Important information on feeding practices in India was provided by the National Family Health Survey (NFHS-2) conducted between 1998-99 and reported in October 2000.The NFHS-2 covered 26 states and the National Capital Territory of Delhi, comprising 99 percent of the total population of India. In all 89,777 ever-married women aged 15-49 years and 88,562 households were covered, using uniform questionnaires, sample designs and field procedures. Following is a summary of key breastfeeding practices according to NFHS-2.

Initiation of breastfeeding immediately after childbirth is important because it benefits both the mother and the infant. As soon as the infant starts suckling at the breast, the hormone oxytocin is released, resulting in uterine contractions that facilitate expulsion of the placenta and reduce the risk of bleeding immediately after birth. It is also recommended that the first breastmilk (colostrum) should be given to the child, because it provides natural immunity to the child. Fig. 1 shows the percentage of children initiating breastfeeding within one hour.

Fig. 1: Initiation of breastfeeding

Children who receive nothing but breastmilk during the first six months are defined as being exclusively breastfed. The introduction of supplementary food before six months of age may put infants at the risk of malnutrition, because other liquids and solid food are nutritionally inferior to breastmilk. Consumption of liquids and solid or mushy food at an early age also increases children's exposure to pathogens and consequently puts them at a greater risk of getting diarrhoea. Fig. 2 shows that only 55% babies of less than 4 months of age are exclusively breastfed in India which falls rapidly from 1st month onward.

Fig. 2: Exclusive breastfeeding (NFHS-2)

It is important to investigate exclusive breastfeeding carefully as it has a bearing on child health, development and nutrition. The data from the Multiple Indicator Cluster Survey, 2000 (MICS II), from UNICEF, India shows very clearly the difference between the two ways of asking about exclusive breastfeeding (Fig. 3). When asked, if they had provided other liquids or solids in the past 24 hours, 36.8% of them said that they did not. However, when asked about the exclusive breastfeeding since birth, the number was merely 15%. (Fig. 3)

Multiple Indicator Survey, 2000 (MICS) II), UNICEF. India Country Office

Fig. 3: Exclusive breastfeeding

The proportion of children receiving both breastmilk and supplements increases from 10% in the first month of life to 49.4% after 6 months and 81% at 12 months. (Fig. 4, NFHS-2)

Fig. 4: Receiving supplements

Introduction of complementary food

From six months of age, the introduction of complementary food is critical for meeting the protein, energy, and micro-nutrient needs of the children. However, in India, the introduction of complementary food is delayed for a substantial proportion of children. Only 24% of breastfeeding children who are 6 months old consume solid or mushy food. This proportion rises to only 46 percent at 9 months of age. Even at 12 months of age, more than one quarter of breastfeeding children did not eat any solid or mushy food in the day or the night before the interview. (Fig. 5)

Fig. 5: Introduction of complementary food

Bottle-feeding

Bottle-feeding has a direct effect on the mother's exposure to the risk of pregnancy because the period of amenorrhoea may be shortened when breastfeeding is reduced or replaced by bottle-feeding. As it is often difficult to sterilize the bottle and the nipple properly, before their use, also exposes children to an increased risk of getting diarrhoea and other diseases (Fig. 6). Thus, it is always advisable to feed the baby with a spoon and a cup to be on the safer side.

Fig. 6: Using bottle with a nipple