Nutritional Status And Dietary Pattern Of Lactating Women In Some Urban Slums

View with images and charts

Nutritional Status And Dietary Pattern Of Lactating Women In Some Urban Slums.

1.1: Introduction

The expectant and lactating mothers are considered as nutritionally vulnerable group especially in the developing countries of the world. Frequent pregnancies followed by lactation increase the health risk of mothers resulting in a high maternal mortality. The success of lactation as well as the health status of infant depends entirely on type of diet by women during pregnancy and lactation. The quality and quantity of mother’s milk is maintained up to some extent by drawing the nutrients from her body reserve indicating additional demand for different nutrients during lactation. Diets consumed by many lactating mothers in our country are poor and lack in many nutrients. Thus special attention should be given to diet of lactating mother. The diets of the lactating mothers very from place to place.¹

However, scientific interest on the consequences of maternal malnutrition on the mother child increased. substantially after the experience of two world wars. Apart from the diet, several other Poverty related factors such as chronic infections, parasitic infestation leading to intestinal mal absorption and closely spaced pregnancies also adversely affect maternal malnutrition status.²

Particularly after delivery, mother loses a lot of blood and there is often a sense of distaste of food that she develops. During this period the nursing /lactating mother should be provided with enough fluid so that she is not dehydrated and extra fluid is also necessary to establish lactation. If the mother during this period does not have a healthy appetite, then she should be encouraged to take food frequently in small amounts until she feels enough to go on the usual diet. The diet of lactating mother is important. The food a mother eats is partly turned into breast milk. If she doesn’t eat enough food, or does not eat with right nutrients she will have less milk. A mother makes 500-750 ml of milk a day. This depends on regular supply of food. Milk secretion begins when the baby is born and the mother continues to supply nutrients to the baby breast-feeding. Lactating mother have to right kind of food so that breast milk will meet nutritional need of the baby, the mother can eat the same foods she was advised to eat during pregnancy but she needs more for not only to feed her baby but also has to maintain her own health. If her diet has been poor and insufficient, her own body tissues will be broken. And she may easily fell sick. The amount of food a mother need in both pregnancy and lactation also depend on the amount of work she does. If women have to do long hours of heavy work she must have more food than a mother who does not work. During pregnancy and lactation mother should rest as much as possible.³

1. 2: Back Ground of the Study:

During pregnancy and lactation a women need more food and a greater variety of foods. More food is the first and most important thing. Diet based on cereal is generally good, but the women need more of them, she should eat one fourth more food than she was eating before her pregnant state. Divide that into four portions this is the extra food she should eat, not only in pregnancy but right through lactation.¹

A variety of food will supply most of the calories and nutrients pregnant women and lactating mother need. Brown wheat flour is better than white refined flour. In some countries and in some cultures, casaba, yams, plantains, and potatoes are used in place of cereals. Legumes and pulses are valuable. The legumes include peas beans etc. the vegetables especially dark green leafy and colored once, such as tomatoes and carrots, supply special nutrients Other vegetables and fruits are also useful.⁸

Dietary guideline for pregnant and lactating mother²

Protein rich high calorie diet

Ensure adequate calorie

Calcium rich food — milk and milk product

Plenty of green leafy and coloured vegetables

Fresh fruits, Plenty of fluid, Iodized salt

Daily calorie Requirements

Pre pregnancy : 2200kcal/day.

Pregnancy : plus 300 kcal/day.

Lactating : plus 500 kcal/day.

Maternal Nutrition situation in Bangladesh

Ave rage wt (kg) : 39 (32 – 48)

Ave rage Height (cm) : 148 (135-149)

Ave rage BMI (kg/m²) : 18

Ave rage Wt gain in pregnancy: 4.7 Kg

Severe under nutrition (BMI< 16) : 8.4 Percent

Ave rage Birth wt : 2.6 kg

Anemia (Hb < 11 g/dI) : 70- 80 Percent

LBW : 30 – 50 Percent

MMR 3.2/1000 live birth.

Nutrient recommendations for lactating women are frequently higher than for any other person within the family group. The basis of most recommendations is that the average lactating mother produces 750 ml of milk each day and thus she needs to consume sufficient food to cover each dietary component secreted in her milk, after making due allowance for the efficiency with which the maternal diet can be utilized for milk production. While in principle this is a perfectly rational approach, there are a number of complicating factors that need to be taken into account; in particular it is becoming increasingly obvious that many of the allowances derived in this way greatly exceed the customary intake of mothers, particularly those living in the developing world, yet there may be no sign of any adverse effect.³

TABLE . Extra Daily Nutrient Allowances for Lactation.³

Nutrient	Non-pregnant/non-lactating	Lactating	Increase
Energy (kcal)	2,100	2,600	500
Protein (g)	44	64	20
Retinol ([tg)	800	1,200	400
Vitamin D (µg)	7.5	12.5	5
Vitamin E (mg)	8	11	3
Vitamin C (mg)	60	100	40
Folate (µg)	400	500	100
Thiamin (mg)	1.1	1.6	0.5
Calcium (mg)	800	1,200	400
Zinc (mg)	15	25	10

Nutrition during Lactation

The physiolo^gic needs of lactation are greater than those of pregnancy, and they demand adequate nutritional support. The basic nutritional needs for lactation include the following additions to the mother’s prep regnant needs.

