By Shalini Bhardwaj

New Delhi [India], June 1 (ANI): During the National Family Health Survey (NFHS-6) survey period, 95.6% of infants under six months were being breastfed, which indicates that breastfeeding remains nearly universal in India. However, if exclusive breastfeeding (EBF) under six months has declined, it suggests that more infants are receiving additional foods or liquids along with breast milk before completing six months.

'According to recent family health surveys, there is a decline in breastfeeding in India, which is quite paradoxical because there has been a major improvement in the maternal mortality rate because of institutionalization of childbirth. Now, why this is happening is probably because the urban caesarean deliveries have increased, and hence, early initiation of breastfeeding doesn't happen very easily. There is a commercial influence on baby food,' said Dr Abha Majumdar, Centre of IVF and Human Reproduction, Sir Gangaram Hospital

'There is so much baby food available, and there are campaigns which sort of undermine breastfeeding practices by saying that formula feeding is the best for the baby. And the largest reason is that maternity leave is very limited in India, and in some places it may be as little as one month to as much as three months. And hence many working mothers face limited maternity leave, lack of designated lactation spaces at workplaces and then the family support is also not so much there,' Dr Abha explained

'So either they express breast milk, refrigerate it and leave it for people at home to feed the baby and slowly, slowly this becomes very cumbersome, and hence they fail to breastfeed the baby beyond the time they have exclusively been with the baby, that is for the initial two, three months, after which the work takes priority in their lives,' she added.

According to Dr Sheetal Agarwal, Consultant - Senior Gynaecologist and Obstetrician, Rainbow Hospital, said, 'The main reason is lack of workplace support with short maternity leave. Lactation failure in mothers is mainly due to stress and pain due to mastitis and sore nipples, thereby discouraging the mother to breast feed.'

However, Breastfeeding remains widespread, and almost all infants continue to receive breast milk. Awareness about the importance of breastfeeding appears to be high in some states, like Sikkim, which registered the biggest improvement, rising from 28.3% to 49.6%, Kerala, 55.5% to 72.7%, which is one of the highest rates.

In Jharkhand, the proportion of children under six months who are currently breastfeeding increased from 95.8% to 96.4%, while in Karnataka it rose from 92.4% to 93.8%, and exclusive breastfeeding increased slightly from 61.0% to 61.6%.

However, in some states such as Assam, exclusive breastfeeding has declined, while the proportion of children under six months who are currently breastfeeding has increased significantly to 98.4%, which is the highest from 95.4% in NFHS 5.

Exclusive breastfeeding practices have also declined in Arunachal Pradesh, although the proportion of children under six months who are currently breastfeeding has increased significantly from 86.5% to 95.1% overall. Similarly, Bihar has shown an improvement in exclusive breastfeeding, rising from 58.9% to 62.5%, while current breastfeeding among children under six months has also increased from 94.9% to 96.9%.

A growing proportion of infants are being given water, animal milk, formula, honey, gripe water, or complementary foods before six months.

This reduces the share of exclusively breastfed infants even though they are still being breastfed. The challenge is not initiation, but adherence. Mothers are continuing to breastfeed, but many are not following the WHO recommendation of giving only breast milk for the first six months.

Possible reasons for the decline in EBF are increased use of formula or packaged infant foods.

Early introduction of complementary feeding due to cultural practices. Return of mothers to work and inadequate maternity support. Misconceptions that breast milk alone is insufficient.

'Policy implication, programmes should focus not only on promoting breastfeeding but also on promoting exclusive breastfeeding for the first six months, along with counselling families and caregivers,' say experts.

Dr Sandeep Chadha, senior gynaecologist and obstetrician, Cloudnine, Noida, says, 'Patient doesn't want to do exercise at all during pregnancy, and doctors also don't motivate for a normal delivery. Most of the time, due to a C-section, mothers avoid feeding. In some cases, when a baby is hungry even after being fed, family members start giving top feeding, which is also a big problem. Both the mother and the doctor should make efforts.'

The percentage of children under the age of 6 months currently breastfeeding in Goa remains the same, 100 %. Haryana recorded the steepest decline, with exclusive breastfeeding dropping from 69.5% to 41.2%, while Uttar Pradesh saw a decline from 59.7% to 34.6%

'Working parents want the baby not to be dependent only on their feed. Increasing choice of formula feeds and ease of administration through feeder bottles. An increasing number of cases with delayed ambulation of the patient,' said Dr Richa Singhal, senior consultant, Cloudnine Hospital, New Delhi.

According to Dr Rahul Verma, Director of Paediatrics and Neonatology at Sir HN Reliance Foundation Hospital, Mumbai, to turn this around, we have to act across three distinct levels.

At the national level, we need strict, zero-tolerance enforcement of the Infant Milk Substitutes (IMS) Act to clamp down on the aggressive digital marketing and indirect promotion of baby formula. Paid maternity leave also needs to be expanded and strictly implemented across both the formal and informal sectors, so working mothers actually have the time to breastfeed.

At the institutional level, hospitals and clinics cannot just celebrate a safe delivery and send the mother home. Post-natal care must include structured, mandatory lactation counselling that involves the family, not just the mother. Doctors and nurses need to actively counsel grandmothers and husbands during prenatal and postnatal visits, educating them on baby cues, normal crying patterns, and how to track wet diapers to prove the baby is getting enough milk. This directly disarms family pressure with scientific facts.

At the individual and household level, we have to shift the burden off the mother alone. Families need to realise that the best way to increase milk supply is to reduce the mother's stress. Instead of questioning her milk supply, family members should take over household chores, manage visitors, and give the mother a peaceful environment to bond with her baby.

To manage anxiety, mothers should be encouraged to practice skin-to-skin contact, which naturally boosts the hormones responsible for milk production, and feel empowered to say no to unsolicited advice. (ANI)