Introduction
In every family there comes a time when a baby is born and brought up. There is an Indian legislation enacted to ensure the proper regulation of infant nutrition and related products - The Infant Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992. This piece of writing will revolve around this legislation, sole purpose of the act is to promote breastfeeding in normal situations and regulate the production, supply, and distribution of infant milk substitutes, feeding bottles and ensure that these products are used safely and appropriately when breastfeeding is not an option.
Section wise criticism and how it lacks implementation
Section-3 No advertisement, publication for distribution, sale or supply of infant milk substitutes and feeding bottle, not even creating a belief that these substitutes are equal or superior to mother’s milk.1 From 2002 to 2008 India’s market of infant formula sales stayed below USD$ 500 million, on the other hand in China it has grown from USD $1 billion to USD 3.5 billion in same period.2 But on the other side from 2007 to 2021, the market of milk substitutes has seen a steady growth due to urbanization and change in life style.3 From 2008- 2015 there was a moderate growth but from 2016- 2023 it has seen as an aggressive rise in sales and consumption of these substitutes, although there are no solid data which supports that there is a rise in any extraordinary situation, (except COVID 19 infection in between 2016-2023) because of which such sales increase. With the base year of 2023, IMARC has expected that the market of these alternatives will grow from USD$ 5.7 billion to USD $ 9 billion, which is a dangerous sign. Where are the authorities empowered U/Ss. 12,13 15, 194 of the act(Food inspector, Food safety officer or any officer authorized)? Are they effective enough to control promotion of these products at the same time, are doctors doing what needs to be done on their part to promote the importance of mother/human milk for infants? It seems fishy on both parts.
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For the sake of better life of these infants, human or mother milk is of utmost importance. Even in 2004, government has issued a new set of guideline ‘National Guideline for Infant and Young Child’ in 2004 to further promote the importance of mother’s milk, this also suggests exclusive breastfeeding for children up to 6 months and further supplement it with certain food products and human milk up to 2 years or more.
Section 45 prohibits use of incentives and other sales improvement tactics by manufacturing companies. 6Wreseach on Infant Formula milk powder market synopsis has projected that a compounded annual growth (year on year growth) is expected to be at 11.10% from 2023 to 2029.6 Due to restrictions in using sales techniques generally these companies use their medical representatives to promote other products and create a brand value amongst customers, then softly promoting their supplements because of their improved brand value, and the same applies to doctors and medical practitioners, Even sometimes companies give gifting and other offers to doctors for products manufactured by companies that are not barred to be advertised, creating a brand value among them. The baby bottle market is projected to grow at the rate of 3.9% CAGR from USD 3.41 billion in 2023 to USD 5 billion by 2033.7 Asia including India is the largest shareholder in this baby bottle market and will continue to grow at 6.2%. 8 Over 27 million containers of these breast-milk substitutes of 400 grams each are sold very year and is growing with almost with the same ratio as the number of children born reported business journalist Rupali Mukherjee in 2018 by the time this law has been enforced for more than 25 years.15 This is going like a hell and the functioning of the legislation in lieu of the working of executive is getting worst. Where, capitalism at its peak has compromised with lots of standards and preferable practices.
The e-commerce giants are alleged to have violated the IMS act of 1992; online shopping portals offering price discounts on the purchase of infant feeding bottles and milk substitutes are violating sections 3 and 4 of the IMS act.17 No control on them for doing that.
Section 6 9of the act deals with the important information required to be printed on bottles or packets of substitutes, information should be under the head of ‘important information’ in capital letters, saying mother’s milk is best for baby, use on the advice of prescription, etc. Even on going through the packets they all comply in accordance with this section. But mere capital letters are not enough to make concerned parties aware of the fact that this act wants to make it clear. At least it should have a provision saying that a certain (50, 60, 70 %) of the packet should contain this information so that it is noticeable by everyone.
Section 6(1) (c) “a warning that infant milk substitute or infant food is not the sole source of nourishment of an infant”10 If the legislation itself is accepting the fact that the prescribed substitute is not the sole source for child’s nourishment then Why is it even prescribed? Why other sources aren’t tried and tested instead of directly jumping to the solution that is to be prescribed as the last resort.
Section7 is about educational and other material related to the benefits and superiority of breastfeeding, harmful effects of bottle feeding, health hazards of improper use of milk substitutes.11 Portion of infants (0-6 months) exclusively breastfeed was 31.3% and 43% in National Family and Health survey 4 and 5 respectively which indicates that educational work has been done so far. Shows that a certain level of infants in whom breastfeeding was initiated one hour after birth showed an increase, in accordance with the guideline in 2004 which has established the importance of breastfeeding as soon as possible (even after half an hour in case of normal delivery). 12 But this data is showing that it needs to be corrected on a large scale even now.
Section 813 of the act is about no use of persons in the health care system for the display of placards or posters relating to infant milk substitutes and feeding bottles, with certain exceptions. Morally up to a certain level all of this is protected and respected by people involved in the health care system. But this is just half-truth because as published in a news report14 says that over the years companies are aggressively promoting and marketing baby milk substitutes through conventions and conferences. RTI shows that many such companies have sponsored the National Conference of Indian Society of Clinical Nutrition held in Delhi in October 2016.