Protein :

The RDA standard for protein needs during lactation is 65g/day during the first 6 months and 62g/day during the second 6 months. This is an increase of about 15 to 20g/day from the regular need of the adolescent girl (44 to 46g/day) and the adult woman (46 to 50g/day)⁴

Energy :

The recommended kcaloric increase is 500 kcalories more than usual adult allowance. This makes a daily total of about 2500 to 2700 kcalories. This additional energy need for the overall total lactation process is based on three factors:

1. Milk content: An average daily milk production for lactating women is 850ml (30 oz). Human milk has an average of 24 kcal/oz. Thus 30 oz of milk has a value of about 700 kcalories⁵

2. Milk production: The metabolic work involved in producing this amount of milk requires from 400 to 450 kcalories. During pregnancy the breast is developed for this purpose, stimulated by hormones from the placenta, forming special milk-producing cells called lobules. After birth the mother’s production of the hormone prolactin continues this milk-production process, which the suckling infant stimulates. Thus milk production depends on the demand of the infant. The suckling infant stimulates the brain’s release of the hormone oxytocin from the pituitary gland to initiate the let-down reflex for the release of the milk from storage cells to travel down to the nipple. This reflex is easily inhibited by the mother’s fatigue, tension, or lack of confidence, a particular source of anxiety.

3. Maternal adipose tissue storage: The additional energy need for lactation is drawn from maternal adipose tissue stores deposited during pregnancy in normal preparation for lactation to follow in the maternal cycle. Depending on the adequacy of these stores, additional energy input may be needed in the lactating woman’s daily diet⁴.

Vitamins and Minerals :

Vitamin A. Breast-milk contains about 50 µg of retinol/100 ml and, on the assumption that a mother will secrete 850 ml, an extra dietary allowance of 400 [tg retinol equivalents has been made by most authorities. Lactating mother would need to eat food quite different from that consumed by the rest of the family.

Vitamin D. The NRC³ recommends an extra 5-ug cholecalciferol during lactation, which makes a total of 12.5ug for women between 19 and 22 years old. Vitamin D is not distributed widely in foods. Natural sources are fatty fish, eggs, liver, and butter, as well as fortified margarine. In some countries cow’s milk is also fortified, but in most, this is limited to some brands of tinned milk. It is unlikely, however, that the typical poor mother in the developing world will have access to such foods.

Vitamin C. Considerable extra allowances have been recommended for vitamin C in order to cover the vitamin C content of breast-milk. In the United States an additional 40 mg/d has been recommended. This was justified by the fact that breast-milk normally contains 4055 mg ascorbic acid/litre. Recommendation for lactating women is 100 mg/d.

Folic-acid. Folic acid deficiency is always a potential problem during pregnancy because of the greatly enhanced physiological needs at that time. It is, in fact, the only vitamin for which the recommended increment is vastly greater during pregnancy than for lactation.⁵ The most recent NRC recommendations have retained an intake of 400 g/d for non ­pregnant, non-lactating mothers but have reduced the total allowance during lactation from 600 to 500 g/d.

Iron: Iron is unique among the nutrients in that the recommended allowance is considerably greater for adult women than men, even when they are not pregnant or lactating. This is because of iron losses during menstruation, which can be a particular problem in heavy bleeders.⁴

A weight-loss regimen is not recommended when one is nursing. For many women breastfeeding helps promote weight loss and makes attaining her pre-pregnancy weight easier. However, if a woman “eats to hunger” and makes an attempt to eat nutritious foods, she should experience a safe gradual weight loss while nursing. They should choose foods that are nutrient dense and spend extra calories wisely for added benefit for you and your baby. Calcium is again very important life.¹¹

Breastfeeding can affect the mother’s nutritional status, depending on the mother’s diet. The energy, protein, and other nutrients in breast milk come from the mother’s diet or from her own body stores. When women do not get enough energy and nutrients in their diets, repeated, closely spaced cycles of pregnancy and lactation can reduce their energy and nutrient reserves, a process known as maternal depletion. However, there are also adaptations that help protect the mother from these effects. The most important is appetite. During pregnancy and particularly during lactation, a woman’s appetite generally increases. The resulting increase in food intake helps meet the additional demands of pregnancy and lactation. Extra food, therefore, must be made available to the mother.⁸

Community and household members should be informed of the importance of making additional food available to women before they become pregnant, during pregnancy and lactation, and during the recuperative interval when the mother is neither pregnant nor lactating. Making more food available to mothers is even more important in societies with cultural restrictions on women’s diets. Efforts to increase the amount of food available to adolescent, pregnant, and lactating women can be the most effective way of improving their health and that of their infants.¹¹

Breast-feeding provides health benefits to the mother as well as to the infant. ¹⁰ To support lactation and maintain maternal reserves, most mothers in developing countries will need to eat about 500 additional kilocalories every day (an increase of 20 % to 25 % over the usual intake). Well-nourished mothers who gain enough weight during pregnancy need less because they can use body fat and other stores accumulated during pregnancy. Lactation also increases the mother’s need for water, so it is important that she drink enough to satisfy her thirst.⁹

Lactation has many positive effects on the mother’s health. One of the most important is lactation infertility. There are many other benefits of breastfeeding for the mother. Breastfeeding immediately after delivery stimulates contraction of the uterus. This may help reduce loss of blood and risk of hemorrhage, a major cause of maternal mortality. There is good evidence that breastfeeding reduces the risk of ovarian and breast cancer and helps prevent osteoporosis.

