India: missing the first feed
Written by Claire Parker, a hospital midwife in the UK. She recently visited India in her role as a health campaigner for Save the Children.
So far a lot of thought has gone into this blog, and not a lot of typing. So here goes: a day-by-day account of our trip to India with Save the Children.
Day one, morning, Rajasthan
Our group departed Jaipur for Kaliptan in Tonk district of Rajasthan. The first visit planned for today was to meet Save the Children’s partner NGO and visit a primary healthcare centre.
Later we were to visit the district-level hospital, meet Anganwadi [community health] workers carrying out their daily duties, then liaise with religious leaders making a difference in their areas.
As we weaved our way between the most elaborately decorated trucks, errant cows on the road and rickshaws, Hemant, the Save the Children staff member who was leading our visits, gave us an overview of the situation for the children of Tonk and Rajasthan.
In the whole state 48% of children are malnourished, and in Tonk district this rises to a staggering 70%. As such, a large proportion of their work is focused on nutrition, hygiene and breastfeeding.
For India’s infants, already facing a 1 in 20 chance of dying before they reach their first birthday, exclusive breastfeeding can be a real lifesaver, yet only 46% of India’s babies are exclusively breastfed.
Hemant explained that this is due in part to the cultural practice of giving pre-lacteal feeds. These are feeds, known locally as ghutti, are traditionally given to the baby instead of breastmilk, which they believe cannot be given until the first prayer, the Azan, is announced from the Masjids in the mosque.
Ghutti can be honey, water, cow’s milk, or water with herbs added. For the newborn, this means they’re deprived of the many benefits of their mother’s colostrum [the first milk produced by a new mother] – sterile, nutritious and protective.
For the mother this means she often doesn’t go on to produce enough milk as the crucial early feeds fail to stimulate her to provide the baby sufficient milk.
The UNICEF Baby Friendly Initiative recommends babies feed from their mother within one hour of birth. For most babies in Rajasthan this may not happen for days, with dire consequences for mother and baby.
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As we passed (precariously overtook) many of the lavishly decorated trucks en route, Hemant went on to explain how HIV and STIs are a major problem there as the truckers use sex workers and ‘bar girls’, something I had also witnessed in Cambodia.
In some families a child is even kept for this ‘profession’ as the financial remunerations can be great.
The health consequences however are devastating. Men pay more when a condom is not used and hence HIV and other sexually transmitted diseases are rife in these groups.
Alcohol abuse can result as the men use liquor to gain ‘strength’ and the girls use it in order to cope and give them ‘energy for their work’.
With so many clients they rely on alcohol to see them through their duties, and nutritious food, condom use and healthcare become less of a priority, with obvious consequences.