Breastfeeding: A key to save children's lives

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/

 

 

 

 

Innocence lost: Child domestic labour

The murder of a 10 year old child domestic worker Irum by her employers in Lahore made headlines last week. I’d like to share with readers however, that Irum’s cruel torture to death is not the first case of torture to death of a child domestic worker in Pakistan. Approximately 45 cases of violence against child domestic workers were reported in media since Shazia Masih’s tragic and cruel murder in January 2010 in Lahore. Irum is 22nd child domestic worker tortured to death and majority of these cases have been reported in Punjab. Iram’s murder was the first case of torture to death of child domestic workers in 2014 followed by two other such cases of 16 year old and 12 year old Fizza Batool all from Lahore.

If someone has any doubts, please google Shazia Masih (Lahore), Jamil (Multan) Yasmin (Okara), Shehzad (Gujranwala) Tehmina (Islamabad) to name a few. All these cases show that child domestic labour is one of the deadliest form of child labour in Pakistan. However, the federal and provincial governments in Pakistan have failed to respond to the situation. The problem with Pakistani society is that we have short memories and forget about such cases after a few days. We don’t have any follow up mechanism and such cases remain in the limelight till media keep following it. Once media loss its interest, everyone forget about it until the new reported case in a few months’ time.

Similarly, the Government is constantly in denial mode despite the fact that it has been proved by the brutal torture to death of 22 child domestic workers. A much higher number got injuries including lifelong injuries and a number are missing. There are organized gangs who are involved in internal trafficking of children and are providing children as domestic servants in big urban centers. The federal government is required to put an immediate ban on child domestic labour by adding child domestic labour in the schedule of banned occupations under the Employment of Children Act (ECA) 1991 through a notification in official Gazette.

The only argument from those in the government against putting child domestic labour in the schedule of banned occupations under the ECA is that it wouldn’t be possible for Labour Inspectors to conduct inspections of houses. In my opinion even where labour department can conduct inspections, what achievement has been made by them or what positive impact is created as for as labour rights in Pakistan is concerned? Agreed that policing is not a solution however, the ban will send a signal to those educated people, bureaucrats, parliamentarians and common people that this is something against the law. Extensive awareness raising campaigns by civil society will help reduce the number of child domestic workers and will also put the employers on an alert against torturing innocent children.

Similarly, I’ll also request Chief Minister Punjab to take a proactive action and immediately ban child domestic labour under the schedule of banned occupations of the Punjab Employment of Children (Amendment) Act 2011. This is important as almost twenty of the twenty two child domestic workers’ torture to death cases have been reported from Punjab. The Government of Punjab should wake up now and respond to this situation.

For resolving the issue of child labour on sustainable basis in Pakistan, the federal and provincial governments should make serious efforts to implement Article 25-A of the Constitution of Pakistan about right to free and compulsory education for children 5 to 16. The Government of Punjab should immediately enact the Right to Free and Compulsory Education Bill and make sufficient budgetary allocation for the implementation of the law.

This blog first published in Tribune Blogs on January 06, 2014 http://blogs.tribune.com.pk/story/20461/in-lahore-does-child-labour-and-torture-go-hand-in-hand/ 

Our unsung heroines

Our frontline health workers including Lady Health Workers (LHWs), Community Midwives (CMWs) and Vaccinators are the real heroes in Pakistan’s fight to prevent child and maternal mortality in the country to be able to achieve Millennium Development Goals (MDGs) 4 & 5. MDG 4 is about two third reduction in child mortality and MDG 5 is about three quarters reduction in maternal mortality ratio by 2015. The progress towards achieving MDGs remains a challenge and an elusive dream for Pakistan where 352,400 children under-5 die of preventable causes every year. The national under 5 mortality rate is 87 per 1000 live births and the maternal mortality rate is at an alarming 276 deaths per one 100,000 live births. There is a need to accelerate the efforts to be able achieve MDGs 4&5.

The LHWs and vaccinators are not only playing a leading role in preventing thousands of preventable child deaths but are also our frontline force against the ongoing fight in the country for the eradication of polio. Unfortunately however, in the recent past we not only witnessed targeting of the LHWs and vaccinators by the terrorists but also a cold shoulder by the government towards resolving their issues.