Malnutrition affect the quality of milk; When the breastfeeding mother is under-nourished, it is safer, easier, and less expensive to give her more food than to expose an infant less than six months of age to the risks associated with feeding breast milk substitutes or other foods.² If the mother’s diet is poor, the levels of micronutrients in breast milk may be reduced or the mother’s own health may be affected. It is therefore important that the mother’s micronutrient intake is adequate. A diverse diet and fortified foods will help ensure that the mother consumes enough micronutrients for both herself and her breastfeeding infant. If a diverse diet is not available, a micronutrient supplement may help.¹³ Lactating mothers should eat the equivalent of an additional, nutritionally balanced meal per day.²⁶

1.3 Rationale:

Bangladesh is one of the developing countries in South East Asia, where the rate of maternal mortality and Infant mortality is enormously high. The reason for the ultimately death is undoubtedly for malnutrition. And the malnutrition is not only due to poverty but also for lack of awareness regarding diet towards vulnerable groups. Analysis of relevant socio economic and demographic variables reveals that ‘poverty’ is the central point of all direct and indirect cause of malnutrition. Results also show that women and children are the primary victims of malnutrition. Bangladesh is one of the most poor and densely populated country. Its population has now far exceeded the carrying capacity. Bangladesh with a land area of 147570 sq. km. harbors a population of 140 million with annual growth rate of 1.4%. Population density in Bangladesh is highest in the world and about 80% of the total population lives under the poverty line.

Malnutrition is not only a major public health problem, but also a serious impediment to overall national, social and economic development of Bangladesh where majority of the people live below poverty line. Natural calamities like cyclone, river erosion, and flood, famine, rendered many people homeless and economically distorted. With these, decreasing in job opportunities causes internal migration of rural people to cities resulting to urban slums.

Nutritional status is directly related to the pattern of food intake and quality of food. In developing countries, the inadequacies of food are not only in the quantity of food, but also in its quality, it leads to malnutrition as well as under nutrition. The diet consists mainly cereals-rice, millet and starchy roots. 80% of their calories are derived from these food sources. The lack of variety in their food and particularly the shortage of protective food, results deficiency diseases from protein-calorie malnutrition.

Among the urban settings most vulnerable people are those who live in slums. So far our knowledge goes such kind of research work, this was not held in our institution before. So, we decided to observe from this research how lactating mothers take foods, whether their requirements of nutrition is fulfilled or not. So that necessary modification can be suggested in their diet and nutrient intake for improving nutritional status of the mothers and infants too.

The information regarding needs of additional food for the lactating mothers is very important. Lactating mother should provide extra food, which in not expensive, but needs awareness about it. The study result will be helpful to develop mothers to take the nutritious food during lactation and lead a healthy and disease free life. And that’s why I decided to do this study. The findings of this study can be used as base line information in future for carrying out further researches.

1.4 RESEARCH QUESTION:

What is the nutritional status and usual dietary pattern of lactating women in slum area?

1.5: HYPOTHESIS

This thesis was aimed to investigating the nutritional status of lactating mother and their dietary pattern, their socioeconomic condition and some other factor related to the nutrition of mother in slums of Bangladesh.

1.6 OBJECTIVE:

General Objective :

To assess the nutritional status and usual dietary intake of lactating women residing in slum area.

Specific Objectives:

1. To assess the anthropometric Nutritional status of lactating women.

2. To assess the level of Hb%.

3. To explore usual dietary intake of lactating women.

4. To find out the relationship between socio-demographic character and nutritional status of the lactating women.

1.7 VARIABLES:

A. Key Variables :

• Height
• Body weight
• Hb%
• Dietary intake
• Parity.
• Gravida.
• Birth spacing.
• Duration of pregnancy
• Antenatal care.

B. Variable related to socio-demographic information :

• Age
• Age at marriage
• Age at 1^st pregnancy
• Educational level of the respondents
• Monthly income of the family
• Age of last child
• Provision of sufficient food during pregnancy.

1.8: Operational definition :

a) Lactating mother: The women who have breast feeding child under 1 year of age.

b) Family member: Total number of members means member of family they are eating from one source of cooking.

c) Monthly Family income: Income from all the ranging members of the of the house hold ion a month.

d) Educational status: Educational qualification is categorized as follows:

· Illiteracy rate: The portion of person who cannot read with under standing and cannot write a short simple statement on their every day life.

· Can sign or read or write.

· Primary: One to five completed year of school.

LITERATURE REVIEW

2.1: LITERATURE REVIEW

Possessing a land area of 147,570 square kilometers and over 15 million populations, Bangladesh is the ninth most populous country and one of the most densely populated countries in the world. Over population and poverty are pervasive in Bangladesh and causing population hazards like the problems of malnutrition. Specially, women are particularly vulnerable; suffering from social, economic and nutritional deprivation to a far greater extent than men. The high prevalence of under nutrition in Bangladesh is popularly attributed to a combination of extreme poverty, environmental insult and poor health.²⁹

