orld Breastfeeding Week is observed every year from August 1 to August 7 to raise awareness, support and promote breastfeeding, including early initiation and six-month exclusive breastfeeding. This year’s theme is Step Up for Breastfeeding: Educate and Support.

There is evidence that there are health and economic benefits of breastfeeding. Both infant health and maternal health are linked with breastfeeding. Colostrum or first milk is rich in proteins that help in newborn’s development and IgA, IgM and IgG immunoglobulin (antibodies), which provide protection to infants. Studies have reported the impact of breast milk on brain development. Moreover, there is an association between breastfeeding and higher IQ in later life. Breastfed babies are less likely to develop asthma, obesity, Type-1 diabetes, ear infections and gastrointestinal infections. With regards to the effect of breastfeeding on maternal health, mothers who breastfeed have a significantly lower risk of having high blood pressure, diabetes, heart diseases and breast and ovarian cancers. The skin to skin contact promotes bonding between mother and child. Lactational amenorrhea leads to birth spacing and acts as a natural method of family planning.

Early initiation of breastfeeding means starting breast milk within an hour of birth. Compared to the initiation of breast milk, it is the continuation of breast milk or exclusive breastfeeding that is not very popular among mothers in the post-partum period. Exclusive breastfeeding (EBF) means giving only breast milk and no other liquid or solid to an infant in the first six months of life. EBF is recommended by World Health Organisation (WHO). A review reported a large percentage of women (up to 50 percent) perceive that breast milk is insufficient. However, in reality, it is only five percent that have a physiological deficiency.

As per WHO globally, the implementation of national and international recommendations remains low, particularly in low-middle-income countries. Pakistan’s national nutritional survey 2018 reports a 5.8 percent rise (from 40 percent in 2011 to 45.8 percent in 2018) in early initiation of breast milk; an almost 10 percent increase (from 37.7 percent in 2011 to 48 percent in 2018) has been observed in exclusive breastfeeding. Khyber Pakhtunkhwa has the highest percentage (61 percent) of early initiation of breastfeeding. One of the factors leading to stunting in children is the lack of exclusive breastfeeding. In Pakistan, currently, 38 percent of children under five are stunted, one of the highest prevalence in the world. In Sindh, 50 percent of children are affected due to stunting.

A study from primary care centres in Lahore to assess mother’s perceptions, understanding and knowledge among those who were unschooled, had intermediate or higher education and had a range of monthly incomes identified 79 percent of highly qualified mothers and families with a monthly income of Rs 100,000 and above preferred formula milk over breast milk. Eighty percent and more mothers in all three educational groups thought that breast milk was not enough and hence supplemental feeding was necessary.

Consumption of formula milk or breast milk substitutes has an impact on breastfeeding.

In a joint effort by WHO and UNICEF, an international code (or set of recommendations) for the marketing of breast milk substitutes (BMS) was adopted in the 34th session of the World Health Assembly (WHA) in 1981. The aim of these recommendations is to protect and promote breastfeeding and guide mothers on the appropriate use of BMS. The international code maintains that breast milk is the first and foremost choice. However, when mothers cannot breastfeed, BMS can be used. The code advises against the promotion of BMS. A report on violations of the code from 1981 to 2021 has been published. Concerns were raised, and WHO and national governments were urged to protect and promote breastfeeding.

A study from primary care centres in Lahore to assess mother’s perceptions, understanding and knowledge among those who were unschooled, had intermediate or higher education and had a range of monthly incomes identified 79 percent of highly qualified mothers and families with a monthly income of Rs 100,000 and above preferred formula milk over breast milk. Eighty percent and more mothers in all three educational groups perceived that breast milk was not enough and hence supplemental feeding was necessary.

To promote breastfeeding, it is necessary to educate not only the mothers but also other family members, particularly elderly members, along with dais (traditional birth attendants), lady health workers, primary care physicians and hospital doctors. Mothers who have a perception of insufficient breast milk or have misconceptions relating to the use of colostrum must be counselled. In addition to the above, health care workers, dieticians, or dedicated consultants can be utilised for this purpose too. Media/ digital promotion, awareness sessions during the antenatal period, use of information leaflets about the benefits of both colostrum and breast milk must take place throughout the year. Mass awareness campaigns must include community-based primary care physicians and primary health care teams (e.g., EPI vaccinators, LHWs) in order to ensure public engagement and follow-up.

Dr Marriam Sheraz is a medical officer in family medicine at the Fatima Memorial Hospital, Lahore

Dr Hina Jawaid is an assistant professor in family medicine at the University of Health  Sciences, Lahore