Civil Society News, New Delhi
Some time in the early 1980s, Dr R.K. Anand, a paediatrician, returned from London to practice in Mumbai. One evening, he went to see a film. Advertisements preceded the main film. Dr Anand watched with deep dismay as one of the ad films cheerily told mothers that bonny babies came from tins of Glaxo milk powder. Dr Anand was working in a charitable hospital and he knew the reality was very different – weak, malnourished babies fed on bottled milk were dying of diarrhoea and pneumonia. But mothers who breastfed had healthier babies.
Almost 30 years later, Dr Anand still remembers that ad jingle and he sang it at the 20th anniversary celebrations of the Breastfeeding Promotion Network of India (BPNI) in New Delhi.
BPNI was founded on 3 December 1991 at Wardha in Maharashtra by a handful of doctors alarmed by the campaign unleashed by giant baby food companies inciting mothers to replace healthy breast milk with their canned products. Since that historic day, BPNI has grown from six small groups in India to 250 groups in 166 countries called the International Baby Food Action Network, (IBFAN).
BPNI was then seen as a fringe group. It evoked amusement, recalled Dr Arun Gupta, founder and central coordinator of BPNI, who heard Dr Anand speak on breastfeeding at a hospital in Jalandhar and decided to join the Wardha meeting. Indian women breastfed their babies anyway, it was believed. But the founders of BPNI knew the truth was very different.
The bottle was replacing breast milk. Mothers threw away colostrum, the first breast milk critical for building the newborn’s immunity. Harmful ideas on nutrition for infants were rampant. Poor feeding practices are the core reason for India’s miserable infant mortality rate.
Twenty years later, the dedication of BPNI’s founders has changed perceptions. Nutrition is now a priority for the Union Government, keen to lower infant and maternal mortality rates. BPNI’s advice is sought. Dr Arun Gupta is a member of the Prime Minister’s Council on India’s Nutrition Challenges. And breastfeeding is included in the Approach Paper of India’s 12th Plan.
A project in which BPNI was a partner, promoted breastfeeding and corrected infant feeding practices in Lalitpur district of Uttar Pradesh by training health workers. It dramatically improved the health of babies and reduced infant mortality rates.
“First you get ridiculed, you face opposition and then you get accepted,” said Dr Gupta philosophically quoting Swami Vivekananda. The Union government has been supportive, he said.
“One of the biggest changes is that women do want to breastfeed. But they need support. That is missing,” says Dr Anand. Today, Lactogen, Farex and Cerelac have faded away, points out Dr Gupta. The next generation of babies will benefit.
But the journey to success has been tough. Dr Anand, Dr Gupta, Dr JP Dadhich and Professor KP Kushwaha briefly recounted BPNI’s troubled past and outlined the challenges ahead.
To beat back the powerful baby food industry, the NGO fought a persistent and heroic battle. In 1992, after years of lobbying, the Union government passed the Infant Milk Substitutes Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act or in brief the IMS Act. This law restricts the marketing of infant milk substitutes, feeding bottles and infant food for babies.
But BPNI, which was put in charge of monitoring the Act, realized soon that companies did not listen and violations were rife. In 1994 Dr Gupta acting on behalf of ACASH (Association for Consumer Action on Health and Safety), an NGO founded by Dr Anand, filed a criminal complaint against Nestle for violating the IMS Act. The case is ongoing. ACASH has successfully forced companies like Johnson and Johnson, Lintas and retail chains like Shoppers’ Stop to adhere to the IMS Act.
BPNI also got the Union government to ban advertisements of infant milk and infant food on television. In 2003 it got the government to ban promotion of baby milk and baby food for children under two years of age. “If we consider the way TV has boomed, imagine how feeding practices of babies would have been destroyed if the IMS Act did not exist,” says Dr Gupta.
The NGO has beaten back WTO attempts to jettison the IMS Act. It has thwarted the ambitions of the Global Alliance for Improved Nutrition (GAIN), a conglomeration of multinationals who wanted to enter the Indian market to promote ‘nutritious’ foods to fight hidden hunger. It has resisted attempts to merge the IMS Act into the Food Safety Bill.
But while BPNI has succeeded in checking the decline in breastfeeding, rates have not dramatically increased. Dr Dadhich said that 20 million out of 26 million infants in India do not receive optimal breastfeeding despite India’s adoption of international guidelines. In Delhi, just 20 per cent of women exclusively breastfeed their babies for six months.
He said though women did want to breastfeed they did not get information or support. They needed counselling services. For this training of health workers on a large scale was essential. Harmful beliefs still continued. So a sustained information campaign advertising breastfeeding was essential to counter industry.
Dr Dadhich also pointed out that there was still no effective mechanism to deal with violations of the IMS Act. To break the nexus between the healthcare system and industry was very difficult. BPNI has always highlighted that industry’s financing of conferences for doctors represents a conflict of interest.
Women in the informal sector need maternity leave and maternity entitlements to exclusively breastfeed babies for six months. The Indira Gandhi Matritva Sahyog Yojana does give a maternity entitlement of `4,000 in three installments to pregnant and lactating mothers but it is inadequate. BPNI has been lobbying for `100 per day, the minimum wage, to be given to mothers at the anganwadi. It has pinned its hopes on the Food Security Bill.
BPNI is also replicating Lalitpur’s Baby Friendly Community Health Initiative in Punjab’s Ferozepur and Gurdaspur districts and in Andhra Pradesh. In Lalitpur district, the project was led by the Department of Paediatrics, BRD Medical College, Gorakhpur, in partnership with UNICEF, the district administration and the state government.
BPNI’s training material was used to train 48 local graduate women as mentors in breastfeeding, complementary feeding, infant feeding and HIV counselling. The mentors in turn trained anganwadi workers, the ASHAs and dais, who then formed a ‘mothers support group’ which fanned out to villages, identifying pregnant women, doing home visits and counselling mothers.
In all the mentors trained over 3,330 village level workers who reached 84 to 90 per cent of mothers with advice. By 2008, breastfeeding within one hour of birth increased from 39.2 to 72 per cent, exclusive breastfeeding from 6.85 per cent to 50 per cent and introduction of complementary foods from 4.6 per cent to 85 per cent.
A group of anganwadi workers and ASHAs came to attend the BPNI meeting. "The training was most useful," says Rama Dubey, an anganwadi worker. “At first the mothers-in-law would not listen to us. So we began with our own families. When a severely underweight baby in my family became healthy thanks to my advice, the mothers-in-law finally got interested. Now, of course, our opinion is respected."
So what is needed are many more trained health workers, mentors specializing in nutrition, linked to an activist medical college or hospital.