Dr. Arun Gupta on Breastfeeding, BPNI, and Breaking the Formula Cycle – World Breastfeeding Week 2025 (Part 2)

Dr. Arun Gupta: We played a role in influencing several policies, though it’s important to acknowledge that we weren't alone in these efforts. Many women's groups and public health organizations collaborated to advocate for an increase in maternity leave to 26 weeks. As a result, by law, maternity leave has been set at 26 weeks since 2017. Our campaign for this change began in 2006 when we approached the Prime Minister. Additionally, one significant achievement from Prime Minister Manmohan Singh was the establishment of a scheme to support poor women who do not receive maternity leave.

Additionally, under Prime Minister Manmohan Singh, we initiated a scheme to assist poor women who do not receive maternity leave. This plan included a cash grant of 1,000 rupees per month, which was entirely driven by BPNI's efforts. This initiative was accepted and continues today as the Pradhan Mantri Yojana. Currently, approximately 5,000 rupees are provided monthly to women to support them while they are at home.

While this cash grant may not fully meet all needs, it represents a meaningful step forward in providing assistance.

Dr. Arun Gupta: All the private sector as well. Everyone who is in the organized sector—shops, establishments, and mines—is covered under that.

That’s the explanation given on the Ministry of Labour site and the Maternity Benefit Act. Therefore, there is no distinction between private and public here; everyone must comply. If they don’t, women should complain to the labour inspector of their area in writing if they don’t get this leave benefit.

Dr. Arun Gupta: Not much. While there may be a few percentage points of difference, the fact remains that 90% of births are taking place in health facilities, whether in improved rural areas or urban settings. Additionally, nearly half of all deliveries occur in the private sector, making any disparities relatively insignificant.

We are waiting for the National Family Health Survey-6. By the end of this year, we may get the full report on where we stand. The 2021 report says only 41% of mothers start breastfeeding within an hour of birth. The rest are either delayed or receive formula, animal milk, etc.

If we start investing in hospitals—strengthening where babies are born—much of the problem can be resolved. Early initiation increases exclusive breastfeeding, reduces malnutrition, infections, and newborn mortality. There are many benefits, yet the health system is not fully supporting mothers, whether it is a cesarean or a normal delivery.

BPNI has started a program called Accreditation of Hospitals as Breastfeeding Friendly. Hospitals apply, there’s a cost, and our team provides one year of technical support. One of our authorized assessors visits the hospital, interviews staff and mothers, and then we issue certificates.

It’s not a pass/fail system—we help them reach a best standard. So far, more than 70 hospitals have been accredited in the last three years. Over 150 have applied.

This initiative is important because government programs don’t reach the private sector, so we created an external, independent assessment process with WHO and government guidance.

Dr. Arun Gupta: We have limited resources in human resources, but we do have trainers across the country who voluntarily dedicate their time. Our main initiative is to produce counselors through a seven-day training course. This program is suitable for a range of professionals, including graduates, doctors, nurses, scientists, and nutritionists—anyone who wants to contribute to helping mothers.

This is one aspect of our mission. While we cannot directly reach ASHA workers, we train trainers in various states who can then educate field workers. Additionally, we have developed courses for hospital staff, allowing them to train other personnel.

We offer two types of training courses. For hospital staff, we have a four-day course focusing on early breastfeeding and the "10 Steps to Successful Breastfeeding." BPNI conducts this course based on demand.

Our training system prioritizes quality. We have four national trainers who each instruct 24 participants in a session. This ensures a high standard of training. Participants are required to pay for these courses, and we organize them in different parts of the country, wherever there is a host willing to facilitate. Once 24 people apply, we proceed to conduct the course with our trainers.

Dr. Arun Gupta: See, this is very important. I would say the medical college should first set their hospitals perfectly right to implement all the 10 steps so that the students can watch that happening. I strongly encourage every medical college to undergo the accreditation process.

If they are not interested in the accreditation process, we have developed tools that are freely available. These tools can help them start making necessary changes in their practices, including monitoring data, establishing policies, and educating mothers during pregnancy. All of these resources are available on our website for free use.

