N=67) Supplementary feeding practices No. % No. %
Exclusive breastfeeding 18 34.0 22 32.8 Breastmilk + plain water 17 32.1 15 22.4 Breastmilk + other feedings 00 0.0 00 0.0 Breastmilk + plain water + other feedings 18 34.0 30 44.8 Breastmilk + solid 00 0.0 00 0.0 Note: Figures in parenthesis are the percentages
• Exclusive breastfeeding by caste of the mother More of SC mothers were found exclusively breastfeeding their children than their OBC and Other caste counterparts . (Table 5.1.5.6)
• Exclusive breastfeeding by sex of the index child Exclusive breastfeeding was low in male (30%) than their female (37%) counterparts. (Table 5.1.5.7)
19 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Table 5.1.5.6: Exclusive breastfeeding and supplementary feeding to children in the age group of 0-6 months by caste of mother Exclusive breastfeeding & SC (N=11) OBC (N=32) OTHER (N=57) supplementary feeding practices No. % No. % No. % Exclusive breastfeeding 06 54.5 10 31.3 17 29.8 Breastmilk + plain water 01 9.1 05 15.6 19 33.3 Breastmilk + other feedings 00 0.0 00 0.0 00 0.0 Breastmilk + plain water + other feedings 04 36.4 17 53.1 21 36.8 Breastmilk + solid 00 0.0 00 0.0 00 0.0 Note: Figures in parenthesis are the percentages
Table 5.1.5.7: Exclusive breastfeeding and supplementary feeding to children in the age group of 0-6 months by sex of index child Exclusive breastfeeding and Male (N= 69) Female (N= 51) supplementary feeding practices No. % No. % Exclusive breastfeeding 21 30.4 19 37.3 Breastmilk + plain water 19 27.5 13 25.5 Breastmilk + other feedings 00 0.0 00 0.0 Breastmilk + plain water + other feedings 29 42.0 19 37.3 Breastmilk + solid 00 0.0 00 0.0 Note: Figures in parenthesis are the percentages
Section-II: Quantitative data collection from the AWWs
Table 5.2.1: Characteristics of AWWs (N = 32) Characteristics Number Percentage Age : − Up to 25 years 09 28.1 − 26-35 years 01 3.1 − 36-45 years 00 0.0 − Above 45 22 68.8 Education: − Primary 00 0.0 − Middle 05 15.6 − Higher secondary 13 40.6 − Graduate and above 14 43.8 Religion: − Hindu 25 78.1 Caste: − SC 00 0.0 − ST 07 21.9 − OBC 12 37.5 − Other 13 40.6 Experience: − Up to 5years 16 50.0 − 6 to 10 years 00 0.0 − More than 10 years 16 50.0 Marital Status: − Married 23 71.9 − Un married 09 28.2 Training: − Received 00 0.0 − Not received 32 100.0
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 20 Sixty nine percent of the AWWs were above 45 years of age and in the rest 28% were upto 25 years of age.
44% of these AWWs were graduates and 41% were educated upto higher secondary. 78% of AWWs were Hindu. 41% of them were belonging to other caste and 37.5% to the OBC.
Half of these AWWs were having upto 5 years of experience and half more than 10 yrs.
Seventy two percent of these AWWs were married.
None of these AWWs has received any training.
Table 5.2.2: Knowledge about initiation of breastfeeding (N = 32) Period of initiation Number Percentage
- Less than one hour 31 96.9 - 1 to 4 hours 00 0.0 - 4 to 12 hours 00 0.0 - More than 12 hours 01 3.1
Ninety seven percent of these AWWs have the knowledge that breastfeeding should be initiated within 1 hr after birth.
Table 5.2.3: Knowledge about pre-lacteal feed (N = 32) Pre-lacteal feed Number Percentage To be Given 05 15.6 Not to be given 27 84.4 Don`t Know 00 0.0
Only 84% of the AWWs have knowledge that prelacteal feed should not be given and the remaining 16% were found supporting prelacteal feed.
Table 5.2.4: Advantages of Colostrum (N = 32) Advantage Number Percentage AB. It saves the children from diseases 24 75.0 C. It contains vitamin and Protein 03 9.4 D. It improves the eye sight 00 0.0 E. It is just like amrit 02 6.3 F. It improves the blood circulation 02 6.3 g. It is complete diet for the new born 03 9.4 H. It helps in creating bonds between the child and mother 00 0.0
Seventy five percent of the AWWs said that colostrum saves the children from diseases.
A few of them also said that It is complete diet for the new born as it contains vitamin and protein and it is just like amrit and improves the blood circulation.
Table 5.2.5: Views about exclusive breastfeeding practices (N = 32) Time after birth (in months) Number Percentage − Two months 00 0.0 − 3 months 00 0.0 − 4 months 01 3.1 − 5 months 04 12.5 − 6 months and more 27 84.4
21 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Eighty four percent of the AWWs were of the view that exclusive breastfeeding should be done for 6 months while a few were having the opinion to exclusively breastfed for 4 and 5 months duration.
Table 5.2.6: Views about introducing water to the newly born child (N = 32) Age Number Percentage Within one month 00 0.0 Within 1-2 months 00 0.0 After 3 months 00 0.0 After 4 months 02 6.3 After 5 months 03 9.4 After 6 months 27 84.4
Eighty four percent of the AWWs were recommending introduction of water after 6 months of age.
Rest of them were not clear when water should be introduced as they were supporting introduction of water at the age of 4 and 5 months.
Table 5.2.7: Views about breastfeeding during day and night times (N = 32) Age Number Percentage During day time − 1-4 times 00 0.0 − 5-6 times 00 0.0 − 7 to 8 times 01 3.1 − More than 8 times 31 96.9 During night time − 1 to 3 times 01 3.1 − 4 to 5 times 06 18.8 − More than 5 times 25 78.1 Ninety seven percent of the AWWs were found advocating breastfeeding frequency more than 8 times during day.
