KARACHI: There are 8.1 million species out of which 6400 are mammals. Humans, the only mammal species, with mothers thinking that they have insufficient milk for their baby. WHO recommends that all infant babies should be breastfed for this would prevent more than 800,000 infant deaths each year.
Global breastfeeding rates have increased over the past decade and in 2023, 48% of all infants under the age of 6 months were exclusively breastfed. Current predictions show that the World Health Assembly target of 50% will be reached by 2025. The 2030 target is that 70% infant should be exclusively breastfed till 6 months of age, however it looks that only few countries would be able to reach this target.
Pakistan has a very high infant and neonatal mortality rate and the major killers of our children, under one year of age, are prematurity, diarrhea and respiratory diseases. Exclusive breastfeeding refers to an infant being fed only breastmilk for the first six months of life.
This was shared by senior pediatricians including Prof. Masood Sadiq, President Pakistan Pediatric Association, Prof. Mohsina Noor Ibrahim, Secretary General PPA, Dr. Khalid Shafi, Prof. Wasim Jamalvi, Dr. Saadullah Chachar and Dr. Hayat Buzdar during a media briefing held at the Karachi Press Club.
In Pakistan the exclusive breastfeeding rate is only 48.4%. This means more than 50% of the children are not given exclusive breastfeed.
The average cost of tins /packet of the artificial formula of 400 gm is around 2000 to 3000 rupees and it is consumed only within 3 days. Statistically, in a month 10 tins are required costing 25,000 rupees per month for buying a month’s formula milk supply. How many people in Pakistan can afford this? Pakistan is a country where 40.2% population is stunted (this means that they are of low weight as well as low height), 17.7% children are wasted (this means they have low muscle mass) and 28% population is under weight, they told.
Strong marketing of formula feed on the media, social media and other platforms worsens the situation. If we want to save our children, we should promote exclusive breastfeeding along with routine vaccinations. The aggressive and unethical marketing of breast-milk substitutes continues to undermine efforts to improve breastfeeding rates.
Breastfeeding protection laws are present already in Pakistan since 2002 and then they were again revised and passed by provincial assembly of Sindh in March 2013. Similar laws also exist in other provinces, but these laws were not covering all the aspects of the unethical promotion of formula milk, so their sale continuously rose, they further said.
Pakistan Pediatric Association felt that if we want to save the lives of our children, improve their health, and improve infant motility rate, we need to promote breastfeeding.
Pakistan Pediatric Association in collaboration with UNICEF and Govt of Sindh Health Department prepared a new law. The Sindh protection and promotion of breastfeeding and infant nutrition act 2023 was passed in July 2023 by Sindh assembly and on 20th September 2023 it was notified. This, therefore, is a valid law in the province of Sindh and hopefully soon similar law will be passed by the other provincial and the national assemblies of Pakistan.
The milk companies opposed this bill even before it was passed and made a cartel. They asked the government not to approve this law. Anyhow this law was approved despite all their efforts. The formula companies continued their efforts to undermine this law and challenged this law in High court of Sindh.
Pakistan Pediatric Association requested Sindh High Court to be a party in this petition. The honorable judge of the Sindh high court approved our request, saying that the pediatricians are the real experts who will facilitate the court. Ultimately, the Sindh high court dismissed the petition of the formula companies against the approval of this law. This law is valid in the province of Sindh and now implementation phase of this law has started.
This law is undergoing major changes since the previous act was based on the recommendations of World Health Assembly of 2016. The most important thing that this law covers the nutrition products, including milk substitutes and their weaning products, hence this law is applied to all these products up to 36 months of age. It does not mean that breastfeeding should continue till 3 years. The important fact about this law is that now the formula companies cannot use the word formula milk and instead write that this is artificial formula.
According to this law, the artificial formula sale will be limited to pharmacies and authorized outlets. Now the formula companies cannot distribute free samples, cannot advertise publicly, cannot give the free coupons, gifts etc. So, the advertisement of artificial formula, as well as, weaning products of children for under 3 years of age cannot be publicized in the media.
There are financial penalties and also the imprisonment of various nature for manufacturers, distributers and for health provider if they do not follow this law.
This is a golden opportunity for us to promote breastfeeding and in this way we will be saving thousands of the children from the diarrheal diseases, pneumonia and allergies.
Furthermore, we will be saving foreign exchange of our country which is being spent on the import of formula.
Pakistan Pediatric Association takes pride in playing a major role in the preparation of this law and in defending this law in court. We hope that from now our health care providers and the related industry will respect and abide by this law.
