This World Breastfeeding Week, India should be counting its successes--early initiation of breastfeeding is growing, and India has one of the world's longest durations of breastfeeding--given the overwhelming scientific evidence in favour of breastfeeding. Yet the data hides deep problems, many of them driven by unscientific cultural beliefs and poverty.
The crucial first hour and first day
The number of children who were breastfed within one hour of birth--a key WHO-recommended practice to ensure early initiation of breastfeeding with a significant impact on lowering neonatal mortality--nearly doubled over a decade, but remains low, and lower than the global average.
In 2005-06 (more recent data is not available for this), almost half of children had not started breastfeeding within a whole day of their birth, and more than half of mothers gave the child something other than breast milk--cow's milk, honey, water--to drink within the first three days of birth, both harmful practices often on account of cultural beliefs.
Exclusive breastfeeding finally grows
The share of children who were exclusively breastfed until they were six months old (a WHO-recommended norm, particularly in poor countries with high susceptibility to infection) has grown far more slowly, but is much higher than in the rest of the world, likely as a result of lower rates of women in the workforce and less access to alternatives like formula. In the United Kingdom, for example, just 1% of babies are exclusively breastfed to six months.
This is the first time this key indicator has grown substantially in India, says Dr Arun Gupta, central coordinator of the Breastfeeding Promotion Network of India, but it needs to grow further. "There is an assumption that India's culture is one of breastfeeding, so women do not need to be supported. Instead of lecturing women to breastfeed, the message that should go out to them is that if you are having trouble, here is the counsellor in the hospital you can talk to," says Dr Gupta.
Given the poor health condition of mothers, however, exclusively breastfed children can also be poorly nourished; 42.2% of women in India enter pregnancy underweight, compared with 16.5% of pre-pregnant women in sub-Saharan Africa, economist Diane Coffey found, and Indian women gain just 7kg or half the recommended weight during pregnancy. One in five children are born with a low birth weight, and 20-30% of children under the age of six months were undernourished as of 2005-06 even though they were being breastfed.
"Throughout India, pregnant women and their babies suffer the consequences of living in a deeply patriarchal society," Coffey said. "Young, newly married women, who are the most likely to become pregnant, are often expected to keep quiet, work hard and eat little."
Long-term breastfeeding may mask lack of food
Breastfeeding in India continues far longer than it does in most other countries--most Indian women are still breastfeeding their two-year-olds, while fewer than half of mothers do so globally. Poorer women in India breastfeed for longer than better off women, possibly indicating that the availability of a "free" food source might be driving India's long breastfeeding duration.
But largely as a result of poverty, families are not able to provide an adequate diet for children once they stop exclusively breastfeeding after the age of six months when breast milk is no longer enough. Less than half of all children aged 6-8 months are getting any solid or semi-solid food. Less than 10% of children between the age of 6 months and two years get an adequate diet, and this proportion is even lower among breastfed children. So while continuing breastfeeding might be something to encourage, especially in disease-prone environments, it cannot substitute access to healthy food.