A shared responsibility

By Wallia Khairi
Tue, 08, 21

Children’s health and well-being could be improved by addressing gender inequalities. This week You! takes a look on how we can play an active role in supporting nursing mothers…

In both rural and urban areas, women are often overburdened with family responsibilities and household chores. For working mothers, there is additional pressure of work as well as taking care of their babies, especially when it comes to breastfeeding.

Breastfeeding is not only time consuming, but also requires a lot of physical energy. World Breastfeeding Week (WBW) is a global campaign observed annually from the 1st to the 7th of August to raise awareness and galvanise action on themes related to breastfeeding. This year’s theme is ‘Protect Breastfeeding: A Shared Responsibility’. It focuses on how breastfeeding contributes to the survival, health and wellbeing of all, and the imperative to protect breastfeeding worldwide.

Stress, fatigue and anxiety can reduce the amount of milk a woman produces. Studies show that when men have information on exclusive breastfeeding, they can support women by helping with housework, looking after children and even providing the much needed continuous emotional and physical support as a skilled assistant or a partner.

Afsah Ali

“Fathers’ play the most important role,” says Afsah Ali, mother of two children and Certified Breastfeeding Specialist (CBS). “It may seem like that there isn’t much that a father can do when it comes to ‘breastfeeding,’ but the reality is very different. Newborns tend to breastfeed for hours, leaving the mother with lack of sleep and rest, the father can help the mother to rest by taking over some basic chores. Fathers can help by passing the baby from crib to mother, with changing baby’s diapers, giving baths to baby, helping the baby get a burp, or by making the baby sleep in their lap.”

Research shows that when a mother has the support and encouragement of her partner, she’s more likely to be successful at breastfeeding and breastfeed for a longer duration of time. “Good breastfeeding support starts at home. Father’s involvement has a direct relationship with child’s cognitive and social development,” tells Afsah who has been providing support to new parents for around five years. She is currently on her journey to become an International Board Certified Lactation Consultant (IBCLC). Afsah has helped thousands of mommies through her programme, The Lactation Club (TLC), to successfully breastfeed their babies.

Ashrah Fareed

When asked about the most difficult part of motherhood, Ashrah Fareed, mother of one and a half-year old toddler, lifestyle blogger and pharmacist shares, “Breastfeeding! Yes! It will always be breastfeeding. My boy never latched and I don’t even want to go into the details of it.” She shared how she searched and learned extensively about being a parent and everything involved with it but never about breastfeeding. “I always felt sure that I would breastfeed my child till he turned two but I didn’t know what laid ahead for me. I was living in a happy bubble that it works like a tap; when the baby feels hungry, he would latch, milk would come and then automatically stop after filling his tummy. What a fool I was!” Her bubble soon burst after her delivery. “I chose to pump breastmilk instead of going for formula. It was hard to exclusively pump milk and then feed. Here, people are not aware that breastmilk can be pumped out and when some first time mothers choose to pump, people don’t support her at all.” There were days when she would cry along with her baby because he was colic and she just didn’t know what to do. “I leaked but couldn’t pump milk because he wants me to hold him all the time. The engorgement pain is a different story. In the end though, it’s all worth it.” She also stated that because of her husband’s support she was able to breastfeed her child. “Society is not at all supportive towards moms in general and always criticise us. I didn’t cook for good six months because I was always busy in pumping. Despite the hurdles, ever mother wants to do everything they find best for their children. I feel so proud of myself to be able to breastfeed my child at least for a year,” she enthuses.

Breastmilk is more than just food for babies – it is also a potent medicine for disease prevention that is tailored to the needs of each child. The importance of exclusive breastfeeding during the first six months of the newborns’ lives remains unrealised. “New mothers are not offered support and are often scared into introducing breastmilk substitutes. If I have to give you numbers, then as per UNICEF, in Pakistan, hardly 18% mothers get to breastfeed in the first hour of birth (which actually is called the golden hour and breastfeeding in this hour sets the trajectory for the breastfeeding journey), and less than 35% mothers exclusively breastfed babies for six months,” highlights Afsah.

Inappropriate marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide. “The very first instinct of our healthcare providers is to blame breastfeeding and recommend a formula. The new mothers are offered constant pressure and stress under the name of support. We need to have a safe space and a culture of nurturing mothers so they can happily nurture the babies,” suggests Afsah.

Many mothers do not feed their babies colostrum, which is the mother’s first milk, which contains vital antibodies that protect newborns against diseases, even though breastfeeding makes sense for both babies and their mothers. Women, who breastfeed, also have a reduced risk of breast and ovarian cancers. Increasing breastfeeding could prevent 823,000 annual deaths in children under five and 20,000 annual deaths from breast cancer. “As a CBS, I know for a fact that successful breastfeeding can rarely happen in isolation. Breastfeeding mothers need constant support and guidance from healthcare providers, lactation experts, partners, relatives and friends,” emphasises Afsah.

