Breastfeeding plays a critical role in early childhood survival, development and maternal well-being. One of the most crucial moments in this journey is the very first hour after birth, often called the “golden hour”. Initiating breastfeeding within this window provides newborn with vital antibodies, warmth and nutrients that protect against infections and improves survival chances. Yet, for many children in India, this golden hour passes without that vital first feed.

What the data tells us?

National Family Health Survey (NFHS) data reveals a worrying trend:

While India has seen meaningful improvement in some breastfeeding practices, progress on other indicators has been slow. Exclusive breastfeeding under 6 months, where an infant receives only breastmilk and no other foods or liquids- has shown a notable gain of 8.8%. Similarly, age-appropriate breastfeeding, which is a composite measure of ‘exclusive breastfeeding under 6 months’ and ‘breastfeeding along with solid or semi-solid food for 6-23 months’ has increased by 11%.

In contrast, early initiation of breastfeeding (within 1 hour of birth)- barely shifted, moving from 41.6% to 41.8% in five years. This stagnation suggests that families maybe more likely to continue breastfeeding in the months after birth, our health systems are still struggling to ensure that the critical first feed happens promptly, especially in the delivery setting.

Why the first hour is still being missed?

Through my work, I have observed that low early initiation rates are not just about a single barrier, they are often the result of interconnected challenges:

• Social norms and myths: In some communities, colostrum is discarded or prelacteal feeds like honey or ‘ghutti’ (a traditional mixture often made with honey and saffron) are given instead.
• Health system gaps: Overworked facility staff may not prioritize breastfeeding support immediately after birth.
• Post natal follow ups: Once mothers return home, consistent counselling is often missing, making sustained breastfeeding often harder.

How MERL can change the story?

Monitoring, Evaluation, Research and Learning (MERL) can bridge the gap between knowledge and practice. With the right systems in place:

• Real-time data dashboards can highlight facilities or communities where early initiation is lagging.
• Feedback loops can ensure supervisors follow up on missed cases.
• Qualitative insights from field monitoring can uncover cultural or logistical barriers not visible in quantitative data.
• Integrated datasets from health and nutrition systems can help track mothers and infants beyond the delivery room.

What I have observed in the field?

During my field visits alongside program officers, nurse mentors, and FLWs (frontline workers), I have observed the counselling given to new mothers and the health checks conducted for both mother and child.

The conversations go beyond simply telling a mother to breastfeed, they address her doubts about milk sufficiency, guide her on positioning and latching, and correct misconceptions about colostrum. I have seen ASHAs demonstrate proper holding techniques, encourage skin-to-skin contact, and even involve grandmothers and husbands in the discussion to ensure family support.

In most cases, these follow-ups happen because ASHAs keep detailed notes in their diaries and registers, often remembering specific families and their needs. While there isn’t yet a robust real-time monitoring mechanism to prompt these visits, their personal record-keeping and commitment make it possible to provide timely counselling where it’s needed most.

Practical ways forward

Based on what I have observed during my field visits and through listening to FLWs, I believe that there are three practical steps that could make a meaningful difference:

1. Strengthen breastfeeding counselling at the point of delivery: Facility staff should ensure mother gets hands-on guidance immediately after birth, including help with positioning and latching.
2. Prioritize early post-partum home visits: ASHAs can reinforce early initiation messages and address common concerns within the first week, using their registers to identify recent deliveries.
3. Focus on family involvement: Counselling should include key family members, especially those influencing newborn care decisions, to break the myths about colostrum and breastfeeding practices.

Further, with the help of MERL we can make sure that these steps don’t just stop at good intentions. By systematically tracking key indicators, triangulating datasets, and generating key insights, we can identify gaps faster and adapt to strategies and ensure that interventions are truly making a difference where they are needed most. In this way, data is not just about measuring numbers, rather it creates a continuous feedback loop that can be utilized to strengthen service delivery, empower FLWs with actionable insights and ultimately improve health outcomes for mothers and newborns.

Closing thoughts

Breastfeeding is one of the most effective public health measures we have, but it is also one the most under tracked one. The first hour matters but so does every hour that follows.

If India is to meet its breastfeeding goals, we must build systems that not only encourage mothers in the delivery room but also stay with them through the months ahead. With the right follow up, right guidance, and a system that values their work, every FLW can ensure every baby gets the best start- right from the first hour.

Citations:

• National Family Health Survey (NFHS 5 and NFHS 4) India Factsheets.
• WHO “Breastfeeding”, 2023.