A malnourished Pakistani girl, Heleema, at a camp for displaced people in Sukkur, Sindh province, southern Pakistan. PHOTO: AARON FAVILA

Why is breast milk being substituted with formula?

Almost 171 million children are victims of stunting and most of them are from developing countries

Saadia Khan May 23, 2017
Human beings are probably the only mammals on earth not benefiting from the precious elixir of life – breast milk. The epidemic of bottle feeding, powerful marketing by milk companies and unjustified formula feed prescriptions portray breast milk substitutes as power packed energy sources. Moreover, everyone is looking to benefit from these useless powders instead of the precious gift of nature. Breast milk is the first form of immunisation for a child and it is a potent caloric source that is in accordance with the need of the baby with no risk of contamination and, the best part is, it doesn't cost a penny.

From the point of conception up to their second birthday, the first 1000 days for a child are a window of opportunity for the parents to set a steady foundation for the growth, development and cognitive functions of a child. This statement is supported by a study published in the medical journal called The Lancet, which states that stunting is associated with 2.9 deficits in school grades.

Children deprived of calories during this period end up enduring long-term negative impacts to growth, cognition, school grades and overall productivity. Stunting is not only used to explain below average height, but also represents a physiological alteration to the body that comes about due to the body being deprived of the basic required caloric intake. This can have long-term stressful, bitter psychological impact on the child as well as the parents’ life.

It is not only the stunted child who suffers, but the entire community that has to pay the price in terms of a 2-3% loss in Gross Domestic Product (GDP) annually. Poor nutrition affects the overall working capacity of any community and approximately 171 million children in the world are victims of stunting, most of them are part of developing countries.

An insufficient calorie intake and being deprived of essential micronutrients during pregnancy and early infancy are reasons why this chronic form of malnutrition leads to stunting. Women are mostly caloric deficient due to various customs, taboos and social issues, and this caloric deprivation is ultimately passed on and transferred to their babies. These thin but malnourished mothers give birth to low birth weight, intrauterine growth restricted or pre-term babies. The child of a stunted mother is 15 times more at risk of being stunted than others.

Some of the main factors that contribute to stunting are as follows:

  1. Poor mental health

  2. Poverty

  3. Poor nutrition practices, aka a lack of breastfeeding

  4. The delayed initiation of complimentary food

  5. A lack of diversity in food

  6. Low caloric food values

  7. Repeated infections

  8. Poor hygiene and sanitation

  9. A lack of immunisation


Many laws have been implemented and discarded over the years to control the sale of breast milk substitutes, but it is high time we fasten our seat belts and pay heed to the massive nutrition crisis in the form of stunting (44%), wasting (15%), and malnutrition (34%) that we are now facing. These figures are not only alarming; they’re an eye opener for medical personnel and administrators. The answer to this problem roots to three simple solutions, the three E's if I may,

  1. Early initiation of breastfeeding.



  1. Exclusive breastfeeding for six months and extended breastfeeding up to the second birthday of the child, along with the timely start of a complimentary feed at six months. Along with effective hygiene and sanitation and good antenatal care.

  2. Emphasis on women’s health, food contamination, and health education at a college level.


Malnutrition, whether acute (wasting) or chronic (stunting) is a killer and is responsible for 60% of deaths in children under five years of age and in Pakistan, the statistics regarding nutrition are highly alarming and can be seen in the following video:

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Currently, the Punjab Nutrition Programme, through Integrated Reproductive Maternal Newborn Child Health (IRMNCH) is at its best and people are working sincerely and whole heartedly to overcome this crisis. Currently, 807 Outdoor Therapeutic Programs (OTP) are working in 29 districts with 42 nutritional stabilisation centres for malnourished children. These programs work solely to manage children with acute malnutrition.

The Punjab Breastfeeding Protection Act 2017 prohibits illegal practices regarding breast milk substitutes; it has created a ripple in the ocean of hope regarding the promotion and protection of breastfeeding. What we must start doing, however, is to create awareness. Start on a personal level and then take to social media - tell people what you know so we can impart valuable knowledge sneakily being swept under the rug by companies selling substitutes to breast-milk. It is common sense, really - what is natural will always be the healthier option - convenience should have nothing to do with that.

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WRITTEN BY:
Saadia Khan A paediatric resident at the Children's Hospital and Institute of Child Health, Multan, she has a keen interest in preventative paediatric medicine and community work, and tweets as@drkhanchc (https://twitter.com/drkhanchc).
The views expressed by the writer and the reader comments do not necassarily reflect the views and policies of the Express Tribune.

COMMENTS (2)

DTAP Clinic | 5 years ago | Reply Thanks for sharing these benefits. Indeed, breastfeeding facilitates bonding between the mum and baby. A knowledge giving article and I will definitely going to save them for future reference. Thanks you!
sim | 6 years ago | Reply It is true. I will agree with the writer. There is no need to use powder milk for nascent babies. They need minerals in there body and they are in the breast milk. Don't know why people have started using substitute for babies at his early age.
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