DAAIMA ON WHEELS - Shivani Nirgudkar PDF

Executive Summary India’s low performance in the World Breastfeeding Trends Initiative (WBTi) 2018 and poor breastfeeding practices revealed by NFHS-5 highlight the urgent need to address breastfeeding challenges. Despite high hospital delivery rates, early breastfeeding initiation is only 41.6%, an...

Executive Summary India’s low performance in the World Breastfeeding Trends Initiative (WBTi) 2018 and poor breastfeeding practices revealed by NFHS-5 highlight the urgent need to address breastfeeding challenges. Despite high hospital delivery rates, early breastfeeding initiation is only 41.6%, and exclusive breastfeeding for six months is at 64%. These issues are compounded by the vast informal economy, where around 400 million workers, predominantly women, face economic instability and lack of maternity support. Women in this sector often return to work soon after childbirth due to low wages, absence of maternity leave, and inadequate breastfeeding facilities, adversely affecting both maternal and infant health. The informal sector’s low wages and lack of social security further hinder breastfeeding practices. Economic pressures and gender disparities exacerbate these issues, with women lacking access to breastfeeding support and resources. Inadequate breastfeeding practices also result in economic losses, as formula feeding is costly compared to breastfeeding. Policy objectives include reviewing literature to evidence the need for better breastfeeding support, forming partnerships with relevant stakeholders, educating healthcare workers and the community, analyzing legal provisions, and establishing systems to monitor breastfeeding barriers in the informal sector. Additionally, the focus is on generating data to improve programs and policies, collaborating with NGOs and employers, and drawing on global case studies to adapt strategies for India. One proposed policy, "Daimaa on Wheels," aims to deploy mobile breastfeeding support units to underserved areas. These units, staffed by lactation consultants and healthcare workers, will provide on-site education, counseling, and supplies. This initiative addresses accessibility barriers and personalizes support, leveraging existing health infrastructure and community health workers. Initial costs include purchasing and outfitting units, but long-term health benefits justify the investment, with potential funding from government budgets and NGO partnerships. Introduction Breastfeeding is described by the World Health Organization as “An unequaled way of providing ideal food for the healthy growth and development of infants”. WHO and UNICEF recommend early initiation of breastfeeding within 1 hour of birth, exclusive breastfeeding for the first 6 months of life and introduction of nutritionally-adequate and safe complementary (solid) foods at 6 months together with continued breastfeeding up to 2 years of age or beyond. Breastfeeding provides a perfect balance of nutrients, including vital antibodies that protect against common illnesses such as diarrhea and pneumonia, which are major contributors to child mortality globally. For mothers, breastfeeding lowers the risk of breast and ovarian cancers, type 2 diabetes, and postpartum depression. Exclusive breastfeeding for the first six months supports optimal growth and development, reduces malnutrition risk, and fosters long-term health benefits. In addition to health benefits, breastfeeding promotes environmental sustainability. Unlike formula feeding, it requires no packaging, transportation, or waste, reducing the carbon footprint. However, global breastfeeding rates remain low due to a range of barriers, including cultural, social, political, and medical challenges, as well as aggressive marketing by formula companies. Cultural misconceptions, lack of familial and community support, inadequate maternity leave, and the influence of the private sector all contribute to these challenges. Gender equality issues also play a crucial role. Women often face discrimination and inadequate support in the workplace, which affects their ability to continue breastfeeding after returning to work. Insufficient facilities and breaks for breastfeeding or expressing milk at work further exacerbate this issue. The short end of the stick is handed to the informal sector, of which 90% of women in India are a part. Challenges like lack of maternity leave, inadequate breastfeeding facilities, irregular work hours, limited access to healthcare, job iInsecurity, lack of legal protection, mobility and transience, and invisibility in supply chains impact child nutrition and well-being. Our policy solutions focus on bridging the gap and alleviating the plight of such undercompensated, overworked mothers. To enhance breastfeeding rates, multifaceted strategies are necessary. These include educating and supporting mothers, implementing stronger policies to protect and promote breastfeeding, and creating supportive environments at home and in the workplace. Public health campaigns, community programs, and legislative measures are essential in overcoming breastfeeding barriers and ensuring every child gets the best start in life. Problem Statement India's performance in the World Breastfeeding Trends Initiative (WBTi) 2018 report was notably low, with a score of 45 out of 100, placing it at rank 79. Data from NFHS-5 (2019-2021) reveals that although 88.6% of women deliver in hospitals, only 41.6% start breastfeeding within the first hour, and just 64% exclusively breastfeed for the first six months. India's informal economy, the largest globally, supports around 400 million livelihoods across all sectors and regions. This sector encompasses approximately 85% of jobs and employs 94% of the female workforce. Of the 384 million workers in this sector, half are in agriculture and the other half are distributed between rural and urban non-agricultural roles. Women often work in domestic roles or in supportive positions within construction. The informal economy faces numerous challenges, including low wages, poverty, debt, and high levels of inequality. Workers in this sector earn less than their formal sector counterparts and frequently fall below the minimum wage. They lack social security, leaving them vulnerable to financial hardship during sickness, old age, or accidents. Gender disparities are pronounced, with women facing tougher conditions, reduced job security, and lower wages compared to men. These challenges significantly impact infant nutrition and breastfeeding practices. Economic instability and low wages compel many mothers to return to work soon after childbirth, disrupting breastfeeding routines and limiting the time available for nursing. The absence of maternity leave and inadequate breastfeeding