KARACHI: A staggering 84 per cent of mothers have reported in a recent survey that they were advised to use formula milk or other milk or food for infant under six months of age making the task for the advocates of breastfeeding in the country more difficult to accomplish.

The report, Breastfeeding — roadmap to promotion and protection, prepared by non-governmental organisation Save the Children, said that the ratio of such mothers was the highest in Khyber Pakhtunkhwa with Balochistan (68pc) as the distant second, but there was no difference among rural and urban regions.

“This highlights the need to discourage the promotion of formula milk in community. Health providers are one of the agents who recommend formula milk. It may be due to the fact that they think formula milk is better and more useful, but importance of breastfeeding initiation, exclusive breastfeeding and sustaining breastfeeding for 24 months stands like a universal truth,” said the report.

It said the fact it stressed on could be seen in terms of scientific evidence supporting its importance, its naturally balanced composition and its suitability for optimal feeding, growth and development.

The report said the trend of doctors recommending formula milk was the highest in Balochistan and the lowest in Sindh. More doctors were providing the same recommendation in the urban areas as compared to the rural areas. Not only were those doctors persuading mothers to use formula milk, they were also in the lead to recommend a specific brand to mothers, making it more evident that there was a strong connection between medical practitioners and formula milk companies.

Among mothers who reported to have received advice for exclusive breastfeeding, 27pc of them were also advised to use commercial baby food along with breastfeeding from three to four months.

“This is a clear violation Af articles 7.1, 7.2 and 7.4 of the Code,” said the report, adding all technical entities and research organisations working for the child health rights as well as advocacy campaigns including the UNICEF, WHO and SNL (Saving Newborn Lives) suggest ‘exclusive breastfeeding’.

The report said some 11pc mothers reported to have seen promotional messages of formula milk and other products and most of them had seen those promotional messages at clinics (doctors or nurses), hospitals or dispensary, etc.

It said there was little difference in rural and urban areas. Among those who saw promotional messages of infant formula, most had seen them on TV, making it the most important source of advertisement by companies. Some 3pc mothers reported receiving free samples in last six months for their infants and majority of those samples were given by doctors and nurses.

“Although majority of the mothers responded that breastfeeding should be initiated immediately after the birth of the baby, there was a gap in knowledge and practices regarding exclusive breastfeeding,” it said.

The report said exclusive breastfeeding was more common in rural areas as compared to urban areas. Most common reasons reported for not breastfeeding were insufficient milk production, weak child, poor health of mother, outside work by mother, etc.

“One important finding was that only 44pc mothers reported to be the key decision-makers in infant feeding followed by doctors and other health workers,” it added.

Only 2pc doctors said they were visited by a company representative in the last six months. It was significantly different in provinces but ‘this difference was not significant in rural or urban areas’. There was a difference in the purpose of visit between provinces and in urban versus rural areas.

In Khyber Pakhtunkhwa, 90pc of the respondents reported that the purpose of the visit was to provide information to pregnant women; in Punjab, majority of the visits (63pc) were for product information to health professionals.

Some health professionals received gifts from companies and few received free samples in the last six months as well, said the report.

“Although majority of the health professionals (67pc) said infants should be exclusively breastfed up to five to six months of age, 32pc said exclusive breastfeeding up to 3-4 months of age, which was not a positive finding,” said the report.

It said most health professionals said they had advised mothers and pregnant women about breastfeeding but a majority of health professionals said they advised breastfeeding along with weaning with packaged baby foods from four months of age onwards.

“What was shocking was that 11pc of these health professionals actually recommended bottle feeding. Majority of the health facilities visited had some information about breastfeeding, but the material had some company’s name on it along with the products included the name of infant formula, baby food, follow-on formula and feeding bottle.”

“Interestingly,” concluded the report, “information available at health facility mentioned that bottle feeding was as good or even superior to breastfeeding, which again is in contradiction to various articles of the international Code. Fifty-seven per cent of the material even regarded infant formula the best substitute of mother’s milk. The proportion was highest in Balochistan”.

Published in Dawn, February 3rd, 2015

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