“Breastfeeding is the best feeding for infants. Every child has the right to successful breastfeeding.”
World Breastfeeding Week (WBW), celebrated annually from August 1 to 7, promotes the benefits of breastfeeding globally. Each year, WBW is dedicated to a specific theme to enhance, support, and protect breastfeeding. This year’s theme, “Closing the Gap: Breastfeeding Support for All,” emphasises inclusive support to ensure that all mothers receive the encouragement and assistance they need.
Breastfeeding is the best feeding for infants and is a natural and essential process that offers numerous health benefits to both infants and mothers. The World Health Organisation (WHO) recommends initiating breastfeeding within the first hour of birth and exclusively breastfeeding (giving only breast milk, not even water) for the first six months of a baby’s life. Afterward, breastfeeding should continue with the addition of age-appropriate complementary foods for up to two years or beyond. Breastfeeding is crucial for a child’s health and survival, promoting long-term well-being by providing numerous health advantages to both mother and child. Evidence-based reports suggest that breastfeeding alone can reduce the under-five mortality rate by 15 per cent.
Despite the knowledge about breastfeeding and its promotion through government programs, the rate of breastfeeding remains unsatisfactory. According to the National Family Health Survey (NFHS-5), conducted in India between 2019 and 2021, only 41.8 per cent of newborns were breastfed within the first hour of life.
The percentage of exclusive breastfeeding for infants up to six months of age was 63.7 per cent. The average duration of breastfeeding in India is approximately 29 months, but this varies based on socioeconomic status and whether the family is in an urban or rural location. States like Manipur (70.7 per cent) and Chhattisgarh (80.8 per cent) have higher breastfeeding rates, while Sikkim (28.3 per cent) and Meghalaya (42.7.1 per cent) have lower percentages.
The breastfeeding rates in the North East states present a concerning picture. According to NFHS-4 (2015-2016) and NFHS-5 (2019-2020) data, the early initiation of breastfeeding within one hour of birth has declined in all North Eastern states except for Meghalaya and Nagaland. In Meghalaya, the rate increased significantly from 60.6 per cent to 78.8 per cent, and in Nagaland, it rose from 53.1 per cent to 57.9 per cent.
Conversely, Sikkim experienced the steepest decline, dropping from 66.5 per cent to 33 per cent. In Assam, early initiation decreased from 64.4 per cent to 49.1per cent. The rate of exclusive breastfeeding saw slight increases in Assam and Meghalaya, from 63.5 per cent to 63.6 per cent and 35.8 per cent to 42.7 percent, respectively. However, other North Eastern states reported decreases in exclusive breastfeeding rates when comparing NFHS-4 and NFHS-5 data.
Societal and cultural views on breastfeeding vary widely, significantly influencing a mother’s decision. In some cultures, breastfeeding is stigmatised, while in others, it is highly valued. Factors contributing to this variation include a preference for formula feeding, misconceptions about breastfeeding, and insufficient public health messages promoting its benefits.
The World Health Organisation (WHO) estimates that increasing breastfeeding rates could save nearly 820,000 newborn lives annually. Breastfeeding provides numerous immediate and long-term benefits, such as promoting adequate growth and development in infants and reducing the risk of non-communicable diseases, illnesses, and deaths related to common infections.
A 2019 international study on the cost of not breastfeeding estimates that in India, inadequate breastfeeding results in 100,000 preventable child deaths (mainly due to diarrhea and pneumonia), 34.7 million cases of diarrhea, 2.4 million cases of pneumonia, and 40,382 cases of obesity. For mothers, the health impacts include more than 7,000 cases of breast cancer, 1,700 cases of ovarian cancer, and 87,000 cases of type-2 diabetes, with India spending Rs 727.18 crore on healthcare due to these illnesses.
Optimal feeding can simultaneously reduce the risk or burden of undernutrition, overweight, obesity, and diet-related non-communicable diseases (including Type 2 diabetes, cardiovascular disease, and some cancers). Despite its unparalleled value, breastfeeding rates remain low in India. One of the most effective ways to improve breastfeeding rates is to promote the early initiation of breastfeeding within one hour of birth, as this can be more easily achieved in institutional settings.
According to NFHS-5 (2021), while 88.6 per cent of women in India give birth in hospitals, only 41.6 per cent are able to start breastfeeding within an hour of birth. There are significant variations among states, highlighting the need to bridge the gap between institutional births and early breastfeeding initiation. For instance, states like Jharkhand and Uttar Pradesh show a gap of 70 per cent, with only 0.1-29 per cent of early initiation of breastfeeding.
Around 12 states, including Bihar, Chhattisgarh, Sikkim, Tripura, Telangana, and Rajasthan, need to close a gap of 50-70 per cent, with early initiation rates between 29.1 per cent and 49 per cent. Other states, such as Assam, Arunachal Pradesh, Meghalaya, Manipur, Nagaland, Mizoram, Punjab, Chandigarh, Kerala, and Odisha need to reduce the gap by 12 per cent to 49 per cent.
Improving breastfeeding rates can be achieved by providing comprehensive breastfeeding support to all women in both public and private maternity hospitals. However, institutional challenges exist, such as the separation of mothers and babies, particularly after cesarean sections, especially in private sector facilities. Other barriers include inadequately trained health staff, unnecessary use of infant formula due to commercial influences, and insufficient counseling and support for mothers during the antenatal and postnatal periods.
A World Bank study in South Asia, including India, identified these challenges. Implementing the “Breastfeeding Friendly Hospital Initiative” (BFHI) under the Government of India’s MAA program can help. This initiative promotes breastfeeding through a structured approach defined by the “Ten Steps to Successful Breastfeeding.” These steps include: having a written breastfeeding policy communicated to all healthcare staff; training all staff in skills necessary to implement the policy; informing pregnant women about the benefits and management of breastfeeding; helping mothers initiate breastfeeding within an hour of birth; showing mothers how to breastfeed and maintain lactation, even if separated from their infants; giving infants no food or drink other than breast milk unless medically indicated; practicing rooming-in, allowing mothers and infants to remain together 24 hours a day; encouraging breastfeeding on demand; giving no pacifiers or artificial nipples to breastfeeding infants; and fostering the establishment of breastfeeding support groups and referring mothers to them on discharge from the hospital. These steps aim to create an optimal environment for breastfeeding and support mothers in establishing and maintaining breastfeeding practices.
These steps aim to create an optimal environment for breastfeeding and support mothers in establishing and maintaining breastfeeding practices. Improving breastfeeding practices through dedicated support and education is essential for the health and well-being of both infants and mothers, ensuring a healthier future for all, and necessitating robust policy measures to support and promote breastfeeding at every level.
(Ginisha Kalsi is a Junior Research Fellow while Dr. Manisha Choudhury is an Assistant Professor, Department of Food Science and Nutrition, College of Community Science of Assam Agricultural University, Jorhat)