During night 78% were found supporting more than 5 times while a 19% of them for 4-5 times.
Table 5.2.8. Advice to mother who feels she does not have sufficient breastmilk for the child (N = 32) Age Number Percentage 1. Mother should eat balanced diet 24 75.0 2. To consult the doctor 09 28.1 3. Mother should take rest 00 0.0 4. To feed cow’s milk to child 00 0.0 5. Mother should breastfeed the child continuously 00 0.0 Note: percentages do not add to 100 due to multiple answers
AWWs were advising the mother who feels she does not have sufficient breastmilk for the child to eat balanced diet.
Almost equal percentage (42-46%) refer them to doctor and suggest to feed cow’s milk to child. Only 17% of AWWs suggested that child should be breastfed continuously in such situations.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 22 Table 5.2.9: Age for starting Complementary feeding to the child (N = 32) Age Number Percentage 4 months 01 3.1 5 month 02 6.3 6 months 27 84.4 7 months 01 3.1 9 months 01 3.1
Eighty four percent of the AWWs supported introduction of complementary feeding at 6 months of age.
While the rest have given 4,5,7 and 9 months as the appropriate time for introduction of complementary foods.
Table 5.2.10: Type of complementary food to be given to the child (N = 32) Type of food Number Percentage 1. Dal water 15 46.9 2. Rice water (mand) 02 6.3 3. Artificial Milk 01 3.1 4. Green vegetable soup 05 15.6 5. Mashed banana 23 71.9 6. Fruit juice 01 3.1 7. Bread soaked in milk 05 15.6 8. Mashed boiled potato 08 25.0 10. Poshtak Ahar available at Anganwari Centre 02 6.3 11. Dalia 14 43.8 12. Khicadi 06 18.8 13. Kheer 12 37.5 14.. Halwa 04 12.5 16. Seasonal fruit 09 28.1 17. Cerelac 02 6.3 18.Horlicks 01 3.1 19. Biscuit//Bread 02 6.3 20. Whatever cooked in the home 01 3.1 21. Boiled eggs(jardi) 01 3.1 15.Dal-Rice 00 0.0 9. Other things cooked in the milk 00 0.0 22. Others 00 0.0 Note: percentages do not add to 100 due to multiple answers AWWs when enquired for the type of complementary food to be given to children, different food items were suggested by them. 72% of them suggested mashed banana 47% dal water, 44% Dalia, 37.5% kheer, 28% Seasonal fruit, 25% Mashed boiled potato 19% khichdi, 16% Bread soaked in milk and Green vegetable soup.
A few of AWWs also suggested Rice water (mand), Artificial Milk, Fruit juice, Poshtak Ahar available at Anganwari Centre, Cerelac, Horlicks, Biscuit/Bread, Boiled eggs (jardi)and Whatever cooked in the home.
23 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Table 5.2.11: Views about plan (duration) to breastfeed the child (N = 32) Period Number Percentage Up to 12 months 00 0.0 13 to 23 months 02 6.3 24 months 16 50.0 More than 24 months 14 43.8 Half of the AWWs were advocating breastfeeding for 24 months of age and 44% of the rest of AWWs were of the opinion that mother should breastfeed her child for more than 24 months.
Table 5.2.12: Views about plan (duration) to breastfeed the child (N = 32) Period Number Percentage 1.Child does not take mother’s milk 01 3.1 2.Child vomits just after taking milk 00 0.0 3. Have less milk in the breast 06 18.8 4. Ganth develop in the breasts 11 34.4 5. Drar in Aureole 03 9.4 6. Milk gets jammed in breasts 00 0.0 7. Pus in the breasts 00 0.0 8. Mother feels weak after feeding breast milk to the child 00 0.0 9. Child feels problems due to inverted nipples 00 0.0 10. Fever 00 0.0 11. Pain in the abdomen after delivery 00 0.0 0. No problem 11 34.4
Besides insufficient milk and pain while breastfeeding the other problems of breastfeeding faced by the mother were breast engorgement (Ganth development in the breasts), less milk in the breast, cracked nipples (Drar in Aureole) and Child does not take mother’s milk.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 24 6. Findings of the Qualitative Data
Section-I: Qualitative data collection through in-depth interview
6.1. Initiation of breastfeeding- The mothers were of the opinion that breastfeeding should be initiated after 2 hours of the birth of the child. The main reason they have given that before this cleanliness of the mother and the child is done and the honey is given to the child first in order to get the stomach cleaned of the child. In practice most mothers were found initiating breastfeeding after 1 hr and most pregnant women were also found of this opinion as newly born feels hungry after birth and one hour is consumed in the cleansing of mother and infant but in practice initiated after 2 hrs.
Mothers-in-law also supported that breastfeeding should be initiated after two hour of the birth of the child as two hours are consumed in the cleansing of mother and child and newborn baby is given honey/ghutti/water firstly after birth. A few of them indicated that breastfeeding should be initiated only after six hours of the birth of the child, because early initiation of breastfeeding can disturb the digestion system of the infant
6.2. Prelacteal feeds- All mothers, pregnant women and mothers-in-law have indicated that they have the custom to give honey /ghutti/ batase ka pani to the child before the mother initiates breastfeeding to the newly born. This was given two-three times from 30 minutes to one hour after the birth of the child. A few of pregnant women wouldn’t followed this custom on doctor’s advice.
Most mothers-in-law have indicated that nothing will happen if they are told for not giving pre lacteal feeding to the infant and a few have mentioned that they will not follow the advise of not giving pre lacteal feeding to the infant because the tradition of giving pre lacteal food is very old and they have followed it from long time hence it should not be changed, in addition to it the stomach of the newly born can not be cleaned without honey/ghutti therefore honey/ghutti is essential for the infant soon after birth.
6.3. Exclusive breastfeeding- Majority of the mothers and pregnant women have indicated that the child should not be given exclusive breastfeeding and have given water right from the birth as well for six months. However, a few of pregnant women were advocating exclusive breastfeeding for 4 or 6 months. Most mothers in law were of the opinion that child should not be exclusively breastfed and water should be given right form birth and some of them also indicated about introduction of other liquids as well from birth with water and breastfeeding.
