Why Bangladesh sees decline in breastfeeding

Everyone knows that breastfeeding supports children's growth and helps mothers keep healthy, yet the rate of breastfeeding in Bangladesh has been on the decline.

The exclusive breastfeeding rate in Bangladesh went down to 55% in 2022 from 65% in 2018, according to the Bangladesh Demographic and Health Survey (BDHS) 2022. 

The latest study also reveals that only 40% of newborns are currently breastfed within the first hour of birth, which was found at 69% in the 2017-2018 edition of the survey.

A group of experts believe the decline is a result of unnecessary caesarean deliveries and aggressive marketing of powdered milk companies, while another group blamed the lack of outdoor facilities for lactation amid growing numbers of working women.

All of them, however, called for increased mass awareness programmes on benefits of breastfeeding.

"Health workers were busy with Covid patients during the peak hours of the pandemic. At that time, powdered milk companies triggered their promotional activities to increase sales. Increased caesarean deliveries also fueled the powdered milk use," Dr SK Roy, chairperson of the Bangladesh Breastfeeding Foundation, told The Business Standard.

The Caesarean-section or C-section rate jumped to 45% in 2022, which was 34% in 2018, 24% in 2014 and 18% in 2011, according to the Bangladesh Demographic and Health Survey. Among all C-sections, 84% happen in private hospitals and 14% in public facilities.

The World Health Organization always recommends that a country should accept a maximum of 10%-15% of C-section births, but anything higher is alarming. In Bangladesh, the unnecessary higher Caesarean deliveries are causing physical harm to mothers and financial losses to families, it warns.

"Many caesarean mothers are unable to breastfeed for the first few days due to illness, so nurse-midwives or hospital staff feed the baby with powdered milk. Once a baby eats formula, it shows reluctance to take breast milk later on," explained Dr SK Roy.

The health expert called for cooperation from all public and private organisations concerned to increase breastfeeding for building a healthy nation.

Dr Khalequzzaman, associate professor of public health and informatics at the Bangabandhu Sheikh Mujib Medical University, said women's participation in jobs has been on the rise. 

"Although the government offers a six-month maternity leave to its women employees, most private organisations do not do so. Some offer as long as four months. So, mothers are forced to feed formula to their babies."

Apart from this, mothers cannot ensure breastfeeding due to a lack of breastfeeding corners, day care facilities at workplaces, he told TBS and said these problems must be solved to increase breastfeeding.

The professor also urged employers to ensure maternity leave for six months and increase daycare centres at institutions to help increase breastfeeding rates. Besides, there should be more discussion about exclusive breastfeeding and antenatal care providers should encourage breastfeeding, he added.

Physicians say if a child is not breastfed for the first 6 months, its immunity decreases. Breast milk provides all nutrients – fat, protein, carbohydrates, minerals, vitamins – to children. 

There is no alternative to breast milk for babies, complementary food can be given after six months, Dr Abu Shimul Sayeed, child specialist at the Mugda Medical College and Hospital, told The Business Standard.

"Breastfeeding up to 2 years of age boosts immunity. The mother should be motivated to breastfeed the baby. Families should also support mothers with nutritious food," he added.

Breastfeeding has an important role in the prevention of different forms of childhood malnutrition, including wasting, stunting, over- and underweight and micronutrient deficiencies.

According to the World Health Organization, optimal breastfeeding practices are key to reducing stunting in children less than five years of age. Early initiation and continuation of exclusive breastfeeding for six months provide protection against gastrointestinal infections and necessary nutrients to prevent stunting. 

Breastfeeding even improves IQ and school attendance, and is associated with higher income in adult life, it says.

Dr Khalequzzam said children under 6 months of age are also prone to ailments. Exclusive breastfeeding is crucial to child survival and protects children against childhood malnutrition as well as many common and life-threatening illnesses such as diarrhoea and pneumonia, he added.

Talking to The Business Standard, Prof Dr Shah Golam Nabi, director at the Institute of Public Health Nutrition, said it has been proposed to keep a separate allocation in the 5th Health, Population and Nutrition Sector Programme to increase mass awareness about breastfeeding.

"Most of our workplaces do not have daycare facilities. Working mothers leave their children at home while they go to work. Considering the reality, we are planning to ensure breastfeeding corners at every office following the Unicef standard in a bid to increase breastfeeding rates," he said and added that they will also work for that at apparel factories.