KARACHI: As World Breastfeeding Week ended early this month, the Sindh health department has yet to devise rules to implement the law on breastfeeding that the provincial assembly had passed more than two years ago, it emerged on Monday.

The law, on paper, promises huge turnaround in the present terribly low breastfeeding practices in Sindh, where the ratio of breastfed children is found even less than the national average of 37 per cent.

Some members of civil society — who are also part of a six-member ‘technical committee’ with the mandate to weigh the law on the breastfeeding — blame the powerful baby milk formula companies for causing delay in implementation of the law in cahoots with some officials.

“You see, the rules formulation is being delayed to the total advantage to the formula companies which are aggressively campaigning for their products,” said Prof Durre Samin Akram, an eminent paediatrician and member of the technical committee, while speaking to Dawn.

The health department had named Dr Akram as the committee chairman and the chief drug inspector as its secretary more than a year ago. The committee was given the mandate to listen to the baby food manufacturers and marketing association representatives and recommend their suggestions (for amendment to the law) to the health secretary. It asked the representatives of the baby food manufacturers and marketing association to appear in person before the committee.

Sources in the health department said there were certain clauses in the Sindh Protection of Breastfeeding and Child Nutrition Act, 2013 with which the baby food manufacturers had not come to terms. They said that though the act had not yet fully been come into effect, the baby food manufacturers wanted some amendments to the law.

Despite several reminders by the committee, bylaws for the Breastfeeding and Child Nutrition Act 2013 had not been formulated for unspecified reasons, officials said.

Infant Feeding Board

Similarly, not a single meeting of the Infant Feeding Board has been held since its formation more than a year ago.

The chairman of the standing committee on health, Dr Sohrab Sarki, is its chairperson while its two members, Nasir Hussain Shah and Mehtab Akbar Rashidi, were lawmakers nominated by the speaker of the Sindh Assembly.

Other members of the board included two paediatricians, two obstetricians, a representative of the Baby Food Manufa­cturer and Marketing Association and Dr Durre Samin Akram from the civil society nominated by the health department.

The health secretary is the secretary of the Infant Feeding Board, while manager of health department’s Nutrition Support Programme is nominated as its member.

Breastfeeding law

The breastfeeding act has certain explicit restrictions on the baby food manufacturers. It envisages penalties such as up to two years of sentence and Rs500,000 fine for the violators.

It says no person shall, in any form whatsoever, promote any designated products except as provided for under this act.

Similarly, no person shall in any manner assert that any designated product is a substitute for mother’s milk, or that it is equivalent to or comparable with or superior to mother’s milk.

It restricts all manufacturers and distributors from offering or making gift or contributions of any kind, or pays to any extent for any reason whatsoever, or gives any kind of benefit, to a health worker or one’s family, or any personnel employed, directly or indirectly, in a health care facility, or any member of the board, or the employees thereof.

The act also binds the manufacturers and distributors that they cannot donate any designated product and equipment or services related to a designated product free of charge or at low cost to a health care facility, or offer or give any benefit to a professional association of medical practitioners for this purpose.

No person other than a health worker who is not engaged by a manufacturer or distributor can instruct any user on the need and proper preparation and use of any designated product, provided that a manufacturer or distributor may instruct any user on the need and proper preparation and use of any designated product.

Similarly, no distributor or manufacturer shall for the purposes of one’s business have contact, directly or indirectly, with general public within a health care facility. Neither of them nor any person engaged by them shall produce, nor distribute any educational or informational material relating to infant and young child feeding.

The law also makes it clear that the label of a designated product should not be designed so as not to discourage breastfeeding and should provide necessary information in Urdu about the appropriate use of such product and the age before which a designated product should not be used.

Every container shall have a clear, conspicuous and easily understood message printed on it, or on a label that cannot become separated from it, which should be written in Sindhi and Urdu, and if so desired by the manufacturers, in English as well.

The label should not contain anything that may discourage breast-feeding; contain a conspicuous notice in bold characters in the prescribed height stating “Mother’s milk is the best for your baby and helps in preventing diarrhoea and other illness”.

Expressions such as ‘maternalised’ or ‘humanised’ or equivalent making comparison with mother’s milk are also prohibited.

Besides, the manufacturers or distributors should not show photographs, drawings or graphics, except those to illustrate the correct method of preparation; except for bottles, teats, pacifiers and nipple shields, contain appropriate instructions in Sindhi and Urdu for the correct preparation in words and easily understood graphics, and indicate the ingredients, composition and analysis of a designated product, required storage conditions, batch number and expiry date, and contain any warning as might be prescribed for the implementation of the law in characters of the prescribed height in Sindhi and Urdu.

Published in Dawn, August 25th, 2015

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