BREASTFEEDING is a natural way of nourishing newborns and young children. In the modern age, however it has become endangered. The onslaught of milk formulas — so-called breast-milk substitutes — and their ruthless, irresponsible and highly unethical marketing create doubts in the minds of mothers and families about the adequacy of breastmilk and its nutritious value and its effects on a lactating mother’s body.

Indeed, milk formula is needed in some limited situations and if used rationally it can be helpful. But such situations are few. It should not become the norm, which it has. And it can never be a substitute for breast milk which manufacturers want us to believe it is and market as such. There was no milk formula before 1865 and the human race had survived before then! But, if it is used only in a restrictive situation then it is not good business. So, it is important for suppliers to push it towards mothers as a norm; in doing so, they undermine the adequacy of breast milk as well as its nutritious value and sow guilt in the mother’s mind as if she is not feeding her baby enough by not resorting to milk formula.

After noting concerns about the general decline in breastfeeding trends related to different factors in developing countries over the years, the World Health Assembly adopted the International Code for Marketing of Breastmilk Substitutes in 1981. The 27th WHA in 1974 had noted a general decline in breastfeeding related to the production of manufactured breast milk. It urged member countries to review sales promotion activities regarding baby foods and introduce appropriate remedial measures, including advertisement codes and legislation where necessary. In 1981, however, the WHA itself, after long debates adopted an international code to the same effect, with 118 countries voting in favour of the code and only one country voting against it.

The crux of the code is that infant formula “should not be marketed and distributed in ways that interfere with the protection and promotion of breastfeeding” and “[T]here should be no advertising and other form of promotion to the general public of products within the scope of this Code”. “No facility of the healthcare system should be used for promoting infant formula… .” “No financial and other inducements to promote products within the scope of this Code should be offered by manufacturers or distributors to health workers or members of their families, nor should these be accepted by the health workers or members of their families.” Ever since this code was formulated, there have been a number of WHA resolutions further urging member states to take action on various additional aspects of breastfeeding protection.

The code is a “minimum requirement” that should be followed to protect breastfeeding. It urges governments to take action including by adopting national legislation to implement its provisions. Out of 194 countries, 144 have legalised the code one way or the other. Apart from supporting governments in implementing the code, there have been many international, regional and national monitoring reports to see how governments are controlling marketing excesses by milk formula companies and distributors. The International Baby Food Action Network, WHO and Unicef and many other national groups have been undertaking such monitoring exercises.

With a strong lobbying effort by the Network for Consumer Protection in Pakistan, the government promulgated the Protection of Breast-Feeding and Child Nutrition Ordinance, 2002. The backdrop of this successful lobbying effort was set by the hard findings that came out of a survey conducted by the same organisation in 1998 involving 33 cities and towns in the country. The survey was published in a report titled Feeding Fiasco — Pushing Commercial Infant Foods in Pakistan. In more than 2,500 one-to-one meetings with mothers, nurses, doctors, paediatricians and company representatives, it was found that not a single company was abiding by the international code in its entirety and every fourth mother was buying some kind of milk formula.

The law codified many provisions of the international code in Pakistan. However, the implementation of this law has been a challenge and milk formula companies continue to violate it on a daily basis. Unfortunately, many doctors and paediatricians continue to play into the hands of the milk formula industry that wines and dines them besides funding their and their family’s travels. Mega entertainment galas are organised in the name of scientific conferences, all financed by the companies that continue to promote milk formula and undermine breastfeeding.

Who knows better than these unethical practitioners that a formula-fed child living in unclean conditions is between six and 25 times more likely to die of diarrhoea and four times more likely to die of pneumonia than a breastfed child.

Despite Quranic injunctions on breastfeeding for two years and scientific evidence for exclusive breastfeeding for the first six months, less than 50 per cent of mothers are exclusively breastfeeding during this period in Pakistan. As a result of ineffective protection for breastfeeding, many mothers are switching to milk formula and unknowingly harming their infants and exposing themselves also to health risks. Each year of breastfeeding reduces the risk of breast cancer among women by 6pc. Breastfeeding also reduces the risk of ovarian cancer.

Another major benefit of breastfeeding for two years is that women do not conceive during this period. It is nature’s way of birth spacing so that women can properly nourish and nurture the baby and recover from the physical stress of the last pregnancy and birth. Promoting breastfeeding hence results in natural population control. In Pakistan’s context, this is one of the best ways to deal with the population tsunami we are facing.

To learn more about the dynamics and tactics of the milk formula industry, watch the Bollywood movie Tigers which is based on true events that unfolded in Pakistan in the late 1980s and early 1990s.

The writer is a former SAPM on health, professor of health systems at Shifa Tameer-i-Millat University and WHO adviser on UHC.
zedefar@gmail.com

Published in Dawn, August 12th, 2022