FATIMA had a pretty textbook pregnancy. Nauseous in the first trimester, uneventful rest of the run. Towards the end, despite everything being completely routine, her labour stalled midway and she had to go for a caesarean section.

She was equipped with everything ranging from baby cotton buds to bamboo fibre diaper liners. She had read every popular book on pregnancy, downloaded all the tracking apps and joined every forum online to help raise her child the best possible way.

She knew she wanted to breastfeed her baby but that’s almost all she knew about it. That it’s the healthier choice.

Zainab was just as ready for welcoming her new baby into the world yet with similar information about breastfeeding. As she sighed at images of women serenely nursing their newborns, this was what she wanted more than ever. She had a natural delivery and all went as planned.

Despite having informed the hospitals of their choice to breastfeed, the babies were immediately whisked away to the nursery and fed a bottle of formula before being brought to them hours later.

The first seven days of August marked World Breastfeeding Week 2020

Fatima’s baby refused to latch and cried incessantly while her mother and mother-in-law tried to convince her that her supply just wasn’t enough to satiate the child. After being fed a bottle of artificial milk, the baby went to sleep comfortably and everyone went about their business. The dream of breastfeeding turned to ashes, and Fatima was left with a feeling of inadequacy that her body was incapable of nourishing her child.

Zainab’s baby latched but within the first week she was also convinced that the baby needed more than she could produce so she must ‘top up’ with a bottle after every nursing session. Five days down the road, the baby started rejecting breastfeeding and her supply dwindled. Her breastfeeding journey came to a premature end, with the child being completely moved on to artificial milk.

These are the stories that have been normalised over decades.

The global surge in artificial milk promotion around the 1960 and 1970s led to it being pushed relentlessly — more so in developing countries — convincing mothers and medical professionals of the ease and quality of formula milk.

The women who had babies then are the grandmothers of today. While the World Health Organisation and the rest of the world resisted the practice, dragging formula-producing companies to court for their manipulative advertising practices, this campaign quietly continued right though the 1980s. It never ended.

When Fatima’s and Zainab’s great-grandmothers had their first babies, their families included women who had exclusively breastfed. These women knew exactly what to do postpartum and initiate breastfeeding immediately and effectively, with minimal intervention to disrupt the natural transition. Come the following generations, that tribe morphed into a village of women convinced that formula is the next best thing to sliced bread.

By the time it was Fatima and Zainab’s turn, the powerful narrative of ‘you don’t make enough milk’ overshadowed the support that initiates the natural process of breastfeeding postpartum.

Where these Pakistani millennials are concerned, medical professionals and families who can see them through their transition into motherhood lack support for breastfeeding. In fact, they are primed, by ignorance rather than malice, to sabotage their breastfeeding journeys before they even begin.

While in the US there are multiple international board certified lactation consultants in a hospital, Pakis­tan does not have a single practising IBCLC. Any doctor and/ or specialist needs to sit for six additional comprehensive exams and complete 1,000 clinical hours before being certified as a lactation consultant.

Breastfeeding like many other activities needs to be categorised as a basic life skill. Unless we start including it in our general curriculum as part of biology lessons and in our baseline MBBS and nursing curriculums in enough detail to equip medical professionals with knowledge to rebuild the tribe that would allow breastfeeding to initiate, millennials are stuck between a rock and a hard place. Higher rates of postpartum depression emerge as their need to breastfeed fails to materialise.

While the rest of the world reverts to supporting and promoting breastfeeding, we remain captive to myths that make it difficult to convince mothers of the benefits of something their bodies are designed to do.

The journey of breastfeeding, from being perceived as a novelty to something that is a natural practice, is long and winding. It involves hospitals, medical professionals, husbands, mothers, siblings and the public at large to be educated on how the practicalities of nursing a child unfold and how each one of them must play their part in supporting a lactating mother in her journey to build a healthier planet. n

The writer is a lactation counsellor, a student IBCLC and a member of LCGB and ILCA.

Published in Dawn, August 8th, 2020

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