INTRODUCTION:

Breastfeeding is an important child survival intervention. Breastfeeding within an hour of birth could prevent 20% of newborn deaths. Infants who are not breastfed are 15 times more likely to die from pneumonia and 11 times more likely to die from diarrhoea than children who are exclusively breastfed, which are two leading causes of death in children under five years of age. In India, only 44.6% of mothers initiate breastfeeding within one hour of birth despite the fact that about 78.7% of mothers deliver in institutions (RSOC, 2014). Further 64.9% of babies are exclusively breastfed during the first six months and only 50.5% of babies between 6-8 months are given complementary foods (RSOC, 2014).³

Given the overwhelming evidence available on the impact of breastfeeding on the reduction of neonatal mortality and infant mortality, it is imperative that efforts are intensified to improve optimal breastfeeding practices (early initiation of breastfeeding within one hour, exclusive breastfeeding for the first six months, and continued breastfeeding for at least two years).³

MAA - "Mother’s Absolute Affection" is a nationwide programme of the Ministry of Health and Family Welfare was launched on 5^th August 2016 in an attempt to bring undiluted focus on promotion of breastfeeding and provision of counselling services for supporting breastfeeding through health systems. The programme has been named ‘MAA’ to signify the support a lactating mother requires from family members and at health facilities to breastfeed successfully.¹

GOAL OF THE PROGRAMME:

To revitalize efforts towards promotion, protection and support of breastfeeding practices through health systems to achieve higher breastfeeding rates.²

OBJECTIVES OF THE PROGRAMME:

a. Build an enabling environment for breastfeeding through awareness generation activities, targeting pregnant and lactating mothers, family members and society in order to promote optimal breastfeeding practices. Breastfeeding to be positioned as an important intervention for child survival and development.

b. Reinforce lactation support services at public health facilities through trained healthcare providers and through skilled community health workers.

c. To incentivize and recognize those health facilities that show high rates of breastfeeding along with processes in place for lactation management.²

COMPONENTS OF THE PROGRAMME:

Fig no: 1: Components of the MAA programme

1. Communication for enhanced awareness and demand generation through mass media and mid media

· To achieve maximum penetration of messages on breastfeeding and build an enabling environment for the programme, awareness generation and advocacy activities are undertaken using multiple platforms – audiovisual (AV), print and electronic – through appropriate mass media, mid media and interpersonal communication at National, State, District and Sub-district levels.

· To make the Programme more effective in achieving its goal, certain priority areas for communication have been identified such as: early initiation of breastfeeding and ‘no’ to pre-lacteals and water; myth of not enough milk; emotional and overall support to the lactating mothers; advocacy with gatekeepers such as mother in laws/husbands and other family members to support breastfeeding; information on where to go in case of difficulty in breastfeeding; breastfeeding in case of working mothers; and ill effects of infant milk substitutes.

2. Training and capacity enhancement of nurses at government institutions, and all ANMs and ASHAs. They will provide information and counselling support to mothers for breastfeeding

· The orientation of ASHAs/AWWs and interpersonal communication and community dialogue through mothers’ meeting conducted by ASHA

· Trained ANMs at sub-centres for providing skilled care in the communities.

3. Community engagement by ASHAs for breastfeeding promotion, who will conduct mothers’ meetings. Breastfeeding mothers requiring more support will be referred to a health facility or the ANM sub-centre or the Village Health and Nutrition Day (VHND) organized every month at the village level

· Key areas requiring counselling are correct positioning and attachment for breastfeeding, frequency of breastfeeding, emotional support by the family, confidence-building of mothers, on-demand feeding, night feeding, clearing myths of not enough milk and support for special situations, such as working mother.

· Each contact point with the newborn at health facilities should be optimized for breastfeeding/IYCF counselling.

4. Monitoring and impact assessment is an integral part of MAA programme. Progress will be measured against key indicators, such as availability of skilled persons at delivery points for counselling, improvement in breastfeeding practices and number of accredited health facilities; and

5. Recognition and team awards will be given to facilities showing good performance, based on evaluation against per pre-decided criteria.

· Those facilities that perform well on promoting, protecting and supporting breastfeeding as per designated criterion (as per assessment report of the assessors) would be awarded and recognized at State level.³

I) PROVISION OF SERVICES RELATED TO IYCF IN HEALTH FACILITIES

A) Antenatal Clinic: at all MCH facilities and Prevention of Parent to Child Transmission of HIV/AIDS (PPTCT)/ delivery points

Actions and key practices:

· Breast examination and counselling on the importance of colostrums feeding and role of early initiation of breastfeeding in establishing exclusive breastfeeding subsequently, during third trimester.

· Specific counselling and management if mother is HIV positive.

· Provide information on where to seek further advice and support for breastfeeding.

· Advocacy for breastfeeding and providing information on correct breastfeeding practices.

· Counsel on the 9th of every month where ANC clinics are being held under Pradhan Mantri Surakshit Matritva Abhiyaan (PMSMA).

Primary Responsibility:

Staff nurses; RMNCH+A counsellor (when available at the facility); ICTC counsellor

Supporting Role: Medical Officer

B) Labour Room: at all delivery points

Action and key practices:

· Undertake breast crawl and initiate breastfeeding. Every newborn, when placed on the mother’s abdomen, soon after birth, has the ability to find its mother’s breast all on its own and to decide when to take the first breastfeed. This is called the ‘Breast Crawl’, which is helpful to the baby as early breastfeeding is successfully established for nutrition and to the mother as it helps in uterine contraction for faster expulsion of the placenta, reduces maternal blood loss and prevents anaemia.

· Support the mother to provide confidence and direction to the baby.

Primary Responsibility:

ANM/SN/MO conducting delivery, preferably those trained in SBA/NSSK.