facilities in informal workplaces exacerbate these issues. Without social security, mothers cannot afford unpaid leave, which negatively affects both maternal and child health. Gender bias further complicates these problems, as women in the informal sector have less access to resources and support for breastfeeding. Early initiation of breastfeeding is particularly low among women with no formal education or those who lack professional delivery assistance. Breastfeeding is crucial for the health and survival of both babies and women and is integral to the 2030 Agenda for Sustainable Development, linking to all Sustainable Development Goals (SDGs). Inadequate breastfeeding practices also lead to significant economic losses. Formula feeding from 0-23 months costs about 19.4% of a worker's nominal wage, whereas breastfeeding is both free and safe. This challenge is more pronounced for women in the informal sector, who make up 96% of the female workforce. The Maternity Benefits (Amendment) Act, 2017, although a step forward, only applies to the formal sector and has led to potential job losses for 11-18 lakh women due to its cost implications. The government should reconsider this issue and potentially share the financial burden to better support young mothers. Even though the new budget includes honoraria for ASHA workers, the allocated funding remains insufficient. Addressing these issues requires societal changes towards creating child-friendly public spaces and supportive workplace policies. Promoting breastfeeding is essential for improving child health, environmental sustainability, and economic growth. Policy Objectives a. To provide an exhaustive review of literature as evidence for the need to improve breastfeeding rates in the informal sector. b. To facilitate partnerships with stakeholders relevant to the informal sector, to create comprehensive support networks and develop breastfeeding-friendly workplace policies.  c. To educate unaware lactating people, healthcare and community workers about the benefits of breastfeeding. d. To examine the current legal provisions, policies and analyze their lacunae with special focus on socioeconomically disadvantaged communities. e. To establish systems to monitor and identify barriers to effective breastfeeding specific to the informal sector. f. To generate and use data to continuously improve programs and policies aimed at supporting breastfeeding mothers. g. To serve as a basis for partnerships with NGOs, healthcare providers, and community organizations to create comprehensive support networks. h. To serve as a basis for collaborations with employers in the informal sector to develop breastfeeding-friendly workplace policies. i. To draw from previous case studies globally and implement them suited to the needs of the Indian lactating population. j. To enable conduction of baseline assessments, surveys and focus group discussions to understand the specific challenges and needs of breastfeeding mothers in the informal sector. Policy Options Policy 1: Daimaa on Wheels Description: The "Daimaa on Wheels" initiative involves deploying mobile breastfeeding support units to underserved areas. These units, staffed by lactation consultants and healthcare workers, provide on-the-spot breastfeeding education, counseling, and support. The mobile units also distribute educational materials and essential breastfeeding supplies. Impact: This approach ensures that breastfeeding support reaches mothers in remote or underserved areas, improving breastfeeding rates and infant health outcomes. It addresses barriers related to accessibility and provides personalized assistance to mothers who might otherwise lack support. Feasibility: Given the success of similar mobile health initiatives, this policy is highly feasible. It leverages existing health infrastructure and community health workers. However, logistical planning and coordination with local health departments are crucial for its success. Cost: Initial costs include purchasing and outfitting mobile units, training staff, and operational expenses. The long-term benefits of improved maternal and infant health outweigh these costs. Funding can be sourced from government health budgets and partnerships with NGOs. Policy 2: Human milk bank support network Description: Establish a regional network of human milk banks with access points via a mobile app for smartphone users and information kiosks at government hospitals and clinics for those without digital access. This network will collect, process, and distribute donated breast milk, aiming to support infants in the informal work sector and promote breastfeeding. Impact: The policy provides crucial nutrition to vulnerable infants and supports breastfeeding, particularly for informal sector workers. It also promotes institutional births and reduces formula reliance. Feasibility: The policy is feasible but faces challenges, including high setup costs and complex logistics. A combined app and physical access points approach helps reach both tech-savvy and non-digital users. Cost: Costs include setting up milk banks, developing the app, and covering staffing and operational expenses. Funding may be sourced from government budgets, international organizations, and private partnerships. The long-term health benefits justify the initial investment. Policy 3: Community-Based Breastfeeding Support Programs Description: Create community breastfeeding support groups led by ASHA and Anganwadi workers, supported by a curriculum and pictorial toolkit tailored for varying literacy levels. Allocate additional funds to the health budget to incentivize these workers. The incentives will be based on the performance metrics and community feedback. The groups will offer education, counseling, and practical support to new mothers, and engage community leaders to foster a supportive environment. Impact: This policy will normalize breastfeeding, reduce stigma, and address cultural barriers. By providing personalized assistance and supporting ASHA and Anganwadi workers, it aims to boost breastfeeding rates and enhance infant health outcomes. Feasibility: The policy is feasible in both urban and rural areas, utilizing existing community structures. Key to success is training, retaining, and incentivizing ASHA and Anganwadi workers, along with distributing effective educational materials. Cost: Costs include worker training, developing and distributing educational toolkits, and organizing community meetings. Increased health budget allocation and community partnerships can help manage expenses. Funding can be sourced from public health grants and NGO collaborations. Policy 4: Formalizing the Work Sector for Women Description: This policy aims to formalize women's work sector through legal frameworks ensuring