KARACHI, Aug 2: With World Breastfeeding Week (Aug 1-7) already under way, it is disconcerting to note that Sindh has no set of laws to ensure safe and adequate nutrition for infants by promoting and protecting breastfeeding.

Interviews with relevant officials show that following the devolution of various federal government functions to the provinces under the 18th constitutional amendment, the health authorities in Sindh have failed to acquire the tool needed to curb the unethical marketing of breast milk substitutes and regulate artificial feeding in infants.

Many products, according to researchers, pose a high risk of gastrointestinal and lower respiratory tract infections.

“Not only are markets filled with various infant formula products, representatives of their manufacturers are also often seen distributing free samples and gifts in hospitals besides offering sponsorships to health professionals working in paediatric in-patient and outpatient wards, delivery suite, antenatal and postnatal care wards,” says a senior paediatrician while speaking to Dawn on Thursday.

Pakistan, which is among the 118 countries that voted in favour of adopting the International Code of Marketing of Breast-milk Substitutes during the World Health Assembly in May 1981, enacted a national breastfeeding law in October 2002 in the shape of a presidential ordinance to enforce the code.

The ordinance called “Protection of Breastfeeding and Child Nutrition Ordinance-2002” prohibited promotion of any milk produced as partial or total replacement for mother’s milk or represented as a complement to mother’s milk to meet the growing nutritional needs of an infant. The law also envisaged formation of a national board to monitor implementation and pinpoint the companies or individuals violating the law for prosecution and suspension of licence. It prescribed imprisonment and fine for violations. The ordinance required from health workers to encourage, support and protect breastfeeding.

Following the devolution, Punjab and Balochistan have in recent months adopted their own sets of laws related to breastfeeding and child nutrition by amending and substituting various sections of the federally-introduced ordinance of 2002, says a source in the health department. However, the source adds, Sindh is yet to have a set of laws to ensure safe nutrition for infants by promoting and protecting breastfeeding.

Feeding practices

According to experts, infant and young child practices directly affect the nutrition status of children under two years of age and ultimately impact child’s survival. Improving infant and young child feeding practices in children 0-23 months of age is therefore crucial to improve nutrition, health and development of children.

Unicef and WHO recommend that children be exclusively breastfed, with no other liquids (including water) or food during the first six months.

The national nutrition survey report of 2011 says that 40.5 per cent mothers initiate breastfeeding within an hour of birth. The percentage is greater in rural areas (41.4pc) than in urban areas (38.4pc). The trend of early initiation of breastfeeding is 50.5pc in Sindh, it adds.

According to Save the Children’s 13th Annual State of the World’s Mother Report (2012), which describes the rating of Pakistan in relation to the early feeding as poor, children in an alarming number of countries are not getting adequate nutrition during their first 1,000 days.

The percentage of children put to breastfeeding within one hour of birth in Pakistan is determined at 29. While 37 per cent of children are exclusively breastfed for first six months, 36pc children are breastfed with complementary food between six and nine months, and 55 per cent are breastfed till the age of two years, the report says, adding that progress of the country towards millennium development goals (MDG-IV) by 2010 remained insufficient.

Chairperson of Pakistan Paediatrics Association Dr Khalid Zuberi says breastfeeding is the best way to provide newborns the nutrients they need. “Not only parents and families, but also doctors, nurses, lady health workers and birth attendants are required to be educated and informed about benefits of exclusive breastfeeding until a baby is six months old,” he says. A child should be breastfed as soon as possible after birth, he says.

About breastfeeding, he says, parents from both rural and urban backgrounds have misconception that needs to be addressed.

He adds that mothers should be told that there is no need to delay the feeding until the colostrum phase is over. Similarly, efforts should be made to get rid of the traditional practice of prelacteal feeding (ghutti, gurr or honey) as newborns after developing a taste may not easily accept breast milk, he says.

Highlighting the need for laws and regulations related to the protection of child feeding and child nutrition, Dr Zuberi observes that the sooner the law is adopted and implemented in Sindh the better it will be, as it will help create an environment and ensure holistic approach towards promotion of breastfeeding. He warns that the marketers are somewhat influencing the basic role of paediatricians and gynaecologists to safeguard the mother and child health.

Dr Tauqirullah Khan, a nutrition programme officer of the Sindh health department, says that the government has been making all-out efforts to increase exclusive breast-feeding (EBF) rate. While mothers, their families and in-laws in rural areas are less educated on the subject, working mothers in urban areas have no sufficient time to breastfeed their child, he says.

Dr Khan says social and cultural misconceptions related to this matter need to be addressed.

In his opinion, the law pertaining to the provision of protection of breastfeeding could not be enacted due to some technical inconsistency in the health department.

“But the law is the need of the hour and things are now moving towards legislation following which the formation of a provincial infant feeding board may also become possible,” he says.


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