1. WBTi India Round 4, 2015 Results, Trends, Analysis and Way Forward

2. Overall….

3. Some won… some lost…

4. Indicator 1: National Policy, Programme and Coordination 3 1.5 The National Breastfeeding Committee has become defunct. Even though some national policies have included issues related to IYCF; there is no dedicated national policy on infant and young child feeding as per the commitment to the Global Strategy for Infant and Young Child Feeding. National guidelines yet to be converted to policy, which would give far more stability and a regulatory framework. Lack of effective coordination mechanisms within Ministries and between Central & State Ministry/Departments.

5. Indicator 2: BFHI 2.5 0 Some early gains achieved are now lost due to non-functioning of the programme for more than a decade. This comprises a major missed opportunity in light of the fact that institutional deliveries are at about 60 – 70% and the indicator for early initiation is still stagnant at 6.

6. Indicator 3: Implementation of the IMS Act 8 9.5 The IMS Act includes three out of four relevant resolutions of the World Health Assembly. Enactment of the IMS Act has led to some curbs on the promotional activities by the manufacturers of products through print and electronic media. However violations continue Weak implementation structure Content missing in IYCF training

7. Indicator 4: Maternity Protection 4.5 3.5 There is basically no maternity benefit (as wage compensation) for more than 90% of the women in the informal sector (MBA does not apply) The MB Act is inadequate; it provides for leave/wage compensation for only 12 weeks and there is no monitoring framework NFSA not implemented

8. Indicator 5: Health and Nutrition Care 4 7 Welcome effort by MoHFW Inadequate skill based in-service training on IYCF for health care providers, including doctors. Inadequate training of health workers on IMS Act and its implementation Lack of child health policy that provides for mothers and babies to be together while in health care institutions. (low hanging fruit)

9. Indicator 6: Mother Support and Community Outreach 5 6 Essentially, gains through ICDS restructuring, the National Policy for Children (2013), National Policy on Early Childhood Care and Education (2013), and continuing progress under the NRHM for antenatal and delivery-related services. Lack of child care services on the ground Lack of skilled counselling for IYCF

10. Indicator 7: Information Support 6 6 Absence of an IEC policy that addresses the risks of using formula feeds in children (wrt WHO guidance). No national IEC strategy for improving infant and young child feeding that ensures all information and materials are free from commercial influence and potential conflicts of interest More low-hanging fruit since much IEC work is already happening

11. Indicator 8: Infant Feeding and HIV 3 5.5 Advances in creating guidelines by the Ministry of Health and Family Welfare and capacity building for health personnel for IYCF counselling in the context of HIV/AIDS. Main gap: skilled counselling to ensure avoidance of mixed feeding in HIV positive cases Supply-side problems in ARV

12. Indicator 9: IYCF During Emergencies 0 0 Ministry of Health has developed an operational guideline on infant and young child feeding which mentions infant feeding in emergency situation. Need a detailed policy and guidelines (wrt IFE guidelines) Much more stewardship required with the NDMA More low-hanging fruit

13. Indicator 10: Monitoring & Evaluation 7 5 Shocking that the ICDS MIS does not capture programmatic data and is unable to monitor IYCF, though field data exists. Limited data from HMIS Large surveys have been sparse with delays in reporting data.

14. Indicators 11-15: Status Early Initiation of Breastfeeding: 6 to 6 Exclusive breastfeeding: 6 to 9 (?!) Median Duration of Breastfeeding: 10 to 10 Bottle Feeding: 6 to 6 Complementary Feeding: 3 to 3

15. Progress and status of South Asian Countries on a Composite WBTi score

16. Conclusions and Recommendations India is lagging far behind all its neighbours Scores can be pushed up easily through many interventions that would not require major changes in policy, major increase in financial / human resources: simply require leadership and will (the low hanging fruit): Better coordination through an effective full-time supra ministerial body Conversion of IYCF guidelines to a national policy Reviving BFHI Including IMS Act in pre and in-service training IEC on dangers of bottle feeding Creating guidelines for IYCF in disaster situations Other major interventions on maternity entitlements and child care services would be required for sustained gains, are long overdue and have a massive significance for the rights of women and children. A road map must be set immediately to achieve these universal entitlements.

17. Moving Forward…. Outcomes reflected in Indicators 15-20 Impact on health and well being of women, children, families, community, society, country, world…. Political Will Change in Pathways reflected in increase in Scores 1-10 Consensus Concerted Action: Policy Advocacy and Grassroots Mobilisation

18. Images from AAM Creches and PLA … Thanking You in Advance…… The WBTi India, 2015 team