Breastfeeding is public health

When a mother breastfeeds, she nourishes more than just her child. She nurtures a healthier society, a more equitable economy and a stronger nation. It must therefore be seen and supported as a public health imperative and a national priority.

Often called a baby’s first vaccine, breastfeeding provides infants with ideal nutrition, bolsters immunity and lays the foundation for lifelong health and cognitive development. Breastfeeding is a high return on investment.

Globally, inadequate breastfeeding leads to $300 billion in losses annually, while every $1 invested generates a $35 return. In Pakistan, where malnutrition contributes to nearly half of all child deaths and costs over 3.0 per cent of GDP, suboptimal breastfeeding rates directly exacerbate this crisis by leaving infants vulnerable to preventable illnesses and impeding their healthy development.

In Pakistan, only 48 per cent of children are exclusively breastfed for the first six months, far below the global target of 60 per cent. Breastfeeding is often wrongly viewed as a woman’s private duty. Many women are unable to breastfeed exclusively -- often not by choice, but due to barriers beyond their control. This is more acute for working mothers, women with disabilities, and those displaced. From lack of paid maternity leave to absence of breastfeeding spaces at work, from cultural misconceptions to health system gaps, women face challenges.

Systemic solutions are urgently needed.

Pakistan has made important strides, including the Maternity and Paternity Leave Act (2023) and Sindh’s updated Code legislation banning unethical marketing of breastmilk substitutes. Laws, however, are only a part of the solution. Enforcement is key and should include stronger governance and regulations to activate infant feeding boards, auditing health facilities, workplaces and raising public awareness to create truly breastfeeding-friendly environments

Accredited Baby-Friendly Hospitals are critical for supporting breastfeeding from the moment of birth. The absence of such facilities is compounded by aggressive and unregulated marketing of breastmilk substitutes, which undermines mothers’ confidence and misleads families.

While Pakistan has adopted the International Code of Marketing of breastmilk substitutes, enforcement of this code is now an imperative. Sindh was the first to update its legislation in line with the 2016 WHO recommendations – the rest of the country must be encouraged to follow this best practice.

Strengthening the health system is vital. Every mother must have access to skilled birth attendants and lactation support. Health workers need to be trained to provide compassionate and evidence-based care. Efforts will gain significant momentum if maternity facilities implement the WHO/Unicef ‘Ten Steps to Successful Breastfeeding’.

Supportive systems must not stop at the hospital door. It must follow mothers into homes, workplaces,and communities.

Community health workers and peer groups can provide mothers with encouragement and practical guidance throughout their breastfeeding journey. Just as crucial are the workplaces, where returning mothers need protected breaks, flexible hours and safe, private spaces to continue breastfeeding with dignity.

Ultimately, promoting breastfeeding is not only about passing laws or training staff, but also about changing mindsets. We must tackle gender norms, cultural myths and misinformation through awareness. When religious leaders, elders, employers and communities champion breastfeeding as a shared value, we shift from individual burden to collective responsibility.

When we empower mothers, educate families and hold systems accountable, we create a nation where every child gets the healthiest start in life and every woman is supported with dignity and equity.

Let us make breastfeeding visible, valued, and vigorously supported - for healthier children, empowered women and a prosperous Pakistan.

The writer is the deputy representative of Programmes at Unicef Pakistan.