ISLAMABAD: The impact of days observed internationally honouring various causes is usually limited to the holding of functions and seminars primarily aimed at media consumption. At a practical level, nothing really changes on the ground.
The World Breastfeeding Week, which lasts from the first of August till the seventh, was observed in Pakistan too with the hosting of various seminars on the topic.
Practically, however, the legal measures which are essential for the promotion of breastfeeding and discouraging the use of formula-milk remain inactive.
Pakistan voted in favour of adopting the “International code of marketing of breast-milk substitutes” during the World Health Assembly, in May 1981.
Yet, the legislation was implemented very late in Pakistan – in the form of “The Protection of Breastfeeding and Child Nutrition Ordinance, 2002”.
The rules of business were notified in 2009, and in October 2013, the Infant Feeding Board was finally notified.
Despite the passage of more than three years, the board still has not met, even once, to date.
The provinces have now enacted their own protection and promotion of breastfeeding acts, but are still in the process of notifying rules of business; and none of the provinces have established an infant feeding board yet.
The boards are mandated to receive reports of violations of the law and recommend investigation of cases against manufacturers, distributors or health workers found to be violating the provisions of the rules.
The breastfeeding laws bind formula-milk companies to label every product with the message that “mother’s milk is the best food for your baby and aids in preventing diarrhoea and other illnesses”.
The laws also prohibit such labels that discourage breastfeeding and propagate formula-milk as a worthy substitute to mother’s milk.
Licence of a physician can get cancelled, if he or she is found prescribing formula-milk unnecessarily.
These laws also forbid the unethical promotion of formula-milk, and the sponsoring of health practitioners with gifts and other perks, in return for promotion of their products.
The relevant laws have been enacted by the government, but their implementation is still a dream, says Scaling Up Nutrition Civil Society Alliance – Pakistan (SUNCSA, Pak) Programme Manager Dr Irshad Danish.
A nation-wide survey conducted by Save the Children in 2012, revealed that the majority of mothers were advised to feed their children with formula-milk, by their doctors.
The results show that not only did these doctors recommend formula-milk, they also suggested specific brands.
This suggests that the doctors were working in partnership with those companies.
National Health Services, Regulations and Coordination (NHSRC) State Minister Saira Afzal Tarar, while speaking at an event in connection with the World Breastfeeding Week, also accepted that “the role of healthcare providers in prescribing and promoting the sale and use of breast milk substitutes or formula-milk, is a major challenge in the way of improved breastfeeding practices”.
NHSRC Director (Nutrition) Dr Baseer Khan Achakzai admitted that the board remained inactive, and had been unable to meet due to other engagements of the members.
He asserted, however, that they had ensured that no formula-milk representative could enter hospital wards, and that doctors were also strictly prohibited from prescribing formula-milk and accepting gifts from those companies.
As per the Demographic Health Surveys, breastfeeding rates have risen very minutely, from 37.1 per cent in 2006-2007, to 37.7 per cent in 2012-2013.
Meanwhile, bottle-feeding rates have risen from an already undesirable 32.1 per cent in 2006-2007 to a shamefully high 41 per cent in 2012-2013.
The World Health Organisation (WHO) recommends that all infants should be exclusively breastfed for the first six months of their lives. Actual practice, on the contrary, remains at an abysmal 38 per cent.
Only about half of the toddlers aged between 20 to 23 months are breastfed, despite the recommendation that breastfeeding should continue for up to two years or beyond.