There was once a time when motherhood was stereotypically associated with a life of stagnation. The new mother’s life would revolve around caring for her child, with no room for personal or professional growth. In these times, breastfeeding, despite its challenges and constraints, came naturally to women since motherhood was the only role they were expected to fit. With time, however, the social expectations facing new mothers have gradually started to change.
While husbands and families unfairly pressure some women to hop back into pre-pregnancy shape soon after birth others have to confront the looming prospect of lagging in careers they had spent years building. Amidst this cacophony of external judgment and inner insecurity, even the thought of breastfeeding a child every two to four hours, each day for two whole years, became physically exhausting and mentally burdensome.
Although it can be argued that such shifts happened pretty much all over the globe, the decline in breastfeeding practices has happened starkly in Pakistan, where formula feeding is openly advertised as the “healthy” option while lactation support is more or less non-existent. In a country where childcare is still considered the woman’s primary responsibility, little or no arrangements have been made to facilitate nursing mothers in public and private institutions through designated breastfeeding corners.
At airports, offices, hospitals, malls, courts, mass transit systems, railway stations, and universities, nursing mothers still have to tacitly locate secluded spots in restrooms and prayer rooms to feed their bawling babies. In 2017, the Parliament was the only state institution to build a nursing room for female parliamentarians with the help of UNICEF. In this context, formula milk naturally emerged not only as a saviour for overburdened mothers but also a facilitator of female empowerment. However, despite its positives, nothing about this normalized, artificial feeding practice could be termed natural.
According to the World Health Organization (WHO), breastfeeding is one of the most effective ways to ensure child health and survival since breastmilk is safe, clean and contains antibodies that help protect against many common childhood illnesses. Furthermore, research has shown that breast-fed children perform better on intelligence tests, are less likely to be overweight or obese, and are less prone to diabetes later in life. Similarly, women who breastfeed also have a reduced risk of breast and ovarian cancers. However, contrary to WHO recommendations, fewer than half of infants under six months old are exclusively breastfed.
“While countries such as the United States and the United Kingdom have since re-emphasized breastfeeding due to its well-documented health benefits, Pakistan continues to see low exclusive breastfeeding rates during the first six months postpartum. National surveys have estimated that only 37 per cent of babies are exclusively breastfed,” said Dr Ayesha Shahbaz, a lactation specialist.
Finding health in a tin
Despite their numerous benefits, breastfeeding practices are on the decline in Pakistan, where mothers are increasingly turning to formula milk either out of necessity or choice. While in some cases professional responsibilities or nutritional deficiencies necessitate formula supplementation, oftentimes the irresponsible marketing of formula milk convinces new mothers that the key to their little one’s growth and development is hidden in a tin.
Dr Shahbaz, a registered medical practitioner, agreed that in certain cases, concerns about milk supply were valid, especially when maternal malnutrition or anaemia was present—both of which are prevalent among women in Pakistan. “Nutritional deficiencies can affect both the quantity and quality of breastmilk. However, a significant barrier also lies in maternal perception. Many mothers doubt their ability to produce sufficient milk and view formula as a more reliable option; a belief that is reinforced by pervasive marketing campaigns depicting robust, chubby babies being fed with formula. Such portrayals can cause anxiety among mothers who fear that exclusive breastfeeding may not be enough for their child’s development,” noted Dr Shahbaz.
According to the World Health Organization (WHO), the inappropriate marketing of breast milk substitutes continues to undermine efforts to improve breastfeeding rates and duration worldwide. Therefore, breastfeeding counseling, along with baby-friendly hospital support and community mobilization approaches, is a key intervention to improve breastfeeding rates.
“Despite the proven importance of this approach, it remains underutilized in Pakistan. There is limited integration of lactation counseling into routine maternal healthcare, and in many cases, even gynaecologists may not be familiar with the role of lactation consultants. As a result, new mothers are often discharged from hospitals with formula milk prescriptions, without being offered adequate breastfeeding guidance,” explained Dr Shahbaz.
