Out of approximately 22 million babies born in India each year, less than 10 million are breastfed within the first critical hour of life. That leaves over 12 million missing out on the immediate benefits of breastfeeding that is proven to reduce the risk of infections, obesity, and non-communicable diseases later in life. This statistic is both shocking and unacceptable, especially in a country still struggling with newborn infections and mortality.
This raises the question: Why can’t our hospitals be breastfeeding-friendly?
A former representative of a major formula company says distributors are offered a volume bonus and doctors and nursing staff cash incentives for recommending infant formula. Shockingly, even monthly “honorariums” to doctors are not unheard of. And, apart from this, there are of course other ways to incentivise medical practitioners.
This troubling revelation could perhaps explain why so many hospitals are failing to prioritise breastfeeding. Reports keep reaching the Breastfeeding Promotion Network of India (BPNI) about the unnecessary use of formula from across states. Evidence indicates that if the health system is weak on breastfeeding counselling, and health workers lack skills to support breastfeeding, it leads to replacement by formula even when the mother wasn’t initially keen. Heavily discounted prices on formula makes it easier.
Instead of investing in the WHO-UNICEF’s 10 Steps, which ease breastfeeding by new mothers, many institutions jump to formula, contributing to a significant public health concern. Between 2016 and 2021, early breastfeeding rates declined in 17 states across India, as per the National Family Health Survey data.
Formula feeding comes at a cost — both to the health of the newborns and the mothers themselves. It impacts the family economy as formula in the long run proves expensive in terms of relative cost and the consequences for infant immunity in the absence of breastfeeding. For mothers, breastfeeding reduces the risk of postpartum bleeding, depression, helps with postpartum recovery, and can lower the risk of certain cancers. Despite these benefits, hospitals don’t give it the priority it deserves.
And when paediatricians promote formula instead of breastfeeding, thinking mothers don’t produce enough milk, it’s hard for new mothers to make an informed choice. The influence of formula companies plays a major role in undermining breastfeeding efforts in hospitals.
The problem becomes more acute in the case of Caesarean deliveries, which account for 47.4% of the births in private and 14.3% in government facilities. This means in 5.7 million births, formula becomes the default. Many mothers who undergo C-sections are assumed to be unable to breastfeed or needing rest. If supported in initiating breastfeeding, many C-section mothers can breastfeed successfully.
Though the private sector accounts for approximately 8 million births annually in India, there is no stipulation on them to promote breastfeeding, while public hospitals are held to certain standards under government guidelines. Private maternity hospitals often prioritise financial gain, convenience, and efficiency.
They must be held accountable for encouraging early breastfeeding by the Union health ministry setting guidelines and enforcing compliance. Clear regulations, proper training for staff, and accountability measures are essential to ensure that the first hour of life, often called the “golden hour,” is dedicated to skin-to-skin contact and breastfeeding, not formula promotion.
When it comes to breastfeeding, women are often shamed for not doing enough. But the problem isn’t with the mothers, it’s the system. The health care institutions and the broader environment around birth are unsupportive. Thus, the onus should be on hospitals and health care providers to create an environment where breastfeeding is the default choice. With more than half of the nation’s births missing out on breastfeeding in the first hour, the urgency of this can’t be overstated.
Both the public and private sector must be compelled to turn hospitals into breastfeeding-friendly spaces. It must be impressed upon doctors, hospital managements and staff that the Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003 (IMS Act) are applicable to every citizen. It bans the promotional efforts of commercial formula. The government must enforce it effectively and hospitals end unnecessary use of commercial milk formulas following WHO guidance on its use.
The government must issue an advisory to all maternity services to implement all the WHO-UNICEF’s 10 Steps and Mother’s Absolute Affection (MAA) programme of the Union health ministry and stop using formula without parents’ informed consent. The government, the private sector, and the civil society have to commit to bridging the gap in five years, if not earlier. Otherwise, we will continue to fail millions of mothers and babies across India.
Arun Gupta is a paediatrician and coordinator of Breastfeeding Promotion Network of India, a 33-year-old non-profit. The views expressed are personal