job security, fair wages, and social benefits. It includes mandatory registration of informal workers, health and maternity benefits, and labor rights enforcement. Impact: Improving job security and working conditions will support breastfeeding, allowing women to balance work and motherhood. The policy reduces gender disparities and  promotes economic empowerment, leading to higher breastfeeding rates, better health, and economic stability for families. Feasibility: Requires political commitment and cooperation among government agencies, labor organizations, and employers. Resistance from sectors using informal labor is possible, but phased implementation and incentives can ease the transition. Successful examples, like Brazil's domestic work formalization, offer guidance. Cost: Includes administrative expenses for worker registration, social benefits, and labor law enforcement. Long-term benefits, such as increased productivity, higher tax revenues, and reduced social welfare reliance, justify the investment. Funding can come from government budgets, international development funds, and employer contributions. Recommended Policy The "Daimaa-on-wheels" policy is a compassionate initiative that not only manages to fulfill most of the aforementioned policy options but also is designed to combat the pressing issue of malnutrition among infants whose mothers toil in the informal sector, particularly within lower socioeconomic groups. These hard working mothers often encounter significant barriers to breastfeeding due to the absence of safe and private facilities, unpredictable work schedules, and insufficient maternity protection. Recognizing these challenges, the policy envisions the deployment of mobile units, meticulously equipped with the necessary facilities to enable mothers to express and transport breast milk safely. These mobile units will be manned by trained female healthcare workers, whose role will be to offer invaluable guidance, maintain sterile storage conditions, and ensure the timely transportation of expressed milk, thereby guaranteeing that infants receive the nutrition they desperately need for healthy development. Furthermore, these mobile units serve a dual purpose; they are not just vehicles for milk expression and transportation, but also act as mobile knowledge centers dedicated to promoting WHO-certified best practices in maternal and child health. Inside these vans, mothers will have access to educational resources and personalized advice on breastfeeding techniques, infant nutrition, and overall health and hygiene. The healthcare workers will conduct workshops and one-on-one sessions to empower mothers with knowledge about the benefits of breastfeeding, proper milk storage, and general child care practices that align with global health standards. This educational component aims to build a foundation of informed motherhood, fostering a community where mothers can confidently nourish and care for their children. The decision to adopt this policy approach is grounded in several compelling reasons. Firstly, the health impact is profound; by ensuring that infants receive nutrient-rich breast milk, the policy directly addresses their critical health needs, promoting optimal growth and bolstering their immune systems. Secondly, the policy fosters economic empowerment by providing working mothers with a viable solution to continue breastfeeding while sustaining their employment, thereby supporting their financial independence. Thirdly, it champions social equity by specifically targeting women in the informal sector, thus helping to bridge the significant gap in healthcare access and resources. Lastly, the policy aligns with existing legal frameworks, such as the Maternity Benefits Act, by offering practical support that extends beyond current legal protections, advocating for more comprehensive maternity rights and protections for all mothers. This multifaceted rationale underscores the holistic and inclusive nature of the "Daimaa-on-wheels" policy, which aspires to uplift both mothers and their infants through thoughtful and targeted interventions. Implementation Plan 1. Pilot Program: Launch a pilot program in selected high-density, low-income areas to test and refine mobile unit operations. These areas will be identified based on demographic studies to pinpoint regions with the greatest need. The pilot phase will involve continuous monitoring and evaluation to gather user feedback and identify challenges, allowing for adjustments and improvements before a broader rollout.  2. Procurement: Procure and equip the mobile units with essential items, including manual breast pumps, sterile storage containers, GPS systems for efficient routing, and sanitation supplies such as FDA-recommended soaps, sterile towels and other sanitation supplies. The equipment will be chosen based on durability, ease of use, and affordability to ensure sustainability. Ensuring all equipment meets safety and quality standards is paramount. 3. Staffing: Recruit and train female healthcare workers to manage the mobile units and provide support to mothers. Recruitment will focus on selecting compassionate and knowledgeable individuals. Training will cover breast pump usage, safe milk storage, hygiene standards, and communication skills. Ongoing professional development will keep staff updated on best practices in maternal and child health. 4. Partnerships: Establish partnerships with local healthcare facilities, NGOs, and community leaders to facilitate community engagement and ensure smooth operations. Local healthcare facilities can provide additional support, while NGOs can assist with outreach. Community leaders will help build trust and promote the service. Regular collaboration will align goals and streamline efforts. 5. Awareness Campaign: Launch an awareness campaign to inform the target population about the "Daimaa on Wheels" service. Use various media channels, including social media, local radio, community gatherings, and printed materials, to reach a broad audience. Highlight the health benefits of breastfeeding, the convenience of the mobile units, and available educational resources. Include testimonials from mothers who benefited from the pilot phase to build credibility. Organize community engagement events for hands-on demonstrations and to address questions, ensuring mothers feel confident using the service. Timeline for Implementation: Months 1-3: Conduct detailed planning, procure necessary equipment, and recruit and train female healthcare workers. Establish partnerships with local healthcare facilities, NGOs, and community leaders. Months 4-6: Launch the pilot program in selected high-density, low-income areas. Test mobile unit operations and gather feedback to refine the service. Months 7-9: Evaluate the pilot program, incorporating feedback to improve the service. Begin scaling up operations based on pilot results. Months 10-12: Execute a full rollout of the "Daimaa on Wheels" service across targeted regions, supported by an extensive awareness campaign to inform and engage the community. Responsible Agencies and Departments: 1. Ministry of Health and Family Welfare: Responsible for overseeing the overall implementation of the "Daimaa on Wheels" policy and ensuring its integration with existing health services. They will provide strategic direction, secure funding, and monitor progress to ensure the policy's objectives are met. 2. Local Health Clinics and Anganwadis: Tasked with coordinating on-ground activities, these departments will ensure compliance with health standards, facilitate the recruitment and training of healthcare workers, and manage the day-to-day operations of the mobile units. 