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Being a mother – How breastfeeding can save lives of Pakistan’s infants

breastfeeding pic
By Farahnaz Zahidi

August 7, 2016

The myth that just mother’s milk does not suffice has caught on, and this trend is an imminent danger to the lives of Pakistani infants

Her fifth child is due any day. Nazeer Bibi lives in a shanty part of Qayyumabad, Karachi, and has already decided that she will feed her baby formula milk.
“I work in three houses as a domestic help to support my family. I leave at 8 am after dropping my older children to school and return by 4 pm, and the baby will have to be at home. What option do I have? Besides, dabbay ka doodh (formula milk) makes babies healthier. I want my baby to be healthy like the babies in advertisements.”
Nazeer’s baby will be one of the 62 per cent Pakistani infants who are not exclusively breastfed. Only 38 per cent of infants under the age of six months are exclusively breastfed, according to the Pakistan Demographic and Health Survey (PDHS) 2012-13. The rates are the lowest in South Asia.
The myth that just mother’s milk does not suffice has caught on, and this trend is an imminent danger to the lives of Pakistani infants, a danger that is not talked about often enough. As the World Breastfeeding Week is celebrated globally from August 1-7, the conversation around breastfeeding needs to be more audible and frequent in Pakistan. But bringing up the topic inevitably initiates parallel discourse regarding how lives of infants are less safer till formula milk is promoted as a choice. “From tobacco, to sugar, to formula milk, the most vulnerable suffer when commercial interests collide with public health,” says an editorial in medical journal The Lancet.
“Formula milk should only be given when there is a medical reason for it,” says Dr Azra Ahsan, an expert in mother and child health. “The baby gets complete nutrition through breastfeeding. The mother passes on her protective antibodies to prevent common illnesses in the baby. As no water is required to prepare it, unlike how formula milk is prepared, the chances of diarrohea and vomiting are minimised.”
According to the World Health Organisation (WHO), breastfeeding has the potential to prevent about 800,000 under-five deaths per year globally if all children 0-23 months were optimally breastfed. Pakistan has one of the highest infant mortality rates in the region, all the more reason that breastfeeding must be encouraged, especially among the lower income strata.
The PDHS 2012-13 findings also show increase in bottle feeding rates in Pakistan.
“Babies who are born to mothers from the lower income strata are more at danger if they are not exclusively breastfed. The water these mothers use to prepare the formula is unhygienic, and the bottles are not sterilized. Also, formula milk is not cheap. Once they start the baby on it, they start diluting the milk over time so that the formula powder lasts longer; as a result, the baby becomes malnourished,” says Neha Mankani who works as a community health midwife at a hospital in Karachi.
According to the World Health Organisation (WHO), breastfeeding has the potential to prevent about 800,000 under-five deaths per year globally if all children 0-23 months were optimally breastfed.
Once the baby is started off on top feed, the unaffording or unaware mother, over time, starts substituting it with unboiled cow’s milk or low quality tea whitening milk powder which is unsuited for an infant. “We can try and convince the mothers but only till they are in the hospital. Also, Community Health Workers (CHWs) have no access to women who deliver at home,” says Mankani, adding that she and her colleagues try to convince mothers to breastfeed.
However, part of the problem could be that healthcare providers are not doing enough to raise awareness. “Healthcare professionals are the main culprits. Instead of advising new mothers to breastfeed, they help perpetuate the trend of using formula milk. They are given incentives by formula milk companies. Research shows that children delivered in hospitals are more frequently formula fed,” says Dr DS Akram, Founder, Health, Education & Literacy Programme (HELP).
The laws protecting the right of the infant to health and nutrition are there. Lawyer Summaiya Zaidi says that the primary focus of laws like the Protection of Breast-Feeding and Child Nutrition Ordinance 2002 is to protect the nutrition of the child and promote breastfeeding as a primary source of nutrition. After the devolution, each province developed its own Acts for the purpose.
“The Sindh 2013 Act stresses that manufacturing, advertising and sale of alternate sources of child nutrition cannot be promoted as better than mothers’ milk or even compared to it. This stresses the primacy of breast milk as the best source of nutrition for a growing baby, and only when the mother is unable to provide the same to her child should alternatives be made available. It basically controls the manufacture and advertising of child nutrition products by placing certain legal limits on promotion of the same,” says Zaidi.
Yet, the tussle between public health experts and forces of consumerism continue. Companies producing or distributing formula milk refused to give any statement regarding how they justify the tempting advertising campaigns.
At the 69th World Health Assembly earlier this year, a resolution welcomed WHO’s guidance on ending the inappropriate promotion of foods for infants and young children. The guidance states that in order to protect, promote and support breastfeeding, the marketing of “follow-up formula” and “growing-up milks should be regulated. This recommendation is in line with the International Code of Marketing of Breast-milk Substitutes.
“The laws are there, but the implementation is a distant dream. Formula companies continue to particularly tantalise urban markets,” says Dr Akram, adding that the government does not seem interested in this cause. Dr Akram and her team run the Baby-friendly Hospital Initiative (BFHI) of WHO and UNICEF successfully in Pakistan for a few years. “When external funding stopped, the government was not interested in investing in it,” she says, adding that companies that produce formula milk mainly target the urban market to tantalise consumers.
“For the poor population in rural areas, breastfeeding is mostly the only available option. The urban social landscape is more challenging when it comes to breastfeeding. More mothers are working mothers; more options for top feed are available here; more people can afford to buy formula milk. Awareness is needed in both rural and urban areas,” says Dr Sara Salman of WHO Sindh.
According to Mankani, despite trying to raise awareness, most mothers follow popular myths. “They feel the baby is healthier if fed formula, owing to the aggressive marketing of formula milk.”
The biggest challenge for exclusive breastfeeding is the perception that mothers are not producing enough milk and should supplement with formula because the baby cries, says Meredith Jackson-deGraffenried from Helen Keller International. “This perception is driven by the misunderstanding that if the mother is undernourished and poor, she must be incapable of adequately nourishing her baby.”
“We try to teach these women basics about expressing their own milk and how to store it. Mother’s milk stays fine for up to three days in a refrigerator, and up to six hours at room temperature. It’s an economical and healthier option. But myths are hard to fight,” says Mankani.
Despite proven benefits like the mother who breastfeeds return to her pre-pregnancy state much earlier, and the incidence of breast cancer in women who breastfeed being much lower, as Dr Ahsan says, the myths seem to be winning.
“Socially, breastfeeding proves a challenge as well. There are usually no crèche or nursing rooms at work. That’s one reason working mothers stop breastfeeding,” says Dr Ahsan.

