A formula that should change
Geetanjali Krishna on a watchdog that seeks to enhance breastfeeding in India by countering commercial influence
In August 2019, a prominent manufacturer of infant milk substitute came under the scanner for sponsoring a study of growth patterns in premature babies in five hospitals across India. A month later, the research study has been found by Indian Council of Medical Research to violate Infant Milk Substitutes, Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act (also known as IMS Act), 1992. This is one of the several cases that watchdog Breastfeeding Promotion Network of India (BPNI) has recently taken up. Set up in 1991, BPNI has been focused on enhancing breastfeeding rates in India by countering commercial influence, building capacity of healthcare providers and advocating for maternity entitlements. “Infant formula and food manufacturers would have us believe that babies can’t thrive without the bottle and doctors sometimes pay lip service to the cause of exclusive breastfeeding,” says Arun Gupta, founder of BPNI. “As a result, new mothers are often made to feel that they can’t produce enough milk for their newborns — often while still being told that there’s no substitute for mother’s milk!”
A pediatrician by training, Gupta’s clinical experiences impelled him to found BPNI. “During private practice, I discovered that many sick babies I was treating had been bottle fed,” says Gupta. “An informal survey of 100 mothers revealed that most hospitals advised them to bottle feed their babies because they weren’t producing enough milk.” Around the same time, he found that a well-known infant food manufacturer had a Buy One Get One Free offer on formula milk!
The doctor felt strongly that it was unethical for companies to market a substitute for breast milk when overwhelming research showed its benefits for both mother and infant. Meanwhile, his own two children were born and Gupta and his wife, also a doctor, realised that there was little or no support available from the family or the health care system to enable breastfeeding. “I realised there was a problem when even our own children couldn’t be breastfed beyond the first six months of their life,” he recounts. So, BPNI was born in 1992.
Since then, BPNI’S most powerful role has been to monitor and watch over the IMS Act which prohibits any kind of promotion of infant formula, feeding bottles and infant foods for children below two years of age. Additionally, BPNI has strenuously advocated for stronger legislative reforms to protect mothers and infants. “We’re also advocating for longer maternity leave and proper lactation training to enable mothers to exclusively breastfeed for as long as possible,” says Gupta.
The present situation certainly needs improvement: As part of the World Breastfeeding Trends Initiative ( WBTI), BPNI works on an annual assessment of the government's policies and programmes on optimising the nutrition of infants and young children. “India has scored 45 out of 100 on policy/programmes on breastfeeding per the 2018 report,” says Gupta. “It is ranked seventh among eight South Asian countries and 78th among 97 globally!” As a result of weakness in policy support, currently three out of five women are not able to begin breastfeeding within an hour of the baby’s birth. Meanwhile, feeding bottles continue to be sold online at discounted rates in flagrant violation of the IMS Act. “Presently, infringements of the Act are not prosecuted although it is a criminal law,” says Gupta. “We’re advocating that these should be treated at par with infringements of the Pre-conception and Pre-natal Diagnostic Techniques (PCPNDT) Act, 1994.”
Presently, BPNI relies on international f unding agencies, UN organisations and the governments of Sweden and Norway for funding. “We don’t accept funds from commercial sources on ethical grounds,” says he. Being a small organisation, they don’t have resources to train medics and paramedics to help new mothers breastfeed right after delivery. “Ideally, the government should provide such training,” says Gupta. “And hospitals should spend the money they spend on buying formula to provide better nutrition to mothers!”
At the end of the day, promoting breastfeeding is as much about maternal and infant health as it is about women’s empowerment. “Instead of advertising campaigns, we need to build the confidence of new mothers that they can successfully breastfeed their infants…” Gupta says. After all, mothers know best — and it’s time they know that!