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Malnutrition can affect people of all ages but has a heavy impact on infants. Insufficient intake of food due to several factors results in malnutrition. It is a population hazard that is common in third world countries around the globe. Despite having considerable development over the years, maternal and infant nutrition remains a persistent concern for Bangladesh. It has been observed that 36% of the preschool age children are underweight and suffer from high rates of micro nutrient deficiencies. Even though many policies have been undertaken and legal frameworks established, traditional postpartum practices are decreasing.

A child needs to be breastfed right after birth as it supplies necessary nutrients. There is an undeniable connection between the mother’s health and the child’s nutrition. Surprisingly even when it’s a traditional practice in a country like Bangladesh, the rates suggest otherwise. According to Hoque M. (2017), only 36% (35% Rural vs. 39% Urban) could initiate breastfeeding within the first hour after birth (BBS, UNICEF, 2016). Almost 2/3rd of the children in the age group below 6 months are exposed to non-breast milk items (BBS, UNICEF, 2016).[2] Hence, the fairly low prevalence of exclusive breastfeeding is relatively responsible for infant malnutrition in the country.

Relation between breast milk and infant malnutrition

The World Health Organization claims the longer a mother breastfeeds, the longer the good health effects will be for both the mother and child. Breast milk contains all the nutrients needed by children in the first six months of life.[3] Breastfeeding is in many ways linked with nutrition and food security; health, development and survival. The World Alliance for Breastfeeding Action (WABA) has declared “Breastfeeding: a key to sustainable development” as its theme in 2016. The WHO recommends exclusive breastfeeding (EBF) for the first six months of life and continuation of breastfeeding for two years.  Breastfeeding not only benefit the child but the mother as well. The World Health Assembly of the WHO even adopted a dedicated instrument in this regard, known as The International Code of Marketing of Breast milk Substitutes 1981.

According to the recommended National Strategy for Infant and Young Child Feeding in Bangladesh 2007, newborn babies must be exclusively breastfed for the first six months and then introduced to complementary foods. It is consistent with the Global Strategy for Infant and Young Child Feeding (WHO, 2002) which looked promising. But there is no implementation plan. Thus, the strategy has not led to the desired impact. The Bangladesh Government aimed to protect the children from zero to five by enacting the Breast-Milk Substitutes Act 2013 which brings significant changes to the 1984 Ordinance.

What is a Breastmilk Subsitute?

According to the International Code of Marketing of Breast-milk Substitutes 1981, any food being marketed or otherwise presented as a partial or total replacement for breast milk, whether or not suitable for that purpose. This instrument also talks about ‘bona-fide breast milk substitutes’ which is an exception to the rule. When human milk (MOM or donor milk) isn’t available, infant formula is the third best option. The International Code calls it “weaning foods or breast-milk supplements.” However, infant formula is not risk-free. In 2007, the WHO issued guidelines for the safe use of powdered infant formula, after a number of premature babies died from infection due to contaminated formula.[4]

Related Bangladeshi legislation

The Breastmilk Subsitute Act of Bangladesh is in line with the International Code but remains silent on exceptions like bona-fide breast milk substitutes.

According to the Act, there will be no advertisement for baby foods, commercially produced supplementary baby foods and imports of its tools and no one can be engaged in these activities.

Section 4 of the 2013 Act states that no person shall print, exhibit, circulate or publish any advertisement of any breast-milk substitutes, infant foods, commercially manufactured complementary foods and any accessories thereof. Section 7 of the Act mentions that, people should be made aware of advantages of breast feeding and importance of homemade nutritious foods. Moreover, offering or proposing offers to any person such as to promote or allure the sale of these products are forbidden by the law.[5]

Breaching any section of this Act would result in an offence punishable with minimum three years imprisonment or with fine of maximum five lacs taka or both.

The Government has taken many other initiatives to curb nutrient deficiency in children. In 1989, the Government of Bangladesh passed a law making it mandatory for all edible salt to be iodized. The Iodine Deficiency Disease Prevention Act, 1989 and Rules, 1994. However, not many complied with the Act. BLAST filed a writ in 1999 challenging 8 salt manufacturers whose salt did not contain the required level of iodine. (BLAST and another vs. Bangladesh and others [‘Iodized Salt’ Case] Writ Petition No. 1043 of 1999). According to UNICEF, 84% of all edible salt is now iodized, helping reduce iodine deficiency disorders.[6]

Previously, the National Food Policy of 2006 laid down few objectives that talk about adequate nutrition for women and children. Later the National Children Policy 2011 put greater emphasis on the same issue. In Clause 6.2, it states that Nutrition of the child shall be given priority for the poverty alleviation of the children. The 2011 policy ensures safe birth and overall growth of children. Clause 6.1.4 states that the employment authority of a working mother shall have to arrange day care center for lactating and working mothers so that can breast feed child.

More recently the National Nutrition Policy 2015 gave further importance in ensuring appropriate nutrition through identification of different causes. Some of its suggested indicators are Increase the initiation of breastfeeding in the first hour of life. Among its recommendations there are, to increase the rate of exclusive breastfeeding in infants younger than age 6 months, to reduce maternal overweight (BMl>23), to reduce the rate of low birth weight etc.

In addition to the above laws, the Labour Act of 2006 allows indirect breastfeeding breaks for mothers at workplace. Section 94 of the Act talks states ‘rooms for children’ at workplace. Employers at establishments with forty or more workers must provide and maintain a suitable room or rooms for the use of children under the age of 6 and their mothers.

It has been submitted that breastfeeding reduces the risk of breast, uterine and ovarian cancer and promotes emotional health. Mothers who breastfeed have a lower risk of depression. It contributes to a child’s growth and supplies the necessary antibodies and provides ideal nutrition for babies.

The Government led initiatives are in abundance with many new laws waiting to be enacted. But without proper implementation, they would just remain inside age old documents. The existing policies must be executed in order to eradicate malnutrition completely. The IYCF indicators are not adequately represented and the health workers have not been properly trained. Breast milk substitutes are still on sale despite the presence of the 2013 Act.

The traditional practice of breastfeeding must be encouraged. However, one cannot disregard the possibility of lack of breast milk due to many factors. The need for formula feeding can be life saving in such situations. This, however, has been overlooked by the much talked about Act of 2013.

Although 2013 Act deserves appreciation due to its indirect attempt to promote breastfeeding, it must be relaxed in special circumstances. Doctors must be fully aware about the rules and comply accordingly. Collective efforts like these would reduce the need for enacting new laws and benefit the society as a whole.

[1] Apprentice Advocate of Dhaka Judge Court

[2] Hoque M (2017), ‘Critical Issues in Child and Maternal Nutrition’, BIDS Critical Conversations 2017

[3] Mazumdar S (2016) ‘There is no substitute’, The Daily Star

[4] Spangler A (2012), ‘Can’t breastfeed? Formula isn’t your only option’, Howtolearn.com

[5] Dr. Anju S (2016) ‘Code of marketing of the breast milk substitutes’, The Daily Star

[6] Child and Maternal Nutrition in Bangladesh, UNICEF Report

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