Maternal malnutrition is a chronic problem in rural Bangladesh. Even though the country is self-sufficient in rice production, the diet of rural people is very low in energy and micronutrients because households do not have access to the resources they need to grow or purchase enough food. The typical diet is predominantly rice because people cannot afford other nutritious foods such as pulses, vegetables, fruits and animal products. Girls and women often eat last and least in the household due to the persistence of cultural practices that favour boys and men. Consequently, mothers do not eat enough food to meet their energy and micronutrient needs, particularly during pregnancy when these needs are greatest ³ . For social and biological reasons, women in the reproductive age group and children are most vulnerable to malnutrition due to low dietary intakes, inequitable distribution of food within the household, improper food storage and preparation, dietary taboos, infectious diseases, and care. Particularly for women, the high nutritional costs of pregnancy and lactation also contribute significantly to their poor nutritional status. Under nutrition threatens both the health and survival of mothers because it increases their susceptibility to life-threatening diseases and their risk of dying, especially during childbirth. Undernourished mothers are often physically weak and are unable to perform income-earning activities and household work to their full potential. Mothers who are undernourished before or during pregnancy are more likely to give birth to underweight infants. These infants face a disadvantaged future: they may grow poorly during childhood, do less well at school, and have less productive working lives. In addition infant girls with low birth weight are more likely to become undernourished mothers themselves, thereby perpetuating the cycle of under nutrition from one generation ⁴ .A recent small-sale study of carried out by NSP survey 2000 of 57000 women revealed that almost one half (45%) of rural mothers and one third (34%) of mothers in urban slums have a BMI less than 18.5 kg/m2 and are undernourished. Using population projections from the 1991 census, an estimated 9 million women of childbearing age (15-44 years) are undernourished in rural Bangladesh compared with only 0.8 million women in a developed ²⁹ .

As under nutrition impedes social and economic development, policies and programs are needed to address the factors responsible for mothers’ poor nutritional status. In order to design appropriate interventions, key stakeholders in health and development need to understand how many mothers are affected, which mothers are at greatest risk, and why these mothers are undernourished. This paper documents the extent of under nutrition among rural Bangladeshi women of childbearing age, and explores a number of socioeconomic factors thought to explain its genesis and distribution. For the purposes of analysis, we employ BMI as a simple and reliable measure of adult nutritional status. It is expected that the findings will lead to consider alternative program strategies for the reduction of poor nutritional status of the mothers of reproductive ages.¹

Ideally, mothers of nursing babies should eat a balanced diet. It is important to eat foods from all the food groups. Which include fruits, vegetables, breads, cereals, and protein-rich foods as much as possible. When breast-feeding, calorie intake should not fall below 1800 calories per day. In South Asia, there is a high prevalence of maternal malnutrition. In some communities over 50% of mothers have a body mass index less than 18.5. Breast milk output and quality varies to some extent with nutritional status. Though this variation is minimal in mild to moderate malnutrition, severely malnourished mothers do produce less milk, which contains decreased nutrients, especially water soluble vitamins.¹²

Generally, it’s recommended that everyday one should eat at least three servings of calcium-rich milk, yogurt, and cheese; seven to eight ounces of protein-rich foods such as meat, fish, or poultry; six to eleven servings of grains, cereals, rice and pasta; two to four servings of fruit; and three to five servings of vegetables.

To support lactation and maintain maternal reserves, most mothers in developing countries will need to eat about 500 additional kilocalories 21 every day (an increase of 20 percent to 25 percent over the usual intake before pregnancy). Well-nourished mothers who gain enough weight during pregnancy need less because they can use body fat and other stores accumulated during pregnancy. Lactation also increases the mother’s need for water, so it is important that she drink enough to satisfy her thirst.⁸

After delivery, all mothers need continued nutrition so that they can be healthy and active and able to care for their baby. All mothers need to eat a healthy and balanced diet with vitamins and minerals. Most lactation experts recommend that breastfeeding mothers should eat when they are hungry. But many mothers may be so tired or busy that food gets forgotten. So, it is essential to plan simple and healthy meals that include choices from all of the recommended groups from the food pyramid.⁹

Along with balanced meals, breastfeeding mothers should increase fluids. Many mothers find they become very thirsty while the baby is nursing. Water, milk, and fruit juices are excellent choices. It is helpful to keep a pitcher of water and even some healthy snacks beside your bed or breastfeeding chair.

Lactation is a physiological process. Human breast milk is nature’s perfect recipe for your babies growth and development. This special blend of nutrients nourishes your baby and provides a unique balance of fats, vitamins, minerals, sugars and proteins. Breast milk empowers your baby with disease fighting immunoglobulin to help protect baby during those early vulnerable first weeks of life.¹⁵

Breast-fed babies have fewer illnesses because human milk transfers to the infant a mother’s antibodies to disease. About 80 percent of the cells in breast milk are macrophages, cells that kill bacteria, fungi and viruses. Breast-fed babies are protected, in varying degrees, from a number of illnesses, including pneumonia, botulism, bronchitis, staphylococcal infections, influenza, ear infections, and German measles. Furthermore, mothers produce antibodies to whatever disease is present in their environment, making their milk custom-designed to fight the diseases their babies are exposed to as well.

To maximize the benefit of breast milk a nursing mother must practice good nutrition. Breastfeeding is a learned behavior that needs a supportive environment. Nutrient needs of the mother during breastfeeding include increased need for energy, vitamins and minerals, and water. Iron supplements may be necessary. Exercise is important.²²

Eating well during pregnancy and lactation requires a few adjustments to general good health dietary guidelines. A woman’s need for calories, protein, vitamins, and minerals and water all increase. Each woman will require different amounts of foods providing key nutrients to achieve the desired pregnancy weight gain and pregnancy support. Age, weight, activity level, and metabolism all influence how much you will need to eat for optimum weight gain, health, and fetal development or breast milk production.

