If told that there was an absolutely free, perfectly safe, 100 percent nutritionally-balanced medicine that can save lives, prevent diseases and improve IQ, the whole world would surely take notice. There is – breast milk.
Globally, child mortality has dropped substantially over the past decade, from 10 million children dying every year to six million. That decline is unprecedented. What worked? A focus on programmes that targeted the root causes of those deaths – providing bed nets for malaria, treatment of pneumonia and diarrhoea through Lady Health Workers or mass campaigns to deliver Vitamin A which is critical for immunity.
These efforts have had a substantial effect on saving children’s lives. Yet, six million unnecessary and tragic child deaths per year remain and we cannot rest in complacency. We need to keep fighting for children’s health, and this, among other effective interventions, means getting children on the breast and not on the bottle. An improved practice of breastfeeding children in Pakistan can add more than 820,000 children a year to the future generations of women and men in this country.
Putting a newborn to the breast within the first hour of life increases the chances of a child’s survival at the single most vulnerable time of their lives. Colostrum, the first stage of breast milk production, essentially confers a mother’s immunity obtained from a lifetime of her own vaccinations and exposure to diseases onto the newborn. Delaying breastfeeding by even 2-23 hours increases a newborn’s risk of dying by forty percent. Delaying this by a day increases the risk to eighty percent. This immunity – only offered by breast milk - is absolutely critical.
Pakistan has some of the worst breastfeeding rates in the world, which is both tragic and correctable. Most child deaths occur in the first month of life. We know that less than two of every 10 mothers initiate early breastfeeding. We need to make every caregiver, every birth attendant, every physician, every Lady Health Worker, every mother aware of the absolute necessity of this one simple action.
Breast milk is all an infant requires to meet nutritional needs for the first six months of life. This is not at all widely practiced in Pakistan where less than four out of ten babies are exclusively breastfed. Recent studies in Punjab and Sindh show even much lower rates.
A breastfed child is kept away from all sorts of contaminated water and fluids which leads to life-threatening infections such as diarrhoea, the number one killer of children in Pakistan. A breastfed child is not being given formula which is unable to confer critical immunity protection passed on from the mother to the infant and which then protects the child from a host of diseases. A breastfed child is less likely to be obese in later life, less likely to have diabetes or asthma.
Research continues to uncover more and more reasons why this is a vital practice, including the benefits of social interaction subsequent to an early bounding between the child and the mother.
Bottle feeding with formula puts a baby at serious risk. Infants who are not breastfed are 15 times more likely to die from pneumonia and 11 times more likely to die of diarrhoea than those who are breastfed. In short, breastfeeding saves lives, while baby formulas don’t.
It is absolutely critical that we change the overuse of formulas. To do that, we must convince every doctor to stop prescribing breast milk substitutes and instead actively encourage breastfeeding. Unicef is just completing development of evidence based medical education workshops on the science behind breast milk and their legal responsibilities. These will be rolled out in the coming year. WHO continues to generate the scientific evidence showing the short and long-term benefits of breastfeeding for babies, mothers and public health at large in Pakistan.
In Pakistan half of all women deliver babies in health facilities and this number is rising. Intensive programmes to improve breastfeeding rates in hospitals called the Baby Friendly Hospital Initiative will be revitalised in Pakistan. For women who deliver at home we will continue to support training of community workers who support and assist them and their families in the pregnancy as well as during and early-post birth stages.
Of course Unicef and WHO together work closely with and support all efforts of the government at both federal and provincial levels in our shared desire to make breastfeeding the only choice for mothers and their children. Critically this year we have seen the endorsement of a new Infant and Young Child Feeding Strategy which includes the revitalisation of sub-national Infant Feeding Boards, bodies designed to ensure that children and their families are not exposed to false advertising and promotion of what we call breast milk substitutes.
Breastfeeding is at an all-time low in Pakistan. We have to change this. Lives depend on it.
Angela Kearney is the Unicef representative in Pakistan.
Dr Michel Thieren is the countrydirector of WHO.