Global Index

India Spotlight Index

India Spotlight Index

Context

The impact of poor infant and young child nutrition in India

In India, around 1.7 million children under five die every year. Half of these deaths occur in the first 28 days of life. The WHO estimates that nutrition-related factors contribute to about 45% of deaths in children under 5 years. Moreover, poor feeding practices during the first six months of life are estimated to contribute to 53% of pneumonia and 55% of diarrheal deaths.

In 2011, India had the highest number of underweight children under five in the world (around 54 million, 37% of the world’s underweight children). Around 70% of these children were anemic, 15% were wasted and 39% were stunted. More recent data from the Rapid Survey on Children 2015 shows that some progress is being made with the proportion of underweight children declining from 45% in 2005-2006 to a historic low of 31%.

The importance of breastfeeding

Optimal infant and young child feeding is recognized as one of the most important factors in preventing infant deaths and addressing undernutrition. 

Breastfeeding confers a range of health and other benefits to infants and children, as extensive research has consistently demonstrated. Babies that are breastfed are at a lower risk of:

  1. Dying
  2. Gastroenteritis
  3. Respiratory infections
  4. Obesity
  5. Type 1 & 2 diabetes 

A recent, systematic review and meta-analysis found that babies that continued to be breastfed 12 months of age exhibited two-fold lesser risk of mortality than those that weren’t breastfed. Research also shows that initiation of breastfeeding within one hour of birth can reduce neonatal mortality by up to 22% by averting deaths related to sepsis, pneumonia, diarrhea and hypothermia.

Mothers also benefit from breastfeeding by deriving greater protection against breast cancer, and may be better protected against ovarian cancer and type 2 diabetes in later life. Recent evidence has demonstrated an association between prolonged breastfeeding and postmenopausal risk factors for cardiovascular disease. These illnesses all represent the greatest threats to women’s health across all ages. By reducing the incidence of infants’ and mothers’ illness, extensive breastfeeding can, therefore, reduce the burden on health systems.

Rates of breastfeeding in India

The rate of breastfeeding of the 26 million babies born each year in India has been improving and is now better than the global average. Rates of timely introduction of complementary feeding have declined recently though, and average national rates of all measures disguise significant variation by state. However, advances are being made. For example, in the seven northern states of India – where over 50% of infants are born and 72% of infant deaths occur – rates of early initiation of breastfeeding within one hour of birth increased from 12.4% in 2006 to 42.1% in 2011.

These rates need to increase if the rate of infant mortality is to fall substantially and if the health of India’s children is to improve significantly. This requires more priority being placed on, and investment directed towards, achieving optimal infant feeding by national and state governments, international and national non-governmental organizations and their funders. The focus needs to be on: i) educating women – and those that influence their choices – about the importance of breastfeeding; ii) providing women, healthcare workers and healthcare facilities with the necessary support systems and tools, and; iii) continuing efforts to limit BMS companies’ marketing of formula and prepared baby foods for infants under six months and to curtail their influence on women, healthcare workers and healthcare facilities.

India first enacted the Infant Milk Substitutes Act in 1992 and strengthened it through an Amendment Act in 2003. (Hereafter, the term IMS Act is used to mean the two documents together). According to an analysis by the Breastfeeding Promotion Network of India (BPNI), the Act complies or exceeds The Code in all aspects, and also incorporates the additional provisions of three of the four relevant WHA resolutions. The only element it omits is that companies place a statement on the labels of BMS products, and in any informational and educational material, that they may contain pathogenic micro-organisms, a requirement of WHA resolution 58.32.

A notable difference between The Code and the IMS Act is its scope: the latter extends to the marketing of complementary foods intended for infants up to two years, whereas The Code’s scope extends only to foods intended for infants up to six months of age. While some experts see this as an important positive departure from The Code, encouraging mothers to prepare complementary foods at home, others see it as a problem. They argue that poor sanitation and hygiene conditions in much of India, and the lack of access of many families to nutritious local foods, means that many mothers feed their children unsafe weaning foods, of poor nutritional quality. If the marketing of manufactured complementary foods were not so restricted, they believe that more companies would make foods that would be safer and more nutritious.

Other areas in which the IMS Act is more demanding than The Code include restrictions on informational and educational materials and labeling (explained later in this chapter). Importantly, the IMS Act also provides for regular monitoring of The Act and for any company found to be in breach of it to be prosecuted. The Breastfeeding Promotion Network of India (BPNI) is the only non-governmental organization in India formally tasked with monitoring companies’ compliance with The Act. When it identifies breaches of the Act, by companies or other entities, it writes to the appropriate ministries to request they take action. Examples of the types of concerns it has raised in recent years relate to adverts in professional journals, pamphlets produced and distributed to hospitals, sponsorship of conferences and quizzes by BMS companies, and adverts and promotions of BMS products on online retail sites.

Improving nutrition for all

The Access to Nutrition Index rates food and beverage manufacturers´ nutrition-related policies, practices and disclosures worldwide on a recurring basis.

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Funders

Bill & Melinda Gates Foundation

Ministry of Foreign Affairs

Robert Wood Johnson Foundation

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