If they choose to pursue accreditation, it costs approximately 20,000 rupees per hospital. This represents a one-year commitment from BPNI, during which we will assist them in reaching the highest standard of care. By creating a standard of excellence, their teachers can also provide the same quality of education to students.

The clinical training we offer to nurses can also be adapted for students, allowing them to gain important skills when they enter the wards. Ultimately, if a hospital adopts a breastfeeding-friendly approach, they will have access to valuable materials that will benefit both staff and students.

Dr. Arun Gupta: We are currently focusing on hospitals, particularly on our breastfeeding-friendly hospital accreditation program. This program is open to anyone interested in applying. It specifically pertains to maternity services, and we do not assess neonatal intensive care units or pediatric wards—our focus is solely on maternity services.

Our flagship program is based on the World Health Organization's 10 Steps to Successful Breastfeeding. Hospitals interested in accreditation go through a two-step process. First, they complete a self-assessment online, after which we provide guidance for an external assessment.

In addition to the accreditation process, we also organize week-long training programs across the country at various medical colleges. These training sessions are available for those who wish to participate.

Lastly, we monitor compliance with the relevant laws and regularly report any companies that violate these regulations.

Dr. Arun Gupta: I believe we don't need more policies. However, one addition to maternity law could be the inclusion of women in the informal sector. This would ensure that they receive at least a minimum wage or full pay, establishing a benchmark for their compensation. Such a change would promote a more inclusive economy.

Additionally, the implementation of existing policies is often weak. The government needs to strengthen its efforts, particularly by involving the private sector, which is currently not engaged. That is where the majority of the work lies, and we are also seeking to collaborate with the private sector on this issue.

Dr. Arun Gupta: I believe there is no comparison between breastfeeding and pumping breast milk. My recommendation is that while the pump can be useful when needed, not every woman requires it.

Therefore, it can be very useful wherever there is a need. I'm not suggesting that the pump shouldn't be used. However, I believe that people should avoid getting sponsorship from pump companies.

Lactation counselors, doctors, and nurses may use a breast pump as needed. It's important to assess whether a mother requires a pump before prescribing one. However, not every mother needs a pump to express breast milk.

Dr. Arun Gupta: Better regulated, but I don’t anticipate much opposition since regulating pumps is more about facilitating proper use. However, some companies also produce bottles, so by definition, they fall under that regulation. My main concern lies with the sponsorship aspect rather than the utilization of the pumps.

When it comes to regulation, I believe pumps should be banned from sponsorships, free supplies, and discounts. Implementing such restrictions is crucial because anyone who receives incentives from these companies—be it doctors, nurses, or counselors—may feel indebted to them. This indebtedness can lead to a situation where they start distributing pumps to everyone.

Dr. Arun Gupta: I'm happy with the work we have done. I'm nearing retirement now. That is something we are building—a new generation of people who will look after BPNI. Currently, we have a new central coordinator appointed at BPNI, Dr. Nupur Bidla, who is in charge of the day-to-day operations. She has a PhD in social work and is now overseeing the work of BPNI.

BPNI will continue to struggle against companies, as violations are increasing daily, and the government is not taking action against them. Unfortunately, these issues are likely to persist. Furthermore, the amount of work required in the country indicates that we need about 50 BPNIs across India. Currently, we do not have BPNI replicas in every state. If each state had a structured office with BPNI dedicated to breastfeeding, it would make a significant difference. Right now, we are just working with four or five people.

Imagine if every state had an organization like BPNI providing training and authorization; that would be ideal. However, such aspirations cannot be fulfilled without funding, and that is a necessity.

On a positive note, India has started to slow down the use of formula. In 1983, we were selling about 40,000 tons annually; now we are down to about 30,000 tons. In contrast, China sells approximately 700,000 tons, as they have very weak laws. We continue to monitor these laws to further reduce formula sales, and we are pleased with our progress.

Additionally, we are continuing our efforts to support women with maternity leave. People reach out to our office to help draft letters to authorities when they aren't receiving their salaries or maternity leave benefits. We assist them as much as we can.

Breastfeeding rates have begun to rise over the past five years. Let us see what happens with the upcoming NFHS-6 data; I'm not sure what the results will show. However, if we stop this work, the breastfeeding rates could quickly decline again.