Are the WHO Guidelines on Breastfeeding Appropriate for India?

Using data from India’s first National Family Health Survey, conducted in 1992–93, this report examines factors affecting breastfeeding practices and the effect of breastfeeding on mortality at each month of infancy. The analysis is done separately for three groups of states classified according to their levels of infant mortality: high-mortality states, medium-mortality states, and low-mortality states. Breastfeeding is nearly universal in India and continues for most children beyond infancy. For many infants, however, supplemental food is introduced at an early age. Up to six months of age, exclusive breastfeeding is most common in medium-mortality states followed by states where infant mortality is high. In all three groups of states, infants who live in rural areas, whose mothers are illiterate, and whose families have low economic status are more likely than other infants to be exclusively breastfed. The World Health Organization (WHO) recommends that children in developing countries should be exclusively breastfed up to 4–6 months of age. According to NFHS-1 results, both exclusive and nonexclusive (i.e., supplemented) breastfeeding lower mortality during early infancy. A surprising finding, however, is that breastfeeding with supplements is more beneficial than exclusive breastfeeding, even for children at very young ages (less than four months). The reason for the less-than-expected beneficial effect of exclusive breastfeeding appears to be that mothers who are poorly nourished and in poor health themselves may not provide adequate breast milk for their growing infants. These results call into question the WHO recommendation that children be exclusively breastfed up to age 4–6 months. They suggest that supplemental food should be introduced at earlier ages, especially when a mother’s health and nutritional status are low. In such situations, it appears that mother’s milk is frequently not adequate to provide the level of nutrition that a growing infant requires. It also appears that the dangers of disease contamination from supplemental foods may not be as great as commonly thought, at least not in India. Thus it may be possible to reduce infant mortality in India by introducing nutritious supplemental food for children at quite young ages (2–3 months) as well as by providing poorly nourished pregnant and lactating mothers with nutritional supplements. Further research is needed to explore the relationship