6.4. Complementary feeding- Most of the mothers and pregnant women have indicated that the complimentary feeding should be given to the child after six months of the age of the child. In practice few pregnant women were introducing complementary feeding at 5 or 7 months.
However all mothers-in-law mentioned introduction of complimentary feeding after six months of the age The items of the complimentary feeds include: Kichdi, dalia, dal ka pani, cooked rice, boiled potatoes, banana, papaya, bhigi roti, milk mein bheegi roti, boiled egg, kheer.
25 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 6.5. Problems in breastfeeding- All of the mothers said that they would consult the doctor in case they face any breastfeeding problem as he has the complete knowledge about the breastfeeding practices; however, a few would consult the AWW, ANM or mother-in-law. Pregnant women would also like to have this information from health workers.
6.6. Practices in the case of second child Mothers have reported that their breastfeeding practices were the same as their earlier child
6.7. Influence of elders The main persons who could influence the mothers for correct breastfeeding practices are – health works (doctor or ANM, AWW), and a few have mentioned mother-in-law, husband and sister-in-law.
Mostly mothers have reported that there would not be any type of protest by any family member if they are given information about appropriate breastfeeding practices. A few of them also mentioning possibility of protest by the mother-in-law/elderly members of the family. The reason of the protest is, the mothers-in-law or other elderly women had breastfed their children with the existing customs and new breastfeeding practices may harm the children.
Majority of the mothers and pregnant women have indicated that they got the information about breastfeeding practices during their pregnancy from ANM, AWW or doctor. The information received were - importance of breastfeeding, early initiation of breastfeeding, the colostrums should be given to the newborn, exclusive breastfeeding to the child for six moths and breastfeeding should be given regularly.
All mothers have indicated that their neighbourhood mothers feed their children in sitting position, the children are in their laps and a few also feed their child in lying position. Their mother-in-laws/elderly women in the family have told them about the breastfeeding practices in their neighbour.
Few mothers but most of the pregnant women were interested to receive the latest information on less production of the breast milk, pain in the breasts, breast engorgement (ganth in the breast) by doctor a few of them also indicated that they would seek such information from mothers-in-law, ANM, and AWW.
All mothers-in-law and male members were of the opinion that breastfeeding is essential for the child. They have given following benefits of breastfeeding that the child remains healthy and strong, does not fall sick, mother’s milk is pure, comprises of nutritious elements, and complete natural food for the child and other foods are harmful for the child.
Mothers-in-law have indicated that they can help the lactating mothers in their family by helping the lactating mother for taking proper food, providing her medical support when required and providing the information on breastfeeding.
Most mothers-in-law were of the opinion that the lactating mothers should be given the latest information on breastfeeding and doctor can impart the information on breastfeeding to the lactating mothers. However a few of them said that there is no need for this as breastfeeding is a very common practice for women and what’s new in it. Majority of mothers-in-law mentioned their unwillingness to any information on latest breastfeeding practices.
Majority of the male members have mentioned that breastfeeding should be initiated after one hour of the birth of the child, pre lacteal feedings should not be given, child should be
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 26 given exclusive breastfeeding up to six months of age, and should be given water and other liquids after six months, introduction of complimentary feeding after five-six months of the age. Most respondents would also like to have the latest information on breastfeeding practices.
Health workers have mentioned that they are informing the women about breastfeeding practices and encouraging them for optimal breastfeeding practices, advise the lactating mother for regular breastfeeding the child for twenty-four months, immediate breastfeeding after the birth of the child and to take proper diet. Breastfeeding is essential as it is the complete food for the child, mother’s milk provides resistance power to child against diseases, the child does not fall sick and breastfeeding also acts as a source of contraceptive for mother.
Health workers have mentioned that they would like to have the latest information about breastfeeding practices. They are of the opinion that they can get the latest information on breastfeeding practices from doctors, and from various training programmes organized by the government and other community workers are also in need of this kind of help.
Section-II: Qualitative data collection through PRA
These data reflects the reasons given by the respondents for following a particular practice.
Reasons for not exclusively breastfeeding the children up to six months- The mother has to perform other works (inside and outside the house) as well, hence it is not possible to exclusively breastfeed the child for longer duration of time. The child is more disease prone only up to four months therefore it is alright to exclusively breastfeed the child up to four months. Some mothers want to be pregnant again; the initiation of complimentary feeding increases the possibilities of being pregnant again.
It is necessary to introduce water to the child since birth. Honey is essential for the child to remain healthy. The mixture of boiled water and ghutti cleans the stomach of the child.
Reasons to continue exclusive breastfeeding up to six months Mother’s milk is the best, complete, and balanced food for the child. The children who are exclusively breastfed up to six months of age remain healthy. The mother too remains healthy by exclusively breastfeeding, otherwise there are possibilities of mother’s being falling sick due to excessive milk in the breasts.
Reasons for giving pre-lacteal feeds- Stomach of the newly born gets cleaned after licking the honey. The elders in the community say to give honey to the child as it helps the child to breath smoothly. The mother becomes very weak after delivery and she becomes more weak if she starts feeding her milk to the child immediately after delivery.
The mother gets yellow thick milk and the child cannot digest the colostrums (the first thick milk), after throwing away 3-4 times this milk, mother initiates breast milk. The mother gets milk in the breast after three days/Late after delivery. The child gets breathing problem if the mother initiates breast milk immediately after the birth.
Reasons for not giving pre-lacteal feeds - Mother’s milk is best for the child.
The mother gets milk in her breast properly if breastfeeding be initiated early. The child does not fall sick if breastfeeding is initiated early/ Mother’s milk acts as a source of immunization for the child / First milk acts as amrit for child.