Originally published here: http://tns.thenews.com.pk/mother/#.V6hsuPkrLIX

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Burying prejudice in football one kick at a time

Published: July 1, 2015
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http://tribune.com.pk/story/912944/kicking-against-the-prejudice-that-hurts-womens-football-in-pakistan/
Mashal Hussain. PHOTO COURTESY: KARACHI UNITED FC

Mashal Hussain. PHOTO COURTESY: KARACHI UNITED FC

KARACHI: Ask her a simple question like ‘how old are you’ and you get a very poetic response from her. “Born in the sultry Karachi summer of ‘87, I’m approaching the cusp of 27 years now,” says Karachi United’s Mashal Hussain. This female athlete who has become an advocate for empowering women through sports can kick the ball hard, speak eloquently and keep her head in the right place.

Mashal recently got back after representing Pakistan at the Girl Power in Play symposium, held on June 18-19, 2015 in Ottawa, Canada, against the backdrop of the FIFA Women’s World Cup 2015. Creating ripples among female sportspersons of Pakistan, she spoke about how ‪Karachi United Football Club – Women’s Squad, have used the medium of sports to create positive social impact and in particular helped empower women.

Coming from what she calls ‘a fairly athletic and active family, always bustling around’, Mashal spent her primary years between Karachi and Toronto. Inclined towards sports from the beginning, she dabbled with many sports. “I stubbornly pushed our school to introduce basketball into the curriculum.”

PHOTO COURTESY: MASHAL HUSSAIN

However, her particular interest in football began in her junior year at McGill University where she briefly worked with the Men’s Varsity Team as a fitness assistant.

“The captain of the squad at the time sustained an injury and I was helping him recover through various drills and exercises. In doing so, I developed a liking for the game and began watching European leagues, learning the game and playing it.” A few months of coaching and the liking grew into a passion and she has been playing and coaching the sport ever since. She, accompanied by her younger sister, represent the same team now.

PHOTO COURTESY: KARACHI UNITED FC

Pushing boundaries as a woman

For Mashal and others like her who have pursued their passions on the road less travelled by females in Pakistan, the path is not always easy.

