Context
- Data from the National Family Health Survey-6 (NFHS-6) reveals a concerning public health trend: despite significant strides in institutional deliveries and maternal health parameters across India, the rate of Exclusive Breastfeeding (EBF) for infants under six months has seen a sharp decline.
Key Findings from NFHS-6 Data
The shift in maternal and child health indicators between NFHS-5 and NFHS-6 highlights a critical disconnect:
- The Decline in EBF: Nationally, exclusive breastfeeding for infants under six months dropped from 63.7% in NFHS-5 to 55.8% in NFHS-6.
- The Urban-Rural Divide: The decline was unexpectedly steeper in rural sectors than in urban centers:
- Rural areas: Fell from 65.1% to 56.2%.
- Urban areas: Fell from 59.6% to 54.5%.
- The Institutional Success Paradox: This drop occurred alongside a rise in institutional deliveries (improving to 90.6%) and a noticeable expansion in the early initiation of breastfeeding within one hour of birth (climbing from 41.8% to 50.1%).
- State-Wise Trends:
- Sharp Declines: States like Uttar Pradesh (dropped to 34.6%), Haryana (dropped to 41.2%), and Delhi (dropped to 54%) recorded significant contractions.
- Improvements: Notable gains and strong performances were reported in Kerala, Gujarat, and West Bengal.
What is Exclusive Breastfeeding (EBF)?
Exclusive Breastfeeding means:
- Feeding an infant only breast milk for the first six months of life.
- No water, formula, animal milk, or solid foods, except:
- Oral Rehydration Solution (ORS)
- Vitamins
- Minerals
- Prescribed medicines
· WHO & UNICEF Recommendation: Initiate breastfeeding within one hour of birth.
Major Drivers Behind the Decline
- Economic & Labor Realities: Over 16.69 crore women are registered on the e-Shram portal as informal sector workers. Women in the informal sector often lack financial cushions or formal workplace adjustments, meaning they must return to manual or migratory labor within weeks of childbirth.
- Legislative Disconnect: The Maternity Benefit Act, 1961 (amended in 2017) guarantees 26 weeks of paid maternity leave, but these protections remain largely restricted to the organized sector, leaving the vast majority of working mothers vulnerable.
- Medical Obstacles: The rise in Caesarean-section (C-section) delivery rates (rising from 21.5% to 27.2%) introduces early complications, including delayed lactation initialization, perceived low milk supply, and a lack of consistent post-operative lactation counselling.
- Commercial Pressure: Aggressive marketing of infant formula milk alternatives places unnecessary pressure on mothers, causing formula to be used as a premature substitute rather than an essential medical fallback.
Government Initiatives & Regulatory Framework
- The IMS Act: The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992 strictly protects breastfeeding from commercial market forces by banning the advertisement and promotion of infant formula.
- Pradhan Mantri Matru Vandana Yojana (PMMVY): A conditional cash transfer scheme providing partial wage compensation to pregnant and lactating mothers to ensure adequate rest and nutrition.
- Saksham Anganwadi and POSHAN 2.0: Oversees nutrition delivery services under the Integrated Child Development Services (ICDS) structure.
Consider the following statements regarding Exclusive Breastfeeding (EBF):
1. It means feeding infants only breast milk for the first six months of life.
2. WHO recommends initiating breastfeeding within one hour of birth.
3. Water may be given to exclusively breastfed infants during the first six months.
Which of the statements given above are correct?
A. 1 only
B. 1 and 2 only
C. 2 and 3 only
D. 1, 2 and 3
The correct answer is B. 1 and 2 only.
Explanation:
• Statement 1 is correct: Exclusive Breastfeeding (EBF) means that the infant receives only breast milk (including milk expressed or from a donor) for the first six months of life.
• Statement 2 is correct: The World Health Organization (WHO) and UNICEF explicitly recommend initiating breastfeeding within one hour of birth and continuing it exclusively for the first six months.
• Statement 3 is incorrect: Under Exclusive Breastfeeding, no other liquids or solids—not even water—are given to the infant during the first six months, with the exception of oral rehydration solutions, drops, or syrups containing vitamins, minerals, or medicines.