3. Non-Governmental Organizations (NGOs): NGOs will play a crucial role in community outreach and mobilization. They will assist in raising awareness about the service, engage with community leaders, and provide additional support and resources to ensure the program's success.  4. Ministry of Road Transport and Highways: This department will facilitate the acquisition and maintenance of the mobile units. They will ensure the vehicles are well-equipped, regularly serviced, and efficiently routed to maximize coverage and accessibility for the target population. Resource Requirements 1. Mobile Units: ₹40,00,000 per unit (including equipment and modifications). Each mobile unit, costing approximately ₹40,00,000, will be equipped with essential facilities. This includes manual breast pumps, sterile storage containers, GPS systems for efficient routing, and sanitation supplies like FDA-recommended soaps and sterile towels. The vans will also require structural modifications to ensure a private and hygienic space for mothers to express milk. a. Privacy Partitions: Creating separate, private spaces for mothers to express milk. b. Sanitation Facilities: Installing washbasins with running water and ensuring the availability of sterile towels and soap. c. Storage Solutions: Providing thermal containers or ice boxes for the safe storage of expressed milk until it can be transported. d. Seating and Workspace: Ensuring there are comfortable seats for healthcare workers and spaces for storing educational materials and medical supplies. e. GPS and Communication Systems: Equipping vans with GPS for efficient routing and systems to facilitate communication with central coordination teams and mothers. 2. Staff Salaries: ₹25,000 per healthcare worker per month, ₹20,000 per driver per month. To manage each mobile unit, we will recruit a team comprising one driver and two female healthcare workers. The healthcare workers will earn a monthly salary of ₹25,000 each, and the driver will earn ₹20,000 per month. These workers will provide guidance on breast milk expression, ensure the sterility of equipment, and manage the storage and  transportation of milk. Their training will include safe milk handling practices, effective use of breast pumps, and communication skills to support and educate mothers. 3. Operational Costs: ₹8,00,000 per unit per month (fuel, maintenance, and supplies). Operational costs are estimated at ₹8,00,000 per unit per month, covering fuel, vehicle maintenance, and supplies. These costs ensure that the mobile units can operate smoothly and reach various high-need areas efficiently. Fuel expenses will vary depending on the distances covered, while maintenance includes regular servicing and unexpected repairs. Supplies include ongoing needs for sterilization materials, breast pump parts, and general consumables required for daily operations. 4. Awareness Campaign: ₹16,00,000 for initial rollout. The initial awareness campaign, budgeted at ₹16,00,000, will focus on informing the target population about the "Daimaa on Wheels" service. This will involve a multi-channel approach: a. Media Outreach: Leveraging local radio, social media, and printed materials to reach a broad audience. b. Community Engagement: Organizing community events and workshops to demonstrate the service and address any questions or concerns. c. Educational Materials: Producing brochures, posters, and videos that explain the benefits of breastfeeding and the support available through the mobile units. d. Partnerships with NGOs and Local Leaders: Engaging NGOs and community leaders to promote the service and build trust within communities. 1. Monitoring and Evaluation (up to 400 words) To ensure the "Daimaa on Wheels" initiative is successful and meets its objectives, we will track several Key Performance Indicators (KPIs). These will include: 1. Number of Mobile Units Deployed: Tracking the total number of operational mobile units.  2. Reach and Coverage: The number of mothers served and geographical areas covered. 3. Breast Milk Volume Collected and Distributed: Measuring the total volume of breast milk collected and safely delivered to infants. 4. Health Outcomes: Monitoring health improvements in infants, such as weight gain, incidence of common childhood illnesses, and overall growth metrics. 5. User Satisfaction: Collecting feedback from mothers regarding the service, including ease of access, quality of care, and overall satisfaction. 6. Operational Efficiency: Evaluating the efficiency of mobile unit operations, including average response times and logistical effectiveness. 7. Community Engagement: Assessing the level of community involvement and support, including partnerships with local healthcare providers and NGOs. To accurately monitor these KPIs, we will employ a variety of data collection and analysis methods: 1. Digital Records: Mobile units will be equipped with tablets to record all interactions, milk collections, and distributions in real-time. This will ensure data accuracy and facilitate immediate analysis. 2. Surveys and Questionnaires: Periodic surveys will be conducted with participating mothers to gauge their satisfaction and collect qualitative data on their experiences. 3. Health Monitoring: Regular health check-ups for infants will be conducted, and data on weight, growth, and health will be recorded. This data will help assess the impact of the initiative on infant health. 4. GPS Tracking: Using GPS data from mobile units to analyze coverage areas, response times, and logistical efficiency. 5. Partnership Reports: Collecting reports from partner NGOs and local healthcare providers to understand community engagement levels and identify areas for improvement.  