According to a WHO-UNICEF report released in 2017, no country in the world fully meets the recommended breastfeeding standards and only 23 out of 194 nations, have exclusive breastfeeding rates above 60 per cent. Statistics suggests that 44 per cent of children are stunted (lower height for age, having poor cognition and other development milestones) in Pakistan. The country stands at 18 per cent for ‘early initiation of breastfeeding’ and only 37.7 per cent of mothers practise ‘exclusive breastfeeding for six months’. If there is compliance to healthy breastfeeding - exclusive and complementary - for two years, it could significantly reduce stunting in Pakistan.

Unfortunately, the current scenario of stunting in the country is stagnant, as revealed by the National Nutrition Survey 2018 published in June this year that over 40 per cent of children under the age of five are stunted. When it comes to rural areas, majority of the population is unaware of breastfeeding benefits and the care a mother requires during this time. Most mothers rely on misplaced local traditions that feeding new-borns concoctions like crushed herbs, tea, honey etc are better than their own milk.

While in urban centres, there aren’t such traditions, but it has its own range of obstacles - not having sufficient time to rest, a place to breastfeed, be able to store their milk hygienically - that lead mothers to abandon breastfeeding partially or completely. Breastfeeding while working adds another dimension to the challenge of nursing. And working women often have to make a tough choice to either compromise on their child’s nutrition or their career.

38-year-old Maria Ahsan is a working mother. While she was willing to breastfeed her child, she struggled doing so while continuing her job. “I had a C-section so it was harder for me to breastfeed initially. After a while, I got the hang of it and breastfed my daughter. Since I had to continue my job, I only breastfed my child for 20 days exclusively and then had to introduce formula milk. At my workplace, there was no privacy and no clean room where I could nurse her comfortably. A close friend of mine advised against getting my child used to breastfeeding since it gets really difficult while working. I tried to breastfeed my daughter along with formula milk just so I’m not depriving her of the necessary nutrients needed for her immunity. I would bring her to work sometimes and then have someone pick her up later. Other days, I would leave for home early but all this was not feasible. I feel guilty about it. If there was a day-care or a facility as such, I would’ve continued breastfeeding her for a year and a half at least,” she narrates.

Alefyah Hasnain, a 28-year-old mother, has a similar story. She used to work at a digital agency but had to quit her job when she was nearing her delivery. “I knew I was going to breastfeed my chid and even my husband insisted on it. However, my employer failed to inform me of my maternity leaves and I had quit in order to care for my child. Although, given the choice, I would have continued working,” she recounts.

Research shows that paid maternity leave policies can help reduce infant mortality by 13 per cent. Paid leave enables women to physically recover from childbirth and regain their physical, mental and emotional health in the short- and long-term. Apart from maternal leaves, paternal leaves are just as important which enable fathers to prioritise family-related responsibilities, while meeting work demands. Fathers who are given leave are able to work with mothers and shape a parenting and breastfeeding team. Working as a team can empower parents and enable exclusive breastfeeding. If these policies are implemented across the board, it will significantly increase the overall well-being of the family, 

While Alefyah is currently a stay-at-home mom and takes good care of her one-year-old son, she has observed a lot of unsolicited criticism and behaviour when it comes to breastfeeding. “You don’t realise how hard and time-consuming breastfeeding actually is until you experience it. Initially you would have to feed your child very frequently and at very odd times too. It is one of the reasons why mothers living in joint families often revert to bottle-feeding - willingly or unwillingly - to do house chores. Many of my friends had to stop breastfeeding because of the pressure from their in-laws. Also, one issue that I face constantly is to feed my son in public. While there are certain malls with specific areas designated for nursing mothers, there is no concept of ‘mother rooms.’ I don’t expect it to be in bazaars, of course, but even at big restaurants there is no room for nursing. Even at prayer rooms in malls, women give you weird and disdainful looks if you are breastfeeding your child in a corner. They expect you to rather do it in the toilet which is just absurd. I have been often told by aunties at gatherings to start giving my child the bottle so I don’t have to breastfeed in public. My husband is very supportive in this regard as he would encourage doing what is best for the baby and me. He very well understands my exhaustion and helps me out with it. In public, if there is no place to go, he would sit with me in the car so I could breastfeed,” she expresses.

