NEW DELHI: Exclusive breastfeeding among infants under six months has declined sharply in India, according to the National Family Health Survey (NFHS-6) 2023-24, raising concerns among child health experts despite significant improvements in child nutrition and maternal health indicators.The survey found that the proportion of infants under six months who were fed only breastmilk fell from 63.7% in NFHS-5 (2019-21) to 55.8% in NFHS-6, a decline of nearly eight percentage points.The national decline masked wide variations across states. Haryana recorded the steepest fall, with exclusive breastfeeding dropping from 69.5% to 41.2%, while Uttar Pradesh saw a decline from 59.7% to 34.6%. Madhya Pradesh recorded a fall from 74% to 56.4%, while Rajasthan declined from 70.4% to 54.3%.In contrast, Sikkim registered the biggest improvement, rising from 28.3% to 49.6%. Kerala improved from 55.5% to 72.7%, one of the highest rates in the country. Gujarat also recorded an increase from 65% to 71.4%, while West Bengal and Bihar reported modest gains.The latest survey shows a striking divide across the country. Chhattisgarh reported the highest exclusive breastfeeding rate at 75.8%, followed by Kerala (72.7%), Gujarat (71.4%), Andhra Pradesh (69.5%) and Odisha (66.7%). At the other end, Uttar Pradesh recorded the lowest rate at 34.6%, followed by Nagaland (37.4%), Uttarakhand (40.8%) and Haryana (41.2%).The findings are significant because exclusive breastfeeding during the first six months of life is considered one of the most effective interventions for child survival, protection against infections and healthy growth and development. The World Health Organization recommends exclusive breastfeeding for the first six months, followed by continued breastfeeding along with complementary foods.The decline comes even as India recorded gains in several child health indicators. Stunting among children under five declined from 35.5% to 29.3%, while severe wasting fell from 7.7% to 5.2%. Full immunisation coverage among children aged 12-23 months increased from 76.6% to 82.6%.The survey also showed improvement in early initiation of breastfeeding. The proportion of children breastfed within one hour of birth increased from 41.8% to 50.1%.Dr Arun Gupta, paediatrician and chief coordinator of the Breastfeeding Promotion Network of India (BPNI), said the decline is particularly worrying because it has occurred despite improvements in maternal healthcare. More women are receiving antenatal check-ups, institutional deliveries have increased and early breastfeeding has improved, yet exclusive breastfeeding has fallen. “The health system is reaching more mothers than before, but breastfeeding support appears to be the missing link,” he said. Gupta said mothers may not be receiving enough counselling and support on breastfeeding during pregnancy and after delivery, while increasing use and promotion of formula milk could also be affecting breastfeeding practices.BPNI called for stronger breastfeeding support and stricter enforcement of the Infant Milk Substitutes (IMS) Act, saying the wide variation across states points to gaps in counselling and support services. “Breastfeeding is not merely an individual choice; it is a public health, nutrition, child rights and national development issue,” the organisation said.