COVID-19 has become a global health emergency and brought a significant impact on every aspect of the daily lives of society. Society should learn in a hard way to get used to living peacefully in this new situation. This situation pushed families and friends to practice social and physical distancing as a way to show that they care. Workers must adapt to working from home, and students have to study from home by utilising the available technology. Experts have published many studies and held online meetings discussing the impact of this pandemic, yet studies on the effect of the pandemic on maternal and child health are still limited. This short article aims to explore the impact of COVID-19 on maternal and child health, particularly for infants and exclusive breastfeeding.
It is well-acknowledged that exclusive breastfeeding benefits for babies. Furthermore, UNICEF (2010) reveals that exclusive breastfeeding has positive influences not only for babies but also for mothers, families, the environment, and nations. Due to the vital impact, the World Health Organization (WHO) recommends that babies should be exclusively breastfed, in which babies only receive breastmilk without water or solid food for the first six months of their life. The rate of exclusive breastfeeding has not been satisfying globally, as it stood only 41% (UNICEF & WHO, 2018). The rate of exclusive breastfeeding in Indonesia has also been frustrating and under the global median and the global target of 70%, while according to the Basic Health Survey (RISKESDAS) 2018 conducted by the Indonesian Ministry of Health, was 37%. This laggard, therefore, has become an enormous homework to be done.
The challenges for mothers and babies during the pandemic
During the pandemic, new mothers, newborn babies, and families are greeted by a problematic situation that has never been happened before. The experience of waiting for the childbirth in the middle of the pandemic will not be the same as the normal situation as the families are covered by dreadful fear. They also have difficulties in reaching health care due to the public containment enacted by most countries. Also, health centres are occupied to treat COVID-19 patients over other health services, including antenatal care (UNICEF, 2020). Mothers and families also worried about getting the infection of COVID-19 when they have to visit the health care to check up and getting information to their babies.
The new mothers also doubt their baby's health and breastfeed the baby, particularly those who have been confirmed positive for COVID-19. Answering this confusing concern, the WHO recently has released the statement that it is safe for mothers, even those who suspected, to breastfeed their babies since the benefits of breastfeeding outweigh the risk of COVID-19 infection. In addition, there is no evidence found that the coronavirus has been found in breastmilk (WHO, 2020). WHO, however, also stresses the necessary precautions to stop spreading the virus before breastfeeding, such as wearing a mask, washing hands, and disinfecting the surfaces they have touched.
Does COVID-19 decrease the number of babies who are exclusively breastfed?
The COVID-19 and breastfeeding interim guidance made by WFP, WHO, and UNICEF (2020) recommends that early initiation of breastfeeding should be given if the mothers do not indicate COVID-19. Unfortunately, these recommendations were not strictly followed by health care facilities. This phenomenon can be found in a city in Indonesia where there was a new mother who could not conduct the early initiation of breastfeeding. The baby was separated from her mom, and the baby was then given formula milk (Tambunan, 2020). Surprisingly, this case has happened in a hospital which is categorised under baby-friendly and pro breastmilk. The application of early initiation of breastfeeding is one of the significant avenues to achieve successful exclusive breastfeeding. There may be more cases, as mentioned earlier, due to the lack of information.
Another impact concerning exclusive breastfeeding due to COVID-19 is about the psychology of mothers. It is inevitable that this crisis potentially causes anxiety for the new mothers for childrearing their babies. The new mothers may suffer baby blues syndrome and post-partum depression due to mainly psychological reasons. The difficulty to exclusively breastfeed for their babies is one of the effects of those disorders since there is an association between the psychological of mothers with smooth breastmilk production (Jalal et al., 2017). This pandemic possibly creates worries and fear for new mothers and can influence the success of exclusive breastfeeding. Job losses are the real impact of COVID-19, and if it happened to families who have infants, it would influence mothers' psychological well-being. It potentially makes that mothers could not breastfeed babies as the issue on breastmilk supply.
Before the pandemic, the rate of exclusive breastfeeding in Indonesia is low, which may worsen. In addition to economic hardship faced by most families during the pandemic, this issue may get more complicated if the families cannot afford to buy formula as a substitute for breastmilk. Under this situation, how the babies will get the necessary nutrition?
The way forward
The benefits of exclusive breastfeeding for babies and their health have been understood. If the babies do not get the best nutrition will result in another health issue, such as malnutrition, which contributes to infant mortality, stunting, and other health burdens. Several actions need to be implemented considering the importance of breastfeeding. First, educating about the importance of exclusive breastfeeding for babies is essential and highlighting that breastfeeding during COVID-19 is safe for babies, even the mother has confirmed with COVID-19. This effort can be made by utilising several canals to spread the breastfeeding information during COVID-19, such as social media for those who have internet access. Second, the Primary Health Centre (PUSKESMAS) role should be strengthened since it plays a pivotal role in disseminating health information to the societies. This effort is particularly true for those who live in remote areas or do not have access to the internet. At the lowest level, the role of health agents must be maximised to educate mothers and families. Lastly, encouraging fathers to be more involved in supporting their wives to breastfeed since breastfeeding is not solely women's domination. The role of fathers in achieving successful breastfeeding is very crucial. Hence, it is essential to raise awareness of the significant fathers' role in supporting exclusive breastfeeding.
By Angga Sisca Rahadian, Social Demography Researcher in Research Center for Population LIPI
Jalal, M., Dolatioan, M. Mahmoodi, Z., Aliyari, R. (2017). The relationship between psychological factors and maternal social support to breastfeeding process. Electron Physician, 9(1): 3561-3569.
Kementerian Kesehatan. (2019). Riset Kesehatan Dasar 2018. Jakarta: Lembaga Penerbit Balitbangkes (LPB).
Tambunan, Liza. 2020. Dampak sosial virus corona: Beban 'berlipat ganda' bagi perempuan di masa pandemi Covid-19. 21 April 2020. https://www.bbc.com/indonesia/indonesia-52323527
UNICEF. (2010). The Community Infant and Young Child Feeding Counselling Package.
UNICEF. (2020). Pregnant mothers and babies born during COVID-19 pandemic threatened by strained health systems and disruptions in services. Diunduh dari https://www.unicef.org/press-releases/pregnant-mothers-and-babies-born-during-covid-19-pandemic-threatened-strained-health.’
UNICEF & WHO. (2018). Global Breastfeeding Scorecard Enabling Women to Breastfeed through Better Policies and Programmes.
WHO. (2020). COVID 19 and Breastfeeding Position Paper
WFP, WHO, UNICEF. (2020). COVID-19 and Breasfeeding Interim Guidance. Diunduh dari https://fscluster.org/sites/default/files/documents/2020-03-18_covid-19_and_breastfeeding.pdf