Discardation of First Breast Milk, Pre-lacteal Feeding of Neo-nants & Exclusive Breast Feeding of Infants among Recently Delivered Women of Uttar Pradesh, India

Since 2005, the primary aim of ASHAs was to visit homes of newborns as the first program in Uttar Pradesh (UP) operated through the ASHAs was the Comprehensive Child Survival Program in 2008. Since then, tracking of all deliveries and newborn babies has been an integral part of the work of ASHAs in all of the NHM's primary health care programmes in UP [1,2]. Here, the role & work of ASHAs is triangulated with the responses of the mothers of newborns & infants. Evaluation studies on the performance of ASHAs was done since 2011 as by then ASHAs had actually worked in the field for a minimum period of 5 years. The National Rural Health Mission was launched in April 2005, but it took approximately one to two years for states to hire ASHAs and put systems in place from the state to the village level [2]. As part of the newborn and infant care programme, Recently Delivered Women provide comprehensive feedback on their infants' Exclusive Breast Feeding (EBF) practises. Further, a comprehensive feedback is also elicited from the Recently Delivered Women on the pre-lacteal feeding of their newborns as part of newborn care program at the district level.

Currently, there are 1.50,000 ASHAs in UP who have been trained on all the 8 training modules suggested by NHSRC, GOI that includes a total of 23 day training for each ASHA [3].

The current study investigates some of the crucial factors on home-based newborn care activities, such as the ideal practise of EBF of newborns and infants, through the responses of mothers of newborns and infants on newborn care. In child health programmes, the ideal practise of EBF in newborns and infants is a critical facilitator of breastfeeding practises. The current article follows up the role of ASHAs in Home Based Newborn Care & child care program through the response of the mothers on EBF & the type of fluids they gave to their children on the day prior to the survey. The mothers were selected as respondents as they were the selected mothers from the list of mothers available with their ASHAs at the time of survey.

The current study also explores some of the crucial variables on the home-based newborn care activities like the poor practice of pre-lacteal feeding of the newborn through the response of mothers of newborns on newborn care. The poor practice of pre-lacteal feeding of newborn in child health programs is a critical barrier in breastfeeding practices. The current article follows up the role of ASHAs in Home Based Newborn Care program through the response of the mothers on the type of pre-lacteals & discarding of milk before breastfeeding the child. The mothers were selected as respondents as they were the selected mothers from the list of mothers available with their ASHAs at the time of survey.

The relevance of the study assumes significance as data on the details of the type of pre-lacteal feeding of newborn as a barrier component of child health & newborn programs are not included in many surveys. Further, response details from the mothers on these options on pre-lacteals where their types are discussed are usually not collected in many studies/surveys. Such responses that collect actual actions on the pre-lacteal feeding & milk discarding before breastfeeding are not collected in many surveys. Such information collection there by indirectly assess the work & approach of ASHAs including the awareness of ASHAs & mothers on the programs related to Early Initiation of Breastfeeding (EIBF) are not the focus in very large-scale health surveys. Similarly, such response on these two barriers on EIBF related activities of newborn care through the work of ASHAs in the current implemented programs do not come under the ambit of many social studies or surveys. The surveys gain more valency when the response is solicited from the horse’s mouth like the current article.

The relevance of the study further assumes significance as data on the details of EBF in actual months & the type of fluid other than breast milk given to newborns & infants in the first 6 months of age that act as a barrier component of child health & newborn programs are not included in many surveys. Furthermore, response details from mothers on the types/contents of fluids discussed in this article are typically not collected in many studies/surveys. Such information collection indirectly assesses the work and approach of ASHAs, including ASHA and mother awareness of programmes related to Exclusive Breastfeeding (EBF), which are not the focus of very large-scale health surveys.

Similarly, such responses to barriers to EBF-related newborn and infant care through the work of ASHAs in currently implemented programmes do not fall under the purview of many socioeconomic studies. The surveys gain more valencys when the response is solicited from the horse’s mouth like the current article where the mothers have responded.

A total of four districts in Uttar Pradesh were purposefully chosen for the study, and data was collected from mothers in those districts. With close-ended questions, a pre-tested structured and in-depth interview schedule was used. These in-depth interview schedule collected descriptive details as responded by mothers. The quantitative data were collected from the mothers, and a total of 500 people took part in the study.

The results reflected that majority of the RDWs in Banda, Barabanki and Saharanpur district and about 94% in Gonda had given milk other than breast milk to their newborn as pre-lacteal feed. Next barrier as an activity was discarding of milk before breastfeeding the child. About 10% in Banda, more than 5% in Barabanki 7 less than 5% of RDWs in the rest two districts replied that they discarded the first milk from their breast before the newborn is put to the breast for the first time.

The results also reflected that majority of the RDWs across the four districts exclusively breastfed their child up to 6 months which was the right thing to do. The descriptive statistics table related to this response clearly shows the mean to be 6 months. Furthermore, nearly half of all RDWs in Banda, one-third of all RDWs in Barabanki, nearly half of all RDWs in Gonda, and more than one-fourth of RDWs in Saharanpur responded that they had given some fluid other than breast milk to their child yesterday or last night prior to the survey thus contradicting their first response on EBF in months & thereby defeating the purpose of EBF.

The final section of RDW responses focused on the type of fluid other than breastmilk given to the child the day before or the night before the survey. Any animal milk was the most popular choice among RDWs in the four districts studied.