The fifth WBTi India report lays bare major gaps in almost all parameters of policy and services supporting women to feed their babies. Prime Minister could change the game with a scheme that has the potential to prevent 99,000 child deaths due to diarrhea and pneumonia, and save Indian economy US$ 14 Billion each year.
On 7 August, a report “Arrested Development” was released depicting how India assists women in removing barriers to optimally feed their babies. The World Breastfeeding Trends Initiative (WBTi), a flagship programme of the International Baby Food Action Network (IBFAN) has prepared this report. The WBTi is based on WHO tools for assessment on 10 indicators of policy and programmes concerning feeding of babies.
The fifth report in a series reveals stagnation over the past 15 years. Women continue to face multiple barriers in the health facility, at workplaces and at home.
This report is about an assessment of policy and programmes on breastfeeding and infant feeding. It finds out how weak are the breastfeeding policy and support services in several sectors like women and child development, health, labour, National Disaster Management Authority, National AIDS Control Organisation, and others. Gaps include weak policy coordination and planning both at the Centre and states, and the major ones are the lack of dedicated funding and monitoring of the programmes; lack of adequate support in health facilities, and inadequate reach with skilled help to women in normal or disaster situations.
As per the WBTi assessment of 2018, India scores 45 out of 100 on policy/programmes, which is just not sufficient to bring about changes. These gaps build deeper barriers to breastfeeding. Not surprisingly, India ranks at number 7 among 8 South Asian countries and 78th among 97 globally.
As a result of weakness in policy support, currently three out of five women are not able to begin breastfeeding within an hour of the baby’s birth. Instead, artificial milk or powdered infant formula is rampant in health facilities. This is because women are not fully supported and the baby food industry continues to influence the behaviour of health workers towards introducing formula right at birth, more so in private health facilities. It is a shame that only 41% women are able to begin breastfeeding within one hour; as against 80% women are delivering in health facilities. It demonstrates a gross lack of concern for women to breastfeed successfully.
Another critical indicator is exclusive breastfeeding for 0-6 months; only one out of two women is able to make it exclusive. The reasons are many including a weak health system support to prevent and solve problems like perceptions of not enough milk, breast conditions like sore nipples, engorgement and mastitis; all these are common and women are likely to give up breastfeeding due to a lack of skilled help/counselling during pregnancy and then 0-6 months in the community and lack of maternity protection for all women.
The third area is after 6 months of age, whether babies are receiving solid foods along with continued breastfeeding. Only two out five babies begin solids at 6-8 months, but unfortunately, only one out of 10 children get the minimum acceptable diet containing a variety of four food groups during the 6-24 month period. This is because of a lack of proper knowledge and availability of a variety of foods in the family basket.
WHY INVEST IN SOMETHING SO NATURAL?
According to the WHO, UNICEF and Global Breastfeeding Collective, this is a critical intervention, which determines the health, nutrition status and development of children and sets in a road to prevent NCDs such as obesity, diabetes and cancers. According to a United Nations report, optimal feeding in India could prevent the deaths of 99,499 children who die each year as a result of diarrhoea and pneumonia. Furthermore, inadequate breastfeeding is estimated to drain the Indian economy of $7 billion due to healthcare costs, and $7 billion in costs related to cognitive losses. India is poised to lose an estimated $14 billion in its economy, or 0.70% of its GNI. According to an estimate, it may cost about Rs 700 crore per year, roughly 1 crore per district to make possible that all interventions are implemented and monitored closely.
Recent reports indicate that India will be world’s third largest economy by 2028 beating Japan and has already become second among the BRICS nations. What is holding back India to invest in this most effective and critical intervention to achieve sustainable nutrition inputs?
Some people may ask why do you need funds? Mothers do it anyway. For the better understanding of all, funds are needed to enforce the existing law to regulate marketing and promotion of baby foods, to establish counselling and support systems in health facilities, establishing mentoring teams at the block and village levels, capacity building, monitoring and evaluation, etc. All this creates what we call an “enabling environment”. Money has been spent on promotional campaigns, which is clearly not enough to increase breastfeeding rates.
While NFSA 2013 mandated the promotion of exclusive breastfeeding during 0-6 months, recognising this to be within the right to food, it failed to enlist what policy and services are required for protection, promotion and support of breastfeeding or even funding for the much-needed interventions. The Pradhan Mantri Matru Vandana Yojna (PMMVY) provides Rs 5,000 as a little wage compensation to women who are out of the formal job system. But it restricts this to the first-born child only. When the Prime Minister announced this on 31 December 2016 for improving maternal and child health nationwide, why are second and third born infants excluded?
HOW INDIA CAN CHANGE THE GAME
Policymakers need to realise the enormity of the problem. Then they need to improve the understanding about the cost of these activities. The next step is concrete planning. A five-year plan with well-defined targets, clear objectives and time lines of activities is the way forward. This will need to be supported by earmarked funds and must be monitored at a high level.
Breastfeeding needs a political decision. The Prime Minister can declare it to be a high priority action for lowering infant mortality and reducing child malnutrition in all its forms. He could flag off a new national scheme, sending strong signals countrywide. The scheme may appoint at least four skilled counsellors at each block, and two or three in each health facility, where mothers come for delivery. This step could be a game changer for India towards improving feeding and caring practices and accelerating reduction in child mortality.
Dr Arun Gupta is a senior paediatrician, working as regional coordinator Asia for International Baby Food Action Network (IBFAN). IBFAN is a Right Livelihood laureate 1998.