he first week of August marks World Breastfeeding Week, a global campaign to highlight the importance of breastfeeding for child and maternal health. It offers a valuable opportunity to assess progress in breastfeeding initiatives, evaluate the support systems in place and propose focused actions to protect, promote and sustain breastfeeding practices worldwide.

According to the UNICEF and the World Health Organisation, scientific evidence confirms that continuing exclusive breastfeeding for the first six months - without any other foods or liquids, enhances cognitive development by 3 to 4 IQ points, lowers the risk of childhood obesity and offers lifelong protection against non-communicable diseases. Most critically, babies who are not breastfed are up to 14 times more likely to die before their first birthday than those exclusively breastfed during their first six months. Furthermore, according to the CDC website, breastfed babies have a lower risk of malnutrition, asthma, obesity, Type 1 and Type 2 diabetes, sudden infant death syndrome (SIDS), ear infections and gastrointestinal illnesses. These health advantages extend well beyond infancy.

Mothers also benefit significantly. Breastfeeding reduces the risk of postpartum hemorrhage, breast and ovarian cancers, Type 2 diabetes and heart disease. According to American Academy of Family Physicians website, health outcomes for parents and babies are best when breastfeeding continues for at least two years. Therefore, breastfeeding should continue as long as desired by parent and child.

The WHO recommends initiating breastfeeding within the first hour, exclusive breastfeeding for six months and continued breastfeeding up to two years and beyond. The WHO promotes exclusive breastfeeding for the first six months, with a global goal of reaching at least 50 per cent by 2025. Last statistics of breastfeeding rates in Pakistan are from 2018. According to the UNICEF, the proportion of children breastfed within the first hour after delivery rose from 40 per cent in 2011 to 45.8 per cent in 2018. Similarly, exclusive breastfeeding increased from 37.7 per cent to 48.4 per cent during the same period. As of 2018, fewer than half of Pakistani infants were exclusively breastfed for six months. Provincial disparities are significant across the country. According to National Nutrition Survey 2018, the highest rates of breastfeeding have been observed in Khyber Pakhtunkhwa (60.7 per cent) and Islamabad (57.6 per cent), lowest in the Punjab (44.3 per cent) and Baluchistan (43.9 per cent). No subsequent national data is available to assess progress toward the WHO’s 2025 target.

In Pakistan, exclusive breastfeeding rates remain a concern despite some progress. With Pakistan hovering around 47-48 per cent in 2018, the country would need modest annual gains, about 1-1.5 percentage points per year, to meet the target.

Initiating breastfeeding within the first hour after birth is crucial, particularly when the baby shows early hunger cues, as it helps make feeding smoother and more comfortable for both mother and baby. These cues include hand-to-mouth movements, lip-smacking, rooting (turning the head and opening the mouth when the cheek is touched) and increased alertness. Mothers should be encouraged to offer the breast as soon as these signs appear, rather than waiting for the baby to cry, which is a late sign of hunger. Since every baby is different, it is important for mothers to observe and learn their baby’s unique signals. Breastfeeding should be done on demand, in response to the baby’s need rather than following a rigid schedule. With time and patience, mothers can gradually learn to recognise these cues and should trust their instincts. Ultimately, they will come to know their baby best. Their confidence will naturally grow with experience.

Colostrum is the first milk a mother produces after birth, often referred to as “liquid gold” due to its rich yellow colour and powerful health benefits. Thick and nutrient-dense like honey, colostrum is produced in small amounts—about a teaspoon per feeding—but is packed with antibodies and immune-boosting properties. It’s nature’s first vaccine, helping protect the newborn’s stomach and immune system from harmful bacteria and viruses. While it may be difficult to extract with a pump, colostrum is easily delivered through direct breastfeeding. In the days following delivery, a mother’s milk gradually transitions from colostrum to mature milk, passing through a phase known as transitional milk. This shift doesn’t happen overnight; mature milk usually comes in around day three to five after birth. Though colostrum may not be visible, mothers must be assured it is going straight into the baby’s mouth, providing essential protection and nourishment during those critical early days of life.

One of the most common problems new mothers encounter is difficulty with the baby’s latch. A poor latch can lead to pain and ineffective feeding. To address this, mothers should ensure that the baby’s mouth covers both the nipple and a significant portion of the areola. In Pakistan, the most common breastfeeding positions include cradle hold, cross-cradle hold, side-lying and football (or clutch) hold. These positions are widely adopted by mothers for various reasons, such as comfort, ease of latch and specific needs like postpartum recovery. Cradle hold is a traditional position where the baby is held with their head in the mother’s elbow crook and their body is supported along the mother’s arm and chest. It’s often used for bonding and can be comfortable for both mother and baby. In cross-cradle hold position, the mother uses the arm opposite the breast she’s feeding from to support the baby. This provides good head and neck control, especially for newborns and smaller babies. Side-lying position is popular for night feeds or when the mother is recovering from a cesarean section, as it allows both mother and baby to rest while feeding. In football (or clutch) hold the baby is tucked under the mother’s arm, similar to holding a football, which can be helpful for mothers with larger breasts or those recovering from a cesarean. Laid-back or biological nurturing position involves the mother reclining and the baby lying on top of her. This encourages the baby’s natural feeding reflexes.

