Breastfeeding : A High Return on Investment to Achieve SDGs Dr. Arun Gupta MD FIAP Regional Coordinator IBFAN Asia

What Lancet says on BF and SDGs: Concluding para of Series 1 of Lancet 2016 Our findings show how essential the protection, promotion, and support of breastfeeding is for the achievement of many of the newly launched Sustainable Development Goals by 2030. Breastfeeding is clearly relevant to the third sustainable goal, which includes not only maternal and child health but also non-communicable diseases such as breast cancer and diabetes as well as overweight and obesity. It is also relevant to the second goal (on nutrition). The effect of breastfeeding on intelligence and on human capital is relevant to the fourth goal (education), the first goal (poverty), and the eighth goal (inclusive economic growth). Finally, by helping close the gap between rich and poor, breastfeeding can contribute to goal number ten—reducing inequalities.

Lancet Series on Breastfeeding 2016 If India were to universalize breastfeeding in coming years, Reduce 156,000 child deaths (13% of under-5), 3,900,000 episodes of diarrhea, 3,436,560 episodes of pneumonia and 4915 deaths due to breast cancer annually. Over and above this it would add 4300 Crores to Indian economy. Add 3 points to IQ of all children, rich or poor. Reduce obesity by 26% Prevent 1 out of 3 new cases type 2 diabetes

Look at where we stand today 26 million births 80 % in health facilities ~ 20 Million 12 million begin to breastfeed within first hour 14 million first meal is formula ~6 million completely exclusive India sells 10,847 Tonnes of Std. Powder Infant formula annually..(for 0-6 months) ~27 million containers of 400 gms. Most common first food in private hospitals

Targets 2025

World Bank estimates on WHA targets

Benefits of Investing ! There is strong body of evidence that shows very high economic returns. (Alderman, Behrman and Puett 2016; Copenhagen Consensus center2015; Hoddinott et al 2013) Benefits of investing on exclusive breastfeeding are particularly high : $35

WB Investment Framework

Key messages of WB report Creating an ..environment in support of breastfeeding requires interventions to provide education and counseling to mothers, widespread media campaigns to promote optimal breastfeeding practices, as well as the development of appropriate policies and legislation to protect exclusive breastfeeding. The estimated global financing required to scale up a core set of interventions across all low- and middle-income countries to achieve the World Health Assembly target for exclusive breastfeeding by 2025 is $5.7 billion, or approximately $4.70 for every newborn. Maternity leave costs are additional cost.

Contd… Interventions included are based on evidence The benefit cost analysis are conservative estimates due to earnings gains due to cognitive losses averted, and related to child mortality averted. It does not include savings from reduced health care costs as a result of inadequate breastfeeding.

Results of Lalitpur Experince

Cost Estimates in India based on our experience At community level Health Facility level INR 435 per birth : INR 169 Non Recurring includes cost of training and capacity building up to block level INR 265 Recurring cost includes: Incentives to frontline workers New appointments 4 workers per block Refresher training Coordination At a Dist.. Level total cost comes to about 2.2 Crores. Appointment of Lactation Counsellors In all 20,000 hospitals Cost about 300 Crores annually ( Salary of INR 15,000PM)

Expected Impacts Five countries where highest child deaths averted in projected scenario are India, Pakistan, Nigeria, Democratic Republic of Congo, and Ethiopia.

Concluding para of Lancet Series 2 Breastfeeding 2016, SDGs All 194 member states of the World Health Assembly have agreed on breastfeeding targets for 2025. In the first paper in this Series, we showed that these targets are realistic and could even be exceeded. Breastfeeding is not explicitly mentioned in the Sustainable Development Goals, but our Series shows that improvements in breastfeeding would help achieve the targets for health, food security, education, equity, development, and the environment. Without commitment and active investment by governments, donors, and civil society, the promotion, protection, and support for breastfeeding will remain inadequate and the outcome will be major losses and costs that will be borne by generations to come.

Conclusion Universalizing breastfeeding can have strong impact of child mortality as well as non communicable diseases like cancer and diabetes. Not only that it has now been shown that its impact is far reaching on national economies through enhancing income generating capacity. GOI should commit resources and develop a budget line for breastfeeding interventions, with a clear plan, with state action plans, that is monitored yearly.