It would seem to be the most natural image in the world - a baby lying in her mother's lap, suckling at her breast. Yet the mixture that five-month-old Swathi is drinking is not milk, nor is it coming from the body of her mother, Raj Kumari. The liquid is a specially prepared formula and is flowing from a dish held by a nurse via a small tube taped to Raj Kumari's breast. Her milk dried up three months ago and without the nutrition and protection it provides, Swathi's weight has plummeted.
The hope is now that by simulating breastfeeding, Swathi's sucking action will stimulate milk production in Raj Kumari again. While it is true there is no "silver bullet" that could instantly reduce India's high levels of malnutrition, most experts agree that the best possible solution is to get more mothers to begin breastfeeding earlier and to continue for longer. "If I could recommend one thing, it would be that the government focus their efforts on encouraging breastfeeding, especially in the first hour of life," said Prof Lawrence Haddad of the Institute of Development Studies.
The World Heath Organisation recommends that mothers in developing countries breastfeed their babies until they are two - exclusively for the first six months, after which other foods should gradually be introduced. To really improve a child's chances of survival it needs to begin suckling almost as soon as it is born: that is when the mother produces colostrum - a thick yellow milk rich in nutrients and antibodies.
"We call it the first immunisation," said Dr Nisar Ahmed, at the Nutritional Rehabilitation Centre in Shivpuri in the central state of Madhya Pradesh. But in most Indian villages, the colostrum is considered dirty because of its colour and is normally thrown away. This means babies can go days without drinking their mother's milk. Instead they are fed by dipping the end of a sari in buffalo milk, milky tea, or a mixture of honey and dirty water.
Even if a local health worker has counselled the mother to begin breastfeeding immediately, the traditional ways often win out because mothers-in-law insist they know best. The result is that many young babies that come to the clinic are already sick with diarrhoea. Often, their mother's milk has already dried up. This is where the supplementary suckling technique that staff are using on Raj Kumari's comes in.
"We vastly improve a baby's chances if we can send it home with a mother who is able to breastfeed again," said one of the nurses. The technique has already proved very successful for other mothers who have stayed in the centre and the nurses are hopeful it will work for Raj Kumari too. "Now I am here I feel my daughter will get better. I'd be happy to breast feed for a bit longer." email@example.com