Here is why breastfeeding your child is important

Published: January 31, 2014
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In Pakistan, 86 per every 1000 children die due to preventable diseases in their infancy. Breastfeeding is one of the ways to protect them. DESIGN: ESSA MALIK

In Pakistan, 86 per every 1000 children die due to preventable diseases in their infancy. Breastfeeding is one of the ways to protect them. DESIGN: ESSA MALIK In Pakistan, 86 per every 1000 children die due to preventable diseases in their infancy. Breastfeeding is one of the ways to protect them. PHOTO: REUTERS

Hooray! The Balochistan Assembly finally enacted the Balochistan Protection and Promotion of Breastfeeding and Child Nutrition Bill 2014 on January 18, 2014. This is truly a progressive step towards a healthier province and a healthier Pakistan.

However, the real test for the provincial government will be to effectively implement this bill, in letter and in spirit. I say this because, even though the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 is very much present on the statute books since its approval, its implementation  continues to remain a distant dream.

As most of us know, Pakistan is not on track to achieve the Millennium Development Goal 4 (MDG 4) targeted to reduce under-five mortality rate by two-thirds between 1990 and 2015. We know that only around 700 days are left to achieve our target and the situation does not look pretty so far.

Countries like Bangladesh and Nepal are on track to achieve the MDG 4. Remember that, in 1990, Pakistan’s under-five mortality rate was 138 per 1000 live births as compared to those of Bangladesh (139 per 1000 live births) and Nepal (135 per 1000 live births). However, over the past two decades, there has been remarkable change. Bangladesh was able to lower its under-five mortality rate to 41 and Nepal to 42, which puts them well on track to meet their MDG 4 targets for 2015; whereas Pakistan is still struggling at 86 per 1000 live births.

With the world’s highest national number of newborn deaths (194,000 in 2010), the neonatal mortality declined by only 0.9% per annum between 2000 and 2010 in Pakistan – less than the global average (2.1%) and less than the national maternal and child mortality declines.

A major source of killer diseases amongst Pakistani children is the lack of exclusive breastfeeding and the use of unhygienic bottles, formula milk and teats. Pakistan has failed to achieve any significant progress in increasing exclusive breastfeeding for six-month-old infants in the last decade.

According to WHO’s definition,

“Exclusive Breastfeeding is defined as only breastfeeding and no additional food, water or other fluids for the first six months of life.”

Only 38% of infants (under six months) in Pakistan were exclusively breastfed, according to the preliminary findings of the Pakistan Demographic and Health Survey (PDHS) 2012-13. This is indicative of the fact that there is hardly any improvement since PDHS 2006-07, when the exclusive breastfeeding for six months was 37%. The PDHS 2012-13 findings also show increase in bottle feeding rates in Pakistan.

On the contrary, in Bangladesh, the rate of exclusive breastfeeding for six months is 64% while in Nepal it is 70%. Bangladesh was able to increase the rates from 43% in 2007 to 64% in 2012 by commitment at all levels. This was also possible because of the active involvement of the civil society and media in the campaigns for the promotion and protection of breastfeeding.

Breast milk is a powerful intervention which can significantly reduce infant mortality. Save the Children’s Super Food for babies report refers to breastfeeding as the closest thing to a ‘silver bullet’ in the fight against malnutrition and newborn deaths. This is apparent from the fact that an estimated 22% of newborn deaths could be prevented if breastfeeding started within the first hour after birth.

“Babies who are not exclusively breastfed in the first six months are at 14 times higher risk of dying than exclusively breastfed infants” said renowned paediatrician and president of the Advocacy and Advisory Network on Newborn (AANN), Dr Tabish Hazir, during an event.

He further stated that Pakistan has the highest bottle feeding rates in South Asia which calls for the strict implementation of the breastfeeding and marketing code, capacity building of the healthcare providers at all levels for improved breastfeeding counselling skills and revision of undergraduate curriculum with greater emphasis on good infant feeding practices, including exclusive breastfeeding.

Research shows that early initiation of breastfeeding benefits the immunity of a baby, reduces the risk of neonatal sepsis and respiratory infections, and is also associated with higher rates of breastfeeding and lower rates of diarrhea throughout the first six months of life.

