ARE WE MISSING THE BASIC LINK IN BREAST FEEDING INTERVENTIONS?

lactation blues

The great decision

The breast-feeding practices in Pakistan, over the years have either been stagnant or showing a decline. Various, social, cultural, health services and nutritional interventions have been suggested and implemented. However, there seems to be not a significant change; the blame is always put on the media and its abuse by artificial milk producing companies. This in a way may be justified.  But, perhaps we need to step back and reflect on the basic physiology, the ‘lactation reflex’ and factors influencing interruption of this process.  This blog is an attempt to draw some attention, on how the mothers’ mental health problems may be an important factor in decline of breast feeding trends varying from its early initiation, exclusive breast milk and then continuing it for at least 6 months.

The dilemma of breast feeding management commences initially due to the artificial divide between the ‘birth attendants’ (of any level of expertise) and the care-giver of newborn/infant (varying from LHW, doctor) later.  Both disciplines have their varying compartmentalized approaches as well as messages; above all both focus separately & exclusively on mothers and newborn/infant respectively. The dilemma gets further compounded when we tend to underestimate the basic lactation reflex and look for quick fixes based on various pre-determined but mainly medicalized and sometime socio-cultural factors.

Pakistan ranks highest among the prevalence of Post-Partum Depression (PPD); figures vary from 28% to 63% have been quoted among various studies.  Interestingly studies demonstrate that breastfeeding can protect depression, however, this association may be in the other direction, i.e PPD may lead or be associated with poor lactation and breast-feeding decline. The causality in either direction is still not clear but in terms of logical thinking the PPD has pre-disposing factors and keeping in mind the lactation reflex and arc, one can imagine that a mentally disturbed mother would experience interferences in the stimulus for lactation. This get furthers complicated when various ‘advisors’ at home and care providers load her with different messages and remedies. The baby gets more irritated and hungry all leading to the declaration that “mother is just simply not producing milk” and an easier decision by all to move on to bottle feeding and related alternatives.

We always cherish in conducting research and big seminars on breast feeding issues and its remedies, but have we ever thought of addressing the issue of PPD, which I believe is easy to screen and detect, and hopefully mange, also. Unfortunately, in our society, seeking an advice for mental health and its related experts is akin to declaring oneself as “mad” or mentally sick. Alternatively, the elders and husband label this situation (PPD) as being normal.  Its high time that we think out of the box and also look into this important dimension, rather than prescribing and promoting recopies for breast feeding, with apparently no significant changes.

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