INFANT and child health is determined by a number of factors, among which maternal health, the healthcare system, immunisation, malnutrition and diarrhoeal diseases stand out. Together these factors have a crucial bearing on child mortality. Pakistan has failed to halt its headlong slide towards the bottom of the child mortality league as demonstrated by our poor performance in under-five child mortality in the MDGs.

In contrast, Bangladesh and Nepal are on track to achieving the target. High child mortality and morbidity can be prevented by the cost-effective measure of promoting, protecting and implementing breastfeeding. Various studies have shown that early initiation of exclusive breastfeeding — within the first hour — and continuing it exclusively for the first six months can go a long way in reducing infant and child mortality and morbidity.

Breastfeeding provides protection against infections, diarrhoea, HIV and malnutrition as well as conferring lifelong immunity against other diseases. In addition, it is also associated with reduced risk of diabetes type 2 in later life in children and breast cancer among mothers. With Pakistan performing abysmally where preventing or treating all the above diseases is concerned, breastfeeding can be one of the silver bullet solutions for protection against these multiple diseases.

However, Pakistan is the only South Asian country where breastfeeding rates have stayed stagnant in recent decades as compared with other countries in the region. In a well-regarded 2006 publication on global health, exclusive breastfeeding in Pakistan between 1990-2002 was reported to be only 16pc. Although Pakistan made some progress between 2002 and 2012, the exclusive breastfeeding rate stayed stubbornly stagnant between 37-38pc during these years. Even this improved rate is miles behind the regional exclusive breastfeeding rates which stand at 70pc for Nepal and 64pc for Bangladesh. These exclusive breastfeeding rates have played a big role in reducing infant and child mortality in those countries.

####Exclusive breastfeeding lowers infant and child mortality.

Many reasons for Pakistan’s neglect of breastfeeding can be adduced. These range from low awareness of the life-saving and life-sustaining benefits of breastfeeding (especially of exclusive breastfeeding) for the first six months and to the aggressive, and unregulated, promotion and sale of baby formula as a substitute for breast milk.

Low uptake of exclusive breastfeeding is also because of illiteracy and governmental failure to undertake public health campaigns to protect and promote breastfeeding, especially exclusive breastfeeding. In the absence of such a drive, bottle-feeding is catching on like wildfire. In fact, the use of formula milk has become the new normal. Backed by expensive media campaigns and the financial incentivisation of doctors, bottle-feeding rates have jumped to an alarming 40pc. Researchers have found that the practice has gained ground among educated working mothers.

The stagnant, and somewhat downward, trends related to breastfeeding should have generated concern among policymakers and public health officials. Yet the protection and promotion of breastfeeding has remained a low priority on the health policy agenda. Government efforts to promote and protect exclusive breastfeeding have been patchy and incoherent. And this is despite the existence of legislation in the form of the Breastfeeding and Child Nutrition Ordinance 2002. The legislation seeks to rein in the aggressive promotion of baby formula as a substitute for mother’s milk at, and in the vicinity of, health facilities.

The ordinance was a delayed corollary of the International Code on marketing of breast milk substitutes that was agreed upon by all WHO member states in 1981. The delayed incorporation of the code into domestic legislation in itself indicates how much value we attach to exclusive breastfeeding in particular and breastfeeding with complementary food for up to two years in general.

Another aspect of the explanation for the unsatisfactory statistics related to breastfeeding lies in the fact that, like much legislation in other fields, implementation has remained a huge issue. However, in recent years, there has been a new impetus towards provincial legislation on the protection and promotion of breastfeeding. KP is the latest province to approve the Protection of Breastfeeding and Child Nutrition Act. This piece of legislation caps other similar legislation passed by other provinces in the past three years.

This legislative advance, though admirable, will not have immediate effect unless the rules specifying implementation procedures are not framed. It took more than seven years to notify the federal child nutrition and breastfeeding ordinance. The hope is that this would not be the case with provincial legislation. However, the situation is unlikely to be very different in the absence of sustained engagement by the provinces and determined advocacy by a coalition of child rights and breastfeeding advocates, nutrition experts, and public health officials.

The writer is a development consultant and policy analyst.

Published in Dawn, October 16th, 2015

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