KATHMANDU: The Nutrition Fellowship, an initiative of the SidArt Foundation, has called for stronger measures to protect, promote, and support breastfeeding in Nepal, citing gaps in breastfeeding practices, workplace support, and enforcement of regulations on breast-milk substitutes. The call follows an analysis by the fellowship of Nepal's progress towards World Health Assembly nutrition targets. The analysis found that bottle feeding among children under two is 28% nationally and reaches 51% in Bagmati Province. According to the Nepal Multiple Indicator Cluster Survey 2024–25, only seven in 10 infants under six months are exclusively breastfed, while fewer than four in 10 newborns begin breastfeeding within one hour of birth. The fellowship said inadequate breastfeeding is estimated to cost Nepal Rs 21 billion annually in 2024, equivalent to about one-fifth of the federal health budget. Families also spend an estimated Rs 4.26 billion each year on breast-milk substitutes. 'Breastfeeding is foundational to children's growth and development, and providing it should not come at the cost of women's economic freedom and dignity,' said Namrata Shrestha, a Nutrition Fellowship student. The fellowship also highlighted challenges faced by working mothers. Nepal's Labour Force Survey 2017–18 found that around nine in 10 employed women were in informal employment, where access to employment benefits and social protection is limited. A 2023 survey of urban workers, published by the World Bank in 2025, found that only 48% of informally employed mothers working when their last child was born took maternity leave. Among those who took leave, 23% borrowed money to support themselves. Only 18% of formally employed mothers reported having access to a breastfeeding space at work. The government has proposed providing at least six months of paid maternity leave and 42 days of paid paternity leave. Lila Thapa, chief of the Nutrition Section at the Family Welfare Division, Department of Health Services, said the government was also working with partners and communities to strengthen breastfeeding counselling and support. The fellowship has called for the swift endorsement and effective implementation of six months of paid maternity leave, with safeguards against job loss and discrimination, particularly for women in informal employment. It also urged stronger enforcement of the Breast Milk Substitutes Act and greater support through breastfeeding-friendly health facilities, workplaces, breastfeeding spaces and breaks, flexible working arrangements and community counselling. Dr Pawana Kayastha, chairperson of the Nepal Pediatric Society Nutrition Chapter, said maternity leave provisions should be accompanied by stronger implementation of the Breast Milk Substitutes Act and the Baby-Friendly Hospital Initiative. 'Families must be protected from inappropriate marketing of infant formula and other products promoted as replacements for breast milk,' she said. Bijayalaxmi Niraula, another Nutrition Fellowship student, said students and communities could help turn government policy into practical support for mothers in hospitals, workplaces, and communities.