Bhubaneswar: More women in Odisha are choosing to give birth in health facilities, but this progress is not leading to better newborn feeding outcomes. Early initiation and exclusive breastfeeding for newborns and infants under six months have declined sharply, according to the National Family Health Survey (NFHS)-6 released by the Ministry of Health and Family Welfare.
Declining breastfeeding rates
The survey reveals that the proportion of infants under six months who are exclusively breastfed fell from 72.9% in NFHS-5 (2019-21) to 66.7% in NFHS-6 (2023-24). During the same period, institutional deliveries increased from 92.2% to 93.9%, highlighting a disconnect between improved access to healthcare facilities and recommended infant feeding practices.
The decline is equally evident in early initiation of breastfeeding. The percentage of newborns breastfed within the first hour of birth dropped sharply from 68.5% in NFHS-5 to 60.9% in NFHS-6. Health experts consider the first hour after birth critical, as early breastfeeding provides colostrum, the baby’s first natural vaccine, and helps establish long-term breastfeeding.
Rural-urban divide
The latest survey also points to an interesting rural-urban divide. Mothers in rural Odisha are more likely to initiate breastfeeding within the first hour of birth than their urban counterparts. According to the NFHS-6, 61.2% of rural newborns were breastfed within an hour of birth compared to 58.6% in urban areas.
However, when it comes to sustaining exclusive breastfeeding for the first six months, a practice recommended by the World Health Organisation (WHO) and UNICEF for optimal growth, development and immunity, the trend reverses. Urban mothers appear to fare slightly better, with 68.3% exclusively breastfeeding their infants for six months compared to 66.5% in rural areas.
Expert insights
Experts say the difference reflects contrasting realities. In many rural communities, traditional knowledge and family support often encourage mothers to begin breastfeeding soon after delivery. But maintaining exclusive breastfeeding for six months can be challenging due to factors such as maternal workload, labour, household responsibilities and limited access to counselling on infant feeding.
“In urban areas, while delays in initiating breastfeeding mostly arise from medical interventions, caesarean deliveries or lifestyle factors, mothers have relatively better access to health information and postnatal support that help them continue exclusive breastfeeding,” said Cuttack-based gynaecologist Kalyani Mohapatra.
Rise in caesarean sections
Interestingly, the rise in institutional deliveries across both urban and rural Odisha has been accompanied by a sharp increase in caesarean section (C-section) births. According to the NFHS-6, the proportion of deliveries conducted through caesarean section increased from 21.6% in NFHS-5 to 29.4% in NFHS-6.
The survey also highlights a striking disparity between public and private healthcare facilities. While nearly 76.8% of deliveries in private health institutions were conducted through caesarean section, the corresponding figure in government health facilities stood at just 19.9%.
