24 Paraganas report.pdf - BPNI

Status of Infant and 

Young Child Feeding 

District : 24 Paraganas (State of West Bengal) 

2003 

Breastfeeding Promotion Network of India 

(BPNI)

STATUS OF INFANT AND YOUNG 

CHILD FEEDING 

2003 

District: 24 Paraganas (State of West Bengal) 

(A part of the study on Status of Infant and Young Child Feeding 

in 49 Districts of India) 

Breastfeeding Promotion Network of India (BPNI) 

BP-33, Pitampura, Delhi – 110088 

Tel: 011-27312445, Tel/Fax: 011-27315606 

Email: bpni@bpni.org Website: www.bpni.org

© Breastfeeding Promotion Network of India (BPNI), 2004 

REPORT WRITING AND PRODUCTION 

• Main Writers: Dr. Arun Gupta and Vandana Sabharwal 

• District Study Coordinator: Dr. Parbati Sen Gupta, State Coordinator, BPNI WB, 6, 

Dover Road, Flat 5-A, Kolkata, West Bengal 

• Other Contributor: Sijo Merry George 

• Cover Design: ‘Process and Spot’ 

• Layout: Amit Dahiya 

All rights are reserved by the Breastfeeding Promotion Network of India (BPNI). The report 

may, however, be freely reviewed, abstracted, reproduced or translated, in part or whole, 

provided the source is acknowledged and provided that the final production is not for sale 

or commercial purposes. 

The Breastfeeding Promotion Network of India (BPNI) is a registered, non-profit, 

independent national organization with international collaboration and works towards 

protecting, promoting, and supporting breastfeeding and appropriate complementary 

feeding of infants and young children since 1991. BPNI works in India with the broad goal 

of empowering all women to breastfeed their infants exclusively for the first six months of 

life and to continue breastfeeding for two years or beyond along with adequate and 

appropriate complementary feeding starting after six months. BPNI works through 

advocacy, training, education, information, research and social mobilization. BPNI works in 

close collaboration with the International Baby Food Action Network (IBFAN) and the 

World Alliance for Breastfeeding Action (WABA). BPNI does not accept funds or 

sponsorship of any kind from the companies producing infant milk substitutes, feeding 

bottles, related equipments, or infant foods (cereal foods). 

This report is based on findings reported by the respective district study coordinator and 

is for the information and education purposes. 

Reproduction is encouraged. Any part of the report may be freely reproduced, as long 

as the meaning of the text is not altered and appropriate acknowledgement and credit 

is given to this publication. 

The map of India used in this report is based upon survey of India map, 2001 

2 Status of Infant and Young Child Feeding: District 24 Paraganas (West Bengal)

This is the report of the study, both quantitative and qualitative, 

of breastfeeding practices and systematic monitoring of 

compliance with the Infant Milk Substitutes, Feeding Bottles and 

Infant Foods (Regulation of Production, Supply and Distribution) 

Act, 1992 (IMS Act) in the district of 24 Paraganas (West Bengal) 

The report reflects the current picture of breastfeeding practices in 

24 Paraganas and lays bare the socio-cultural loopholes that need 

to be plugged – first at the district level and then at the national 

level – thereby striving towards the ultimate goal of achieving 

optimal breastfeeding practices across the nation. 

Status of Infant and Young Child Feeding: District 24 Paraganas (West Bengal) 3


Contents 

Page No. 

Acronyms 6 

Acknowledgements 7 

About BPNI 8 

Preface 9 

1. Introduction 11 

2. Background 12 

3. Objectives of the Study 16 

4. Study Design, Data Collection and Analysis 17 

5. Findings of the Quantitative Study 20 

6. Findings of the Qualitative Study 30 

7. Findings of Monitoring the Compliance with the Infant Milk Substitutes, Feeding 

Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 

1992(IMS Act) 

33 

8. Conclusions and Suggested Action Ideas for BPNI District Branch Coordinators 37 

Annexure 

1. Guidelines for Conducting District Level Mobilization Meeting and Advocacy iii 

2. Status of Infant and Young Child Feeding in 29 Districts (98 Blocks) of India, 

2003 

3. Quantitative Survey on Infant and Young Child Feeding - Guidelines and 

Questionnaires 

4. Qualitative Survey on Infant and Young Child Feeding - Guidelines and 

Questionnaires 

v 

vi 

xi 

5. Tenth Five Year Plan Goals 2003 – 2007 for Infant Feeding Practices xxii 

6. Infant Feeding Practices – District Wise Quantitative Data xxiii 

7. Initiation of Breastfeeding by State (NFHS -2, 1998-99) xxiv 

8. Recommended Feeding Indicators by State (NFHS -2, 1998-99) xxv 

9. Nutritional Status of Children by State (NFHS -2, 1998-99) xxvi 

10. Definitions of Infant Feeding Behaviours xxvii 

11. Resources xxviii 


Acronyms 

ANM 

AWWs 

BFHI 

BPNI 

CEDAW 

CRC 

CHWs 

DWCD 

EBF 

FB 

FOGSI 

FORCES 

GOI 

HIV 

IAP 

IBFAN 

ICDS 

IF 

IMA 

IMR 

IMS 

IMS Act 

IYCF 

MICS 

NACO 

NAP 

NFHS 

NGOs 

OBC 

PPTCT 

RCH 

SC 

ST 

TBAs 

TNAI 

UNICEF 

VCCTC 

WABA 

WHA 

WHO 

UN 

UT 

Auxiliary Nurse Midwives 

Anganwadi Workers 

Baby Friendly Hospital Initiative 

Breastfeeding Promotion Network of India 

Convention on the Elimination of All Discrimination Against Women 

Convention on the Rights of the Child 

Community Health Workers 

Department of Women and Child Development 

Exclusive Breastfeeding 

Feeding Bottles 

Federation of Obstetrics & Gynecological Societies of India 

Forum for Crèche and Child Care Services 

Government of India 

Human Immunodeficiency Virus 

Indian Academy of Pediatrics 

International Baby Food Action Network 

Integrated Child Development Scheme 

Infant Foods 

Indian Medical Association 

Infant Mortality Rate 

Infant Milk Substitutes 

The Infant Milk Substitutes, Feeding Bottles and Infant Foods 

(Regulation of Production, Supply and Distribution) Act, 1992 

Infant and Young Child Feeding 

Multiple Indicator Cluster Survey 

National Aids Control Organization 

National Action Plan 

National Family Health Survey 

Non Government Organisations 

Other Backward Castes 

Prevention of Parent to Child Transmission 

Reproductive and Child Health 

Schedule Caste 

Schedule Tribes 

Trained Birth Attendants 

Trained Nurses Association of India 

United Nations Children’s Fund 

Voluntary and Confidential Counselling and Testing Centres 

World Alliance for Breastfeeding Action 

World Health Assembly 

World Health Organisation 

United Nations 

Union Territory 


Acknowledgements 

At the outset, we would like to offer our heartfelt thanks to all those involved in conducting 

interviews and collecting information, and to all mothers and children who patiently provided 

answers, and without whom this study could not have happened. Our sincere apologies to those 

to whom it may have caused any inconvenience. 

We deeply appreciate the role of Dr. Parbati Sen Gupta, the district study coordinator at 24 

Paraganas, who was involved in conducting the study, as well as its compilation and analysis. We 

are grateful to Dr. Y. P. Gupta for his contribution in development of the report as well as in its 

final analysis, particularly of the qualitative study. Mr. D.S. Singal’s contribution in analysing 

district wise in-depth interviews has been extremely valuable. Dr. B.S. Nagi assisted with data 

entry, tabulation, and analysis and Dr. Jagdish C. Sobti provided the final comments; we are 

extremely thankful for their contribution. Our very sincere thanks to Amit Dahiya for the design 

and layout - without his help the report would not have come out in this form. We are also 

thankful to Radha Holla and Rajeshwari Parkash, who helped us in the editing of this report. 

Our thanks are due to Deepika Shrivastava of UNICEF, India, whose support and guidance have 

been invaluable to the success of this work. Thanks a million! 

Both our staff, who worked over weekends and through day and night to put it in the present 

shape and Rakesh Ahuja, who did a wonderful job in designing the cover in such a short time, 

deserve our special appreciation. 

We sincerely thank the Government of Luxembourg and UNICEF-NATCOM Luxembourg, who 

provided financial support and UNICEF, India, who helped to secure this support and monitor it. 

Lastly, we would like to specially thank Maryse Lehners of IBFAN Luxembourg, who was 

instrumental in mobilising this support from UNICEF, Luxembourg. Her efforts are deeply 

appreciated; BPNI is highly obliged for her contribution. 

Dr. Arun Gupta 

Vandana Sabharwal 


About BPNI 

The Breastfeeding Promotion Network of India (BPNI) is a registered, independent, non-profit, 

national organization that works towards protecting, promoting and supporting breastfeeding and 

appropriate complementary feeding of infants and young children. It was founded in 1991, and has 

been spearheading action on infant and young child feeding in the country as well as the South 

Asian region. 

Working towards empowering all women to exclusively breastfeed their babies for the first six 

months and continue breastfeeding for two years or beyond with appropriate complementary 

feeding beginning after six months, BPNI has grown rapidly, both in terms of the number of members 

as well as in the geographical areas. Today, there are about 2500 members spread across the 

length and breadth of India with interstate variations. 

Our Aim 

To contribute to the reduction in malnutrition, and improved infant and young child health and 

development through improved infant feeding practices. 

Our Vision 

Optimal infant and young child feeding is established as a societal norm in all communities. This 

is done in the best interests of the child and to ensure the best possible start to life to every child as 

foundation for fulfillment of every child’s right to survival, growth, development, protection and 

participation without discrimination. By the end of 2007, technical breastfeeding support will be 

available in at least 200 districts with BPNI established as a leader in this movement across the nation 

having memberships in all 600 districts (presently exists in around 300 districts). 

Our Mission 

BPNI seeks to enhance nutrition, health and development of infants and young children through 

programmes designed to increase national and state commitments, education of public and health 

care workers, countering commercial influences, capacity development of district level persons, 

providing technical support and training to enhance skills of community workers, and social 

mobilization to improve optimal infant and young child feeding practices. 

BPNI believes that breastfeeding is the basic right of every individual, mother and baby. It 

endorses the international 1 and national 2 instruments committed to improve infant feeding 

practices. BPNI works in collaboration and strengthened partnership with Governments and UNICEF 

and other stakeholders to ensure achievement of its objectives. 

Our Funding Policy 

BPNI follows clear ethical and funding policies that do not lead to any conflicts of interest and 

does not accept funds or sponsorship of any kind from companies producing infant milk substitutes, 

feeding bottles, related equipments, or infant foods (cereal foods). 

1 

Global: Convention on the Right of the Child (CRC), Convention on the Elimination of All Forms of Discrimination Against Women 

(CEDAW), World Fit for Children, World Health Assembly resolutions, Global Strategy for Infant and Young Child Feeding. 

2 

National: National Plan for Action on Children, National Nutrition Policy, National Plan of Action for Nutrition, National Nutrition 

Mission, National Health Policy 2002, and IMS Act 1992 /2003 GOI. 


Preface 

India is one of the first countries to have taken the lead in harmonizing the global 

recommendations on infant and young child feeding in its policies. 

With the launch of the National Nutrition Mission, and implementation of the State and National 

Plans of Action on Children, there is a renewed interest in positioning exclusive breastfeeding for 

the first six months as the key intervention at all levels. In its 10 th Five Year Plan, the Government 

of India has set a target to increase the rate of exclusive breastfeeding during the first six months 

to 80 percent from the current level of 41.2 percent 3 , and to increase the rate of initiation of 

breastfeeding within one hour to 50 percent from the current level of 15.8 percent. It also targets 

to increase the rate of complementary feeding for 6-9 months old infants to 75 percent from the 

current levels of 33.5 percent. 

The 10 th Five Year Plan has also set State specific targets. For the state of West Bengal these are to 

increase the rate of exclusive breastfeeding during the first six months to 70.7 percent from the 

current level of 48.8 percent (0-3 months), the rate of initiation of breastfeeding within one hour 

to 79.1 percent from the current level of 25.0 percent and increase rate of complementary feeding 

of infants aged 6-9 months from 46.3 percent to 100 percent. 

The IMS Act, 1992 (as Amended in 2003) and the Draft National Guidelines on Infant and Young 

Child Feeding, likely to be formally launched soon, clearly position the recommendations of 

optimal infant feeding including exclusive breastfeeding for the first six months and continued 

breastfeeding for two years or beyond along with appropriate and adequate complementary 

feeding beginning after six months. 

At the same time, the National Aids Control Organisation (NACO) is planning to expand its 

activities around the issue of infant and young child feeding by HIV positive mothers. NACO’s 

planned expansion at district levels includes creating Voluntary and Confidential Counselling 

and Testing Centres (VCCTC) & Prevention of Parent to Child Transmission Centres (PPTCT), 

would also lead to an increased demand of skilled counsellors on infant and young child feeding 

in the context of HIV. 

