By now we have all seen the cover of the the March edition of Malayalam magazine Grihalakshmi. The magazine features a model breastfeeding a baby with a headline “Mothers tell Kerala, ‘please don’t stare, we need to breastfeed’”. The image has evoked a range of responses – applause for a campaign to normalise breastfeeding in public, brickbats for supposed titillation, and questions over why the magazine chose a model to feature on the cover instead of an actual breastfeeding mother.

But here is a conversation around breastfeeding that does not get half as much attention: the one about how the majority of women in India get little support to be able to breastfeed, even though the law mandates maternity assistance by the government.

Forty-two percent of Indian women are underweight during pregnancy, the government’s pre-budget economic survey in 2016 pointed out. Under the National Food Security Act, which was passed in 2013, the Indian government is bound to provide cash assistance to mothers to help them take time away from work to breastfeed their infants. The cash can help them buy nutritional support through pregnancy and lactation. But this maternity assistance remains an unfulfilled promise, as a letter written by a group of 40 gynaecologists and paediatricians to Prime Minister Narendra Modi on International Women’s Day highlights.

The letter lays out the following facts. An infant should be breastfed within the first hour of life. New mothers should be able to breastfeed exclusively – that is, the baby receives no additional food or drink – for the first six months. The child should be breastfed as often as he or she wants. Both the World Health Organisation and the United Nations Children’s Fund recommend these measures as being optimal for the health of the child.

The letter points out how most women in India struggle to achieve these optimal breastfeeding goals simply because they do not have financial support to be able to take off from work and be with the child for the first six months, or do not receive enough nutrition through their pregnancy and after to be able to produce enough breast milk.

Only five percent of women working in India’s organised sector are eligible for assistance under the Maternity Benefits Act, which increased fully-paid maternity leave for women working in the public and private sectors from 12 weeks to 26 weeks. The law also has provisions for working from home for nursing mothers even beyond the 26-week maternity leave period, as well as the setting up of crèches with nursing breaks for women with small children.

But the large majority will not be able to avail of these benefits.

“In India 95% women workers are in the informal and unorganized sector and do not receive any wage compensation during pregnancy and after childbirth, although we expect them to rest, gain weight, improve their own health and then provide the baby with exclusive breastfeeding for six months,” the letter states.

Unfulfilled promises

Maternity benefits were first rolled out as as a pilot project in 2010 in 53 districts under a scheme called the Indira Gandhi Matritva Sahyog Yojana. The government made cash transfers of Rs 4,000 each to pregnant and lactating women in three installments for upto two child births.

The benefits were expanded to the whole country under the National Food Security Act passed in 2010 and the entitlement raised to Rs 6,000.

As it is, Rs 6,000 is far below fair compensation for loss of wages. As Dipa Sinha, convenor of the Right to Food campaign, has calculated, full wage compensation at the minimum wage rate for six months is more than Rs 27,000 – four times more than the entitlement.

But both the Congress-led UPA government and the current BJP-led NDA government have failed to implement the Rs 6,000 entitlement scheme properly. Till October 2015, the government claimed to examining expenses. By the end of 2016, it changed guidelines to transfer the cash benefit in three instead of two installments and adding more conditions for beneficiaries to receive payments.

In July 2017, the Supreme Court observed in four years since gone by since the National Food Security Act was enacted, the government had failed to make implementing authorities and bodies functional in some states and called compliance to provisions of the Act pathetic.

But there had already been a twist in the tale. In a New Years Eve address to the country on December 31, 2016, Prime Minister Narendra Modi announced a rebranded maternity benefits scheme that would actually reduce the extent of benefits delivered. The entitlement of Rs 6,000 was brought down to Rs 5,000. An additional Rs 1,000 was promised under a different scheme, the Janani Suraksha Yojana, which has a different set of eligibility criteria and objectives. Moreover, the entitlement was restricted to the birth of a first child only.

The gynaecologists, paediatricians and activists writing to the Prime Minister are asking that the government take its promises to ensure better maternal health seriously by implementing the National Food Security Act within which entitlements of the Pradhan Mantri Matru Vandana Yojana – the central scheme for maternity entitlements – be made universal and free of any conditions. They say that linking benefits to the number of children or age of the woman is fundamentally discriminatory to both women and children as citizens.

The group also asks that women receive the cash benefits of at least Rs 6,000 instead of Rs 5,000 and that this benefit be increased progressively to match coherence with wage compensation.

A third demand is that pregnant and lactating women be given supplementary nutrition through locally prepared foods – preferably hot cooked meals at anganwadi centres.

In India, where it is wonderfully unremarkable to see women breastfeed on the thresholds of their village houses, on suburban trains in Mumbai or local buses in Chennai, it is perhaps time to turn public attention to these government promises that can enable all women to breastfeed.