The last approved PC-1 of LHW Programme has targeted the expansion of LHWs from existing number to 130,000 by 2015 with a focus on expansion to marginalize and disadvantageous uncovered areas. The 18^th Amendment has implicated the expansion by bringing a standstill situation to the programme owing to lack of funds for meeting the operational cost of existing LHWs and barring the expansion. Lately, through judicial intervention the LHWs have been regularized throughout the country and their rewards have also been increased. However, we still see LHWs on the streets demanding documentation of their regularization and implementation of the decision in letter and spirit by the federal and provincial governments. 

Lack of frontline line health workers such as LHWs and Community Midwives is one of the major reasons of Pakistan’s slow progress towards achieving MDG 4 & 5 as currently there are 97,639 LHWs and 3,843 Lady Health Supervisors (LHSs) in the country covering only 60% of the population against the proposed target to increase this number to 130,000 by 2015. Following Supreme Court of Pakistan’s intervention, the previous government regularized the services of LHWs, LHSs and other staff of the Family Planning & Primary Health Care Programme with Federal Government’s full funding for this programme up to 7^th NFC Award (FY-2015) as already decided by the Council of Common Interests.

While regularizing the LHWs, the previous federal government included a stringent condition; the posts that may become vacant as a result of resignation, losing jobs or otherwise shall stand abolished for the purpose of federal funding and new recruitment w.e.f. 1-7-2011 will be financed by the provincial governments. Likewise, any new creation of posts/appointments or future need will be financed by the provinces from their own budget/resources. This condition resulted in decrease in the number of LHWs instead of increasing their number i.e. in Punjab the number LHWs decreased from 49,000 to 47,300 and similarly in other provinces.

The incumbent federal government should intervene and reverse this decision by allowing the provincial governments to fill the vacant position i.e. 1,700 positions in Punjab to be filled immediately. Secondly, coordinate with the provinces and support them in recruiting more LHWs and making budgetary allocations for necessary supplies to reach to the uncovered areas and help Pakistan progress towards achieving MDGs 4 & 5. Similarly, the provincial governments should also take responsibility and start allocating resources for increase in the number of LHWs, CMWs and vaccinators in the respective provinces to be able to reach out to 100% population and achieve mother and child health related targets.

According to the findings of research studies by Professor Dr. Zulfiqar A Bhutta and others, in many countries, community health workers are now offering a wide menu of services to communities in different types of challenged settings. Their services include conducting deliveries, conducting counseling and health education, immunization, management of childhood illnesses at community level such as diarrhea, malaria and pneumonia and malnutrition. The community health workers’ services have led to decrease in child and maternal mortality in different countries.

The successive governments since 1993 have relied on LHW Programme for the delivery of health services to the far flung areas. The key policy instruments of development in Pakistan over this time period have included LHW Programme as a primary area of investment for meeting health challenges. Besides, non-governmental initiatives such bilateral projects, UN initiatives for child health etc have also heavily relied on LHW Programme for delivery of services targeting the achievement of MDGs.

The menu of services of LHWs include 20 key tasks related to maternal, newborn and child health care and the health indicators in LHW covered areas are significantly better than the national averages. Research has proved that the coverage of some key interventions for maternal and child health such as fully immunized children, knowledge of mothers about preparation of ORS, antenatal consultations, measures of exclusive breastfeeding  have improved in LHW covered areas. The children under 3 years of age in LHW covered areas are 15 percentage points likely to be fully immunized as compared to areas not covered by LHWs. When analyzed LHWs performance for difference in poor and rich, it has been found that the effects were larger for poorer households especially in maternal and neonatal health practices, immunization and growth monitoring according to Oxford Policy Management findings of 2009.

There are issues around LHWs coverage, remuneration and operational aspects of their programme. Currently LHWs cover only 60% of the population, nearly 25% of LHWs are low performing, there are delays in the salaries disbursements, the stock outs of medicines along with non availability and/or dysfunctional equipment is a continuous problem, the supporting referral system is not helpful due to staff absenteeism and other issues at the referral facilities.

It is imperative that LHWs coverage is expanded to un-served rural poor populations and urban slums and that will be possible only if their number is increased and all the current vacant positions are filled immediately. Similarly, it is important to ensure that they are provided with the required stock of medicines and equipment, their terms of reference are reviewed and routine immunization is formally incorporated; they are trained to be able to provide mothers with skilled support to improve child feeding practices, including breastfeeding and to contribute in maternal and newborn care. The monitoring mechanisms should be strengthened as well to ensure effective utilization of this vital human resource.