All this is expected to generate massive action on the issue of infant and young child feeding at 

district levels and below. Recognising that the success of all these plans requires a huge capacity 

building exercise at the district level, the Breastfeeding Promotion Network of India (BPNI) 

included the following objective in its Strategic Plan: 2003-2007 - “To strengthen core training 

resources and enhance capacity of district level groups”. 

In fact, capacity building at the district level was started by BPNI in mid 2002. To reach the 

grassroots level more effectively, BPNI is working to energize and stimulate more action at the 

district level, with the belief that when people themselves investigate their local situation and are 

3 

Simple average of exclusively breastfed children during the first 6 months. As it is 55.2 percent for < 4 months and 27.3 percent for 4-6 

months. Source: National Family Health Survey (NFHS-2) 1998-99. International Institute for Population Sciences India, 2000. 


part of its analysis, they understand it clearly and are more emphatic in generating action to 

ameliorate the situation. 

In one capacity building workshop under the project, “Protection of Breastfeeding in India”, 

supported by the Government of Luxembourg and UNICEF NATCOM, Luxembourg and 

facilitated by UNICEF India, 49 district study coordinators were trained to conduct a study in the 

respective districts. All the 49 district study coordinators initiated action and mobilised their 

respective districts, which led to documentation of the status of IYCF in these 49 districts across 

25 states and 4 UTs. This is the report of the study from 24 Paraganas district in West Bengal. 

The report will be very useful to programme managers and policy makers at the district, state and 

at national level, and agencies working on health and nutrition, NGOs working on child health 

and maternal health, as well as UN agencies, and all others concerned for advocacy to 

mainstream the component of infant and young child feeding in various nutrition, health and 

development programmes. 


1. Introduction 

This report presents the findings of the quantitative and qualitative study of breastfeeding 

practices and the results of monitoring the compliance with the IMS Act for 24 Paraganas district 

in West Bengal. This is a part of the study on “Status of Infant and Young Child Feeding in 49 

Districts of India”, carried out in 25 States and 4 Union Territories of India, conducted in three 

phases during the year 2003. 

1. In Phase I, quantitative data was collected by interviewing mothers and families of 

infants between the ages of 0 - 9 months. 

2. During Phase II, qualitative data was collected through in-depth interviews of mothers, 

mothers-in-law, health workers and others. 

3. Phase III or the last phase was when the data was collected on implementation of and 

compliance with the IMS Act through interviews of hospital authorities, chemist shop 

owners, health workers and mothers. 

The report provides not only a view of infant and young child feeding practices in 24 Paraganas, 

but also brings to light several reasons that help or hinder these practices. The report consists of a 

brief background, methodology, findings of the quantitative study in part-1, findings of 

qualitative study in part-2 and findings of compliance with the IMS Act in part-3. Finally, it 

attempts to make recommendations for future action. 


2. Background 

In India, while the infant mortality rate (IMR) has shown a significant decline from 146 per 1000 

live births in 1951 to 68 per 1000 in the year 2000, there still remains the need to accelerate 

improvements in infant and neonatal survival. Problems such as malnutrition, poor maternal 

and adolescent nutrition, gender discrimination, all continue to be major challenges. Even today, 

every fourth infant born in India has low birth weight and every second young child is 

malnourished, reflecting inadequate caring practices related to health, hygiene, infant and young 

child feeding, psychosocial care, and care for girls and women. Inadequate infant and young 

child feeding practices contribute to the sharp increase in malnutrition – almost fourfold 

between the first few months of life and the completion of two years of age. According to WHO 

estimates, malnutrition is responsible for around 55 percent of young child mortality. 

It is estimated that worldwide 10.9 million children under five years of age die every year, of 

which 2.42 million deaths occur in India alone. The Global Strategy on Infant and Young Child 

Feeding, adopted by World Health Assembly (WHA), recognises that two-thirds of these deaths 

occur during the first year and is related to inappropriate infant feeding practices. In terms of 

sheer numbers it comes to 16 lac deaths every year. Recent research on accelerating child 

survival published in the Lancet, clearly establishes that universal exclusive breastfeeding for the 

first six months is the single most effective child survival intervention – it reduces under-5 

mortality by 13 percent 4 . 

Promotion of optimal infant and young child feeding practices is crucial for preventing 

malnutrition; early growth faltering; for reducing malnutrition, infant and neonatal mortality; 

and for promoting integrated early child development. Breastfeeding is a critical entry point for 

ensuring progressive fulfillment of children’s rights to survive, grow and develop to their full 

potential, without discrimination. 

India has become one of the first countries in the world to update its legislation to protect, 

promote and support breastfeeding, in harmony with the new Global Strategy for Infant and 

Young Child Feeding, endorsed by the WHA in May 2002 and UNICEF Executive Board in 

September 2002. 

The enactment of the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of 

Production, Supply and Distribution) Act, 1992 (as Amended in 2003) is a major step forward in 

ensuring the best possible start in life for young children. It mandates that all mothers be 

empowered so that their infants receive exclusive breastfeeding for the first six months. 

Thereafter, they shall receive optimal complementary feeding, along with continued 

breastfeeding up to two years of age or beyond. Scientific evidence is available that breast milk 

alone is the ideal nourishment for infants for the first six months of life, and their ’first 

immunization’. It contains all the nutrients, antibodies, hormones and antioxidants that an 

infant needs to thrive – the ‘nurture provided by nature’. It protects babies from diarrhoea and 

4 

Jones G, Steketee RW, Black RE, Bhutta ZA, Morris SS and the Bellaagio Child Survival Study. Lancet, 362, July 5, 2003, 65-71 


acute respiratory infections, stimulates their immune systems and thereby prevents and reduces 

malnutrition, morbidity and mortality in infants and young children. 

The rationale behind promotion of optimal infant and young child feeding, especially 

breastfeeding, is not confined to its singular contribution to improved child survival and healthy 

growth. Optimal infant feeding also contributes to improved development outcomes and better 

active learning capacity in young children. Breastfeeding creates a strong bond between the 

mother and the child, both for girls and boys, stimulating development of all five senses of the 

child, providing emotional security and affection, with a lifelong impact on psychosocial 

development. New research also indicates that it confers cognitive benefits, thereby enhancing 

brain development and learning readiness. Breastfeeding is in fact one of the first learning 

processes in life for infants. Responsive care and feeding is another way in which infants 

participate actively in their own development. The benefits of breastfeeding for maternal health, 

well-being and empowerment including those for birth spacing are also well established. –. 

2.1. Status and 10 th Five-Year Plan Goals for India and West Bengal 

Data from NFHS -2 reflects that in India, 47.0 percent (percentage below -2 SD) children under 

the age 3 years are underweight and in the state of West Bengal 48.7 percent children under the 

age of 3 years are underweight. 

According to the NFHS-2, in India, breastfeeding within one hour was initiated in only 15.8 

percent of infants, which reaches 37.1 percent within the first 24-hours; only 55.2 percent of 

children of 0-3 months and 27.3 percent of 4-6 months were exclusively breastfed. According to 

the Multiple Indicator Cluster Survey (MICS) 2000 of UNICEF India, the percentage of ‘true’ 

exclusively breastfed babies between 0-3 months is even lower (15.6 percent). Data from NFHS-2 

also reflects that in the state of West Bengal, breastfeeding within one hour was initiated in 25 

percent of infants, which reaches 50.6 percent within a 24-hour period. But only 48.8 percent 

infants of 0-3 months are exclusively breastfed. 

After the age of six months, introduction of complementary feeding is critical for meeting the 

protein, energy, and micronutrient needs of the children. However according to NFHS-2, in 

India, it is delayed in the case of a substantial proportion of children. Only 33.5 percent of 

children (6-9 months old) who are breastfed consume solid or mushy foods. In West Bengal, 46.3 

percent children between 6-9 months of age receive complementary foods along with breast 

milk. 

Recommended Optimal Infant and Young Child Feeding Practices 

Starting breastfeeding immediately after birth, preferably within one 

hour. 

Exclusive breastfeeding for the first six months. 

Continued breastfeeding for two years or beyond. 

Introducing appropriate and adequate complementary feeding after 6 

months. 


The 10 th Five Year Plan for West Bengal aims to: 

• improve the initiation of breastfeeding within one hour to 79.1 percent from the 

current level of 25.0 percent, 

• improve exclusive breastfeeding during 0-6 months to 70.7 percent from 48.8 percent 

(at 0-3 months) 

• improve complementary feeding figures from the current level of 46.3 percent to 100 

percent. 

Such achievements are possible only with clear and comprehensive plans implemented seriously 

and in partnership with all those concerned or involved in infant feeding programmes including 

NGOs (See Fig. 1). 

120% 

100% 

80% 

79.1% 

70.7% 

100.0% 

60% 

48.8% 46.3% 

40% 

25.0% 

20% 

0% 

Initiation of Breastfeeding 

within 1 hour 

Exclusive breastfeedong 

(0-6 months) 

Complementary feeding 

(6-9 months) 

NFHS-2 

Tenth Plan Goals 

Note: NFHS 2 data for exclusive breastfeeding is for the 0-3 months period 

Fig. 1 Infant Feeding Practices: Comparison between NFHS 2 and the Tenth Plan goals for West 

Bengal 

2.2. Making it Possible 

The promotion of early and exclusive breastfeeding is a well-recognized acceleration strategy for 

child survival. Studies conducted the world over as well as in Bangladesh and India, have 

demonstrated that such quantum leaps are possible through effective counselling and support 

interventions. Haider et al 5 from Bangladesh demonstrated the feasibility of increasing exclusive 

breastfeeding through home-based community peer counsellors who were trained in 

counselling. The programme achieved 70 percent exclusive breastfeeding in five months. In the 

study done in Haryana 6 , it was demonstrated that promotion of exclusive breastfeeding till the 

age of six months is feasible in a developing country through existing primary health-care 

5 

Haider R, Ashworth A, Kadir I, Huttly SRA. Effect of community -based peer counsellors on exclusive breastfeeding practices in Dhaka, 

Bangladesh: a randomised controlled trial. Lancet 2000; 356: 1643-47 

6 

Bhandari N, Rajiv B, Sarmila M Jose M, Robert E B, Bhan M K. Effect of community-based promotion of exclusive breastfeeding on 

diarrhoeal illness and growth: a cluster randomized control trial. Lancet 2003; 361: 1418-1423. 


services, and reduces the risk of diarrhoea and prevents growth faltering. The study also 

demonstrated that the incidence of exclusive breastfeeding at 3 months was higher in the 

intervention group (79 percent) as compared to the control group (48 percent). An intervention 

study conducted by BPNI in Bhuj 7 to promote breastfeeding through behaviour change 

communication strategy, demonstrated that the exclusive breastfeeding rate was 38.3 percent in 

the intervention group as compared to 1.7 percent in the control group. In another study from 

Bangladesh evidence was provided of remarkable reductions in infant mortality by 32 percent, 

with the increase in exclusive breastfeeding rates from 39 percent to 70 percent 8 . 

7 

Effect of counselling on infant and young child feeding by trained community workers on exclusive breastfeeding: A study from 235 

villages in 3 blocks of district Bhuj, Gujrat. BPNI (Unpublished Data, 2004) 

8 

Arifeen S, Black RE et. al. Exclusive breastfeeding reduces acute respiratory infections and diarrhoea deaths among infants in Dhaka slums. Pediatrics, 

2001:108: E.67 


3. Objectives of the Study 

This study was done in 24 Paraganas to assess current infant and young child feeding practices 

across the district, to capture, in particular, the geographical and socio-cultural differences in 

breastfeeding practices. 

The study had the following specific objectives: 

• To assess the status of infant and young child feeding practices in 24 Paraganas 

district. 

• To understand the barriers of optimal breastfeeding practices. 

• To investigate the status of the implementation of and compliance with the IMS Act, 

1992. 


4. Study Design, Data Collection and Analysis 

4.1. Quantitative Study: Status of Infant and Young Child Feeding 

The study was conducted in both rural and urban areas of 24 Paraganas. The total numbers of 

interviews of mothers of three strata (See Annexure 3) in the district was 180 (90 from the cluster 

of villages in two rural blocks and 90 from the block headquarters). 

In the rural areas, two blocks were randomly selected such that one block was within 5 kms of the 

district headquarters and the other, 10 kms beyond. In each selected block, the first village was 

selected randomly. Five more adjacent villages were selected to form a cluster of six villages. 

Thus, there were two clusters of villages per district. 

In the first selected village of each cluster, one house was selected at random. Then going from 

house to house, 15 mothers with children aged between 0-3 months were selected for interviews. 

Similarly, 15 mothers each were selected with children between the ages of 3-6 months as well as 

between 6-9 months. Thus, a total of 45 mothers were selected for interviews. In case the quota of 

45 children in the three age strata was not completed, another adjoining village in the cluster was 

visited. This exercise was continued till the quota of 15 interviewee mothers (total of 45) in the 

three categories was completed. The same exercise was repeated in the second selected block. In 

this way the total number of completed interviews from each block was 90. 

A similar exercise was followed in the case of urban areas. Two clusters of wards were selected at 

random and from each cluster, 45 mothers were interviewed. The process followed was the same 

as for selecting respondents in the rural areas. Thus, there were 90 mothers interviewed from the 

urban areas of block headquarters. 

