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The Paradox of Progress: Breastfeeding Practices Among Educated Women in Kashmir

The Paradox of Progress: Breastfeeding Practices Among Educated Women in Kashmir

This comprehensive analysis examines the complex landscape of breastfeeding practices in Kashmir, where increasing education levels and healthcare access have paradoxically coincided with declining breastfeeding duration—especially among educated women. Drawing from recent research by Government Medical College Srinagar involving 1,293 mothers across Jammu (n=680), Kashmir (n=512), and Ladakh (n=101), we identify a troubling trend: 75% of educated women do not breastfeed for extended periods, while 25% have adopted packaged milk substitutes for newborns. Despite high breastfeeding initiation rates (55% within one hour post-birth), exclusive breastfeeding at six months remains at only 50%. Through examining socioeconomic, structural, and commercial determinants, this article proposes multisectoral interventions to realign policy with physiological and cultural imperatives.

01: The Kashmiri Context

Breastfeeding represents one of the most cost-effective interventions for reducing child mortality globally, with the potential to prevent 820,000 child deaths annually. The World Health Organization (WHO) unequivocally recommends exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods for up to two years or beyond. In India, these guidelines are reinforced through the Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Promotion, Supply and Distribution) Act, 1992 (IMS Act), designed to curb inappropriate marketing of breastmilk substitutes.

Kashmir presents a paradoxical scenario where rising education levels and healthcare access coexist with declining breastfeeding practices among educated women. Recent research spearheaded by Government Medical College Srinagar provides troubling insights: 70% of educated women breastfeed only up to one year, compared to 85% of less-educated mothers. Meanwhile, exclusive breastfeeding rates for infants 0-6 months vary dramatically: 52.1% in Kashmir, 52.0% in Jammu, and a critically low 15.8% in Ladakh. 

02: The Kashmiri Breastfeeding Study

The landmark study referenced herein employed cross-sectional observational methods across three distinct regions: Jammu, Kashmir, and Ladakh. Researchers recruited 1,293 mothers with children aged 0-2 years through probability proportional to size (PPS) sampling, yielding representative samples of 680 (Jammu), 512 (Kashmir), and 101 (Ladakh) participants. Data collection utilized pre-tested structured questionnaires administered during facility visits (immunization clinics, pediatric OPDs) and community outreach. Key variables assessed included:

  • Initiation timing (within 1 hour vs. delayed)

  • Exclusive breastfeeding (EBF) duration (0-6 months)

  • Prelacteal feeding practices

  • Supplementation with packaged milk

  • Maternal socioeconomic and employment status

  • Regional variations in feeding norms

Statistical analysis employed logistic regression to identify predictors of suboptimal breastfeeding, controlling for education, employment, region, and healthcare access.

03:  Regional Disparities and Educational Paradoxes

3.1 Breastfeeding Initiation and Duration Patterns

  • Timely Initiation: 55% of Kashmiri mothers initiate breastfeeding within the first hour after birth.

  • Six-Month Continuation: Only 50% maintain exclusive breastfeeding until six month.

  • Educational Disparity: 70% of educated women breastfeed ≤1 year vs. 85% among less-educated counterparts.

  • Prelacteal Feeds: 31.5% of Kashmiri infants receive prelacteal feeds (honey, sugar water, or formula) before breastfeeding establishment.

3.2 Exclusive Breastfeeding (EBF) Rates by Region.

RegionEBF Rate (0-6 months)Primary Supplement
Jammu52.0%Animal milk
Kashmir52.1%Animal milk
Ladakh15.8%Early weaning foods

3.3 Determinants of Suboptimal Breastfeeding

  • Employment Status: 75% of educated working women (public/private sectors) cite inadequate maternity leave as the primary barrier to sustained breastfeeding

  • Perceived Insufficient Milk (PIM): 40% of mothers discontinued EBF due to PIM—a concern more prevalent among educated women.

  • Commercial Influence: 25% of Kashmiri mothers use packaged milk substitutes for newborns despite the IMS Act prohibiting promotion.

  • Healthcare System Gaps: Inconsistent implementation of the Baby-Friendly Hospital Initiative (BFHI) and inadequate lactation counseling

04: Barriers to Optimal Breastfeeding Practices

4.1 Structural and Policy Limitations

  • Inadequate Maternity Leave: Kashmir’s working women face limited paid maternity leave (currently 26 weeks under Indian law), which is often insufficient for establishing lactation. Mothers returning to work encounter:

    • Lack of workplace lactation facilities

    • Inflexible schedules preventing pumping

    • Commuting times disrupting feeding/pumping routines

  • Weak IMS Act Enforcement: Despite prohibiting promotion of breastmilk substitutes, companies exploit loopholes through:

    • Indirect marketing via "educational materials"

    • Promotion of complementary foods for infants <6 months

    • Gifts and sponsorships to healthcare provider.

