Where and how breastfeeding promotion initiatives should focus its attention?

Sir,

We read the article on “Where and how breastfeeding promotion initiatives should focus its attention? A study from rural Wardha” by Dongre et al. with interest.(1)

The study has concentrated on positioning and attachment of the baby to the breast, which is quite commendable because it is a basic and practical issue that has always been overlooked in most of the studies conducted on the effectiveness of breastfeeding. The methodology has also included enquiry about the last feed and modifying the time of assessment according to the next anticipated feed, which is again a simple but powerful factor missed by most other studies.

The authors have mentioned that 94.9% of the study population underwent institutional delivery, but they have not mentioned the breastfeeding counseling given by health care workers in those hospitals, which is an important confounding factor in this study. The authors have stated that “significantly more mothers with feeding problems had problems in positioning and attachment of infant to the breast and this was a missed opportunity to educate and support mothers regarding breastfeeding problems.” Without knowing whether breastfeeding counseling was actually given or not, it is difficult to arrive at the above conclusion.

In the study, if a mother was found to have difficulty with positioning or attachment, she had been helped in doing so after taking the observations. After such counseling and help, the assessment of breastfeeding could have been redone to determine whether such help actually resulted in improved feeding or not. Such reassessment would have been an excellent evidence to prove the effectiveness of the authors’ concluding statement, which states that educating mothers regarding the position and attachment of infant to the breast can improve breastfeeding.

The authors have considered “low weight for age” as one of the feeding problems. They have not mentioned how much percentage of the expected weight or percentile in growth charts was taken as the cut-off. Failure to gain weight within the expected range since birth would have been a better indicator than absolute “low weight for age.” The most important cause of “low weight for age” is low birth weight and not poor breastfeeding.