Breastfeeding Week: Dated wisdom, lactation stigma still assail mothers

Breastfeeding is a Sustainable Development Goal for health, but in India, there is an epidemic of shaming and misinformation directed at women.

“Being a doctor, I thought I had good knowledge of lactation and breastfeeding already,” Elsa John, an anaesthetist and a first-time mother in Vellore, told this author. “But nothing prepared me for the doubts that came in the initial days when I had to do it.”

She recalled that a nurse pinched her nipples hard to produce milk. “They repeated this every time there was a shift change, over eight to 10 times,” she recalled. “They also demonstrated, vaguely, a few ways I should hold my baby. None of the information was helpful.”

Exclusively breastfeeding a child for six months is the best way to ensure infants are nourished, according to the World Health Organisation. It is one of the U.N. Sustainable Development Goals for health. But in India, there are many challenges to realising this goal – including an epidemic of shaming and misinformation directed at women.

“The first milk, the colostrum, is thought to be nutrient-rich and full of antibodies good for the child,” Dr. John said. “But nobody ever tells you that it’s just droplets of milk that may not even be visible in the first few days.” When others said there was “no milk”, she said she felt ashamed in an already difficult time.

“I was judged by my paediatrician when I learnt that I had flat nipples and sought help,” S.J., a postgraduate resident in physiology in Vellore, said on condition of anonymity. “Nobody identified this problem in my antenatal period, but once I started having issues, my doctor scolded me for not working on it earlier in my pregnancy.” She added that there is a “severe” lack of counselling options for pregnant women on neonatal care.

In India, “most women are guided by the older women in their families on what to expect during childbirth and how to care for their children,” a public health researcher in rural Maharashtra said. “However, even those older women don’t have a good scientific basis for [their] knowledge.” She wished to remain unnamed.

In physiological terms, the milk let-down reflex causes a mother to lactate freely when stimulated by her baby’s suckling and oxytocin, a hormone released “when the mother feels bonded to her child,” Dr. S.J. said. The reflex isn’t likely to be stimulated by pinching the nipples, however.