4.2. Qualitative Study: Status of Infant and Young Child Feeding 

The main aim of undertaking the qualitative study was to understand the barriers to optimal 

breastfeeding practices. The study helped to establish some of the positive factors on which 

health workers, community workers and communicators can build on to motivate mothers and 

other stake holders (in the family and community) to promote optimal infant and young child 

feeding practices. 

The qualitative study was based on in-depth interviews. The information gathered from in-depth 

interviews will be of great help especially in designing the interventions to improve knowledge, 

attitude and practice related to optimal infant feeding practices. 

The following issues were covered by the in-depth interviews: 

• Knowledge of appropriate breastfeeding practices, for example, initiation, colostrum 

feeding, exclusive breastfeeding and introduction of complementary feeding (mothers of 

infants, pregnant women and mothers-in-law); 


• Exact practices adopted for the infants (new mothers or those having child less than 4 

months) and reasons for adoption of both favourable as well as unfavourable infant 

feeding practices; 

• Visualizing factors which can be used as a starting point to promote healthy feeding 

practices; 

• Identifying factors, which will generate or strengthen community and familial support for 

mothers to adopt appropriate breastfeeding practices 

• Identification of key stakeholders at the community level-TBAs, influential women, 

women’s groups or forums etc. which can be targeted for the promotion of optimal infant 

and young child feeding practices at the community and family level. 

In-depth Interviews: Steps Adopted 

In rural areas – Two villages were selected from one block of the district. The selected two villages 

were different in terms of remoteness from the headquarters or the nearest town, class and 

ethnic group and any other characteristics that were appropriate in distinguishing the two 

villages. 

In urban areas, two localities of a city preferably with different socio-economic status were 

selected. 

In each of the selected villages / urban locality, the following numbers of persons were 

approached for in-depth interviews of different categories of the respondents – 

Mothers of infants 0 – 6 months : 3 

Pregnant women : 2 

Mothers– in – law : 1 

Others : 1 husband / father – in – law 

Community workers : 1 or 2 ANMs / Anganwadi workers / Volunteers 

4.3. Monitoring of Implementation and Compliance with the Infant Milk 

Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply 

and Distribution) Act, 1992 (IMS Act) 

A systematic monitoring of the IMS Act was undertaken to understand the implementation of 

the same and the type and methods of promotion adopted by baby food companies and 

compiling the same. This study helped to understand the baby food companies’ behaviour and 

difficulties in implementation of the IMS Act. The data for this study was collected through 

interviews with hospital administrators, doctors in hospital as well as in practice, nurses, mothers 

of infants and chemists. 


The following persons were interviewed: 

1. Hospital administrator : 1 

2. Doctors in hospital : 2 

3. Doctors in practice : 2 

4. Nurses : 3 

5. Mothers of infants 3-6 months : 5 

6. Chemist Shop : 1 

It was also decided to analyse labels of infant milk substitutes, feeding bottles and infant foods 

and company materials. Promotions on the Internet were also recorded. The report of these 

activities will be printed in our series of reports “Under Attack” which is a compilation of 

violations of the IMS Act. 

4.4. Data Analysis 

All completed schedules for quantitative, qualitative data and monitoring the compliance with 

the IMS Act, were collected at BPNI National Secretariat, New Delhi, where data entry and 

analysis has been done district-wise and all districts together to get a feel of the country 

perspective. This report gives you the findings for the district of 24 Paraganas. 


5. Findings of the Quantitative Study 

The summary findings of the quantitative data collected regarding infant feeding practices in 

district of 24 Paraganas are presented in Table 1. 

Table 1: Breastfeeding practices at a glance in the district of 24 Paraganas 

Percent of initiation of BF within 1 hour 39.6 

Percent of initiation of BF within 1-4 hour 18.8 

Percent of giving pre-lacteal feed 51.0 

Commonest pre-lacteal food given to new born 

Artificial milk 

Percent of Exclusive Breastfeeding 0-3 months 51.8 

Percent of Exclusive Breastfeeding 4-6 months 25.0 

Percent of Exclusive Breastfeeding 0-6 months (Simple Average) 42.5 

Percent of Complementary Feeding 6-9 months 76.9 

5.1. Background Characteristics of the Respondents 

The background characteristics of the respondents are described in Table 2. Data was collected 

from 192 respondents. 


Table 2: Background Characteristics of the respondents (N = 192) 

Characteristics Number Percentage 

Age 

Upto 20 years 

21-25 years 

Above 25 years 

Education 

Illiterate 

Just literate/No formal education 

Upto Primary 

Upto Middle 

Upto Higher Secondary 

Upto Graduation 

Post-Graduation & Above 

Working outside the house 

Yes 

No 

Religion 

Hindu 

Muslim 

Christian 

Caste 

SC 

ST 

OBC 

Other 

Sex of Index Child 

Male 

Female 

56 

85 

51 

42 

14 

27 

66 

18 

21 

4 

23 

169 

145 

42 

5 

78 

3 

45 

66 

91 

101 

29.2 

44.3 

26.6 

21.9 

7.3 

14.1 

34.4 

9.4 

10.9 

2.1 

12.0 

88.0 

75.5 

21.9 

2.6 

40.6 

1.6 

23.4 

34.4 

47.4 

52.6 

5.2. Breastfeeding Practices 

5.2.1. Initiation of Breastfeeding 

It is recommended that breastfeeding be 

initiated within one hour of birth and 

nothing be given to the infant before 

beginning to breastfeed. As seen in Fig.1, 

100% 

80% 

39.6 percent of mothers initiated 

60% 

breastfeeding within one hour, whereas 

39.6% 

18.8 percent initiated within 1-4 hours 

40% 

41.6% 

and 41.6 percent started breastfeeding 

18.8% 

20% 

after four hours or later. According to 

NFHS-2 (1998- 1999) only 25 percent 

0% 

mothers initiate breastfeeding within one 

hour in the state of West Bengal. The 

present data therefore reflects a strong 

Within 1 hour 1-4 hours More than 4 

hours 

need to intensify efforts towards improving 

Fig. 1: Initiation of Breastfeeding 

the initiation of breastfeeding as soon as possible after birth. 

Percentages 


5.2.2. Pre-Lacteal Feeds and Type of Pre-lacteal Feeds Given to the New Born 

Fifty one percent mothers gave pre-lacteal feeds to the baby, mostly artificial milk (See Fig.2 and 

Fig.3). Our study has shown that the practice of giving pre-lacteal feeds is high in 24 Paraganas. It 

is clear that practice of giving pre-lacteal feeds is high, due to which initiation of breastfeeding is 

delayed and it also breaks the “exclusive breastfeeding” norm. 

100% 

80% 

49% 

60% 

40% 

20% 

51% 

0% 

Yes 

No 

Fig. 2: Giving Pre-lacteal Feeds 

COMMENT 

Efforts should be made to discourage the practice of giving pre-lacteal feeds as well as to 

enhance early initiation of breastfeeding. For this mothers and other family members need to 

be counselled by skilled health workers or community workers during the prenatal period 

and assisted at the time of birth. 

Sugar Water 

9% 

Powder Milk 

8% 

Honey 

17% Glucose 

14% 

Other 

1% 

Water 

9% 

Artificial Milk 

42% 

Fig. 3: Type of pre-lacteal feed given to newborn 


5.2.3. Exclusive Breastfeeding 

It is recommended by UNICEF, WHO and Government of India that babies be exclusively 

breastfed for the first six months. Exclusive breastfeeding means that no other food or drink 

should be given to the baby for the first six months. Fig.4 represents exclusive breastfeeding 

practices of the respondents of this study during 0-6 months. It shows that 51.8 percent of 

children in the age group of 0-3 months are exclusively breastfed whereas this percentage is 25.0 

percent for children in the age group of 4-6 months. The percentage of exclusively breastfed 

babies (0-3 months) is high than that of NFHS-2 (48.8 percent). 

The nature of other foods and fluids given with breastfeeding was explored in the study. For 

children aged 0-6 months who are not exclusively breastfed, around 3 percent mothers gave 

water along with breastmilk. Around 50 percent of mothers have been giving other feedings and 

plain water to children aged 4-6 months along with breast milk (Fig. 5). 

COMMENTS 

As the 10th five-year plan goals for the state of West Bengal aim at increasing exclusive 

breastfeeding for the first six months to 70.7 percent, intense efforts are needed to counsel 

pregnant and lactating women in this direction. 

100% 

Percentages 

80% 

60% 

40% 

20% 

51.8% 48.2% 

25.0% 

75.0% 

42.5% 

57.5% 

0% 

0-3 months 4-6 months 0-6 months 

Age Group 

Exclusive Breastfeeding 

Artificial Feeding 

Fig. 4: Status of exclusive breastfeeding among 0-6 months 


100% 

80% 

60% 

40% 

20% 

0% 

5% 

0% 

3.1% 

Breastmilk + plain 

water 

27% 

25.0% 

26.0% 

Breastfeeding + 

Other feedings 

16.9% 

50.0% 

28.3% 

Breastfeeding + 

plain water + 

other feedings 

2.4% 

13.6% 

6% 

Breastmilk + solid 

0-3 months 4-6 months 0-6 months 

Fig. 5: Type of supplementary feeding among 0-6 months 

5.2.4. Bottle -feeding 

Though artificial feeding rate is quite high for the children of age 4-6 months, it is interesting to 

note that the rate of bottle-feeding is not as high (26.6 percent) (Fig. 6). 

No 

73.4% 

Yes 

26.6% 

Fig. 6: Bottle-feeding rate 

5.2.5. Continued Breastfeeding 

It is recommended that breastfeeding should continue for a period of two years or beyond along 

with appropriate and adequate complementary feeding starting after six months. Plan to 

continue breastfeeding among respondents of this study is shown in Fig.7. In this study 28.6 

percent mothers planned to continue breastfeeding for a period below 18 months and 20.8 

percent of mothers intended to continue breastfeeding the child for 18-24 months. Around 51 

percent mothers planned to continue beyond two years. 

24 Status of Infant and Young Child Feeding: District 24 Paraganas (West Bengal)

More than 24 

months 

50.6% 

Less than 18 

months 

28.6% 

18 - 24 months 

20.8% 

Fig. 7: Plan to continue breastfeeding 

5.2.6. Frequency of Breastfeeding during the day and Night Feeding 

It is recommended that breastfeeding should be given both during day and night to maintain 

lactation. Fig. 8 gives the frequency of breastfeeding during day and night among the 

respondents. Seventy five percent of women breastfeed the child more than 5 times during the 

day and 93.2 percent of women breastfeed the child during night. It is highly encouraging to note 

that women are breastfeeding at night. This is a good traditional practice. 

COMMENTS 

It is interesting to note that, though the practice of exclusive breastfeeding is low in this district, 

still about 51 percent mothers wanted to continue breastfeeding for two years or beyond as 

recommended. This could be used as a positive reinforcement during counselling to build 

women’s confidence. It is highly encouraging to note that women are breastfeeding at night; this 

is a good traditional practice and should continue to be promoted. 

Breastfeeding 

during the night 

93.2% 

Breastfeeding 

more than 5 times 

during the day 

time 

75% 

0% 20% 40% 60% 80% 100% 

Fig. 8: Frequency of breastfeeding during the day and night 


5.2.7. Complementary Feeding Practices: Age 6-9 Months 

It is recommended that after six months of age babies should receive complementary feeding 

with solid local foods along with continued breastfeeding. Fig. 9 shows the feeding practices of 

children in the age category of 6-9 months. In this study it is remarkable to note that 100 percent 

mothers continued to breastfeed during 6-9 months. As shown in Fig. 9, 76.9 percent of mothers 

were giving solid/semi-solid food to the children aged 6-9 months and 36.9 percent of mothers 

also gave cow/goat/buffalo milk to children. Janam Ghutti or Gripe water was given by 30.8 

percent of mothers. 

COMMENTS 

Many babies have started receiving complementary foods during this age period. According to 

NFHS –2 data 46.3 percent babies received complementary feeding from 6 to 9 months in West 

Bengal. What is required is to ensure that it continues to increase and that high quality 

adequate complementary feeding is provided with care and stimulation to achieve the growth 

potential. Most of liquid milk or other products provided during this period should be replaced 

by solid mushy home made/ indigenous/ family foods, to help prevent babies getting 

underweight. Also, intake of Janam Ghutti or gripe water should be discouraged. It is expected 

that with these efforts and interpersonal help given to mothers during postnatal period we will 

be able to achieve the tenth plan goal of 100 percent for providing complementary feeding to 

infants aged 6-9 months. 

100% 

80% 

60% 

40% 

100.0% 

84.6% 

38.5% 40.0% 

36.9% 36.9% 

30.8% 

76.9% 

26.2% 

20% 

0% 

3.1% 

Mother’s milk 

Plain water 

Sweetened water with 

sugar/gur/glucose/honey 

Fruit Juice 

Tea/Coffee 

Cow/Goat/Bufallo milk 

Powder Milk 

Gripe water or Janam 

ghutti etc. 