A structured reporting schedule will ensure continuous monitoring and timely adjustments: 1. Monthly Reports: Detailed monthly reports will be prepared, highlighting key metrics, progress, challenges, and any immediate corrective actions taken. These reports will be shared with all stakeholders, including funding agencies, local health departments, and partner organizations. 2. Quarterly Reviews: Comprehensive quarterly reviews will be conducted to assess the overall performance of the program. These reviews will include in-depth analysis of all KPIs, financial audits, and strategic planning sessions to address any long-term challenges. 3. Annual Evaluations: An annual evaluation will be carried out to provide a holistic view of the program’s impact over the year. This evaluation will include a summary of achievements, lessons learned, and recommendations for the future. The results will be presented in a detailed report and shared in community meetings, stakeholder conferences, and public forums to ensure transparency and community involvement. 2. Stakeholder Analysis (up to 400 words) In accordance with the power interest matrix: High Power, High Interest: Government Agencies (MoHFW, Local Health Departments, Anganwadis): They have significant control over resources and policies. Regular meetings and detailed updates are needed to keep them engaged and address their needs. Healthcare Workers (Doctors, Nurses, ASHA Workers): Essential for delivering breastfeeding support, these workers need proper training, resources, and incentives. Their active participation is crucial. High Power, Low Interest: Employers in the Informal Sector: They can implement workplace policies but may not prioritize breastfeeding support without clear benefits or regulations. Providing evidence of benefits and offering guidance can help keep them on board. International Public Health Collectives: They have significant influence and resources but may not focus on this initiative without seeing how it fits with their broader goals. Low Power, High Interest: Local Communities (Families, Community Leaders): They are interested in improving health outcomes and can influence social norms. Regular updates and community engagement activities will keep them informed and involved. Non-Governmental Organizations (NGOs) (e.g., Mobile Creches, SNEHA, Swadhar, Sukarya, Ekum Foundation): These groups are dedicated to maternal and child health and can offer support and advocacy. Partnering with them and seeking joint funding can enhance the initiative. Student Organizations: They are interested in public health and can support through advocacy and volunteering. Involving them in awareness campaigns and support activities will keep them engaged. Low Power, Low Interest: Health Scientists and Academics: They can contribute research but may not be directly involved. Providing periodic updates and engaging them in relevant discussions as needed will be helpful. Medical Schools: They can integrate breastfeeding into curricula but have limited immediate impact. Monitoring involvement and including relevant training in programs is useful. Engagement Strategies: Manage Closely (High Power, High Interest): Keep government agencies and healthcare workers engaged with regular meetings and updates. Address their concerns and involve them in key decisions.  Keep Satisfied (High Power, Low Interest): Provide updates and highlight benefits to employers and international organizations. Ensure they understand the value of the initiative to maintain their support. Keep Informed (Low Power, High Interest): Regularly update local communities, NGOs, and student organizations. Involve them in activities and seek their feedback to keep them engaged. Monitor (Low Power, Low Interest): Keep health scientists and medical schools informed with occasional updates. Engage them in discussions when relevant and consider their contributions to research and training. Legal and Ethical Considerations Relevant Laws and Regulations India's Infant Milk Substitutes (IMS) Act of 1992, amended in 2003, enforces strict guidelines to protect, promote, and support breastfeeding by regulating the marketing of breast-milk substitutes. This law aligns with the International Code of Marketing of Breast-Milk Substitutes. Violations have occurred, such as a Nestle-sponsored clinical trial in 2020 that breached the IMS Act. Additionally, the Pradhan Mantri Matru Vandana Yojana (PMMVY) offers conditional cash transfers to support breastfeeding mothers, but it's limited to the first childbirth and provides insufficient financial support. Potential Legal Challenges Despite the IMS Act, formula milk companies exploit loopholes by using trusted healthcare professionals for indirect marketing. In 2019, the Indian Council of Medical Research (ICMR) called for an end to Nestle-sponsored clinical trials that violated the IMS Act. Reports indicate that aggressive marketing misleads mothers about the necessity and safety of formula feeding, often undermining breastfeeding efforts. The Centre for Science and Environment found undisclosed genetically modified ingredients in popular infant formulas, raising health concerns. Ethical Implications The promotion of formula milk raises ethical concerns, particularly when it involves misleading marketing that exploits parental anxieties. The aggressive tactics undermine breastfeeding, which is crucial for child health. Additionally, the low coverage and inadequate financial support of schemes like PMMVY leave many women, especially in the informal sector, without necessary maternity benefits. Ethical considerations also include the need for proper education on breastfeeding and the potential risks of formula milk. Establishing milk banks, as seen in Brazil, could help address situations where breastfeeding isn't possible due to health reasons or lack of support, but must be carefully managed to prevent issues like adulteration and ensure proper storage. India's Maternity Benefit Act of 1961, recently amended in 2017, increases maternity leave to 26 weeks but only applies to women in formal employment. Over 90% of women in the informal sector are excluded, necessitating more inclusive legislation and better monitoring to ensure all women receive maternity entitlements. The ethical responsibility extends to recognizing the work of women in all sectors and providing universal, wage-linked, and unconditional maternity benefits. 