Pakistanis spending billions on formula milk unnecessarily: experts

ISLAMABAD: At a time when fewer than 2,000 newborn infants in Pakistan genuinely require breast milk substitutes due to maternal death, critical illness or rare metabolic disorders, the country consumes formula milk and baby food worth over Rs110 billion every year, officials and health experts disclosed on Friday.

Senior paediatricians and public health experts say this vast gap between actual medical need and consumption volume raises serious concerns about the aggressive and unchecked marketing tactics of multinational formula milk companies operating in Pakistan.

With approximately six million births annually, and a maternal mortality ratio of 186 per 100,000 live births, only a small proportion of newborns are unable to receive breast milk immediately after birth.

Experts estimate that even accounting for severe maternal illness and rare infant conditions, fewer than 2,000 newborns nationwide require breast milk substitutes in the immediate postnatal period.

Despite this, the formula milk industry continues to expand, largely fuelled by unregulated marketing, promotions in health facilities, and distribution practices that blur the line between medical necessity and consumer convenience.

Seven multinational companies currently dominate Pakistan’s infant formula market. These firms are lobbying the Sindh government to soften the Sindh Protection and Promotion of Breastfeeding and Young Child Nutrition Act, 2023, while pushing to prevent similar laws at federal and provincial levels.

The Sindh Act, considered one of South Asia’s most progressive breastfeeding protection frameworks, aligns with the International Code of Marketing of Breast-Milk Substitutes and World Health Assembly (WHA) resolutions.

It bans promotional activity in health settings and giving gifts to professionals, and mandates prescription-only sales of breast milk substitutes for children up to 36 months.

Industry groups like the Baby Nutrition & Food Council claim that the law restricts access and scientific information. They seek to reclassify formula milk as a food product instead of a therapeutic good, shifting regulation from the Drug Regulatory Authority of Pakistan to under-resourced provincial food authorities.

Prof Zulfiqar A Bhutta, founding director of the Institute for Global Health & Development at the Aga Khan University (AKU), said: “There is absolutely no reason why a large proportion of newborn infants in Pakistan should be deprived of the benefits of exclusive and early breastfeeding.

“This has nothing to do with poverty but a combination of ill-conceived misperceptions and lack of attention to this life-saving early intervention, which not only saves lives but is essential to long-term child development.”

He stressed the need to train healthcare providers and establish support structures for working mothers, including fully compensated maternity leave.

Pakistan’s weak breastfeeding practices carry enormous health and economic consequences. According to the World Health Organisation, suboptimal breastfeeding contributes to nearly 50 per cent of child deaths, mostly from infections like diarrhoea and pneumonia. Economically, the country loses an estimated $2.8 billion annually due to increased illness, medical costs and impaired cognitive development.

Even though breast milk substitutes are rarely medically necessary, they are often marketed for use among older infants and toddlers, especially in urban areas.

Prof Jamal Raza, executive director of the Sindh Institute of Child Health & Neonatology, said: “Breastfeeding is the single most effective intervention for child survival. It is the baby’s first vaccine and the mother’s gift of a lifetime.

“Formula lacks living immune cells, enzymes and the perfect bioavailability of nutrients. It introduces risks like contamination, overfeeding or incorrect preparation. Breast milk is complete, protective and sacred, a natural beginning designed by both biology and divine wisdom.”

The Sindh Act does not ban formula milk but regulates it strictly to ensure proper use. It also establishes a board for oversight, bans advertising to children under 36 months, prohibits cross-promotion and limits industry access to health professionals.

Dr Fyezah Jehan, chair of Paediatrics & Child Health at AKU, noted: “The amazing thing is that breast milk changes to give babies exactly what they need, right when they need it — unlike formula, which is one-size-fits-all.”

She said colostrum, the first milk, is rich in antibodies vital for newborns. “For preemies [premature babies], breast milk contains more protein, fat, antibodies and growth factors.

“It even changes during a single feed, starting watery and ending thick to provide satiety. Would we wear an outfit that is not our size? We do something like that when we revert to formula for our babies.”

Pakistan remains among the few countries in the region to pass such protective legislation, yet progress is fragile. Although a revised federal bill aligned with WHA guidelines has cleared the Senate, it remains stuck in the National Assembly amid intense industry lobbying.