Baby Shows and Hoardings promoting infant formulas have disappeared through efforts of paediatricians-Prof. A.G. Billoo


HELP Seminar on Saving Newborn Lives through promotion of Breast Feeding

Baby Shows and Hoardings promoting infant
formulas have disappeared through efforts
of paediatricians - Prof. A.G. Billoo

Doctors should emphasis upon exclusive breast feeding
for at least six months-Prof. Jamal Raza

Sindh has passed protection of Breast Feeding and Child
Nutrition Bill, formed Infant Feeding Board - Prof. D. S. Akram

KARACHI: Paediatricians have struggled a lot to promote breast feeding and it is because of their efforts that we now do not see any Baby Shows and Hoardings promoting infant formulas all over the country. This also shows that laws have their own importance. Government failures are there but our failings are there too. We should promote public-private partnership in health and appreciates the good work being done by various Non Governmental Organizations. This was stated by Prof. A. Ghaffar Billoo an eminent paediatrician of the country. He was speaking at an interactive meeting organized by an NGO HELP (Health, Education and Literacy Programme) headed by Prof. D. S. Akram on May 29th 2014. Mr. Iqbal Durrani Health Secretary Government of Sindh was the chief guest on this occasion. The meeting was also attended by representatives of Sindh Health Department, World Food Programme, print and electronic media besides some paediatricians.

Prof. Billoo further stated that ever since we celebrated the International Year of the Child, the Pakistan Paediatrician has intensified its efforts to promote breast feeding emphasizing the advantages of exclusive breast feeding. Companies promoting Infant formulas are not invited to the PPA conferences and they are not allowed to provide fundings for these meetings, though some might be doing it secretly through different means. We had to struggle for twenty five years and we have made some progress to protect breast feeding from breast milk substitutes.

Prof. Billoo agreed that NGOs should be certified and their accounts as well as services should also be audited. Media can help a lot by printing, airing and telecasting short messages to promote breast feeding. While the EPI programme has been success in certain areas, in Polio it has been a failure that is why we have to face the present travel restrictions. We have failed to win the polio war. He emphasized the importance of continuous education of public highlighting the benefits of polio vaccination. WHO recommends six months exclusive breast feeding and we have also urged the government authorities to increase the maternity leave for females from three to four months. Day Care Centers should also be established at workplace so that those mothers who are breast feeding their babies can feed them while on duty. Earlier responding to various questions from the participants, Prof. Billoo said that doctors are part of the society. They cannot be singled out. The whole society is involved in unethical practices and there are some ethical issues with the healthcare professionals as well. There may be some black sheep who still promote and patronize infant formulas but it is the duty of every paediatrician and obstetrician to advise the mothers to breast feed their babies and opt for exclusive breast feeding for first six months. He commended the work being done by HELP and HANDS and hoped that all NGOs will help for the welfare of the society at large.

Sindh Health Secretary Mr. Iqbal Durrani in his speech at the occasion said that if we look at the infant mortality and under five mortality rates in our neighboring countries in Asia, they have all reduced it by over 50% during the last twenty years but our performance has been very dismal. These are not very rich countries which show that the real issues were with the management, hence we need to improve our management and governance. We need to highlight and promote the advantages of breast feeding. As regards the figures presented by Prof. Jamal Raza based on the Gallop Survey, he said that one has to take these figures very carefully because it is all dependent on the sample size and from where the sample was taken. HELP and HANDS are doing a commendable job, he remarked.

Referring to the meeting of the Infant Feeding Board which has not taken place so far, he pointed out that rules and regulations of the Board have to be framed. We have made some beginning by forming this board and we can make a dent by our work. Hence, it is important that we continue our work despite all odds and hindrances.

Dr. Dureshawar Khan Nutrition Focal Person from Government of Sindh in her presentation talked about the Sindh Protection of Breast Feeding and Child Nutrition Ordinance 2013- Violations and Penalties pointed out that while bills were important, their implementation is more important. Infant Feeding Board could not meet because we had no Chairman of standing committee on Health, no Health Minister and no one was appointed to head this Infant Feeding Board. Some of these offices have now been filled. Code violations will be investigated. Promotion of designated products like bottles, soothers and labeling of products and promotion of complimentary foods are banned. Formulas are only to be promoted for children over the age of six months. Implementation and education material will all be submitted to this Board before publication and distribution. But the important question remains that who will monitor implementation of this Ordinance, she asked?