It is crucial that the provincial governments take a leadership role, with the support of the federal government, and strengthen the Programme at the provincial levels. The Programme should be structured in such a way that the staff is satisfied and are able to concentrate on performing their job which is critical for Pakistan’s acceleration of progress towards achieving MDGs.

This blog also published as an op-ed in The News on Sunday on October 13, 2013 http://jang.com.pk/thenews/oct2013-weekly/nos-13-10-2013/pol1.htm#4 

Malnutrition in Pakistan: A crisis long overlooked

“Well fed people can enhance their dignity, their health and their learning capacity. Putting resources into social programs is not expenditure. It is investment”, Luiz Inácio Lula da Silva, former President of Brazil

Finally the federal government has launched the long awaited National Nutrition Survey (NNS) 2011 in Islamabad in a high level ceremony where both the Federal Minister for Planning and Development and the Minister of State for Health Services Regulations and Coordination with the respective secretaries, representatives of the Provincial Governments and the Planning Commission of Pakistan, Donors, UN Agencies and civil society were present.

Findings of the NNS 2011 are depressing and clearly depicts how neglected the subject is in Pakistan. There has been no improvement in nutrition indicators for the last almost 4 decades and Minister Ahsan Iqbal rightly lamented the fact that the last decade following NNS 2001 has been totally lost as no tangible steps have been taken to improve the situation.

The NNS 2011 was the largest nutrition survey in the history of Pakistan conducted by the Agha Khan University’s Division of Women and Child Health, Ministry of Health and UNICEF with the financial support of AusAID and DFID. The NNS 2011 covered all provinces, Azad Jammu and Kashmir (AJK), Gilgit Baltistan and the Federally Administered Tribal Areas (FATA). This included 1,500 enumeration bocks (EBs)/villages and 30,000 households with a 49% urban and 51% rural distribution.

Results from the NNS 2011 indicated little change over the last decade in terms of core maternal and childhood nutrition indicators. With regard to micronutrient deficiencies, while iodine status had improved nationally, vitamin A status has had deteriorated and there had been little or no improvement in other indicators linked to micronutrient deficiencies.

The NNS 2011 revealed that the nutritional status has not changed much over the past decade. The anthropometry measurement of children under 5 revealed that 43.7% were stunted (too short for her/his age/low height for age) in 2011 as compared to 41.6% in 2001 NNS. Similarly, 15.1% children were wasted (weight that is too low for her/his height) compared to 14.3% in 2001. As per World Health Organization’s standards, a national average of 15% or above is labelled as an “EMERGENCY”.

The NNS 2011 indicates that stunting, wasting and micronutrient deficiencies are endemic in Pakistan. These are caused by a combination of dietary deficiencies; poor maternal and child health; a high burden of morbidity; and low micronutrient content in the soil, especially iodine and zinc. Most of these micronutrients have profound effects on immunity, growth and mental development. They may underline the high burden of morbidity and mortality among women and children in Pakistan.

Malnutrition plays a substantial role in Pakistan’s high child morbidity and mortality rates. Due to its correlation with infections, malnutrition in Pakistan currently threatens maternal and child survival and an estimated 35% of all under 5 deaths in the country are linked with malnutrition. It is imperative to respond to the situation if Pakistan has to be on track to achieve Millennium Development Goal (MDG) 4; about two third reduction in under 5 mortality.

More than 1.5 million children in Pakistan are currently suffering from acute malnutrition, making them susceptible to infectious diseases which may even lead to death. Long-term (chronic) malnutrition undermines both physical and mental development; nearly half of Pakistan’s children are chronically malnourished, and have their brain development and immune systems impaired, with life-long consequences.

Most of the irreversible damage due to malnutrition happens during conception and in the first 24 months of life meaning that risk begins from the day of conception to up to two years of age also referred to as the first 1000 days.

“Addressing malnutrition is one of the best investments Pakistan can make in its future”. There is a need to provide primary attention to nutrition-specific evidence-based interventions focused both on women and young children, while also addressing key malnutrition determinants.

It was encouraging to listen to the federal Minister for Planning and Development Ahsan Iqbal, during the launch of the NNS 2011, who was very clear that it is time for retrospection and that the issue is not going to be resolved through routine approach and all the stakeholders should respond to the situation as an emergency.