“Women’s football in Pakistan involves cultural frustrations, religious misconceptions, the issue of women’s rights, emancipation from a conservative tradition and a general changing of mind set of the local population,” says Mashal. The gender issue, according to her, is deep-rooted and is, globally, a feminist issue. In the context of Pakistan, Hussain admits that there is a gender bias regarding aspects such as funding, media promotion, government support, facilitation of infrastructure, grassroots development, and of course, awareness.

“Women who realise and follow their passion are rare in our society. And if that passion happens to be sports-related, we need to become the role models we want to look up to,” says Mashal.

When asked about the original and synthetic turf issue in the football world cup, which experts see as part of gender bias against female footballers, Mashal expressed satisfaction that at least the world has come to realise this.

“That is a positive step; not enough, though. While we’re fighting for media coverage and funding of grassroots development, the fact that uproar was created and acknowledged about this issue means that more people are paying attention.”

PHOTO COURTESY: KARACHI UNITED FC

Silver linings

Luckily for Mashal, her family has been supportive of her playing and forging a career in this field.

“I know how lucky I am and it is a personal goal of mine to influence today’s youth to become the kind of people my parents are.”

In addition, she has had a good experience since she began working at Karachi United.

“Most of our staff is male, but they never let the gender bias get in the way of football and my role as their superior. Outside the organisation, of course, no such utopia exists,” she says.

As one who has faced gender bias head on, Mashal does not only blame the men.

“Gender bias is also perpetuated and propagated by females in our country. So that is another barrier we strive to break.”

PHOTO COURTESY: KARACHI UNITED FC

Women must play

Women’s participation in sports is showing encouraging and important impacts on women’s development, of which Mashal is a strong proponent.

“Sport empowers women by instilling in them the confidence that they are often denied in countries such as our own. In sport, women are not only encouraged to be competitive, but they are also accepted for being aggressive and fierce with being labelled. It empowers women by giving them a sense of belonging,” says Mashal.

Mashal feels that including women would ensure the overall development of any sports industry that could potentially bolster the country’s economy and global standing and that the media will always sensationalize women’s sports.

“People shouldn’t be watching our players because of their aesthetic appeal or religious background. Instead, the success stories I consider truly inspirational are based on personal growth, economic empowerment, career development, societal contribution, impact and a personal sense of fulfilment.”

PHOTO COURTESY: KARACHI UNITED FC

State of women’s football in Pakistan

“Women’s football is abysmal in the country. That we are the only professional entity working towards grassroots development (girls between the ages of 3-16) should shed some light on why the country is ranked,” says a disgruntled Mashal.

The fact that an open trial for the national team has not been held in years sheds light on the plight of women’s football in the country. Mashal added that the local governing body is in cahoots and is struggling to understand that holding one tournament a year will not promote the sport at the grassroots or the competitive level.

“I cannot comment on discrimination, per se, but the state of affairs of Pakistan Football is laughable and sad at the same time.”

Aspiring female footballers look up to Mashal as a success story. When asked to comment on that, she replies that her story has barely begun.

“My story is in its initial chapters still. The plot has not thickened and the character development has only just begun. So, no, I do not consider myself a success story. However, I have had the pleasure of working with girls and women who are success stories already,” she says, and shares that some of the players that have come through the Karachi United (women’s) pipeline are proving to be real game changers for the organization, the team, and for Pakistan.

PHOTO COURTESY: KARACHI UNITED FC

Our voices must be heard

“It was empowering to be in the company of so many influential and driven individuals,” says Mashal, when asked about her recent experience at Ottawa.

Women Deliver, UNICEF, Right to Play, GAIN, and One Goal teamed up to host the Girl Power in Play symposium. The two-day event focused on the power of girls’ involvement in sport and gathered decision makers, sports stars, influencers, and girls and women involved in sport.

“I’ve met people whose stories resonate with me because I can appreciate their effort.”

Mashal had stumbled upon an open application for this event last year.

“I came across it while perusing how to get involved with the FIFA Women’s World Cup, for which opportunities were scarce. After I applied, they got back to me a few months later and we were good to go,” she says and commends Women Deliver for channelling everyone’s motivation and zeal into a productive and focused forum. Women Deliver is a global advocacy organization bringing together voices from around the world to call for action to improve the health and well-being of girls and women.

Mashal also said that the games have been great, though watching them from Pakistan poses problems due to relying on live streaming.

In the opinion of Mashal, the biggest obstacle to women’s participation and progress is opportunity.

“It will take a few generations, perhaps. I am so glad, however, to have been able to contribute towards this slow, but necessary revolution.”