An IAS officer writes about a project that improves weight gain in babies in Nandurbar district of Maharashtra
Our hearts almost skipped a beat when we heard the success story of Community Health Worker (CHO) Dr. Sandeep Kakuste with baby Pinki Lakhan Patil, who was born underweight in a brick oven. Pinki weighed 1.7 kg at birth. Since she was exclusively breastfed, she could not have gained weight by any other method. However, following the techniques of IIT Bombay’s ‘Health Spoken Tutorials’, Pinki gradually gained weight and weighed 2.5 kg in 14 days – a weight gain of 800 grams in a fortnight. CHO Dr Rakesh Patil says that never in his seven-year career has he seen weight gain from breastfeeding at this rate.
Nandurbar has an exclusive breastfeeding rate of 86.6%. (The breastfeeding rate is an indicator that measures whether the child has had breast milk exclusively during the first six months of life). According to this mathematical figure, this would mean that in babies from 0 to 6 months, the incidence of underweight/wasting/stunting would be proportionally less in the district, because children only drink their mother’s milk and nothing else.
Yet, according to NFHS-5 data, Nandurbar’s indicators of stunting, wasting, and underweight remain very high. No less than 57.2% of children are underweight, 45.8% are stunted and 30.7% are wasted. This means that the high rate of exclusive breastfeeding does not translate into a reduction in child malnutrition.
Speaking of breastfeeding, for a layman like me, the only image and explanation that emanates is that of a mother holding her child to her breast, until I came across Health Spoken Tutorials which can easily be called of “mechanical engineering” on the phenomenon of breastfeeding. . These tutorials have helped us simplify ‘hold and lock’ so effectively that we have started to see positive and good results with corresponding proportional weight gain in children.
In the field, when I saw ‘cradle hold’ practices with a child’s head often tilted towards the mother, I wondered if we as adults could ever drink water from the same way in a glass or bottle with the head tilted to the side. In nipple-feeding, I have often seen the mother hold her child to her breast as she continued to do agricultural work.
It makes perfect sense for the child to be held at the breast in a way that makes it easier for him to drink milk. Central to breastfeeding is the idea of “milk transfer” from mother’s breast to child. The idea of a “proper latch” of the child on the mother’s breast is also at the heart of breastfeeding.
During my visits to the district hospital, I saw many babies running out of energy and crying and many worried mothers complaining, “Ye doodh nahi pi raha hai”. This made me curious as to why the starving child resisted drinking his mother’s milk.
The tendency is more often to blame the recipient for their handicaps – illiteracy, ignorance and poverty. I often heard comments like “Mata khud hi bachche ka bhala nahi chahti” or “Yeh log itne bachche kar lete hai ki sab pe dhyan nahi dete”.
The question that comes to mind is: are we really helping these mothers with an easier and more effective technique or are we just justifying our own incompetence?
The mothers Dr. Kakuste and Dr. Patil helped were so thrilled to see the weight gain in their children that they stuck to the new Breastfeeding Skill from the Tutorials and followed it through.
These spoken health tutorials not only introduced us to a different grip or new technique, but also gave us clear analogies as to why we need to be convinced by these instructions. For example, we have learned that simply extending the child’s neck while breastfeeding helps the swallowing process, just as we extend our neck when drinking water. We have also learned that a complete alignment of the child to the mother’s breast increases his comfort when drinking his mother’s milk.
The logic behind each idea and the micro-managed distribution of the “take” has only helped us push these techniques wide and deep into health systems and as well as into ICDS, which is what we thought so far that only doctors could understand. Our ASHA tais and Anganwadi sevikas have absorbed these tutorials.
Speaking of weight gain in a child between 0 and 6 months, the only intake we have is that of breast milk. We don’t quantify it because we couldn’t store that on a larger scale. For example, when we look at growth rates in Nandurbar, we find that it is quite normal for a child 0-6 months to gain 300-350 grams monthly. This basically translates to almost 10-12 grams per day.
While the National Nutrition Mission guidelines recommend weight gain of 28 grams per day, the health tutorials have helped us achieve weight gain of 35-40 grams and even 50 grams per day.
What have we learned here? Although the mothers of these starving babies have been told about exclusive breastfeeding for the first six months, they do not know about effective breastfeeding. The hungry bellies of those little babies all around us, who cannot speak, are overshadowed by the inability of mothers to transfer their milk into their stomachs.
We thank Dr. Rupal Dalal of Health Spoken Tutorials, IIT Bombay, and Dr. Devaji Patil for helping us establish the implementation framework. We offer our appreciation and gratitude to Nandurbar collector Manisha Khatri for being a strong anchor in supporting this project.
Minal Karanwal, Sub-Division Officer, Project Officer, Nandurbar District (Maharashtra), is the IAS Officer for Batch 2019.