Besides, the launch of the NNS 2011 another positive development is Pakistan’s joining of the Scaling Up Nutrition (SUN) initiative at the global level in April 2013. More than 40 countries have joined the SUN Movement so far Pakistan being the largest country. SUN is an opportunity which the government should utilize effectively and gear up to improve the situation of nutrition in the country. Key donors, UN Agencies, National and International NGOs are there to support the federal and provincial governments to scale up efforts for nutrition in a coordinated and efficient manner.  

There is a need for multi-sectoral interventions to address malnutrition involving health, education, social protection, water and sanitation, agriculture and private sector with a high level commitment from leadership to plan and implement multi-sectoral interventions.

Recently during the launch of the Lancet Series on Maternal and Child Nutrition 2013 in Pakistan, prominent nutrition expert and lead researcher of the NNS 2011 Professor Dr. Zulfiqar A. Bhutta said that the NNS 2011 underscores the primacy of addressing maternal and child under-nutrition at scale through targeted effective interventions; the current coverage rates for many key interventions remain poor and must be prioritized for scaling up. A broad multi-sectoral concerted approach is needed with political ownership of the problem and its determinants at the highest level said Dr. Bhutta. He further stated that there is a need to focus on Infant and Young Child Feeding strategies, Exclusive Breastfeeding promotion and complementary feeding, an area that has received scant attention to so far.

Given the success of salt iodization in reducing deficiency, greater attention must be focused on large scale fortification strategies for staples and common commodities/weaning foods, including home fortification recommended Dr. Bhutta and said that there are clear opportunities for linking the current cash support program and social safety nets to key nutrition interventions targeting women and children (hence addressing food insecurity).

It is also imperative to support women and their families to practice optimal breastfeeding and ensure timely and adequate complementary feeding. Breast milk fulfills all nutritional needs of infants up to six months of age, boosts their immunity, and reduces exposure to infections. There is also a need for steps by the federal and provincial governments for the implementation of the respective breastfeeding laws i.e. the Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013for effectively monitoring the unnecessary promotion of breast milk substitutes. The rules of the 2013 Act require to be notified immediately and an Infant Feeding Board established and notified to ensure implementation of the law. Similarly, effective steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002should be taken at the federal level.

The writer is Director Advocacy and Child Rights Governance, Save the Children Pakistan Country Programme and tweets @amahmood72

 

This blog was also published at http://everyone.savethechildren.net/articles/malnutrition-pakistan-crisis-long-overlooked  and also appeared as an Op-Ed in The News on Sunday on October 06, 2013   http://jang.com.pk/thenews/oct2013-weekly/nos-06-10-2013/pol1.htm#5

 

 

Unite for child rights in Pakistan

By Arshad Mahmood

More than 40 child rights activists from across the country gathered in Islamabad to review the state of child rights in Pakistan and plan that how will they respond together as Child Rights Movement (CRM) Pakistan to improve the situation. CRM Pakistan is a coalition of more than 100 civil society organizations working for the promotion and protection of child rights across Pakistan having its national and AJ&K, Balochistan, Khyber Pakhtunkhwa (KP), Punjab and Sindh chapters.

The CRM Pakistan planned policy advocacy initiative focusing on child rights at the federal and provincial levels and called upon the federal and provincial governments to take serious and committed steps to improve the deteriorating state of child rights in Pakistan.

It was agreed that CRM will engage extensively with the new federal and provincial governments and parliamentarians to ensure that all pending legislation related to child rights i.e. The Prohibition of Corporal Punishment Bill, the Criminal Law Amendment Bill, the Child Marriages Restraint Amendment Bill and the National Commission on the Rights of Children Bill at the federal level are enacted during 2013 which has also been declared as the Year of the Rights of the Child in Pakistan.

The CRM meeting noted with concern that a number of children related legislations are pending at the provincial level and urged the provincial governments to enact the Balochistan Child Protection and Welfare Bill, the Punjab Commission on the Rights of the Child Bill, the Right to Free and Compulsory Educations Bills in Balochistan, KP and Punjab and the Prohibition of the Employment Children Bills in the all the four provinces. It was also decided that advocacy campaigns will be launched at the federal and provincial levels using various means to put pressure on the parliament for the enactment of all pending bills.

The CRM Pakistan also called upon the Government of Sindh and KP to notify rules of the Sindh Child Protection Authority Act 2011, the KP Child Protection and Welfare Act 2010 and the KP Borstal Institutions Act 2012 and make proper budgetary allocation for the effective implementation of these laws.

