Dr. Arun Gupta on Breastfeeding, BPNI, and Breaking the Formula Cycle – World Breastfeeding Week 2025 (Part 1)

Dr. Arun Gupta: I started medicine at Medical College Patiala back in 1968, from where I graduated and then joined the master’s course. In 1976, I finished my MD in Pediatrics from Patiala and then joined a government job in a town called Kapurthala near Jalandhar city, Punjab.
That lasted for a few months. I was transferred to Jalandhar and posted in the Department of Radiology because at that time, specialization was not a priority for the government. Doctors were posted where they were needed, regardless of their specialization. They had only one vacancy for a pediatrician in a district.
After 3–4 months, I resigned and opened a clinic in Jalandhar city. Later, it was expanded to a 30-bedded hospital in Jalandhar. So from 1979 to 1990, I worked in that hospital with my wife, who is also a doctor, and two junior doctors.
We had 3–5 admissions of small children on a daily basis in our hospital. During that period, I noticed a major push for infant formula by Nestlé in that town, which I realized was not limited to that town alone—it must have been a strategy all over the country. They were giving freebies to promote formula. If you bought one tin of Lactogen, you got one free.
There were about 17 hospitals in Jalandhar providing maternity services at the time. I happened to interview about 100 mothers who came to me for routine checkups, including babies less than 3 months old.
I found that all of them, born in those 17 hospitals, were carrying Lactogen with them. To create evidence, I went to the market, bought a few tins of Lactogen, and received freebies myself.
So, I started a lot of lobbying with our pediatric association to stop accepting sponsorship from Nestlé, because they were receiving a lot of it at the time. Even the Journal of the Indian Academy of Pediatrics featured advertisements for Nestlé’s Lactogen and other products.
To cut the story short, I realized that we were very poor at supporting breastfeeding mothers, including in my own family. My children were born in 1979 and 1981, and we failed to achieve full breastfeeding as recommended. We were not aware of the skills needed to help a mother breastfeed, so we failed ourselves. After six months, both babies were off breastfeeding.
Even my mother would say the same, since she probably saw the change in society. I was born in 1951. At that time, there was no formula push.
In the 1970s, I think the Western push came into India. That’s how formula was normalized in hospitals and started disturbing breastfeeding.
There were also studies from cities like Chandigarh. Professor Dr. BNS Walia from Chandigarh documented that between 1975 and 1985, in the same population, breastfeeding rates were going down. National-level surveys were not available at that time.
So that’s when we decided that something needed to be done. I got trained in lactation management in 1989 at Devlali, in a program organized by Dr. R. K. Anand, a senior pediatrician from Mumbai who is 18 years older than me. We got together and discussed a lot about the issue because he was also very concerned. A few friends like him joined hands. In the training, we learned the skills and understood that you have to help mothers in order for them to breastfeed successfully. These are small but crucial skills—like building confidence, helping the mother maintain a good position for feeding, and latching techniques.
This was not taught to us during our courses. We traced the history back to the medicalization of childbirth. Whatever little skills families learned from dais (traditional birth attendants) were lost, because the health system—which was not ready to support breastfeeding—started delivering babies and introducing formula at the same time.
Baby food companies survive around the failure of breastfeeding. If breastfeeding doesn’t fail, they don’t survive.

We moved to Delhi in 1990 to advocate for this cause. Along with friends from Bombay and Delhi—Dr. R. K. Anand, Dr. N. B. Kumta (who is no more), and my friend Dr. Tarsem Jindal (also no more)—four of us sat down at my home and set up BPNI. This was the result of a recommendation in 1991. We were trained as trainers for breastfeeding in Devlali as well as in Wardha. Many people got together and we decided that there should be an organized front for breastfeeding.
After moving to Delhi, I practiced for a few more years and then left clinical practice completely. Since then, I have only worked on the policy framework to promote breastfeeding and to help mothers with successful practices. Currently, we are designing programs and policies that can help mothers.

Dr. Arun Gupta: No, I think the major issue was that maternity leave in those days was just three months. Societal pressure, yes. Even my mother would say, "Both of you have to go to work, so it's better to give formula." We were still trying our best. Even seniors and our teachers suggested giving a bottle if the child cried.
We were not aware of the concept of “not enough milk.” It’s not a matter of production going down—it’s about the flow. That’s something we only learned after our training in 1999. Understanding how hormones like oxytocin and prolactin work was new knowledge.
Even today, most people—including doctors—do not fully understand this. I'm not saying all doctors, but most lack the skills to help a mother breastfeed successfully. These skills have to be passed on to the mothers, and that requires time—which, unfortunately, doctors do not always have.

So it should be someone who can give time. It could be nurses, counselors, or anybody. Sometimes it takes more than half an hour—35 to 40 minutes—to counsel a mother.

Dr. Arun Gupta: Every hospital where babies are born should have someone available to help and support a mother technically. This could be a family member by the mother’s side, and a health worker who is kind and skilled in lactation support. It could be a nurse or a doctor willing to give time, or if neither is available, a lactation counselor.
Unfortunately, even though we train people, they are still only in the thousands. Lactation support should be universal and available to mothers at the time of birth. Before birth, the mother must decide what she will feed her baby.
If she decides to give bottle feed, she needs 10 times more support than a breastfeeding mother to keep infant feeding safe.
Postpartum, she is very sensitive. If 10 people tell her to give a bottle, and another doctor tells her to breastfeed, she will be confused. If she has pain or feels she doesn’t have enough milk and no one is willing to support her, it becomes very difficult.
That gap should not exist if breastfeeding is to be successful.

Dr. Arun Gupta: No, they are not widely available. 

Dr. Arun Gupta: Formula use is more common in the private sector. It’s very hard to say about the availability of lactation experts because no data is available. The government is training people in hospitals and assuming they are counselors. It’s unclear whether they have received specialized training.
BPNI has a one-week training course for counselors. It’s a clinical training conducted in hospitals. We are a small organization training people for the entire country. So the number of trained professionals remains low.

Dr. Arun Gupta: No, there were no obstacles in launching it. It was a decision we took, but we weren’t sure what the future would look like.
At that time, the major focus of our work was to push the country toward enacting a law to ban the promotion and advertising of baby foods—which we succeeded in doing.

The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992—IMS Act, 1992—was enacted to protect and promote breastfeeding. It also regulates the production, supply, and distribution of infant food substitutes and their advertisements.

Of course, it took 8–9 years to get that law passed in Parliament. There was a lot of pressure from formula companies at the time.
Even Mr. Verghese Kurien of Amul Dairy was against it. He was instrumental in pressuring the government not to draft the law.

Now, no one can legally promote baby foods, although we still find that many people are doing it.

Apart from the IMS Act, we have been training lactation experts.
Funding has been a big challenge to continue the work. At one time, the number of people working in BPNI reached 20. We were supporting all states of India with training, but due to funding constraints, people had to leave their jobs.

Now, we have only four or five people working for BPNI.