Supporting role:

Doctors, staff nurses.

C) Post-natal ward: at all delivery points.

Actions and key practices:

· Ensure the initiation of breastfeeding within one hour.

· Support for early initiation of breastfeeding, avoiding pre lacteal feeds, promoting colostrums feeding, and establishing exclusive breastfeeding.

· Management of breast conditions.

· Direct observation by the health service provider for technique and attachment while breastfeeding the infant for the first time and on a subsequent occasion.

· Recording birth weight, identification of LBW babies and appropriate management.

· Counselling on infant feeding options in the context of HIV (for mothers identified as HIV positive) during antenatal period and after birth.

· Appropriate data entry for early initiation of breastfeeding column in all delivery registers.

· PNC ward and the delivery room must have IEC materials on walls for early initiation of breastfeeding & exclusive breastfeeding in the local language.

Primary Responsibility:

ANM/SN/MO conducting delivery, preferably those trained in SBA/NSSK; RMNCH+A counsellor at high load facilities

Supporting role:

Doctors, staff nurses

D) Outpatient services/consultations (immunization, Well-Baby Clinic, pediatric OPD, ICTC)

At all MCH facilities/ delivery points.

Actions & key practices:

· Ensure exclusive breastfeeding message and complementary feeding messages are reinforced.

· Breastfeeding problems are discussed and addressed.

· Growth monitoring of all inpatient children and use of WHO Growth Charts for identification of wasting and stunting and appropriate management.

· Group counselling on IYCF and nutrition during pregnancy and lactation.

· Review of breastfeeding practices of individual child and nursing mother and counselling on age-appropriate infant feeding practices.

· Review of feeding practices, counselling & support on feeding options in context of HIV (for mothers identified as HIV positive)

· In high caseload facilities with an IYCF counselling centre already established, an RMNCH+A counsellors/ designated staff nurse should be available for fixed hours (coinciding with the timing of outpatient services) at this centre to counsel and solve referral problems. The above package of services may also be provided at dedicated IYCF centres.

Primary Responsibility:

ANM if only she is available, staff nurses; RMNCH+A counsellor at high caseload facilities; ICTC counsellor

Supporting Role:

Medical Officer

E) Inpatient services (sick children admitted in pediatric wards)

At all MCH facilities delivery points

Actions and key practices:

· Monitoring of lactation and breast conditions, support to resolve any breastfeeding-related problems.

· Anthropometric measurements of all inpatient young children; identification of children with under-nutrition and appropriate nutrition counselling and management.

· Implementation of the IMS Act.

· Age-appropriate messages regarding feeding of sick child and childcare practices.

Primary Responsibility:

Staff nurses; RMNCH+A counsellor at high caseload facilities

Supporting Role:

Matron, Medical Officer

F) Special Newborn Care Units and Newborn Stabilization Units:

Actions and key practices:

Counselling on breastfeeding/breast milk feeding of low birth weight and preterm babies, helping mother for cup feeding the baby and, age-appropriate feeding advice before discharge.

Primary Responsibility:

Staff nurses; RMNCH+A Counselor at high caseload facilities

Supporting Role:

Medical Officer

II) PROVISION OF SERVICES RELATED TO IYCF AT COMMUNITY OUTREACH LEVELS:

A) Village Health and Nutrition Days (VHND):

AWC or sub-centre, as relevant

Actions & key practices to be promoted:

Counselling and practical guidance on breastfeeding as an integral component of birth preparedness package – prepare mothers for early initiation of breastfeeding

Activities:

Group counselling on maternal nutrition and infant feeding

Health service provider: ANM

Where feasible, demonstration of food preparation and sharing of recipes for optimal use of locally available foods for children 6-23 months; In a special situation, demonstrate preparation of safe replacement feed

Supporting Role:

AWW, ASHA, LHV and ICDS supervisor.

B) Routine Immunization sessions (RI sessions): AWC or sub-centre, as relevant.

Activities:

Group counselling on age-appropriate IYCF practices and maternal nutrition.

Health service provider: ANM

Supporting Role: ASHA, AWW

C) Biannual Rounds for Vitamin A supplementation; or during months dedicated to child health (e.g.; Shishu Sanrakshan Maah)- AWC or sub-centre, as relevant

Activities:

Group counselling on IYCF and maternal nutrition.

Health service provider: ANM

Supporting Role: ASHA, AWW

D) IMNCI/sick child consultation:

Community level, sub-centre, AWC

Activities:

Assessment of age-appropriate feeding and feeding problems, counselling on age-appropriate feeding and feeding during illness

Health service provider: ANM

Supporting Role: ASHA and AWW ³

ACTIVITIES OF THE PROGRAMME:

a) One day sensitization of ASHA – to develop them as the first information link on breastfeeding in the community

b) ASHAs conduct mothers’ meetings to promote, protect, manage and support breastfeeding, and complementary feeding

c) Reinforcement of routine activities of ASHAs on breastfeeding

d) Infant and Young Child Feeding training for ANMs of all sub-centres in a phased manner

e) Breastfeeding support and management services at sub-centres and VHNDs

f) Reinforcing roles and responsibilities regarding breastfeeding – one-day orientation

g) Capacity building of ANMs/nurses and developing master trainers

h) Facility strengthening

i) Room for breastfeeding

j) Setting up of National Resource Centre

k) Award for facilities³

REFERENCES:

1. http://unicef.in/AddNewPage/PreView/19

2. http://vikaspedia.in/health/health-campaigns/mothers-absolute-affection

3. http://nhm.gov.in/MAA/Operational_Guidelines.pdf

Received on 26.09.2019 Modified on 18.10.2019

Int. J. Nur. Edu. and Research. 2020; 8(1): 117-120.

DOI: 10.5958/2454-2660.2020.00025.3