CRM noted with concern that there is no child protection system in the Islamabad Capital Territory (ICT) which makes the children living in the capital more vulnerable. The CRM decided that there will be targeted advocacy at the federal level so that the government should introduce a proper child protection system for ICT. It was also discussed and agreed steps should be taken for the implementation of the Right to Free and Compulsory Education Act 2013 in ICT and the Federally Administered Tribal Areas (FATA) where the laws has recently been extended by the President of Pakistan.

It was agreed that CRM will continue with its advocacy for increase in budgetary allocation for children in health including nutrition, education and child protection sectors at the national and provincial levels and will continue follow up for the implementation of Pakistan’s international obligations such as recommendations of Human Rights Council (UPR Process) and Concluding Observations and Recommendations of the Committee on the Rights of the Child etc.

The CRM also decided to get involved in debate related to Pakistan’s achievement of the MDGs and the post 2015 agenda for sustainable development. The coalition has planned to develop a Child Protection Monitoring Mechanism and regularly generate research reports and quarterly or bi-annual situation reports /newsletters and factsheets etc. It was also decided that meaningful child participation in CRM’s advocacy initiatives will be ensured.

The CRM Pakistan also discussed the situation of children in emergencies in Pakistan and called upon the government of Pakistan to take steps for the rehabilitation of children and their families affected by manmade and natural disasters in FATA and across the country. It was also decided that CRM will be involved in advocacy to keep highlighting the plight of the children affected by emergencies.

The Child Rights Movement called upon the federal government to ratify the Optional Protocols to the UN Convention on the Rights of the Child on the Involvement of Children in Armed Conflict and Communications Procedure for Children and decided to launch a campaign in this regard.

There were exclusive sessions on advocacy, the use of social media for advocacy and monitoring of child rights violations mechanism development. The CRM planning meeting concluded with a resolve to unite for child rights in Pakistan. There was a unanimous agreement that working as coalition in an organize manner has more potential to achieve great results for the children of Pakistan particularly at the policy, legislation and budgetary allocation level.

The writer is among the founding members of CRM Pakistan and Director Advocacy and Child Rights Governance with Save the Children Pakistan Program.

Undernutrition: An unfinished agenda

“Nutrition is crucial to both individual and national development. The evidence in the Lancet Series on Maternal and Child Nutrition furthers the evidence base that good nutrition is a fundamental driver of a wide range of developmental goals. “The post 2015 sustainable development agenda must put addressing all forms of malnutrition at the top of its goal” was a unanimous agreement at the launch of the Lancet Series in Pakistan. Lancet is a pioneer medical research journal which focuses on health issues. The launch ceremony was well attended by representatives of the federal and provincial governments, UN agencies, donors, academia, media and civil society.

While there has been a tremendous increase in a global political commitment to improve nutrition; yet this has translated into a modest impact. This presents a substantial unfinished agenda i.e. to address the cause of 45% (3.1 million) of all under 5 child deaths due to malnutrition said the President and CEO of Save the Children US, Carolyn S. Miles observed in her opening remarks at the launching ceremony in Islamabad. In Pakistan alone, 35% of all under five deaths can be attributed to the menace of malnutrition observed Ms. Miles. 

She further noted that the national and international momentum to address human nutrition and related food security and health needs has never been higher but we have to seize this opportunity and take concrete actions. Carolyn Miles reaffirmed Save the Children’s commitment to the cause of addressing malnutrition and assured that Save the Children will remain a frontline ally for responding to nutrition issues in Pakistan.

One of the leading global experts on nutrition and a lead author of the Lancet Series Dr. Zulfiqar A.  Bhutta from the Agha Khan University presented the key finding of the four papers. Breastfeeding practices are far from optimum, despite improvements in some countries said Dr. Bhutta. Sub optimum breastfeeding results in an increased risk for mortality in the first 2 years of life and results in 800,000 deaths annually. Furthermore, nearly 15% of deaths of children younger than 5 years can be reduced (i.e. 1 million lives saved), if the ten core nutrition interventions identified in the Lancet Series are scaled up.

“If we want to address issues of malnutrition we would need long term sustained initiatives. This includes food security, child protection, gender dynamics which calls for nutrition sensitive interventions such as programs aimed at poverty alleviation, empowering women, targeted agriculture safety nets and early childhood development programs” recommended Dr. Bhutta.

