Pak low breast­feed­ing rates lead­ing to stunted growths

Kuwait Times - - HEALTH & SCIENCE -

DERA MU­RAD JA­MALI, Pak­istan: Motherof-seven Mah Pari lives in a fer­tile re­gion of Pak­istan’s south­west Balochis­tan prov­ince but her two-year-old son, Gul Mir, is cry­ing from hunger as she cra­dles him in her arms. “All my ba­bies were weak after they were born. Maybe it is be­cause my breast milk is not good,” she sighs. In Pak­istan, many moth­ers are told to feed their new­borns tea, herbs or for­mula milk, one of the ma­jor fac­tors be­hind a stunted growth rate in chil­dren of a stag­ger­ing 44 per­cent.

“In our Balochi cul­ture, we give bat­tri, crushed herbs twice a day, morn­ing and even­ing,” says the dis­traught mother, whose eighth preg­nancy was barely show­ing un­der her skill­fully tai­lored yel­low tu­nic. “I also gave him tea and breast milk twice a day, in the morn­ing and the even­ing,” she adds - far less than WHO rec­om­men­da­tions.

Else­where in the coun­try, ba­bies are of­ten fed ghee (clar­i­fied but­ter), honey or su­gar cane. “I work all day at home, I don’t have time to breast feed,” says Mah Pari, who firmly be­lieves that tra­di­tional con­coc­tions are bet­ter than her own milk. Gul Mir, age two, reg­is­ters just 5 kilo­grammes on a weigh­ing scale in a ru­ral mo­bile feed­ing cen­ter run by Doc­tors With­out Bor­ders (MSF) in Manju Shori. That is less than half the ideal weight for a tod­dler his age, while the av­er­age new­born in the West weighs 3.5kg - and his de­pri­va­tion at such a crit­i­cal stage is likely to have per­ma­nent con­se­quences.

‘It’s a Cri­sis’

The sit­u­a­tion is not lim­ited to Balochis­tan, the poor­est and least sta­ble of Pak­istan’s four prov­inces. The coun­try’s rate of growth stunt­ing is among the high­est in the world, ac­cord­ing to UNICEF, be­cause of a lethal mix of risk fac­tors: bad nutri­tion, hy­giene prob­lems and un­clean wa­ter, com­bined with a lack of ed­u­ca­tion for moth­ers. The con­se­quences are per­ma­nent and dis­abling: lim­ited height, in­com­plete brain de­vel­op­ment, and el­e­vated risk of dis­ease.

It has a huge im­pact on the na­tional level, re­duc­ing IQs and pro­duc­tiv­ity of a large per­cent­age of the pop­u­la­tion. It “is a cri­sis, it’s a mas­sive emer­gency,” said An­gela Kear­ney, head of UNICEF in Pak­istan, em­pha­siz­ing that one the lead­ing causes of mal­nu­tri­tion is the lim­ited breast­feed­ing. Only 38 per­cent of ba­bies are fed breast milk ex­clu­sively dur­ing their first six months in line with the UN rec­om­men­da­tions. This low fig­ure is blamed on lo­cal tra­di­tions, the heavy work­loads of moth­ers and pow­er­ful mar­ket­ing by the milk in­dus­try.

Like many grand­moth­ers, Razul looks after the chil­dren when her daugh­ter-in-law is work­ing at home or in the fields. “The doc­tor told us to give the baby Num­ber One milk,” she says, re­fer­ring to a brand mar­keted by Nes­tle. It was a dis­as­trous de­ci­sion for her grand­daugh­ter Ak­ila: The wa­ter in feed­ing bot­tles is of­ten un­clean, and as fam­i­lies are poor, they use only one spoon of pow­der. Razul says her daugh­ter-in-law doesn’t have enough breast milk be­cause the fam­ily is poor and she can only eat bread. But, as is of­ten the case, they de­cided to buy baby milk in­stead of feed­ing the mother bet­ter.

‘We Throw the Milk’

“Peo­ple here think that only for­mula can give en­ergy to their chil­dren,” ex­plains Im­tiaz Hus­sain, a pro­vin­cial health of­fi­cial. “It is pre­scribed by doc­tors, of­ten quacks, who are after money and get kick­backs from phar­macy stalls,” he claims. “There is lack of knowl­edge, and un­eth­i­cal and ag­gres­sive ad­ver­tis­ing of breast milk sub­sti­tute,” adds Kear­ney, de­spite an in­ter­na­tional con­ven­tion and Pak­istani law which pro­hibits mar­ket­ing breast milk sub­sti­tutes.

Nes­tle, for its part, says its ad­heres to the law “very strictly” and its rep­re­sen­ta­tives can only con­tact health pro­fes­sion­als, not par­ents, to ad­vise them on the nu­tri­tional facts about their prod­ucts. But badly ad­vised moth­ers still re­frain from breast­feed­ing at the mo­ment when the child needs it most: the hours after its birth or dur­ing pe­ri­ods of sick­ness.

“Some moth­ers do not agree to breast­feed (for) fear of pass­ing on dis­eases” or ham­per­ing re­cov­ery, laments Mo­ham­mad Sid­dique, nurse su­per­vi­sor of the nutri­tion depart­ment of MSF Balochis­tan. “As for for­mula milk, they are of­ten pre­scribed (...) for the first 24 hours of the baby’s life, be­cause the mother does not feed him her colostrum,” he adds, re­fer­ring to the mother’s first milk that con­tains vi­tal an­ti­bod­ies that pro­tect new­borns against dis­ease.

Many women find them­selves be­wil­dered at the ap­pear­ance of this se­cre­tion that marks the be­gin­ning of lac­ta­tion. “We... throw that milk, throw it aside, be­cause the color is yel­low and it is wa­tery” says Sam­ina as she gently rocks her 10-day-old daugh­ter Kosar, who is suf­fer­ing from menin­gi­tis. The gov­ern­ment, which claims to be “aware of the prob­lem”, has set a goal of re­duc­ing the rate of stunt­ing to 40 per­cent by 2018 - but the is­sue isn’t men­tioned in its ten-year plan. Most in­ter­ven­tions are funded by in­ter­na­tional donors. “It has to get bet­ter,” says Kear­ney, call­ing on fa­thers, grand­moth­ers, ob­ste­tri­cians and ven­dors of in­fant for­mula to sup­port moth­ers in breast­feed­ing. “Breast is best,” she says. —AFP

DERA MU­RAD JA­MALI, Pak­istan: In this pho­to­graph taken on Sept 7, 2016, Mah Pari car­ries her son Gul Mir as she waits for her turn at the mo­bile feed­ing cen­ter of Medecins Sans Fron­tieres (MSF). —AFP

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