Infant Feeding Practices among Urban Slum Dwellers

Infancy is a period of critical growth and development. At such a juncture in life nutrition plays a very important role. Any nutritional deficiency at this stage in development may lead to a lifelong handicap in terms of physical as well as mental growth. Optimal breastfeeding and complimentary feeding practices ensure that the child remains in the normal trajectory of growth and is not inflicted with nutritional deficiencies.

In a developing country such as India , with a Crude Birth Rate of 24 and an Infant Mortality Rate of 62, the issue of infant feeding practices has greater significance. Millions of babies are born annually and a large number die even before they reach the first year of life. Since malnutrition has been attributed as the single most important cause of childhood mortality and morbidity, this is a clear indicator of the poor infant feeding practices in the country.

About one fourth (24%) of the urban population of India is poor i.e. their consumption expenditure is less than the poverty line of Rs.454 per month. The urban poor constitute the fastest growing section of the population with a staggering 2.7 million babies being born annually in urban poor households. Lack of sanitation and access to health facilities exposes them to various stressful conditions of ill health and malnutrition.  When infrastructure and services are lacking, slums and other vulnerable settlements are amongst the world’s most life threatening environments.

This paper explores infant feeding practices and their effect on the nutritional status of the infants born to urban poor based on data from National Family Health Survey 2. The Standard of Living Index (SLI), an asset based indicator provided in NFHS-2 is used to analyze health information by low, medium and high economic segments within urban areas. The figures for low SLI segment of urban population have been taken as representing the ‘urban poor’. This data shows that neonatal and infant mortality rates among the urban poor, as drawn from NFHS 2, are 39% and 66% respectively which are well above the national averages of 31.7% and 47%. This clearly shows that the state of health is worse in case of infants born to urban poor. 

Breastfeeding is considered best for infants. The World Health Organization recommends that infants should be exclusively breastfed during the first six months of life. Breastfeeding should ideally be started within 1 hour of the birth of the child and colostrum or “first milk” should be given to the child. Colostrum has a protective role as it contains antibodies, immunoglobulins and other anti-infective agents. Findings from our reanalysis suggest that only 17.9% infants in the lower urban SLI receive breast milk within the first 1 hour of delivery and 63.4% mothers squeezed out the first milk considering it to be “unfit” or “dirty”. This increases the chances of the infant contacting common infections such as diarrhea, ARI etc., especially under the unhygienic conditions of the slums. This further worsens the nutritional status of the infant pushing the child into the vicious cycle of malnutrition and infection.

In urban slums most of the women work outside their homes. The urgency to return to income generation and lack of provision to take care of young children at work leaves the infant to be taken care of by the older siblings, thereby reducing the duration of breastfeeding

Giving pre-lacteals such as jaggery water, honey etc. to infants is a common practice among the urban poor.  Faulty feeding practices begin with giving any other nourishment but breast milk before complimentary feeding is nutritionally required- or with substituting it entirely for breast milk which place babies at risk of illness, even death. In the urban slum situation where the mother has to return to work, abrupt and incorrect introduction of complimentary foods is common. Premature introduction of these foods is often accompanied by increased morbidity and mortality from infections. One of the major concerns in the introduction of complimentary feeds is poor hygiene and sanitation. In the adverse environmental conditions of the urban slums hygiene and sanitation are questionable. Inadequacy of sanitation facilities and ignorance of the mothers and caretakers leaves a child more susceptible to contacting infections when complimentary foods are first introduced in the diets of the infants.

The limited presence of well trained slum level health workers, a poorly defined health care delivery system and poor coverage by even the most far reaching program such as Integrated Child Development Services (ICDS) are the major causes of the worsening infant health and nutritional status in the urban slums. These factors compound the effect of common problems such as poverty, ignorance, illiteracy and cultural beliefs and practices.

Incomplete immunization is also a major problem affecting the health status of the infants in the urban slums. Only 42.9% children in the urban low SLI are completely immunized. This accompanied by sub-optimal infant feeding practices make it almost impossible to ensure adequate nutritional status for the infants.

Various policies aiming at the improvement and wellbeing of infants and young children have been instituted by the Government of India. This shows that the government is well aware of the problem and is ready to make policy level efforts to improve the situation. But it is at the implementation level that the problem actually surfaces.

The following measures may help improve the situation:

·        Ensuring presence of community based workers such as trained volunteers, members of community based organizations, anganwadi workers or traditional birth attendants who would counsel slum dwellers on appropriate practices of infant feeding. They would also be able to help address problems faced by slum women regarding breast feeding or complimentary feeding as well as provide them necessary information to help them identify appropriate food items for the child from their usual diet.

·        Encouraging the family members to make the family environment conducive to better care of the mother as well as the infant. Other family members such as the mother-in-law, sister-in-law or older siblings may be educated about feeding and care practices. This would help ensure proper care of the child by other family members even when the mother is away.

·        Facilities should be made available at places of employment of these slum women such as construction sites, brick kilns, lime kilns etc. so that they can look after their children while at work. Arrangement of mobile crèche facilities and sensitization of the employers to the health needs of these children and mothers is an important strategy to improve infant feeding practices in such situations.

·        Regular outreach facilities should be arranged for the slum dwellers. At such occasions besides immunization of children, timely and appropriate treatment of and counseling on common infections such as diarrhea can be undertaken. Women and other family members can be provided with necessary knowledge to manage these common illnesses at home as well as identify danger signs.