“Pakistan has made insufficient investments in nutrition sensitive interventions that are critical to produce policy change and impact” lamented Dr. Bhutta and called for a collective societal approach, whereby all segments of society such as media, government, civil society and public work in collaboration to provide an enabling environment which puts the issue of malnutrition at the center stage.

“The Lancet Series in 2008 identified the need to focus on the crucial period from conception to a child’s second birthday-the 1000 days in which good nutrition has lasting benefits throughout life”.

“In Pakistan, about one quarter of the new borns are born at a low birth weight. Whereas, one half of the children suffer from chronic malnutrition. This seriously undermines the prosperous development of Pakistan as consequences of malnutrition cut the nations GDP by up to 4%” said Mr. Dan Rohrmann, Country Representative UNICEF Pakistan. “Despite the economic development of the nation, we are facing a silent crisis of malnutrition with indicators amongst the worst in the world and no improvements in recent four decades regretted Mr. Rohrmann and emphasized that if this issue is prioritized, malnutrition can be ended in a life time of a generation.

The Development Partners for Nutrition (DPN) group is involved in advocacy for considering nutrition as a priority at the national development agenda, policy and strategy support and strengthen nutrition in implementation shared Ms. Silvia Kaufmann, Chief Nutrition, UNICEF Pakistan. The DPN is supporting the development of provincial nutrition guidance notes and provincial inter-sectoral nutrition strategies she informed.

Mr. Aslam Shaheen, Chief Nutrition, Planning Commission of Pakistan lauded the efforts of Save the Children in launching the Lancet Series in Pakistan and observed that recommendations highlighted in the lancet paper will build into the Vision 2025 and government’s 5 year development plan. He also informed the participants that the Government of Pakistan will formally launch the National Nutrition Survey 2011 in the coming few weeks.

The launch of the Lancet Series on Nutrition  is timely and relevant for Pakistan as recommendations could be used in the Integrated Provincial Nutrition Strategies being prepared in all the four provinces through a consultative process. Save the Children together with the DPN is committed to providing support to the federal and provincial governments to have the strategies in place and implemented. There is also a commitment for full support and cooperation to the government for implementing the Scaling up Nutrition (SUN) initiatives commitments in Pakistan. Together with the Development Partners for Nutrition and the civil society of Pakistan we are committed to work for improving the nutrition situation in Pakistan. However, for these initiatives to materialize political will and leadership is needed by the government both at the federal and provincial level.

The launch got excellent coverage from Pakistan’s leading newspapers and on social media including facebook and twitter. There was great resolve and commitment among the stakeholders to use the findings of the series in the ongoing efforts to improve the nutrition situation in the country and put nutrition on the agenda of decision makers, civil society and media and the national and provincial levels.

 

The was blog also published at:

http://www.healthynewbornnetwork.org/blog/undernutrition-unfinished-agenda

http://www.trust.org/item/20130827063530-lq9ek/

http://everyone.savethechildren.net/articles/undernutrition-pakistan-unfinished-agenda

 

 

 

 

The superfood with the potential to save hundreds and thousands of children’s lives

Imagine a food that is free, nutritious and has the potential to save thousands of children’s lives. Well there’s no need to imagine it, it already exists- a mother’s milk; breastfeeding is one of the most powerful weapons we have to fight child mortality. The teachings of Islam also strongly endorse that mothers should breastfeed their children for two years.

The Global Breastfeeding Week concluded with a number of advocacy and awareness raising events across the country and globally. The World Breastfeeding Week which, each year, presents an important opportunity to put the spotlight on the importance of breastfeeding for saving children’s lives. But this can’t just be a one week effort; we need strong leadership and political action all year round to promote it.

According to the medical journal, the Lancet, suboptimum breastfeeding results in more than 800,000 child deaths annually. If we can ensure that every newborn is given breast milk immediately after birth and is fed only breast milk for the first six months, we can greatly increase the chance that they will survive and go on to fulfil their potential. Around one in eight of the young lives lost each year could be prevented through breastfeeding, making it one of the most effective of all ways to prevent the diseases and malnutrition that can cause child deaths.

It is estimated that 3.1 million children die from malnutrition each year. Breastfeeding is not only crucial for tackling malnutrition and saving children’s lives, it also has the potential to have tangible impacts on the economic and social development of countries likes Pakistan. Malnutrition can undermine future earning potential by as much as 20% and can inhibit growth of GDP by as much as 2-3%.  Today’s malnutrition will knock $125bn off the global economy by 2030, when these children reach working age. 

