THERE is much hue and cry over the government’s proposal of making infant formula milk and other baby foods expensive. The general refrain is that it will lead to even more malnutrition among Pakistani babies. Opponents, citing the National Nutrition Survey of 2018, say that already four out of 10 children under the age of five are stunted while 17.7 per cent suffer from wasting.
The outcry over the proposed 17.5pc GST on baby food seems to suggest that most babies in Pakistan are fed on preservative-infested canned milk and food instead of mother’s milk or home-cooked wholesome fresh food.
There is some truth in that. While not a majority, a confoundedly large number of Pakistani babies miss out on mother’s milk. According to the Pakistan Demographic and Health Survey (PDHS)of 2017-2018, the early initiation (within the first hour of birth) of breastfeeding in the country stands at a mere 20pc while only 48pc of mothers practise exclusive breastfeeding for six months. Given such dismal stats, one would like to think that taxing formula baby milk and canned food may just act as a deterrent to discourage the use of formula in favour of mother’s milk.
But there are simpler ways to root out malnutrition in Pakistani children, experts will tell you. And it is closely connected to the mother’s well-being. It is important to ensure that the woman’s physical and mental health, especially during pregnancy and nursing, is optimal. That can be ensured through providing her with nutrition, supplements and adequate rest and comfort so that she is able to feed her baby without compromising on her own health or getting anxious about not finding the privacy to carry out this important task. If, for the first six months of a child’s life, her/his mother is treated as someone special, there is no reason for the infant to be malnourished. This, in turn, will result in a healthy adult.
For mothers to continue breastfeeding, good nutrition and plentiful milk are not the only requisites.
The first step towards translating this into action is by ensuring that just three essential food items — aata (wheat flour), daal (legumes) and cooking oil — are made so affordable that the poorest of families can sleep with a full stomach. Although the latest PDHS shows that the proportion of underweight women has decreased from 14pc to 9pc, the proportion of married women who are overweight or obese has increased from 40pc to 52pc; it does not signify they are healthy. In fact, according to 2019 data from Nutrition International’s Food Fortification Programme, up to 41.7pc women of reproductive age in Pakistan are anaemic, 18.2pc iron-deficient, 27.3pc deficient in Vitamin A and 79.7pc in Vitamin D. These deficiencies find their way into their children.
In the long run, malnourishment, as the prime minister pointed out in his first address to the nation when he compared the X-rays of a two-year-old malnourished child’s brain with those of a healthy toddler’s, will impact not only physical but also cognitive development, leading to reduced learning abilities and lower productivity in adulthood. Today, 53.7pc of under-fives suffer from anaemia, 51.5pc from vitamin A deficiency, and 62.7pc from vitamin D deficiency.
One way to address this is by fortifying food. Last year, Sindh became the first province to legislate on mandatory food fortification. The Sindh Food Fortification Bill, 2020, mandates all wheat flour mills to fortify flour with iron, zinc, folic acid and Vitamin B12, while cooking oils must be fortified with vitamins A and D. It awaits the governor’s signature for the Sindh Food Authority to enforce the law. Balochistan also got its food fortification bill passed in the assembly. Other provinces need to follow suit.
With the proportion of births assisted by skilled birth attendants having increased significantly to 69pc, new moms can now be instructed and assisted in the initiation of breastfeeding. It will go a long way in getting mothers to continue this for at least the first six months and even beyond.
Although most healthcare providers know about the significance of early initiation of breastfeeding, it may not always be emphasised by them at birth, at least not enough to discourage new parents from using breastmilk substitutes. At times, it is the health practitioner who advises mothers to supplement without assessing lactation failure when mothers say they are unable to produce milk for the baby, instead of encouraging frequent suckling to help them do so. Supplementing interferes with the natural demand and supply process and when the baby is given formula milk, the mother’s body does not get the tip-off to make more milk.
However, for mothers to continue breastfeeding, good nutrition and plentiful milk are not the only requisites. They need a conducive family and strong institutional support. Tragically, neither is on the horizon whether in a rural or an urban setting. From domestic help to women working in government offices or MNCs in cities, to those working in fields in villages, new mothers do not get enough rest to recoup or the necessary privacy to breastfeed in comfort.
For the urban woman, working from home or having a flexible and hybrid working arrangement as was made possible during the Covid-19 lockdown, can be incorporated in offices at least for the first six months for her to make the transition back to work and still be able to continue to breastfeed her newborn.
But if she has to return, and in the absence of a crèche at her workplace (where she can leave her little one and go every couple of hours to hold and feed her), she must be educated on how to pump milk for use by the carer at home, in her absence.
With more women joining the workforce, it is time laws that protect and promote breastfeeding and child nutrition in the provinces are revised. Sindh has been doing some mulling and has included a six-month maternity leave for women. It has also added a clause to stop the distribution of canned baby milk and food during emergencies in the amended version of the breastfeeding law which one hopes gets approved soon.
The writer is a Karachi-based independent journalist.
Published in Dawn, January 17th, 2022