First trimester feeding in a rural Sri Lankan population

One hundred Sinhalese mothers with infants at three months age in a rural population in Central Sri Lanka were interviewed by questionnaire on the feeding of their infants from birth to 3 months of life. 96% of babies were being breast fed at 3 months age. However, 32% have already been started on formula. Of this 32, eight mothers were from poor families receiving state subsidies. 20 of the 32 were giving expensive formulas made by multinational companies, (including four of the eight mothers receiving state subsidies and feeding formula) in spite of the availability of cheap comparable state subsidized formulas. In rural Sri Lanka only about a quarter have access to drinking water but 96% were giving water or other weak nutritional solutions at 3 months of age. 72% were using bottles for feeding. 77% were being given sugar and, 13% salt through non-milk solutions while 11% were getting sugar through their formula. Maternal employment, increasing maternal age, less than sixteen hours of maternal contact time per day with child, delay in initiation of breast feeding after birth were all significantly associated with a higher risk of formula feeding. A lower birth order and early initiation of breast feeding after birth were associated with a higher risk of babies being fed on non-milk solutions. In the light of these findings it is suggested that the time is now opportune for the National Nutritional Programme to shift its present emphasis from the promotion of breast feeding in these (and similar) areas to the promotion of exclusive breast feeding in the early infant's diet, while discouraging formulas, non-milk solutions, weaning foods, salt, sugar and the use of the bottle as a feeding utensil.