Despite institutional delivery being as high as nearly 79% nationally, the number of children in India breastfed within one hour of birth is less than 42%. According to the National Family Health Survey 4 (NFHS-4) data released a few days ago, children breastfed within one hour of birth in urban India is nearly 43%, while it is 41% in the case of rural India. The Janani Suraksha Yojana scheme — cash incentives to pregnant women to attend antenatal clinics and opt for institutional deliveries — has led to a sharp increase in institutional delivery (from 39% in 2005-06 to 79% in 2015-16) and near doubling of children breastfed within one hour of birth in the last 10 years.

Breastfeeding babies soon after birth can prevent a significant number of neonatal deaths. According to C.K. Mishra, Secretary, Ministry of Health and Family Welfare, about 20% newborn deaths and 13% under-five deaths can be prevented by early initiation of breastfeeding.

At 99.9% in both urban and rural areas, Kerala has the highest institutional births in the country. Tamil Nadu is a close second with 99.2% institutional births in urban areas and 98.7% in rural areas. Yet, Kerala and Tamil Nadu do not fare greatly when it comes to initiating breastfeeding within one hour of birth. At 64%, Kerala is well below Goa’s average of 73%. Similarly, Maharashtra with only 90% institutional deliveries has 57.5% for early initiation of breastfeeding compared to Tamil Nadu’s nearly 55%.

Bihar has shown the most improvement in initiating breastfeeding within one hour of birth — from 4% in 2005-06 to 35% in 2015-16. Though Uttar Pradesh has improved its performance, it is still about half of the national average — 7.2% in 2005-06 to 25% in 2015-16. Other States that have shown good improvement on this front are Haryana, Jharkhand, Madhya Pradesh, Punjab, Rajasthan.

Similarly, all States have registered an improvement in the case of exclusive breastfeeding of children under age six months. While Goa has shown a dramatic increase from 17.7% to nearly 61%, Chattisgarh has witnessed a drop from 82% in 2005-06 to 77% in 2015-16.

“There are various reasons why early initiation of breastfeeding does not happen. You need dedicated people who can counsel mothers on the need to breastfeed within one hour of delivery and there are socio-cultural barriers to breastfeeding babies too,” says Dr. Ajay Khera, Deputy Commissioner and Head of Child Health, Ministry of Health and Family Welfare. “It is to overcome these that the government launched MAA — Mother’s Absolute Affection — programme in August last year. Under the programme, there are special efforts to create community awareness and promotion of breastfeeding, capacity building and skilling of healthcare providers at all delivery points in the country.”

According to Dr. Sutapa B. Negi from the Indian Institute of Public Health, Delhi, early initiation of breastfeeding becomes difficult in the case of babies delivered through caesarean section, babies born preterm and low birth weight (less than 2.5 kg) babies. “Caesarean deliveries account for 10-15% and nearly 20% babies have low birth weight while 15% are born preterm,” says Dr. Khera.

According to NFHS-4 data, the national average for babies delivered by caesarean section is 28%, which is more than three times the 2005-06 figure of 8.5%.

While percentages may varying from one State to another, there is not much difference in the rate of breastfeeding within one hour of birth among rural and urban population. Except for a few States like Andhra Pradesh, Bihar, Gujarat and Tamil Nadu, rural areas have slightly higher percentage of babies being breastfed within one born of birth than their urban counterparts. “This implies that need for support regarding breastfeeding is universal,” Mishra said last year during the inauguration of MAA programme.

Published in The Hindu on March 12, 2017