India's exclusive breastfeeding rate falls even as early initiation improves, experts urge support

India has made notable progress in getting mothers to start breastfeeding soon after childbirth, but a widening gap between early initiation and sustained exclusive breastfeeding is emerging as a critical challenge, according to health experts and the latest national survey data.

The National Family Health Survey (NFHS-6) shows that the proportion of children under six months who were exclusively breastfed fell from 63.7% in NFHS-5 to 55.8% in NFHS-6. In contrast, breastfeeding within one hour of birth increased from 41.8% to 50.1% during the same period. This suggests that while more mothers are initiating breastfeeding promptly, many struggle to continue exclusively for the first six months after leaving healthcare facilities.

The findings were discussed during World Breastfeeding Week, observed through the week ending Friday, with experts emphasising the need for sustained support rather than just early initiation.

Karnataka's mixed picture

Karnataka presents a relatively better picture on exclusive breastfeeding. The proportion of infants under six months exclusively breastfed increased marginally from 61.0% to 61.6%, keeping the State above the national average. However, early initiation in the State declined slightly from 49.1% to 48.3%.

There has been improvement in complementary feeding in Karnataka. The proportion of children aged six to eight months receiving solid or semi-solid food along with breast milk increased from 45.8% to 57.9%. Yet, the proportion of breastfeeding children aged six to 23 months receiving an adequate diet remains low, despite rising from 10.6% to 14.2%. Among all children in this age group, the proportion receiving an adequate diet rose from 12.4% to 18.3%.

The challenge after discharge

Sarath Gopalan, president of the Nutrition Society of India and senior consultant paediatric gastroenterologist at Madhukar Rainbow Children's Hospital, said many mothers want to breastfeed but find it difficult to continue exclusively for six months.

“India has made progress in helping mothers start breastfeeding soon after birth, but many struggle to continue exclusively for the first six months. Often, the challenges begin after they leave the hospital, when they may not have the same support and guidance,” he said.

Several factors affect sustained breastfeeding, including caesarean deliveries, inadequate lactation counselling, lack of support at home, and difficulties in returning to work. Maternity protection also remains limited, with more than 90% of working women in the informal sector outside the coverage of formal paid maternity leave.

Maternal nutrition matters

Anura Kurpad, professor and head of physiology at St. John's Medical College and senior advisor (health and nutrition) at Tata Trusts, said the nutritional needs of the mother should receive greater attention.

“While a mother's body naturally prioritises the baby's nutritional needs, it often does so at the expense of her own nutritional reserves,” he said. Nutrients such as iron, zinc, folate, calcium, and copper are transferred to breast milk even when the mother's diet is inadequate. Prolonged nutritional depletion can contribute to anaemia, micronutrient deficiencies, fatigue, and poorer maternal health, Dr. Kurpad said.

He added that supporting breastfeeding requires attention to maternal nutrition, rest, and recovery. Simple additions to regular meals — such as milk or curd, eggs where culturally acceptable, pulses, groundnuts, seasonal fruits, and vegetables — can help meet increased nutritional requirements during lactation.

Breastfeeding needs a support system

Adhunika Prakash, founder of Breastfeeding Support for Indian Mothers, said breastfeeding should be treated as a public health priority rather than an individual responsibility.

“Closing this gap requires greater awareness, stronger support systems, and evidence-based guidance for every mother,” she said, calling for comprehensive lactation education in medical and nursing curricula and access to skilled lactation counselling irrespective of socioeconomic background.