Indian Pediatrics - Editorial

Letters to the Editor

Indian Pediatrics 2003; 40:1112-1113

The IMS Act 1992

This is in response to the article–The IMS Act 1992; Need for More Amendments and Publicity(1). While I do not underestimate the importance of legal support to the issue of breastfeeding and complementary feeding, the real battle has to be fought in the community with the support of health workers, anganwadi workers, TBAs and the community. According to National Family Health Survey (NFHS)-2, exclusive breastfeeding was 55.2% among 0-3 month old infants(2). According to BPNI study of 2003 (data collected from 98 blocks in 49 districts - 25 states and 3 Union Territories), it was 54.5% at 3 months but had declined to 27.3% at 6 months(3).

Health, ICDS personnel and TBAs who are in close contact with the community, do not have the knowledge regarding correct infant feeding practices and Medical Officers too are by and large ignorant (or disinterested) and so bottle feeding, formula feeding and inadequate and delayed introduction of complementary feeding is widely prevalent. The solution therefore, lies in training the health and ICDS workers regarding appropriate infant feeding practices. TBAs can be taught regarding initiating breastfeeding soon after birth and thereafter feeding on demand, and advise against ghutti, and other commonly used substances, and against giving water. Most births take place at home except in one or two Southern States and even those who deliver in hospital are there for only a couple of days, and so efforts and inputs in the philosophy of Baby Friendly Hospital can give only limited results.

The situation regarding introduction of complementary feeds at 6 months is equally dismal. According to NFHS-2, only 31% babies receiving semisolids between 6 and 9 months, the figure being less than 20% in Rajasthan, Uttar Pradesh and Bihar. The Eastern States fare much better even though their exclusive breastfeeding status is unsatisfactory(2).

While mothers are advised to give modified household food after six months, there are occasions when readily available complementary food is welcomed to save time in the case of a working mother. While promotion in the form of exaggerated advantages, gifts etc. are to be deprecated, banning any kind of promotion under the age of two years, does not seem realistic(4). Hardly any infant is given commercial baby food after 2 years since they are eating ordinary household diet. One advertisement of Cerelac I came across advises introduction of commercial food at 6 months, but unfortunately at the bottom again mentions 4 months. This is unethical and the company should be hauled up for it, but to ban advertisement till after 2 years seems contrary to the infant feeding advice.

The only way to improve child nutrition is to take the meassage to the community through the workers working at the community level (after training them) and through the Panchyat, Women’s group etc. The support of father and older members of the family is crucial for success.

Shanti Ghosh,
5, Sri Aurobindo Marg,
New Delhi 110 016.

References

1. Tiwari SK, Chaturvedi P, The IMS Act 1992; Need for more amendments and publicity. Indian Pediatr 2003; 40: 743-746.

2. National Family Health Survey (NFHS-2) 1998-99: International Institute for Population Services (IIPS) and ORC Macro-2000, India, Mumbai: IIPS.

3. Report. Breastfeeding Promotion Network of India (BPNI) 2003.

4. Policy. The Infant Milk Substitute, Feeding Bottles and Infant Foods (Regulations of production, supply and distribution) Amendment Act, 2003. What has changed? Indian Pediatr 2003; 40: 747-757.