Child nutrition in Sindh — progress, policy and path ahead
The writer is a PhD scholar
Every year, World Breastfeeding Week from August 1st to 7th serves as a global reminder of the critical role breastfeeding plays in the survival, health and well-being of infants and young children. While breastfeeding is often perceived as a natural and instinctive act, the reality for many mothers, particularly in rural and underserved areas like Sindh, is far more complex. This week is not only an opportunity to raise awareness about the benefits of breastfeeding but also a moment to reflect on the challenges and structural barriers that hinder its practice in Pakistan.
The data from Sindh's Infant and Young Child Feeding (IYCF) survey by Sindh Bureau of Statistics reveals alarmingly low rates of early initiation and exclusive breastfeeding. This underscores the urgent need for policy enforcement, community-level support and awareness to ensure every child receives the best nutritional start in life.
The statistical snapshot on IYCF in Sindh (2018-19) reveals critical gaps in early childhood nutrition practices. Only 23% of newborns in Sindh were breastfed within the first hour of birth, and just 47% of infants under six months were exclusively breastfed, indicating poor early initiation and exclusive breastfeeding practices. Complementary feeding also shows concerning trends, with 68% of children aged 6-23 months receiving the minimum recommended meal frequency, but only 15% achieving the minimum diet diversity and a mere 12% receiving a minimum acceptable diet.
Continued breastfeeding was reported at 77% for children aged 12-15 months and 59% at 20-23 months. Significant disparities exist across regions. For example, Larkana had the highest minimum diet diversity at 22.5% while Shaheed Benazir Abad had the lowest, 5.7%. Similarly, Hyderabad showed the highest early initiation of breastfeeding at 34.8%, compared to just 11.9% in Sukkur.
The data also highlights inequities based on household wealth, maternal education and place or type of delivery children from urban, wealthier and more educated backgrounds fared better in IYCF indicators. These findings stress the importance of promoting timely initiation of breastfeeding, exclusive breastfeeding for six months, and the introduction of safe, diverse complementary foods to improve child health outcomes in Sindh.
After health department was devolved to provinces under the 18th Amendment, several provinces enacted their own legislation: Punjab amended its version in 2012, Sindh passed the first provincial law in February 2013, followed by Balochistan in 2014 and Khyber-Pakhtunkhwa in 2015. The Sindh Protection and Promotion of Breast-Feeding and Child Nutrition Act, 2013 was a landmark provincial initiative aimed at promoting exclusive breastfeeding for the first six months and continued breastfeeding up to two years.
In contrast, the Sindh Protection and Promotion of Breast-Feeding and Young Child Nutrition Act, 2023 revived and significantly strengthened the earlier legislation. It extended the scope of protection beyond infants to include children up to 36 months of age and placed stricter restrictions on the marketing and promotion of not only infant formula but also follow-on formulas, feeding bottles, pacifiers and related products. In essence, while the 2013 Act laid the legislative foundation, the 2023 law modernised, expanded and enforced that framework, turning policy into meaningful action for child nutrition and maternal health in Sindh.
As World Breastfeeding Week draws to a close, it is essential to move beyond symbolic gestures and commit to sustained action. The passage of the Sindh Protection and Promotion of Breast-Feeding and Young Child Nutrition Act, 2023 is a major step forward, reinforcing the government's responsibility to support mothers and safeguard infant health. However, laws alone are not enough. Effective implementation, public awareness and frontline support for breastfeeding mothers especially in marginalised areas must become a priority. There is need to protect, promote and support breastfeeding as a fundamental right and a life-saving intervention for the youngest citizens of Sindh and Pakistan.