The Natural Nipple In Nepal: How Breastfeeding Can Be Improved Worldwide -- Part 1
About a year ago, when conducting ‘Barriers to Breastfeeding’ research across the United States, I became intrigued by The Global Breastfeeding Scorecard statistics, demonstrating that Nepal was the most successful country in the world to support women in the WHO recommendation of breastfeeding for two years. Initially, I hypothesized that these rates were likely correlated to Gross Domestic Profit (GDP), with the poorest nations perhaps having increased breastfeeding rates out of necessity: lack of access to formula or bottles.
This did not seem to be the case with Nepal, as their success rates supersede countries with far lower GDP. According to Dr. Prakash Sunder Shrestha, President of the Nepal Breastfeeding Promotion Forum, “The persistent failure of governments to invest significantly in breastfeeding is hard to comprehend. Many thousands of babies die each year because they did not enjoy the benefit of breastfeeding and multiple thousands more grow up deprived of the many wonders of this special gift of god of nature and of the mother.”
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. A year passed of attempting to contact him. Then in August 2019, the Outlook inbox sound binged like pick striking gold: the correct email had been reached and Dr. Shrestha wanted to meet for an interview!
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.
Fast forward to Dullakel Pediatric Hospital. It’s a humid, smoky, festival day and the resulting traffic rendered me wandering into the lobby a standard ten minutes late asking random Doctors where I could find Dr. Shrestha’s office for ‘breastfeeding research’ (come to find out, this rendered me the funny local nickname 'Breastfeeding!') but sooner or later, I found Dr. Shrestha mid an opportunistic medical student lecture, true to his passion for preventative education.
He spent the next two hours in what was the most surprising interview of this journey yet. I was expecting him to excitedly uncover all of these tips and tricks he deems as responsible for the success rates of his country- but found a rather jaded opinion of how much better Nepal could be doing in supporting women along their breastfeeding journey.
It was an odd dynamic, myself and this Nepalese doctor at the end of his career spent sharing the same cause and resonating in the same frustration. He began his medical career in Calcutta, India. During residency, he 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. To read my interview with Dr. Shrestha on our other blog post here.
To find out more about what is being done differently in the hospital setting, I traveled to Propokar Maternity Hospital, where there is an average of 15,000 babies born every month. More clinical interviews here confirm the result of Dr. Shrestha's impact on Nepal’s success statistics. One NICU nurse, Rama, explains policy prohibits the use of bottles in hospital. The reason? The exact primary barrier to breastfeeding that we uncovered in the/U.S. exists here: nipple confusion.
This realization surprised me. If anything, I was expecting the bottle nipples here to be better matched to mom’s shape, feel, and flow. “What happens if a mom cannot be with her baby?” I asked.
“Breastfeeding is the expected and culturally supported norm. If a mom is critically ill, we use this little spoon to slowly drip her pumped breastmilk into the infant’s mouth.”
Shocked, yet impressed with the clinical dedication to prevent nipple confusion, I discussed these findings with Dr. Shrestha, as they did not seem feasible to immediately implement in Western hospital systems where time and cost savings drive care. Ultimately, our time together resulted in the unified view of the solution to the hospitals and community that can sanitize products: a better bottle nipple.
Here is the synopsis of that discussion: We agreed that companies have the positioning power to make a difference and that currently, formula marketing plays on the fear that mom can’t produce enough milk- causing early introduction of bottles. What Dr. Sundrath described next shocked me once again. He confirmed what Nurse Rama had told me, describing what they also call ‘Nipple Confusion’. I shared with him our findings from U.S. surveys and explained we have the same problem, especially when moms need to introduce a product after going back to work in three months. “You have the right point. Nepal is increasing maternal leave to 14 weeks- but how can we expect exclusive breastfeeding when moms have to go back to work after that?”
After realizing Nepal faces the same challenges with current bottles on the market, yet has done a good job bolstering cultural support and hospital protocol that prevents introducing a product at all, I spilled my thought process behind The Natural Nipple.
“Why not have industry take the lead in driving the policy change that promotes breastfeeding, rather than presenting, up until now, the primary barrier against it?” I asked. “There are few people like you and me in this world,” replied Dr. Shrestha. “Formula companies have the funding to buy policy change by putting their curriculum now at the medical education level and spend millions of dollars on advertising why moms need it. It’s the human right of the baby to have breastmilk.”
“I agree, it’s not scientific marketing, but if this is how the consumer and future key stakeholders are digesting information why not fight fire with fire? In the 30 years that you’ve been trying, the policy still hasn’t changed to the degree that you hoped would support breastfeeding families.”
This is why I’m passionate about what we can control and I think it’s important for people who are driving the industry to begin making a difference. To do that you have to be passionate about the cause. Why not be the first bottle company that comes out of a clinical and research background, with the specific purpose to empower breastfeeding, promote bonding, and optimize wellness worldwide?