27 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand Reasons for giving complementary feedings to the child after the age of six months- Only mother’s milk is not sufficient for the child, it is essential to give complimentary feeds to the growing children. This is good for physical as well as mental growth of the child. The mother goes out to work, therefore, it is essential to give complimentary feeds to the child. After taking cow/goat’s milk, the child becomes healthy.
Reasons to continue breastfeeding up to twenty-four months - The child must be given breastfeeding up to two years. After two years of age the child needs supplementary food, mother’s milk is no longer enough for the child. Breastfeeding has to be stopped in the process of being pregnant again. Regular breastfeeding prevents the mother from breast engorgement (ganth in the breasts). The mother becomes weak after breastfeeding the child for this much duration.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 28 7. Assessment of Infant and Young Child Feeding in the hospitals of Udhamsingh nagar, Uttarakhand
The description of infant feeding practices in these hospitals is done under different heads to analyze the policy and practices of these hospitals. 1) BFHI status of hospital 2) Status of “Ten steps of Successful breastfeeding” in the hospitals 3) Breastfeeding related problem solving skills of Health staff 4) Status of IMS Act in Health Facilities 5) Infant feeding Practices followed by mothers delivered at the health facility
7.1. Finding BFHI status of hospitals in Udhamsingh Nagar district of Uttarakhand BFHI is very effective in determining the optimal infant feeding practices of the community. Under this, the health facilities with maternity services, wanting to be certified as BFHI, have to follow the ten steps to successful breastfeeding. These hospitals are assessed and certified as baby friendly (BF) if they adopt the “Ten steps” and follow these practices.
Table 7.1: BFHI status of hospitals Hospital BFHI Non-BFHI Don’t Know Govt. Hospital - - Private Hospital - - In this district govt. hospital was found baby friendly. There is strong need to encourage all hospitals especially private hospitals to follow baby friendly practices.
7.2. Ten steps of BFHI in the hospitals The ten successful steps of breastfeeding were enquired for assessing the baby friendly nature of the hospital. Practice of these ‘Ten steps of successful breastfeeding’ in hospitals is very helpful to make mother initiate optimal breastfeeding practices and carry out even after discharge from hospitals.
7.2.1. Written Breastfeeding policy that is Routinely communicated Doctors in both the hospitals said that they have breastfeeding policy in their hospitals but nurse in private hospital was unaware of that.
Breastfeeding policy needs to be routinely communicated, as it was not routinely communicated in all cases.
7.2.2. Train all health care staff in skills necessary to implement policy Here no doctor or nurse got skill training in IYCF.
7.2.3. Inform all pregnant women about the benefits and management of breastfeeding Nurses in both hospitals replied that they inform pregnant women about the benefits and management of breastfeeding but this was not the case with doctors. There is a need to
29 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand sensitize doctors to inform pregnant women about the benefits and management of breastfeeding.
7.2.4. Help mothers initiate breastfeeding within half an hour of birth Skilled assistance by health care providers for first hour of birth is necessary to initiate breastfeeding early. Nurses were helping mothers to initiate breastfeeding within half an hour of birth in this hospital but not the doctors.
7.2.5. Show mothers how to breastfeed and how to maintain lactation even if they are separated from their infants The doctor and nurse in one hospital were showing mothers how to express breast milk and how to maintain lactation even if they are separated from their infants but this was not the practice in other hospital. Expression of breast milk is important especially for the mothers who returned back to work few months after delivery and providing this needed support by health care providers is highly encouraging.
7.2.6. Give newborn infants no food or drink other than breast milk Health care providers were not recommending prelacteal feeding but this was practiced in these hospitals as elder family members influenced these.
7.2.7. Practice rooming-in allow mothers and their infants to remain together 24 hours a day Rooming-in of the child with the mother is important to initiate breastfeeding and making it a success. In this study health care providers confirm this practice in these health facilities.
Table-7.2 Ten steps of BFHI No. Ten steps of BFHI Yes No Don’t Know Doctor Nurse Doctor Nurse Doctor Nurse 1 a) Written breastfeeding policy 2 1 - - - 1 b) Routinely communicated 1 1 1 1 - - 2 Train all health care staff in skills - - 2 2 - - necessary to implement policy 3 Inform all pregnant women about the - 2 2 - - - benefits and management of breastfeeding 4 Help mothers initiate breastfeeding - 2 2 - - - within half an hour of birth 5 Show mothers how to breastfeed and 1 1 1 1 - - how to maintain lactation even if they are separated from their infants 6 a) Knowledge to give newborn infants 2 1 - 1 - - no food or drink other than breast milk b) Give newborn infants no food or - - 2 2 - - drink other than breast milk 7 Practice rooming-in allow mothers and 2 2 - - - - their infants to remain together 24 hours a day 8 Encourage breastfeeding on demand 2 2 - - - - 9 Give no artificial teats or pacifiers to ------breastfed infants 10 Foster the establishment of 1 - 1 - - - breastfeeding support groups to help mothers who have left the hospital
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 30 7.2.8. Encourage breastfeeding on demand The nurses and doctors were found encouraging breastfeeding on demand, which is a very good trend as breastfeeding on demand help regulate milk supply according to the child’s need.
7.2.9. Give no artificial teats or pacifiers to breastfed infants Artificial teats or pacifiers were not prevalent in these study settings.
7.2.10. Foster the establishment of breastfeeding support groups to help mothers who have left the hospital In this study one doctor was fostering the establishment of breastfeeding support groups and encouraging mothers to revert back for advice after leaving the hospital once but not the other one in govt. hospital. There is a need to sensitize the doctors to foster support groups to help mothers who have left the hospital and make them successful in carrying out optimal infant feeding.
7.3. Problem solving skills of the health care staff The skills of health workers are very important to solve problems of the mothers when they arise and make them successful in sustaining breastfeeding.