Solid or semi-solid 

(mushy) food 

Others 

Fig. 9: Feeding practices of children in the age group 6-9 months (N=65) 


5.3. Effect of other Factors on Infant Feeding Practices 

5.3.1. Effect of Education, Caste of Mother and Sex of Index Child on Initiation of Breastfeeding 

Tables 3-5 show that there is a significant difference in initiation of breastfeeding in illiterate 

mothers as compared to literate mothers. Similarly, there is a significant difference in initiation 

of breastfeeding by caste and by sex of the index child. 

5.3.2. Effect of Education, Caste of Mother and Sex of Index Child on Pre-lacteal Feeds Given 

Incidence of giving pre-lacteal feeds is 42.9 percent in illiterate mothers and 53.3 percent in 

literate mothers as shown in Tables 3-5. There is a significant difference in incidence of giving pre 

lacteal feeds by caste and by sex of the index child. 

5.3.3. Effect of Education, Caste of Mother and Sex of Index Child on Frequency of Breastfeeding 

Illiterate mothers are more frequently breastfeeding their children during day as compared to 

literate mothers. However both the groups are breastfeeding during night. Frequency of 

breastfeeding during the day is highest in STs (100 percent) as compared to SCs, OBCs and other 

groups. There is no significant difference in frequency of breastfeeding by sex of the index child 

during the day (Tables 3-5). 

Table 3: Breastfeeding practices by education of the mother 

Indicators 

Initiation of breastfeeding 

- Within 1 hour 

- 1-4 hours 

- More than 4 hours 

21 

7 

14 

Illiterate 

(N=42) _ 

No. % 

50.0 

16.7 

33.3 

55 

29 

66 

Literate 

(N=150)_ 

No. % 

36.7 

19.3 

44.0 

Total 

(N=192)_ 

No. % 

Pr-lacteal feed given 18 42.9 80 53.3 98 51.0 

Breastfeeding more than 5 times during the day 34 81.0 110 73.3 144 75.0 

time 

Breastfeeding during the night 41 97.6 138 92.0 179 93.2 

76 

36 

80 

39.6 

18.8 

41.7 

Table 4: Breastfeeding practices by caste of the mother 

Indicators 



- 1-4 hours 


SC 

(N=78) 

36 (46.2) 

16 (20.5) 

26 (33.3) 

ST 

(N=3) 

0 (0.0) 

2 (66.7) 

1 (33.3) 

OBC 

(N=45) 

21 (46.7) 

6 (13.3) 

18 (40.0) 

OTHER 

(N=66) 

19 (28.8) 

12 (18.2) 

35 (53.0) 

Pr-lacteal feed given 35 (44.9) 1 (33.3) 25 (55.6) 37 (56.1) 

Breastfeeding more than 5 times during the day 

time 

66 (84.6) 3 (100.0) 39 (86.7) 36 (54.5) 

Breastfeeding during the night 74 (94.9) 3 (100.0) 45 (100.0) 57 (86.4) 

Note: Figures in parenthesis are the percentages. 


Table 5: Breastfeeding practices by sex of the index child 

Indicators 



- 1-4 hours 


Male 

(N=91) _ 

No. % 

31 

16 

44 

34.1 

17.6 

48.4 

45 

20 

36 

Female 

(N=101) _ 

No. % 

44.6 

19.8 

35.6 

Total 

(N=192)_ 

No. % 

76 

36 

80 

39.6 

18.8 

41.7 

Pr-lacteal feed given 50 54.9 48 47.5 98 51.0 

Breastfeeding more than 5 times during 68 74.7 76 75.2 144 75.0 

the day time 

Breastfeeding during the night 85 93.4 94 93.1 179 93.2 

5.3.4. Effect of Age, Education and Caste of Mother, and Sex of the Index Child on Exclusive 

Breastfeeding 

Tables 6, 7, 8 and 9 provide data on effect of these factors on exclusive breastfeeding. 

• Exclusive breastfeeding by the age of the mother 

Exclusive breastfeeding rate is high in mothers of age group up to 20 years (45.9 percent) as 

compared to those in the age group from 21-25 years (45.6 percent) and above 25 years (33.3 

percent) (Table 6). 

• Exclusive breastfeeding by education of mother 

There is a significant difference in initiation of breastfeeding by education. Exclusive 

breastfeeding is higher among illiterate mothers (54.5 percent) as compared to literate 

mothers (38.3 percent) (Table 7) 

• Exclusive breastfeeding by caste of mother 

There is a significant difference in initiation of breastfeeding by caste. Exclusive 

breastfeeding practice by mothers is highest in STs (66.7 percent). (Table 8) 

• Exclusive breastfeeding by sex of the index child 

More males (44.1 percent) were exclusively breastfed than females (41.2 percent) in 24 

Paraganas. (Table 9). 

Table 6: Exclusive breastfeeding and supplementary feeding to children in the age group of 0-6 months by 

age of mother 

Exclusive breastfeeding & supplementary 

feeding practices 

Upto 20 yrs 

(N=37) 

21-25 yrs 

(N=57) 

Above 25 yrs 

(N=33) 

Exclusive breastfeeding 17 (45.9) 26 (45.6) 11 (33.3) 

Breastmilk + plain water 0 (0.0) 1 (1.8) 3 (9.1) 

Breastmilk + other feedings 10 (27.0) 16 (28.1) 7 (21.2) 

Breastmilk + plain water + other feedings 10 (27.0) 14 (24.6) 12 (36.4) 

Breastmilk + solid 2 (5.4) 2 (3.5) 4 (12.1) 

Note: Figures in parenthesis are the percentages 



education of mother 

Exclusive breastfeeding and Supplementary feeding 

practices 

Illiterate 

(N=33) 

Literate 

(N=94) 

Exclusive breastfeeding 18 (54.5) 36 (38.3) 

Breastmilk + plain water 0 (0.0) 4 (4.3) 

Breastmilk + other feedings 9 (27.3) 24 (25.5) 

Breastmilk + plain water + other feedings 6 (18.2) 30 (31.9) 

Breastmilk + solid 2 (6.1) 6 (6.4) 



caste of mother 

Exclusive breastfeeding & supplementary feeding 

Practices 

SC 

(N=50) 

ST 

(N=3) 

OBC 

(N=30) 

OTHER 

(N=44) 

Exclusive breastfeeding 28 (56.0) 2 (66.7) 6 (20.0) 18 (40.9) 

Breastmilk + plain water 2 (4.0) 0 (0.0) 1 (3.3) 1 (2.3) 

Breastmilk + other feedings 11 (22.0) 0 (0.0) 14 (46.7) 8 (18.2) 

Breastmilk + plain water + other feedings 9 (18.0) 1(33.3) 9 (30.0) 17 (38.6) 

Breastmilk + solid 1 (2.0) 0 (0.0) 2 (6.7) 5 (11.4) 



sex of index child 

Exclusive breastfeeding and supplementary feeding 

practices 

Male 

(N=59) 

Female 

(N=68) 

Exclusive breastfeeding 26 (44.1) 28 (41.2) 

Breastmilk + plain water 1 (1.7) 3 (4.4) 

Breastmilk + other feedings 18 (30.5) 15 (22.1) 

Breastmilk + plain water + other feedings 14 (23.7) 22 (32.4) 

Breastmilk + solid 4 (6.8) 4 (5.9) 



6. Findings of the Qualitative Study 

This study was carried out in 24 Paraganas with a view to understand the barriers and positive 

factors, which may help to promote optimal infant and young child feeding practices. The 

findings are described in the subsections given below. 

6.1. Knowledge and Practices Related to Breastfeeding 

6.1.1 Initiation of Breastfeeding 

The study result shows that 33.3 percent of lactating mothers, 50 percent of elderly women, 100 

percent of health workers and pregnant women had the knowledge that breastfeeding should be 

initiated soon after birth or within 1 hour. However, 50 percent of elderly women reported that 

breastfeeding should be started after 3 days of the birth of the child. In practice around 67 

percent of mothers initiated breastfeeding within 1 hour after birth and the rest initiated after 2-3 

hours. 

It is interesting to see that all health functionaries and pregnant women had the correct 

knowledge about initiation of breastfeeding. According to the quantitative survey 39.6 percent of 

women initiated breastfeeding soon after giving birth. However efforts should be made to 

encourage this positive practice to achieve the tenth plan goal of 79.1 percent initiation of 

breastfeeding within 1 hour. Special emphasis should also be made to counsel elders of the 

family along with counselling lactating women otherwise desired changes might not be 

achieved. 

6.1.2. Pre-lacteal Feeds 

All lactating women, pregnant women and elders in the community told that pre-lacteal feeds 

should be given. Fifty percent of elders in the community said that if pre-lacteal feed is not given 

then the health of the baby may worsen. All health workers felt that pre-lacteal feeds are not 

necessary for the child. 

The practice of giving pre-lacteal feeds is high in 24 Paraganas. There is a need to convince 

mothers and their relatives about the harmful effects of giving pre-lacteal feeds. Counselling and 

support given to mothers before and during the time of birth can result in reducing the incidence 

of giving pre-lacteal feeds. A community campaign can be initiated to build up efforts to reduce 

the incidence of giving pre-lacteal feeds. 

6.1.3. Understanding the Meaning of Exclusive Breastfeeding (EBF) 

None of the lactating mothers, health workers or elders in the community had the right 

perception about exclusive breastfeeding. All lactating mothers and 50 percent of health workers 

supposed exclusive breastfeeding to mean giving of breastmilk till 4 months of the age of the 

child. Whereas 50 percent of elders said it to be between 3-4 months. Also none of the pregnant 

women were aware of the term “exclusive breastfeeding”. In practice 50 percent of pregnant 

women discontinued exclusive breastfeeding at 5-6 months of the age of their earlier child. 


This is a common problem in all the states. In the first place, health professionals need to be 

educated about the accurate meaning of exclusive breastfeeding and about sustaining this 

practice for the first six months. Also, campaigns for educating masses and providing them with 

accurate and complete information on exclusive breastfeeding are needed. 

6.1.4. Duration of Continued Breastfeeding 

All lactating women and pregnant women said that infants should be breastfed as long as 

possible whereas none of the elderly women of the community perceived that an infant should 

be breastfed till 6 months. 

It can be concluded from the findings of qualitative survey that the practice of continued 

breastfeeding is sub-optimal in 24 Paraganas. Efforts are needed in this direction to ensure and 

maintain breastfeeding for the two years or beyond. These include accurate information after 

delivery and interpersonal counselling support by skilled healthcare providers or peer 

counsellors. 

6.1.5. Complementary Feeding 

Complementary feeding to children is generally started after the age of six months. All lactating 

mothers, health workers and pregnant women told that complementary feeding should be 

started within 5-6 months of the age of child. All the elderly women said that it should be started 

within 6-7 months. 

This finding also raises the need to educate health workers of the community about optimal 

infant feeding practices, as only then can the present scenario be changed. 

6.1.6. Problems in Breastfeeding 

None of the lactating mothers had any problem in initiation and continuation of breastfeeding. 

All pregnant women responded that if they had any problem in the initiation of breastfeeding, 

they would approach the health staff or the elders. 

6.1.7. Practices in the Case of the Second Child 

As seen from the survey about 66 percent of lactating mothers reported that their second baby is 

better breastfed as compared to the earlier child. Also all the lactating women and pregnant 

women wanted to receive counselling on infant feeding and reported that there would be no 

resistance. Fifty percent of elders approved that latest information on breastfeeding should be 

imparted to the nursing mothers in their families. All lactating mothers and 50 percent of 

pregnant women said that the most appropriate person to provide the information on 

appropriate breastfeeding technique would be the health staff. However 50 percent of pregnant 

women said that the most appropriate person to provide the information on appropriate 

breastfeeding technique would be the elders. 

6.1.8 Influence of Elders on Breastfeeding Practices 

All lactating mothers and pregnant women said that they were influenced by their mothers-inlaw’s 

or elders in the community in the adoption of breastfeeding practices. 


6.2. Reasons and Barriers for Adoption of Optimal Feeding Practices 

• Mothers do not understand the advantage and importance of starting breastfeeding 

early. 

• Mothers are not advised about starting breastfeeding, as well as the harmful effects of 

giving pre-lacteal feeds and water to the newborn immediately in the post natal period. 

• Elders have influence on breastfeeding practices of mothers; however, their knowledge 

about the most favourable infant feeding practice is sub-optimal. 

• Mothers are not clear about the exact meaning and duration of exclusive breastfeeding. 

• Family members do not support health workers for bringing about the necessary change. 

6.3. Recommendations: For Achieving Optimal Feeding Practices 

• Skilled health workers must counsel all the mothers on initiating and sustaining 

breastfeeding during prenatal, antenatal and postnatal period. Proper training must be 

given to the health worker and community workers, and they in turn should provide 

interpersonal counselling and support to women. 

• Family members, in particular the mother-in-law, must be counselled as they have the 

most influence on the mother. 

• There is a need to launch communication campaigns to create a positive environment 

for discontinuing the practice of giving pre-lacteal feeds. 