When breastfeeding a single baby 300-500 calories per day should be added to the diet. When feeding twins an extra 600-1000 calories per day should be added to your diet. Total caloric intake when lactating is 2300-2500 calories for singleton and 2600-3000 calories for twins. Obviously calcium for milk production comes from the mother. When calcium levels in mom’s blood are not adequate for her needs and those of her child, calcium deposited in her bones is withdrawn for milk production.¹⁷

In fact, if something is lacking in mom’s current diet, mom’s body will dip into her reserves of nutrients to keep breast milk nutrient. Lactating mother should be assured that the composition of nutrients in human milk is consistent. A nutrition shortage for mom is more like to reduce the quantity of milk than the quality of the milk for baby.

Good nourishment is essential to prevent depletion of mother and to provide the right nutrients for baby. Remember, the food that mother eats provides the nutrients in her milk and thus the infant’s nutrition. Many of the nutrient-rich foods suggested for pregnancy should be consumed dairy products, eggs, fish, other animal foods, whole grains, vegetables, especially leafy greens, and vitamin C fruits. Standard food-group orientation suggests more portions of most everything.

For healthy breastfeeding, mother’s comfort is important. Lactating mothers requires extra amount of food. The culture and practice in this country is such family members are enthusiastic during and before delivery they hardly know about the dietary requirements for lactating mothers. Husband in nuclear family and mother in law in the joint family was the key member who decides what to be cooked and served to members of family, so substantial knowledge about the diet and nutrition requirements of nursing mothers can contribute to better maintenance of lactating mother’s health and nutrition.³⁰

Does breastfeeding affect the mother’s nutritional status?

It can, depending on the mother’s diet. The energy, protein, and other nutrients in breast milk come from the mother’s diet or from her own body stores. When women do not get enough energy and nutrients in their diets, repeated, closely spaced cycles of pregnancy and lactation can reduce their energy and nutrient reserves, a process known as maternal depletion. However, there are also adaptations that help protect the mother from these effects. The most important is appetite. During pregnancy and particularly during lactation, a woman’s appetite generally increases. The resulting increase in food intake helps meet the additional demands of pregnancy and lactation. Extra food, therefore, must be made available to the mother, Community and household members should be informed of the importance of making additional food available to women before they become pregnant, during pregnancy and lactation, and during the recuperative interval when the mother is neither pregnant nor lactating. Making more food available to mothers is even more important in societies with cultural restrictions on women’s diets. Efforts to increase the amount of food available to adolescent, pregnant, and lactating women can be the most effective way of improving their health and that of their infants.²⁶

Summary of Main Points

1. Unless extremely malnourished, virtually all mothers can produce adequate amounts of breast milk. When the breastfeeding mother is undernourished, it is safer, easier, and less expensive to give her more food than to expose the infant to the risks associated with breast milk substitutes.

2. Maternal deficiencies of some micronutrients can affect the quality of breast milk. These deficiencies should be avoided by improving the diet or providing supplements to the mother.

3. Lactation places high demands on maternal stores of energy and protein. These stores need to be established, conserved, and replenished.

4. Delay of the first birth and adequate birth spacing help ensure that maternal stores are sufficient for healthy pregnancy and lactation.

5. Breastfeeding provides health benefits to the mother as well as to the infant.

While malnutrition is a ubiquitous problem in rural Guatemala, it is of special concern among pregnant and nursing women; the poor nutrition of mothers during this period is passed on to their children early in life. Thus the problem is perpetuated through several generations, forming an obstacle to health and economic development.

Another cause for concern about malnutrition among mothers is that any malnutrition they experience prior to this period is exacerbated during pregnancy and lactation due to the extra stress that their bodies experience. This can lead to grave consequences because they are supporting the growth and development of new life. Although Guatemalan mothers desire conditions that promote the optimal heath of their children, many are unable to provide them. The resources to practice good nutrition are unavailable and knowledge regarding proper nutrition is lacking. Coupled with local customs and taboos that diminish optimal nutrition, especially during pregnancy and lactation, malnutrition continues to plague rural Guatemala. In order to better understand cultural influences on nutrition during pregnancy and lactation, Gudrid Mariella Jimenez Arriola conducted a study in which she collected qualitative data regarding the habits and traditions of rural Guatemalan mothers. Jimenez conducted interviews and group discussions with the women in three communities near Chiquimula, Guatemala. Jimenez discussed eating habits during pregnancy and lactation with the women and questioned them regarding their beliefs about proper nutrition during these times. She also recorded information regarding the sources of these beliefs and the motivation for the habits and practices they foster. Through the interviews and discussion groups, Jimenez found many traditions regarding nutritional needs during pregnancy and lactation that have been passed among the Guatemalan women. Despite the abundance of such beliefs, most of the women in the study said that they do not change their nutritional habits during these periods. When questioned about their specific beliefs, the women in the different groups gave similar answers. In some instances, the women in the focal groups gave more detailed answers; group discussion and the opportunity to respond to others’ answers likely stimulated the increased responses.¹⁴

Effect of Maternal Nutrition on Breastfeeding

Can malnourished mothers produce enough milk to breastfeed successfully?

Yes. In all but the most extreme cases, malnourished mothers can follow the same recommendations for breastfeeding as mothers who are not malnourished. These recommendations include exclusive breastfeeding 22 for six months followed by on-demand breastfeeding and the introduction of complementary foods.

