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Breastfeeding and the law
‘Mother has right to breastfeed her child’
The Gujarat High Court has ordered Ahmedabad Civil Hospital to ensure that a woman breastfeeds her newborn girl, who was weaned away from her mother by her parents because she was a lovechild. When the court was told that the parents had forced the separation of the mother and child because they disapproved of her relationship with the child’s father, the court asked the hospital staff to take help of woman constables, if needed, to ensure that the parents did not interfere with their daughter’s life. Sarita — her parents claim that she was married — eloped with a Marathi boy, Hitesh, some time last year. Her parents filed a habeas corpus in the Gujarat high court and she was brought to the court by cops on July 27 last year. But she refused to go with her parents. The court told them Sarita was not a minor and was free to live with Hitesh. TNN From the archives of The Times of India 2007, 2009
Only 44% newborns get mother’s milk
The Times of India, Sep 2, 2015
Less than 50% are breastfed in first hour of birth in India
Despite increase in institutional deliveries, the number of children in India being breastfed in the first hour of birth is less than half.
India in fact ranks lowest among South Asian countries, including Afghanistan, Bangladesh and Sri Lanka in breastfeeding practices, with only 44% women being able to breastfeed their babies within one hour of delivery.
According to the World Breastfeeding Trends Initiative (WBTi) 2015, India scored 78 out of 150, only marginally higher than its 2012 score of 74. Paucity of data, ineffective policies, lack of budget and coordination, and absence of better monitoring are limiting breastfeeding practices in India.
Prepared by the Breastfeeding Promotion Network of India (BPNI) and the Public Health Resource Network (PHRN), the report indicates marginal improvement in Infant and Young Child Feeding (IYCF) practices. "It is not understandable why only 44% of women are able to begin breastfeeding within an hour when more than 75% of women deliver in institutions as claimed by PM Modi," Arun Gupta, BPNI central coordinator said. The report recommends an effective monitoring mechanism, national policy on IYCF, revival of baby-friendly hospitals, maternity protection and provision of a nine month maternity leave. The assessment, done every three to five years as part of WHO's World Breastfeeding Trends Initiative (WBTi), reveals gaps in all ten areas of policies and programmes to be implemented for enhancing breastfeeding rates.
According to the data, out of 26 million born in India, 14.5 million children are not able to get optimal feeding practices during the first year of life. While 44.6% women initiate breastfeeding within one hour of delivery, 64.9% are breastfed up to six months and 50.5% babies receive complementary food within 6-8 months.
The report said increasing sale of infant food, lack of support to women in the family and at workplaces and inadequate healthcare support as reasons behind low breastfeeding rate in the country.
2017/ 41.6% children breastfed in first hour of birth
The pace of improvement in breastfeeding has been slow with less than half of children in India being breastfed in the first hour of birth, even as institutional deliveries have improved rapidly, accounting for almost 80% of all deliveries, data released from the fourth national family health survey (NFHS) shows.
The survey reveals that around 41.6% of children are being breastfed in the first hour of birth, up from 23.4% around 10 years ago.On the contrary , institutional deliveries have jumped from 38.7% to 78.9% between NFHS-3 and NFHS-4 -indicating an increase of over 40 percentage points. Exclusive breastfeeding among children under six months of age have also increased marginally in last 10 years from 46.4% to 54.9%, the new data shows.
Breastfeeding has dropped by around 10 percentage points in children of 6-8 months age after they start receiving semi solid food. Experts say India scores the lowest in breastfeeding practices among south Asian countries. “India needs a clear plan of action with budget allocations to scale up breastfeeding and infant and young child feeding indicators,“ said Arun Gupta, central coordinator for Breastfeeding Promotion Network of India.
2019/ rural children breastfed more
Breastfeeding is inversely proportional to household wealth and other factors, says study.
Malnutrition among children in urban India is characterised by relatively poor levels of breastfeeding, higher prevalence of iron and Vitamin D deficiency as well as obesity due to long commute by working mothers, prosperity and lifestyle patterns, while rural parts of the country see higher percentage of children suffering from stunting, underweight and wasting and lower consumption of milk products — these are among the findings of the first-ever national nutrition survey conducted by the government.
