r.i.c.e.

There are so many ways in which the deck is stacked against poor babies in India. A few days ago, Jo, one of our board members, sent me the HUNGaMA Survey Report from 2011. HUNGaMA is a survey of about 100,000 children in the 100 Indian districts that perform the worst in terms of child malnutrition. It is carried out by the Naandi Foundation. The survey measures a lot of parenting behaviors that influence children’s growth—it looks at what children eat, whether family members wash their hands, and how children are cared for when they are sick.

As I was flipping through the report, I thought of the 17 babies I’d been spending time with in February and March. How are they doing in this summer heat? April, May and June are the hottest months in Sitapur—weather.com said the high temperature for tomorrow is 113 degrees Fahrenheit. How are the moms doing? The heat can be dangerous for adults and children alike; one particularly hot summer day in Rajasthan, Dean got heatstroke—he was so confused that he thought he was in the City Palace Museum with King Pratap in Udaipur! Since then we’ve been careful to drink tons and tons of water and Gatorade in the summer.

In the heat of the summer, moms are understandably worried about their babies. But many of them make a possibly fatal mistake—giving the babies sips of water. Giving infants water is really common in India; in the 100 districts in the survey, of which Sitapur was one, over a fifth of infants were given water to drink in the first month of life. Almost 40% more were given water between the first and fifth months.

What’s the problem with giving babies water? After all, if it is good for adults to have lots of water in the heat, why isn’t it good for babies? In rich countries, doctors don’t want babies below six months to have water because they are concerned that it will interfere with the baby’s absorption of nutrients from breastmilk, and there is good evidence that babies get all the water they need from breastmilk, even on the hottest days. In places where the water is contaminated, as in Sitapur, giving babies water not only prevents them from getting the nutrients they need, it may make them sick with diarrhea. And especially in the heat, diarrhea can swiftly turn into dehydration, which can kill little babies.

Apparently, giving young infants water in hot places seems intuitive to mothers in other countries as well. Last June, Nicholas Kristoff of the New York Times wrote an article about women in Niger, who also tend to give their babies water in hot weather.

I don’t yet have any good ideas for how to educate moms about exclusive breastfeeding for infants. But despite mothers’ good intentions, it is probably going to be tougher than it seems. In the villages in Sitapur, I would hear public health messages on the radio encouraging mothers to breastfeed within an hour after birth, yet still, many of the mothers I was spending time with did not breastfeed their infants for a few days after birth. This was due to the belief that colostrum (a protein and anti-body rich “first milk” which looks yellowish and thick) is bad for babies. Like I said, the deck is stacked against them.