In Part II of my talk on Gender, Work, and Health, presented at the National Labour Institute in Delhi, first to a group of research scholars from various parts of India and second to a group of policy makers from different countries, I talked about how a rights-based approach would improve implementation of policies that would bring about a Breastfeeding Model that Works.
A breastfeeding model that works:
Recognizes the importance of breastfeeding
Accords with World Health Organization Guidelines and the Indian Constitution and Maternity Benefits Act
Recognizes the importance of food.
Breastfeeding is the normal way humans feed their young, and also introduce their young to the diverse flavours of foods. Currently in India, however, only 1 in 3 babies is exclusively breastfeeding for the first six months, and even fewer continue breastfeeding for at least two years, as the WHO Guidelines recommend.
Salient features of the WHO Guidelines on Breastfeeding
Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.
Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.
Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.
1. Lack of confidence in their bodies. Women are easily convinced that they do not produce “enough milk” or that their milk is not “good enough.” Even if their baby is feeding well it can be turned against women – some people imply that “too frequent” feeding indicates that the milk is not adequately nourishing. Breastmilk, unlike formula milk, digests easily and therefore it is normal for infants to feed frequently, day and night.
2. Lack of awareness: In some communities babies are not given colostrum due to traditional beliefs.
3. Post-partum dietary restrictions. Some women report being denied certain foods post-partum due to traditional beliefs. Their diet is sometimes so restricted that they do not get adequate nutrition, and feel weak, contributing to a sense of inadequacy and vulnerability to advertising messages of formula companies.
4. Lack of rest / leave. Some women must meet expectations from their employers or their in-laws to resume work schedules that lead them to spend less time on breastfeeding before the 6 months of exclusive breastfeeding are complete, and not accommodate continued complementary breastfeeding beyond. This may be due to poverty, inequality or low regard for breastfeeding.
Three strategies to overcome these obstacles are:
First, women, men and health workers should learn about the importance of breastfeeding, including the importance of colostrum for the baby and balanced diet for the mother. India has national guidelines on infant and young child feeding, which align with the WHO guidelines and promote breastfeeding as well as food. More on food in part III of this talk.
Second, we need to regulate those who market breastmilk substitutes. For this we have the
and the Indian Law known as IMS which is short for
Unfortunately the International Code and the Indian law are routinely violated.
In India the Breastfeeding Promotion Network of India takes note of code violations but the penalties are so paltry that it hardly makes a difference. At the global level groups like Baby Milk Action have managed to exert public pressure against companies that violate these laws and encourae the public also to volunteer to monitor code compliance.
Read more: Kelly Mom, On the Trail of Code Complicity
Third we need to ensure that women have adequate maternity leave and breastfeeding breaks.
I will talk more about points 2 and 3 now, and save point 1 for the next segment of the talk. In that segment I will also raise some further issues women face in feeding themselves as well as their children.
Marketing of Breastmilk Substitutes
In an attempt to get customers as young as possible, the food industry starts with substitutes for infant milk (breast-milk). There are certain medical conditions which necessitate the use of formula milk. There are also many situations in which its use is optional. How will a mother decide in those situations, whether to use formula milk and if so, how much? You might say, she will consult the doctor. But how will the doctor decide to what extent to recommend measures to improve breastfeeding and to what extent to recommend formula use?
Here is where the formula marketing comes in. There is a huge “stomach share” that can be influenced towards the use of formula if the manufacturers can get the right message to the right people. The WHO Code addresses many of the marketing strategies that formula companies use to influence doctors as well as consumers to the detriment of public health. It states that formula companies cannot advertise to the public, give free samples in health care facilities, give gifts to health-workers, cannot show pictures of babies on their labels or otherwise “idealize the product,” and must include a message on the benefits of breastfeeding. This ensures rational use of formula when circumstances demand.
The same rules are part of the Infant Milk Substitutes Act:
All labels of IMS /Infant food, must say in English and local, languages that breastfeeding is the best.
Also, the labels must not have pictures of infants or women or phrases designed to increase the sale of the product.
This means that formula must be labeled in such a way that provides information about the contents, and tells the user how to prepare it, but does not try to “sell” the product.
