According to the national family health survey-3 data[7
] the percentage of children who are breast fed within 1 h of birth in rural India and in rural West Bengal are 21.5% and 24.5% respectively; whereas in this study this was better at 34.2%. Similarly, a proportion of children aged 0-5 months who were exclusively breastfed was more at 58.7% in this study than rural India (48.3%) or rural West Bengal (57.1%). The value of another indicator, i.e., children aged 6-8 months receiving solid or semi-solid food and breast milk was again a little better at 66.6% than rural India (53.8%) and rural West Bengal (55.3%). The possible reasons for the differences noted are that the national survey had been conducted about 4 years earlier and that this study had the limitation that it was not conducted on a probability sample but on mothers coming for vaccination or for treatment for mild sickness of the children (hence the larger number of younger children in the sample).
WHO recommends that breastfeeding should be initiated immediately after birth, preferably within 30 min of delivery.[8
] The delay in initiation will lead to a delay in the development of Oxytocin reflexes, which are very important for the contraction of the uterus and breast milk reflex.[9
] Though 23.7% mothers perceived that breastfeeding should be initiated within 1st
h of birth in this study, actually a higher 34.2% initiated breastfeeding within 1st
h of birth of the baby, which is still lower than what are found in another study.[10
] In this case, even 76.3% delivery at Government hospital could not achieve a figure higher than 34.2%.
A total of 89.5% mothers agreed that colostrum should be offered to the newborn; but in practice 23.7% discarded it possibly due to decisions taken by other members of the family. A large proportion of mothers at 42.1% had given pre-lacteal feeds to the baby, mainly in the form of plain water, honey, jaggery water and sugar water. These practices were more common in illiterate mothers which are similar to the findings in other studies.[11
] Thus literacy plays a very vital role in understanding the protective value of colostrum and the danger of pre-lacteal feeding. Parmar et al
] reported that 51.8% of home-delivered and 37.2% of institutionally delivered mothers gave pre-lacteal feeds to their children. The lower percentage of pre-lacteals in institutional deliveries also in our study highlights the importance of appropriate health education during perinatal period.
Of 216, children aged 6 months or more, 126 (58.3%) were exclusively breast fed until 6 months. This was almost same as 58.7% mothers of infants aged 0-5 months stated that their babies were exclusively breast fed in the 24 h recall period. The limitation of this study was the possible recall bias of the mothers of older children. However, the observation of this study was lower than that observed by Kulkarni et al
] (70.2%) and Banapurmath et al
A total of 28.1% babies were bottle fed in this study. When the standard of environmental sanitation is poor and education is low, bottle feeding is likely to be as nutritionally poor and bacteriologically dangerous. The feeding bottle is a vital factor in the infamous malnutrition-infection cycle, often reported to be a major cause of infant and child mortality.[15
A total of 28% mothers knew that semi-solid food (complementary feeding) is to be started along with breastfeeding from 6 months of age. This is even lower than what reported by others.[12
] 44.8% mothers believed that complementary feeding should be started at an older age (8-12 months). The commonest reason for delayed complementary feeding was the notion “the child will vomit everything.” Another important reason was ignorance. A study[19
] had shown that improvement of feeding practices was possible through proper utilization of existing health services helping the mothers understand the rationale of the practices so that good feeding practices can be sustained.
There are some controversies raised by this study. All mothers over 30 have had a high practice scores, even though half of them had a low score for perception. Contrary to popular belief the perception and practice of mothers wane with high education. These may be due to the effect of co-variables, which need further research. Lowest practice score was found in richest PCI group at 41.7%. The poor practice of mothers with high educational and economic status may be explained by the fact that they represent most of the working mothers who have a significantly low IYCF practice score. Better perception score in mothers of nuclear family because these mothers are more socially and economically empowered. It may also be hypothesized that with increase of mother's age she becomes more matured; but she does not necessarily become more responsible with better socio-economic status.
Summary of key findings is that 65.8% mothers did not initiate breast feeding within 1 h of birth, 41.7% mothers of children aged 6 months or more did not exclusively breastfeed their babies up to 6 months and 28.1% used bottles for baby-feeding in this study. Thus, the study highlights that inappropriate IYCF practices are still very much prevalent in the rural community. Lack of adequate knowledge of the mothers, culturally prevailing misconceptions and lack of sustained support and motivation of mothers, particularly working mothers are major contributors to the prevailing situation. Thus, emphasis should be given to IYCF education program during all contacts with eligible mothers. The interactions between health-care providers and the nursing mothers should be more frequent to ensure sustained correct infant and child care practices.