SUPPORTING OPTIMAL BREASTFEEDING IN INDIA: WHAT WILL IT TAKE?

Over 800,000 under five child deaths in the developing world can be prevented through optimal breastfeeding of children under-two (Lancet 2013). Breastfeeding helps reduce child mortality, and improves nutritional status and neurocognitive development of children. Breastfeeding rates of children aged 0-5 months in India have improved considerably over the past eight years. In 2005-06, the National Family Health Survey reported that only 46.3 percent of Indian children were being exclusively breastfed. Recently, the Rapid Survey on Children (RSOC), reported that this rate had spiked up to 64.9 percent by 2014. Despite this improvement in rates, there is still much more that needs to be done in terms of enforcing and promoting women’s breastfeeding rights and capabilities in India.

UNICEF India/2014/Biswas

The World Alliance for Breastfeeding Action (WABA) has been coordinating annual World Breastfeeding Weeks for over two decades. This year (August 1-7, 2015) WABA calls for action to support women to combine breastfeeding with work, one of the major causes of low breastfeeding rates globally. Heymann et al. (2012) had found higher rates of exclusive breastfeeding in countries which guaranteed breastfeeding breaks at work. However, although a majority of countries (137 out of 148) had break policies in place for working women, no breastfeeding breaks existed in 45 countries. In India, a majority of women belong to the informal and agricultural sector, and are often not entitled to paid maternity breaks and flexible working hours and don’t have access to supportive work environments. Although social assistance schemes such as the Indira Gandhi Matritva Sahyog Yojana (IGMSY) cash transfer programme, are in place, strict eligibility policies restrict coverage of the schemes; as a result less than 1 per cent of women workers in India are eligible for maternity benefits (Lingam and Kanchi, 2013). But are lack of support, time and inaccessibility to social assistance schemes the only reasons behind low exclusive breastfeeding rates in India?

Poor knowledge of optimal breastfeeding practices and insufficient support from health and nutrition programs can also contribute to suboptimal breastfeeding, especially exclusive breastfeeding for the recommended period of 6 months. An evidence review conducted by the POSHAN team (Avula et. al (2013)), highlighted the role of using Village Health and Nutrition Days (VHNDs), home visits by health workers and group education sessions as platforms for delivering counselling on breastfeeding. The review also suggested that policies to support breastfeeding exist in India, but translating policies to deliver breastfeeding-focused services on the ground remains a challenge.  More recently, a POSHAN study on delivering nutrition interventions in Odisha (Avula et al., 2015) found that exposure to counselling on breastfeeding was very low (less than a third of mothers of children under 6 months) despite over 90 percent having received at least one home visit by a health worker in the last 3 months.  Although 90 percent of mothers reported having institutional deliveries and over 80 percent reported receiving breastfeeding counselling at childbirth, it was also unclear whether they had been counselled prior to birth. Although it is recognized that coordination between the Integrated Child Development Services (ICDS) and the National Rural Health Mission (NRHM) frontline workers was essential for delivering breastfeeding counselling and promoting optimal infant and young child feeding practices, the POSHAN study findings indicate that health workers are often not clear about their roles in relation to counseling mothers to support breastfeeding.

The reasons behind poor adherence to global breastfeeding recommendations are multi-dimensional, and an optimal strategy must consider multiple barriers. POSHAN research has highlighted an urgent need to strengthen existing health and nutrition programs and build frontline worker capacity and skills to deliver counseling and support services. This, together with other actions, can help to create a supportive environment to enable women to breastfeed.

Written by: Abhilasha Vaid, IFPRI