According to a new study in Greece, children who were breastfed for more than six months scored the highest on cognitive, language and motor development tests as toddlers.

According to the findings of a qualitative assessment done to explore factors responsible for the violation of the health codes in Pakistan, many healthcare providers are unaware of laws related to the protection of breastfeeding.

To be able to witness in our lifetime that no child will be born to die from a preventable disease, it is imperative to put breastfeeding at the centre of our efforts. This means not only the involvement of the government and the health system, but also of the media and the community. Steps to eradicate major barriers such as community and cultural pressures; the shortage of frontline health workers; lack of maternity legislation and inappropriate promotion of breast-milk substitutes are also important to ensure that every infant receives the life-saving protection that breastfeeding can offer.

Similarly, the breast milk substitutes producing companies should abide by the health codes and dedicate one third of all packaging to a warning label stating that formula is inferior to breast milk.

This has also been made mandatory under the Protection of Breastfeeding legislation in Pakistan. The Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013 has made it mandatory for the companies to include a warning in Urdu and Sindhi languages that the formula is inferior to breast milk.

An Infant Feeding Board has been notified at the federal level to monitor the implementation of the federal law. Punjab requires to effectively implement the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment) Act 2012 while Khyber Pakhtunkhwa has committed at the highest level that soon it will also enact a legislation for the protection and promotion of breastfeeding.

In terms of laws and legislations, Pakistan seems to be developing. However, when it comes to the implementation of these laws, we see very little progress.

It is time that we focus on our health system and help our infants live longer, healthier and more sustained lives.

Arshad Mahmood

Arshad Mahmood

He has a Masters degree in Human Rights from the London School of Economics and is currently working for the promotion and protection of child rights in Pakistan. He tweets @amahmood72 (twitter.com/amahmood72).

The views expressed by the writer and the reader comments do not necessarily reflect the views and policies of The Express Tribune.

  • Nabeela Waheed

    Mother’s milk is the ideal nutritionally perfect food for newborns and infants. Not
    only the doctor, but everyone who converses with a new mother– the nurse,attendant and her family members–has a distinct role to play. The doctor’s
    responsibility is to assure the mother that she can give her child complete
    nutrition by exclusive breastfeeding and to ensure that breastfeeding is
    started early. The paramedical staff should educate her about the benefits of
    breastfeeding and help her continue with it. The family’s role is to support
    her and take good care of her food and nourishment.
    Government should focus their plan of action and budget allocation for promoting breast feeding, based on gaps which exist in current policy and programmes and civil societies should promote breast feeding and good nutrition for women in both rural and urban areas.Recommend

  • Johan

    Every year in
    Pakistan around 352400 children cannot reach to celebrate their fifth birthday.
    Out of these total deaths 35% are due to malnutrition. One of the major cause
    behind the large number of death ratio is the breastfeeding rates are very low.
    According to Pakistan Demographic and Health Survey (PDHS) 2006-07 the exclusive
    breastfeeding rate was 37% whereas according to PDHS 2012-13 the rate increased
    to 38% with 1% increase.

    Federal and provincial governments should should prioritize the policy level changes and their implementation.Recommend

  • Sarnad

    A great blog. How ever i would like to add that the implementation of this law requires commitment from the government in terms of notification of infant feeding boards but at the same time more accountability measures need to be put in place to monitor malpractices by the companies who are selling Breast Milk substitute. There also needs to be a mechanism developed by the government to spread awareness about the importance of mothers milk and exclusive (starting from 1st hour of birth till 6 months) breastfeeding (nothing else given to child even water). Probably the government needs to send out Public service messages through the Public Information Department to the Press for making it Mandatory to be printed If not every day, every other day in their papers

    Secondly, i would like to congratulate you on your campaign on Breast feeding. I can see that companies who were previously airing their adds using less then 1 year child have stopped those adds and now the focus has shifted to 1+..Recommend

  • Irshad Danish

    The author of this wonderful blog has appropriately described
    importance of breastfeeding.