But breastfeeding is undervalued. Global rates of breastfeeding have remained below 40% for the past 20 years as breastfeeding has slipped down the list of political priorities. In some countries, particularly in East Asia and the Pacific, the number of breastfed children is starting to fall.

In Pakistan only 37 per cent of children are exclusively breastfed for the first six months meaning that too many children are missing out on the vital nutrients they need in the first months of life. Similarly, the early initiation of breastfeeding is only 29 per cent in the country. That needs to change.

If babies receive colostrum – the mother’s first milk – within an hour of birth, it will kick start the child’s immune system, making them three times more likely to survive. If the mother continues feeding for the next six months, then a child growing up in the developing world is up to 15 times less likely to die from killer diseases like pneumonia and diarrhoea.

So what needs to happen? We need to ensure that women have the support they need to breastfeed and overcome the main barriers preventing them from doing so. Those barriers include community and cultural practices which discourage women from breastfeeding, severe shortages of midwives and health workers meaning that too often the opportunity for new mothers to be supported to breastfeed in the first few hours is lost, lack of adequate maternity legislation and marketing practices by some breast milk substitute companies leading to infant formula being used unnecessarily and improperly, ultimately putting children at risk.

Tackling these barriers demands a new and concerted effort from many different groups of people; governments, local communities and business. For example, governments and local communities need to take action to empower women to make their own decisions about breastfeeding, governments need to invest in strengthening health systems to protect, promote and support breastfeeding and introduce nationwide breastfeeding-friendly policies and legislation. Finally, businesses need to act responsibly in their marketing on Breast Milk Substitutes and governments need to ensure that national regulation of Breast Milk Substitutes is strengthened and enforced. This issue is increasingly important in emerging economies, where some companies are aggressively marketing their products, despite the threat that this undermines support for breastfeeding.

In the last two decades there has been huge global progress in reducing child mortality with five million fewer children dying in 2011 than in 1990. The world is nearing a tipping point, the time at which the eradication of preventable child deaths becomes a real possibility.  But there is still a lot to do to reach that point - breastfeeding is key to unlocking further progress and saving hundreds and thousands of children’s lives.

Pakistan, voted in favour of adopting the International Code of Marketing of Breast-milk Substitutes during the World Health Assembly in May 1981, and promulgated “The Protection of Breastfeeding and Young Child Nutrition Ordinance 2002” to enforce the code. The ordinance prohibits the promotion of any milk produced as partial or total replacement for mother’s milk or represented as a complement to mother’s milk to meet the growing nutritional needs of an infant. The ordinance requires from health workers to encourage, support and protect breastfeeding. Following the devolution, earlier this year, the Sindh Assembly enacted the local legislation by Sindh “The Sindh Protection and Promotion of Breastfeeding and Child Nutrition Act 2013”. Similarly, last year the Punjab Assembly also adopted the law as the Punjab Protection of Breastfeeding and Young Child Nutrition (Amendment) Act 2012.

“It’s heartening to know that Sindh and Punjab have enacted laws for the Protection and Promotion of Breastfeeding. However, the real test is its implementation in letter and spirit”. “Despite the Protection of Breastfeeding and Child Nutrition Ordinance on statute books since 2002, its implementation has always remained a distant desire.” Similarly, Punjab and Sindh have not been able to notify the rules and Infant Feeding Boards to monitor implementation of the law.

Keeping in view, the importance of breastfeeding in preventing fatal childhood diseases and neonatal mortality it is important that Balochistan and Khyber Pakhtunkhwa also enact laws on the pattern of Sindh and steps are taken for the effective implementation of these laws in all provinces. This will ensure safe nutrition for infants by promoting and protecting breastfeeding.

Similarly, the federal government should also take practical steps for the implementation of the Protection of Breastfeeding and Young Child Nutrition Ordinance 2002 for the Islamabad Capital Territory and Federally Administered Areas. Infant Feeding Boards require to be notified immediately in Islamabad, Sindh and Punjab to monitor the implementation of the respective laws.

There is also a need to put promotion of breastfeeding on the agenda of civil society including NGOs, print and electronic media and academia to play their role in its promotion at all levels and create widespread awareness in the society which will ultimately lead to reduction in preventable infant and under 5 mortality in Pakistan.

The writer is a child rights activist and tweets at @amahmood72