The Comprehensive National Nutrition Survey released by the government on Monday shows that 83% of children between 12 and 15 months continued to be breastfed, a higher proportion of children in this age group residing in rural areas are breastfed (85%) compared to children in urban areas (76%). Breastfeeding is inversely proportional to household wealth and other factors influencing this trend may include working mothers who have to travel long distances to reach their workplace.
Because of these reasons, it also noted that rural children receive meals more frequently in a day at 44% as compared to 37% of urban children. However, a higher proportion of children residing in urban areas (26.9%) are fed an adequately diverse diet as compared to those in rural areas (19%).
Children and adolescents residing in urban areas also have a higher (40.6%) prevalence of iron deficiency compared to their rural counterparts (29%), which experts say is due to a better performance of the government’s health programmes in rural areas.
Children in urban areas are also overweight and obese as indicated by subscapular skinfold thickness (SSFT) for their age. While 14.5% of children in the age group of 5 to 9 years in cities had higher SSFT than 5.3% in rural areas, 10.4% of adolescents surveyed in urban areas in the age group of 10-19 had higher SSFT than 4.3% in rural areas.
“We are aware of the need for a special focus on urban areas under the Poshan Abhiyaan [Nutrition Mission] and NITI Aayog is currently developing a strategy to deal with problems unique to children living in cities as well as factors hampering implementation of government programmes,” Alok Kumar, Advisor, NITI Aayog told The Hindu.
Wealthier households in urban areas and sedentary lifestyle of children may also be responsible for higher deficiency of Vitamin D in urban areas (19%) as compared to rural areas (12%), though the study shows that 74% of children living in cities consume dairy products as compared to 58% in rural areas.
Rural children lag in intake of zinc which causes diarrhoea, growth retardation, loss of appetite and impaired immune function. Among children aged 1-4 years, zinc deficiency is more common in rural areas (20%) compared to urban areas (16%).
Rural areas also witness higher prevalence of stunting (37% in rural versus 27% in urban), underweight (36% in rural versus 26% in urban) and severe acute malnutrition (34.7% in rural areas for children in 5-9 years versus 23.7% in urban areas and 27.4% in urban areas for adolescents in 10-19 years versus 32.4% in rural areas).
Reasons for low breastfeeding level
2017/ Low level of investment in breastfeeding
India is among the world's five largest emerging economies where investment in breastfeeding is significantly low resulting in an annual economic loss of $14 billion because of child deaths and cognitive losses caused from poor breastfeeding practices, according to a report.
In India, less than 50% of children are breastfed within an hour of birth, whereas the rate of exclusive breastfeeding in the first six months stood at 55%. Early initiation of breastfeeding and exclusive breastfeeding can prevent nearly 99,499 deaths of children every year due to diarrhoea and pneumonia.
Five countries China, India, Indonesia, Mexico, Nigeria account for over 2,36,000 child deaths every year because of inadequate breastfeeding. These countries together incur an annual economic cost of $119 billion due to mortality and cognitive losses, says the report by UNICEF and WHO in collaboration with Global Breastfeeding Collective.
“We strongly recommend exclusive breastfeeding for the first six months. This protects children by providing them immunity against diseases and helps mothers reduce weight and chances of breast cancer,“ says Dr Indu Taneja, senior consultant (obstetrics & gynaecology) at Fortis. The report also highlights the growing number of deaths in India among women due to cancer while Type-II diabetes is also attributable to inadequate breastfeeding. “Breast milk works like a baby's first vaccine, protecting infants from potentially deadly diseases and giving them all the nourishment they need,“ said Dr Tedros Adhanom Ghebreyesus, director-general, WHO.
The scorecard, which evaluated 194 nations, reveals no country in the world fully meets recommended breastfeeding standards. It found that only 40% of children under six months are given nothing but breast milk and only 23 countries have exclusive breastfeeding rates above 60%.
The analysis shows an annual investment of just $4.70 (approx Rs 300) per newborn is required to increase the global rate of exclusive breastfeeding among children under six months to 50% by 2025.
It suggests that meeting this target could save the lives of 5,20,000 children under the age of five and potentially generate $300 billion of economic gains over 10 years from reduced health care costs and increased productivity .
Substitutes for breast-milk
2018: They flourish, despite the ban
Your infant may have unknowingly been exposed to potential health risks due to commercial compulsions. Almost three decades after strict laws were instituted to control the marketing and promotion of baby foods in India, aggressive promotions to doctors by companies, including Nestle, Abbott and Danone, through conferences, conventions, digital platforms and freebies, continue unabated, thereby creating a health hazard for millions of babies.