There is a common misconception that malnutrition greatly reduces the amount of milk a mother produces. Although malnutrition may affect the quality of milk, studies show that the amount of breast milk produced depends mainly on how often and how effectively the baby sucks on the breast. If a mother temporarily produces less milk than the infant needs, the infant responds by suckling more vigorously, more frequently, or longer at each feeding. This stimulates greater milk production. When the breastfeeding mother is under-nourished, it is safer, easier, and less expensive to give her more food than to expose an infant under six months of age to the risks associated with feeding breast milk substitutes or other foods.²²

Can breast milk production be increased by giving the mother additional food?

Some evidence suggests it can. Two randomized intervention trials, in Burma and Guatemala, have so far been conducted to answer this question. In both studies, food supplementation of malnourished lactating mothers resulted in a small increase in infant milk intake. In another study in Indonesia, maternal supplementation during pregnancy improved infant growth rates, possibly by increasing breast milk production. Therefore, although maternal malnutrition is not considered an important constraint to breastfeeding for most mothers, giving additional food to malnourished mothers during pregnancy and/or lactation may help increase milk production and will certainly improve their own nutritional status and families provide additional energy to care for themselves and their families.¹²

Should breastfeeding mothers take extra vitamins and minerals?

It depends on the mother’s diet. Breast milk is rich in the vitamins and minerals needed to protect an infant’s health and promote growth and development. If the mother’s diet is poor, the levels of micronutrients, in breast milk may be reduced or the mother’s own health may be affected. It is therefore important that the mother’s micronutrient intake is adequate. A diverse diet containing animal products and fortified foods will help ensure that the mother consumes enough micronutrients for both herself and her breastfeeding infant. If a diverse diet is not available, a micronutrient supplement may help.

The levels of thiamin, riboflavin, vitamin B-6, vitamin B-12, iodine, and selenium in breast milk are also affected by how much is in the food the mother eats. In areas where deficiencies of these micronutrients are common, increasing the mother’s intakes through improved diets or supplements will primarily improve breast milk quality and infant nutrition.

Other micronutrients (such as folate, calcium, iron, copper, and zinc)²⁵ remain at relatively high levels in breast milk even when the mother’s reserves are low. This means that the breastfeeding mother’s own reserves can be used up and that it is primarily the mother herself who will benefit if she eats more food high in these micronutrients. Additional calcium and iron, in particular, are often needed to protect maternal reserves.¹⁵

Does breastfeeding benefit the mother’s health?

Yes. Breastfeeding has many positive effects on the mother’s health. One of the most important is lactational infertility. This is the period of time after giving birth that the mother does not become pregnant due to the hormonal effects of breastfeeding. Studies show that this effect is greater when the infant suckles more frequently and is exclusively breastfed. Increasing the interval between births has benefits for the mother and her children.

Fewer pregnancies reduce the mother’s risk of maternal depletion and maternal death. A related effect is lactational amenorrhea, the period of time after giving birth that the mother does not menstruate due to the same hormonal effects of breastfeeding. This is the basis for the lactational amenorrhea method (LAM)²⁷ of contraception. Lactational amenorrhea also reduces the amount of menstrual blood loss. which helps to prevent anemia by conserving the mother’s iron stores.

There are many other benefits of breastfeeding for the mother. Breastfeeding immediately after delivery stimulates contraction of the uterus. This may help reduce loss of blood and risk of hemorrhage, a major cause of maternal mortality. There is good evidence that breastfeeding reduces the risk of ovarian and breast cancer and helps prevent osteoporosis.¹⁷

Practices to Improve The Maternal Nutrition

The women indicated that the sources of information about nutrition during pregnancy and lactation are their mothers, grandmothers, older people, and mothers-in-law, as well as professional personnel such as doctors. In addition to having beliefs about foods that are good to eat during pregnancy and lactation, the women also had opinions about foods that are harmful during these times. Although most of the women knew of no foods that should be eliminated from the diet during pregnancy, many were aware of foods that should not be consumed immediately after delivery or during lactation. For example, some reported that women should not eat fresh foods immediately after giving birth, but all the foods they eat should be cooked and served hot. Most of the women commented that mothers could resume a normal diet 40 days after delivery.

Although there are various traditions among the women regarding proper practices and habits during pregnancy and lactation, what the women actually eat during these times changes little. Apparently, this tradition is not for lack of knowledge or beliefs; instead, it stems from the poverty and the scarcity of resources in the communities. The women continue with their normal diets consisting of cereals, legumes, native herbs, sugars, and fats. This monotonous diet is barely sufficient for their normal nutritional requirements, much less for their increased needs during this period. When asked at which meal of the day they receive the best nourishment, most of the women indicated that they eat the most at lunchtime, but the actual food consumed varies little from what they eat at other meals. They said they eat a large at lunch because they are hungrier and they have more time to prepare food. They also reported that during pregnancy and lactation they have a marked preference for foods of animal origin, as well as for foods that they rarely eat at other times. These responses indicate that while the women feel better nourished if they eat more, they are not necessarily better nourished, as their situation calls for a larger variety of food as opposed to more food.³⁰

Illiteracy and lack of knowledge regarding good nutritional practices during lactation is obviously related. This suggests that women would benefit from education programs developed in their behalf. Furthermore, literate women tend to have fewer opinions regarding foods that are unhealthful during lactation. The education regarding food and nutrition of Lactating mothers should be extended to the entire family so that all are aware of the needs of women during these critical times. Because in a traditional rural or even in an urban society a women is not independent enough to prepare or take care of her own diet and nutrition. It is out of tradition here in this region so pertinent information should be possessed by the decision maker before take necessary action for maintaining adequate dietary provisions as well as to maintain proper nutrition. It is encouraging to see young women in rural areas -motivated to improve their situations. These young women have a powerful influence on the nutrition of their families and, therefore, entire communities. Before giving birth, they determine the health of their children. After giving birth, mothers provide vital nourishment through breastfeeding. Their influence continues as they prepare meals for the entire family.²³