Along with this, read this point in Section 24 of the Food Safety and Standards Act (FSSA): “no person can make false claims in oral, writing or even by visual representations regarding the nutritional value of the product or efficacy of the product without providing any scientific justification.”
Now let us look at the reality of Baby Food advertising. Unfortunately it is rife with violations of the law.
The Breastfeeding Promotion Network of India reported in 2013 that “Baby Food Companies Continue to Mislead Mothers.” Globally, Kelly Mom has documented code violations by every formula company.
In 2012 the Food Safety Standard Authority of India (FSSAI) found the following companies in violation of its standards regarding truth in advertising. Several of the listed companies also violate the IMS Act.1. Complan 2. Complan Memory 3. Boost 4. Horlicks 5. Emami – Healthy and Tasty Soybean Oil 6. Saffola 7. Engine Mustard Oil 8. Nutricharge men (Daily nutrition supplement capsules) 9. Kellogg’s Special K 10. Britannia Nutrichoice Biscuits 11. Kellogg’s Extra Muesli 12. Bournvita Little Champs 13. Today Premium Tea 14. Pediasure 15. Real Active Fibre 16. Nutrilite 17. Kissan Cream Spread 18. Rajdhani Besan 19. Britannia Vita Marie
These companies make false claims as part of an overall strategy to promote powders and packaged food-like substances in lieu of meals made from whole foods. We will return to this in the third segment on Foods.
Coming to the point on Maternity Benefits, let us look at the Indian Constitution:
Article 42 of the Constitution of India 1949
Provision for just and humane conditions of work and maternity relief the State shall make provision for securing just and humane conditions of work and for maternity relief.
The relevant Act that puts this into practice is the MATERNITY BENEFIT ACT, 1961. Apart from maternity leave, women are entitled to nursing breaks, over and above the usual breaks. They may use the time to nurse the child or to pump milk for the child. Here is what the act says about Nursing breaks:
11. Nursing breaks
Every woman delivered of a child who returns to duty after such delivery shall, in addition to the interval for rest allowed to her, be allowed in the course of her daily work two breaks of the prescribed duration for nursing the child until the child attains the age of fifteen months.”
However, we find that many employers violate this act and in fact create an environment in which women who bring up their right to nursing breaks may soon find themselves out of a job.
The Ministry of Women and Child Development, Govt. of India, recently organised a day long consultation on the Maternity Benefit Act, 1961. Among the issues they raised were the increase in unorganised workers, sub-contracted workers and others who find it difficult or impossible to demand rights in the workplace, and workplace discrimination against pregnant women:
“The MB Act glosses over the discrimination which pregnant women face at the time of recruitment and widely prevailing practice of dismissal if a woman employee is pregnant. It is usual that the application of a worker for paid maternity leave is answered by employers with termination notices.”
Why are we unable to guarantee basic constitutional rights? How can it be that even though the Ministry is aware that the Maternity Benefit Act is not being upheld, we aren’t seeing any improvement?
Returning the first point, women, men and health workers should learn about the importance of breastfeeding. Certainly this is important. It will be more effective, however, if girls and women understand that at every age and every stage of life, through puberty, menstruation, pregnancy, lactation, and beyond, their bodies are just right, not shameful or inadequate, and their milk is just right for their babies. Similarly, at every stage, in childhood, adolescence, through pregnancy and postpartum, they are entitled to eat all the food the family eats, in adequate quantity. This requires a basic cultural change. Though the consequences are more dire in poor households where girls and women are malnourished even before applying postpartum dietary restrictions, the cultural change needs to happen in all levels of society.
To support a breast-feeding model that works, we must also support a food model that works. I suggest that we understand the decline in breast-feeding rates not only in terms of how well we, individually and as a society, understand the importance of breastfeeding, but also how we understand food, and what policies we are making that impact the access of people to food – real food, and not edible-food like substances. Breastfeeding is the first stage of human’s introduction to food and society, and our policies towards breastfeeding reflect our policies towards food, land, water and human rights.
To be continued in Part III: Towards a Food Model that Works.