3. Communication Strategy The key messages for different audiences need to be tailored to resonate with their specific interests and concerns. For the general public, the message emphasizes the overall importance of breastfeeding for child health and development, stating, "Breastfeeding is crucial for the health and development of your child. The Daimaa on Wheels initiative brings essential breastfeeding support to your community." For mothers and expectant mothers, the focus is on the direct benefits and support available: "Get personalized breastfeeding support and education from our mobile units right in your community. Breastfeeding has numerous benefits for both mother and baby. Our team is here to help you succeed." Healthcare providers are encouraged to collaborate with the initiative, with messages such as, "Collaborate with Daimaa on Wheels to enhance breastfeeding support for mothers in your care. Your partnership is vital in reaching more families and promoting healthier breastfeeding practices." Government and policymakers are urged to support the program through investment and policy backing: "Support the Daimaa on Wheels initiative to improve maternal and child health across our region. Investing in breastfeeding support is investing in our future. Help us make this initiative a success." For NGOs and community organizations, the messages highlight partnership and impact: "Partner with Daimaa on Wheels to bring essential breastfeeding support to underserved areas. Your involvement can make a significant difference in the health and well-being of our community." Finally, media outlets are asked to cover and promote the initiative: "Highlight the importance of breastfeeding and the innovative Daimaa on Wheels initiative in your coverage. Help us spread the word about this crucial program to ensure no mother is left without support." The channels for dissemination include social media, traditional media, community outreach, healthcare facilities, and partnerships with NGOs and community organizations. Social media platforms such as Facebook, Instagram, and Twitter will be used to share updates, success stories, and educational videos about breastfeeding and the Daimaa on Wheels initiative. Engaging with communities through live Q&A sessions with lactation consultants and healthcare workers will help create a direct line of communication. Traditional media collaboration with local newspapers, radio stations, and TV channels will help reach a broader audience through informative segments and interviews. Publishing articles and press releases will also raise awareness. Community outreach will involve organizing events and workshops in collaboration with local health departments and community centers. These events will be crucial for raising awareness and providing on-the-spot support. Informational materials like pamphlets, brochures, and posters will be distributed in local clinics, hospitals, schools, and public places to reach expectant and new mothers directly. Healthcare facilities will display informational materials and train healthcare workers to inform and refer mothers to the Daimaa on Wheels program. Partnering with NGOs and community organizations will leverage existing networks to spread the word and mobilize support. Joint events and campaigns will maximize reach and impact, ensuring that the initiative is well-promoted across different segments of society. The timeline for public outreach begins with the pre-launch phase (Month 1), where key messages are developed, informational materials designed, and outreach activities planned. Engagement with key stakeholders, including government officials, healthcare providers, and community leaders, is crucial for building support and partnerships. The launch phase (Month 2) involves an official launch event with media coverage and key stakeholders, accompanied by social media campaigns and traditional media outreach to introduce the program to the public. The post-launch phase (Months 3-6) will see regular community events and workshops to ensure a consistent presence and support. Social media platforms will be updated continuously with success stories, testimonials, and educational content. The effectiveness of the communication strategy will be monitored and evaluated, with adjustments made as needed to enhance reach and impact. Sustained engagement (ongoing) will involve maintaining ongoing communication with all stakeholders, providing updates on program progress and success stories. All communication channels will continue to be leveraged to keep the public informed and engaged, ensuring the long-term support and sustainability of the Daimaa on Wheels initiative. Risk Assessment and Mitigation Implementing the Daimaa on Wheels initiative brings several potential challenges and unintended consequences, necessitating careful planning and mitigation strategies. One significant risk involves logistical hurdles, such as vehicle breakdowns, fuel shortages, and delays caused by traffic or adverse weather conditions. To address these issues, we will develop a robust maintenance and contingency plan that includes regular vehicle inspections, emergency repair kits, and alternative routes to navigate traffic and weather-related disruptions. Another potential challenge is community acceptance and participation. Some communities may be hesitant to engage with the mobile units due to a lack of awareness or trust in the initiative. To overcome this, we will organize community engagement sessions before the rollout, involving local leaders and providing clear information about the benefits and services offered. Building strong relationships with community stakeholders will foster trust and encourage participation. Funding and resource allocation are critical risks. Insufficient funding or delays in financial support could hinder the initiative's progress. To mitigate this, we will create a diversified funding strategy, seeking support from government grants, private sector partnerships, and NGOs. Regular financial audits and transparent reporting will ensure accountability and continuous support. Staffing challenges, such as recruiting and retaining qualified healthcare professionals, are also potential obstacles. High turnover rates or a lack of skilled professionals could affect service quality. To address this, we will offer competitive incentive packages, ongoing training, and professional development opportunities to retain staff. Partnerships with medical schools and training institutes will help create a pipeline of qualified professionals for the initiative. The political landscape could pose risks, such as changes in government policies or political opposition. This can be mitigated by maintaining a non-partisan stance and engaging with policymakers across the political spectrum to secure broad support. Advocacy efforts will emphasize the health and economic benefits of the initiative, appealing to policymakers' interests in public health and economic development. Data privacy and security are critical concerns, especially when handling sensitive health information. To mitigate the risk of data breaches or misuse of information, we will implement stringent data protection protocols, including encryption, secure storage systems, and regular audits to ensure