Section 1016 set aside provisions relating to employees of a company which produces, supplies, and sells breast/human milk substitutes that neither commission based sales target should be given nor to educate any of pregnant women or mother of an infant. In a world of initiative based working models we cannot even assume that it’s not happening in multi layered manufacturing and marketing companies.
So the whole criticism is around the poor implementation of the major provisions of the act which is resulting in the long run ruining the health of our future generations. Statement of object submitted by then HRD ministry is nowhere into consideration
Rest of the act revolves around the punishment regarding violation and other procedures to be followed in order to implement this act. There is no data available with respect to the case registered, investigations done by food safety officers, number of convictions done, which itself is sufficient to justify how seriously concerned authorities are.
How vital mother’s milk is-
Just highlighting the flaws in the implementation will never work for benefit, what we need to do is work on two fronts, firstly on stricter implementation, then on highlighting the importance of mother’s milk. Mother’s / Human milk is of utmost importance when it comes to the over health of the infant. WHO along with UNICEF recommends breast milk is one and only ideal food for infants if everything is normal. It is safe, clean and contains antibodies. Those breastfed perform better on intelligence tests; have less chances to attract obesity. Women that breastfeed are of low risk of breast and ovarian cancer18. It’s crucial for the bio-psychological system to promote health of both. Hormones released during breastfeeding enhance affection, bonding. This increases release of oxytocin and prolactin (which helps in creation and release of milk), skin to skin touch between mother and infant helps in both breastfeeding and emotional bond strengthening.20, 21
On similar line length, the National Guideline for Infant and Young Child in 2004 emphasizes on early initiation of breastfeeding in case of normal delivery within one hour and in case of cesarean within 4-6 hours. Other than pointing at breastfeeding, it highlighted the importance of Colostrum (Thicker and yellow milk that comes in small amount in first few days), generally it is considered to be something which is bad on unhygienic, but it is highly nutritious, contains anti-infective substances.19
So not only stricter implementation of The Infant Substitutes, Feeding Bottles and Infant Foods (Regulation of Production, Supply and Distribution) Act, 1992, we need to promote practices of breastfeeding if everything is normal. Doctors and other medical staffs (as they are the most trusted sources to spread this information) can do that by educating mothers and families from early days of pregnancy, support through counseling, developing baby and breastfeeding friendly environment at home and in public places too, address other misconceptions regarding breastfeeding, in case of problem in getting infant’s mother milk, human milk bank is an alternate option better than any of the substitutes.
Conclusion
A loosely implemented legislation can create any kind of issue, especially if it is related to the health of our future generations. We are excelling in almost every sector of our life but when it comes to health, a lot of standards and precautions are sacrificed. In the name of growth we are bound to grow in a manner where the interest of each and every social and age group is served at its best, in the case of early child health care, especially in implementing this law we are lacking in strictness for medical practitioners and other stakeholders. After 25 years of enactment of this act, if data shows that we have not achieved 100% of what we aimed at is a matter of shame for the system and personnel directly and indirectly involved in it. We need to course correct our action plan and implement it in a stricter way, if done as a two way process which means stricter implementation as well as educating and encouraging mother to be, mother of infants and families, wholeheartedly will definitely help us out in achieving the aim of this act. In case if the infant's mother is not there or not lactating we can have a better alternate option of human milk bank, in association with the Human Milk Banking Association of India.
References-
1. https://www.indiacode.nic.in/bitstream/123456789/1958/3/A1992-41.pdf Section 3 (page no 3)
2.https://ysph.yale.edu/news-article/indias-infant-milk-substitutes-act-monitoring-and-enforcement/ (para 1)
4. https://www.indiacode.nic.in/handle/123456789/1958?view_type=browse&sam_handle=123456789/1362#:~:text=An%20Act%20to%20provide%20for,connected%20therewith%20or%20incidental%20thereto. (Ss. 12,13,15,19 )
6. https://www.6wresearch.com/industry-report/india-infant-formula-milk-powder-market
7. https://straitsresearch.com/report/baby-bottle-market
8. Asia-Pacific Dominates the Global Market….. https://straitsresearch.com/report/baby-bottle-market
12. Results https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-023-00602-z
14. https://timesofindia.indiatimes.com/india/despite-ban-marketing-of-breast-milk-substitutes-continues/articleshow/64200270.cms News report. Over 27 million containers of infant formula of 400 gm
17. Sinduja Jane, Flipkart, Amazon among E-commerce giants in trouble for discounts on Feeding Bottles, NEWINDIANEXPRESS.COM (30 Aug. 2019) https://www.newindianexpress.com/business/2019/Aug/30/flipkart-amazon-among-e-commerce-giants-in-trouble-for-discounts-on-feeding-bottles-2026280.html
18. Breastfeeding https://www.who.int/health-topics/breastfeeding#tab=tab_1
19. Value of Colostrum (Page no 5) https://wcd.nic.in/sites/default/files/nationalguidelines_0.pdf
20. Klaus M. Mother and infant: early emotional ties. Pediatrics. 1998;102(5):1244–46. https://pubmed.ncbi.nlm.nih.gov/9794962/
21. Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews. 2007;(2) https://pubmed.ncbi.nlm.nih.gov/17636727/