Despite this, working women do not get enough support to continue breastfeeding. Worldwide, only 40 per cent of women with new-borns have even the most basic maternity benefits at their workplace. Availability of longer maternity leave means higher chances of breastfeeding. A recent study found that women with six months or more maternity leave were at least 30 per cent more likely to maintain any breastfeeding for at least the first six months

Zubia Basit

“With poverty and increasing inflation, it is impossible for parents to continue buying breastmilk substitutes as per the increasing needs of the babies. Breastmilk comes at no cost, except that the mothers need to be supported. If we, as a society, provide that support system, we take over the responsibility of enabling mothers to have time and resources to produce milk, we can make sure our babies grow as per standards and are well taken care of.”

“I decided to become a lactation specialist when my first child was born and I faced a lot of difficulties being a first time mother as we don’t have any lactation support in Pakistan,” shares Zubia Basit, a mom turned breastfeeding counsellor. Breastfeeding is beautiful and natural, but sometimes it can be tough. Presently, there is little public tolerance for breastfeeding in Pakistan, unlike many other Muslim countries. “Educate, educate, educate. Educate each other about the benefits of breastfeeding and expectant mothers about the mechanics of breastfeeding. All you need is to educate mothers and general public about the benefits of breastfeeding,” stresses Hareem Sumbul, Lactation Educator at Lactnation Fund.

Hareem Sumbul

Sadly, there are a plenty of taboos and stigmas attached to breastfeeding. Hareem highlights some: They say ‘you cannot possibly make enough milk to exclusively breastfeed’ which is incorrect, a woman’s body is capable of producing enough milk for multiple babies; ‘Bottle feeding is essential’, it is actually what changes the way a baby latches and either gradually kills your supply or causes immediate or eventual breast rejection; ‘To make milk you need to drink milk,’ false, keeping a healthy diet and not skipping any meals is recommended but no specific foods are essential for producing breastmilk.

Baby feeding is a taboo not only in Pakistan, but also one internationally. Mothers agree how difficult it is to feed your baby. Where can a mother possibly go to if she has to feed her baby? “We expect mothers to stay home or breastfeed inside a toilet. Imagine eating a meal in the toilet, if this thought or imagination doesn’t sit well with you, how is it okay for an infant to eat his/her meal in a toilet? We definitely need a lot more efforts from our government and business entities to provide safe spaces and better rules to support nursing mothers,” recommends Afsah.

Naushaba Zaman Durrani

In Pakistan, a small but increasing number of newborns are enjoying the benefits of breastfeeding. According to the National Nutrition Survey (2018), proportion of children put to breast within one hour after delivery increased from 40 per cent in 2011 to 45.8 per cent in 2018. Likewise, practice of exclusive breastfeeding has increased from 37.7 per cent in 2011 to 48.4 per cent in 2018. “It is overwhelming but the unbreakable, unbelievable bond between a mother and her child is very rewarding.” says Naushaba Durrani, mother of a 10-month old boy. Her mother who was a Principal in a Nursing Academy in Karachi guided her throughout. “I am happy I was guided by professionals as well in the hospital about breastfeeding. My mother was very impressed to see how they handled me and the baby.” Addressing the dire need of help and support to mothers breastfeeding their infants, the Aga Khan University Hospital (AKUH) launched the country’s first nurse-led lactation clinic. The clinic, under the joint collaboration of AKUH and the Aga Khan University School of Nursing and Midwifery, aims to empower and help mothers ensure infants’ good health. It serves women in person and via tele-consultation. Civil Aviation Authority (CAA) has taken a considerable step forward by installing baby feeding cabins. Currently, they have been installed in Lahore and Islamabad airports. However, they aim to implement it in other national airports as well. The Pakistan Paediatrics’ Association (PPA) has been asking for stricter implementation of the breastfeeding laws to protect children from malnutrition. Owing to lax government attitudes, bottle-feeding rate in Pakistan is above 40 per cent, as per UNICEF estimates. Healthcare practitioners need to be less enthusiastic about recommending formula if women are reluctant to give their babies colostrum, instead they should try to convince the mothers about its medical benefits, and emphasise the need for exclusively breastfeeding their children, unless medical reasons prevent them from doing so.

Support a mother to breastfeed

  • Offer encouragement.
  • Help with the baby between feeds, and older children in the family, to allow the mother to rest or nap.
  • Make nutritious meals and snacks to help increase her energy.
  • Help with cleaning and other jobs around the house to decrease these responsibilities.
  • Find breastfeeding friendly meeting places.
  • Fathers can find tips, information and links to other services to help understand and connect with their baby and support their partner.
  • Grandparents play an important part in the encouragement and support of breastfeeding.