NFHS-6 Explained: Why Delhi's Infant Feeding and Breastfeeding Indicators Are Slipping

What the survey is: The National Family Health Survey (NFHS) is India's largest household survey on population, health, nutrition, fertility, family welfare and women's empowerment. It is conducted under the Ministry of Health and Family Welfare (MoHFW), with the International Institute for Population Sciences (IIPS), Mumbai as the nodal agency. Launched in 1992-93, it provides representative data at the national, state and district levels for evidence-based policymaking and for tracking the Sustainable Development Goals (SDGs).

NFHS-6 specifics: NFHS-6 was conducted in 2023-24 and covered nearly 6.79 lakh households across 715 districts, in all States and Union Territories except Manipur. It is the first round after the COVID-19 pandemic and the first to be coordinated solely by IIPS (without external partners such as USAID/DHS). At the national level it reported broad gains in institutional deliveries, immunisation and several nutrition indicators; against that backdrop, Delhi's slide in infant-feeding practices stands out.

A point to note: NFHS-6 dropped some modules (such as disability), which the government said are captured by other systems like the Census and the Sample Registration System — a point of methodological debate among researchers.

Early initiation of breastfeeding: This measures the proportion of newborns put to the breast within one hour of birth. It is critical because the first feed delivers colostrum — the thick, antibody-rich "first milk" that provides passive immunity — and because early initiation helps establish lactation and sustained breastfeeding.

Exclusive breastfeeding (0-6 months): This means feeding the infant only breast milk (including expressed milk or milk from a wet nurse), with no other food or drink — not even water — except oral rehydration solution and prescribed drops/syrups such as vitamins or medicines. The World Health Organization (WHO) recommends exclusive breastfeeding for the first six months, because breast milk alone supplies all the energy and nutrients an infant needs and protects against common childhood infections.

Continued breastfeeding: WHO and UNICEF recommend continued breastfeeding up to two years or beyond, alongside complementary foods after six months. A fall in "currently breastfed" and "exclusively/predominantly breastfed" figures, as seen in Delhi, signals weakening at this foundational stage.

The six-month transition: From six months of age, breast milk alone is no longer sufficient, so infants must begin complementary feeding — safe, age-appropriate solid and semi-solid foods — while breastfeeding continues. Delayed or poor complementary feeding is a major cause of undernutrition in the 6-23 month window.

IYCF indicators: To measure feeding quality, WHO and UNICEF use a standard set of Infant and Young Child Feeding (IYCF) indicators. The Minimum Acceptable Diet (MAD) for children aged 6-23 months is a composite of Minimum Dietary Diversity (MDD) — eating from at least 5 of 8 defined food groups in a day — and Minimum Meal Frequency (MMF), the minimum number of feeds per day. A child meeting both thresholds is counted as receiving a minimum acceptable diet.

Why Delhi's number is worrying: With only about 11% of Delhi's 6-23 month children meeting the minimum adequate diet, the data implies that the large majority are not getting enough dietary diversity and meal frequency at the very age when the brain and body are developing fastest.

The anthropometric measures: These are the standard ways of measuring child malnutrition. Stunting (low height-for-age) reflects chronic undernutrition — long-term deprivation that stunts growth. Wasting (low weight-for-height) reflects acute undernutrition — recent, severe weight loss, with severe wasting being its most dangerous form. Underweight (low weight-for-age) is a composite measure capturing both chronic and acute undernutrition. Overweight (high weight-for-height) signals the opposite problem of excess.

Delhi's mixed signal: In Delhi, stunting improved but wasting and underweight worsened — an example of the "double burden" of malnutrition increasingly seen in urban India, where undernutrition and over-nutrition coexist, often shaped by poor feeding practices and changing diets.

Reasons cited by experts: Although the survey itself does not identify causes, doctors quoted in the coverage point to early return to work after childbirth, with mothers introducing formula or other feeds to fit care-giving arrangements; a tendency to discontinue breastfeeding early even among homemakers for want of sustained encouragement; and gaps in breastfeeding support, caregiver awareness and nutrition counselling. Experts stress that genuine biological inability to lactate is rare, and caution that heavier reliance on formula may be linked to more digestive and allergy-type problems.

Structural and urban factors: Underlying drivers include inadequate maternity protection (especially for informal-sector and self-employed women), aggressive marketing of breast-milk substitutes, urban time-pressures, and weak continuity of counselling between hospital discharge and the community. These help explain why an affluent, highly urbanised territory can still see feeding indicators slip.

The first 1,000 days: The period from conception to a child's second birthday — about 1,000 days — is the most critical window for growth, immunity and brain development. Deficits here can cause irreversible damage, lowering cognitive ability, school performance and lifetime earnings, and raising the risk of disease.

Wider stakes: Optimal breastfeeding is estimated to prevent a substantial share of newborn and under-five deaths and to reduce diarrhoeal and respiratory illness; it also benefits maternal health. Poor early nutrition therefore has long-term human-capital, economic and intergenerational consequences, which is why it features in SDG 2.2 (ending all forms of malnutrition).

Constitutional basis: Article 47 (Directive Principle) makes raising the level of nutrition and public health a primary duty of the State, while the right to nutrition and health has been read into the Article 21 right to life.

Key schemes and laws: India's main interventions include the Integrated Child Development Services (ICDS)/Anganwadi system; POSHAN Abhiyaan (National Nutrition Mission, 2018), now consolidated under Mission POSHAN 2.0 (Saksham Anganwadi and POSHAN 2.0); the MAA — Mothers' Absolute Affection programme (2016) of MoHFW, which promotes early initiation, exclusive breastfeeding for six months and continued breastfeeding; and Pradhan Mantri Matru Vandana Yojana (PMMVY) for maternity benefit. On the regulatory side, the Infant Milk Substitutes, Feeding Bottles and Infant Foods (IMS) Act, 1992 (amended 2003) restricts the marketing of breast-milk substitutes, and the Maternity Benefit (Amendment) Act, 2017 extended paid maternity leave to 26 weeks. The National Food Security Act, 2013 also provides for maternity benefits.

The decline points to the need to strengthen breastfeeding and IYCF counselling at both health facilities (under the MAA programme) and the community (through ASHA and Anganwadi workers), with continuity maintained after hospital discharge. Workplace and maternity support must be widened — functional crèches, lactation rooms, and extension of effective maternity benefit to informal-sector and self-employed women — so that returning to work does not force early weaning. Enforcement of the IMS Act against the inappropriate marketing of formula, combined with sustained behaviour-change communication, can counter the drift toward substitutes. Finally, cities like Delhi need a sharper focus on the urban double burden of malnutrition, with better data disaggregation, targeted complementary-feeding programmes, and convergence between health, women-and-child-development and food-security efforts.