Why breastfeeding needs structural reform, not just awareness: experts call for science-backed, system-level support

The Hindu

11 hours ago

Despite high initiation rates, India continues to see a drop in exclusive breastfeeding by six months, with only 63.7% of infants meeting World Health Organisation (WHO) guidelines, according to the National Family Health Survey (NFHS) -5. Health experts say the science of breastfeeding is well established, but implementation gaps, particularly the absence of sustained support systems hinder its continuity. This year's World Breastfeeding Week theme, 'Prioritise Breastfeeding: Build Sustainable Support Systems', reflects a need for systemic reforms, especially better support systems.
'Breastfeeding success depends on physiological, psychological and social factors. It doesn't end with hospital discharge,' said Swaramya Chandrasekaran, senior consultant, obstetrics, Rela Hospital, Chennai. In most tertiary care centres, delivery is followed by rapid discharge, leaving mothers without structured postnatal guidance. Without interventions, challenges like poor latch, delayed milk let-down and infant crying are often misinterpreted as insufficient milk, leading to early supplementation.
'Data shows the average duration of exclusive breastfeeding in India is 4.9 months. This is not a behavioural failure , it is a systemic failure,' added Pilli Govardhan, neonatologist, MGM Healthcare, Chennai. He noted that early initiation, skin-to-skin contact and antenatal lactation counselling are proven to improve breastfeeding outcomes but remain inconsistently applied.
Common physiological barriers
Latching difficulties, maternal nipple pain and low perceived milk supply are primary causes for early discontinuation. 'Without trained staff to correct positioning and latch, mothers often stop within weeks,' said Aksheya S., lactation care counselor, SRM Global Hospitals. Pain and stress can inhibit oxytocin --the hormone essential for milk ejection, further complicating feeding.
In addition, Sandhya Vasan, head of obstetrics, SIMS Hospital, Chennai highlighted psychosocial barriers such as lack of support from partner, family and workplace stress. 'Stress elevates cortisol, which interferes with prolactin-driven milk production. The science is clear physiological processes are not immune to social determinants.'
Addressing infrastructure gaps and role of frontline workers
Frontline workers -ASHAs (Accredited Social Health Activist) and ANMs (Auxiliary Nurse Midwife)- play a pivotal role in extending lactation support into communities. However, most receive only basic training. 'They are not equipped to diagnose a poor latch, assess milk transfer, or identify feeding-related weight faltering,' said Dr. Swaramya. Experts recommend competency-based lactation training, access to visual tools and referral pathways for unresolved cases.
'Digital aids, growth monitoring charts and helpline access can increase field-level efficacy,' said Dr. Vasan. Incentivising follow-ups on exclusive breastfeeding, similar to immunisation tracking, is another evidence-based strategy.
Scientific evidence supports frequent emptying of the breast to maintain supply. But for women in informal sectors, lack of maternity leave or safe spaces to feed or express milk forces early weaning. 'Access to clean, private feeding rooms directly correlates with breastfeeding duration,' said Dr. Govardhan. 'These are not amenities, they are physiological necessities.'
Although India's Maternity Benefit Act mandates breastfeeding breaks and crèche facilities, compliance is low. Public-private partnerships and CSR-backed infrastructure in factories and informal work hubs could address these gaps. 'We need mobile crèches, lactation pods and peer-led support at the community level,' said Dr. Swaramya.
Targeted advocacy and routine care
Marginalised mothers especially from tribal, migrant and urban poor communities face compounded challenges of malnutrition, low literacy and poor access to health information. 'Broad messaging is not enough. We need multilingual, audio-visual counselling and incentives embedded in schemes like ,Pradhan Mantri Matru Vandana Yojana (PMMVY), Mothers' Absolute Affection (MAA) program and the Indira Gandhi Matritva Sahyog Yojana (IGMSY)' said Ms. Aksheya.
'Treat breastfeeding as a health right,' added Dr. Vasan. Inclusion of local leaders in programme planning can enhance trust and cultural fit.
Experts recommend integrating lactation support into existing maternal and child health systems. 'Breastfeeding counselling should be as routine as blood pressure checks during Antenatal Care (ANC),' said Dr. Govardhan. Suggestions include mandatory counselling during immunisation visits, staff nurse training at PHCs, and using Anganwadi centres as breastfeeding support hubs.
Dr. Swaramya stressed the need to track breastfeeding like any other health metric. 'We track hemoglobin and birth weight, why not exclusive breastfeeding at 3 and 6 months?' she said.
While the hormonal pathways, physiological timelines and behavioural benefits of breastfeeding are well documented, experts agree that India's current systems treat it as optional or supplemental. 'Breastfeeding is a biological process that requires structured, evidence-based support at every level : hospital, home and workplace,' said Dr. Vasan.
The path forward, they say, lies not in more campaigns but in embedding lactation science into everyday healthcare delivery