DAWN.COM

KARACHI, Aug 18: Advocating baby friendly health initiatives, medical professionals say breast milk is a life-time gift from mothers to their children and for that there is a need for physical and psychological preparation of mothers before delivery both in urban and rural settings.

Breastfeeding campaigners say mothers who do not start feeding their children within an hour of their birth are virtually depriving them of a healthy start in life.

A ‘Save the children’ report issued this year said that malnutrition and child mortality could be fought with relatively simple and low-cost nutrition interventions, including a six-month exclusive breastfeeding, with the greatest potential to save lives in children’s first 1,000 days and beyond.

A senior doctor at the nutrition rehabilitation clinic and ward of a public hospital in North Karachi said he and his team members usually received acute malnourished children with indicators such as underweight, stunting, wasting and anaemia, for which the mothers and
their families could be blamed.

By breastfeeding the risk of malnutrition, infection and death among children could be reduced, said the doctor, adding that babies fed with formula and denied breastfeeding early tended to require more doctors visits, hospitalisations and prescriptions.

The mother of a 17-month-old girl from Lyari at the same hospital said thinking that she did not have enough of her own milk to feed the baby, she started giving her some animal and dry milk. “Now, I am told that she has been suffering from frequent ailments — common cold, cough, fever, pneumonia and diarrhea — for nothing but departing from breastfeeding.

The poor resorting to bottles and teats were at risk of contaminated and unhygienic feedings, said an expert, adding: “Well-off or working mothers in the urban setting should also not forget that while they opt for giving bottle and formula feed to their little ones they are not only comprising the overall mental and physical wellness of their children but were also failing to increase the physical and emotional bonds between them and their children.”

Experts called for institutionally-supported baby-friendly feeding practices originating at the gynecology/obstetrics and paediatrics departments of the hospitals.

Sindh has one of the highest malnutrition rates with acute malnutrition affecting 23 per cent of under-five children while chronic malnutrition or stunting affecting half of the under-five population.

Prof D. S. Akram, chairperson of the Health Education and Literacy Programme and Nutrition Resource Centre, said inappropriate feeding practices with food insecurity contributed significantly to the burden of malnutrition and therefore increased mortality in most developing countries, including South Asia. She said there should be a complete ban on smart formula and their endorsement by hospitals and physicians.

Dr Salma Shaikh, a professor of paediatrics and dean of the basic sciences faculty at the Liaquat University of Medical and Health Sciences, Jamshoro, said good nutrition during the first 1,000 days of life was critical to future health, well-being and learning abilities of the child.

“Among the lifesaving low-cost solutions which have the greatest impact on child survival and nutrition, breastfeeding has proved to be the most effective. Breast milk provides all nutrients needed for healthy development of an infant along with antibodies which protect babies from common illnesses like diarrhoea and pneumonia,” she said, adding that those protective effects were most significant with six months of exclusive breastfeeding followed by continued breastfeeding for two years with appropriate complementary feeding.

Such optimal breastfeeding practices, Dr Shaikh said, could prevent an estimated 19pc of all under-five child deaths.

She referred to the breastfeeding trends in the country and the exclusive breastfeeding rate – 37pc as recorded in 2006/7 — compared to other countries such as Sri Lanka, where it was 90pc.

She said that early initiation of breastfeeding was essential to establish a good feeding practice, but was mostly delayed in our community due to cultural beliefs, and poor physical and psychological preparation of mothers before delivery. “Counselling women during prenatal period, identifying and addressing concerns and constraints can promote early initiation of breastfeeding,” she said, recalling the Baby Friendly Hospital (BFH) initiatives launched by the United Nations Children’s Fund and World Health Organisation in the 1990s and said it was a good effort to ensure that more hospitals and maternity homes as well as child clinics and paediatrics wards provided breastfeeding support.

However, the programme was launched in many hospitals in Sindh as a limited-time project and could not be continued despite merits, she said, adding that the system could be revived in the shape of some institutionalised intervention.

Prof Shaikh siad about 1,000 doctors employed at the public hospitals across the province, trained under the Integrated Maternal Newborn Child Health, could be motivated or bound to work for baby-friendly health initiatives.

Under the Unicef-WHO initiative, a maternity facility can be designated ‘baby friendly’ when it does not accept free or low-cost breast milk substitutes, feeding bottles or teats, and has implemented specific steps to support successful breastfeeding.

Dr Durreshehwar, the Sindh government’s focal person on nutrition, said the baby-friendly hospital programme in the past had succeeded in inculcating breastfeeding habits in mothers. Though implementation of the initiatives was slow, Sindh had got 58 out of the 68 health facilities for the public or private sector declared as ‘Baby friendly hospitals’, she said, lamenting that the BFHs in the province could now be counted on fingertips.