Exclusive breastfeeding (EBF) – defined as feeding infants solely breast milk for the first six months – is a critical practice that delivers lifelong benefits for child health and development. However, the rapid economic transition in India has led to a surge in maternal employment, which can adversely impact EBF rates. This article explores the evolving landscape of exclusive breastfeeding among Indian children over the past decade, uncovering key determinants and identifying strategies to promote this vital nutrition intervention.
Exclusive Breastfeeding: A Cornerstone of Infant Health
Exclusive breastfeeding is the practice of feeding infants only breast milk, without any additional food or liquids, except for oral rehydration solutions, vitamins, minerals or medicines, for the first six months of life. This optimal feeding approach is universally recognized for its unparalleled nutritional, immunological, and developmental advantages for children.
National surveys in India have documented a steady improvement in EBF rates over the past decade. From 2005-06 to 2019-21, the overall prevalence increased from 47.45% to 64.01% – a promising trend that reflects growing awareness and commitment to this vital infant feeding practice. However, a closer examination reveals stark disparities, with employed mothers consistently exhibiting lower EBF prevalence compared to their unemployed counterparts.
Maternal Employment and the EBF Challenge
India’s rapid economic growth has led to a surge in female labor force participation, with the proportion of working women increasing from 23.3% in 2017-18 to 32.8% in 2021-22. While this is a positive development for gender equality and national progress, it poses a significant challenge for maintaining optimal breastfeeding practices.
Our analysis of National Family Health Survey (NFHS) data from 2005-06 to 2019-21 reveals that the EBF prevalence among employed mothers stood at 51.1%, 51.1%, and 60.3% respectively, compared to 45.9%, 54.8%, and 67.3% for unemployed mothers. Notably, the odds of practicing EBF doubled from the NFHS-3 to NFHS-5 period, but employed mothers consistently exhibited a significantly lower likelihood (Adjusted Odds Ratio: 0.94, 0.91, 0.98) than their non-working counterparts.
This disparity can be attributed to various factors, including limited maternity leave, lack of workplace policies supporting breastfeeding, and the challenges of balancing work demands with the time-intensive nature of exclusive breastfeeding. Employed mothers often face pressure to resume work duties shortly after childbirth, leading to early introduction of complementary foods and premature cessation of exclusive breastfeeding.
Determinants of Exclusive Breastfeeding
Beyond maternal employment, our analysis identified several other factors influencing EBF practices in India. Mothers with normal body mass index (BMI), higher media exposure, and more frequent antenatal care visits exhibited increased odds of exclusive breastfeeding. Conversely, older maternal age, delivery in a healthcare facility, female infant gender, and delayed breastfeeding initiation were associated with lower EBF likelihood.
Interestingly, the data also revealed a concerning finding – mothers who received postnatal care were less likely to practice exclusive breastfeeding. This suggests a need for further exploration of the content and quality of counseling provided during the critical postpartum period, to ensure that healthcare providers are equipped to effectively promote and support optimal breastfeeding behaviors.
Policy Landscape and Programmatic Initiatives
India has made substantial strides in creating an enabling environment for exclusive breastfeeding through a range of policy interventions and national programs. The National Code for Protection and Promotion of Breastfeeding (1983), the Infant Milk Substitutes Act (1993), and the Maternity Benefit (Amendment) Act (2017) have all aimed to safeguard the rights of breastfeeding mothers, particularly in the workplace.
Beyond the legal framework, the government has also invested in large-scale initiatives like the Mothers’ Absolute Affection (MAA) program, the Infant and Young Child Feeding (IYCF) guidelines, and the Integrated Child Development Services (ICDS) scheme. These initiatives aim to promote early and exclusive breastfeeding through capacity building of frontline workers, comprehensive communication campaigns, and targeted interventions at the community level.
However, the implementation and enforcement of these policies and programs remain a significant challenge, particularly in ensuring that working mothers receive adequate support and benefits to continue exclusive breastfeeding. Strengthening monitoring and evaluation frameworks, improving workplace compliance, and enhancing the counseling skills of healthcare providers will be crucial for bridging this gap.
The Way Forward: Protecting Breastfeeding Mothers
Exclusive breastfeeding is a fundamental human right and a vital investment in the future health and well-being of India’s children. As the country continues its economic transformation, safeguarding this critical practice will require a multi-pronged approach that addresses the unique needs of working mothers.
Key strategies should include:
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Robust Workplace Policies: Mandating longer maternity leaves, providing designated lactation spaces, and ensuring flexible work arrangements to enable employed mothers to maintain exclusive breastfeeding.
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Comprehensive Counseling and Support: Strengthening the capacity of healthcare providers to deliver high-quality, individualized breastfeeding support, particularly during the critical postpartum period.
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Community-based Interventions: Leveraging frontline workers and local networks to raise awareness, address cultural barriers, and empower mothers to make informed feeding choices.
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Intersectoral Collaboration: Fostering partnerships between the health, labor, and women’s welfare sectors to develop and implement cohesive policies that protect the breastfeeding rights of working mothers.
By addressing the unique challenges faced by employed women and investing in a holistic, multi-stakeholder approach, India can ensure that exclusive breastfeeding remains a cornerstone of child health and nutrition, even as the country’s economic landscape continues to evolve. The future health and development of India’s children depend on our ability to surmount these barriers and uphold the fundamental right to optimal infant feeding practices.