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India’s breastfeeding policies need improvement: report

Sep 10, 2015

The South Asian counties managed to advance much further because the policy makers prioritized optimum breastfeeding and infant and child feeding, something India has not been able to do so far.

New Delhi: Existing policies, programmes and schemes have fallen short of meeting the objective of enhancing Infant and Young Child Feeding practices said the ‘4th Assessment of India’s Policies and Programmes on Infant and Young Child Feeding’ , “Arrested Development”.

The report has been prepared by Breastfeeding Promotion Network of India (BPNI) and Public Health Resource Network (PHRN) and released by Nutan Guha Biswas, Addl. Secretary, Ministry of Women and Child Development, Government of India.

Assessment done as part of the World Breastfeeding Trends Initiative (WBTi) reveals gaps in all ten areas of policies and programmes to be implemented for enhancing breastfeeding rates. The report provides an objective assessment on infant and young child feeding (IYCF) policies and programmes as well as practices, with India scoring a total of 78 out of 150 indicating the nation has made little improvements since its last assessment in 2012.

Breakdown of the overall score revealed a major drop during the assessment of indicators 1 (Policy, Programme, & Coordination), 2 (Baby Friendly Hospital Initiative), 4 (Maternity protection), 9 (Infant Feeding during Emergencies) and 10 (Mechanisms of Monitoring & Evaluation System).

Reasons for this stagnation include non-converting IYCF guidelines into a policy, non-functioning of the BFHI programme for over a decade, non-review of the maternity benefit laws, neglecting infant feeding in the disaster management programme, infrequency of surveys and the paucity of national data.

Little improvement was seen in the scoring of indicator 3 (Implementation of the International Code of Marketing of Breastmilk Substitutes), 5 (Health & Nutrition Care System), 6 (Mother Support & Community Outreach) and 8 (Infant Feeding & HIV).

As per Dr Arun Gupta, Regional Coordinator, IBFAN ASIA, Central Coordinator, BPNI, “Though there are some welcome advances displayed in India’s current assessment, there are even more missed opportunities to actualize potentially easy gains. These missed opportunities reflect the failure of key decision makers in giving issues related to Infant and Young Child Feeding priority and due attention. The report underlines the need to create an optimal environment towards the health and well-being of all children and their families.”

He added, “It is not understandable why only 44% women are able to begin breastfeeding within one hour when more than 75% deliver in institutions as claimed by our Prime Minister during his speech few days back at the “Global Call to Action Summit 2015”.

The World breastfeeding Trends Initiative (WBTi) is adapted from the World Health Organization (WHO) tool developed by International Baby Food Action Network (IBFAN) Asia for assessing and monitoring the state of implementation of the Global strategy for Infant and Young Child Feeding. It is currently being implemented in more than 100 Nations. The assessment is done on the basis of scoring given to the questions answered for each of the defined indicators. Being 15 in number, indicators 1 to 10 deal with IYCF policy and programmes and 11 to 15 deal with IYCF practices.

Breastfeeding Promotion Network of India (BPNI) and Public Health Resource Network (PHRN) jointly coordinated the India Assessment 2015, between February and June 2015 using the revised WBTi 2014 tool. Typically done every 3 to 5 years, the aim of the survey is to study the impact and trends of various related policy measures.

This round of assessment and analysis for India comes at a time when major cuts have been announced in the social sector budgets related to education, health, and nutrition, including a massive cut in the Integrated Child Development Services scheme. Even though it has been over two years to National Food Security Act, rules are yet to be finalized. The experience of those working at the grass-roots also suggest that problems of implementation of existing schemes and programmes for children are grave and likely to be exacerbated by the budget cuts.

Analysis of the report further revealed that there is still a lot of scope for improvement and India can make significant gains over the next three years if priority is given to addressing indicators currently not performing well.

Given that 44.6% initiate breastfeeding within one hour, 50.5% babies receive complementary foods within 6-8 months, 64.9% get exclusive breastfeeding( RSOC 2014 data), it means out of 26 million born in India  14.5 million children are not able to get optimal feeding practices during the first year of life.

“All these indicators can be improved by simple and doable means not requiring vast investment but better coordination and conscious governance. There is scientific evidence available to support the actions that need to be taken in these indicators given the tools and training materials are readily available,” said Dr Vandana Prasad, National Convener, PHRN & former Member, National Commission for Protection of Child Right.

As per the 2012 WBTi report, India scored a total of 74 out of 150 which was much lower than that scored by Afghanistan (99/150), Bangladesh (107.5/150) and Sri Lanka (129/150). The South Asian counties managed to advance much further because the policy makers prioritized optimum breastfeeding and infant and child feeding, something India has not been able to do so far.

“The assessment report is an opportunity to policy makers and programme managers to raise India’s score by the time the next assessment comes around,” added Dr Gupta.

Aggressive promotion of baby foods, lack of support to women in the family and at work places, inadequate health care support and weak overall policy and programmes were some of the reasons because of which infant and young child feeding practice indicators have not shown a consistent rise. The 2014 report of Euromonitor International has estimated a market worth 22 billion Rupees in India, and one that is growing each year, (Rupees 12666 to 22,693 million from 2007 to 2012) “Sales of infant formulas and infant foods are increasing at a rapid pace in India, which is a cause of concern,” said Dr J P Dadhich National Coordinator, BPNI.

The WHO has identified ‘poor infant feeding’ as a risk factor for survival of the child. It also estimates that 53 percent of pneumonia and 55 percent of diarrheal deaths are attributable to poor feeding practices during the first six months of life. Several studies have shown that initiation of breastfeeding within the first hour of birth decreases neonatal deaths by 22%.

Several professionals , civil society groups and international agencies have signed up a Call to Action to Government of India to take actions to bridge the gaps including development of plans of action that are monitored and  coordinated, sanctioning budget, reviving the Baby Friendly Hospital Initiative (BFHI),  enforcing the IMS Act, and implementing  maternity entitlement for all women.

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