The recent call by the UN to view breastfeeding as a human rights issue and should be protected and promoted for the benefit of babies and mothers has come as a welcome step as few nations have necessary stringent, comprehensive and enforceable legal measures to curb the menace of infant formula that is flourishing across the world and India, in particular.
There have been numerous instances of newborn babies being fed infant formula substitutes as their first meals, often without the mother’s knowledge. Despite delivering healthy babies, new mothers do not get to hold them or feed them immediately after birth. Most parents go for formula milk simply because the doctors have recommended them to do so. Once dependent on formula milk, mothers face extreme difficulty in getting back to breastfeeding in the long run.
In India, 14 million babies out of 26 million are exposed to health risks due to introduction of either powder milk or animal milk based formula within hours of their birth. According to World Health Organisation, “Powder Infant formula is not sterile.” Yet we remain silent. But why?
Giving other liquids and fluids and foods to babies less than six months is full of risks. According to the WHO, infant formula does not contain the antibodies found in breastmilk. The long-term benefits of breastfeeding cannot be replicated with infant formula. When infant formula is not properly prepared, there are risks arising from the use of unsafe water and unsterilised equipment or the potential presence of bacteria in powdered formula. Malnutrition can result from over-diluting formula to “stretch” supplies. While frequent feeding maintains breastmilk supply, if formula is used but becomes unavailable, a return to breastfeeding may not be an option due to diminished breastmilk production.
In India, about 12 million infants get breastfeeding within an hour but 14 million infants don’t, as recommended by the WHO and Government of India’s health guidelines. Keepers of the law that protects their rights in India are seemingly not aware. This is a huge challenge. But once we meet that, the story could be reversed and risks reduced.
As per Euromonitor report, about 27 million containers of infant formula are sold every year in India meant for babies between zero to six months. This number is staggering. Almost equal to the number of babies born and plays a disrupting role in breastfeeding practices at a very nascent stage. This is no surprise that India’s rate of breastfeeding within one hour is 44 per cent even though 80 per cent women do deliver in health facilities.
There are reports that infant formula is introduced to babies without the consent of mothers. That is even more surprising given the risks. Introduction of formula milk to newborns is a serious problem that leads to drop out of breastfeeding. This not only deprives the newborns of highly nutritious and antibody laden colostrum or the mother’s “first milk” but contributes to lactation failure.
The Union health minister, J.P. Nadda, rightly put this point across most succinctly when he said during the launch of the national programme to promote breastfeeding last August, “What was natural has been made unnatural by market forces.”
Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, (IMS Act) and Amendment Act 2003 should be effectively enforced in its letter and spirit. This strong law restricted the growth of milk formula in India. From 2008 to 2012, sales grew from 24,428 to 27,783 tonnes. During the same period, in China, where the law is not that stringent, sales went up from 2,94,800 to 5,60,000 tonnes. This means in China sales are twenty times higher.
Can we minimise this problem? Yes, we can. It requires some investment. Women need accurate information about breastfeeding and risks of formula feeding before being introduced. Taking consent before introducing something harmful to the baby should be mandatory which is not the practice these days. It is just been given and accepted as “doctors” or “health” advice and must be good.
There have been few success stories in hospitals where skilled counsellors have assisted and supported women at the time of birth and later during breastfeeding.
However, this trend is yet to catch up. Hospitals need to realise that having such counsellors could be a good business model for private hospitals and at the same time help improve their image too. The Government of India had earlier embarked on Baby Friendly Hospital Initiative where “10 Steps to successful breastfeeding” applied and feeding bottles and infant formula were out. It’s time that such programmes are relaunched.
Dr Arun Gupta is national coordinator of the Breastfeeding Promotion Network of India