World Breastfeeding Week: Why Lactation Support In India Needs Structural Reform

India's public health system is aware of the advantages that breastfeeding has for both mothers' and children's health. The number of institutional deliveries has significantly increased. NFHS-5 (2019–21) reports that 88.6% of births now take place in medical facilities. But only 41.8% of mothers start breastfeeding within the first hour. This is an increase from 9.5%  in NFHS-1 (1992–93), but progress has slowed, and some states have seen a drop compared to previous rounds of the survey.

The percentage of infants under six months who are exclusively breastfed has gone up from 54.9% in NFHS-4 (2015-16) to 63.7% in NFHS-5. There are still worries about pre-lacteal feeding and using bottles, especially in states like Uttar Pradesh and Uttarakhand, where pre-lacteal feeding is still pretty common.

According to reports, 45.9% of infants between the ages of six and eight months are getting complementary feeding. Only 11.1% of children between the ages of six and twenty-three months are getting a diet that meets the minimum standards. This shows that even though more women are giving birth in health facilities, there is still not enough help with feeding babies after birth.

Breastfeeding Support In India

Not breastfeeding enough can lead to several health problems that can be avoided. A study by Pérez-Escamilla et al 2016 noted that poor breastfeeding habits in the country cause about one lakh child deaths annually, mostly from diarrhoea and pneumonia. This problem causes about 34.7 million cases of diarrhoea and 2.4 million cases of pneumonia in children every year, as well as more than 40,000 cases of childhood obesity.

Breastfeeding is also beneficial for the health of the mother. The study says that not breastfeeding enough leads to more than 7,000 cases of breast cancer, 1,700 cases of ovarian cancer, and 87,000 cases of type 2 diabetes each year among mothers. These health problems also cost a lot of money to treat and care for, about ₹727 crore a year. More research shows that breastfeeding lowers the risk of being underweight, overweight, and getting certain noncommunicable diseases.

Despite the benefits, not all hospitals offer the same level of breastfeeding support. Some offer skin-to-skin contact and breastfeeding advice, but others do not have trained staff or basic procedures. For a lot of mothers, these first few hours set the tone for how they would feed their babies in the future.

The fact that work can be challenging is another issue. After giving birth, many women return to work two to three months later. It becomes difficult to continue breastfeeding in the absence of designated breastfeeding areas or safe breaks. Although the Maternity Benefit Act permits women to take 26 weeks of paid leave, it is not always followed, particularly in informal jobs, where the majority of Indian women are employed.

Enhancing Mechanisms to Encourage Improved Breastfeeding

To improve breastfeeding outcomes, more frequent training, better facilities, and clearer guidelines are required. Hospitals can guarantee that breastfeeding starts early by allowing mothers and infants to remain in the same room, permitting skin-to-skin contact, and providing easy access to lactation support. Health audits ought to guarantee the consistency of these procedures.

Regulations at work must also be taken into consideration. There should be clear rules about private spaces and nursing breaks in addition to maternity leave. These protections should be enshrined in labour laws and supported by systems that guarantee their implementation.

In rural areas, mothers typically speak with community health workers such as Anganwadi staff and ASHAs first.

Mothers in rural areas often talk to community health workers like ASHAs and Anganwadi staff first. Different states have different ways of training them on breastfeeding, and sometimes NGOs help with this. Low-income urban areas don't have the same level of support. To make sure that outreach is always the same, both urban and rural areas need a structured approach.

District and state health reports should include regular checks on breastfeeding indicators. World Breastfeeding Week awareness campaigns are helpful, but they need to be backed up by ongoing systems for collecting and analysing data.

India has improved public health by expanding programs like vaccinations and clean water. To improve breastfeeding outcomes, we need to plan, coordinate, and hold people accountable in the same way that we do for other parts of the health and social support system.

Authored by Dr Sabine Kapasi, CEO at Enira Consulting Pvt Ltd, Founder of ROPAN Healthcare, and UN Advisor. | Views expressed are the author's own.