Arun Gupta Central Coordinator BPNI 9th Feb 2017 Where is Right to Health, Nutrition( Life) without a Focus on Breastfeeding? Arun Gupta Central Coordinator BPNI 9th Feb 2017

Have you ever wondered why?

Why Baby Milk Formula Sales are Slow India than China ? Source: Euromonitor International (2013) Passport Baby Food in India Report Euromonitor International (2012) Passport Baby Food in China Report

Because we have a law.. Infant Milk Substitutes Feeding Bottles, and Infant Foods (Regulation of Production, Supply and Distribution) Act 1992, and Amendment Act 2003.

Still……a fact 2.7 Crore containers of 400gms are sold every years. Meaning thereby one for every baby born…

BUT Not implemented well

Violations few examplaes are a tip of iceberg….. E-marketing Sponsorship

Out of these, 2/3rd were given formula without their knowledge The survey conducted by Breastfeeding Support for Indian Mothers, a Facebook group of 30,000 mothers 950 mothers who delivered in private hospitals were given artificial baby milk Out of these, 2/3rd were given formula without their knowledge

Just half the babies born begin to breastfeed within first hour ?

Story in NOT so good !!

Protection Promotion and Support 3 elements are needed BUT WE DON’T invest in all

Missing in the National Plan of Action Missing in the introductory text: Reference to National Guidelines on IYCF in the policies Reference to The IMS Act Missing  in the  Key Priority Area 1: Survival, Health, and Nutrition        Counseling on breastfeeding during pregnancy  Access to counseling on Breastfeeding and complementary feeding  (0-2 years) under child care services Access to counseling on Breastfeeding in Preventing HIV infections  Implementation of the IMS Act Optimal IYCF during emergencies/disasters  Maternity entitlements  

Himachal Story

Where we stand today?

Initiation of breastfeeding < 1 hour Initiation of breastfeeding < 1 hour. 13% rise in 10 years against 80% inst Deliveries

Trends in Exclusive Breastfeeding < 6 months.

Look at where we stand today in numbers 26 million births 80 % in health facilities ~ 20 Million 12 million begin to breastfeed within first hour 14 million first meal is formula ~6 million completely exclusive India sells 10,847 Tonnes of Std. Powder Infant formula annually..(for 0-6 months) ~27 million containers of 400 gms. Most common first food in private hospitals

Do we need to invest in breastfeeding and babies?

UN Human Rights Statement In November 2016, the United Nations Human Rights Commission issued a joint statement on protection, promotion and support of breastfeeding, which noted that “Women who choose to breastfeed often lack the necessary support structures. Gaps in knowledge and skills among healthcare providers often leave women without access to accurate information or support”.

Lancet Series on Breastfeeding 2016 If India were to universalize breastfeeding in coming years, Reduce 156,000 child deaths (13% of under-5), 3,900,000 episodes of diarrhea, 3,436,560 episodes of pneumonia and 4915 deaths due to breast cancer annually. Over and above this it would add 4300 Crores to Indian economy. Add 3 points to IQ of all children, rich or poor. Reduce obesity by 26% Prevent 1 out of 3 new cases type 2 diabetes

World Bank estimates on WHA targets

Benefits of Investing ! There is strong body of evidence that shows very high economic returns. (Alderman, Behrman and Puett 2016; Copenhagen Consensus center2015; Hoddinott et al 2013) Benefits of investing on exclusive breastfeeding are particularly high : $35

3 Solutions

1. Cousellors in Health Facilities MAA Programme is a welcome step by MOH Needs strengthening Appoint counselors in each hospital well trained Get private hospitals on board

Support ….. Not all women get it

2. Maternity Entitlements for all women Extend maternity benefits Act for all women Maternity Benefit cash scheme may have a counselling component clearly backed by a budget line.

3. Budget Line for Breastfeeding and infant and young child feeding practices Allocate 1 Crore per district for capacity building and strengthening block level

Cost Estimates in India based on our experience At community level Health Facility level INR 435 per birth : INR 169 Non Recurring includes cost of training and capacity building up to block level INR 265 Recurring cost includes: Incentives to frontline workers New appointments 4 workers per block Refresher training Coordination At a Dist.. Level total cost comes to about 1.06 Crores (Recurring). Appointment of Lactation Counsellors In all 20,000 hospitals Cost about 300 Crores annually (Salary of INR 15,000PM)

Thanks !