Prof. Jamal Raza Director National Institute of Child Health Karachi speaking about the violations of the Code highlighted the results of a Gallop Survey which showed that 84% of mothers were advised to use infant formulas and this figure was 90% in Khyber PK and 68% in Baluchistan. There was no significant difference in urban and rural areas. This survey also showed that 47% of doctors advised to use infant formulas; it was more in urban areas than rural areas. Again 27% were advised to purchase a particular brand and doctors were involved in promotion of certain brands of infant formulas. However, 82% also talked about benefits of breast feeding at the same time. Our infant mortality rate is about 74 per thousand while these figures were 88/1000 for five to nine years old children and 92/1000 for ten to fourteen years old children. We have 55% neonatal deaths in under five deaths. Diarrhoea, measles, malaria are the major cause of these deaths and these are all preventable. He laid emphasis that doctors should emphasize on exclusive breast feeding for first six months. Prof. Jamal Raza also disclosed that Infant Formula market in Pakistan was worth 9.4 Billion rupees and there are twelve companies of which three Nestle, Meiji and Morinaga had the major share, Nestle being on top.

Earlier Prof. D. S. Akram chairperson of HELP talked about the achievements and accomplishment of their two years project Saving Newborn lives by Early Initiation of Breast Feeding and Exclusive Breast Feeding. This project, she said, started on August 1st 2012 in collaboration with Research Advocacy Fund (RAF). We had some obstacles. We started in Sindh and Baluchistan provinces first. In January this year we went to Khyber PK and few months ago to Punjab. Dynamics of every health department in each of these provinces are different and they have their own different priorities. We also wanted to engage at least one university in each province. We had positive experience as we found Dr. Nasir Bugti an efficient activist in Baluchistan and in Sindh Dr. Dureshawar the focal person on nutrition. Save the Children Fund was also our partner. Sindh has passed Protection of Breast Feeding and Child Nutrition bill in February 2013. Lady Health Workers are being trained in lactation management skills. Sindh has also formed Infant Feeding Board. DUHS in Karachi has started teaching breast feeding and child nutrition in medical and dental colleges. However, no meeting of the Infant Feeding Board could take place so far. Baluchistan has also passed breast feeding protection and child nutrition bill and they have started four lectures on these topics in the medical institutions.

We went to Punjab in January 2014. The provincial government there is very progressive. Decisions are taken very fast. Rules and Regulations are being finalized by them. Fatima Memorial Medical and Dental College at Lahore have included teaching lactation management skills. We engaged Khyber Medical University in Khyber PK. Dr. Mehar Taj was working in the past but then some changes took place. She has now once again started working. We had a wonderful cooperation from the women parliamentarians both from the government as well as from the opposition and they all extended us their valuable support. We have now also formed Breast Feeding Alliance with some CSO to improve breast feeding practices. While enactment of legislations has been our accomplishments, violation reporting and action against them has been our failures, she added.

Dr. Maroof Imam introduced HELP. He pointed out that there had been no optimum feeding practices promotion with the result that our infant mortality remains very high at 70/1000 live births while less than five mortality was 87/1000. Exclusive breast feeding is practiced by 37.1% of mothers while 28.8% had early initiation of breast feeding. Almost 22% of neonatal deaths can be reduced by early initiation of breast feeding during the first hour after birth.

During the discussion Dr. Shahzad from Health TV referred to the quackery which is rampant in Pakistan. He also highlighted the negative attitude of the Media who are least interested in giving coverage to health related issues. Various persons and organizations, he alleged, were on pay roll of various institutions and they lack professional approach. Mr.Shaukat Ali Jawaid agreed with Dr.Shahzad as regards lack of professionalism in the print as well as electronic media. He further stated that those who are supposed to cover Health do not have even the basic core knowledge of health and they are least interested to learn as well. Owners of these media houses also have least regard for professionalism and do not give health any priority. He also highlighted the unethical practices among the healthcare professionals in general and paediatricians, obstetricians in particular who promote and patronize the infant formulas for their personal interest. He was of the view that the Paediatricians must concentrate on self monitoring of their colleagues rather than looking for laws which may not be easy to implement. Prof. Billoo and Prof. D.S. Akram both agreed that of course there are some doctors including paediatricians who are alleged to be involved in such unethical practices but we have continued our struggle and achieved some success in different areas though a lot more needs to be accomplished.

Another participant suggested that there should be some Appellate Board before the case of any violations is processed further for punishment. Corruption and unethical practices by the PM&DC, and the media war also figures during the discussion. Ms. Imtiaz Kamal opined that problems and difficulties faced by working mothers also need to be highlighted. Dr. Amara Shakeel programe manager HELP presented vote of thanks.