Here are some nutrition guidelines for the nursing mother:

• It is during lactation that the nursing mothers tend to feel thirstier, owing to the fact that part of their water consumption is utilized by the body for the formation of milk. It is here where it becomes necessary to increase your water intake by one quart per day, so that you are drinking a total of 2.5 to 3 quarts.
• You should increase your calorie consumption to about 2500 calories per day and opt for healthy foods that are rich in nutrients required by the body.
• Eat more of protein rich foods. The basic rule says that you should eat I gram of protein each day for every pound you weigh.
• Eat multiple small meals. Follow a five-meal routine: breakfast, lunch, after- noon snack, an extra snack during the evening and dinner.
• There is a need to keep away from tobacco, as there is likelihood that the nicotine might get transferred into the child’s body through breast milk.
• Say no to alcohol, as alcohol can retard the growth of your baby.
• It is recommended to consult your doctor before taking any kind of medication.
• It is advisable for the nursing mother to continue taking her prenatal vitamins.¹⁹

Most mothers are highly motivated to eat a nutritious diet during their pregnancies. Assuming that you ate an adequate diet while you were pregnant, you can produce plenty of milk for your baby by keeping up this motivation and making sure that you continue your healthy eating patterns during lactation. While you should attempt to eat a “good diet” while you are nursing, you need to be aware that your diet doesn’t have to be perfect in order to support lactation. You can still breastfeed even if your diet is less than ideal. You may be surprised to learn that studies have shown that maternal nutrition has only a minor effect on the composition and quantity of breast milk produced. Usually, unless a mother is severely malnourished, her milk is fine. Mothers whose diets are poor deplete their own energy levels, and may become anemic, but their bodies will continue to produce the milk their baby needs by pulling from the mother’s energy stores at her expense, but not her baby’s. Most women in this country don’t suffer from a lack of food, but rather from eating too much of the wrong kinds³².

If you are a vegetarian, you probably will not need to change your diet unless your diet doesn’t include any animal protein (vegan and macrobiotic diets). If you do not want to consume any animal products, you should consider taking a vitamin supplement containing vitamin B12. If you don’t eat any dairy products, you should make sure to get enough calcium. I recommend that every nursing mom continue taking prenatal vitamins for as long as she lactates. Just like “drinking to thirst”, you should “eat to hunger” while nursing. Studies have shown that most nursing mothers tend to lose up to one and a half pounds a month for the first 4-6 months after giving birth, and continue to lose weight at a slower rate beyond that time. They tend to lose more weight than formula feeding moms who take in fewer calories. If you want to lose weight (and most of us do – how depressing to still be wearing those old maternity clothes we got so sick of after the baby is born…) plan to do so slowly. It’s best not to try to aggressively lose weight during the first couple of months after birth, because during that time your body needs to recover from childbirth and establish a good milk supply. Losing weight too quickly (more than one to one and one half pounds per week) has been associated with the release of environmental contaminants stored in body fat into the milk.²²

Begin your weight loss program slowly when you are breastfeeding. Increase your activity level and eat less fat and sugar and more fruits and vegetables. Try to take in at least 1,800 calories each day, and definitely no less than 1,500 calories. Even moderate dieting during lactation can help you lose 4-5 pounds each month, but don’t expect to lose body fat until about 2 weeks postpartum. The weight you lose immediately after birth is usually fluid loss. Mothers who breastfeed more frequently lose weight faster than mothers who nurse less often, and mothers who nurse for shorter periods of time tend to lose weight more slowly than mothers who nurse longer. You may get lucky and find that you can eat more than you ever could before and still lose weight while nursing.

Lactation is a remarkable process during which the maternal body produces a secretion that provides no immediate benefit to the mother but can totally sustain the offspring. All mammals produce milks with different compositions, each one specific to the needs for growth and development of their offspring. Regardless of a woman’s intention to breastfeed, her body prepares for lactation from the first moments of pregnancy: the mammary gland begins its maturational process with the development of the alveolar ductal system and the lacteal cells so that the breast is ready to produce milk upon delivery of the infant. The woman’s hormonal balance during pregnancy contributes to the preparation of the breast and promotes accumulation of energy stores, but it suppresses the production of milk until the birth of the infant.

Between 1940 and 1980, there was relatively little active investigation of nutrition during lactation and of the impact of breastfeeding on the mother. Except for the 10 editions of Recommended Dietary Allowances, which have included specific nutrient recommendations for lactating women since they were first published (NRC, 1943), relatively few publications by the National Academy of Sciences, the government, or professional organizations have paid detailed attention to nutrition during lactation. The Academy’s publications include three reports prepared by committees of the Food and Nutrition Board under the sponsorship of the Maternal and Child Health Program (Title V, Social Security Act): Nutrition in Pregnancy and Lactation (NRC, 1967), A Selected Annotated Bibliography on Breast-Feeding, 1970-1977 (NRC, 1978), and Nutrition Services in Perinatal Care (NRC, 1981). However, these reports did not include interpretive reviews of the literature.

