The Natural Nipple In Nepal: Coming Together To Find A Solution -- Part 2

The WHO and UNICEF have established recommendations for breastfeeding practices, which The Global Breastfeeding Scorecard analyzes to see how countries protect, promote and support breastfeeding. Although every mother decides how to feed her child, this decision is strongly influenced by economic, environmental, social and political factors.

After coming across the staggering result of over thirty years of Dr. Shrestha’s career and dedication to improving the health of his community through breastfeeding, I wanted to meet him for myself and discover what breastfeeding success secrets Nepal beheld. Less than a month later, I packed up my life into one (overly stuffed luggage) and hopped on a flight with this goal: to understand what Nepal is doing differently from the rest of the world to promote breastfeeding and optimizing future generation wellness and disseminate that with our markets globally.

During residency, Dr. Shrestha witnessed infant malnutrition and the introduction of solid foods at two months of age. He began seeing the relationship of this practice to long term negative health outcomes and became passionate about educating his patients, who often could not afford the resulting follow on care, on the preventative benefits of breastfeeding... 

Nepal also faces challenges in providing mothers with the support they need. Maternity leave is too short, the Baby-friendly Hospital Initiative has become dormant, monitoring for violations of the Code is weak, and quality improvements for counseling services are needed.”


How are you measuring breastfeeding success rates to 66% <6 months and 89% at 2 years?

Dr. Shrestha summarized that The Nepal Demographic Health survey report is done weekly on paper and is not readily accessible in some mountain regions. Additionally, the survey question asks if you breastfed yesterday as an indicator of exclusive breastfeeding. It is good we are getting information on if the duration is prolonged, but not entirely accurate in practice.

He shared that the major barriers to effective education and breastfeeding are industry related. The formula, Lactogen, is actually not translated into Nepali, and the use instructions are printed on the inside of the can: meaning no mother in Nepal can actually read how to appropriately supplement their infant’s feedings! Another issue he identified as a marketing push for complementary feeding with a Nestle soy cake, that was then distributed to malnourished children (probably in an altruistic effort), but not sustainably designed to provide proper nutrition or support the economy by incorporating locally available foods. There are crucial immune proteins that educate the immune system found in breastmilk, beneficial bacteria that establish the gut microbiome- and in turn how food is metabolized throughout life, as well as nutrients that these ‘complementary’ products lack. It didn’t make sense to him for the healthcare system to be reimbursing these products that were not improving health or supporting the local economy- considering corn maize is actually more sustainable for these Nepalese communities.


What are you doing to provide access to skilled breastfeeding counseling in healthcare facilities? 

In 1998,  to combat this challenge at a primary level, Dr. Shrestha proposed breastfeeding education courses be offered in 8th grade at the community level as well as for medical students and nursing students at the professional level. Neonatologist and chief of the Dullakel Research department, Dr. Prithuja Poudyal, was able to speak directly to the professional benefit of training nurses and physicians as lactation consultants alike. “We are all on the same page and want to collectively ensure the continuity of breastfeeding education.”


Dr. Poudyal took an hour out of her intensive schedule to tour me around the NICU and post-natal units.



How are you engaging community support programs that PROTECT, PROMOTE AND SUPPORT BREASTFEEDING?

She typically works 36-hour shifts and in all her spare time, organizes theatre plays for the community that enacts latching difficulties and how they can impact the entire family. Afterward, she provides techniques such as the football hold supported by a pillow, and the importance of replacing the volume of breastmilk produced with adequate hydration.


One of your call to action priorities is to fully implement the breastfeeding code with legislation- how is that going?

“Not well, policy needs to change and reinforcement is lacking.”


What can be done to change this?

Dr. Shrestha replied, telling me a few different tips and tricks to help begin the change:

  1. Spreading awareness of the importance of breastfeeding
  2. Having confidence itself produces the oxytocin 
  3. Some of the best techniques for promoting latching are:
    • Football hold
    • Leg and arm well supported
    • Mouth wide open & entire Areola in mouth
  1. Training of professionals
  2. Policy of government 
  3. Monitoring and reinforcement of policy