According to sources of the Express Tribune, the baby milk and infant formula sector in Pakistan is projected to generate approximately 440 million US dollars in revenue in 2025, with an anticipated annual growth rate of 4.26 per cent from 2025 to 2029. Currently, eight companies are leading the infant formula market, with their prices ranging from Rs1,000 to Rs10,000 for a 400 grams standard tin.
However, despite the booming infant formula industry, nutrition levels among the masses have remained alarmingly poor. In the National Nutrition Survey 2018, which surveyed the nutritional status of children under the age of five, 40 per cent of children were stunted, 15 per cent wasted, and 23.1 per cent were underweight. Furthermore, the nutritional status of women of reproductive age was equally concerning, with an estimated 38.2 per cent suffering from anaemia, 47.7 per cent deficient in vitamin A, and an alarming 76.4 per cent living with a vitamin D deficiency.
While nutritional deficiencies and women’s psychological inclination towards formula could partly explain the shift away from breastfeeding, extended living arrangements and the unavailability of breastfeeding spaces in public areas are also discouraging factors.
Dr Nighat Khan, General Secretary of the Women Care Foundation, estimated that 15,500 children were born in Pakistan every day. “All these children need mother's milk for two years. Women can easily breastfeed newborn children at home however, oftentimes there are many modesty constraints in the joint family system. Furthermore, nursing women cannot breastfeed their babies in markets, railway stations, and parks, which is a tragedy,” said Dr Khan.
Expanding on the problem, Professor Dr Nasreen Aslam Shah, former Head of the Department of Social Work at the University of Karachi, reiterated the fact there were no designated spaces for breastfeeding babies at bus stops, parks, shopping centers, or public places. “When a newborn baby gets hungry in a public place, mothers are forced to feed their child inside a chador or burqa, which is difficult. Other women are forced to carry formula milk to deal with such situations,” emphasized Dr Shah.
Nursing spaces and gender inclusivity
“Designed by women, for women.” Although the presence of this label on a product or service might create an illusion of female empowerment, it is a subtle reminder of a much more sinister reality. Everything else in the world is neither for women nor designed by women.
From the seating alignment in cars to the standard temperature maintained in indoor public spaces and even the height of shelves at stores, the subject user or citizen is by default always a man. In Pakistan, this male bias in urban planning manifests in the design of urban spaces, which often neglect the provision of infrastructural arrangements like daycare centres or nursing spaces, which are necessary to accommodate women in the public sphere through different life stages.
Javeria, a 30-year-old new mother pursuing her higher studies at the University of Peshawar revealed that her daughter was just six months old. “Travelling to the university through public transport every day is a challenge since no separate breastfeeding area is designated in public spaces. Even the BRT Peshawar does not have such a facility. Since nursing a child in public is against the norms of our culture, many working or studying mothers are compelled to feed formula milk through a bottle,” explained Javeria.
Similarly, Humaira Ahmed, a resident of Karimabad, agreed that breast milk was essential for the health of the child however, breastfeeding mothers faced many difficulties upon setting foot outside the home. “It is impossible to breastfeed a child outside the house. There should be separate nursing rooms designated in markets, shopping centers, railway stations, airports, and public entertainment centers,” opined Ahmed.
In Punjab, guidelines have been established by the Punjab Women Development Department for the establishment of daycare facilities however, many public and private institutions still lack designated spaces for breastfeeding.
Dr Uzma Ashiq Khan, Executive Member of the Punjab Day Care Fund Society and Assistant Professor of Gender Studies at the Lahore College for Women University (LCWU) revealed that initiatives aimed at establishing a nursing corner or daycare facility for women often received a mixed response.
“While some institutions claim they do not have space for a daycare others feel they are not necessary. However, the debate on daycare centres holds immense significance in the field of gender especially when it comes to assisting working women. Mothers looking for a job often check whether an organization provides a daycare facility or not. Even if such spaces are designated, consistent monitoring is needed to ensure that they are not misused,” opined Dr Khan.
