May 2021, Volume 71, Issue 5

Student's Corner

Has Pakistan failed to ban the sale of formula milk?

Areeba Nakhuda  ( Final Year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Emaan Amin  ( Final Year MBBS Student, Dow Medical College, Karachi, Pakistan. )
Sakina Abbas  ( Second Year MBBS Student, Dow Medical College, Karachi, Pakistan. )



Madam, according to a report published by WHO and UNICEF, countries continue to promote infant formula as a substitute for breast milk.1 Out of 194 countries, 136 have adopted measures from the International Code of Marketing of Breast-milk substitutes while 79 countries have banned the marketing of breast milk substitutes in hospitals.1 Pakistan introduced a Protection of Breastfeeding and Child Nutrition Ordinance in October 2002 to restrict the promotion of infant formula milk.2 The Ordinance prohibits the marketing of infant formula as a substitute for mother's milk.2 Healthcare workers are prohibited from accepting any gifts or samples from the formula milk companies, and they should promote breastfeeding.2 Breastmilk improves nutrition and provides antibodies for protection against various diseases.1 Babies should be exclusively breastfed for the first 6 months after which complementary food should be given along with breastfeeding up to 2 years of age.1 Undernutrition is responsible for about half of the under 5 deaths as it increases the frequency and severity of common infections.3 However, in Pakistan, 48% of infants are breastfed exclusively for 0-5 months and the under 5 mortality rate in Pakistan is 67.2 per 1000 live births.4 Healthcare providers play a pivotal role in encouraging parents' decision to breastfeed their child by regular counselling where they highlight the benefits and address any misconceptions. During the COVID19 pandemic, there has been a decline in counselling, skilled lactation and other services by healthcare providers to encourage breastfeeding practice.1 Practices of social distancing have made community counselling and mother support groups for promotion of breastfeeding challenging, leaving a gap for formula milk companies to profit from the crisis and weaken the confidence in nursing.1 A study in Pakistan revealed that 70.5% of the healthcare workers had no knowledge about the national breastfeeding law. As a result, formula milk companies continued to violate the ban on distributing free samples and gifts to the healthcare staff.5 This calls for a strict reenforcement of regulations in hospitals and conducting nationwide awareness campaigns via social media, television, newspapers to counter the marketing of breastmilk substitutes and promote breastfeeding. Keeping in mind that the benefits of breastfeeding outweigh the risks associated with coronavirus, WHO and UNICEF have encouraged mothers to breastfeed during the COVID-19 pandemic as there is no substantial evidence that the virus can be transmitted via breastmilk.1


Disclaimer: None to declare

Conflict of Interest: None to declare

Funding Disclosure: None to declare




1. World Health Organization. Countries failing to stop harmful marketing of breast-milk substitutes, warn WHO and UNICEF. [Online] 2020 [Cited 2020 November 27]. Available from URL:

2. Government of Pakistan, Ministry of Law, Justice, Human Rights and Parliamentary Affairs: Protection of Breastfeeding and Young Child Nutrition Ordinance: Ordinance No XCIII of 2002. Islamabad. 2002. [Online] 2020 [Cited 2020 November 27]. Available from URL:

3. UNICEF. Malnutrition in Children - UNICEF DATA [Online] 2020 [Cited 2020 November 27]. Available from URL:

4. UNICEF. Pakistan - UNICEF DATA. [Online] 2020 [Cited 2020 November 27]. Available from URL:

5. Salasibew M, Kiani A, Faragher B, Garner P. Awareness and reported violations of the WHO International Code and Pakistan's national breastfeeding legislation; a descriptive cross-sectional survey. Int Breastfeed J 2008;3:24. doi: 10.1186/1746-4358-3-24.


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