    Breastfeeding is the
    most effective and least costly life-saver EVER and baby’s first immunization. Numerous
    studies from around the world have shown that stomach viruses, lower
    respiratory illnesses, ear infections, and meningitis occur less often in
    breastfed babies and are less severe when they do happen

    It is good that we have good
    piece of legislations for protection and promotion of breastfeeding at federal level
    and in three provinces. However, effective implementation of these laws still requires
    attention of relevant duty bearers.Recommend

  • Nadeem Shahid

    A very well written educational blog on very important issue by Mr. Arshad
    Mehmood. Exclusive early initiating breastfeeding is said to be the 1st
    vaccination f or the infant. Exclusive Breastfeeding
    (feeding only mother’s milk from the birth of infant up-to the age of six months
    without any feeding other food or liquid)
    keeps the baby protected against
    diarrhea which is a big killer of infants in Pakistan.

    Breast milk contains an ideal balance of
    nutrients such as fat, carbohydrates, proteins, vitamins, and minerals that is
    easy to digest and also meets the nutritional needs of babies.

    Breastfeeding even helps in the growth and
    development of a baby’s jaws and future teeth, and can lower the chances of
    developing dental caries later in life.

    Breastfeeding helps infants build a strong
    and well-developed immune system. Breast milk contains colostrums, which has
    antibodies that help protect against infections (e.g., ear infections,
    respiratory infections, gastrointestinal infections, and meningitis) as well as
    against allergies, eczema, and asthma. It may also lessen the risk of obesity
    and juvenile diabetes. In addition, because breast milk is a baby’s natural
    food, most infants are not allergic to the protein and can digest it more
    easily than formula.

    Breastfeeding may even result in a higher
    score on the Mental Development Index, a test that measures a child’s overall
    intelligence and may improve their visual function. Breastfeeding has even
    resulted in fewer incidences of Sudden Infant Death Syndrome (SIDS). Finally,
    breastfeeding helps newborns feel more secure and comfortable because of close
    and regular physical contact.Recommend

  • AM

    In Bangladesh much of the credit for 20% increase went to the mass media campaign as stated in the BDHS.Recommend

  • imran takkar

    Legislation with effective implementation as
    well as mass awareness and capacity building of the healthcare provider for the
    promotion of breastfeeding is the cry of the day in a country where highest
    bottle feeding rates in south Asia region.Recommend

  • Nadeem Shahid

    The blogger Mr. Arshad Mehmood is a veteran child & health advocacy expert he educates people about the importance of breastfeeding and shares their efforts for promoting breastfeeding. about breastfeeding Health expert say initiating
    breastfeeding to infant is the 1st vaccination for the baby which develops babies’ immunity against the various diseases such as diarrhea, meals and pneumoniaRecommend

  • iqbal detho

    I agree with the writer about the status of breastfeeding in Pakistan.It needs both behavioral changes and implementation of said laws at Provincial and District levels.One aspect lacking implementation is that while making laws proper budgeting is not done and left at the mercy of donor support and no sustainability once those projects are over.Also one wonders why higher judiciary is not interpreting right to life ,when such huge number of children are dying due lack of social and public policy.Every Child is born with right to survive (life) but not to die.Judiciary can exercise suomoto like other countries has invoked such jurisdiction in South Africa(Right to use generic drugs for fighting HIV/AIDS),Brazil(Street children should be provided right to food and shelter). Recommend

  • Nadeem Shahid

    A very nice blog on a very important issue by Mr. Arshad Mehmood a veteran Child and health advocacy expert in Pakistan. No doubt that the Breast milk provides the ideal nutrition for infants. It has a nearly perfect mix of vitamins, protein, and fat — everything your baby needs to grow. And it’s all provided in a form more easily digested than infant formula. Breast milk contains antibodies that help your baby fight off viruses and bacteria. Breastfeeding lowers your baby’s risk of having asthma or allergies. Plus, babies who are breastfed exclusively for the first 6 months, without any formula, have fewer ear infections, respiratory illnesses, and bouts of diarrhea. They also have fewer hospitalizations and trips to the doctor.
    Breastfeeding has been linked to higher IQ scores in later childhood in some studies. What’s more, the physical closeness, skin-to-skin touching, and eye contact all help your baby bond with you and feel secure. Breastfed infants are more likely to gain the right amount of weight as they grow rather than become overweight children. The health experts’ says breastfeeding also plays a role in the prevention of SIDS (sudden infant death syndrome). Recommend