Barrister Rida Noor stated that a law regarding daycare centers was passed in the National Assembly in 2022, however, by 2023, there were still no daycare centres established. “According to the law, if any company or institution fails to offer such spaces, a warning is issued, after which a fine of Rs100,000 may be imposed along with up to six months of imprisonment,” said Noor.
Vice President of the Pakistan Paediatric Association Professor Mohammad Hussain conceded that the lack of dedicated breastfeeding spaces in public places such as airports, universities, and even hospitals posed a significant barrier for mothers. “While Pakistan has made commitments under global frameworks like the Global Strategy for Infant and Young Child Feeding, there is limited national legislation mandating breastfeeding-friendly spaces in public institutions. Even where policies exist, implementation remains weak due to lack of awareness, funding, and administrative will,” implored Hussain.
Facilitating breastfeeding
“A mother should breastfeed her child for at least two years.” In our society, the aforementioned comment is casually thrown around by older women trying hard to school a new mother on the correct way of being a mother. However, practically, very little support is afforded to the anxious mother, who lacks the necessary guidance on both motherhood and lactation.
According to Dr Shahbaz, who is also a public health consultant, effective maternal and infant health is dependent on a coordinated approach involving gynaecologists, paediatricians, and lactation specialists. “Integrating lactation counseling into the essential antenatal and postpartum visits is crucial to equip new mothers with the knowledge and skills needed for successful breastfeeding. These sessions not only promote awareness of the health benefits of breastfeeding but also prepare mothers to manage common breastfeeding challenges,” advocated Dr Shahbaz, who also felt that training nursing staff in basic lactation management could further strengthen lactation support.
Dr Shahbaz also stressed the need for early consultation with lactation specialists, who could provide dietary guidance and recommend appropriate supplementation to support lactation. “Health systems strengthening through the training of staff, revival, and support of baby-friendly hospital initiatives and incorporation of lactation specialists into the triangle of care could make a significant impact. On a policy level, initiatives such as nursing rooms in public and private spaces are a step forward, but their impact will be limited unless broader cultural and healthcare shifts actively encourage breastfeeding,” claimed Dr Shahbaz.
On the other hand, Dr Samrina Hashmi, a gynaecologist, still felt that ensuring gender-inclusive infrastructure in public spaces was crucial to facilitate breastfeeding practices. “The tragedy is that there aren’t even proper female washrooms in many areas of major cities let alone breastfeeding rooms. Women's issues are continuously ignored in our cities, and a lack of such basic facilities causes significant stress to women,” noted Dr Hashmi.
Considering the lack of nursing spaces in institutions and public areas, pumping could be a good option for mothers wishing to avoid formula milk when breastfeeding is not feasible. However, in Pakistan, the high cost of breast pumps, which are available at prices between Rs12,000 to Rs35,000, and the lack of accessibility for lactation support make formula milk the more convenient option.
Sindh government spokesperson and member of the provincial assembly, Sadia Javed conceded that breastfeeding facilities were not available in Karachi however, the government was making efforts in this regard. "The Karachi Terminal has been built on the superhighway, where facilities have been provided for women, while seven major bus terminals are also being built in Sindh as part of the 2025-26 budget. Under these projects, rest areas, waiting areas, and breastfeeding facilities will be established for women. The private sector is also being included in these initiatives,” claimed Javed.
Ms Zainab Naveed, an officer at the Women Development Department, stated that institutions applying for funding were provided financial assistance by the government to build the necessary daycare infrastructure. “Three categories are defined based on the number of children, and guidelines have been issued on providing the required facilities. Office employees and security arrangements are also part of the setup,” said Naveed.
Director Nutrition Khyber-Pakhtunkhwa Fazal Majeed revealed that the K-P government had established 22 daycare centres and breastfeeding corners across universities and hospitals. “Under the Khyber-Pakhtunkhwa Protection of Breast-Feeding and Child Nutrition Act 2015, it is mandatory to establish separate breastfeeding spaces for mothers in public places across the province," said Majeed.