Table-7.3 Problem solving skills of the health care staff
Problems Yes No Doctor Nurse Doctor Nurse 1) Sore nipples 2 - - 2 2) Breast engorgement - - 2 2 3) Inverted nipples - 1 2 1 4) Breast abscess - - 2 2 5) Insufficient milk - - 2 2
In this study settings it was found that majority of the health staff were not skilled enough to give the right direction and solve the breastfeeding related problems of the lactating mothers. No doctor or nurse were found skilled in solving breastfeeding related problems like breast engorgement, breast abscess and insufficient milk while both doctors were skilled in solving sore nipples and one nurse in solving the problem of inverted nipples in the lactating mother. Skills to solve breastfeeding related problems need special focus while training these health staffs on Infant and Young Child Feeding.
7.4. Status of IMS Act An attempt to investigate the implementation status of “The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 as amended in 2003 was also done in these health facilities. Hospital policies and awareness of these health care staff about IMS Act was explored as these are very much influential in determining the community infant feeding practices.
Doctors were not asking mothers to bring infant milk formula, feeding bottles and infant foods but one nurse was found doing so.
One doctor in the health facilities said that manufactures sponsor fellowships, study tours, conference, seminars, books or clinical meetings in the hospital.
31 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand None of the nurses and storekeepers in these hospitals was found aware about IMS Act. Awareness and sensitization of these health care staff is major concern as these people come in direct contact of the mother and families.
Special schemes on sales of Baby Soaps, Talcum, Oils, Baby Foods, Feeding bottle were offered in chemist shop but the trend of sale was not found increasing.
Table- 7.4. Status of IMS act
Indicators Yes No Don’t know Doctor Nurse Doctor Nurse Doctor Nurse 1) Hospital asks mothers to bring - 1 2 1 - - infant milk formula, feeding bottles and infant foods. 2) Policy about promotion of - - 2 1 - 1 breast-milk substitutes, bottles or teats in the hospitals 3) Sponsorship of doctors by the 1 - 1 2 - - manufacturers 4) Facility receive some or all of its 1 - 1 2 1 1 infant formula, feeding bottles or teats through donations or at subsidized prices 5) Knowledge about existence of 2 - - 2 - IMS act 6) Store keeper at hospital aware - 2 - about IMS Act 7) Special displays by the chemists - 2 - 8) Special schemes on sales of 1 1 - Baby Soaps, Talcum, Oils, Baby Foods, Feeding bottle products were offered 9) Trends of sales of infant milk - 2 - substitutes were found increasing.
7.5. Infant feeding practices by the mother in the hospitals Infant feeding practices in hospital can only be decided after interviewing the mothers delivered at these hospitals.
In these hospitals prelacteal feeding was given in two newborns but initiation of breastfeeding within 1 hour was done in most cases.
Rooming-in and feeding on demand was commonly practiced.
Mothers in these hospitals hadn’t received information on breastfeeding during antenatal visits and explanation of positioning and attachment; therefore in absence of this support mother had not planning to continue exclusive breastfeeding for 6 months.
The health care support system should be encouraged to assist all women to follow optimal infant feeding practices.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 32 Table-7.5 Practices regarding breastfeeding by mother
Indicators Yes No 1) Prelacteal feeds milk/water 2 2 2) Babies started to breastfeed within 1 hr in normal 3 1 deliveries 3) Rooming-in 4 - 4) Babies fed on demand 4 - 5) Mother’s plan to continue exclusive breastfeeding for 1 3 6 months 6) Anything to drink or eat after putting the baby to - 4 breastfeeding 7) Discussion on breastfeeding during antenatal visits 1 3 8) Positioning and attachment explained in hospital - 4 9) Knowledge about how to express breast milk in the 2 2 hospital 10) Asked to bring infant milk formula, feeding bottles - 4 and infant foods. 11) Received education material - 4
33 Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 8. Conclusion and Suggested Action Ideas
he study shows that Infant and Young Child feeding practices are far from optimal in TUdhansingh Nagar, District of Uttarakhand. A comprehensive plan must address changes in hospital norms, training of health providers, pre and post-partum counselling, development of lactation clinics, community talks, and mass media campaign. Some strategies are suggested here keeping in mind that partnership at different levels is necessary to achieve the goal of optimal IYCF in the community. 1. At Policy Level 2. At Health Care Services Level 3. At family Level
1. At Policy Level i. Create a Separate “Budget head” for Breastfeeding support, Optimal Nutrition & Care ii. Mainstreaming IYCF counselling as “service delivery” in all child health and development programmes. iii. Incorporate early initiation of breastfeeding, exclusive breastfeeding for first six month and complementary feeding at six months with continued breastfeeding up to two years as criteria/indicators in the MPRs with a view to monitor the same in Monthly development reviews. Include IYCF counselling (during pregnancy and after) as progress indicator iv. To effectively implement the IMS Act, notify state nodal officers and CDPOs to act as Block resource persons and be trained by NIPCCD through State resource persons. CDPOs should regularly educate public and the ICDS functionaries on provisions of the IMS Act and how to monitor and report it
2. At Health Care Services Level i. Baby care/ Breastfeeding support centers- Create breastfeeding support centers lead by Lady Supervisor in her circle after appropriate training is provided to them, they could in turn act as trainers of frontline workers. ii. BFHI (Baby friendly Hospital Initiative)- Early intervention in the health facility is highly effective in increasing the duration of exclusive breastfeeding. Proper positioning, attachment and knowledge about how to express breast milk need to be explained to all mothers in the hospital. iii. Intensifying IEC activities on IYCF feeding counseling to ensure early initiation and exclusive breastfeeding through print and electronic media, ensuring accuracy and in line with IMS Act, involving partners without any conflicts of interest.
3. At Family Level i. Ensure that counselling on IYCF is provided to ALL families especially the elderly women in the community, as routine service through multiple contacts/home visits and proper monitoring of its effect. ii. Customs /Taboos like prelacteal feeding and introduction of water before 6 months should be addressed strongly with adequate knowledge about sufficiency of breastfeeding for first 6 months. iii. Counselling of families to support the mother for exclusive breastfeeding of child for 6 months.
