Matter of choice

The nine months of pregnancy is the right time to start thinking about how to feed a baby

While breastfeeding is considered to provide more nutrition and protection, women must be given information about the choices and support for their decisions.

About 26 million babies are born in India every year and yet too few women make informed decisions on feeding their babies. The Government of India’s new programmes to reduce maternal and infant mortality, which includes antenatal counseling, can make a big difference saving the lives of thousands of children and their mothers.

A recent survey conducted by the Facebook group Breastfeeding Support for Indian Mothers showed that more than 50% of women who delivered in private hospitals were introduced to infant formula at birth and out of these in two thirds cases, it was given without their consent. Women are often told to feed their babies formula thinking that they do not produce enough milk. This perception is largely due to either because of lack of skills of health workers working with these women or myths propagated by baby food industry.

Use of any kind of infant formula during infancy is related to increased risk of infections like diarrhea and respiratory disorders in newborn babies. To reduce such risks World Health Organisation advises that: “In situations where infants are not breastfed, caregivers, particularly of infants at high risk, should be regularly alerted that [powdered infant formula] is not a sterile product and can be contaminated with pathogens that can cause serious illness; they should be provided with information that can reduce the risk”.

The government’s routine health package of an antenatal check includes counseling on breastfeeding with the aim of having all women breastfeed. But the recent NFHS 4 data shows that only 41.6% are breastfed within the first hour of birth and only 54.9% infants are exclusively breastfed. That means half the country’s infants are given artificial feeding, of which formula is quite common. According to a Euromonitor Report, 10,847 tonnes of standard infant formula or milk powder for the age group of zero to six months was sold in India in 2012. This means that India sells about 27 million containers of 400 gms every year. Going by the estimated growth of formula industry in 2022, this figure will be 32.7 million.

The latest National Family Health Survey shows that about 80% of all the births in the country take place in medical institutions and a little more than 50% in public institutions. This implies that about 30% occur in private institutions. It is at these private institutions that many infants are given powdered infant formula without heed to the WHO’s guidelines on acceptable medical reasons for giving substitutes. The WHO recommends that once constituted infant formula should be consumed immediately and not after a couple of hours. Prepared feeds provide ideal conditions for bacteria to grow, especially when kept at room temperature. Feeds that are prepared for use later must be refrigerated and discarded if not used within 24 hours.

Disseminating information

Pregnancy, especially the second and third trimester, is the opportune time when women can be given information between the choices of breastfeeding and formula feeding.

The recent Pradhan Mantri Surakshit Matritva Abhiyan announced by Prime Minister Narendra Modi aims at reducing maternal and infant mortality rates through safe pregnancies and safe deliveries. This initiative is the perfectly channel through which to introduce a “baby or infant feeding decision during pregnancy” programme. This would include skilled counseling support that continues into birthing and later.

Most women who give up breastfeeding usually do so due to psychological factors that interfere with success of breastfeeding not because of biological or physiological factors.

A mother who decides to breastfeed needs to be supported both mentally and physically. The efforts should start from the antenatal period by counseling her on the breastfeeding benefits to her and her baby. There needs to be counseling to build a woman’s confidence so that she can breastfeeding without any hindrance and support for the woman if a problem should arise. Reassurance during pregnancy is essential because a woman has a lot on her mind at this time.

Some women face difficulties in allowing infants to attach to to the nipple as well as breast conditions like breast engorgement, inverted nipples and mastitis. While there problems are entirely preventable and require only some practical help, they often become reasons for introducing formula feeding after birth. Counseling families and creating a positive family environment is also crucial to this process.

Support for formula-feeding mothers

A mother who decides to formula feed needs more support so that she is aware and prepared for the risks it entails. She must be provided information on how sterile or not infant formula is, the time it takes for contamination of formula, nutritional quality and content, and short- and long-term health implications. She should also be told to follow the WHO guidelines on how to prepare formula for bottle-feeding at home such that it is safe for the newborn.

Women should have the option of feeding their babies as they choose but before they make that choice they should be fully aware of the options. It is also essential that everyone respect this choice and women be supported to implement that their decisions.

The Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and its amendment in 2003 recommends providing unbiased information on both breastfeeding and formula feeding. The Act also suggests that all the educational material, whether audio or visual, dealing with prenatal or postnatal care include clear information on benefits and superiority of breastfeeding, preparation for and the continuance of breastfeeding for at least six months, the harmful effects on breastfeeding due to the partial adoption of bottle feeding, the difficulties in reverting to breastfeeding of infants after a period of feeding by infant substitutes, the financial and social implications in making use of infant milk substitute and feeding bottles and the health hazards of improper use of infant milk substitutes and feeding bottles.

Women can be given all this information in just one counseling session under the Pradhan Mantri Surakshit Matritva Abhiyan. This may be done through face-to-face counseling and through reading materials. Keeping safety of infant health as the primary outcome, this sessions should be followed by a decision-making session to help a woman choose between breastfeeding and formula feeding. The decision can be recorded and passed on the health facility where she is going to give birth to her baby.

The writer is a paediatrician and founder of the Breastfeeding Promotion Network of India.

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Swara Bhasker: Sharp objects has to be on the radar of every woman who is tired of being “nice”

The actress weighs in on what she loves about the show.

This article has been written by award-winning actor Swara Bhasker.

