Adequate breastfeeding to infants can reduce the mother’s diabetes and cancer chances

India ranks at 79 out of 98 countries that have policies and programmes for protection, promotion and support of breastfeeding and infant and young child feeding. An international study estimates that India could prevent 100,000 child deaths and more than 37 million episodes of diarrhoea and pneumonia if breastfeeding was adequate. Other benefits include reducing obesity and increased IQ in children, reduced cancers and Type 2 diabetes in women who breastfeed. But the infant and young child feeding practices are far from optimal. The NFHS-5 data revealed that 88 per cent women deliver in hospitals, 51 per cent are able to begin breastfeeding within an hour of birth, 61.9 per cent breastfed exclusively during 0-6 months, 56 per cent received timely complementary feeds at 6-8 months and only 16.1 per cent received adequate diet during 6-23 months. It shows 26.9 per cent children are underweight, 31.9 per cent stunted, 18.1 per cent wasted and 5.5 per cent obese. The World Breastfeeding Trends Initiative (WBTi) measures support to women for breastfeeding on 10 parameters. India lags behind 78 countries. The 10 parameters include governance and funding, support to women in hospitals, the enforcement of relevant infant feed legislation, maternity protection, and counselling services for the pregnant and breastfeeding mothers. India scored 1.5 out of 10 because it does not have an officially adopted policy, which hinders a dedicated plan of action and attached budgets. Giving priority to the policy and having coordination mechanisms can change the game.

The Government did launch the Mothers' Absolute Affection programmebut early breastfeeding has gone down by 2.5 percentage points because of dwindling quality of care in the hospitals and increasing caesarean sections. Other challenges are lack of enforcement of the law that controls marketing, inadequate human resources, overburdened health facilities, weak monitoring and evaluation mechanisms, and inability to involve private hospitals. India can bridge these gaps by institutionalizing lactation professionals in each hospital providing maternity services and assessment and monitoring of the hospitals against a benchmark of WHO’ sprogrammes. Involving key organizations working in this field and public health organizations, Association of Healthcare Providers of India (AHPI) can make a difference. There is a lack of readiness for supporting women and children during the disasters that occur frequently in the country. The National Disaster Management Plan, 2016 made a provision for 'baby foods' without even addressing its safety during feeding. It did not address the supply issue for supporting breastfeeding. This has changed now but remains to be implemented as per the revised plan of 2019. To bridge this gap State and district administration can prepare at least 50 breastfeeding/lactation counsellors, who will act as responders to provide emotional support to women with young infants to breastfeed and reduce the risk of artificial feeding. Ensuring adequate funding and coordination is another area that needs to improve. Funding estimates include approximately Rs 5 lakh for each hospital, about Rs 1 crore per district for human resources. Additional funds are needed for adequate, good quality and diverse diets for children. The private sector should be asked to make provisions and focus on maternity packages. In 2022, WBTi will do its sixth assessment and it is an an opportunity for India to jump the rank by investing in critical and foundational intervention in child health and nutrition.

(The writer is a doctor and Central Coordinator, Breastfeeding Promotion Network of India. The views expressed are personal.)