Breastfeeding Disconnect: 89% Hospital Births, Yet Only 41% Fed In First Hour

Breastfeeding is universally recognised as a critical intervention for addressing malnutrition and a foundational pillar of food security. It requires no external resources, leaves no carbon footprint, and remains resilient to supply chain disruptions, making it a sustainable, equitable, and climate-resilient first food system. As we mark World Breastfeeding Week 2025 under the theme “Invest in Breastfeeding, Invest in the Future,” it is a timely reminder that protecting, promoting, and supporting breastfeeding is not only essential for child survival and development but also a powerful investment in healthier communities, stronger economies, and a more sustainable future. 

India, home to one of the largest child populations globally, faces a dual challenge: promoting optimal breastfeeding practices while combating widespread malnutrition, particularly among children under five. Recent data from the National Family Health Survey (NFHS-5, 2019–2021) and other studies highlight both progress and persistent gaps in breastfeeding practices, with significant implications for malnutrition, health, and economic outcomes.

According to NFHS-5, only 41.8% of infants are breastfed within one hour of birth, a modest improvement from 9.5% in NFHS-1 (1992–93) but stagnant compared to NFHS-4 (2015–16). Alarmingly, 18 states and Union Territories have seen declines in early initiation rates. Exclusive breastfeeding for the first six months has risen to 63.7% from 54.9% in NFHS-4, approaching the World Health Organization’s (WHO) target of at least 50% by 2025. However, regional disparities persist. Complementary feeding remains inadequate, with just 45.9% of children aged 6–8 months receiving timely solid foods and only 11.1% of children aged 6–23 months getting an adequate diet. These trends reflect uneven progress.

India bears a heavy malnutrition burden, with 35.5% of children under five stunted, 19.3% wasted, 32.1% underweight, and 67.1% anaemic. India accounts for one-third of the world’s 46.6 million stunted children. Malnutrition contributes to nearly 50% of under-five deaths, with diseases like diarrhoea and pneumonia, preventable through optimal breastfeeding-being major culprits. Globally, the WHO estimates that proper breastfeeding could prevent over 820,000 under-five deaths annually. Suboptimal breastfeeding practices directly exacerbate malnutrition. Maternal malnutrition further compounds the issue, with 25% of the indigenous women and 18.7% women (15-49 years) underweight, increasing the likelihood of low-birth-weight infants who face higher risks of stunting and wasting.

Poverty and food insecurity affect 389 million people in South Asia, with 62 million Indian children malnourished. Rural areas (50% underweight children) fare worse than urban areas (38%). Cultural beliefs, such as giving prelacteal feeds or delaying weaning beyond six months, persist due to a lack of awareness. Gender inequality also plays a role; women with limited decision-making power often prioritise food for family members over themselves, worsening maternal and child nutrition. Working mothers face additional barriers. In India, most female workers are in informal jobs or small firms (fewer than 10 employees), exempt from the Maternity Benefit Act, leading to inadequate maternity leave and lack of lactation support, which contributes to lower exclusive breastfeeding rates. Despite 89% of institutional births in India, only about 41.8% of newborns are breastfed within one hour of birth, up from 10% in the early 1990s, but still low given high institutional deliveries.

Breastfeeding’s benefits extend beyond health. It enhances cognitive development, school performance, and adult income potential, breaking the cycle of poverty and malnutrition. According to the World Bank “Investing in early nutrition is not just a health or social policy—it’s an economic growth strategy. Children who escape stunting are 33% more likely to escape poverty as adults.”  Every dollar invested in breastfeeding yields $35 in economic returns. Conversely, malnutrition’s long-term costs are staggering: stunted children face reduced productivity, low educational performance and higher healthcare costs, perpetuating socioeconomic disparities. A return of $23 is expected for $1 invested in nutrition interventions to reduce stunting.

India’s National Nutrition Mission (POSHAN Abhiyaan) aims to reduce stunting by 2% annually, but progress has been slow (1.3% per year from 2015–20). The Infant Milk Substitutes Act seeks to curb formula marketing, yet enforcement remains weak. Healthcare system gaps, such as limited counselling and failure to implement rooming-in practices, hinder breastfeeding promotion. Workplace policies also lag, with many women lacking access to lactation spaces or sufficient maternity leave.

To address these challenges, India must strengthen health systems through staff training and antenatal counselling, educate families to counter harmful cultural norms, promote timely complementary feeding, and enforce supportive policies such as extended maternity leave and workplace lactation spaces.

Ensuring access to nutritious diets and antenatal care is also vital to reduce low birth weight and disrupt the cycle of intergenerational malnutrition. Ultimately, investing in breastfeeding and Infant and Young Child Feeding remains a high-impact, evidence-based strategy to reduce malnutrition and improve child health and development.

(The author is Senior Fellow, Health Initiative, Observer Research Foundation, New Delhi)

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