‘YOU can’t make enough milk.’ ‘You can’t possibly breastfeed, don’t you have to return to work?’ ‘You have to give a bottle at night.’ ‘Give formula with it for more balanced nutrition.’ These are actual comments not just by family, but also medical professionals in our country to new mothers who were successful­ly and seamlessly breastfeeding at the time.

Eighty-four per cent of babies born in the US will be able to initiate their breastfeeding journey successfully whereas for a child born in Pakistan the breastfeeding initiation rate is a mere 18pc, and more prevalent in rural areas where medical intervention is less likely. That does not mean that less privileged spaces are safer for small babies — there are other dangerous medical circumstances that result in a higher infant mortality rate in these places. It merely means that more often, artificial milk or formula is either not available or too expensive and so nature is allowed to take its course.

While there are less than seven deaths per 1,000 live births per year in the developed world, in Pakistan the number stood at a whopping 59.10 in 2020; 38pc of these deaths were due to diarrhoea and 64pc to pneumonia. Breastfeeding has been scientifically proven to eliminate risk factors for gastrointestinal infections as well as respiratory illnesses by protecting the gut microbiome within the first six months. Unlike in the case of, say, complex cancer treatment, this is not because medical science has advanced in the developed world or because of the availability of some technology we don’t have access to. It is because there is an absolute dearth of skilled breastfeeding support here as well as lack of knowledge surrounding human lactation not just among the public but also health professionals.

The Baby Friendly Hospital Initiative under Unicef currently doesn’t have an accredited hospital in Pakistan. The US has 600 certified baby-friendly hospitals that make up 28pc of all medical facilities, while 100pc of hospitals in Scotland and Ireland are accredited as baby-friendly. Wales and England follow with 86pc and 53pc.

There are lessons to learn during World Breastfeeding Week (Aug 1-7).

It shows that lack of knowledge is not limited to new parents or their families. It is also seen in medical professionals including specialists such as obstetricians, gynaecologists and paediatricians who work closely with neonates and new/expectant mothers. Also, the medical curriculum barely includes hum­an lactation, making breastfeeding more of a blind spot. So, instead of addressing the lactation issue, any breastfeeding problem is only met with a suggestion to introduce formula.

Whereas over 95pc of women are physically able to breastfeed postpartum there is an exceptionally high rate of breastfeeding failure based on Perceived Insufficient Milk. In reality, milk production is sufficient but because of the way we are conditioned to judge supply, we end up misconstruing the baby’s normal behaviour as a sign of being underfed.

This perception is erroneously pushed socially by families and friends and also in healthcare settings. On the flip side, a sleeping baby might be seen as a calm, well-fed child, which is not necessarily correct. It might be a case of being underfed on breastmilk or overfed on formula!

A perfect diet is not required to be able to breastfeed. A better diet of course ensures better breastmilk composition but the complete requirement for the healthy growth of a child does not need the mother to follow a specific diet plan. The quantity is driven by the frequency of removal of milk from the body. A woman’s body is capable of producing enough milk for twins and triplets; exclusively breastfeeding one child is not an anomaly.

Formula is usually based on cow’s milk which a baby calf consumes to grow into an ox in a year — physically a fully grown adult but mentally light years behind a one-year-old human child. Artificial milk also has a limited number of nutrients whereas breastmilk composition includes over 200 genetically compatible, species-specific nutrients which are constantly altering to meet a child’s specific requirement.

Introducing the bottle alters the way a child latches on to the mother, gradually reducing supply; it also risks outright breast rejection. Formula and bottle-feeding are not the best practice vis-à-vis child nutrition. These are allowed alternatives in case there is some breastfeeding problem that is taking a while to resolve, but let us stop normalising them to the extent that they prevent successful breastfeeding if that is what parents wish for their child.

As a society, we have a shared responsibility towards protecting breastfeeding against practices that cause its erosion due to ignorance and the lack of skill and knowledge of human lactation as a science.

The writer is a certified lactation educator counsellor (UC San Diego), a student IBCLC and member of LCGB and ILCA. She runs a lactation clinic at Lahore Children’s Centre and Lactnation, the Breastfeeding Support Facebook Group.

Published in Dawn, August 5th, 2021