NEW DELHI: Despite India seeing a rise in institutional deliveries, early breastfeeding in the first hour, as mandated by the World Health Organisation and UNICEF, continues to be low, a new report released on Friday said.
The best way to initiate early breastfeeding, which protects the new born from acquiring infection and reducing newborn mortality, is to ensure that hospitals – both government and private – start educating a woman about breastfeeding, right from her pregnancy to the time she is discharged after delivery, said India’s sixth World Breastfeeding Trends Initiative (WBTi) assessment report, released on the occasion of World Breastfeeding Week (August 1-7).
The report by Breastfeeding Promotion Network of India (BPNI), a 31-year-old organisation working to promote exclusive breastfeeding in the country, said that India has improved its performance on the World Breastfeeding Trends Initiative, moving from a score of 45 in 2018 to 62 in 2025, out of a maximum score of 100.
The country’s global ranking has improved from 79 to 41, and has also moved up in colour coding from Yellow to Blue, indicating steady progress on both policy and programmes that protect, promote and support breastfeeding and infant and young child feeding practices.
"India’s progress is commendable and encouraging. If India were to reach the top 10 countries in the ranking, stronger coordination, funding, and enforcement of the IMS Act will be the key given that aggressive marketing of baby foods continues,” said Dr Arun Gupta, lead author and founder of BPNI.
BPNI has been mandated by the government to oversee implementation of the Infant Milk Substitutes, Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act, Act, 1992, which aims to protect and promote breastfeeding by regulating the production, supply, and distribution of infant milk substitutes, feeding bottles, and infant foods.
The improved ranking, however, takes place in the backdrop of serious challenges in Infant and Young Child Feeding (IYCF) as shown by the National Family Health Survey (NFHS)-5 data that reveals early initiation of breastfeeding is 41.8 per cent, exclusive breastfeeding 63 per cent, complementary feeding 45 per cent, and minimal acceptable diet stood at just 11 per cent.
According to Dr Nupur Bidla, central coordinator of BPNI, “Early initiation of breastfeeding is still 41.8 percent despite institutional delivery going up to 88.6 per cent.”
“This is because of the alarming rise in cesarean or C-sections in the country. Most hospitals and their staff separate the newborn from the mother soon after conducting a C-section. This is against the WHO mandate. C-sections should not become an excuse to separate a mother from her baby. Women must be supported to initiate breastfeeding even after C-section delivery.”
“When a mother initiates breastfeeding within one hour after birth, production of breast milk is stimulated. The yellow or golden first milk produced in the first days, also called colostrum, is an important source of nutrition and immune protection for the newborn,” Dr Bidla told TNIE.
She said India needs to seriously implement the Baby Friendly Hospital Initiative/Ten Steps to Successful Breastfeeding, as recommended by the WHO and UNICEF, which have recommended that children initiate breastfeeding within the first hour of birth and be exclusively breastfed for the first six months of life – meaning no other foods or liquids are provided, including water - and continue to breastfeed for another two years.
The report, which assessed and monitored India on 10 indicators of policy and programmes and five practices of breastfeeding and Infant and Young Child Feeding, found that the second indicator Baby Friendly Hospital Initiative/Ten Steps to Successful Breastfeeding has seen only a marginal increase from zero out of ten in 2018 to 1.5 out of ten in 2024-25.
Titled ‘Spotlight on Breastfeeding and Infant and Young Child Feeding in India’, the report said that India’s MAA ((Mothers' Absolute Affection) programme, launched in 2016, is the strength and has the potential to implement all the Ten Steps to Successful Breastfeeding.
“The country has a certification system National Quality Assurance Standards (NQAS) and a training programme for the staff. However, NQAS and hospital staff training do not address all the Ten Steps to successful breastfeeding. There is weakness in overall coordination, process of external assessment/award system and monitoring and implementation of the IMS Act,” the report said.
The Indicator 2 revolves around the MAA programme and is the weakest in scoring and the only indicator in Red of all the ten indicators, added Dr Gupta.
“India can put a high priority on it by significantly increasing financial support for each district for training, monitoring and reporting. Central government may ensure increased coverage and quality via adequate skill training of hospital staff, technical support to states, and institutionalising monitoring,” said Dr Gupta, a paediatrician and former member, PM’s Council on India’s Nutrition Challenges.
“Involvement of the private sector could be another strategic move for the central government to achieve better coverage of services both in hospitals and follow-up counselling,” he added.
WBTi is a global assessment tool developed by BPNI/ International Baby Food Action Network (IBFAN) and used in over 100 countries. Based on WHO’s tools, it objectively evaluates ten indicators of policy and programmes and five of infant feeding practices, producing a composite score, colour coding, and global ranking.
“Major input might be achieved if the National Steering Committee is revived and a plan of action can be developed and monitored by the Women and Child Development Ministry,” said Dr Bidla.
The plan should include action in all areas including emergencies.
“We need a coordinated, well-financed capacity-building and support plan that is institutionalised at both national and state levels. Without that, frontline workers and mothers remain unsupported in the hospitals where they give birth and during follow-up,” said Dr Vandana Prasad, a community paediatrician with Public Health Resource Society.
She further argued that the Maternity Benefit Act 2017 needs to be urgently amended to expand the scope of maternity protection laws to all informal workers.