It is not an easy task

According to General Physician Dr Rana Farukh, no formula milk can replace a mother’s feed, unless a mother is unable to lactate due to health reasons. “A mother can try by improving the breastfeeding position so the baby can latch effectively, consume foods and beverages rich in calcium and other nutrients, increase the consumption of fluids and fruits and take milk producing supplements at a doctor’s recommendation. If nothing works, then only it is feasible to look at alternates,” she explains. “Soon after birth, the mother’s breasts secrete milk-like fluid colostrum, enriched with the immunity boosters called the immunoglobulin. These act as a reserve army and fight as the first line-of-defence until the new-born’s own immune system kicks in, which is why breastfeeding is essential for the baby. On the other hand, for the mother it balances the hormones after delivery, reduces the risks of breast and ovarian cancer, type II diabetes, postpartum depression and even serves as a contraceptive. For top feed, you have to go through the packaging of the milk and then dispensing it into sterilised feeders. The risks that arise from using infant formula are the use of potentially unsafe water, unsterilized equipment or the possible presence of bacteria in powdered milk. While there is a niche for formula milk in a few cases, breastfeed is still a top priority,” she informs.

A common misconception that prevails is if the child doesn’t look visibly chubby or has a lean physique, s/he would be considered ‘weak’. For this, mothers are often asked to stop breastfeeding or introduce formula milk. “If your child is achieving all the milestones and performs well on the health scale, there is no need to be worried about the weight of the child. A chubby baby is not necessarily a healthy baby,” Dr Rana clarifies.

While breastfeeding is beneficial for the mother and the baby, it can be physically and mentally exhausting as well, “Breastfeeding is not an easy task; rather it’s quite painful at the beginning, followed by the added responsibilities a woman is expected to take and unpredictable schedule of the baby. The sleepless nights, cracked nipples, developing breast abscesses, listening to a thousand critics from the friends and family, exhausting daily house chores, never-ending lists of expectations from the people might push you towards postpartum depression. For this, mothers have to stay optimistic and seek regular medical advice so that they can enjoy the motherhood and not stress out,” she suggests.

“Usually, new mothers are seen around sleep-deprived, exhausted, overburdened by the daily chores which must not be the case. The caretakers must ensure that the mother gets proper sleep, stays well-hydrated and consumes nutritious food (including fruits and dry fruits), along with the positive vibes surrounding her in terms of help with the other responsibilities. Fathers especially play a critical role here as their support is indispensable from taking care of the baby to keeping the mother happy,” Dr Rana stresses.

It is a team effort

World Breastfeeding Week is celebrated every year from 1st to 7th August to encourage breastfeeding and improve the health of babies and their mothers around the world. It commemorates the Innocenti Declaration signed in August 1990 by government policymakers, WHO, UNICEF and other organisations to protect, promote and support breastfeeding. This year’s World Breastfeeding Week slogan is ‘Empower Parents, Enable Breastfeeding’.

It is imperative that both parents are empowered in order to give a healthy and happy lifestyle to their babies. Research shows that paid maternity leave policies can help reduce infant mortality by 13 per cent. Paid leave enables women to physically recover from childbirth and regain their physical, mental and emotional health in the short- and long-term. Apart from maternal leaves, paternal leaves are just as important which enable fathers to prioritise family-related responsibilities, while meeting work demands. Fathers who are given leave are able to work with mothers and shape a parenting and breastfeeding team. Working as a team can empower parents and enable exclusive breastfeeding. If these policies are implemented across the board, it will significantly increase the overall well-being of the family, given that paternity leaves are not compromising existing maternity leave benefits or leave availability.

From a nutrition point of view, a healthy diet id pivotal for a good lifestyle. Unfortunately, malnutrition (particularly micronutrient deficiency) is a major challenge in Pakistan. Estimates have suggested that 51 per cent of women are anaemic, 37 per cent iron deficient, 46 per cent deficient in vitamin A and 69 per cent in vitamin D. When a mother suffers from such deficiencies, ultimately she experiences a host of issues after birth and these problems prevails in her child as well. To combat the issue, the UK government’s largest Food Fortification Programme (FFP) is working with provincial governments (Punjab, KP, Sindh) to make food fortification compulsory through food authorities’ by-laws, regulations, quality control and regulatory compliance mechanisms. Food fortification adds essential vitamins and minerals to staple foods. It helps prevent deficiencies and provide nutritious food which will promote the health of the general public especially women and children. Wheat flour and edible ghee/oil industries have a social responsibility to provide fortified and high-quality product. It is imperative that the consumers are provided with fortified food so these deficiencies can be avoided in the future generations.

Moreover, for babies, it is necessary that healthcare professionals are less enthusiastic about recommending formula milk to parents. They should instead try to emphasise on the importance of breastfeeding to the parents. Government should also ensure that all formula milk brands mention the benefits of breastfeeding and the health risks of substitutes on their packaging.

Breastfeeding is the mother’s domain but it is still a team effort. With close support from fathers, families, workplaces and communities it becomes easier to create a healthy environment for a mother to breastfeed. To achieve the goal of reducing stunting and rearing a healthier generation, we must empower both parents.