Bangla campaign to promote breast-feeding

To its credit, Bangladesh has one of the best records among developing countries of meeting targets for child health and maternal care.

Nearly 80 percent of its children have been immunised against the six killer diseases, compared to below 50 per cent in Turkey, and 85 per cent in Indonesia. And most illiterate rural women are using the simple treatment of ORT for diarrhoea, bringing down the number of infant deaths from dehydration in Bangladesh.

Yet, poverty continues to take a toll. A majority of people are malnourished, 30,000 women die of pregnancy and child-birth complications, and 35 per cent of all new-borns are under weight, according to Unicef, the world children's agency.

Dhaka was among the first to ratify the 1990 Convention on the Rights of the Child, and has over the years taken specific actions for child survival, protection and development. The government has also been very supportive of efforts to inform and advise mothers on the importance of breast-feeding, which is the best possible nourishment for a newborn for the first six months.

In most government-run hospitals in Dhaka, the staff have been trained to help mothers begin breast-feeding within an hour of giving birth. Newborns are given no food or drink other than breast milk unless recommended by doctors.

The campaign, initiated by Unicef and the World Health Organisation, has so far managed to convert 15 hospitals and clinics in Dhaka into "baby-friendly" institutions, though the credit for being the very first in Bangladesh goes to the Khulna Medical College, in the country's southeast.

To qualify as 'baby-friendly', a hospital has to fulfill 10 requirements, among which the most important are to inform all pregnant mothers of the benefits of breast-feeding, show mothers how to breast-feed successfully, and allow the mother and baby to be together for 24 hours of the day.

What the campaign is trying to get across is the message that breast-feeding is safe, hygienic and inexpensive. It will also significantly alter the picture of malnutrition among children in the country, said Dr M Q K Talukder, prominent pediatrician and chairman of the Bangladesh Breast-Feeding Foundation.

A survey conducted by the Bangladesh Bureau of Statistics showed that there was malnutrition even among children of "not so poor" families in the country.

Unicef has been providing financial and other assistance to the campaign in Bangladesh, which was launched five years ago. The World Bank is also assisting the BBFF, through its 2.5 million dollar 'integrated nutrition programme' in Bangladesh.

Explaining that the programme was intended to combat malnutrition among mothers and children, Mansura Hossain, deputy chief-coordinator of BBFF, said it would be implemented by a bottom-up structure of committees set up in each of the country's 460 rural thanas or subdistricts.

"The members of the committees, each comprising a medical assistant, nurse, health inspector and two medical officers from a thana, will be trained on breast-feeding practices, child diseases and malnutrition to ensure that health complexes across the country will be baby-friendly by 2000," Dr Hossain said.

Training them will be district level officers, who will themselves have been trained by medical professionals at their closest medical college, the doctor added.

The role of the committees is crucial to the success of campaigns because 90 per cent of Bangladeshi women have their babies at home, so that is the best place where mothers can be taught the benefits of breast-feeding. Traditionally, women delay breast-feeding thinking that the 'colostrum' that flows immediately after child birth is not good for the baby.

Dr A K M Sahabuddin, a professor at the Institute of Child and Mother Health in Dhaka, believes child health should be a key goal of overall national development. "No nation can expect to make progress ignoring the health aspects of children and mothers," he said.

What Dr Sahabuddin would like to see happen eventually is the creation of a baby-friendly community in Bangladesh. Though the majority of rural women breast-feed, as families move into the cities ad mothers join the work force, breast-feeding is being seen as inconvenient and old-fashioned, specially by the middle class.

A nurse at the post-graduate hospital in Dhaka says: "We try our level best to motivate the pregnant and lactating mothers to take to breast-feeding. But most of them seem to be more concerned with their pre-natal and post-natal condition."

"Moreover, a pregnant woman leaves hospital within two to four days of child birth. We have no feedback on breast-feeding practices at home," she added, talking only on the assurance that she would not be identified.

A recent study by the London-based interagency group on breast-feeding monitoring shows that infant formula manufacturers and distributors continue to violate a WHO code for marketing breast milk substitutes. The study was conducted in four countries including Bangladesh, where it was found that company-sponsored information promoting artificial feeding, was being distributed free.

The report, however, also recognised that the health care system in all four countries is poor -- lacking basic supplies and staffed by poorly paid workers with varying levels of training.

UNI