E-Paper
Breastfeeding as the foundation for lifelong good health
This article is authored by Lalita Panicker.
India’s needs a cohort of healthy, productive young people to lead the way to the future. The building blocks for this begin in infancy, namely in nutrition. As we observe World Breastfeeding Week, let us relook at this vital input to infant health. In the first six months, breast milk alone meets almost all of a baby's needs. The antibodies present in the mother's milk protect infants against the diarrhoea and pneumonia that account for a large share of infant and young child deaths in India. The child needs a nutritious and varied diet after six months, along with breastmilk, for the brain and body to reach their potential. The first two years of a child’s life impacts on her/his development throughout life. The cognitive gains missed in this period are not easily recovered and this will have a deep effect on the child’s life as she/he enters school and later as she/he becomes an adult.
This foundation in childhood is very important for India which has a young demographic. A young generation that begins life undernourished will morph into a workforce that is not only less healthy but also less productive. This could lead to what economists have warned us about, that India is growing old before it grows rich.
NFHS-6 records that wasting, which reflects acute undernutrition and carries a higher immediate risk to a child's life, has not changed much from the previous one—it has come down 19.0% from 19.3%, one of the highest in the world. One indicator of a child's survival, namely exclusive breastfeeding among infants under six months, declined, from 63.7% to 55.8%. This means breastfeeding begins at birth but is not sustained through the first six months, once the mother and infant are home.
After the first six months, there is complementary feeding along with breastmilk. The share of children aged 6 to 8 months receiving solid or semi-solid food alongside breast milk rose from 45.9% to 59.5%. Yet only 15.3% of children aged 6 to 23 months receive what the WHO defines as a minimum acceptable diet, measured by the diversity of foods and the number of daily meals, up from 11.0% in NFHS-5. Solid food is often of poor quality, which means many children are without an adequate diet in the second and third years of life.
Adhunika Prakash, founder, Breastfeeding Support for Indian Mothers (BSIM), says, “For a health issue which impacts 100% of the population, breastfeeding doesn’t get the importance it deserves. We have gone from a nation which would breastfeed babies until they themselves stopped breastfeeding to a nation where most mothers aren’t exclusively breastfeeding even for six months. Most countries which have a high breastfeeding rate use a multi-pronged approach to protecting breastfeeding and for good reason; investment in breastfeeding is known to reduce health care costs and to improve overall health outcomes of the general population. Most medical professionals in India receive little to no lactation education as part of their curriculum. Including lactation education as a mandatory part of their education would be a game-changer. Mothers, irrespective of the socioeconomic background they come from, should also receive one-on-one support from a lactation counsellor to reach their breastfeeding goals.”
Dr Naveen Thacker, executive director, International Paediatric Association (IPA), adds, “Breastfeeding is one of the most effective ways to give every child the best start in life. India has made encouraging progress in helping mothers begin breastfeeding soon after birth but sustaining exclusive breastfeeding for the first six months remains a challenge. Once mothers leave the health facility, many face limited support, workplace pressures and inconsistent counselling. Some mothers and babies, especially those with preterm births, low birth weight or caesarean deliveries, need even greater support, and these challenges may be contributing to the decline in exclusive breastfeeding. India already has strong policies and programmes in place. The priority now is to ensure every mother receives quality lactation counselling before discharge from hospital, strengthen initiatives like the Baby Friendly Hospital Initiative, and provide continued support in the community. Early initiation is an important first step, but it is sustained support that enables mothers to breastfeed successfully for six months. Breastfeeding is not a mother's responsibility alone--it is a shared one. Mothers need encouragement and practical support from their families, guidance from health care providers, and workplaces that give them the time and space to breastfeed or express milk. Policymakers also have an important role in creating an environment where breastfeeding is protected and supported. This is especially important for working mothers, who often face greater challenges in continuing exclusive breastfeeding. India has strong initiatives such as the MAA, LaQshya programme and human milk banks for vulnerable newborns. But our priorities must be to expand workplace breastfeeding support, strengthen donor human milk banking and ensure every mother has access to quality lactation counselling. When mothers feel supported--not judged--they are far more likely to breastfeed successfully, giving every child the healthiest possible start in life.”
Several states have made improvements in this field. Sikkim recorded the largest gain, up 21.3 points to 49.6%. Kerala rose 17.2 points to 72.7%, the highest in the country, with Gujarat close behind, up 6.4 points to 71.4%. West Bengal (up 5.1 points to 58.4%) and Bihar (up 3.6 points to 62.5%) also rose. Gains of this scale suggest that deliberate efforts have been made to support mothers rather than leaving them to manage on their own: One-to-one and peer counselling in the community, and the active involvement of fathers and grandmothers in feeding decisions.