All women growing up in India, South Asia, or anywhere in the world frankly; will remember in some form or the other that gentle girlhood admonishing, “Nice girls don’t do that.” I kept recalling that gently reasoned reproach as I watched Sharp Objects (you can catch it on Hotstar Premium). Adapted from the author of Gone Girl, Gillian Flynn’s debut novel Sharp Objects has been directed by Jean-Marc Vallée, who has my heart since he gave us Big Little Lies. It stars the multiple-Oscar nominee Amy Adams, who delivers a searing performance as Camille Preaker; and Patricia Clarkson, who is magnetic as the dominating and dark Adora Crellin. As an actress myself, it felt great to watch a show driven by its female performers.

The series is woven around a troubled, alcohol-dependent, self-harming, female journalist Camille (single and in her thirties incidentally) who returns to the small town of her birth and childhood, Wind Gap, Missouri, to report on two similarly gruesome murders of teenage girls. While the series is a murder mystery, it equally delves into the psychology, not just of the principal characters, but also of the town, and thus a culture as a whole.

There is a lot that impresses in Sharp Objects — the manner in which the storytelling gently unwraps a plot that is dark, disturbing and shocking, the stellar and crafty control that Jean-Marc Vallée exercises on his narrative, the cinematography that is fluid and still manages to suggest that something sinister lurks within Wind Gap, the editing which keeps this narrative languid yet sharp and consistently evokes a haunting sensation.

Sharp Objects is also liberating (apart from its positive performance on Bechdel parameters) as content — for female actors and for audiences in giving us female centric and female driven shows that do not bear the burden of providing either role-models or even uplifting messages. 

Instead, it presents a world where women are dangerous and dysfunctional but very real — a world where women are neither pure victims, nor pure aggressors. A world where they occupy the grey areas, complex and contradictory as agents in a power play, in which they control some reigns too.

But to me personally, and perhaps to many young women viewers across the world, what makes Sharp Objects particularly impactful, perhaps almost poignant, is the manner in which it unravels the whole idea, the culture, the entire psychology of that childhood admonishment “Nice girls don’t do that.” Sharp Objects explores the sinister and dark possibilities of what the corollary of that thinking could be.

“Nice girls don’t do that.”

“Who does?”

“Bad girls.”

“So I’m a bad girl.”

“You shouldn’t be a bad girl.”

“Why not?”

“Bad girls get in trouble.”

“What trouble? What happens to bad girls?”

“Bad things.”

“What bad things?”

“Very bad things.”

“How bad?”

“Terrible!!!”

“Like what?”

“Like….”

A point the show makes early on is that both the victims of the introductory brutal murders were not your typically nice girly-girls. Camille, the traumatised protagonist carrying a burden from her past was herself not a nice girl. Amma, her deceptive half-sister manipulates the nice girl act to defy her controlling mother. But perhaps the most incisive critique on the whole ‘Be a nice girl’ culture, in fact the whole ‘nice’ culture — nice folks, nice manners, nice homes, nice towns — comes in the form of Adora’s character and the manner in which beneath the whole veneer of nice, a whole town is complicit in damning secrets and not-so-nice acts. At one point early on in the show, Adora tells her firstborn Camille, with whom she has a strained relationship (to put it mildly), “I just want things to be nice with us but maybe I don’t know how..” Interestingly it is this very notion of ‘nice’ that becomes the most oppressive and deceptive experience of young Camille, and later Amma’s growing years.

This ‘Culture of Nice’ is in fact the pervasive ‘Culture of Silence’ that women all over the world, particularly in India, are all too familiar with. 

It takes different forms, but always towards the same goal — to silence the not-so-nice details of what the experiences; sometimes intimate experiences of women might be. This Culture of Silence is propagated from the child’s earliest experience of being parented by society in general. Amongst the values that girls receive in our early years — apart from those of being obedient, dutiful, respectful, homely — we also receive the twin headed Chimera in the form of shame and guilt.

“Have some shame!”

“Oh for shame!”

“Shameless!”

“Shameful!”

“Ashamed.”

“Do not bring shame upon…”

Different phrases in different languages, but always with the same implication. Shameful things happen to girls who are not nice and that brings ‘shame’ on the family or everyone associated with the girl. And nice folks do not talk about these things. Nice folks go on as if nothing has happened.

It is this culture of silence that women across the world today, are calling out in many different ways. Whether it is the #MeToo movement or a show like Sharp Objects; or on a lighter and happier note, even a film like Veere Di Wedding punctures this culture of silence, quite simply by refusing to be silenced and saying the not-nice things, or depicting the so called ‘unspeakable’ things that could happen to girls. By talking about the unspeakable, you rob it of the power to shame you; you disallow the ‘Culture of Nice’ to erase your experience. You stand up for yourself and you build your own identity.

And this to me is the most liberating aspect of being an actor, and even just a girl at a time when shows like Sharp Objects and Big Little Lies (another great show on Hotstar Premium), and films like Veere Di Wedding and Anaarkali Of Aarah are being made.

The next time I hear someone say, “Nice girls don’t do that!”, I know what I’m going to say — I don’t give a shit about nice. I’m just a girl! And that’s okay!

Swara is a an award winning actor of the Hindi film industry. Her last few films, including Veere Di Wedding, Anaarkali of Aaraah and Nil Battey Sannata have earned her both critical and commercial success. Swara is an occasional writer of articles and opinion pieces. The occasions are frequent :).

Watch the trailer of Sharp Objects here:

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This article was published by the Scroll marketing team with Swara Bhasker on behalf of Hotstar Premium and not by the Scroll editorial team.