Mothers are receiving conflicting information on what is best for their babies, and it is coming from their healthcare providers.

Marketing milk in maternity wards Are Indian moms coerced into giving baby formula
Delve Health Monday, August 06, 2018 - 13:36
Written by  Disha Shetty

Vidya Sanap, a 32-year-old researcher at IIT-Bombay, had just delivered a baby through a C-section. Aware of how important colostrum, the nutrient-rich yellow liquid that oozes out of a mother’s breast soon after birth is, she was eager to breastfeed. When the bed-ridden mother called out to the nursing staff to help her do it, she says she was chided. “Your breast milk won’t dry out if you don’t feed your baby for the next three or four days. Stop being so desperate,” the nurse snapped, Vidya says.

To Vidya this was an eye opener. As a first-time mother she was having to pushback against her caregivers to do what research proves was best for her baby. Vidya then had to reach out to a woman friend who helped her hold her newborn son close to her breast as he had his first meal. Two hours later the nurse arrived again with a newly opened formula milk tin. This time Vidya was too tired to argue. When Vidya was getting discharged, her doctor prescribed formula milk to her. There was no counselling about breastfeeding.

The UNICEF says that breastfeeding is the best start a mother could give her baby. It advocates for breastfeeding within the first hour of birth, but government data shows that only 41.6% of all Indian babies have that healthy start. Only half of the babies are exclusively breastfed for the first six months of their lives.

But mothers like Vidya - well educated, well informed ones - are reporting something more.  They would love to breastfeed, they say, but the nurses, and at times even doctors, tell them how hard it would be and ask them to consider formula milk. It’s the best option for you and the baby, they are told.

Vidya Sanap

Except, it is not, unless circumstances demand it. 

The research is unanimous. Breast milk does not just protect the newborn against infections but also increases IQ in the long run and plays a role in controlling obesity as well as diabetes. An analysis in the leading medical journal The Lancet showed that despite the strong evidence, only around one-third of babies being born in low-income countries like India are exclusively breastfed for the first six months of their lives.

Globally, the formula milk versus breast milk debate is in the news after the US government opposed a resolution backing breastfeeding at the UN-affiliated World Health Assembly (WHA) in Geneva this year. The resolution said that since decades of research suggests mother’s milk is healthiest for infants, countries around the world should try to limit the marketing of formula milk.

In 2011 the Asia-Pacific region alone gave the formula milk manufacturing companies profits worth US$ 14.7 billion. Since then, estimates suggest that their market share has grown by as much as 20% every year. Both India and China are huge emerging markets for these products.

Studies say that around the world, a million deaths can be prevented merely my optimal breastfeeding. It would also reduce around 10% of the global disease burden in children.

And yet, mothers are having to fight back.

My Baby, My Decision

Sitting on her bed with her legs crossed and two-day old baby boy on her lap, Jincy Varghese, a 31-year-old new mother, felt like it was the end of the world for her. She could not stop crying. For hours she was trying to breastfeed her baby but she wondered if she was doing it right. Meanwhile her newborn son kept crying. The hospital staff offered her an option – feed the baby formula milk. Varghese refused.

Her baby was shifted to the NICU after birth for monitoring. When she went to feed her baby, the nurses informed her that the baby had already been fed formula milk. Seething with anger, she felt like the choice was taken out of her hand. “I was willing to breastfeed my baby and yet the staff at the private hospital in Mumbai where I gave birth kept advocating formula milk,” she shares, speaking almost breathlessly, as she recalls her experience after her delivery last year.

It was only after her discharge from the hospital, when Varghese started talking to more women who had recently given birth, that she realized her experience was not an isolated one.

“When I was pregnant I had started an online petition to increase maternity leave and written to Maneka Gandhi and to a lot of politicians,” says Varghese animatedly. She decided that if there were more mothers who felt that the choice of what to feed their babies was taken out of their hands then she must to something to start a dialogue about it.

The result was her online petition and hashtag called #mybabymydecision. The petition also has been signed by over 37,000 people. She alleges that the hospitals open formula milk containers without the permission of the mother right after a baby is born. The new mother is then sent home with this box and recommended formula milk.

Jincy Varghese

What’s more, this does not come cheap.

One small tin of formula milk can cost as much as Rs 500 and lasts only five days. In the first six months alone, the families will spend thousands of rupees on the milk. One doctor, on condition of anonymity, says, “It happens with the consent of the hospital administration. Now formula companies are targeting nurses who push formula milk to the new mother." What the mothers are also not told is that it is difficult to wean the babies away from the formula milk once started.

India though already has a strict law in place called the IMS (Infant Milk Substitute) Act which prohibits formula milk companies from offering incentives or marketing their products to the hospitals. Yet some mothers we spoke to for the story reported that hospitals gave them a list of specific companies to buy the formula milk from.

Dr Arun Gupta, who heads the Indian chapter of the International Baby Food Action Network (IBFAN), a global consortium that acts to stop misleading marketing emphasized that now formula milk is often being fed to newborns without the consent of the mother. “What people don’t realize that formula milk is by nature non-sterile. You might be able to control the quality of the milk powder but what about the water that is being used?”

Globally the sales of formula milk have flattened. With more companies now entering Indian markets Dr Gupta says that newer, underhanded ways are being used to reach the doctors and bypass the law. “There are online communities where thousands of doctors are registered. Marketing of these products now happens in such spaces,” he says.

Informed choice

What is important to understand is that formula milk has a role. There are mothers who are too sick after child-birth and unable to breastfeed the baby. Some might not produce enough milk or be on medicines that make breastmilk unfit for consumption. Some might simply choose not to breastfeed at all. Formula milk is a viable option for all of these groups. 

“The percentage of deliveries in which a mother is medically unable to breastfeed is lower than 3%,” says Dr Santosh T Soans, President, Indian Association of Pediatrics (IAP). “A mother is too tired after childbirth and it is crucial that she be given support to continue breastfeeding,” he adds. This support can come from nurses, husbands and extended family members. It can also come from their doctors.

During pregnancy a woman is often seeing a gynecologist who also oversees the birth. But once that is done, a pediatrician takes over. Soans alleges that the newborns are put on formula even before the pediatrician reaches the hospital. “Soon after birth, a new mother is very tired. We need to have trained lactational consultants to help her as well as train both the obstetrics as well as the nurses,” Soans suggests.

France Begin, Senior Advisor, Infant & Young Child Nutrition at UNICEF explains, “There is nothing that can replace the breast milk.” She adds, “For certain mothers it is not always possible to breastfeed. We want to make sure is that the decision is an informed one.”