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Muhammad Qasim
Child mortality rate can increase from two to 70 times higher than the average in emergencies and the risk of hospitalisation for babies who are bottle-fed is 50 times greater than that of breast-fed infants.

Even in non-emergency settings, non-breastfed babies under two months of age are six times more likely to die. Children are most vulnerable groups during emergencies, and small children are the most vulnerable of all, because of increased risk of death due to diarrhoea, pneumonia and malnutrition.

Head of Community Medicine at Islamabad Medical & Dental College Professor Dr Muhammad Ashraf Chaudhry said this while talking to ‘The News’ in connection with World Breastfeeding Week, which is being observed from August 1-7 in more than 120 countries including Pakistan to encourage breastfeeding and improve health of babies around the world.

The theme of WBW 2009 is ‘Breastfeeding - a vital emergency. Are you ready?’ highlights the need to protect, promote and support breastfeeding in emergencies for infant and young child survival, health and development, he said.

Dr. Ashraf said that in emergency, massive amounts of infant formula and powdered milk are commonly donated. Some donations are a direct result of media appeals for infant formula. Frequently they are distributed to all mothers. Generous donations can do more harm than good. This can lead to early unnecessary cessation of breastfeeding and illness and death for many infants. Donated or subsidised supplies of Breast Milk Substitutes (BMS), bottles and teats should not be sought or accepted in emergencies. Breastfeeding in emergencies is also undermined by myths such as ‘stress dries up breast milk’ and ‘malnourished women can not breastfeed’, he added.

Bottle-feeding is very common in Pakistan. Studies reveal that more than one quarter (27 per cent) of children less than six months are fed with a bottle with a nipple. Health experts believe that bottle-feeding brings countless problems that range from as petty as hassles of preparing formula milk and keeping feeding-bottle ‘disinfected’ to as complex as millions of infant deaths worldwide.

Dr Ashraf said that bottle-feeding practices may result in increased morbidity because of unsafe water and preparation practices. “During the first two months of life, a bottle-fed baby is nearly six times more likely to die from diarrhoea and a host of other infections than a breast-fed child,” he said. It is important that in Pakistan, more than 400,000 babies die during their first year of life mainly because of diarrhoea and Acute Respiratory Infections (ARS).

Breastfeeding is the best way to provide newborns with nutrients they need. World Health Organisation recommends exclusive breastfeeding until a baby is six months old and continued breastfeeding with the addition of nutritious complementary foods for up to two years or beyond.

Dr Ashraf said that breast milk is a basic right of human infants and young children and is a complete food for first six months of life and can save more than one million lives around the globe each year. “Breast milk contains disease fighting cells and proteins called antibodies that help protect infants from germs and illness such as diarrhoea & respiratory infections,” he said and added that breastfeeding reduces the risk of hypertension, diabetes, asthma, and obesity in children in their future life.

“As far as benefits of breastfeeding for mothers are concerned, it promotes bonding between mother and baby. Lactation prolongs postpartum amenorrhoea and provides protection against pregnancy (natural contraceptive). Breastfeeding mothers have protection from postpartum depression, obesity, breast cancer, ovarian cancer, risk of hip fracture and diabetes,” said Dr Ashraf while responding to a query.

He added that breastfeeding also saves healthcare costs. Total medical care costs for the nation are lower for fully breastfed infants than never breast-fed infants since fewer sick care visits, prescriptions and hospitalisations, he said.

In spite of numerous advantages of breastfeeding and risks of artificial feeding, breastfeeding appears a lost art and the feeding bottle usurped the breast. Global data shows that less than 40 per cent of infants under six months of age are exclusively breastfed. In Pakistan, there is 85 per cent exclusive breastfeeding at one month, with the figure plummeting to 55% at two months and then to 37% at six months. This proportion is very low with the recommended 100 per cent exclusive breastfeeding for children under six months.

Dr Ashraf when asked about the factors that discourage or cause discontinuation of breastfeeding, said misconceptions of mothers, merely following the ‘fashion’ inadequate milk, exhaustion, lack of supporting environment, lack of counselling on the part of health care providers, and aggressive marketing of formula milk producers are among major causes. “Other factors include placid role of government in discouraging the so-called ‘substitutes’ of breast milk and non- implementation of breastfeeding ordinance 2002/relevant rules and regulations to encourage breastfeeding.”

The awareness and behaviour of families and community need to be altered positively to promote breastfeeding through raising awareness among masses by using all channels of mass communication. “Journalists have an important role in helping to protect infants in emergencies by not supporting appeals for donations of infant formula and by reminding audiences that breast milk is a reliable and sterile food that helps to prevent illness, while artificial feeding may further add to the health risks,” said Dr Ashraf.

He said that government should expedite the process of notifications of rules and regulations of the Breastfeeding Ordinance 2002. “To achieve the objectives of WBW, lady health workers should be mobilised for promotion of breastfeeding as they are the delivery agents at the household level,” he said.

Dr Ashraf opines that the UNICEF and Ministry of Health (Nutrition Wing) should involve Ulema to sensitise the people that breastfeeding for two years is also in accordance with Islamic teachings. “Breastfeeding may be included as a subject in the medical, nursing and midwifery curricula and healthcare providers should remove myths and misconceptions about breastfeeding,” he concluded.
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