Status of Infant and Young Child Feeding in Udhamsingh nagar, Uttarakhand 34 Annexures Annexure – 1
I Annexures
Annexures II
III Annexures
Annexures IV Annexure – 2
QUALITATIVE SURVEY ON INFANT AND YOUNG CHILD FEEDING
Format for conducting in-depth interviews
(MOTHERS OF INFANT 0 – 6 MONTHS)
Village/ urban locality:______Block: ______District: ______
Probe and then record Background information • Name • No. of living children Boys ___Girls ____ • Age (in years) • Sex – Boy/ Girl • Education • Age of the infant (months) Knowledge on Breastfeeding uotkr f’k’kq dks dc Lruiku djkuk pkfg, vkSj D;ksa\
uotkr f’k’kq dks Lruiku ‘kq: djkus ls igys D;k dqN vkSj ;k fiykus dk fjfr fjokt gSa\
D;k vki tkurs gS fd cPps dks fdrus le; rd ¼efguksa½ 1 dsoy Lruiku djkuk pkfg;sA
2 dsoy Lruiku vkSj ikuh nsuk pkfg;sA
3 dsoy Lruiku vkSj vU; rjy inkFkZA cPps dks dsoy Lruiku djkus ds ckjs esa mUdk fopkj iwNs ek=k Lruiku gh D;k gS\ bls cPps dks fdrus eghuksa rd fiykuk pkfg,\ D;k blds lkFk ikuh fiykuk t:jh gS ;k ugha & ,slk D;ksa\
fdl vk;q esa cPps dks iwjd vkgkj nsuk ‘kq: djuk pkfg,\ iwjd vkgkj esa D;k&D;k gksuk pkfg,A
V Annexures Ifjokj ;k lekt esa ,slk dkSu lk O;fDr gS tks vkidks lgh Lruiku ds rjhdks ds ckjs esa izHkkfor dj ldrk gS\ ml O;fDr dk ek¡ ls D;k fj’rk gS ;k lekt esa mldk D;k LFkku gS\
Future intentions regarding breastfeeding practices ;fn gS\
D;k vki cPps dks mlds tUe ds fdruh nsj ckn viuk Lruiku djkuk pkgsxh\ ¼;fn oks nsj ls Lruiku djkuk pkgrh gS] rks mlls dkj.k iwNs\
;fn ‘kq: esa vkidks Lruiku djkus esa dksbZ leL;k vkrh gS rks vki fdlls lykg ysxh vkSj D;ksa\
If the woman has living children, prove about the breastfeeding practices of youngest child. ek¡ us cPps dks tUe ds fdruh nsj ckn Lruiku djkuk ‘kq: fd;k\
uotkr f’k’kq dks Lruiku ds iwoZ vU; dqN fiyk;k] ;k fn;k x;k\ D;k fn;k x;k\ vkSj fdruh&fdruh nsj ckn fn;k x;k\
fdruh nsj rd dsoy Lruiku gh cPps dks djk;k x;k\ vkSj fdruh nsj Lruiku vkSj ikuh fiyk;k x;k\
Annexures VI vkids lekt esa ;k iM+ksl esa efgyk,¡ Lruiku ds dkSu & dkSu ls rjhds viukrh gS\ ¼;fn ekrk crkrh gS rks iwNs fd mls bl ckjs esa dSls tkudkjh feyh vkSj ;g Hkh iwNs fd muds Lruiku ds rjhdks ls izHkkfor gksdj mudks viuk;k ;k ugha
D;k bl cPps ls igys okyksa dks Lruiku ds rjhds vyx Fks\ vxj gka rks D;k vtx&vyx rjhds viuk, x;sa\
;fn ekrkvksa dks mfpr Lruiku dh fof/k ds ckjsa esa crk;k tk, D;k ekrkvksa ;k ifjokj ds vU; lnL;ksa dh rjQ ls dksbZ fojks/k gksxk\ ;fn gka rks D;k fojks/k gksxk\
Strengthening capacity of the mother for optimal breastfeeding practices D;k ek¡ Lruiku ds ckjs esa fdlh vk/kqfud tkudkjh dh bPNqd gS\ mls fdl izdkj dh tkudkjh nh tk,\
,slk dkSu lk lgh O;fDr gksxk ftlls og Lruiku ds ckjs esa tkudkjh ysuk pkgsxh\
VII Annexures QUALITATIVE SURVEY ON INFANT AND YOUNG CHILD FEEDING
Format for conducting in-depth interviews
(PREGNANT WOMAN)
Village/ urban locality:______Block: ______Distt: ______
Probe and then record Background information • Name • No. of living children Boys ___Girls ____ • Age (in years) • Sex – Boy/ Girl • Education • Age of the infant (months) Knowledge on Breastfeeding uotkr f’k’kq dks dc Lruiku djkuk pkfg, vkSj D;ksa\
uotkr f’k’kq dks Lruiku ‘kq: djkus ls igys D;k dqN vkSj ;k fiykus dk fjfr fjokt gSa\
D;k vki tkurs gS fd cPps dks fdrus le; rd ¼efguksa½ 1 dsoy Lruiku djkuk pkfg;sA
2 dsoy Lruiku vkSj ikuh nsuk pkfg;sA
3 dsoy Lruiku vkSj vU; rjy inkFkZA cPps dks dsoy Lruiku djkus ds ckjs esa mUdk fopkj iwNs ek=k Lruiku gh D;k gS\ bls cPps dks fdrus eghuksa rd fiykuk pkfg,\ D;k blds lkFk ikuh fiykuk t:jh gS ;k ugha & ,slk D;ksa\
fdl vk;q esa cPps dks iwjd vkgkj nsuk ‘kq: djuk pkfg,\ iwjd vkgkj esa D;k&D;k gksuk pkfg,A
Annexures VIII ifjokj ;k lekt esa ,slk dkSu lk O;fDr gS tks vkidks lgh Lruiku ds rjhdks ds ckjs esa izHkkfor dj ldrk gS\ ml O;fDr dk ek¡ ls D;k fj’rk gS ;k lekt esa mldk D;k LFkku gS\
Future intentions regarding breast feeding practices ;fn vkidks xHkkZoLFkk ds nkSjku Lruiku ds ckjs esa fdlh izdkj dh tkudkjh feyh gS\ ;fn gka rks fdlls vkSj fdl izdkj dh tkudkjh feyh gS\
