The Global Breastfeeding Scorecard 2022 found that only 48 per cent of children worldwide younger than six months are breastfed exclusively (given nothing but breast milk) – though this figure is 10 percentage points higher than a decade ago – and that while 70 per cent of women continue to breastfeed their infant for at least one year, by two years of age, breastfeeding rates decline to 45 per cent.

Experts blame several factors, such as misinformation about the topic, the lack of skilled nursing staff to coach new mothers, and a decline in the ability of family members to help new parents overcome challenges.

A lack of legislation does not help. While strong laws exist to support maternal mortality and health, experts say, no such laws exist for lactation, which leads many women to quit their careers during the breastfeeding years.

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This led Adhunika Prakash, a certified lactation counsellor, to launch Breastfeeding Support for Indian Mothers (BSIM), a Facebook collective, in 2013.

“All women should have access to skilled care during pregnancy, childbirth and breastfeeding to ensure management of complications,” she says.

“Strategies to support exclusive breastfeeding should address issues like lack of knowledge, access to support from health experts and awareness about infant formula marketing. Legislation to bolster women’s rights to breastfeed at the workplace and in public areas is also required.”

She was motivated to help new mothers tackle the issue after her return from Ireland, where she had joined a mother’s support group while struggling with breastfeeding her elder child.

“The interactions with the other mothers’ and nursing professionals helped me navigate my tough lactational journey and I felt really empowered. I thought of replicating a similar model for Indian women,” she says.

BSIM now has over 150,000 members and helps new mothers access expert counselling. During meetings and webinars, participants dispel myths around feeding and share science-based advice. The Facebook group’s team of 10 provides valuable and timely support for breastfeeding members.

Prakash has also written a book – Breast Potion: Essentials of Breastfeeding for the Expectant and New Parent – to share her knowledge and experiences.

“There’s not enough information about the subject to guide and counsel young mums,” she says. “Unlike earlier, generational wisdom isn’t getting passed onto modern mums because of weakening familial ties. Also, there’s no formal education on breastfeeding.”

Health workers point out that the entrenched formula-milk lobby, which promotes artificial milk over mother’s milk, projects the former as an accessible, affordable and convenient option. This is readily accepted by stressed and sleep-deprived new mums.

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A report by the non-profit Breastfeeding Promotion Network of India (BPNI), compiled from June 2022 to May 2023, revealed frequent violations by baby-food companies to entice mothers to use their products in place of breastfeeding.

Nupur Bidla, BPNI’s national coordinator, says that breastfeeding can be quite a daunting experience leading to incorrect methods, uninformed decisions and stress.

Worse, over half a billion working women are not given essential maternity protection in national laws, she adds, and just 20 per cent of countries require employers to provide employees with paid breaks and facilities for breastfeeding or expressing milk.

According to Bidla, the common assumption is that mothers can easily feed newborns due to their maternal instinct.

“However, they are often confused about basic things, like how to hold the baby during feeds, how to burp them, and so on.

“All these anxieties hamper the flow of two hormones, oxytocin and prolactin, in the body, creating a barrier in expressing milk. The former, also known as the love hormone, produces the milk, while the latter helps supply it to the baby.”

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Although BPNI mostly does policy-level interventions, it has also started an initiative called “iDecide” under which mothers pay a one-time fee of US$2.50 to access information on breastfeeding through six video modules. The organisation has more than 21,000 members, including nursing and lactation professionals, policy experts, and public health volunteers.

Rather than writing off formula milk completely, it is better to advise mothers to choose formula milk if they have health challenges, Bidla says.

In such cases, the group provides tips on how to prepare and store formula milk and safeguard hygiene.

BSIM has also launched a new project under which it gives accreditation to breastfeeding-friendly hospitals that provide trained staff to guide new mothers.

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Shruti Kanchan, a lactation consultant based in Mumbai, India who gave birth to twin boys, says her own motherhood journey was fraught with challenges.

This drove her to quit her high-paying tech job, nurture her twin boys till they were three, and work as a specialist in the area. She currently works with several hospitals to coach other mothers in breastfeeding.

“When I gave birth through a caesarean section, I was ill-advised by the hospital staff that it would be ‘impossible’ to breastfeed twins, so I should opt for formula milk,” she says.

“But something didn’t feel right. So I sought out other mums who were undergoing similar challenges and how they were tackling them.”

That’s when Kanchan stumbled upon BSIM, which she joined to learn more about breastfeeding and related issues. Later, she volunteered her free services to other mothers on the platform before she began a freelance lactation consultancy.

Among the most common problems mothers face when feeding babies, Kanchan says, is not understanding how to feed them optimally, leaving babies cranky and undernourished.

“The trouble in such cases is ‘tongue tie’, a situation where the strip of tissue attaching the tongue to the floor of the mouth [the frenulum] is shorter than normal. This prevents the baby from latching on properly, hindering milk supply, which can also lead to sore or cracked nipples,” she explains.

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As a specialist, Kanchan’s job includes assessing the latch, showing the right posture to the mother while expressing milk, and advising on the need to consult a doctor.

To help normalise breastfeeding, some US celebrities – including Eva Longoria, Jessica Simpson and Amy Schumer – have spoken out on the issue.

Bollywood actor Neha Dhupia has also launched an Instagram handle “Freedom to Feed”, to motivate young mothers and promote breastfeeding.