Beyond pregnancy: Anaemia in breastfeeding mothers

Breastfeeding can be one of the most joyful aspects of motherhood; however, for many women the experience is fraught with exhaustion, melancholy, and a struggle to bond with their infants. While exclusive breastfeeding is highly recommended for infants, the struggle faced by many mothers is often overlooked. The inability to breastfeed can leave a lot of women feeling as though they aren’t adequately providing for their babies. This is made worse by the fact that its underlying causes are often dismissed or misattributed. Nutritional deficiencies such as anemia contribute to reduced milk production and, resultingly, the early cessation of breastfeeding. While awareness about the need to prevent anemia during pregnancy is widely known, its effects on breastfeeding are less talked about and, therefore, often ignored. 

We recently celebrated World Breastfeeding Week, where the focus was on ensuring breastfeeding support to all. As we strive toward ‘closing the gap,’ by reducing health inequities, we should not lose sight of improving maternal nutrition for successful breastfeeding.

According to the latest NFHS-5 data, an overwhelming 61% of breastfeeding mothers have anaemia; this is higher than its prevalence in pregnant women (52%). Caused primarily by deficiencies in micronutrients such as iron, folate, Vitamin- A, B12, the condition leaves breastfeeding mothers at risk given the increased iron demand for foetal development and milk production. This poses multiple challenges for women and their babies, leading to potential long-term physical and cognitive health effects. The nutritional ‘costs’ of breastfeeding are higher than in pregnancy. However, nursing mothers’ nutrition remains a neglected area. Traditional food supplements for lactating women in different parts of India are limited to snacks made using nuts, herbs, jaggery, millets and ghee, that are believed to enhance breastmilk output. Given the high prevalence of anaemia, it is crucial to focus on measures to take an evidence-based approach to addressing nutritional deficiencies.

The impact of anaemia extends beyond health, significantly affecting women’s productivity and earning potential, especially in working mothers. Anaemia is not merely a nutritional deficiency but has multifaceted determinants including infections, chronic inflammation as well as haemglobinopathies in some population groups. To effectively combat this, a comprehensive approach is essential, involving diverse diets providing sufficient essential nutrients, improvement in water, sanitation and hygiene (WaSH), control of infections, the enhancement of antenatal and post-natal care through regular screening and supplementation, psychosocial support to women and the amplification of community health education to raise awareness about family participation in taking care of women and babies. 

Iron deficiency and associated anaemia can be treated with relatively inexpensive iron and folic acid supplementation. Both the World Health Organization and India’s Anaemia Mukt Bharat programme advocate for iron and folic acid supplementation for lactating women for six months postpartum. However, compliance rates drop significantly from 95% among pregnant women to just 65% among lactating women, largely due to a lack of awareness on the importance of treating postpartum anaemia.

Symptoms of anaemia are often not overt, leading to its severity being overlooked.  Testing during postpartum period is crucial for early detection and treatment. Child immunisation visits to health centres can be exploited as opportunities for haemoglobin testing for mothers. Identifying at-risk women - those with a history of anaemia, postpartum haemorrhage, multiple pregnancies, or other risk factors--and providing them with oral iron supplements can help mitigating the adverse effects of anaemia.

New mothers frequently feel isolated, grappling with social stigmas against public breastfeeding. Compounded by the silent epidemic of anaemia, often overshadowed by their focus on newborns, robust support systems are needed for addressing the health and nutritional needs of breastfeeding women. By addressing the root causes of anaemia and providing concerted support, we can enhance mothers' health and well-being, empowering them to thrive in their vital roles.

To effectively tackle widespread nutritional deficiencies such as anaemia and fulfil the promise of comprehensive support to breastfeeding mothers, an integrated approach is required. Strengthening community awareness, expanding opportunities for regular testing, and enhancing support for mothers is key. This, coupled with interdepartmental cooperation and a steadfast commitment to gender equality are essential for meaningful progress. Through sustained initiatives and comprehensive policies, we can empower mothers, reduce anaemia prevalence, and pave the way for a healthier future for generations to come. 

This article is authored by Dr Bharati Kulkarni, Scientist G, and head of reproductive and child health and nutrition, ICMR.