Hooray,
the Balochistan Assembly has finally enacted the Balochistan Protection and
Promotion of Breastfeeding and Child Nutrition Bill 2014 on January 14 however;
the real test is its implementation in letter and spirit. I am saying this
because we know that the Protection of Breastfeeding and Young Child Nutrition
Ordinance 2002 is on the statute books since 2002 but its implementation has
always remained a distant dream.
As
most of us know, Pakistan is not on track to achieve Millennium Development
Goal (MDG) 4 targeted to reduce under-five mortality rate by two-thirds between
1990 and 2015. We know that around 700 days have left only to achieve our
target. Countries like Bangladesh and Nepal are on track to achieve the MDG 4.
Remember that in 1990; Pakistan’s under-five mortality rate was 138
per 1000 live births as compared to those of Bangladesh (139 per 1000 live
births) and Nepal (135 per 1000 live births). However over the past two decades
there has been remarkable change, Bangladesh was able to lower its under-five
mortality rate to 41 and Nepal to 42 which put them well on track to meet their
MDG 4 targets for 2015 while Pakistan is still struggling at 86 per 1000 live
births. With the World’s highest national number of newborn deaths (194 000 in
2010), the neonatal mortality declined by only 0.9% per annum between 2000 and 2010 in Pakistan; less than the global average (2.1%) and less than national maternal
and child mortality declines.
A
major source of killer diseases among Pakistani children is the lack of
exclusive breastfeeding and the use of unhygienic bottles, formula milk and
teats. Pakistan has failed to achieve any significant progress in increasing exclusive
breastfeeding for six months in the last decade. “Exclusive
Breastfeeding is defined as only breastfeeding and no additional food, water or
other fluids for first 6 months of life”. Only 38% of infants in Pakistan are exclusively breastfed for 6 months
according to the preliminary findings of the Pakistan Demographic and Health
Survey (PDHS) 2012-13. This is
indicative of the fact that there is hardly any improvement since PDHS 2006-07
when the exclusive breastfeeding for six months was 37%. The PDHS 2012-13
findings also shows increase in bottle feeding rates in Pakistan.
On
the contrary, in Bangladesh the rate of exclusive breastfeeding for six months
is 64% while in Nepal it is 70%. Bangladesh was able to increase the rates from
43% in 2007 to 64% in 2012 by
commitment at all levels. This was also possible because of the active
involvement of the civil society and
media in the campaigns for the promotion and protection of breastfeeding.
Breast
milk is a powerful intervention which can significantly reduce infant
mortality. Save the Children’s Super Food for babies
report refers to breastfeeding as the closest thing to a ‘silver bullet; in the
fight against malnutrition and newborn deaths. This is apparent from the fact
that an estimated 22% of newborn deaths could be prevented if breastfeeding
started within the first hour after birth.
“Babies
who are not exclusively breastfed in the first six months are at 14 times
higher risk of dying than exclusively breastfed infants” said renowned
Paediatrician and President of the Advocacy and Advisory Network on Newborn
(AANN) Dr. Tabish Hazir
during an event. He further stated that Pakistan has the highest bottle feeding
rates in South Asia which calls for the strict implementation of the breastfeeding
and marketing code, capacity building of the healthcare providers at all levels
for improved breastfeeding counselling skills and revision of the undergraduate
curriculum with greater emphasis on good Infant and Young Child Feeding
practices including exclusive breastfeeding.
Research
shows that early initiation of breastfeeding
benefits the immunity of a baby, reduces the risk of neonatal sepsis and
respiratory infections and is also associated with higher rates of
breastfeeding and lower rates of diarrhea throughout the first six months of
life. According to a new study in Greece, children who were
breastfed for more than six months scored the highest on cognitive, language
and motor development tests as toddlers.
According
to the findings of a qualitative assessment done to explore factors responsible
for the violation of the Code in Pakistan many healthcare providers are
unaware of laws related to the protection of breastfeeding.
To be
able to witness in our lifetime that no child will be born to die from a
preventable disease, it is imperative to put breastfeeding at the centre of our
efforts. This means not only the involvement of the government and the health
system, but also of the media and the community. Steps to eradicate major
barriers such as community and cultural pressures; the shortage of frontline health
workers i.e. Lady Health Workers who cover only 60% of the population; lack of
maternity legislation and inappropriate promotion of breast-milk substitutes are
also important to ensure that every infant receives the life-saving protection
that breastfeeding can offer. Similarly, the breast milk substitutes producing
companies should abide by the Code and dedicate 1/3 of all BMS packaging to a
warning label stating that formula is inferior to breast milk.
This
has also been made mandatory under the Protection of Breastfeeding legislation
in Pakistan. The Sindh Protection and Promotion of Breastfeeding and Child
Nutrition Act 2013 has made it mandatory
for the BMS companies to include a warning in Urdu and Sindhi languages that
formula is inferior to breast milk. An Infant Feeding Board has
been notified at the federal level to monitor the implementation of the federal
law. Punjab requires to effectively implement the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment)
Act 2012 while Khyber Pakhtunkhwa has
committed at the highest level that soon it will also enact a legislation for
the protection and promotion of breastfeeding.
The writer holds a Masters in Human Rights from the London School of
Economics is working for the promotion and protection of child rights. He
tweets @amahmood72
This blog also appeared in Tribune Blogs http://blogs.tribune.com.pk/story/20611/here-is-why-every-woman-should-breastfeed-her-child/
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