Protecting Breastfeeding in South Asia

Breastfeeding is the cornerstone of child survival and development. Initiating breastfeeding within the first hour of birth alone can save the lives of 200,000 newborns per year in South Asia^[1],[2]. When combined with exclusive breastfeeding for the first 6 months of life and continued breastfeeding until 2 years or more, the benefits extend beyond survival, ensuring healthy growth, immunity, optimal brain development, and fostering a strong bond between mother and baby.

In this article, we speak with UNICEF South Asia’s Regional Advisor for Nutrition, Zivai Murira, and Regional Nutrition Specialist, Vani Sethi, on the dangers of unethical marketing of breastmilk substitutes and the importance of strengthening national legal measures to protect and promote breastfeeding in the region.

What is the state of breastfeeding practices in South Asia?

South Asia has made gradual progress in improving breastfeeding practices over the last two decades. For example, the percentage of babies who are exclusively breastfed in South Asia for the first 6 months has increased from 47 per cent in 2000^[3] to 60 per cent in 2024^[4]. The region has achieved the World Health Assembly target of 50 percent exclusive breastfeeding by 2025 but falls short of the Global Breastfeeding Collective target to reach exclusive breastfeeding by 70 percent by 2030. While this progress is encouraging, still only 39 per cent of newborns are breastfed within the first hour of birth^[5] leaving millions of newborns waiting too long for the benefits of breastfeeding.

What are some of the barriers to optimal breastfeeding in the region?

In South Asia, caesarean delivery is on the rise, which is associated with delayed initiation of breastfeeding. In addition, perceptions of insufficient milk supply and prevailing social norms in some countries stand in the way of exclusive breastfeeding. Too often, mothers do not receive the accurate information or lactation counselling they need. This support is particularly critical for adolescent mothers, those whose babies are at risk of poor growth and development, as well as mothers who have delivered through caesarean section. To make matters worse, the baby food industry exploits parents’ worries by using unethical and predatory marketing to promote formula as a convenient and superior alternative to breastmilk. Between 2015 and 2021, annual sales of formula have grown by at least 15 per cent^[6] in South Asia. 

What are governments doing to protect families from unethical formula marketing?

For decades, experts have been sounding the alarm against the aggressive and inappropriate marketing of breastmilk substitutes and bottles and teats. In 1981, the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes to prohibit and restrict inappropriate promotion of breastmilk substitutes and baby foods^[7].

All countries in South Asia, except for Bhutan, have introduced national ‘Code’ measures. However, these measures have weaknesses that can be exploited by the baby food industry. Many countries also lack strong monitoring and enforcement systems, making it difficult to enforce measures even when they do exist.

How is UNICEF supporting countries in South Asia to make progress in implementing legal measures to protect breastfeeding?

We are working with governments in the region to strengthen the implementation, monitoring and enforcement of national legal measures to protect breastfeeding. In just 18 months, we’ve seen notable progress across many countries^[8].

Bangladesh has resumed the registration process for breastmilk substitute products. A dedicated unit within the Institute of Public Health Nutrition reviews and approves applications and labels. These actions, taken together, are resulting in labels that are easier to read and free of any misleading promotional claims or graphics.

Pakistan’s Sindh Province introduced the new 2023 Sindh Protection and Promotion of Breast-Feeding and Young Child Nutrition Act which replaced baby food industry representatives with civil society members from bodies that oversee national regulations. Taking inspiration from Sindh, other provinces are accelerating legislative efforts to amend existing national legal measures.

The Maldives has finished drafting its new Food Safety Bill, which when enacted, will be the parent act to the Regulation on Import, Produce and Sale of Breast Milk Substitutes. This new bill gives the needed legal authority to enforce code measures, which was previously lacking.

Bhutan has incorporated the provisions of the Code into a Food and Nutrition Security Policy, which was endorsed in November 2023. When enacted, The Food and Drug Bill of Bhutan will be the parent act to this policy and will mandate implementation of all code provisions.

These successes are encouraging and proof that tangible progress is achievable in a short period of time. 

What can governments do to strengthen protection of breastfeeding?

Governments have a responsibility to prevent predatory marketing of commercial milk formulas. They can do so by:

1. Strengthening national legal measures. Governments must develop or update legal measures to effectively regulate the marketing of commercial milk formula to parents, caregivers, and medical professionals and to limit industry influence on health systems.
2. Enhancing monitoring and enforcement. Strong legal measures are not enough. Governments must scale up efforts to monitor and enforce breastfeeding protections by creating independent, transparent, and well-funded bodies free from commercial influence.
3. Engaging judicial networks. Governments must involve lawyers and judges who practice, advocate and/or teach human rights and public health law in policymaking processes from the beginning to develop, implement and enforce robust legal measures.                

While South Asia has made strides in protecting and promoting breastfeeding, much work remains. Breastfeeding is not just about a mother and her child. It’s a shared responsibility of all - parents, families, governments, skilled health workers and workplaces - to support, enable and protect breastfeeding.

Together, we must work to give every child the best start to life.  

Please see the Nourishing South Asia reports for more details on ongoing efforts to strengthen legislation.