7. Findings of Monitoring the Compliance with 

the Infant Milk Substitutes, Feeding Bottles and 

Infant Foods (Regulation of Production, Supply 

and Distribution) Act, 1992(IMS Act) 

This study of the IMS Act was conducted in order to understand the marketing and promotional 

practices of baby food manufacturers that are barriers in the successful implementation of the 

IMS Act and that undermine the practice of breastfeeding especially exclusive breastfeeding. 

The study was conducted during the year 2003, the year the Act was amended (and subsequently 

enacted from 1 January 2004). This study is therefore based on monitoring of the IMS Act, 1992. 

For understanding the marketing practices of baby food manufactures interviews were 

conducted using questionnaires that were specifically designed and field-tested. The findings for 

the district of 24 Paraganas are briefly described here. 

7.1. Visits by Company Representatives 

As shown in Table 10, 60 percent of doctors and all the nurses reported that the representatives of 

the companies manufacturing infant milk substitutes and infant foods visited them in their 

hospitals. However none of the hospital respondents reported that representatives of such 

companies visited them in their hospitals. 

Table 10- Distribution of responses regarding visits to hospital/clinic by representatives of companies 

manufacturing IMS/ FB/IF 

Doctors N-5 Nurses N-3 Hospital Administrators N-1 

Yes 3(60) 3 (100) 0 (0) 

No 2(40) 0 (0) 1 (100) 

Note: Figures in the parenthesis are the percentages 

7.2. Purpose of Visit by Company Representatives 

7.2.1. Distribution of Samples 

Most representatives who came for promotion of infant milk substitutes to doctors and nurses 

distributed samples of infant milk substitutes including Lactogen 1&2. However health 

administrators did not report receiving the samples of infant milk substitutes. 


COMMENTS 

This is a violation of Section 4 of the IMS Act, which prohibits anybody from distributing 

samples of infant milk substitutes. This calls for urgent corrective actions by both the health 

professionals as well as companies. 

Doctors and nurses also reported receiving samples of infant foods. No samples of feeding bottles 

were distributed to doctors, nurses or health administrators interviewed for this study (Table-11). 

Table 11: Distribution of responses by name of manufacturers /representatives who visited the 

hospital/clinic for distribution of samples of IMS/FB/IF 

Purpose of visit – distribution samples 

Product name 

INFANT MILK 

SUBSTITUTES 

Company name 

Doctors 

(N-5) 

Nurses 

(N=3) 

Lactogen 1&2 Nestle 2 1 

INFANT FOODS 

Nestum Nestle 2 1 

Cerelac Nestle 2 1 

Amul Spray 

FEEDING BOTTLES 

Amul 

Not Distributed 5 3 

7.2.2. Distribution of Informational Material 

No informational material was distributed to doctors, health administrators or nurses by any 

representative of the company. 

7.2.3. Distribution of Gifts or Other Purposes 

None of the doctors, health administrators or nurses interviewed said that company 

representatives offered any gifts. 

7.3. Display of Company Material in Hospitals and Clinics 

None of the hospitals visited for the study displayed any promotional material like poster, 

calendar, clock or any similar items produced by the baby food companies. 

7.4. Instructions Given by Health Workers for Preparing Infant Milk Substitutes 

and Infant Foods 

Eighty percent of the doctors and around 67 percent of the nurses in the study reported that they 

instructed mothers for preparing infant milk substitutes, feeding bottles and infant foods. 


7.5. Information on Breastfeeding Provided to Mothers by Doctors and Nurses 

In this study 80 percent of the doctors who were interviewed reported that they provided 

information to the mothers about breastfeeding. However none of the nurses in the survey 

provided any information to the mothers. 

Majority of the doctors said that they gave individual counselling to the mothers. Doctors also 

reported that they counselled mothers mostly during postnatal period followed by counselling at 

the time of birth. All these doctors reported that they provided information on the advantages of 

breastfeeding and also stressed that breastmilk is a complete balanced food. Some doctors also 

provided information to the mothers on observing personal hygiene and the health of nipples 

and breast during counselling. Some of them also cleared doubts about breastfeeding and 

about the method of breastfeeding. None of the doctors interviewed used audio or video aids 

for counselling, like flip charts, flash cards or posters. The doctors in this study did not distribute 

any educational materials related to breastfeeding. 

7.6. Awareness of the IMS Act and the Cable Television Networks (Regulation) 

Amendment Act, 2000 

As shown in Tables 12 and 13, 60 percent of the doctors and all hospital administrators 

interviewed were aware of the existence of the IMS Act. However 40 percent of the doctors and 

all hospital administrators were aware of the existence of the Cable Television Networks 

(Amendment) Act, 2000. 

None of the nurses interviewed knew about the IMS Act or about the Cable Television Networks 

(Amendment) Act, 2000. 

Table 12: Awareness about existence of 

Infant Milk Substitutes, Feeding Bottles and 

Infant Foods (Regulation of Production, 

Supply and Distribution) Act, 1992(IMS Act) 

Table 13: Awareness about existence of 

Cable Television Networks (Amendment) 

Act, 2000 

Respondents % Respondents % 

Doctors (N-5) 60 Doctors (N-5) 40 

Nurses (N-3) 0 Nurses (N-3) 0 

Hospital Administrators (N-1) 100 Hospital Administrators (N-1) 100 

7.7. Direct Promotion to Mothers 

Among the mothers interviewed, none of them had been visited by any company representative, 

neither at the hospital or at home. 

None of them received any samples or gifts from any company. No one had joined any baby club 

or been invited for baby shows run by companies. 


7.8. Information Received by Mothers on Breastfeeding 

All mothers had received information about breastfeeding, mostly from the doctors. Other 

sources of obtaining information about breastfeeding were from relatives, friends, health 

workers, advertisements on television and newspapers, magazines etc. 

7.9. Recommendations 

Given that IMS Act has now been further strengthened and became effective in 2004, it bans all 

forms of promotion of baby foods for babies during the first two years. Such promotions detected 

during the present study would become much more serious violations if we take into account the 

provisions of IMS Act, 1992 (As Amended in 2003). 

• It is recommended that state governments take effective steps for the implementation of 

the Act. The government must also disseminate information about various provisions of 

the IMS Act to the public, especially to doctors. 

• It is also advised that health professionals and their associations, baby food 

manufacturers and institutions respect the IMS Act in letter and spirit to achieve the 

objectives of protection, promotion and support of optimal infant feeding practices. 

• Develop a mechanism to conduct regular monitoring (every 2-3 years). 


8. Conclusions and Suggested Action Ideas for 

BPNI District Branch Coordinators 

The study shows that the breastfeeding practices followed in the district of 24 Paraganas (West 

Bengal) are sub-optimal. 

Following are some of the key finding of the study: 

• Around 40 percent of mothers initiated breastfeeding within one hour of birth. 

• Fifty one percent of mothers gave pre-lacteal feeds to their infants, the most common 

being artificial milk. Almost all family members favour this practice and the belief in this 

custom is so strong that health workers find it difficult to convince mothers against 

giving pre-lacteal feeds. 

• The incidence of exclusive breastfeeding is low in this area. Around 43 percent mothers 

practiced exclusive breastfeeding for the first six months. The reason for this is the lack of 

clarity with regard to the meaning of exclusive breastfeeding especially among health 

workers as well as elders in the community. 

• It is discouraging to note that only about 50 percent mothers are willing to breastfeed 

their babies up to two years of age or beyond. 

• A significant positive behaviour is that most mothers feed their babies during night. This 

will help in the continuation of breastfeeding for a longer period of time. Therefore this 

practice needs appreciation. 

• It was also observed that infant feeding practices among mothers were most influenced 

by their mother-in-law, who themselves lack knowledge of optimal infant feeding 

practices. Therefore, efforts should be made to counsel mothers– in-law’s along with 

mothers during antenatal and postnatal periods. 

• All health workers should be trained to better their knowledge on the optimal feeding 

practices of the infants. This would help them to impart the correct knowledge to the 

community. It has been observed that none of the nurses interviewed counselled 

mothers on appropriate breastfeeding practices. Therefore nurses should be trained on 

this regard so that they provide proper guidance to the mothers. 

• None of the nurses are aware of the existence of the IMS Act and the Cable Television 

Networks (Regulation) Amendment Act, 2000. Baby food companies continue to visit the 

doctors and nurses for promoting their products and distributing samples and 

educational materials, which are not in accordance with the law. Therefore it is 

recommended that state governments should take effective steps for implementation 

and awareness of the Act. 


8.1. Action ideas 

For bringing a positive change in infant feeding practices in your area action will be required at 

all levels. Following are some ideas for getting started: 

• Call for a district level partners meeting The findings of the district study (quantitative 

and qualitative) must be made available for discussion at this meeting to evolve proper 

action plan for improvement. Involve as many partners as possible including IAP, IMA, 

FOGSI, TNAI, nutritionists, nurses, etc. This plan should address activities such as 

training, capacity development, advocacy, monitoring and evaluation. (Guidelines for 

conducting district level mobilization meeting and advocacy are given in Annex 1. In 

Annex 2 recommendations that have emerged from the National Report “ Status of 

Infant and Young Child Feeding in 49 Districts of India: 2003” are given to help in the 

planning.) 

• Advocate for effective implementation of the IMS Act Contact the district and state 

governments for better implementation of IMS Act and to create awareness among the 

community, as well as encourage them to follow the law. Use advocacy material 

developed by BPNI like ‘The Law to Protect, Promote and Support Breastfeeding’, 

’Protecting Breastfeeding From Commercial Influences’, etc., to spread awareness 

among the masses. 

• Advocate with your District RCH and ICDS Arrange for briefings, meetings with the 

district RCH and ICDS and request them to assist you in strengthening infant and young 

child feeding programmes. 

• Mobilise actions in the next district Further mobilise the neighbouring districts by 

constant interaction with them and informing them about the action plans as well as the 

studies conducted. Ask them to join in all the meetings organised. By doing so they would 

themselves be stimulated to inculcate such plans and studies in their districts. 


Annexures 

Annexures 

i

ii 

Annexures

Annexure – 1 

Guidelines for Conducting District Level Mobilization 

Meeting and Advocacy 

BPNI is a registered, non-profit, independent national organization with international collaboration and works towards 

protecting, promoting, and supporting breastfeeding and appropriate complementary feeding of infants and young 

children since 1991. BPNI works to protect, promote and support breastfeeding in India with the broad goal of 

empowering all women to breastfeed their infants exclusively for first 6 months of life and to continue breastfeeding for 

two years or beyond along with adequate and appropriate complementary feeding through advocacy, training, 

education, information, research and social mobilization. BPNI also works in close liaison with International Baby Food 

Action Network (IBFAN) and World Alliance for Breastfeeding Action (WABA). 

BPNI does not accept funds or sponsorship of any kind from the companies producing infant milk substitutes, feeding 

bottles, related equipments, or infant food (cereal foods). 

Areas of work: 

1. Working in your local setting 

2. Working with media 

3. Interaction with public 

4. Resource Centre 

5. Community level meeting 

6. Survey 

7. Training 

8. Advocacy 

9. Reporting 

Here are some guidelines for conducting district level mobilization meeting which will help to plan and work in your 

district; 

1. Working in your local setting 

Making your group and its activities known in your local setting is crucial for the success of our organisation. Following 

are some ideas for getting started and maintaining your presence in the community: 

• Form a DISTRICT BRANCH as per constitution with minimum of ten members and inform all concerned in the district 

about your existence. 

• Open a DISTRICT BRANCH account so that funds can be transferred. 

• Involve National Partners’ (IAP, IMA, FOGSI, TNAI, FORCES, etc.) in a committee like for example, Infant and Young 

Child Feeding Committee, and involve them in all your activities. 

• Involve yourself and your branch in all the activities of national partners. 

2. Working with the media 

• Involve the media (print, television, cable, radio) in the local events in your area – this may be done in connection 

with events such as World Breastfeeding Week, International Women’s Day, and Children’s Day, National Nutrition 

Week, National Newborn Week, etc. 

• Offer to show a video on breastfeeding and/or give a talk on Infant and Young Child Feeding practices to local 

groups. 

3. Interaction with the public 

Interaction with public is one of the most effective ways of telling people about the work in which you are involved. 

The most important point is to identify women groups, Lions Club, Rotary Club, and other local social groups and NGOs 

working in your area. Remember that groups that invite you to speak are generally sympathetic towards your work and 

will be eager to find out more. 

Annexures 

iii

The points to be included in your talk should include: 

• Introduction of yourself and the organisation you represent. 

• Introduction of your topic (promoting breastfeeding, IMS Act, WBW, etc.). 

• Give background information on the subject. 

• Provide detailed information about the subject. 

• Ask the audience for questions and involve them in your future activities. 

4. Resource Centre 

As your group and its resources expand, you may wish to set up a resource centre within your premises or with another 

NGO, social group having a library or display centre, to share the information that you have available. Although a 

resource centre would ideally have a room to itself, it can also be just a few shelves of materials in one corner of a 

room. 

5. Community level meeting 

Community level meetings are one of the most effective ways of gathering different levels of people from the 

community to talk about the issue. These are also referred to as corner meeting, awareness meetings, etc. 

