What are we talking about?

Only 41% i.e. 15 million newborns out of 26 million born in India are deprived of their mothers’ milk within an hour at birth, which is a public health recommendation of Government of India and WHO. Achieving this can cut 20% neonatal mortality. The rise of early breastfeeding concerns only the health sector. It is a standard of healthcare we fail to provide.

Why early breastfeeding is this low?

One of the major reasons is the lack of skilled lactation support by health staff. Another is aggressive push of baby food industry to use infant formula in the health facilities, who introduce formula feeds as “fixed routines”. Reasons also include mistaken beliefs about the first milk, poor knowledge of timing and contents of this healthy diet. More than half of newborns in private hospitals offered infant formula and in many cases it was given without the knowledge or consent of parents; one survey done by a mother support group revealed. Providing skin-to-skin contact at birth is a critical step in emotional development of the baby and establishing breastfeeding early.

Why should we aspire to reach 90%?

It can contribute to rapid and significant decrease in risk of infectious disease and deaths in newborn babies, which is critical for India. And for a low birth weight baby it is even more crucial. According to a study published in the Lancet recently, that examined associations between timing of breastfeeding initiation, post-enrolment neonatal mortality (enrolment 28 days), and post-neonatal mortality up to 6 months of age (29–180 days), found that neonatal mortality between enrolment and 28 days was 1.41 times higher in infants initiating at 2–23 and 1.79 times higher in those initiating at 24–96 hours. Establishing this standard of care sets a road for optimal breastfeeding practices, with unparalleled benefits for both women and children’s health.

Secondly, in 2007 while doing analysis of three NFHS surveys, an economist concluded “..Also the higher the age at which women have their first child and the earlier the start of breast feeding of newborn children, the less is the prevalence of child malnourishment”. It can trigger positive action towards better feeding practices, which contribute to reduction in both under nutrition and over nutrition.

According to WHO, increasing breastfeeding rates can reduce wasting, stunting, obesity and undernourishment.

Despite the benefits, it varies from 25% to 70% in the States. Even the highest in Goa at 70% is low by any standards.

Does the policy support this?

The policy framework supports this intervention. Effective implementation is required along with committed resources. Niti Aayog launched a “National Nutrition Strategy” in August 2017 that clearly makes a point on this intervention. The CEO of Niti Aayog also shot a letter to Chief Secretaries to pay attention to this indicator while addressing child malnutrition. One year back, Ministry of Health and Family Welfare launched a flagship “MAA” programme for promotion and protection of breastfeeding in health facilities. The Indian Parliament in 2016 enacted a new amendment to the “Maternity Benefit Act 1961’”providing 26 weeks of maternity leave and other benefits to all women both in public and private sector as well as in shopsand establishments. A legal framework Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003(IMS Act) bans any kind of promotion of baby foods for children under the age 2 in health facilities.

Our Prime Minister has envisioned New India by 2022. Isn’t every newborn baby a part of new India? To fulfill PM’s vision, we all have to rise and take action. Whether it is the policy makers, finance managers, programme managers, health professionals and the family members around women. This is an opportunity we cannot allow to miss.

What will it take to reach 90%  ?

Following Steps can go a long way:

Give a high priority with dedicated budget line to actions on breastfeeding: Hon’ble Prime Minister could include this indicator of progress in “Pragati” and dedicate a budget line in the national health accounts. This can put it on high priority.

Set up facility level lactation support counselling centres: All health facilities both public and private, which provide maternity services should do this. MOHFW has already issued a guideline to do so, this action could be put on urgent priority to educate women during antenatal period and to assist at the time of birth to begin breastfeeding. Having such centres with lactation counsellors in every government health facility is estimated to cost about 484 Crores annually.

Create  nutrition counselling and support centres at block level: While community workers already stationed at village level can deliver the messages in the communities during the life cycle, a technically sound team of lactation support mentors at the block level, who can also serve as trainers of frontline workers and provide referral support to women who have problems while feeding such as ‘not enough milk’, breast engorgement, breast infection and sore nipples. This is estimated to cost about 500 crores annually. This is an act of “programming” a baby for life long development and protection, which continues in the form of exclusive breastfeeding for the first six months, and continued breastfeeding for two years or beyond along with adequate complimentary feeding when the baby is six months old and  ready to receive other foods.

Policy decision for use of breastmilk substitutes:  MOHFW could notify about it to ensure safety of infant feeding.  All maternity services should be mandated not  to use infant formula at birth unless it is medically indicated as per WHO guidelines .

Way Forward

Current political climate is most suitable for such actions. Nutrition is on high-level political agenda. To find solutions for good nutrition for women and children the Hon’ble Prime Minister Narendra Modi chaired a meeting himself on 4 November 2017 and the cabinet has approved “National Nutrition Mission”. Government of India could create this budget line during the upcoming budget to implement this critical intervention by health sector. It makes an economic sense as investing $1 on breastfeeding provides $35 as returns. Allocation of specific funding for protection, promotion and support of breastfeeding may sound out of place but would set in motion a process to halt deteriorating malnutrition situation and fulfill our commitments more realistically.


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