compliance with privacy regulations. Another unintended consequence could be the overreliance on mobile units at the expense of strengthening existing healthcare infrastructure. To avoid this, we will ensure that the mobile units complement and integrate with stationary healthcare facilities rather than replacing them. Coordination with local health departments and continuous evaluation of the initiative's impact on existing services will help maintain a balanced healthcare system. Cultural sensitivities must also be addressed to ensure the initiative is appropriate and respectful. Continuous engagement with community leaders and cultural advisors will be conducted, and training sessions for staff will include cultural competence to ensure respectful and sensitive interactions with community members. Conclusion This policy underscores the unwavering commitment to recognizing breastfeeding as the best source of nutrition for infants. It reaffirms that everyone has the right to be well-informed about breastfeeding benefits, conditions, and practices to make educated choices. To achieve this, the following actions are essential: 1. Government: Ensure compliance with the International Code of Marketing of Breastmilk Substitutes and the Infant Milk Substitutes Act, with strict penalties for violations. Provide special provisions for breastfeeding individuals in the informal sector not covered by the Maternity Benefits (Amendment) Act, 2017. Review and create policies to increase compensation for wage loss during lactation. Strengthen Human Milk Bank networks to support breastfeeding and milk donation. Implement the “Baby Friendly Hospital Initiative” in all maternity and newborn facilities. 2. NGOs: Work with governments to enforce policies supporting breastfeeding. Collaborate with rural community leaders to develop strategies encouraging breastfeeding. 3. Health Sector: Ensure mothers and expectant mothers are informed about the benefits of breastfeeding, nutritional needs, medical conditions preventing breastfeeding, and best alternatives. Implement the Baby-Friendly Hospital Initiative to protect and promote breastfeeding. 4. Medical Schools: Educate students on breastfeeding benefits and social determinants of health and well-being. Encourage support for nurses, community health workers, and midwives. 5. Health Scientists and Academics: Collect data on breastfeeding practices among vulnerable groups. Collaborate with advocates and media to share evidence-based messages. Increase funding for unbiased research on breastfeeding. Develop a national monitoring system to track breastfeeding rates and related policies. By taking these steps, we can ensure that breastfeeding is supported and promoted at all levels of society, creating a healthier future for our children. REFERENCES: 1. Breastfeeding Promotion Network of India, Association of Healthcare Providers. Joint Media Brief AHPI-BPNI [Internet]. 2021 Dec. Available from: https://www.bpni.org/wp-content/uploads/2021/12/Joint-Media-Brief-AHPI-BPNI-Englis h.pdf 2. UNICEF. Breastfeeding [Internet]. 2015 [cited 2020 Jan 31]. Available from: https://www.unicef.org/nutrition/index_24824.html 3. Horta BL, de Lima NP. Breastfeeding and Type 2 Diabetes: Systematic Review and Meta-Analysis. Curr Diab Rep. 2019 Jan 14;19(1):1. 4. Basree MM, Shinde N, Koivisto C, Cuitino M, Kladney R, Zhang J, et al. Abrupt involution induces inflammation, estrogenic signaling, and hyperplasia linking lack of breastfeeding with increased risk of breast cancer. Breast Cancer Res. 2019 Jul 17;21(1):80. 5. Schwarz EB, Nothnagle M. The maternal health benefits of breastfeeding. Am Fam Physician. 2015 May 1;91(9):603–4. 6. WHO. Early childhood development begins with a mother’s breast [Internet]. 2016 Aug 1 [cited 2020 Feb 1]. Available from: https://www.who.int/mediacentre/commentaries/2016/childhood-development-breastfeedi ng/en/ 7. Economics of breastfeeding [Internet]. Times of India. Available from: https://timesofindia.indiatimes.com/blogs/voices/economics-of-breastfeeding/ 8. Alive & Thrive. Cost of Not Breastfeeding in India [Internet]. Available from: https://www.aliveandthrive.org/sites/default/files/attachments/Cost-of-Not-Breastfeeding _India_v4.pdf 9. To increase the rate of breastfeeding in India, need for government to step up support [Internet]. The Wire. Available from: https://thewire.in/health/to-increase-rate-of-breastfeeding-in-india-need-for-government-t o-step-up-support 10. World Alliance for Breastfeeding Action. World Breastfeeding Week 2016 Action Folder [Internet]. Available from: https://waba.org.my/v3/wp-content/uploads/2019/10/wbw2016-af-i.jpg 11. Misinformation and formula milk donations are threatening breastfeeding during COVID-19 [Internet]. UNICEF. Available from: https://www.unicef.org/rosa/stories/misinformation-and-formula-milk-donations-are-thre atening-breastfeeding-during-covid-19 12. Early initiation of breastfeeding declines in 12 states/UT: NFHS-5 [Internet]. NewsClick. Available from: https://www.newsclick.in/early-initiation-breastfeeding-declines-12-states-UT-NFHS-5 13. Prasad V, Malhotra N. Breastfeeding determinants in healthy term newborns. Int Breastfeed J [Internet]. 2018 Jan 5. Available from: https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/s13006-018- 0146-0 14. Why kids are not being breastfed at the earliest [Internet]. Times of India. Available from: https://timesofindia.indiatimes.com/city/chennai/why-kids-are-not-being-breastfed-at-the- earliest/articleshow/70402837.cms 15. Is it just so my right? Women repossessing breastfeeding [Internet]. Dokumen.tips. Available from: https://dokumen.tips/documents/is-it-just-so-my-right-women-repossessingbreastfeeding. html 16. Murtagh L, Moulton AD. Working mothers, breastfeeding, and the law. Am J Public Health. 2011 Feb;101(2):217–23. 17. Navarro-Rosenblatt D, Garmendia ML. Maternity leave and its impact on breastfeeding: A review of the literature. Breastfeed Med. 2018 Nov;13(9):589–97. 18. Heck KE, Braveman P, Cubbin C, Chávez GF, Kiely JL. Socioeconomic status and breastfeeding initiation among California mothers. Public Health Rep. 2006 Jan;121(1):51–9. 19. Contraindications to breastfeeding or feeding expressed breast milk to infants [Internet]. CDC. 2019 [cited 2020 Feb 1]. Available from: https://www.cdc.gov/breastfeeding/breastfeeding-special-circumstances/contraindications -to-breastfeeding.html 20. Colombo L, Crippa BL, Consonni D, Bettinelli ME, Agosti V, Mangino G, et al. Breastfeeding determinants in healthy term newborns. Nutrients [Internet]. 2018 Jan 5;10(1). Available from: http://dx.doi.org/10.3390/nu10010048 21. Nommsen-Rivers LA. Does insulin explain the relation between maternal obesity and poor lactation outcomes? An overview of the literature. Adv Nutr. 2016 Mar;7(2):407–14. 