Weight gain should be monitored. The time when baby is switched over to other food, mother should reduce her calorie intake. Other wise chances of excessive weight gain are more. Avoid all emotional problems and anxiety. Support of husband and other members of the family is necessary. All most all drugs reach babies through breast milk so before taking any medicine consult a doctor.

Breastfeeding protects from anemia one of the highest risk groups- an interesting example of a win-win situation in nature. Revised from a paper presented to The First National Workshop on Iron deficiency anemia is commonly stated to be a disease of pregnant and lactating women. Such statements are misleading on two counts. Breastfeeding reduces the risk of developing iron deficiency anemia, particularly for those women who are most at risk of developing it. First, a large production of women in many developing countries are either pregnant or lactating during most of their reproductive years, and thus should hardly be considered as outside of the risk groups at any time during their fertile years. This is reflected in the overall prevalence rates for anemia in both developed and developing countries according to DeMaeyer, et al. Using similar reasoning, a high proportion of lactating women are certainly anemic in most countries, especially poor ones. Thus it is correct to include them along with all other women of reproductive age among the groups to be targeted for intervention.

In summary lactating mother should try to eat a nutritious diet while nursing, for her sake and her baby’s.

METHODOLOGY

Methodology:

3.1: Study Design:

Descriptive cross-sectional study.

3.2: Study Period;

January to June 2010

3.3: Place of data collection :

Some Slums of Narayangaj city.

3.4: Place of Study :

NIPSOM.

3.5: Study Population:

Lactating mother having children under 1 year of age in some selected area.

3.6: Sample Size : 98

3.7: Inclusion criteria:

As most of the slum dwellers were low income group and daily basis worker during the day time most of the people were sent out for work so we could not randomize the selection process. During data collection interview was taken of lactating mothers who were present at their residence and those who were to be interviewed. So all slum dwellers present at their home during data collection period were taken as respondents.

3.8: Exclusion criteria:

Mother with chronic illness like kidney diseases, heart diseases, liver diseases or acute severely ill mother.

3.9: Data Collection Technique :

• Face to face interview :
• Anthropometric assessment by measuring height, weight and calculating BMI.
• Hemoglobin estimation of the mother by Sahli’s method
• Clinical assessment.
• Food habit by food frequency questionnaire.

3.10: Data Collection Instrument:

• Pre-tested structured questionnaire
• Height measuring scale
• Weight machine
• Measuring tape
• Haemoglobinometer
• N/10 HCl solution
• Distilled water
• Spirit
• Syringe with needle

3.11: Ethical Consent:

The purpose of the study was duly explained to each of the subjects individually and after the verbal consent they were selected as sample.

Ethical Clearance and informed written consent were taken.

3.12: Data Analysis:

The data were checked for any missing value and discrepancy. Those with any discrepancies were sorted list wise. Then data were entered into the template of computer aided statistical soft were SPSS 17 . Analysis of data were performed as per objective

RESULTS

Table1.Distribution of the respondents by age

Age group	Frequency	Percent
? 20 years	23	23.5
21-25 years	33	33.7
26-30 years	27	27.5
>30 years	15	15.3
Total	98	100.0

Mean = 24.86; SD = ± 5.189

This table shows mean age of mothers was 24.86; SD = ± 5.189. Maximum mothers were in age group 21-25 years (33.7%) & minimum in > 30 years (15.3%)

Table-2. Distribution of the respondents by educational qualification

Education	Frequency	Percent
Illiterate	56	57.1
Can sign/read/write	33	33.7
Primary	9	9.2
Total	98	100.0

This table shows the distribution of the respondents by their level of education. Among the respondents 57.1% were illiterate, 33.7% could sign/write only, 9.2% has passed primary level of education

Table-3. Distribution of the respondents by religion

Religion	Frequency	Percent
Islam	94	95.9
Hindu	4	4.1
Total	98	100.0

This table shows the distribution of the respondents by religion. Most of the respondents (95.9%) were Muslim & the rest were Hindu.

Figure-1. Distribution of the respondents by religion

Table-4. Distribution of the respondents by age of the last child

Age of last child	Frequency	Percent
<5 months	12	12.2
6-10 months	48	49.0
>10 months	38	38.8
Total	98	100.0

Mean = 8.96; SD = ± 2.872

Table shows 49.0% infants were in 6-10 months.

Figure-2. Distribution of the respondents by age of the last child

Table-5. Distribution of the respondents by number of alive child

Alive child	Frequency	Percent
1	16	16.3
2	34	34.7
3	33	33.7
? 4	15	15.3
Total	98	100.0

Mean = 2.52; SD = ± 1.028

Table shows majority ( 34.7%) of family’s total number of children were 2. 33.7% of family’s total number of children were 3, 15.3% of family’s total number of children were? 4 and 16.3% family’s number of children was 1.

Table-6. Distribution of the respondents by profession

Profession	Frequency	Percent
House wife	33	33.7
Day labour	20	20.4
Service	39	39.8
Others	6	6.1
Total	98	100.0

Table shows the distribution of the respondents by occupation. Among the respondents 33.7% were housewives, 20.4% were day labour & 39.8% were services.

Figure-3.Distribution of the respondents by profession

Table-7.Distribution of the respondents by monthly family income of all sources

Monthly income	Frequency	Percent
?4000	29	29.6
4001-5000	30	30.6
5001-6000	24	24.5
>6000	15	15.3
Total	98	100.0

Mean = 4323.47; SD = ± 1211.207

Table shows the mean monthly income of the respondents were 4323.47;

SD = ±1211.207. Monthly income of