India's exclusive breastfeeding rates drop sharply despite healthcare gains

Saritha, 27, a domestic help in central Delhi's Rajendra Nagar, could not exclusively breastfeed her two sons for the recommended first six months, despite having normal institutional deliveries. Her husband drives for a ride-hailing platform and takes odd jobs. She returned to work within two months of delivery and introduced infant formula before her sons turned six months old. 'If I do not work, we cannot pay rent or meet our living expenses,' she said.

Saritha represents a growing number of mothers in India unable to exclusively breastfeed (EBF) their infants for the recommended six months. EBF is considered one of the most effective interventions for child survival and healthy development. Breast milk provides all necessary nutrients, antibodies against common illnesses, and supports growth and brain development. For mothers, it aids recovery and reduces cancer risks.

The World Health Organization and UNICEF recommend initiating breastfeeding within one hour of birth and continuing exclusively for six months. Trends in EBF are closely monitored in India's National Family Health Survey (NFHS) as key indicators of child health and nutrition. Lower EBF rates can adversely affect child nutrition, increase infections and healthcare costs, and slow progress in reducing child mortality.

The latest NFHS-6 (2023-24) reveals worrying trends. Despite 90.6% of deliveries being institutional, EBF declined from 63.7% in NFHS-5 to 55.8%. Early initiation of breastfeeding improved from 41.8% to 50.1%, but the overall EBF rate fell. Sharpest declines occurred in large states: Uttar Pradesh dropped from 59.7% to 34.6%, Haryana from 69.5% to 41.2%, Delhi from 64.3% to 54%, and declines also in Rajasthan and Madhya Pradesh. In contrast, Kerala, Gujarat and West Bengal improved.

The decline was steeper in rural areas, where EBF fell from 65.1% to 56.2%, compared to urban areas from 59.6% to 54.5%. This paradox comes at a time of significant gains in maternal and child health: improved early breastfeeding initiation, expanded maternity benefits, and greater women's empowerment. Nearly 89% of women now participate in household decisions, 89% have bank accounts, and internet use among women rose from 33.3% to 64.3%.

Experts say empowerment alone may not be sufficient. Growing economic pressures, informal employment, and lack of adequate maternity protection force many mothers to return to work early. The decline in EBF underscores the need for stronger workplace support, paid maternity leave, and community-based lactation support to help mothers breastfeed exclusively.