  • Nadeem Shahid

    I would like to say a big tanks to Balochistan cabinet, Members of Provincial Assembly of and Dr. Ali Nasir Bugti head of Provincial Nutrition Cell, Health Department of government of Balochistan for enactment of such an important law. This will definitely, lead to improve infant and child health by reducing the IMR (Infant Mortality Rate) in province.
    I agree with Mr. Arshad Mehmood the blogger that the real test for the government of Balochistan to effectively implement this law. I hope that the provincial health authorities will notify Infant Feeding Board immediately for monitoring of this provincial law in Balochistan.
    Balochsitan is the only province of Pakistan with high MMR ( Maternal Mortality Ratio) is 785 out of 100000 live births 36 % of women are underweight, 48.1% of women have hemoglobin deficiency and 16.1% women are iron deficient . whereas, under 5 mortality rate is 89 out of 1000 live births NNS. We urge the provincial government to allocate adequate resources and budget for the Nutrition interventions in the province to reduce MMR and IMR the preventable deaths to achieve the MDGs 4&5. Recommend

  • Mrs Shabana Nadeem

    I appreciate Express tribune for publishing such a educating contents on their esteemed paper related to women and child health. I have read the blog and gone through the all comments. Being a women and a mother I simply say EXCELLENT and thumbs-up to the Balochistan Assembly for enactment of long awaited law for the people of Balochistan. Only we can have positive results of this law if its implemented in its true spirit.Recommend

  • Malik Wasim

    This is a very rich blog covering all the important aspect and giving a complete picture the breastfeeding status in the country. Every year in Pakistan around 352400 children cannot reach to celebrate their fifth birthday. Out of these total deaths 35% are due to malnutrition. One of the major cause behind the large number of death ratio is the breastfeeding rates are very low. According to Pakistan Demographic and Health Survey (PDHS) 2006-07 the exclusive breastfeeding rate was 37% whereas according to PDHS 2012-13 the rate increased to 38% with 1% increase.
    We need to take some positive steps at the legislation level as well as it’s implementation. Recommend

  • http://crspk.blogspot.com AM

    There is a need for widespread awareness about breastfeeding besides improving the state of mothers in the country. Media and CSOs has an important role to play in this regard. Above all the Provincial Governments should wake up.Recommend

  • Habiba

    Very well stated as the writer has a great grip on issues related to legislation and their implementation regarding child rights and protection related issues.
    Personally I have remained with the Aga Khan University as a young researcher in the past. Majority of research topics were related to nutrition, mothers and neonatal health.
    One of the studies was on the availability of fortified food to mothers and babies for which the sample was picked from 4 districts, from Punjab and Sindh.
    For the data collection I along with a team of midwives and LHVs were placed in Faisalabad city for the door to door survey. During the data collection we would enter every third house to check the availability of fortified food products at home, measure the height and weight of children and ask a few questions from mothers regarding still births, miscarriages and vitamin deficiency etc.. . during this I found may mothers had experienced at least one miscarriage/still birth in life. Very few of them answered in affirmative regarding the usage of fortified food products. and majority of them would say that they were instructed by the doctors to stop breast feeding their child after 1 year as they were experiencing Calcium and vitamin D deficiency.
    As far as my assumptions regarding hindrance in breastfeeding is concerned, young mothers are very much into the cult of maintaining their body weight, they take less to maintain a desirable size, secondly there are those who lack the availability of nutritious food to maintain a healthy life style.
    Spreading awareness is required for mothers regarding the significance of breastfeeding, and ensuring its availability for her child. Deteriorated health of the mother directly impacts the continuation/ frequency of breast feeding.
    As far as the the implementation of the laws related to the promotion of breastfeeding is concerned the fortification of all forms of food products must be enhanced to make nutritious food available for mothers to overcome their deficiencies.Recommend

  • http://www.mced.org.pk Fakhar Haleemzai

    Indeed its a great effort to write over health issues and its status in Pakistan. A comprehensive and multidimensional article it is. Its gives the Pakistan lagging status on MDG-4, comparativeness of neighboring countries and the remaining days mentioned in the article give alarming to the state and policy makers to have some alternative for achieving the target within the given time frame. On other hand presenting the significance of breastfeeding with evidences and facts with references to different definitions and references and reminding the milk production companies the liabilities applies on them, keeping in view the health of mother and child. Balochistan, one of the deprived province, enacted the “Balochistan Protection and Promotion of Breastfeeding and Child Nutrition Bill 2014 on January 18, 2014” which will create a pressure over the rest of provinces to follow the same and side by side presented the status of Punjab and KP on the matter. The writer suggested for further legislation on the matter for improvements and timely enactment of the bills. Recommend

  • mshaiq

    A very comprehensive article. I’m in full agreement with the author and as he has already mentioned, Pakistan has passed the law but implementation is a whole different story. That’s where the civil society needs to come in to lobby for implementation of the law. The provincial government need to allocate funding and resources towards the implementation and we need to take this information to mothers.