Though several regulations and an International Code to curb unscrupulous promotions and marketing of infant food exists here in India, ironically nearly half the infants under six months are not exclusively breastfeda rate that has not improved substantially in two decades.
This indicates that aggressive marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates, and to an unhealthy nexus that exists between companies and healthcare professionals, to influence established outcomes.
The International Code adopted by World Health Assembly in May 1981, followed by Indian laws — Infant Milk Substitutes (IMS) Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992 — ban any kind of promotion and sponsorship by health workers of baby food, infant milk substitutes and feeding bottles.
However, data shared with TOI shows that over the years companies have been aggressively promoting and marketing baby food through conferences and conventions, exotic trips and even offering discounts on e-commerce sites like Amazon, discountkart and Infibeam. RTI details show that Nestle, Danone, Abbott among others, sponsored the National Conference of Indian Society of Clinical Nutrition held in Delhi-based Institute of Liver and Biliary Sciences in October 2016.
Other examples of fraudulent practices include neonatal workshop in 2016 at Cloudnine Hospital being sponsored by Nestle, Abbott and Mead Johnson Nutrition, while Mead Johnson offered to sponsor an International Neonatology Conference in Madrid in December 2017. In fact, there are several examples of nutritional conferences being sponsored by food companies, including Nestle, health activists say.
Recently, concerns are being raised by activists on Danone using Docplexus, a digital platform of doctors, to promote its brand and advertise products, as well as its health claims, which is also banned under the IMS Act.
Popular baby food brands sold here include Lactogen, Cerelac, Nestum (Nestle), Farex and Dexolac (Danone), and Similac (Abbott Nutrition).
Promotion — targeted at children aged between 0-2 years — of any kind of baby foods and feeding bottles, including advertisements, inducements on sales, pecuniary benefits to doctors, including sponsorship, is banned under the IMS Act. The Act was enacted by the Parliament in 1992 to control marketing of baby foods that was recognised to be a health hazard causing high morbidity and mortality among infants and young children, and later strengthened in 2003 to cover babies up to 2 years of age.
The Act says “no person shall advertise for the distribution, sale or supply of infant milk substitutes, feeding bottles or infant foods; or give an impression that feeding of infant milk substitutes and infant foods are equivalent to, or better than, mother’s milk; or take part in the promotion of infant milk substitutes, feeding bottles or infant foods”.
“Breastfeeding has long been recognised to be normal food for babies and critical for their health, survival and development during early years, and no mother should be pushed to adopt formula feeding at the hospital. There is strong evidence that baby food companies aggressively promote the use of their products directly or indirectly disregarding the International Code or national legislations. Governments need to act decisively to enforce regulations to put an end to all kinds of promotions of foods for infants and young children,” said Dr Arun Gupta, Regional Coordinator of International Baby Food Action Network (IBFAN), Asia, which works on child malnutrition through improved infant feeding practices, told TOI.
Medical research from Nepal, Ghana, and India suggest that early initiation of breastfeeding reduces neonatal mortality by 44% among infants surviving at least 48 hours, and is especially beneficial for preventing sepsis-related deaths. Baby food companies including Danone and Abbott say they strictly adhere to Indian regulations, and are committed to ethical marketing.
In response to specific “charges”, a Danone spokesperson said Docplexus is an online platform for doctors only, no consumer has access to this information and hence there is no violation of the IMS Act. Confirming it participated in the NNF conference in October 2017, she added, FSMP (food for special medical purposes) medical nutrition products were discussed.
Queries mailed to Nestle remained unanswered.
Dr RK Anand, paediatrician and founder, Consumers’ Action on Safety and Health (ACASH), who was instrumental in the 80s for pushing the government into formulating the Infant Milk Substitute Act said, “Companies have been flouting rules for decades by unethically marketing infant food. Mothers are not being guided properly and, in fact, could be misled regarding breastfeeding. Hence companies need to be monitored. Counselling and support by doctors is required to help new mothers so that they adopt good breastfeeding practices.”
Over 27 million containers of infant formula of 400gm each are sold every year in India meant for babies between zero to six months, the number is staggering — almost equal to the number of babies born, and plays a disrupting role in breastfeeding practices, at nascent stage, experts added, saying cases filed by IBFAN, are languishing in courts.