No substitute for breastfeeding

Doctors "technically" prescribe breast milk substitutes in violation of the Breast Milk Substitute (BMS) Act-2013, a practice that must stop to promote exclusive breastfeeding, says a new study.

"Doctors technically prescribe BMS products so that none understands who prescribed it," said the study titled "Promoting Breastfeeding: Role of Stakeholders in the Light of the BMS Act-2013", conducted by Brac.

Exclusive breastfeeding (an infant only receives breast milk during the first six months) can significantly reduce child death and enhance cognitive development.

Globally, breastfeeding has the potential to prevent 220,000 deaths of under-5 children a year, the study noted.

BMS Act strictly prohibits BMS during this period unless it is an emergency; still the Act is widely violated. Exclusive breastfeeding was 64 percent in Bangladesh in 2011, but has come down to 55 percent, according to an official data.

In her presentation, Fahmida Akter, staff researcher of Brac, said people have limited knowledge of BMS Act, whereas BMS company representatives are exceptionally knowledgeable about it and know how to bypass the law to promote BMS.

"They influence the doctors for doing business, some doctors even get commissions. It is a give and take policy," she told a discussion in Shahid Dr Milton Hall of the Bangabandhu Sheikh Mujib Medical University yesterday.

On the other hand, most of the government's health officials are not much aware of their roles in code implementation.

Often, mothers do not think breastfeeding is enough for child nutrition, while educated and urban mothers have misconception that breastfeeding affects their health. This also influences the rural mothers, the study said.

The study collected data from 48 government officials, healthcare, and BMS providers, and held 10 focused group discussions in Beanibazar and Fenchuganj upazilas of Sylhet and Jessore Sadar and Sharsha upazila of Jessore during January and February of 2014.

Professor Mohammad Shahidullah, president of Bangladesh Pediatric Association, said BMS companies use various techniques to allure the physicians to promote BMS. It is crucial to enforce the BMS Act as well as educate all about  breastfeeding.

Professor Laila Arjumand Banu, secretary general of Bangladesh Perinatal Society, said nurses and lower-level staff of the hospitals have links to the BMS company representatives, a nexus that needs to be eliminated.

She suggested a "to do checklist" after the birth of a child in the maternity clinics.

Noted gynecologist Prof TA Chowdhury suggested a total ban on advertisements of BMS products, and thoroughly train the health personnel, directly involved in neonatal services on breastfeeding.

Bangladesh Breastfeeding Foundation Chairperson Dr SK Roy said they were working on how to stop commercials that promote BMS.

Dr ABM Muzharul Islam, director of the Institute of Public Health and Nutrition, Rowshan Ara Begum, president of Obstetrical and Gynaecological Society of Bangladesh, also spoke.

Dr Kaosar Afsana, director of health nutrition and population programme of BRAC, chaired it.