Points to remember include: 

• Prior to the talk, gather information about the audience, their prior knowledge about your work, number of 

people attending, etc. 

• The use of video, slides or overhead projectors will make the community level meeting more interactive and 

interesting. 

• Collaborate and cooperate with local NGOs. 

6. Survey 

It is necessary that you have a clear picture of the area and the status of the issue that you are going to work on. To 

find out the present status your organisation could: Conduct a survey on the infant feeding practices. 

• Conduct a survey on the compliance with the Indian Law to protect breastfeeding: The Infant Milk Substitutes, 

Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Amendment Act, 2003 

7. Training 

In order to ensure that accurate information is collated, it is necessary that a trained local person collect the 

information. District branches can make a request to BPNI, Delhi, for conducting the training. 

8. Advocacy 

Advocacy is the interaction with the decision makers, (government officials, district colleges, health and food and 

nutrition departments, etc.) on the issue and this is very important to BPNI. You also could request for resources. 

Frequent meetings with the state government, panchayat, district level organisation all help to promote the issue as 

well as the organisation. 

9. Reporting 

• All activities are to be reported to the BPNI headquarters and to the state branch / state coordinator, so that they 

can be included in the BPNI official bulletin for sharing with other branches and members. 

• Reports must be disseminated locally to government departments and any other concerned institutions and 

individuals. 

iv 

Annexures


Status of Infant and Young Child Feeding in 49 Districts 

(98 Blocks) of India, 2003 

A National Report of the Quantitative Study 

Conclusions and Recommendations 

Family level 

• Support and assist newly delivered mothers, especially first timers in the initiation of breastfeeding within one hour. 

• Efforts should be made to help mothers-in-law gain accurate and adequate knowledge about breastfeeding and 

complementary feeding as well as nutrition of lactating mothers, so as to bring about attitudinal change in their 

behaviour. They, in turn, can give correct advice to their daughters-in-law and thus play a pivotal role in improving 

the health of both the mother and the child. 

Community level 

• Skilled counselling by TBAs, AWWs and CHWs on the correct method of breastfeeding and also on the 

understanding of exclusive breastfeeding. 

• Self Help Groups in villages could be motivated to spread messages on exclusive breastfeeding among women - 

that breast milk is the best food for babies, not the tinned infant milk substitute. Similar action could come from 

peer counsellors especially trained for this purpose. 

• Organisation of breastfeeding discussions by health workers/AWWs in villages so that mothers get latest/correct 

information on both breastfeeding and complementary feeding. 

Service level 

• Arrangement of crèches for working women at the work place where they can also breastfeed their babies 

• Medical doctors need to be provided with skilled training in breastfeeding counselling and the management of 

related problems. 

• Skilled training to health functionaries, ICDS workers and NGO staff from top to grassroots level is needed. 

• Doctors need to be especially informed not to prescribe infant formula indiscriminately and remain consistent with 

National Guidelines on Infant and Young Child Feeding. 

Policy level 

• The Government must increase maternity leave from 135 days to 180 days so that working mothers can exclusively 

breastfeed the baby for 6 months as per recommendation. 

• Efforts must be initiated at all levels in the Centre and States to strengthen basic education curriculum on optimal 

infant and young child feeding in the secondary schools, colleges, nursing schools, ICDS systems and medical 

colleges. 

• Efforts must be initiated to provide accurate and updated information with reference to the IMS Act and National 

Guidelines on Infant and Young Child Feeding. 

• Effective steps and guidelines to implement the IMS Act must be issued 

• Influence the producers and distributors of infant milk substitutes, feeding bottles and infant foods to respect the 

IMS Act. 

Annexures 

v


Generic Guidelines 

Quantitative Survey on Infant and Young Child Feeding 

The main aim for undertaking qualitative study is to find the status of infant feeding practices. In this 

information from lactating mothers will be elicited using the interview schedule. The investigator will have to 

provide complete training for conducting the interviews to the field workers. 

Here are some guidelines for conducting quantitative study- 

Sampling: From the district select two blocks. Select one block using the simple random sampling technique, 

from blocks that are within five kilometers of the district headquarters. Similarly, randomly select the second 

block from the blocks, which are beyond 10 kilometers from the district headquarters. 

From each selected block, randomly select a village. Select five more villages adjacent to the village 

already chosen. This will be referred to as a cluster of villages. Thus, there will be two clusters, that is, one for 

each block. 

In the selected cluster, begin the survey from a house selected randomly, from either South, North, East 

or West side (this is also selected randomly). Move from house to house and complete the interview schedule. 

Make sure the house selected has a mother with a child of 0-9 months of age. 

There are three strata (groups) of mothers to be interviewed. One would be mothers having children 

between the ages of 0-3 months-old (up to 2 months and 30 days old); second, consists of mothers with children 

between the ages of 4-6 months (3 months and one day to 5 months and 30 days); and the third group has 

mothers with children between the ages of 7-9 months (6 months and 1 day to 8 months and 30 days old. In 

cases where there is more than one child in a household (of different age groups), only one is to be selected for 

a specific category. For example, if in a household, there are two children in the 0-3 month age group, only one 

is to be selected (the older one). On the other hand, if there are two children in a single household in the age 

groups of 0-3 months and 4-6 months, then both would be selected. 

From each category 15 mothers are to be interviewed, (15 mothers having children 0-3 months-old; 15 

mothers having children 4-6 months-old; and 15 mothers having children 6-9 months old). This means that from 

one cluster of villages, 45 mothers will be interviewed. After interviewing selected mothers in the first village, if 

the required quota is not complete, move to next village. In case the required quota of 45 mothers in three 

categories from the cluster of five villages cannot be completed, select a sixth village and if need arises, move 

to a seventh village, and so on, until the required quota is complete. Make sure that these villages are near the 

initial selected cluster of five villages. 

Please note that if the quota of 15 mothers with children 0-3 months old is complete, then only interview 

mothers with children in the age groups 4-6 months and 6-9 months in the remainder houses that are yet to be 

visited. On completion, 45 mothers in three categories, that is, fifteen in each category would have been 

interviewed. 

Interview schedules can be made or marked in three colours: one colour is for 0-3 months-old age 

group, second for 4-6 and the third colour for the 7-9 months-old age group. 

Repeat the same exercise in the second selected block. The total number of completed interview 

schedules from rural areas must be 90. 

vi 

Annexures

A similar exercise will be repeated at the block headquarters. Randomly select two clusters of wards. 

From each cluster of wards, interview 45 mothers as explained above. Thus, there will be 90 mothers interviewed 

from the block headquarters. 

Therefore, the total number of mothers interviewed in all three strata in a district will be 180 (90 from the 

cluster of villages in two blocks and 90 will be from the block headquarters). 

There may be few cases in a district where a block contains only urban area. In such cases, select four 

cluster of wards, one each in the East, West, South and North of the block. From each cluster of wards, interview 

45 mothers as explained above. 

The field worker should check the filled in interview schedules. Please check to see that every question has been 

answered. The interviewer must complete each schedule in every respect before moving to the next house. 

He/she is not permitted to revisit a respondent. 

Checking the fieldwork 

(1). The person who is coordinating the study, is to thoroughly check the first day’s interview schedules in front 

of the interviewer, so that any doubts and ambiguities that the interviewer may have can be clarified on the first 

day of the data collection. 

(2). Check the completed interview schedules every week. This will help to monitor the fieldwork. 

(3). Minimum one visit to the field must be made. This must be done without informing the interviewer. If possible, 

talk to one or two respondents to ensure that they were visited by the interviewer for gathering information. 

Such efforts ensure the quality of the data collected. 

(4 

Guidelines for data entry of the interview schedule 

The interview schedule is very simple and should not pose a problem when training the investigator. 

However, some guidelines are given below: 

1. Appropriate option (s) mentioned must be encircled. For example, 

1.7 – Level of Education – there are seven options. The option applicable to respondent mother must 

be encircled. Suppose, the mother’s educational level is ‘Upto Middle’, option 4 is to be encircled. 2. 

Answers to questions that are not multiple choices are to be clearly written. , For example, 

Q. 1.8.1 – If yes, what is her job Here, investigator is to clearly mention the nature of the respondent’s 

job. 

Annexures 

vii

QUANTITATIVE SURVEY ON BREASTFEEDING 

Interview Schedule for Mothers used for finding quantitative status of breastfeeding in 98 blocks in 49 

districts of India 

(Baby up to 12 months - 24 months) 

1.1 State/Country/Province:___________________ 1.2 District ____________________ 

1.3 Block: __________________ 1.4 Village/Ward_____________________________ 

1.5 Name of the Mother _________________________________ 

1.6 Age of the mother _______________________ 

1.7 Level of Education: 

1. Illiterate 2. Just Literate/No Formal Education 3. Upto Primary 

4. Upto Middle 5.Upto Higher Secondary 6. Upto Graduation 

7. Post Graduation and above 

1.8 Does the mother work outside the house 1. Yes 2. No 

1.8.1 If yes, What is her job______________________ 

1.9 Number of living children of the mother: Total _______, Male_______, Female____ 

1.10 Name of the last born Child ________________ 

1.11 Age of [Name] in months _________ 

1.12 Sex [Name] 1.Male 2. Female 

Section 2 

2.1 Did you have check-up during pregnancy 1. Yes 2. No 

2.1.1 If yes, 

a) By whom 

1. Doctor 2. ANM/Nurse 3. TBA 4. Other (specify)________ 

b) Did anybody give you advice/guidance counseling on breastfeeding during checkup 

Who 

gave this 

1. Yes 2. No 

If yes, What was the content of this 

2.2 Where was the child [Name] born 

1. Home 2.Govt. Hospital 3. Pvt. Hospital 4. Other (Specify) 

2.3 Type of delivery 1. Normal 2. Caesarian 3.Forceps 

viii 

Annexures

Section 3 

3.1 After how much time after the birth of the child you started breastfeeding 

1.Within one hour 2. 1-4 hours 3. 5-12 hours 

4. 13-24 hours 5. More than 24 hours. 

3.2 Was anything given to the child [name] before starting the breastfeeding 

1. Yes 2. No 

3.2.1 If yes, what was given: 

1. Water 2. Artificial milk 3. Powder/tinned milk 

4.Sugar Water 5. Tea/Coffee 6. Gutti 

7. Honey 8.Glucose 9. Gur 

10. Other (Specify) _________________ 

3.2.2 If No, who told you not togive 

1. Doctor 2. ANM/AWW/Nurse 3. Mother-in-law 

4.Dai 5. Husband 6. Other (Specify) __________ 

3.3 How many times did you breastfeed yesterday during the day ___________ 

3.4 How many times did you breastfeed last night ______________________ 

3.5 For how many months you plan to breastfeed [name]_____________ 

4. Since this time yesterday, did pname] receive any of the following items of food (read out 

every item and record) 

ITEM Yes No 

Mother's Milk 1 2 

Plain Water 1 2 

Sweetened Water with Sugar/Gur/Glucose/Honey 1 2 

Fruit Jice/Aereated Drinks 1 2 

Tea/Coffee 1 2 

Cow/Goat/Buffalo Milk 1 2 

Powder/tinned milk 1 2 

Others medicated fluids 1 2 

Solid or semi-solid (mushy) food 1 2 

Any other (Specify)_________ 1 2 

Annexures 

ix

5. Did [name] drink anything from a bottle with a nipple since birth 1. Yes 2. No 

6. At what age did [name] start receiving solid/semi-solid/mushy foods on a regular basis, 

i.e. 

daily/ _________ (in months) 

7. If the child [name] is taking solid/semi-solid/mushy foods, please tell how many times 

during the last 24 hours________ 

Name of the Interviewer_______________ 

Date of Interview 

x 

Annexures


Generic Guidelines 

Qualitative Survey on Infant and Young Child Feeding 

The main aim of undertaking the qualitative study is to understand the barriers of optimal breastfeeding 

practices. The study will also help in finding some of the positive factors on which health workers can build their 

efforts to motivate mothers and other family members and community to promote optimal infant and young 

child feeding practices. 

Here are some guidelines for conducting qualitative study- 

The qualitative study is based on in-depth interviews. The information gathered from in-depth interviews would 

be of great help especially in designing the interventions to improve knowledge, attitude and practice related 

to optimal breastfeeding. The in-depth interviews will be conducted among: 

• Breastfeeding mothers 

• Women who are pregnant at this time 

• Mothers – in- law 

The in-depth interview will cover the following issues: 

• Knowledge of appropriate breastfeeding practices e.g. initiation, colostrum feeding, exclusive 

breastfeeding and introduction of supplementary feeding (mothers of infants, pregnant women and 

mothers-in-law). 

• Exact practices adopted for infants and exploring reasons for adoption of both favourable as well as 

unfavourable infant feeding practices. 

• Visualizing factors that can be used as a starting point to promote healthy practices. 

• Identifying factors that will generate or strengthen community and familial support for mothers to adopt 

appropriate breastfeeding practices. 

• Identification of key stakeholders at the community level (TBAs, influential women, women’s groups or 

forums, etc., that can be targeted for promotion of appropriate breastfeeding practices at the 

community level. 

