The world, in its dizzying pursuit of progress, often overlooks the most fundamental act of sustenance: breastfeeding. Yet, this cornerstone of child health is alarmingly underutilised globally. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding with complementary foods up to two years or beyond. However, stark realities paint a different picture.

The Breastfeeding Crisis:

The global breastfeeding landscape is alarming. UNICEF reports that only 42% of infants under six months receive exclusive breastfeeding, making WHO’s recommendation a distant dream, underscoring a critical gap in maternal and child health[1]. Exclusive breastfeeding significantly reduces the risk of infant mortality by approximately 13%[2] and about 20% of all neonatal deaths could be prevented if all newborns were initiated breastfeeding within one hour of birth[3]. Beyond survival, breast milk is a nutritional powerhouse, supporting cognitive development, bolstering immunity, and lowering the risk of chronic diseases such as obesity, diabetes, and asthma.

The economic implications of inadequate breastfeeding are equally staggering- mortality and other losses attributed to inadequate breastfeeding could cost the country’s economy USD 14 billion[4]. Studies estimate that suboptimal breastfeeding costs low- and middle-income countries billions of dollars annually in healthcare expenses and lost productivity.[5] In India, the economic burden is compounded by factors like malnutrition, which is often linked to suboptimal breastfeeding.

While significant strides have been made, as evidenced by increasing exclusive breastfeeding rates in the National Family Health Survey (NFHS) 5[6], they remain suboptimal across regions.[7] The unfortunate reality remains that nearly one lakh children succumb to preventable diseases each year in India, as highlighted by a UN report[8]. Rural areas face significant challenges due to factors such as poverty, illiteracy, and reliance on traditional beliefs and practices. [9] Given our rapid developmental context, there is potential for India to become a global leader in child health by further improving breastfeeding practices and ensuring every child has access to this lifesaving nourishment.

The Human Cost: Stories from Madhya Pradesh

Beyond the macro-picture, the human cost of this crisis is immeasurable. The reality for rural women, in states like Madhya Pradesh — where Antara Foundation is supporting maternal and child health interventions across eight focus districts — is even more discomforting. Often burdened by domestic chores, lack of awareness, health literacy and support from family systems and communities – mothers are likely to not exclusively breastfeed.

Case of Sonal Kumari, in Tamia – Chhindwara District*[10]: A newborn girl experienced sudden weight loss by the 7th day of her birth, as the family anxiously reached out to the local ASHA for help. Upon analysing the problem, it was discovered that Sonam, a first-time mother, was facing challenges to breastfeed the baby—not knowing how.

Struggling to make ends meet, Jhirnya – Khargone District: Sheela, a young mother from the remote village of Topli, faced immense challenges in caring for her newborn. Poverty and misinformation compounded her struggles, leaving her isolated and unsupported in a dimly lit hut for over a month postpartum. Frontline workers discovered she was unable to breastfeed due to inverted nipples. Her isolation, coupled with a lack of support and awareness, brought her to the brink of resorting to cow’s milk. Despite her dire situation, family resistance prevented her from seeking medical help.

Her body still bearing the marks of creation – Betul District: A young mother named Jaya was discovered struggling during a routine home visit 14 days after childbirth by her designated ASHA. Her baby was visibly distressed, crying for hours and she was unable to breastfeed for the past two days. Upon examination, Maya was found to have breast engorgement, causing her significant pain and preventing successful breastfeeding.

The Denominator Common to All:

Across these cases, lack of health literacy, awareness about their health needs, and apprehensions about breastfeeding caused women not to breastfeed or seek help on time. Early initiation of breastfeeding and continued breastfeeding after childbirth was often hindered by factors such as health risks and incorrect breastfeeding techniques. Moreover, lack of support from family members and communities – especially, the absence of male engagement and active family participation in supporting breastfeeding mothers exacerbated these challenges.

What Helped: Key Interventions

The case studies of Sonal, Sheela, and Jaya underscore the multifaceted challenges faced by breastfeeding mothers in rural Madhya Pradesh. However, they also highlight the effectiveness of target interventions. All three women were supported by their local front-line cadre with counselling and risk-management support through their postnatal period and beyond. Key factors contributing to successful outcomes include:

• Early Identification and Intervention: Prompt action by ASHA workers in addressing issues like weight loss, inverted nipples, and engorgement was crucial. Moreover, empowering mothers with information on seeking medical help in emergencies ensured their safety and the baby’s well-being.
• Comprehensive Breastfeeding Support: Consistent counselling on exclusive breastfeeding practices, techniques, and frequency by frontline workers provided essential knowledge and support. Addressing common challenges, such as latching difficulties, milk supply concerns, and mastitis, through timely guidance and reassurance played a pivotal role in sustaining breastfeeding.
• Strong Community Partnership: Collaboration between frontline health workers and organisations like Antara Foundation strengthened the overall impact. This partnership ensured access to additional resources, training, and support, enhancing the capacity of the frontline workforce.