Despite widespread awareness of the benefits of exclusive breastfeeding (EBF), mothers in Karachi’s urban slums face significant barriers that prevent them from fully adhering to recommended practices, a new study has found.
Myths, lack of family support, maternal health issues and socioeconomic pressures continue to hinder optimal infant feeding practices even though caregivers understand its importance. These findings came out as a result of a qualitative study conducted in the informal settlements of Rehri Goth, Ibrahim Hyderi, Ali Akber Shah Colony, and Bhains Colony, which involved 84 participants including mothers, fathers, and mothers-in-law.
The research was carried out by a team comprising Sajid Iqbal of the Shifa College of Nursing, Kheezran Ahmed, Sana Qaiser, Benazir Baloch, Yasmin Parpio, Yasir Shaikh, and Imran Nisar from the Aga Khan University, Maryam Mansoor of the Brigham and Women’s Hospital, Ameer Muhammad of the Vital Pakistan Trust, Amy Ginsburg of the University of Washington and Valerie Flaherman of the UCSF Benioff Children’s Hospital.
The research team was led by Fyezah Jehan of the Aga Khan University. The study revealed that while a majority of mothers and caregivers acknowledged that breast milk protected against illness and was vital for a child’s growth, actual practices often deviated from this knowledge due to deep-rooted cultural beliefs, practical challenges and inadequate healthcare support.
Many mothers reported to be struggling to breastfeed due to pain after childbirth, lack of milk, or poor technique, especially in the absence of proper antenatal or postnatal counseling. In several cases, breastfeeding was interrupted or replaced by early supplementation, including formula, herbal tonics or traditional remedies like ghutti and tea. This was often encouraged by elder women in the household who played a central role in feeding decisions.
Myths such as breast milk being contaminated or the evil eye preventing feeding were also commonly cited. “Mothers understood the benefits of breastfeeding, but were often overruled by elders or hampered by their own physical recovery and emotional stress,” the researchers observed.
Another striking barrier was the lack of psychosocial support. Many mothers were burdened with household duties and lacked assistance at home, making regular breastfeeding difficult. Some reported that husbands and other family members were either uninvolved or prioritised household chores over the infant’s feeding needs. A few mothers also shared that when they were away from home, other female family members sometimes breastfed the baby—a practice generally frowned upon.
Concerns about infant growth frequently led to early supplementation. While many mothers resisted using formula milk due to fears of indigestion and cost, others were encouraged to introduce supplementary foods prematurely if they perceived the baby as weak or underweight. Health workers were sometimes consulted, but elders remained the primary source of advice.
“Women believed their breast milk wasn’t sufficient, especially when the baby cried frequently or seemed small, leading them to start complementary feeding before six months,” the study noted.
Mothers also cited dietary advice from nurses or elders to boost milk production, such as consuming dates with milk, lentils, cumin, apples and popcorn. Some used breast pumps to relieve discomfort when milk supply exceeded demand, while others discarded expressed milk, fearing it was unhygienic—a belief reinforced by older women in the household.
The researchers emphasised that although knowledge about EBF was relatively high, implementation was often thwarted by cultural practices, family dynamics and lack of structured support systems.
With less than 48 per cent of Pakistani mothers practicing exclusive breastfeeding for the first six months as per the National Nutrition Survey, these findings shed light on the urgent need to integrate family members, especially grandmothers and fathers, into awareness campaigns.
The researchers also recommended incorporating EBF counseling into routine antenatal and postnatal checkups and improving maternity leave policies, particularly for women in the informal sector.
The study, funded by the Bill and Melinda Gates Foundation, concluded that future policies should adopt a family-centered approach, acknowledging the social realities that influence infant feeding choices. “Addressing maternal health, dispelling myths and building community-level support structures are key to improving EBF rates and child health outcomes,” the authors said.
Published in News Daily on 08-July-2025.
