SAIRA had twins through IVF. As it was a precious pregnancy, she underwent a planned Caesarean section, after which the nursing staff whisked away the babies to the ‘hospital nursery’. The babies were healthy and stable, but were only brought to Saira for breastfeeding 24 hours later. They were bottle-fed formula multiple times in the interim. Neither baby was now interested in latching onto Saira, who, though suffering from excruciating post-surgery pain, was still balancing her attempts to feed the twins. The first thing her mother-in-law said to her was: “These days, girls just don’t want to breastfeed.” This broke an already tired Saira’s heart and she experienced her first bout of depression.

Our country does not have a well-developed allied health services sector. Respected areas that demand highly qualified personnel, including mental health professionals, nutritionists, chiropractors, etc, routinely go unregulated in countries like ours. The nursing staff is not trained as strong professionals; they end up doing menial tasks. In contrast, nursing in the developed world is a well-paid field, with its own specialisations, and staffed with highly qualified personnel.

Another area which most of us have never heard of is that of lactation consultants. An International Board Certified Lactation Consultant is an important position in any healthcare setting. Mostly registered nurses wishing to specialise in infant feeding take this as an additional step towards career progression. However, the UK currently has a large number of IBCLCs from non-healthcare backgrounds like mine. As non-healthcare providers, we have to clear 14 health sciences subjects with college-level credits, consistently maintain international life support certification and complete an intensive course in medical terminologies before embarking on 95 hours of lactation-specific education. We also have to complete 1,000 hours helping mothers breastfeed their babies (or 500 hours if training under a qualified IBCLC). Then we register for a four-hour comprehensive exam to become an IBCLC. This qualification needs recertification every five years, which, in turn, requires constant studying and clinical practice.

Even today, in the American residency programme, the correct answer to an exam question pertaining to breastfeeding is always ‘to refer to a lactation consultant’, as globally, doctors do not study lactation as a function of the human body. Most of my own patients are doctors and specialists themselves.

With the current level of knowledge, or the lack thereof, most doctors in Pakistan daily pass along old wives’ tales and harmful hearsay as medical advice. ‘Feed 15 minutes from each breast and then offer a bottle’ is their usual suggestion. This has succeeded in not only jeopardising but also ending thousands of breastfeeding journeys. Many of the babies in the Neonatal Intensive Care Unit who are given formula instead of breastmilk have undergone major surgeries within their first year, and are exposed to reduced gastrointestinal function — formula increases the risk of necrotising enterocolitis manifold in NICU babies.

Lactating mothers need support.

Many of the nurses and student nurses I train in providing breastfeeding support soon return to harmful cultural practices as, by design, they don’t see the importance of the process. The first points of post-natal support are hospital staff and close family — both need constant and comprehensive education on the new mother’s bre­astfeeding journey. The state needs to prioritise breastfeeding beyond the suffocating lactation pods at airports and once-a-year photo ops.

Breastfeeding is im­­portant not only for the first seven days of August (World Breastfeeding Week). It is essential and must be prioritised every day of the year. This is not a new-age fad. It is undeniably the most important decision made for a newly minted population for a lifetime of health outcomes, especially in a country where 45 per cent of the people live below the poverty line, with abysmal access to food sources and healthcare.

Mothers need help, and professionals need education and support in the form of more effective allied health professionals. The public in general needs to understand that breastfeeding is teamwork. A mother physically feeds the infant, but the entire household must come together to facilitate her and help protect the breastfeeding journey. Everyone is a stakeholder. Leave petty clashes for other matters. We need to be united within the household and outside. Everyone has a role to play. Find yours.

The writer worked as a finance professional. Motivated by personal breastfeeding challenges, she transitioned to healthcare. She is an IBCLC and trains healthcare professionals, provides global telehealth support and runs a lactation clinic in Lahore.

Published in Dawn, August 5th, 2025