Breastfeeding is often considered to be a ‘natural’ process for the mother and her newborn. This view not only implies that initiating breastfeeding is easy but it also downplays the challenges faced by new mothers, particularly those living in rural parts of Pakistan’s province of Sindh.
Sindh has the lowest rate of breastfeeding in the country with less than 10 per cent of mothers being able to sustain exclusive breastfeeding for the recommended period of six months. The constraints of living in small quarters with many family members and a lack of support from those around them are some of the many reasons why women discontinue breastfeeding, says Zohra Kurji, an assistant professor at the School of Nursing and Midwifery and a prominent researcher on breastfeeding practices in the province.
Ms Kurji’s research has found that many women living in large, extended families lack the privacy to breastfeed and the authority to take decisions. Many are expected to resume work on the farms immediately after delivery, while others are expected to run the household just days after giving birth leaving them with little time to learn how to nurture their child. Such obstacles lead to many women choosing to provide formula milk, water or even complementary foods to newborns even though breast milk is a sufficient source of nutrition.
Local social conventions such as throwing away colostrum milk, which is incorrectly perceived to be dirty, and rituals that call for a newborn to be fed honey also reduce a baby’s immunity to disease and contribute to the province’s poor nutrition indicators, she adds.
Ms Kurji is one of a small number of certified lactation consultants* in the country who are actively working to promote breastfeeding at the community and provincial level. Since 2007 she has been working with new mothers and midwives by informing pregnant women of the importance of only breastfeeding for six months, and by supporting lactating women as they initiate the practice.
She is currently serving as a technical member on the province’s Infant Feeding Board to support the Sindh government on a local policy to meet targets set by the federal government’s Infant and Young Child Feeding Strategy 2016 – 2020. Both policies seeks to achieve targets under the Sustainable Development Goals which call for tackling the sources of poverty, malnutrition and poor health that hinder the life prospects of children.
Besides contributing insights from her research to the provincial plan, Ms Kurji is also working to develop a curriculum that will educate midwives and lady health workers on how to overcome common and complex problems in initiating and sustaining breastfeeding.
“Breastfeeding is a critical first step in a child’s journey to good health. It is a skill that needs to be learnt by mothers and babies and that there are many social, biological, cultural and psychological factors that can disrupt this vital process. The goal of my research and advocacy work is to give every woman the guidance and support they need to ensure that our young are adequately nourished and protected from disease,” Ms Kurji states.
* Certified lactation consultants have completed 90 hours of lactation education and conducted 1,000 hours of supervised clinical work with breastfeeding mothers and babies. Ms Kurji is certified by the US-based International Board of Lactation Consultant Examiners.