The steepest declines are in the large northern states, several of which were among the country's stronger performers in the last round of the survey. Exclusive breastfeeding has dropped 28.3 points in Haryana (to 41.2%), 25.1 points in Uttar Pradesh (to 34.6%), 17.6 points in Madhya Pradesh (to 56.4%) and 16.1 points in Rajasthan (to 54.3%), down from around 60% to 74% in NFHS-5.
This means breastfeeding is being started but not sustained, with the drop coming in the weeks after birth. Based on the available evidence, some of the most likely factors include:
Changing delivery patterns and institutional support: Changing delivery patterns make post-caesarean breastfeeding support an important institutional priority. Caesarean deliveries are up from 21.5% to 27.2% between the two rounds, and are far more common in urban areas (around 40%) than rural ones (around 23%). A growing share of births are taking place in private facilities, with the share of institutional births in public facilities falling from 61.9% to 58.6%. A caesarean makes the first hours of feeding harder: Mother and baby are often separated during recovery, and pain and limited mobility delay the first feed.
Formula introduced in the early days: Aggressive marketing of breast-milk substitutes is a long-recognised driver of decline in exclusive breastfeeding, which is why the Infant Milk Substitutes, Feeding Bottles and Infant Food Act bans all promotion of infant formula, feeding bottles and related products, and makes violations an offence. Enforcement, however, is uneven. Violations continue to be documented, from the marketing of formula and feeding bottles to, more recently, promotion on social media.
Maternity protection that reaches few mothers: India provides 26 weeks of paid maternity leave, among the most generous in the world, but this is largely in the formal sector. Over 90% of working women are in the informal sector, and return to work without legally-protected time to breastfeed their children. They are covered instead by a cash benefit, the Pradhan Mantri Matru Vandana Yojana, but at ₹5,000 to ₹6,000 for a first child, it is hardly enough compensation and comes with no protected time off.
Limited support after mother and child return home: Breastfeeding is sustained, or lost, in the weeks after birth, yet support in that window is thin. Women lack lactation counselling, there are few places to breastfeed or express milk at workplaces, markets and transport hubs. Where structured support exists, exclusive breastfeeding lasts longer.
With sustained efforts, there can be significant improvements. Kerala stands out as a state that has worked on breastfeeding steadily and seriously, exclusive breastfeeding has risen from 55.5% to 72.7% and early initiation from 66.7% to 82.3% between the two rounds. It was the first state to be recognised as baby-friendly, in the 1990s. It has since launched a certification programme, called the Mother and Baby-Friendly Hospital Initiative, run with IAP Kerala and the state health mission, which regularly checks whether maternity wards actually follow good breastfeeding practices. Hospitals in the state provide lactation counselling, kangaroo mother care for small and premature babies, and human milk banks for newborns who cannot get their mother's milk, support.
Dr Ramesh Agarwal, professor and chief, division of neonatology, Department of Paediatrics, AIIMS, New Delhi, says, “Frankly speaking, I do not suspect anything wrong has happened in the last four years. Successful breastfeeding requires education and capacity-building for mothers and families starting from the antenatal period. The initial support that the mothers need to successfully breastfeed their babies is considerable. It is not simply telling the mother that breastfeeding is good. A provider or a family member really needs to provide physical and emotional support to the mother during initiation and subsequent successful feeding. This has become even more important given increasing C-section rates. The health facilities have become busier, and providers find it difficult to spare enough time. Also, there has to be commitment from everyone, especially those around mothers, to support breastfeeding. By any measure, breastfeeding remains the most effective intervention not only to improve survival and child development but also to enhance longer-term health outcomes. Successful breastfeeding is not just the mother's responsibility; the onus lies with everyone, including families, health care providers, workplaces, and policymakers. The families need to understand that the mothers need physical support, making sure they eat well, and most importantly, psycho-emotional support. Providers must be skilled and spend time enabling the mother in initiation and subsequent support to feeding. Workplaces and even public places must provide proper facilities for mothers to feed their babies. The government sector provides six months' leave and an additional two years for childcare, but the private sector lags considerably. The informal sector has hardly any support available to mothers. This needs to change.”
(The views expressed are personal)
This article is authored by Lalita Panicker.