22. Matias SL, Dewey KG, Quesenberry CP Jr, Gunderson EP. Maternal prepregnancy obesity and insulin treatment during pregnancy are independently associated with delayed lactogenesis in women with recent gestational diabetes mellitus. Am J Clin Nutr. 2014 Jan;99(1):115–21. 23. Lyons S, Currie S, Peters S, Lavender T, Smith DM. The association between psychological factors and breastfeeding behaviour in women with a body mass index (BMI) ≥30 kg/m²: A systematic review: Breastfeeding and psychological factors. Obes Rev. 2018 Jul 24;19(7):947–59. 24. Hurst NM. Recognizing and treating delayed or failed lactogenesis II. J Midwifery Womens Health. 2007 Nov;52(6):588–94. 25. Kim J, Unger S. Human milk banking. Paediatr Child Health. 2010 Nov;15(9):595–602. 26. WHO. Donor human milk for low-birth-weight infants [Internet]. 2019 Jul 22 [cited 2020 Feb 1]. Available from: https://www.who.int/elena/titles/donormilk_infants/en/ 27. Breastfeeding within an hour of C-section delivery [Internet]. UNICEF. Available from: https://www.unicef.org/rosa/stories/breastfeeding-within-hour-c-section-delivery 28. This World Breastfeeding Week, India needs to ask why its maternity benefit laws fall short [Internet]. The Wire. Available from: https://thewire.in/health/this-world-breastfeeding-week-india-needs-to-ask-why-its-mater nity-benefit-laws-fall-short 29. The Lancet. The burden of suboptimal breastfeeding in low- and middle-income countries: A maternal perspective [Internet]. 2023. Available from: https://www.thelancet.com/action/showPdf?pii=S2589-5370%2823%2900024-X 30. Why commercialization of mother’s milk is raising ethical questions [Internet]. IndiaTimes. Available from: https://www.indiatimes.com/explainers/news/why-commercialisation-of-mothers-milk-is- raising-ethical-questions-574550.html 31. Sale of breast milk raises eyebrows [Internet]. Times of India. Available from: https://timesofindia.indiatimes.com/home/sunday-times/sale-of-breast-milk-raises-eyebro ws/articleshow/92623732.cms 32. Breast milk sales picking up in India: Is it dairy or Ayurveda? [Internet]. The Print. Available from: https://theprint.in/features/breast-milk-sales-picking-up-in-india-is-it-dairy-or-ayurveda/1 278329/ 33. Global Governance Journal. The ethics of human milk exchange and sale [Internet]. Available from: https://www.tandfonline.com/doi/full/10.1080/09692290.2020.1864757 34. India Pediatrics. A landscape analysis of human milk banks in India [Internet]. 2019. Available from: https://www.indianpediatrics.net/july2019/608.pdf 35. Scroll. A for-profit market for breast milk is emerging around the globe, including in India [Internet]. Available from: https://scroll.in/article/1008478/a-for-profit-market-for-breast-milk-is-emerging-around-t he-globe-including-in-india 36. Google. Indian laws for commercialization of breast milk [Internet]. Available from: https://www.google.co.in/search?q=indian+laws+for+commercialization+of+breast+milk &btnK=Google+Search&client=safari&channel=ipad_bm&sxsrf=APwXEddBeZxHsaIL ALhlH52fAltxmui8Wg%3A1680285617172&source=hp&ei=sR8nZJSRCPGZseMP0M Cb8AI&iflsig=AOEireoAAAAAZCctwV952osvlh8GVd14KYssw4fc30hX 37. Moneycontrol. Breastmilk sale by two companies prompts demand for a law barring practice [Internet]. Available from: https://www.moneycontrol.com/news/trends/breastmilk-sale-by-two-companies-prompts- demand-for-a-law-barring-practice-9924551.html 38. Impact Ethics. The ethics of human milk exchange and sale [Internet]. 2016 Mar 29. Available from: https://impactethics.ca/2016/03/29/the-ethics-of-human-milk-exchange-and-sale/ 39. Live Law. Not make breastfeeding obligatory, declare newborns' right to mothers' milk a fundamental right: Madras HCs 15 posers to Centre [Internet]. Available from: https://www.livelaw.in/not-make-breastfeeding-obligatory-declare-newborns-right-mothe rs-milk-fundamental-right-madras-hcs-15-posers-centre/ 40. Breastfeeding in public: What are the laws in India? [Internet]. PubMed Central. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764724/ 41. The truth about not being able to breastfeed [Internet]. The Cut. 2018 May. Available from: https://www.thecut.com/2018/05/the-truth-about-not-being-able-to-breastfeed.html 42. What to know about breastfeeding in public: Legal rights and social attitudes [Internet]. PubMed Central. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4011403/ 43. Kluger J. The truth about breastfeeding and formula shortage [Internet]. New York Times. 2022 May 16. Available from: https://www.nytimes.com/2022/05/16/well/family/breastfeeding-formula-shortage.html 44. Express Healthcare. Need for donor human milk in India [Internet]. Available from: https://www.expresshealthcare.in/news/need-for-donor-human-milk-in-india/438369/ 45. A landscape analysis of human milk banks in India. Indian Pediatrics. 2019. 46. Maternity bill amendment to cause job losses for women: Report [Internet]. Fortune India. Available from: https://www.fortuneindia.com/macro/maternity-bill-amendment-to-cause-job-losses-for- women-report/102061 47. Experts raise concern over exploitative formula milk marketing, call for clampdowns in Lancet series [Internet]. India Today. 2023 Feb 8. Available from:  https://www.indiatoday.in/health/story/experts-raise-concern-over-exploitative-formula-m ilk-marketing-call-for-clampdowns-in-lancet-series-2332185-2023-02-08 48. The history of the breastfeeding debate [Internet]. Time. Available from: https://time.com/5353068/breastfeeding-debate-history/ 49. Show-cause notice to Nestle arm triggers debate on infant milk substitutes act [Internet]. The Hindu Business Line. Available from: https://www.thehindubusinessline.com/companies/show-cause-notice-to-nestle-arm-trigg ers-debate-on-infant-milk-substitutes-act/article30607066.ece 50. On maternity benefits [Internet]. The Hindu. Available from: https://www.thehindu.com/opinion/op-ed/on-maternity-benefits/article20393885.ece 51. CSE study finds genetically modified ingredients in food products [Internet]. Down to Earth. Available from: https://www.downtoearth.org.in/coverage/food/cse-study-finds-genetically-modified-ingr edients-in-food-products-61245 52. India is planning a network of human breast milk banks, but first needs to put safeguards in place [Internet]. Scroll. Available from: https://scroll.in/pulse/841072/india-is-planning-a-network-of-human-breast-milk-banks-b ut-first-needs-to-put-safeguards-in-place 53. Ministry of Women and Child Development. Pradhan Mantri Matru Vandana Yojana (PMMVY) [Internet]. Available from:  https://wcd.nic.in/sites/default/files/FINAL%20PMMVY%20%28FAQ%29%20BOOKE LT.pdf 54. India Spend. A for-profit market for breast milk is emerging around the globe, including in India [Internet]. Available from: https://www.indiaspend.com/uploads/2021/03/26/file_upload-446784.pdf