Steps to be adopted when conducting and in-depth interview in a district 

In rural areas Select two villages from one of the block of the district. The block may be the same one where 

quantitative survey was undertaken. However, select two new villages preferably (other than the ones surveyed 

earlier). The selected two villages may be different in terms of remoteness from the block headquarters or 

nearest town, class and ethnic group and any other characteristics which you may think is appropriate in 

distinguishing the two villages. 

In urban areas, two localities of a city, preferably with different socio-economic status must be selected. In each 

of the selected villages / urban locality, the following number of persons should be approached for in-depth 

interviews in the different categories: 

Annexures 

xi

Mothers of infant 0 – 6 months 

: 3 mothers 

Pregnant women 

: 2 pregnant women 

Mothers – in – law 

: 1 mother – in – law 

Others 

: 1 husband / father – in – law 

Community workers : 1 or 2 

Reporting of the Qualitative Study 

Major efforts must be devoted to articulate the findings of the in-depth interviews. The findings should explore 

how the breastfeeding practices differ from rural to urban areas, what factors influence the adoption of 

appropriate or inappropriate practices, or if they do not differ at all. 

A checklist is provided below to develop a report of the study: 

I. Objective of the qualitative study, brief background of the study area and the characteristics of the 

persons included for in-depth interviews. 

II. Findings / observations – 

- Related to general knowledge level of each component of breastfeeding (initiation, colostrum 

feeding, exclusiveness, etc). Whether the knowledge differs among different categories of the 

respondents, or from rural to urban areas. 

- Current practices adopted by the mother and main reasons / barriers for adoption. 

- Description of the general believes and myths prevailing in the society. 

- Whether mothers-in-law or other persons have any influential role. 

- Whether there are any diverse messages being spread by different categories of health 

professionals. 

III. Conclusions – Given the scenario in a particular district, what can be done at the - 

- Familial level 

- Community level 

- Service provider level – government as well as private 

- Media level 

- Any other suggestion for the promotion of optimal infant feeding practices . 

xii 

Annexures

QUALITATIVE SURVEY ON INFANT AND YOUNG CHILD FEEDING 

Format for conducting in-depth interviews 

(MOTHERS OF INFANT 0 –6 MONTHS) 

Village / urban locality: _____________ Block: ____________ District : __________ 

Probe and then record 

Background information 

• Name : 

• No. of living children- Boys____ Girls ____ 

• Age (in years) : 

• Sex - Boy / Girl 

• Education : 

• Age of the infant (months) 

Knowledge on Breastfeeding 

When the infant should start breastfeeding and why 

What are customs for pre-lacteal feeding to babies 

How long infant should be breastfed Probe the duration for only breast milk, with water, with other food 

and supplements 

Perception on exclusive breastfeeding - What is exclusive breastfeeding How long should infant be 

exclusively breastfed Is water to be given or not Why 

At what age, infant should start with complementary feeding The complementary feeding should 

consist of what items 

Annexures 

xiii

Who influences in the family / community on adoption of breastfeeding practices 

Current breastfeeding practices 

When did you start breastfeeding If delayed, why If at desired time, who advised for this 

Did any thing given to baby other than breast milk If yes, what, why and its quantity and frequency 

Practice of exclusive breastfeeding in last 24 hours as well as since birth 

Whether faced any problems in initiation and continuation of breastfeeding What problem What 

support is needed to overcome the problem 

Does the amount of milk perceived sufficient If no, perceived corrective action by the mothers 

What is the frequency of breastfeeding in day and in night 

Whether mother has been advised on breastfeeding practices by any one If yes, from whom and type 

of advice received from each one of them 

xiv 

Annexures

What type of breastfeeding practices are followed by other women in your community / 

neighborhood (If explained by the mother, probe, how did she come to know about the practices 

followed by other women and whether it has any influence on the practices adopted by the mother). 

Is there any change in the breastfeeding practices adopted for older siblings If yes, what changes and 

why 

If mothers are counselled for appropriate breastfeeding techniques, will there be any resistance from the 

mother or from any other family members If so, who will resist 

Strengthening capacity of the mother for optimal breastfeeding practices 

Whether mother is willing to receive latest information / techniques on appropriate breastfeeding What 

sort of information may be helpful for her 

Who would be the appropriate person from whom she would like to receive the information on 

breastfeeding 

Thank You 

Annexures 

xv



(PREGNANT WOMEN) 

Village / urban locality: _____________ Block: ____________ District : __________ 



• Name : 







When the infant should start breastfeeding and why 

What are the customs for pre-lacteal feeding for babies 

How long infant should be breastfed Probe the duration for only breast milk, with water, with other food 

and supplements 

Perception on exclusive breastfeeding - What is exclusive breastfeeding How long should infant be 

exclusively breastfed Is water to be given or not Why 

At what age, infant should be started with complementary feeding The complementary feeding should 


Who influences in the family / community on adoption of breastfeeding practices 

xvi 

Annexures

Future intentions regarding breastfeeding practices 

Whether you have received any advise on breastfeeding practices as a part of your ANC care If yes, 

from whom and type of advice received from each one of them 

After childbirth, when would you intent to start breastfeeding If intention is to be delayed then why 

If faced with any problems in initiation and continuation of breastfeeding, whom would she approach 

and why 

If the woman has living children, probe about the breastfeeding practices of youngest child. 

When she had first put the baby to the breast 

Any pre-lacteal given What and how long was its frequency 

How long did exclusive breastfeeding continue and breastfeeding with water 

At what age of the last child, complementary feeding was started What type of food was given 

Strengthening capacity of the woman for optimal breastfeeding practices 

Whether mother is willing to receive latest information / techniques on appropriate breastfeeding What 

sort of information may be helpful for her 

Who would be the appropriate person from whom she would like to receive the information on 

breastfeeding 

Thank You 

Annexures 

xvii



(MOTHER – IN – LAW / FATHER – IN – LAW / HUSBANDS) 

Village / urban locality: _____________ Block: ____________ District: __________ 



• Name : 







Do you think breastfeeding to infant is important What are the advantages of breastfeeding an infant 

Ideally, when should the infant should be put on breastfeeding after birth and why 

Whether the infant should be fed with other liquids before starting breastfeeding Is it customary in your 

culture What liquid is normally given to infant in your society 

Suppose an infant is not given any pre-lacteal. Is it against the custom in your opinion What will 

happen 

Do you know how long an infant should be given only breast milk / with water / with other liquids 

xviii 

Annexures

What kind of support you may like to provide to the breastfeeding mother in you family 



Would you approve that the latest art of technique on breastfeeding should be imparted to the nursing 

mother in your family From whom this knowledge should be imparted 

Probe from Mother – in – law 

Would you like to receive any latest information on breastfeeding in order to guide younger generation 

on optimal feeding Would you be willing to act as a change agent to promote appropriate 

breastfeeding practices in your community 

Thank You 

Annexures 

xix



(COMMUNITY HEALTH / NUTRITION / OTHER WORKERS) 

Village / urban locality: _____________ Block: ____________ District: __________ 



• Name : 







Are you doing anything related to promote breastfeeding as a part of your job If yes, what 

Do you think breastfeeding of infants is important What are the advantages of breastfeeding an 

infant 

Ideally, when should the infant should be put on breastfeeding after birth and why 

Do you know how long an infant should be given only breast milk / with water / with other liquids 

xx 

Annexures

In your opinion, whether any pre-lacteal is given to infants If, yes, why community member insist on prelacteal 

Do you advice them for not giving it If yes, did your effort have any impact on the appropriate 

practice 



What kind of support you may like to provide to the breastfeeding mother in your community 

Would you like to have the latest art of technique on breastfeeding which will help you in convincing 

community members From whom this knowledge should be imparted 

Would you be willing to act as a change agent to promote appropriate breastfeeding practices in your 

community If yes, what should be done to support you and other such community workers 

Thank You 

Annexures 

xxi


Tenth Five Year Plan Goals 2003 - 2007 for 

Infant Feeding Practices (State wise and for the country) 

States 

Current levels 

of % children 

breastfed 

children within 

one hour of 

birth 

Tenth Plan 

Goal 

increases to 

50% 

Current levels 

of % of 

children 0-3 

months 

exclusively 

breastfed 

Tenth Plan 

Goal 80% of 

children upto 

6 months to 

be exclusively 

breastfed 

Current level 

of % of 

children 

complementa 

ry feeding of 

infants aged 

6-9 months 

Andhra Pradesh 10.3 32.6 74.6 100.0 59.4 100.0 

Arunachal Pradesh 49.0 100.0 33.9 49.1 60.2 100.0 

Assam 44.7 100.0 42.5 61.6 58.5 100.0 

Bihar 6.2 19.6 55.2 80.0 15.0 33.6 

Goa 34.4 100.0 - - 65.4 100.0 

Gujarat 10.1 32.0 65.2 94.5 46.5 100.0 

Haryana 11.7 37.0 47.2 68.4 41.8 93.6 

H.P. 20.7 65.5 17.5 25.4 61.3 100.0 

Jammu & Kashmir 20.8 65.8 41.5 60.1 38.9 87.1 

Karnataka 18.5 58.5 66.5 96.4 38.4 86.0 

Kerala 42.9 100.0 68.5 99.3 72.9 100.0 

M.P. 9.9 31.3 64.2 93.0 27.3 61.1 

Maharashtra 22.8 72.2 38.5 55.8 30.8 69.0 

Manipur 27.0 85.4 69.7 100.0 86.8 100.0 

Meghalaya 26.7 84.5 16.1 23.3 77.1 100.0 

Mizoram 54.0 100.0 40.7 59.0 74.2 100.0 

Nagaland 24.5 77.5 43.9 63.6 81.3 100.0 

Orissa 24.9 78.8 58.0 84.1 30.1 67.4 

Punjab 6.1 19.3 36.3 52.6 38.7 86.6 

Rajasthan 4.8 15.2 53.7 77.8 17.5 39.2 

Sikkim 31.4 99.4 16.3 23.6 87.3 100.0 

Tamil Nadu 50.3 100.0 48.3 70.0 55.4 100.0 

Tripura* NA 100.0 NA 70.0 NA 100.0 

Uttar Pradesh 6.5 20.6 56.9 82.5 17.3 38.7 

West Bengal 25.0 79.1 48.8 70.7 46.3 100.0 

Andaman & Nicobar Is* NA - NA - NA - 

Chandigarh* NA 28.5 NA 60.0 NA 90.0 

Dadar & Nagar Haveli* NA 72.2 NA 55.8 NA 69.0 

Daman & Diu* NA 32.0 NA 94.5 NA 100.0 

Delhi 23.8 75.3 13.2 19.1 37.0 82.8 

Lakshdweep* NA 100.0 NA 99.3 NA 100.0 

Pondicherry* NA 100.0 NA 70.0 NA 100.0 

INDIA 15.8 50.0 55.2 80.0 33.5 75.0 

Source of current level: NFHS 1998-99 

Tenth Plan 

Goal 

Introduction of 

semi-solid at 6 

months to 75% 

of children 

Notes: 

1. NFHS was not conducted in States with a * mark. In these the values have been estimated 

2. Current status for children in 0-3 years age-group is taken as representing status for children in 0-6 years age-group. 

