Caught between unsupportive health workers and an unethical baby food industry, new mothers are being dissuaded from breastfeeding.

India is supposed to be a “breastfeeding nation” but breastfeeding rates in the country do not support this claim. Only about 44% of babies – that is 12 million out of 26 million – begin breastfeeding within one hour of their birth, according to national data sources. The majority are given formula milk, either powdered or liquid, or animal milk.

To understand how new mothers view health services and formula-feeding, the Breastfeeding Support for Indian Mothers, a Facebook group with more than 29,000 members conducted a survey. More than 950 mothers who delivered their babies in private hospitals responded. More than half the respondents said their children were given artificial milk and out of these two-third said that it was without their consent. From the comments of these women, it is evident that health workers often doubted new mothers’ ability to produce milk and undermined their confidence in breastfeeding.

Playing on hormones

It is all about how hormones that control breastfeeding work. Breastmilk is produced by the hormone prolactin, the secretion of which is directly impacted by the amount of suckling by the baby. Breastmilk is ejected from the mother’s breast and into the baby’s mouth during nursing under control of another hormone oxytocin, the production of which is influenced by the mother’s state of mind. More oxytocin is produced when a woman is happy and confident and less if she has doubts, anxiety or is in pain.

Just after a baby is born, the mammary glands produce a form of milk called colostrum. The small quantities of colostrum are sufficient nutrition for the baby but since it is not free-flowing, like the milk that the glands later produce, it is often perceived as less production. The time of production of colostrum is the critical period when the baby is most active to suckle. Not allowing the baby to breastfeed at this time causes problems in breastfeeding later.

The baby food industry started exploiting this hormone mechanism about five decades ago. They made campaigns associating the lack of breastmilk production with guilt such as “if you don’t have enough milk we have the safe alternatives…don’t feel guilty …” Today, in any corner of the world, more than 90% women still make this association. Industry has subtly and systematically undermined women’s confidence, as Gabrielle Palmer’s book The Politics of Breastfeeding: When Breasts are Bad for Business historically captures.

In November 2016, the United Nations Human Rights Commission issued a joint statement on protection, promotion and support of breastfeeding, which noted that “Women who choose to breastfeed often lack the necessary support structures. Gaps in knowledge and skills among healthcare providers often leave women without access to accurate information or support”.

Further, the commission observed that “aggressive and inappropriate promotion of breast-milk substitutes, and other commercially prepared food products for children from 6 to 36 months that compete with breastfeeding, continue to undermine efforts to improve early and exclusive breastfeeding rates and act as barrier for women to exercise their rights. These marketing practices often negatively affect the choice and ability of mothers to breastfeed their infants optimally, and to enjoy the many health benefits breastfeeding provides.”

According to the World Health Organisation, once babies are introduced formula, a return to breastfeeding may not be possible due to diminished breastmilk production. So, if babies are given formula without the consent of their mothers, does that amount to violations of the rights of both mother and child?

What’s needed

When a new mother comes to a health worker and says that she is not producing enough breastmilk, the most common response is to offer treatment with alternatives such as formula. Instead, health workers should investigate the cause of the deficiency and help by showing her the correct of feeding techniques that she may not be aware of and build her confidence to breastfeed. Even new mothers who are anaemic or malnourished lactate and can breastfeed, if given the right health support.

Health workers should be careful not to make a new mother feel guilty, even if she had been using formula – this is a result of bad practice in society and the health system. If a woman makes a choice in favour of artificial feeding having known its risks, health workers should respect her choice and explain to her how safely practice formula feeding.

At the same time, hospitals must have lactation counsellors on their staff to help women feed from the start during colostrum production. In addition, existing maternity staff should be trained to support women at time of birth and breastfeeding. Unless the health system takes this action, artificial feeding will continue to be common practice

The government’s role

Even after 25 years of enacting a law that bans sponsorship of health workers and their associations, the practice continues today. Baby food companies continue to give discount on their products through e-commerce sites, although they have been prohibited to do so. We believe this aggressive promotion contributes to undermining breastfeeding.

The health ministry committed to the new WHO guidelines on ending inappropriate promotion of foods for infants and young children adopted at a the World Health Assembly in 2015. The ministry can take a cue from both this resolution and the United Nations Human Rights Commission Statement to issue a notification to ensure a parent’s consent before a baby is fed formula in a hospital and to end to inappropriate promotion of baby foods and sponsorship in the health systems.

The writer is a paediatrician and founder of the Breastfeeding Promotion Network of India.