Importance of Breast Feeding

1. BREASTFEEDING
BY
Mujeeb Ahnmed Wadho
Public Health Specialist/
Epidemiologist

2. Breastfeeding is the
best gift a mother
can give to her
newborn

3. Introduction
 In infancy, no gift is more precious than
breastfeeding.
 Infants are meant to breastfeed.
 Breastfeeding provides the best possible
start to life in all areas of development.
 Early initiation and exclusive breastfeeding
for six months of life can save more than one
million babies.

4. Breastfeeding
 Breastfeeding is the feeding of infant or
young child with breast milk directly
from woman’s breasts, not from a baby
bottle/ other container.
 Babies have a suckling reflex that
enables them to suck and swallow milk.

5. FACTS & FIGURES
 Breast milk is the best source of nourishment for
human infants, preventing disease, promoting
health and reducing health care costs.
 Artificial feeding is associated with more deaths
from diarrhoea/pneumonia in infants.
 A lack of exclusive breastfeeding during the first
six months of life contributes to over a million
avoidable child deaths each year.

7. FACTS & FIGURES – cont’d
 Unfortunately, “Breastfeeding practice”
among mothers in Pakistan, is still
alarmingly low.
 Exclusive breastfeeding as well as the
duration for which a child is breastfed, is
lowest in Pakistan, compared for
neighbouring South Asian countries
including India, Bangladesh, Nepal and Sri
Lanka.

8. FACTS & FIGURES – cont’d
 Globally, less than 40% of infants under six
months of age are exclusively breastfed
 In Pakistan, 37% of infants under six
months of age are exclusively breastfed
(Demographic & Health Survey of Pakistan, 2006-07).
 Highest bottle-feeding Rate: 32%

9. FACTS & FIGURES – cont’d
 Exclusive Breastfeeding Rates in other
countries of the Region:
 Sri Lanka: 76%
 Nepal: 53%
 India: 46%
 Bangladesh: 43%

10. FACTS & FIGURES – cont’d
 Almost two-thirds of babies (65%) in Pakistan are
given something other such as ghutti, fresh animal
milk etc in the first three days of life (prelacteal
meal) a practice that should be discouraged
because it may inhibit breastfeeding /or introduce
contaminants.
 In Pakistan, 400,000 babies die during their first
year of life due to diarrhoea and Acute Respiratory
Infections such as pneumonia.

11. FACTS & FIGURES – cont’d
 Children who are not exclusively
breastfed 14 times higher risk of dying
as compared to those who are breastfed
 10% higher risk of getting diarrhoea

12. FACTS & FIGURES – cont’d
 22% of neonatal deaths could be prevented if
breastfeeding is initiated within first hour by all
mothers
 Even in developed countries, lack of breastfeeding
is associated with increased risk to the survival and
health of babies.
 Exclusively breastfed infants are two and half
times less likely to become ill and two times less
likely to die than infants who are not breastfed.

13. FACTS & FIGURES – cont’d
 Breastfeeding percentage: 2006-07: 37.1%
 2012-13: 37.7%
 Bottle feeding rates (2006-07): 32.1%
 2012-13: 41 percent
 Exclusive breastfeeding rates lowest among
educated women belonging to upper
socioeconomic strata

14. FACTS & FIGURES – cont’d
 Bottle feeding rates high among
working women, women belonging to
upper income class and those residing
among urban areas and those seeking
care from health professionals
 Pakistan has highest bottle feeding
rates and lowest exclusive
breastfeeding rates in South Asia

15. Factors responsible for depriving
children from their right of breastfeeding
 Mother’s ignorance about its importance
 Newborns or mothers pathological factors
 Different taboos and myths
 Lack of training by health workers for
preparation of mother for breastfeeding after
delivery
 Awareness and effectiveness of law, its
implementation and monitoring

16. Factors responsible for depriving
children from their right of breastfeeding
One of the reasons for
reduction in the rate of
breastfeeding is easy
availability of its supplements

17. Breastfeeding cannot be
promoted in the absence of
effective crackdown on the
unethical promotion of the
infant formula by the
industry.

18. ADVANTAGES OF MOTHER'S
MILK
 Breast milk contains all necessary nutrients
for the baby , at that it is in the optimum
ratio and a kind , adapted for features of
digestive system of the newborn, it develops
by mother's organism by the individual
order.

19. ADVANTAGES OF BREAST
FEEDING
 The structure of mother's milk
change in process of the baby's
growth , in accordance with his
needs. Colostrum is produced at
first time after childbirth , then
mammary gland produce
transitional milk and from
second-third week mother's
milk becomes mature.