3. As NFHS data for Chandigarh, Jharkhand and Uttaranchal are not available, goals laid down are for undivided states. 

4. As NFHS data for A&N Islands was not available, no goals have been set. 

xxii 

Annexures


Infant Feeding Practices: District Wise Quantitative Data 

State / UT District Initiation of BF within 

1 hour (%) 

Giving Prelacteal 

Feed (%) 

Exclusive 

Breastfeeding 0-6 

months (%) 

Complementary 

Feeding 6-9 months 

(%) 

Andhra Pradesh Anantpur 21.0 49.2 77.4 57.8 

Guntur 21.2 26.3 58.9 83.3 

Kurnool 17.8 39.4 69.7 50.8 

Arunachal Pradesh East Kameng 26.7 8.3 55.8 76.7 

Assam Kamrup 63.7 7.8 81.4 98.3 

Sonitpur 29.4 46.1 47.9 61.7 

Bihar Begusarai 13.6 73.4 17.6 97.8 

Gaya 1.3 72.1 57.0 53.8 

Nawadah 17.2 33.6 20.3 38.8 

Patna 5.5 89.0 15.8 73.8 

Chattisgarh Bilaspur 9.5 20.7 60.6 46.7 

Delhi Delhi 2.8 75.0 11.4 88.9 

Goa North Goa 18.3 52.7 26.4 80.6 

Gujarat Surat 20.8 70.8 22.4 100.0 

Vadodara 28.8 46.2 41.3 49.2 

Haryana Rohtak 6.1 87.8 17.8 66.7 

Sonepat 13.3 80.3 13.3 65.0 

Himachal Pradesh Shimla 16.2 60.3 3.8 86.4 

Jammu & Kashmir Badgam 46.7 98.3 45.3 45.0 

Jharkhand Ranchi 15.4 50.0 54.6 83.9 

Karnataka Banglore 64.7 28.8 49.2 90.0 

Devangere 57.2 25.3 66.4 83.3 

Gulbarga 16.0 38.1 78.3 39.3 

Kerala Kannur 81.7 5.0 40.0 95.0 

Madhya Pradesh Bhopal 3.3 46.1 37.0 63.3 

Gwalior 1.1 61.1 54.2 71.7 

Maharashtra Alibagh 69.2 18.1 27.5 81.7 

Amravati 7.2 18.9 33.3 78.3 

Borivli 28.9 42.2 37.3 68.9 

Thane 68.3 84.4 6.8 96.7 

Manipur Imphal 36.7 69.4 89.9 81.7 

Orissa Cuttak 60.2 31.4 27.1 24.1 

Sundergarh 58.2 21.2 59.6 71.4 

Punjab Ludhiana 1.7 97.8 11.0 83.3 

Rajasthan Jaipur 21.1 76.6 36.4 16.4 

Kota 30.0 46.1 31.9 88.3 

Sikkim Gangtok 54.4 33.3 31.7 93.3 

Tamil Nadu Chidambaram 53.3 33.9 29.1 88.3 

Chengelpattu 71.0 20.8 19.8 74.0 

Tripura Agartala 17.6 46.7 52.5 28.6 

Uttar Pradesh Allahabad 16.7 60.0 60.5 48.3 

Gorakhpur 25.0 47.8 60.7 68.3 

Lucknow 4.4 78.5 15.8 44.3 

West Bengal 

24 Paraganns 

39.6 51.0 42.5 76.9 

South 

Murshidabad NA 68.3 19.5 100.0 

Nadia 12.2 56.1 20.0 63.3 

Chandigarh Chandigarh 27.1 58.0 33.9 88.3 

Daman & Diu Daman 74.1 44.4 45.7 40.5 

Pondichery Pondichery 24.5 10.6 22.7 72.3 

INDIA 28.3 49.2 39.7 70.0 

Annexures 

xxiii


Initiation of Breastfeeding by State 

Percentage of children born during the three years preceding the survey who started breastfeeding within one 

hour and within one day of birth and percentage whose mother squeezed the first milk from her breast 

before breastfeeding by state, India, 1998-99 

State 

North 

Percentage started 

breastfeeding within one hour 

of birth 

Percentage started 

breastfeeding within one day 

of birth* 

Percentage whose mother 

squeezed first milk from breast 

Delhi 23.8 51.2 59.9 

Haryana 11.7 31.1 76.5 

Himachal Pradesh 20.7 42.3 86.2 

Jammu & Kashmir 20.8 59.2 77.1 

Punjab 6.1 19.5 87.3 

Rajasthan 4.8 33.6 69.1 

Central 

Madhya Pradesh 9.9 29.3 71.1 

Uttar Pradesh 6.5 13.4 75.6 

East 

Bihar 6.2 20.7 42.1 

Orissa 24.9 63.2 58.1 

West Bengal 25 50.6 76.3 

Northeast 

Arunachal Pradesh 49 77.1 49.5 

Assam 44.7 77.6 64.1 

Manipur 27 47.5 39.9 

Meghalaya 26.7 71.6 66.9 

Mizoram 54 78.2 60.7 

Nagaland 24.5 70.2 59.8 

Sikkim 31.4 73.4 74.5 

West 

Goa 34.4 61.8 47.4 

Gujarat 10.1 36.6 61.1 

Maharashtra 22.8 47.7 66.4 

South 

Andhra Pradesh 10.3 37.3 52.4 

Karnataka 18.5 41.5 61.4 

Kerala 42.9 92 52.8 

Tamilnadu 50.3 78.7 21.5 

India 15.8 37.1 62.8 

Note: Table includes only the two most recent births during the three years preceding the survey, whether living or dead at the 

time of interview. 

*Includes children who started breastfeeding within one hour of birth 

Source: National Family Health Survey, 1998-99 (NFHS-2), International Institute for Population Sciences, Mumbai, India. 

xxiv 

Annexures


Recommended Feeding Indicators by State 

Recommended feeding indicators for children age 0-23 months by state, India, 1998-99 

State 

North 

% of children 0-3 

months who are 

exclusively 

breastfed 


months who 

receive breastmilk 

and solid/mushy 

food 

Recommended feeding indicators 



breastfed 



breastfed 

% of children < 12 


bottle fed 

Delhi 13.2 37.0 70.4 59.9 41.0 

Haryana 47.2 41.8 88.3 77.5 15.9 

Himachal Pradesh 17.5 61.3 73.1 60.2 30.8 

Jammu & Kashmir 41.5 38.9 90.0 69.5 32.3 

Punjab 36.3 38.7 76.0 53.8 30.2 

Rajasthan 53.7 17.5 91.5 76.3 12.1 

Central 

Madhya Pradesh 64.2 27.3 91.4 73.2 11.4 

Uttar Pradesh 56.9 17.3 87.9 78.6 16.8 

East 

Bihar 55.2 15.0 95.1 85.1 10.3 

Orissa 58.0 30.1 94.6 89.7 13.8 

West Bengal 48.8 46.3 95.8 86.9 21.1 

Northeast 

Arunachal Pradesh (33.9) (60.2) (94.1) (76.0) 6.6 

Assam 42.5 58.5 96.1 83.5 12.5 

Manipur 69.7 86.8 90.8 67.9 13.0 

Meghalaya 16.1 77.1 91.2 63.2 30.9 

Mizoram 40.7 (74.2) (89.9) 47.4 18.4 

Nagaland 43.9 81.3 83.7 (61.4) 23.1 

Sikkim 16.3 87.3 89.6 (82.0) 20.0 

West 

Goa * (65.4) (76.0) (56.5) 63.2 

Gujarat 65.2 46.5 86.2 56.1 6.3 

Maharashtra 38.5 30.8 89.0 63.7 14.7 

South 

Andhra Pradesh 74.6 59.4 84.6 60.6 13.2 

Karnataka 66.5 38.4 86.5 44.9 11.4 

Kerala 68.5 72.9 95.5 61.8 20.4 

Tamilnadu 48.3 55.4 69.4 29.0 34.1 

India 55.2 33.5 88.9 68.9 15.9 

Note: Table includes only the two most recent births in the three years preceding the survey. 

( ) Based on 25-49 underweight cases 

*Percentage not shown; based on fewer than 25 underweighted cases 


Annexures 

xxv


Nutritional Status of Children by State 

Percentage of children under age 3 years classified as undernourished on three anthropometric indices of 

nutritional status, according to state, India, 1998-99 

State 

North 

Percentage below -3 SD 1 

Weight-for-age 

Percentage below – 2 SD 

Delhi 10.1 34.7 

Haryana 10.1 34.6 

Himachal Pradesh 12.1 43.6 

Jammu & Kashmir 8.3 34.5 

Punjab 8.8 28.7 

Rajasthan 20.8 50.6 

Central 

Madhya Pradesh 24.3 55.1 

Uttar Pradesh 21.9 51.7 

East 

Bihar 25.5 54.4 

Orissa 20.7 54.4 

West Bengal 16.3 48.7 

Northeast 

Arunachal Pradesh 7.8 24.3 

Assam 13.3 36.0 

Manipur 5.3 27.5 

Meghalaya 11.3 37.9 

Mizoram 5.0 27.7 

Nagaland 7.4 24.1 

Sikkim 4.2 20.6 

West 

Goa 4.7 28.6 

Gujarat 16.2 45.1 

Maharashtra 17.6 49.6 

South 

Andhra Pradesh 10.3 37.7 

Karnataka 16.5 43.9 

Kerala 4.7 26.9 

Tamilnadu 10.6 36.7 

India 18.0 47.0 

Note: Each index is expressed in standard deviation units (SD) from the median of the International Reference Population. 

1 Includes children who are below -3 SD from the International Reference Population median 


xxvi 

Annexures

Definitions of Infant Feeding Behaviours 


‘Exclusive Breastfeeding, Predominant, Breastfeeding, Bottlefeeding and Complementary Feeding 

Category of infant 

feeding 

Exclusive breastfeeding 

Predominant 

breastfeeding 

Requires that the infant 

receives 

Breastmilk (including milk 

expressed or from 

wet0nurse) 

Breastmilk (including milk 

expressed or from wetnurse) 

as the 

predominant source of 

nourishment 

Allows the infant receive 

Drops, syrups (vitamins, 

minerals, medicines) 

Liquids (water, and waterbased 

drinks, fruit juice, 

ORS), ritual fluids and 

drops or syrups (vitamins, 

minerals, medicines) 

Breastfeeding Breastmilk Any food or liquid 

including non-human milk 

Bottlefeeding 

Complementary feeding 

Any liquid or semi-solid 

food from a bottle with 

nipple/teat 

Breastmilk and solid or 

semi-solid foods 

Any food or liquid 

including non-human 

milk. Also allows 

breastmilk by bottle 

Any food or liquid 

including non-human milk 

Does not allow the infant 

to receive 

Any thing else 

Anything else (in 

particular, non-human 

milk, food-based fluids) 

Source: WHO Global Data Bank on Breast-feeding. Breastfeeding: the best start in life. WHO Nutrition Unit, 1996 

Annexures 

xxvii


Resources 

BPNI REPORTS 

Code Compliance: The Indian Scene. 1997 

 

 

Under Attack – The IMS Act, 1998. This report provides information about the violations of the IMS Act 

during the period 1997-98. 1998 

Commercial Infant Foods (Analysis of Promotion). The book contains ways and means of promotion 

of commercial infant foods used by the manufactures. 1998 

Child Nutrition and Media – A Workshop, A Report. 1999 

Breastfeeding Counselling & Complementary Feeding – Training of Trainers, A Report. 1999 

Training of Leaders in Monitoring The IMS Act. 1999 

IBFAN South Asia Regional Training Seminar, A Report. 2001 

Summary Recommendations & Plan of Action to Support Infant Feeding in South Asia. 2001 

Statement to Support Infant feeding in South Asia. 2001 

BPNI’s Recommended Feeding Practices for Infant and Young Children. 2001 

Under Attack 2000 – A Flier. 2000 

 

 

Under Attack – The IMS Act, 2000. This book is the report on violations of the IMS Act, is based on the 

results of monitoring activity conducted by BPNI during the years 1999 to 2000. 2000 

National Partners Meeting: Promotion Breastfeeding, The Way Forward, Executive Summary and 

Recommendations. 2002 

Capacity Building Workshop for District Coordinators of BPNI – A Report 2002 

National Planning Workshop on Infant and Young Child Feeding – A report 2002 

 

Report on Regional meetings (Guwahati, Shimla, Maharashtra, Tamil Nadu & Patna) on Infant and 

Young Child Feeding 2002 

A report on participation – WABA Global Forum II – 2002 

 

 

 

Implementation of International Code of Marketing of Breast Milk Substitutes in India – A Case Study 

2002 

Report on Regional Seminars (Karnataka, Delhi, Mumbai & Punjab) on Infant and Young Child 

Feeding 2002 

How Industry Undermines breastfeeding – Under Attack 2003. This book is the report on violations of 

the IMS Act, is based on the results of monitoring activity conducted by BPNI during the years 2001 

to 2002. 2003 

INFANT AND YOUNG CHILD FEEDING UPDATES 

 

 

 

Update-1: Exclusive Breastfeeding – The First 6 Months. 

Update 2: Complementary Feeding. 

Update 3: Problems in Initiating Breastfeeding. 

xxviii 

Annexures

Update 4: Not Enough Milk. 

Update 5: Breast Problems 

Update 6: Nutrition of the Young Child During the First Two Years 

(Copies of all these UPDATES are available with BPNI for Rs 10/- each including postage) 

EDUCATION MATERIALS 

The Law to Protect, Promote and Support Breastfeeding (2nd edn.) Rs. 60.00 

Breastfeeding & Infant Feeding: A Guide for Parents (In English & Hindi). (2 nd edn.) Rs. 25.00 

Breastfeeding & Complementary Feeding – Guidelines for Doctors. Rs. 150.00 

Breastfeeding & Complementary Feeding – Guidelines for Nutrition Professionals. Rs. 150.00 

Breastfeeding & Complementary Feeding – Guidelines for Nurses. Rs. 150.00 

The Science of Infant Feeding. Rs. 450.00 

Protecting, Promoting and Supporting Breastfeeding - The Indian Experience Rs. 290.00 

VIDEO CASSETTEE and CD on Breastfeeding 

Video Cassette “Maa Ka Pyar Sishu Ahaar” (In Hindi & English). Updated 2002 Rs. 250.00 

CD”Maa Ka Pyar Sishu Ahaar” (In Hindi & English). Year 2002 Rs. 100.00 

POSTERS 

The Magic Only A Mother Can Do (Hindi & English). 1996 Rs 5 each 

Closeness and Warmth. 2000 Rs 10 each 

BPNI Website www.bpni.org 

Annexures 

xxix

Breastfeeding Promotion 

Network of India (BPNI) 

BP-33, Pitampura, Delhi 110 088 (INDIA) 

Tel: +91-11-27312445 

Tel/Fax: +91-11-27315606 

Email: bpni@bpni.org; Webiste: www.bpni.org

24 Paraganas report.pdf - BPNI

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