Birthing to breastfeeding: How to help mothers break the disconnect

India is getting better at medical care during motherhood, but that progress is not carrying through to the first months after birth. The National Family Health Survey-6 (NFHS-6), conducted in 2023-24, shows that 95.9 per cent of pregnant women now receive antenatal care and 90.6 per cent of births take place in health facilities—up from 92.6 per cent and 88.6 per cent, respectively, in NFHS-5 (2019-21).

Yet, exclusive breastfeeding of babies under six months has fallen sharply—from 63.7 per cent to 55.8 per cent between 2023-24 and 2019-21. There has been progress at the very beginning: 50.1 per cent of children are now breastfed within an hour of birth, compared with 41.8 per cent earlier. But the numbers suggest a growing disconnect between the increasingly supervised experience of pregnancy and childbirth and the support mothers receive once they begin feeding their babies.

A 2023 review in The Lancet reaffirmed that exclusive breastfeeding lowers the risk of diarrhoeal disease, respiratory infections and hospitalisation in infancy while supporting healthy growth and development. Lactation expert Divya Malik Dhawan from Apollo Cradle, New Delhi, adds another aspect. “People don’t realise that breastfeeding is not just important for the child. It has important health advantages for the mother too,” says Dhawan.

Breastfeeding triggers the release of oxytocin, helping the uterus contract after childbirth and reducing postpartum bleeding. Longer durations of breastfeeding have also been linked to lower lifetime risks of breast and ovarian cancers, Type 2 diabetes and cardiovascular disease.

Doctors say the decline is being driven more by lifestyle than biology. Many urban mothers return to work within a few months of delivery, receive inadequate lactation support or assume they are not producing enough milk in the first few days after birth. Formula is often introduced early while social media has fuelled anxiety through constant comparisons of feeding schedules, sleep patterns and weight gain.

“Instead of viewing the mother’s choices as a matter of convenience, we have to recognise the barriers that she faces,” says Dr Preeti Prabhakar Shetty, a senior consultant obstetrician and gynaecologist. “We need to strengthen the support systems that enable successful breastfeeding.”

Shetty says higher caesarean delivery rates, delayed skin-to-skin contact between mother and newborn, maternal fatigue, early formula supplementation, lack of trained lactation counsellors and pressure to return to work all reduce the chances of successful exclusive breastfeeding.

Another challenge is perception. “One of the biggest myths is that breastfeeding should come naturally and effortlessly,” says Dr Shetty. “It is a learned skill—both for the mother and the baby. It requires guidance, patience and support.”

When difficulties arise, many women assume they have insufficient milk and begin supplementing with formula. Dr Parimala Devi, consultant in obstetrics and gynaecology at Kauvery Hospital, Chennai, says another misconception is that premium infant formulas are somehow superior because they are enriched with DHA (docosahexaenoic acid), probiotics or other nutrients. “According to WHO (World Health Organization) and the Indian Academy of Pediatrics, breast milk remains superior to any infant formula regardless of its cost,” she says.

Studies have shown formula-fed babies have higher risks of obesity, Type 2 diabetes and respiratory and gut infections later in life.

Many women stop not because they cannot breastfeed but because the challenges of the first few weeks become overwhelming. “A caesarean section can make breastfeeding slightly more challenging in the first few days because latching may be delayed, mothers are recovering from surgery and positioning can be difficult. However, these challenges are temporary. With proper support, most mothers are able to establish breastfeeding successfully within the first few weeks,” says Dr P.M. Gopinath, director, reproductive medicine, Kauvery Hospital.

Experts say the solutions lie in better support for the mother after delivery. “More than 95 per cent of caesarean mothers can breastfeed successfully with early skin-to-skin contact, rooming-in with the baby and support from a lactation consultant,” says Dr Devi.

Strengthening lactation support—both in hospitals and during the postnatal period—is also essential to improve exclusive breastfeeding rates. “Medical supervision during pregnancy does not automatically translate into successful breastfeeding. Exclusive breastfeeding depends on what happens in the hours, days and weeks after birth,” says Shetty.