Breastfeeding boosts child survival, nutrition and development, while protecting mothers’ health - yet formula-milk marketing continues to undermine global efforts.

After a baby is breastfed, it is essential to burp them - regardless of the feeding position. Burping helps release any air the baby may have swallowed during feeding, which can reduce discomfort and prevent complications. The most common and effective method is to gently place the baby upright against an adult’s shoulder and lightly pat or rub the back. Sometimes, this may need to be repeated several times until the baby successfully burps. Skipping this step and laying the baby down immediately after feeding increases the risk of vomiting and, more seriously, aspiration. Although it may feel repetitive, burping is a simple, yet vital part of feeding during the first few months of exclusive breastfeeding, ensuring baby’s safety and comfort.

Low milk supply can be a concern for some breastfeeding mothers and may affect the baby’s growth and comfort. Signs of low milk production include fewer than six wet diapers a day after the first week, poor or slow weight gain and an irritable or restless baby who seems unsatisfied after feeding. Recognising and understanding the causes of low milk supply is key to addressing the issue early. Common contributing factors include poor latch or incorrect positioning, infrequent nursing or long gaps between feeds, maternal stress and fatigue, dehydration, inadequate nutrition and certain medical conditions such as thyroid disorders, PCOS (polycystic ovarian syndrome) or hormonal imbalances. Additionally, the early introduction of pacifiers or bottles can interfere with breastfeeding by disrupting the baby’s natural feeding cues.

Mothers can increase the breast milk supply by breastfeeding frequently. Feeding the baby on demand helps stimulate the hormone responsible for milk production. Ideally, a mother should aim to feed her baby every 2-3 hours during the day and every 3-4 hours at night. As long as both mother and baby are stable, skin-to-skin contact should be initiated immediately after birth. Placing the naked baby on the mother’s bare chest offers instant reassurance, helping the newborn feel safe and secure. This simple practice helps regulate the baby’s breathing, heart rate and body temperature. Letting the baby rest skin-to-skin for a few minutes can have a calming effect and supports the natural transition to life outside the womb. Once the baby is settled, breastfeeding can be initiated more smoothly, taking advantage of the baby’s early readiness and instinct to feed. Mothers can also do breast compression. Breast compression is a technique that can help increase milk flow during breastfeeding. The mother can apply gentle pressure on the breast tissue with her hand while the baby is nursing. Breast compression can help the baby get more milk, and it can signal the body to produce more milk. A mother can also use a breast pump after feedings to stimulate milk production and supply. Pumping can help empty the breasts more completely, which can signal the body to produce more milk. However, it’s essential to avoid over-pumping as it can lead to sore nipples and decreased milk supply.

Mothers must prioritise wholesome, nutrient-dense foods, stay hydrated and listen to their body’s needs. Drinking 8-10 glasses of water, including cumin and carom seed water can support milk production. Healthy, balanced meals to support milk production include protein-rich foods such as lean meats, eggs, dairy, beans, lentils and seafood low in mercury. In addition, whole grains, fruits and vegetables can be included to ensure a variety of nutrients. Some foods or drinks may cause a baby to become fussy or show signs of intolerance - like rashes, diarrhoea, or wheezing. If this happens, mothers could consider avoiding the suspected food for up to a week and monitor any changes. Finally, there’s no need for a special diet while breastfeeding.

Breastfeeding boosts child survival, nutrition and development, while protecting mothers’ health - yet formula-milk marketing continues to undermine global efforts. Moreover, despite its proven benefits, many mothers face challenges in starting and continuing breastfeeding. Many healthcare workers in both the developed and under-developed regions struggle to support breastfeeding effectively due to inadequate training. Pre-service curricula for doctors, nurses, and midwives often devote little time to breastfeeding counselling and support skills, including WHO outlined ten steps to successful breastfeeding. Strengthening this aspect of medical education is essential for improving breastfeeding outcomes.

Supporting breastfeeding is not just ethically right - it’s also economically wise. It reduces healthcare costs, enhances child brain development, improves school performance and strengthens national economies. Creating supportive environments is essential to reduce the environmental impact of formula feeding. A sustainable breastfeeding support system includes healthcare workers especially general practitioners, families, workplaces and communities, helping mothers overcome challenges and ensuring healthy outcomes.

The writer is a family physician at Evercare Hospital, Lahore.