4.2 Health System and Sociocultural Factors

  • Perceived Insufficient Milk (PIM): 40% of Kashmiri mothers report PIM—often rooted in:

    • Inadequate breastfeeding knowledge

    • Delayed initiation impairing milk production

    • Suboptimal positioning and latch

  • Commercial Marketing Influence: Aggressive promotion undermines confidence in breastfeeding, especially among educated women.

  • Regional Cultural Practices: In Ladakh, early weaning traditions (often at 2–3 months) contribute to critically low EBF rates (15.8%)

4.3 Biological and Educational Paradoxes

Contrary to global patterns where maternal education predicts better breastfeeding, Kashmir shows an inverse relationship:

  • Educated Women: Higher employment participation → workplace barriers → shorter duration

  • Less-Educated Women: Greater cultural adherence → higher EBF rates (85% continue beyond one year)

05: Multidimensional Strategies for Improvement

5.1 Policy and Legislative Reforms

  • Extend Paid Maternity Leave: Advocate for 9–12 months paid leave aligned with WHO recommendations

  • Enforce/Strengthen the IMS Act:

    • Close loopholes allowing indirect marketing

    • Ban company-sponsored "health education"

    • Empower organizations like BPNI to report violations.

  • Implement BFHI Universally: Ensure all maternity facilities adhere to the Ten Steps to Successful Breastfeeding.

5.2 Health System Interventions

  • Universal Lactation Support:

    • Integrate IYCF counseling into antenatal care

    • Establish postnatal home-visiting programs

    • Deploy mobile health (mHealth) for troubleshooting

  • Manage Perceived Insufficient Milk:

    • Community-based peer counseling

    • Relaxation techniques to reduce stress

    • Galactagogue foods where culturally appropriate

  • Baby-Friendly Workplace Initiatives:

    • On-site childcare facilities

    • Designated lactation rooms with refrigerators

    • Flexible feeding/pumping breaks

5.3 Community and Education Programs

  • School Curricula Integration: Teach breastfeeding benefits and techniques in secondary education

  • Mass Media Campaigns: Counter commercial messaging by highlighting:

    • Cognitive benefits (higher IQ in breastfed children).

    • Reduced maternal cancer risks.

  • Religious Leader Engagement: Utilize Friday sermons/mosque gatherings to promote breastfeeding as a religious duty

5.4 Targeted Regional Approaches

  • Ladakh: Address early weaning through culturally tailored education on the dangers of premature complementary feeding

  • Urban Kashmir: Workplace lactation support programs and tele-lactation services

  • Rural Jammu/Kashmir: Mobile lactation clinics and mother support groups

06: Conclusion: Reclaiming a Cultural Imperative

The decline in breastfeeding among educated Kashmiri women represents not a rejection of tradition, but a failure to modernize systems to support biological imperatives. Education should empower—not impede—breastfeeding, yet workplace barriers, commercial influences, and inadequate support have created conditions where 75% of educated mothers cannot sustain breastfeeding. The 2023 Srinagar study reveals a critical juncture: without intervention, exclusive breastfeeding rates risk further decline, particularly in vulnerable regions like Ladakh (15.8% EBF).

The path forward requires synergistic policy enforcement (strengthening the IMS Act), structural support (extended maternity leave, workplace accommodations), and community mobilization. As Prof. (Dr) Iffat Hassan of GMC Srinagar emphasized during 2023 World Breastfeeding Week events, "Mass awareness about breastfeeding" must become a public health priority. By realigning education with empowerment, commercial regulation with child health, and workplaces with women’s biological needs, Kashmir can transform its breastfeeding landscape—ensuring every child receives their right to thrive.

References & Bibliography

Peer-Reviewed Articles

  1. Tiwari SK, Chaturvedi P. The IMS Act 1992: Need for More Amendments and Publicity. Indian Pediatrics. 2003;40:743-746.

  2. Bukhari ST, Gattoo I, Bhat TA. Breast Feeding Pattern in Infants of Less Than Six Months of Age in Kashmir. International Journal of Advanced Research. 2015;3(11):544-548.

  3. Breast Feeding Practices Among Kashmiri Population. Academia.edu. Accessed 2025.

Institutional Reports

  1. WHO. Infant and Young Child Feeding. Fact Sheet. 2024.

  2. WHO/UNICEF. Global Strategy for Infant and Young Child Feeding. 2023.

  3. National Family Health Survey (NFHS-4). India Report. 2015-16.

Policy Documents

  1. Government of India. The Infant Milk Substitutes, Feeding Bottles and Infant Foods (Regulation of Promotion, Supply and Distribution) Act. 1992 7

  2. UNICEF. The International Code of Marketing of Breastmilk Substitutes. 2024.

News & Events

  1. Government Medical College Srinagar. World Breastfeeding Week Activities. 2023.

Note: All statistics cited from the Government Medical College Srinagar study are derived from the provided data sample of 1,293 mothers across Jammu, Kashmir, and Ladakh.


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