India's indifferent approach on breastfeeding hurts child health: Experts

Even after nearly three decades since the passage of one of the strongest acts - Infant Milk-substitutes Act (IMS Act) - for community child health and breastfeeding practices, corporate interest from global baby-food lobby is seen derailing the efforts put by the government and health professionals.

The 29th World Breastfeeding Week concluded on August 7, 2021 and experts see much ground still to be covered for India to effectively implement best practices in breastfeeding and child health.

"In India, we have one of the best laws, that is globally appreciated for community child health. But even after 30 years of the Act, there are violations detected which defeats the very objective of the law. Unfortunately, the government action on violations is missing. The corporate takes advantage of it and silently push their baby-products, which are otherwise banned under the law," said Dr Arun Gupta, central coordinator of Breastfeeding Promotion Network of India (BPNI). The Indian Parliament has tasked BPNI with monitoring of the law, while investigation and prosecution for the violations rest with the Government.

Violations tip of the iceberg

A latest BPNI report on breastfeeding and monitoring of IMS Act between January 2019 and May 2021 revealed frequent violations by baby-food companies to entice mothers to use their product in place of breastfeeding. It reported 33 such violations of different sections of the Act indicating it as just tip of the iceberg. IMS Act covers infant milk substitutes, feeding bottles and infant foods. The Act prohibits any kind of promotion by any means. It also prescribes labelling requirements and standards for these products.

As per the trade estimates, In India, powdered milk consumed by the infants and young children up to 3 years of age, stands at 29,836 tonnes worth ₹3,500 crore. This consumption has increased from 22,000 tonnes in 2010 and is likely to increase to 31,400 tonnes by 2024.

India’s poor score on breastfeeding

As a result of poor monitoring and policy implementation India struggles in global rankings for breastfeeding practices. As per the World Breastfeeding Trends Initiative (WBTi) - a global body, India ranked 79 with a score of 45 on 100 counts. The top five countries included Bangladesh, Sri Lanka, Afghanistan, Cuba and Gambia for higher score on ten key areas. These include policy, governance, baby-friendly hospital initiatives, implementation of international code of marketing for breastmilk substitutes, maternity protection, counselling for pregnant and breastfeeding mothers and infant feeding.

Even as the percentage of institutional births has improved from 82 per cent to 88 per cent, the awareness about the exclusive breastfeeding for 0-6 month is still not encouraging. As per the data, the rate of early breastfeeding during 0-6 months had fallen from 53.7 per cent in 2015 to 51.1 per cent in 2020. "This is serious. It shows that India has not made progress on supporting, promoting and protecting breastfeeding at the policy and programme implementation level. There is visible change in the social thinking though in past 30 years," said Gupta.

On ground practice a challenge

In Kutch district's Gandhidham, paediatrician Dr Rajesh Maheshwari reveals that in early 2000s, the district had encouraging rate of early breastfeeding as constant awareness campaigns were conducted. "But after the 2001 earthquake the priorities changed and again we are back to square-one in terms of practice of early breastfeeding. We have observed a common practice of gynaecologists encouraging parents to use breastmilk substitutes in cases of caesarean section deliveries. This leave the child with weakened immunity and underdeveloped brain," Maheshwari said.

WHO recommends breastfeed of a child from the very first hour of the birth right up to six months. "Breastmilk substitutes can be recommended only for mothers who are sick and unable to breastfeed, or mother with twins or for orphaned kids. But there is no watch or monitoring at clinic level to ensure good practices," Maheshwari said.

An associate professor at Baroda Medical College, Dr Maulik Shah looks at the issue from an awareness aspect. "The main problem is the lack of awareness. We don't educate our would-be mothers or girls about the importance of the breastfeeding to a child. Our society expects mothers to know all aspects of raising a kid. But in the growing trends of nuclear families, the knowledge doesn't get passed on from the earlier generations," he said.

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