PAKISTAN: More work needed on breastfeeding awareness
Posted by African Press International on April 22, 2012
LAHORE, – Low awareness of the benefits of breastfeeding in Pakistan poses a significant health risk to infants, say experts.
The tin of infant formula milk in Nargis Bibi’s kitchen stands on a high shelf, along with two feeding bottles. As she offers a bottle to her firstborn, a son aged nearly four months, Nargis, educated to grade five and the wife of a corner shop owner, tells IRIN: “I know all about boiling water to mix the formula, and I also wash the bottles in hot water.”
She says she is feeding her child mostly formula rather than breast milk because she believes “it will make him bigger and stronger. My milk was no longer enough.” Nargis has not heard about the World Health Organization (WHO) recommendation that infants be exclusively breastfed till they are six months old, or of the benefits of this. “All my sisters fed their babies formula. They are older than me and they strongly advised me to do the same,” she added.
“The indicators we have show Pakistan has fallen behind its neighbours as far as good breastfeeding practices go, and this plays a major role in the high child and infant mortality rate in the country,” said Baseer Achakzai, director of the Nutrition Wing at the National Institute of Health, Islamabad.
Pakistan’s under-five mortality rate stands at 87 per every 1,000 live births, according to the UN Development Programme’s Human Development Report for 2011, making it one of the highest in the region.
According to the Pakistan Demographic and Health Survey 2006-7, only 37 percent of infants are exclusively breastfed till six months. “This proportion is very low when compared with the recommended 100 percent exclusive breastfeeding for children under six months,” the survey said. “The propensity to feed infants under two months with plain water (13 percent) and other milk (28 percent) is high. At 2-3 months, the propensity to feed plain water and other milk increases further.”
“Even now there are so many mothers who are simply not aware of the need to exclusively breastfeed infants. This is something health workers in communities and paediatricians everywhere need to promote far more aggressively and actively,” said Anees Fatima, a paediatrician at a government hospital.
A major cause of diarrhoea among infants, she told IRIN, was improper sterilization or the making up of formula with unboiled water. “Such gastrointestinal infections are a major cause of childhood death, especially among younger children who get dehydrated quickly.” She also pointed out recent studies conducted around the world had shown that breastfeeding “protected against a variety of infections”.
But many mothers remain unconvinced. “Look at me, I am weak and often sick. What good can my milk do my newest baby?” asked Fakhra Bibi, 35, a mother of five in a semi-rural area on the outskirts of Lahore. Rather than breast milk, she feeds her daughter, aged two months, a mixture of honey with water and a formula. “I sometimes add less powder to the water than the amount written down because we are poor, and cannot afford to buy too many tins,” she said. Fakhra’s husband works as a farm labourer, earning some 6,000 rupees (US$67) a month.
“We try to encourage all women to breastfeed, but it is not easy to change ideas. We also try to promote better nutrition for mothers, many of whom are anaemic,” Asma Akhtar, a Lady Health Worker who works in the area under a government scheme, told IRIN.
While Pakistan passed a specific law in 2002 to promote breastfeeding, this has had little impact on the ground. “I have heard only very vaguely about the law. The mothers I work with have heard nothing of it,” Akhtar said.
“Besides, more than laws, what we need to do is to persuade mothers that breastfeeding exclusively till six months is beneficial to their baby’s health. Too many feed formula, in addition to their own milk, because they have been told it is `better’,” she said.
“We need to catch up with other nations and make sure people are aware about breastfeeding benefits,” the National Institute of Health’s Achakzai said.
But the task for now seems to be a challenging one, with Nargis Bibi saying: “I have been told, and also read, formula has many vitamins. Surely these are good for my baby.”