20. Slide 2a

21. Benefits of breastfeeding for the
Infant
 Provides superior nutrition
for optimum growth.
 Complete food for babies up
to six months of age
 Provides adequate water for
hydration.
Slide 2.1

22. Benefits of breastfeeding for the
Infant
 Protects against infection and
allergies.
 Promotes bonding and
development.

23. Advantages for the Baby
 Less illnesses, diseases (diarrhoea,
pneumonia, ear infections etc) & disorders
 Antibodies in breast milk
 Always the right temperature
 Nurturing benefits from skin to skin contact
 Aids in development of baby’s brain and
nervous system

24. Advantages for the Baby
 Breastfeeding reduces the risk of
hypertension, diabetes, asthma,
cancer and obesity in their future
life.

25. Composition of Breast milk
 Proteins: less casein in human milk and it forms a softer
curds which is easier to digest. Human milk also contains
antibodies (anti-infective proteins). Cow’s milk contains
too much of the protein casein which are difficult for a
baby’s immature kidneys to excrete.
 Fat content: Human milk contains essential fatty acids
which are needed for baby’s growing brain, eyes & blood
vessels. Enzyme lipase, in human milk helps to digest fat.
Cow’s milk does not contain enzyme lipase to digest the fat
and baby becomes constipated. Cow’s milk more saturated
fatty acids than breast milk which can cause obesity in
baby.

26. Composition of Breast milk – cont’d
 Lactose: Breast milk contains more lactose
than others milk which an energy source for
brain development.
 Vitamins and Iron: Human milk contains
more of some important vitamins than cow’s
milk like Vitamin A & vitamin C. only about
10%of the iron in cow’s milk is absorbed
(iron deficiency anaemia) but about 50% of
the iron from breast milk is absorbed.

27. Composition of Breast milk – cont’d
 Too much salt: Cow’s milk contains too
much salt which can sometimes cause
hypernatraemia and fits, especially if the
child has diarrhoea.
 Biochemical advantages: Prevention of
neonatal hypocalcemia and
hypomagnesaimia & helps in prevention of
fits in the baby.

28. Colostrum
Property
 Antibody-rich
 Many white cells
 Purgative
 Growth factors
 Vitamin-A rich
Importance
 protects against infection and
allergy
 protects against infection
 clears meconium; helps prevent
jaundice
 helps intestine mature; prevents
allergy, intolerance
 reduces severity of some
infection (such as measles and
diarrhoea); prevents vitamin A-
related eye diseases
Slide

29. Protective effect of
breastfeeding
on infant morbidity
Slide

30. Slide 2d

31. Protective Effect of
Breastfeeding
on Infant Mortality
Slide 2

32. Relative risks of death from diarrhoeal disease
by age and breastfeeding category in Latin
America
1
4.1
1
15.1
2.2
0
2
4
6
8
10
12
14
16
Diarrhoea 0-3 mo Diarrhoea 4-11 mo
exclusive
breastfeeding
partial
breastfeeding
no breastfeeding
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of
breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.

33. Relative risks of death from acute
respiratory infections by age and
breastfeeding category
in Latin America
1
4
2.1
2.9
1
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
ARI 0-3 mo 4-11 mo
exclusive
breastfeeding
partial
breastfeeding
no breastfeeding
Adapted from: Betran AP, de Onis M, Lauer JA, Villar J. Ecological study of effect of
breast feeding on infant mortality in Latin America. BMJ, 2001, 323: 1-5.
Slide 2

34. Breastfeeding Reduces
the Risk of Chronic
Disease
Slide 2

35. Breastfeeding decreases the risk of
allergic disorders – a prospective birth
cohort study
Type of feeding Asthma Atopic
dermatitis
Allergic
rhinitis
Children exclusively
breastfed 4 months or
more
7.7% 24% 6.5%
Children breastfed for a
shorter period
12% 27% 9%
Adapted from Kull I. et al. Breastfeeding and allergic diseases in infants - a prospective birth
cohort study. Archives of Disease in Childhood 2002: 87:478-481.

36. Slide 2e

37. Breastfeeding decreases the prevalence
of obesity in childhood at age five and six
years, Germany
4.5
3.8
2.3
1.7
0
0.5
1
1.5
2
2.5
3
3.5
4
4.5
5
months breastfeeding
Prevalence
(%)
0 months
2 months
3-5 months
6-12 months
Adapted from: von Kries R, Koletzko B, Sauerwald T et al. Breast feeding and obesity:
cross sectional study. BMJ, 1999, 319:147-150.

