As per the National Nutrition Survey 2018 key findings published last month, there has been a steady increase in the proportion of children receiving breast milk during the first hour after birth between 2011 and 2018.
However, the trend for exclusive breastfeeding is not linear. From 50% in 2001, it decreased to 37.7% in 2011 and then again to 28% in 2018, bringing Pakistan close to the World Health Assembly target of 50%.
So why exactly has there been a decrease in women exclusively breastfeeding their infants?
Pediatrician at Margalla General Hospital Dr Nazia Abbasi says breastfeeding practices in Pakistan are decreasing every year due to multiple factors.
These factors include the fact that earlier only women who belonged to upper-class households used to avoid breastfeeding because they think it has an impact on their body shape among other things. But now women from the middle-class work full-time and don’t have the facility of daycare centers at their workplaces.
Shazia Luqman who works at a university in Islamabad gave birth to twins twice and never had complaints of less milk production. But she couldn’t take her kids to her workplace as it lacked the facility of a daycare center.
“At work I used to feel uncomfortable as I always felt the need to breastfeed as I had access milk production but had no choice but to wait. I couldn’t afford to quit my job,” she shares.
On the other hand, lower middle-class women complain about low milk production because of malnourishment.
According to the survey, the proportion of children who are exclusively breastfed for the first six months of life is highest in Khyber-Pakhtunkhwa (60.7%) and KP-NMD (59.0%), and lowest in Azad Jammu and Kashmir (42.1%) and Balochistan 43.9%.
Prevalence of the practice of continued breastfeeding is highest at one year of age at 68.4% and thereafter decreases to 56.5% at two years of age. Relative to the rates in 2011 this represents a decrease from 77.3% and an increase from 54.3%, respectively.
Dr Abbasi says children who are not breastfed for six months after their birth are more likely to suffer from various respiratory infections, such as, pneumonia and diarrhea. “Mothers must breastfeed exclusively for the first six months and continue it for at least the first year of the child’s life,” advises Dr Abbasi.
However, in urban areas a lot of women cannot breastfeed because there are no daycare centers at their workplaces, informs Dr Abbasi. On the other hand, most offices and organizations don’t allow children at work. “There is no replacement for mother’s milk and formula milk can never be a good substitute to it,” she says.
Related: Breastfeeding Tips For New Moms
It is also important to note that only a small segment of the society can in fact afford formula milk. Dr Abbasi explains that a lot of children are also malnourished because most people turn to lose milk as formula milk is a financial burden, and the former can affect the child’s physical growth and cause various infectious diseases.
Medical officer at the pediatrician department at the Mayo Hospital, Dr Imran Shah says that after six months the child can be fed comfort food. This may include khichri, semolina, kheer and banana. Hence, in case the child can’t be breastfed exclusively, he/she should be fed comfort food.
Moreover, lack of awareness also leads to a decrease in mothers breastfeeding their infants. For instance, a lot of women believe they cannot breastfeed their children if they have Hepatitis or TB.
However, Dr Shah clarifies that women who have AIDs are not allowed to breastfeed. Women who have TB and Hepatitis can breastfeed their children.
He also pointed out that the infant should be breastfed in the first hour of its birth as the mother’s milk has colostrum, which has antibodies and it boosts the strength to fight against diseases.
Most importantly, breastfeeding also strengthens the bond between the mother and the child, he elaborates. “It is also a natural contraceptive and reduces the chances of breast cancer in mothers,” mentions Dr Shah.
How to promote breastfeeding?
Dr Shah says there are things that can be done on governmental level like organizing lectures by medical field officers who talk about the importance of breastfeeding.
“When lady health workers visit houses and talk about these issues, women don’t pay attention to it thinking they are women of their [own] areas, hence they think how can they teach us.”
On the other hand, as the employment rate of women has increased, offices should be encouraged to set up a separate nursing room for mothers, recommends Dr Shah.
Dr Abbasi also says that companies need to revise their policies. “In Pakistan most women don’t get paid leaves and are required to forgo income in order to breastfeed,” she says. “In a country like Pakistan, breastfeeding should not be viewed as a personal choice as almost all women do understand how important breastfeeding is for the health of their children,” she adds.
There is a need to recognize the social and economic realities that curtail options for women who want to breastfeed their kids.