Breastfeeding and SDGs

More than 150 countries of the world are celebrating World Breastfeeding Week from first to seventh August. This year’s theme is ‘sustaining breastfeeding together’ and links achievement of Sustainable Development Goals (SDGs) to breastfeeding. However, to achieve those goals, all the stakeholders need to work together.

The WHO recommends exclusive breastfeeding during the first six months of an infant’s life. It advocates for continued breastfeeding, with appropriate complementary foods, for children up to the age of two years or even beyond. Breastfeeding, especially during the first six months, plays a crucial role in a child’s health development. It is the smartest and most cost-effective investment in a country’s future. A 2016 Lancet Series on Breastfeeding indicates that breastfeeding helps in reducing under-five mortality, improving maternal health, affecting educational attainment through its positive impact on physical and cognitive development and increasing worker and country productivity by providing a healthier and more educated workforce. Since malnutrition contributes to half of all infant deaths, breastfeeding helps to reduce infant mortality.

However, many women workers cannot afford to take time away from work and thus are unable to nurse a child for at least six months and beyond. In the absence of workplace support towards breastfeeding, work is incompatible with breastfeeding. Worldwide research indicates that return to work is a major factor in women’s decision to quit or reduce breastfeeding which raises the risks of food or water-borne illnesses and diarrhoea in children.

Pakistan is the sixth-most populous country with the 10^th largest workforce in the world. Women constitute only 24% of the total labour force and their participation rate is 22.2%, the lowest in the region and one of the lowest in the world. Keeping in view the total fertility rate of 3.8% in Pakistan, what affects women, especially working women the most in Pakistan are employment breaks that happen because of child bearing and rearing. Pakistan Demographic and Health Survey 2012-13 indicates that only 38% of the children in Pakistan are exclusively breastfed during the first six months of their lives, which not only endangers their future cognitive development but also their physical growth. On the other hand, the bottle feeding rates have been continuously rising. According to World Bank Data, Pakistan had under-five mortality of 81 per thousand and infant mortality rate of 66 per thousand in 2015. Under the Goal 3 of SDGs, the target is to reduce under-five mortality to at least as low as 25 per 1,000 live births.

One of the ways to reduce this mortality rate and prevalence of stunting in children under five is to promote breastfeeding. The federal and provincial governments have enacted necessary legislation on protection and promotion of breastfeeding and child nutrition. The Infant Feeding Boards have also been notified under the legislation. As with all legislation in Pakistan, there are issues of implementation. In some provinces, the implementing rules have not been notified so far. The above-referred legislation promotes breastfeeding and restricts the use of formula milk for infants and young children, under two years. These laws prohibit the use of labels which promote use of formula milk as a substitute for mother’s milk, or even comparable with or superior to mother’s milk. The licence of a physician can get cancelled for unnecessary prescription of formula milk. A 2013 study by Save the Children Pakistan revealed that most of the women using formula milk were recommended its use by their doctors/healthcare providers. The study further indicated that use of formula milk is positively related to family income and employment status of a new mother. The use of formula milk is also perceived as linked to higher social class, thus attracting the lower-income families.

While Goal 5 of the SDGs talks about achieving gender equality and empowering all women and girls, little attention is being paid to workplace nursing support programmes for working mothers who breastfeed. Working mothers find it difficult to continue their breastfeeding due to the lack of supportive measures at workplaces, unavailability of space to express breast milk or nurse infants, lack of breastfeeding breaks, lack of flexibility in working hours and employers’ support towards breastfeeding. This ultimately leads to discontinuation of breastfeeding among working mothers.

The legally mandated duration of maternity leave in Pakistan is 12 weeks, with six-week pre-natal and six-week post-natal leave. Since a woman worker has to report back to work on completion of six weeks after delivery and there is no supportive legislation/institutional framework for nursing mothers, women substitute bottled milk for breast milk much earlier than the WHO-advised limit of six months.

As referred above, provinces have enacted legislation on protection of breastfeeding but no concrete steps have been taken to promote breastfeeding among working mothers. It is ironic that the government wants to improve child and maternal health and increase female labour force participation, however, the supportive environment which can enable working mothers to maintain their employment is lacking. Paid nursing breaks are imperative not only for child’s health and development, but also for improving the employment and retention rates for employed women. The issue of breastfeeding is also connected with the provision of daycare centres at workplace. Legislation in Punjab provides for establishment of daycare centers at workplace for workers’ children. Similar initiative needs to be taken by other provinces.

In order to change the current situation, the federal and provincial governments should formulate rules regarding nursing breaks at the workplace either under the labour legislation or breastfeeding legislation. These rules must clearly specify the number, duration — at least 30 minutes for one break, and the duration of entitlement to these breaks. Moreover, these breaks must be considered part of the working time. The rules must provide flexibility in working hours for mothers.

Let’s work together for incorporation of breastfeeding provisions in our labour laws and formulate such policies which help workers reconcile work and family commitments so that they don’t have to view these two as undesirable alternatives.

The article is first in a series of articles linking achievements of SDGs with coherent labour law reforms in Pakistan.

Published in The Express Tribune, August 3^rd, 2017.

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