38. Breastfeeding has
psychosocial
and developmental
benefits
Slide 2

39. Intelligence quotient by type of feeding
BF 2.1 points
higher than FF
Study in 6 months
to 2 year- olds
1988
BF 8.3 points
higher than FF
Study in 7.5-8
year-olds
1992
BF 2 points
higher than FF
Study in 3-7
year-olds
1982
BM 7.5 points
higher than no BM
Study in 7.5-8
year-olds
1992
BF 12.9 points
higher than FF
Study in 9.5
year-olds
1996
BF = breastfed
FF = formula fed
BM = breast milk

40. Duration of breastfeeding associated with
higher IQ scores in young adults,
Denmark
99.4
102.3
106
101.7
104
96
98
100
102
104
106
108
Duration of breastfeeding in months
< 1 months
2-3 months
4-6 months
7-9 months
> 9 months
Adapted from: Mortensen EL, Michaelsen KF, Sanders SA, Reinisch JM. The association
between duration of breastfeeding and adult intelligence. JAMA, 2002, 287: 2365-2371.

41. Benefits of breastfeeding for the
mother
 Protects mother’s health
 helps reduces risk of uterine bleeding and helps
the uterus to return to its previous size
 reduces risk of breast and
ovarian cancer
 Helps delay a new pregnancy
 Helps a mother return to pre-pregnancy weight
Slide 2

42. Advantages for Mother
 Decreased postpartum bleeding & depression
 Earlier return to pre-pregnancy weight
 Delayed resumption of ovulation
 Reduced risk of ovarian cancer
 Reduced premenopausal breast cancer

43. Advantages for Mother
 Promotes between mother and
baby
 Reduces risk of hip fracture,
osteoporosis after menopause.
 Prevents obesity
 Makes life easier

44. Advantages for Mother
 It saves time and money
 No bottles to warm in the middle of
the night

45. Benefits for Society
 Breastfeeding saves on health care costs.
 Total medical care costs for the nation are
much lower for fully breastfed infants than
never breastfed infants since breastfed
infants typically need fewer sick care visits,
prescriptions and hospitalizations.

46. Benefits for Society
 Breastfeeding produces more productive
workforce. BF mothers miss less work, as
their infants are sick less often
 BF is better for our environment because
there is less trash and plastic waste
compared to that produced by formula cans
and bottle supplies.

47. WHEN TO FEED?
 You should feed your baby just after childbirth. It is desirable, that
mom constantly was in contact with her baby also. You should
feed him by the first request. It may be tired for you to feed every
hour, but you can't make a schedule for the work of a little
stomach.
 Hunger is new sensations for the baby, he hasn't felt it before. The
digestive system of the baby’s only starts to develop. When
intervals between feedings are greater, the baby sucks very
greedy, swallows the air, overeats .It's difficultly to digest a plenty
food at one sitting. And the baby get a problems with a tummy, he
becomes restless. Feed your child gradually, but more often.
 Mother's milk assimilates well, infants can't to overeat it. It's quite
another matter the artificial feeding, there are more problem with
it , than you can imagine.

48. Baby Friendly Hospital Initiative
 BFHI was launched by WHO &
UNICEF in 1991
 The initiative is a global effort for
improving the role of maternity
services to breastfeed babies

49. Baby Friendly Hospital Initiative
 It aims at improving the care of pregnant
women , mothers and newborns at health
care facilities that provide maternity services
for protecting, promoting and supporting
breastfeeding.
 To become Baby Friendly Hospital,
Hospitals & maternity centres must practice
of the “Ten Steps to Successful
Breastfeeding”

50. The Ten Steps
to Successful
Breastfeeding
From: A Joint WHO/UNICEF
Statement
Published by the World Health
Organization

51. MYTHS ABOUT
BREASTFEEDING
 Breastfeeding ruins the shape of your
breasts
 Small breastfed women won’t have enough
milk
 Artificial milk is as good as the real breast
milk
 Breastfeeding takes more time than bottle
feeding
 You must wean if you get pregnant

52. MYTHS ABOUT
BREASTFEEDING – cont’d
 Mother’s milk is poisonous
 You can’t breastfeed after a caesarean
section
 Breastfeeding is painful
 You can’t breastfeed if you plan to go to
work or school
 Night nursing disturbs sleep

53. MYTHS ABOUT
BREASTFEEDING – cont’d
 You will to have a good diet or your milk
won’t nourish the baby properly.
 Breastfeeding make you fat or make you
week
 Breastfed newborn need vitamins and
supplements
 You can’t take medication while you are
breastfeeding
 Breast milk is not enough

54. MYTHS ABOUT
BREASTFEEDING – cont’d
You should give him water in
hot weather
Stop breastfeeding when you are
sick (having diarrhoea or
vomiting), it contaminates your
child

55. MYTHS ABOUT
BREASTFEEDING – cont’d
 BF does not provide any protection
against becoming pregnant.
 BF women cannot take the birth
control pill
 Babies who are breast-fed on demand
are more likely to be “colicky”.