D;k vki cPps dks mlds tUe ds fdruh nsj ckn viuk Lruiku djkuk pkgsxh\ ¼;fn oks nsj ls Lruiku djkuk pkgrh gS] rks mlls dkj.k iwNs\
;fn ‘kq: esa vkidks Lruiku djkus esa dksbZ leL;k vkrh gS rks vki fdlls lykg ysxh vkSj D;ksa\
If the woman has living children, prove about the breastfeeding practices of youngest child. ek¡ us cPps dks tUe ds fdruh nsj ckn Lruiku djkuk ‘kq: fd;k\
uotkr f’k’kq dks Lruiku ds iwoZ vU; dqN fiyk;k] ;k fn;k x;k\ D;k fn;k x;k\ vkSj fdruh&fdruh nsj ckn fn;k x;k\
fdruh nsj rd dsoy Lruiku gh cPps dks djk;k x;k\ vkSj fdruh nsj Lruiku vkSj ikuh fiyk;k x;k\
IX Annexures lcls NksVs cPps dks fdl vk;q esa iwjd vkgkj nsuk ‘kq: fd;k Fkk\ vkSj fdl izdkj dk iwjd vkgkj fn;k x;k\
Strengthening capacity of the women for optimal breastfeeding practices D;k ek¡ Lruiku ds ckjs esa fdlh vk/kqfud tkudkjh dh bPNqd gS\ mls fdl izdkj dh tkudkjh nh tk,\
,slk dkSu lk lgh O;fDr gksxk ftlls og Lruiku ds ckjs esa tkudkjh ysuk pkgsxh\
Annexures X QUALITATIVE SURVEY ON INFANT AND YOUNG CHILD FEEDING
Format for conducting in – depth interviews
(MOTHER – IN – LAW / FATHER – IN LAW / HUSBANDS )
Village / urban locality : ______Block ______District :______
Probe and then record
Background information
• No. of living children –Boys_____ Girls____ • Name • Sex - Boy / Girl • Age (in years) • Age of the infant (months) • Education
Knowledge on Breastfeeding D;k vki lksprh gS fd cPps dks Lruiku djkuk vko’;d gS\ Lruiku ls dkSu&dkSu ls Qk;ns gSa\
mfpr :i ls uotkr f’k’kq dks tUe ds le; ds fdruh nsj ckn Lruiku djkuk pkfg,] vkSj D;k
D;k uotkr f’k’kq dks Lruiku ‘kq: djus ls iwoZ dksbZ vU; rjy inkFkZ nsuk pkfg;s\ ;fn ;g vkidh lkekftd jhfr gS rks cPpsa dks D;k rjy inkFkZ fn;k tkrk gS\
;fn uotkr f’k’kq dks Lruiku ds iwoZ dqN vkSj u fn;k tk,] tks fd vkids jhfr&fjokt ds foijhr gS] rks vkids fopkj ls D;k gksxk\
XI Annexures D;k vki tkurs gS fd cPps dks fdrus le; rd ¼efguksa½ 1 dsoy Lruiku djkuk pkfg;sA
2 dsoy Lruiku vkSj ikuh nsuk pkfg;sA
3 dsoy Lruiku vkSj vU; rjy inkFkZA vius ifjokj esa Lruiku djkus okyh ek¡ dks vki fdl izdkj dh enn dj ldrs gS\
vkids fopkj es cPps dks fdl vk;q ls iwjd vkgkj nsuk ‘kq: djuk pkfg;s\ iwjd vkgkj esa D;k&D;k oLrq,¡ gksuh pkfg;sa\
D;k vki vius ifjokj esa Lruiku djkus okyh ek¡ dks vk/kqfud rjhdksa dh tkudkjh nsuk pkgsaxs\ ;g tkudkjh vkids fopkj ls dkSu ns ldrk gSA
Probe from Mother –in-law D;k Lruiku ds ckjs esa vki vk/kqfud tkudkjh ysuk pkgsaxs ftlls vki ;qok ih<+h dks mfpr e’ojk ns ldsA D;k vki ;g dne mBkuk pkgsaxs ftlls vkids lekt dh ekrk,¡ mfpr :i ls Lruiku djok ldsA
Annexures XII QUALITATIVE SURVEY ON INFANT AND YOUNG CHILD FEEDING
Format for conducting in-depth interviews
(COMMUNITY HEALTH / NUTRITION / OTHER WORKERS)
Village/ urban locality:______Block: ______Distt: ______
Probe and then record Background information • Name • No. of living children Boys ___Girls ____ • Age (in years) • Sex – Boy/ Girl • Education • Age of the infant (months) Knowledge on Breastfeeding vki vius fu;fer M;wVh ds vfrfjDr Lruiku lEcfU/kr dk;ksZ esa yksxks dks izksRlkfgr dj jgsa gSa\ ;fn gk¡ rks dSls\
D;k vki tkurs gS fd Lruiku djkuk t:jh gSA Lruiku djkus ds D;k ykHk gS foLrkj iwoZd crk,¡\
uotkr f’k’kq dks tUe ls fdrus le; ckn Lruiku ‘kq: djkuk pkfg,\ vkSj D;ksa\
D;k vki tkurs gS fd cPps dks fdrus le; rd ¼efguksa½ 1 dsoy Lruiku djkuk pkfg;sA
2 dsoy Lruiku vkSj ikuh nsuk pkfg;sA
3 dsoy Lruiku vkSj vU; rjy inkFkZA
XIII Annexures vkids fopkj esa uotkr f’k’kq dks ek¡ dk nw/k ‘kq: djus ls igys D;k dqN vkSj fiykuk @ nsuk pkfg, ;fn gk¡ rks vkids lekt ds yksx ,slk djus dks D;ksa dgrs gSA D;k vki mudks ,slk u djus dh lykg nsrs gSa\ ;fn gk¡ rks D;k mUgksaus vki dh lykg ls mfpr <+x ls uotkr f’k’kq dks Lruiku djkuk ‘kq: fd;k\
cPpksa dks fdl vk;q esa iwjd vkgkj nsuk ‘kq: djuk pkfg,A iwjd vkgkj esa vkids fopkj esa D;ksa djuk pkfg,\
vki vius lekt esa] Lruiku djkus okyh efgykvksa dks D;k lykg nsuk pkgrh gS\