    Nabeela Waheed has the right idea where she suggests that the doctors, nurses/ healthcare workers that come into contact with the new mothers need to inform these mothers of the benefits of breastfeeding.

    Yes, laws require implementation but in a country like Pakistan, the first step is always awareness of the problem and information about ways to correct it.Recommend

  • Yasmeen Baloch

    Thanks for sharing such great news. As we all know that Balochistan due to its diverse issues is suffering from highest ratings of MMR and IMR among the other provinces of Pakistan. This law will surely help to reduce current ratio. But there might be a lot of problems arise during the implementation of this act. Every mother wants a better health of her child and she knows how breast feeding is important for them. But due to lack of proper nutrition they are not able to provide proper breast feeding to their children. The main reason behind this is poverty.

    Save the children should assure this policy for working women that they should be facilitated on work places with a private room to feed their children.

    I hope you and your team will be there with proper solutions

    Congratulations on achieving such milestone.Recommend

  • Gull Lashta Nadeem Rind

    I appreciate the Balochistan government for enactment of this child nutrition protection law. Proper implementation of this law and raising awareness among health care providers, mothers, lactating and pregnant women will result a positive impact on the lives of women of our province.
    This is the time to discuss the malpractices in health profession, those doctors; health care providers encourage or introduce formula milk to mothers must be punished under this law.
    Would this modern world believe that Balochistan is on top with heights MMR 785 and IMR 89. Besides, these high shameful figures of women and child death, Balochistan government never spent nor allocated a single penny for nutrition interventions in the province where malnutrition and is declared as an emergency as per classification of WHO.
    Dr Abdul Malik, Chief Minister Balochistan, Sir, I don’t request, rather demand provincial government to allocate resources and budget for nutrition programme for Balochistan.
    Concluding this I would say that a comprehensive awareness raising campaign, strict monitoring and implementation of Law should be the priority of the government. Recommend

  • adnan Sajid

    Excellent piece of blog on this ignored area of Nutrition, which can play an important role in minimizing the rate of malnutrition in our Country. Let me share from my personal engagement from the last so many years in advocating with policy makers and religious leaders in favor of breast feeding milk importance that, breast milk is not only food. It is a complete diet for children in the correct amount to ensure their growth and development at that particular age. Studies have shown that children who are breastfed perform better than their counterparts in school.Recommend

  • Meer Jaan Baloch

    A great blog! It will be a helpful source to guide the design of national policy to speed up progress towards MDGs 4 and 5 and work towards the longer term goal of ending preventable deaths among women and children.
    A great effort for improving survival and health of newborn and to educate the policy makers to implement the Laws regarding Newborns and Women.Recommend

  • waheed

    We need to take some positive steps on the legislation for protection and promotion of breastfeeding to protect our newborn and move towards healthy Pakistan.L.H.W can play important role in increase awareness and behavior change on exclusive breastfeeding through educate the mother that A Mother can give her child complete nutrition by exclusive breastfeeding .Recommend

  • http://www.dawoodbtzi.blogspot.com Dawood Batozai

    I must say that the credit should be given to the Balochistan team of SC for being able to advocate on such an important and critical matter which is very important and a need of the time. Islam also teaches us to fulfil the right of a child by breastfeeding it for a complete two years. We must continue to work on how to be able to see this bill in action which is the most important step after its enactment-its implementation. Many congratulations once again to all those involved in advocating for this important matter. Thumbs up and keep up the good work.Recommend

  • Emma Gedge

    I’m so glad I discovered your website. This blog post has helped me so much. I’ve gotten so many ideas about breastfeeding and I want to thank you for that. Keep sharing!Recommend