56. MYTHS ABOUT
BREASTFEEDING – cont’d
The mother should not
breastfeed if she is taking
medicine.
 If the baby is off the breast for few
days/weeks the mother should not
restart BF because the milk sours.

57. Common Misconceptions Affecting
BF in Emergencies
 Malnourished mothers can not breastfeed.
 Stress prevents mothers from producing
milk.
 Once a mother stops BF, she cannot restart.
 When a woman has been raped, she cannot
breastfeed.
 HIV positive mothers should never
breastfeed.

58. Causes of low Breastfeeding in our
Country
 Social taboos – talking about
breastfeeding issue is social taboo
 Unethical promotion of formula
milk
 Lifestyle consciousness
 Fashion

59. Factors/barriers that cause
discontinuation of Breastfeeding
1. Inadequate milk
2. Exhaustion
3. Working women
4. Lack of supporting environment for
working mothers
5. Lack of counselling on part of health care
providers
6. Promotion of breastfeeding substitutes by
multinationals

60. Factors/barriers that cause
discontinuation of Breastfeeding
 Women from higher socio-economic strata
 Women who have a C-section
 Lack of antenatal visits to healthcare
facilities
 If women in the upper strata will not
breastfeed their children, the same trend will
trickle down to all levels of society

61. Breastfeeding Rules
 “Protection of Breastfeeding and Young
Child Nutrition Ordinance 2002”
 Government notified the Rules and
Regulations regarding breastfeeding
ordinance on Feb 9, 2009. “Protection of
Breastfeeding and Child Nutrition Rules”

62. Practices prohibited by Ordinance
 Creating impression that the Infant’s
formula milk is better than mother’s milk
 Giving gift or benefit to health workers or
his family.
 Distribution and donation of infant formula
milk and products
 Distribution of educational and information
material

63. Practices prohibited by Ordinance
 Distribution and acceptance of free
samples
 Pictures, graphics or texts that
encourage bottle-feeding or
discourage breast-feeding

64. Labeling
 Contain a conspicuous notice in bold
characters:
 “ MOTHER’ S MILK IS BEST FOOD FOR
YOUR BABY AND HELPS IN
PREVENTING DIARRHOEAL AND
OTHER ILLNESSES”

65. Complaint Procedure
 Under the section 15 of the Ordinance, any
person may make an application in writing
to the Board or a Provincial Committee
concerning contravention of any of the
provisions of the Ordinance or the Rules.

66. National Infant Feeding Board
 Head: Minister of Health
 Secretary: Dy DG of Health
 Members:
 Provincial health secretaries
 Pediatricians
 Gynecologists
 Representatives of industry
 Consumer rights organizations

67. Powers of Board
 Receive violations of the Ordinance and take
action against violators
 Call for consultations with provincial
governments and stakeholders in order to
ensure implementation and strict
compliance with the provision of Ordinance
and these Rules.
 Provincial Breastfeeding Committees

68. Recommendations to Promote
Breastfeeding
 Awareness campaign through media about
benefits of BF & hazards of artificial feeding
 Regular lectures on breastfeeding in girls
colleges
 Repeat video films at waiting rooms of air
ports, railway stations, bus stops etc
 Strict implementation of Protection of
Breastfeeding and Child Nutrition Rules
2009

69. Recommendations to Promote
Breastfeeding
 Penalties for violators of BF Rules
 Targeting health providers, working women
with urban residence and higher income
strata and marginalized women
 Role of Lady Health Workers
 Role of Ulemas
 Inclusion of Breastfeeding subject in the
syllabus of schools and colleges

70. Recommendations to Promote
Breastfeeding
 Provision of 4 months maternity leave to
pregnant working mothers & reduction of
working hours for lactating mothers
 Provision of separation room or nursery for
working mothers where they can keep their
babies and can feed them after every two
hours
 Antenatal breastfeeding counselling

71. Recommendations to Promote
Breastfeeding
 Creation of mother-friendly
workplaces
 Motivation of gynecologists and
lady health workers to advocate in
favor of breastfeeding throughout
pregnancy term

72.  http://www.who.int/maternal_child_adolescent/topics/child/imci/en/
 http://en.wikipedia.org/wiki/Integrated_Management_of_Childhood_Illness
 http://rho.emro.who.int/rhodata/?vid=2753#
 http://www.emro.who.int/child-health/strategy-
implementation/implementation-of-imci-in-pakistan.html
References

73. Thank you!