D;k vki uohure @ vk/kqfud Lruiku djkus ds rjhdks ds ckjs esa tkudkjh ysuk pkgsaxaA rkfd vki lekt ds yksxks dks Lruiku ds lgh rjhdks ds lEcU/k esa izsfjr dj ldsA Lruiku dh uohure tkudkjh dgk¡ ls izkIr gksxhA
D;k vki vius lekt esa mfpr Lruiku ds rjhdks ds ckjs esa izksRlkgu nsuk pkgsxh] ;fn gk¡ rks vkidks mlds fy, fdl rjg dh enn dh t:jr gSA D;k ,slh enn nwljs leqnk; dk;ZdrkZvksa dks Hkh t:jr gSA
Annexures XIV Annexure – 3 Tenth Five Year Plan Goals 2003 - 2007 for Infant Feeding Practices (State wise and for the country)
States Current levels Tenth Plan Current levels Tenth Plan Current level Tenth Plan of % children Goal of % of Goal 80% of of % of Goal breastfed increases to children 0-3 children upto children Introduction of children within 50% months 6 months to complementa semi-solid at 6 one hour of exclusively be exclusively ry feeding of months to 75% birth breastfed breastfed infants aged of children 6-9 months Andhra Pradesh 10.3 32.6 74.6 100.0 59.4 100.0 Arunachal Pradesh 49.0 100.0 33.9 49.1 60.2 100.0 Assam 44.7 100.0 42.5 61.6 58.5 100.0 Bihar 6.2 19.6 55.2 80.0 15.0 33.6 Goa 34.4 100.0 - - 65.4 100.0 Gujarat 10.1 32.0 65.2 94.5 46.5 100.0 Haryana 11.7 37.0 47.2 68.4 41.8 93.6 H.P. 20.7 65.5 17.5 25.4 61.3 100.0 Jammu & Kashmir 20.8 65.8 41.5 60.1 38.9 87.1 Karnataka 18.5 58.5 66.5 96.4 38.4 86.0 Kerala 42.9 100.0 68.5 99.3 72.9 100.0 M.P. 9.9 31.3 64.2 93.0 27.3 61.1 Maharashtra 22.8 72.2 38.5 55.8 30.8 69.0 Manipur 27.0 85.4 69.7 100.0 86.8 100.0 Meghalaya 26.7 84.5 16.1 23.3 77.1 100.0 Mizoram 54.0 100.0 40.7 59.0 74.2 100.0 Nagaland 24.5 77.5 43.9 63.6 81.3 100.0 Orissa 24.9 78.8 58.0 84.1 30.1 67.4 Punjab 6.1 19.3 36.3 52.6 38.7 86.6 Rajasthan 4.8 15.2 53.7 77.8 17.5 39.2 Sikkim 31.4 99.4 16.3 23.6 87.3 100.0 Tamil Nadu 50.3 100.0 48.3 70.0 55.4 100.0 Tripura* NA 100.0 NA 70.0 NA 100.0 Uttar Pradesh 6.5 20.6 56.9 82.5 17.3 38.7 West Bengal 25.0 79.1 48.8 70.7 46.3 100.0 Andaman & Nicobar Is* NA - NA - NA - Chandigarh* NA 28.5 NA 60.0 NA 90.0 Dadar & Nagar Haveli* NA 72.2 NA 55.8 NA 69.0 Daman & Diu* NA 32.0 NA 94.5 NA 100.0 Delhi 23.8 75.3 13.2 19.1 37.0 82.8 Lakshdweep* NA 100.0 NA 99.3 NA 100.0 Pondicherry* NA 100.0 NA 70.0 NA 100.0 INDIA 15.8 50.0 55.2 80.0 33.5 75.0 Source of current level: NFHS 1998-99
Notes: 1. NFHS was not conducted in States with a * mark. In these the values have been estimated 2. Current status for children in 0-3 years age-group is taken as representing status for children in 0-6 years age-group. 3. As NFHS data for Chandigarh, Jharkhand and Uttaranchal are not available, goals laid down are for undivided states. 4. As NFHS data for A&N Islands was not available, no goals have been set.
XV Annexures Annexure – 4
Definitions of Infant Feeding Behaviours
‘Exclusive Breastfeeding, Predominant, Breastfeeding, Bottlefeeding and Complementary Feeding
Category of infant Requires that the infant Allows the infant receive Does not allow the infant feeding receives to receive Exclusive breastfeeding Breastmilk (including milk Drops, syrups (vitamins, Any thing else expressed or from minerals, medicines) wet0nurse) Predominant Breastmilk (including milk Liquids (water, and Anything else (in breastfeeding expressed or from wet- water-based drinks, fruit particular, non-human nurse) as the juice, ORS), ritual fluids milk, food-based fluids) predominant source of and drops or syrups nourishment (vitamins, minerals, medicines) Breastfeeding Breastmilk Any food or liquid including non-human milk Bottlefeeding Any liquid or semi-solid Any food or liquid food from a bottle with including non-human nipple/teat milk. Also allows breastmilk by bottle Complementary feeding Breastmilk and solid or Any food or liquid semi-solid foods including non-human milk
Source: WHO Global Data Bank on Breast-feeding. Breastfeeding: the best start in life. WHO Nutrition Unit, 1996
Annexures XVI