Lactation education

The loneliest lactation consultant in the world

Arj Rizvi’s breastfeeding journey had got off to a rocky start. She had just given birth to her first child, a son, and wanted to breastfeed. But after a few weeks of trying, her nipples had become painfully sore and she was concerned that she was producing enough milk to support the growth of her new baby.

“That’s when you get demotivated,” said Rizvi, a 31-year-old listener from Karachi, Pakistan. “You think the milk is not enough and your child is hungry, then you start giving him formula. I have seen many young mothers in my family who have given up breastfeeding because of this problem. Even Rizvi’s mother, who had breastfed her own children and supported Rizvi’s desire to do the same, urged her to supplement with formula.

While health practitioners in the West aggressively encourage breastfeeding, sometimes at detriment women struggling to maintain the practice—social norms in Pakistan and elsewhere in South Asia favor bottle-feeding, the product of decades of marketing by infant formula manufacturers. While some of these companies have have changed their practices in response to public pressure, many Pakistanis still view breastfeeding as insufficient nutrition for a growing child – a view encouraged by a medical establishment that often quickly recommends formula milk and reinforced by a startling shortage of breast-feeding specialists. breastfeeding trained.

Arj Rizvi’s breastfeeding journey had got off to a rocky start. She had just given birth to her first child, a son, and wanted to breastfeed. But after a few weeks of trying, her nipples had become painfully sore and she was concerned that she was producing enough milk to support the growth of her new baby.

“That’s when you get demotivated,” said Rizvi, a 31-year-old listener from Karachi, Pakistan. “You think the milk is not enough and your child is hungry, then you start giving him formula. I have seen many young mothers in my family who have given up breastfeeding because of this problem. Even Rizvi’s mother, who had breastfed her own children and supported Rizvi’s desire to do the same, urged her to supplement with formula.


While health practitioners in the West aggressively encourage breastfeeding, sometimes at detriment women struggling to maintain the practice—social norms in Pakistan and elsewhere in South Asia favor bottle-feeding, the product of decades of marketing by infant formula manufacturers. While some of these companies have have changed their practices in response to public pressure, many Pakistanis still view breastfeeding as insufficient nutrition for a growing child – a view encouraged by a medical establishment that often quickly recommends formula milk and reinforced by a startling shortage of breast-feeding specialists. breastfeeding trained.

Zohra Kurji is a pediatric nurse at the Aga Khan University Hospital, Karachi and the only practicing lactation consultant in Pakistan certified by the International Board of Lactation Consultant Examiners, the global standard for breastfeeding support training . “There was no support from doctors on how to initiate breastfeeding,” she said, recalling her work in the hospital’s neonatal intensive care unit at first. of the 1990s. “I watched these mothers struggle with tremendous amounts of guilt and frustration.”

When Kurji gave birth to her own twins in 1995, she said she was repeatedly told by doctors and family members that it was impossible to properly breastfeed her babies without resorting to formula. “Awareness of a breastfeeding supply and demand system – the more milk a baby drinks from the breast, the more milk the body produces – did not exist in Pakistan at the time,” says Kurji. She gave up after five months.

Her experience reflects a gradual change in attitude towards breastfeeding that began to occur in the 1980s. After thriving in the West by promoting bottle-feeding as the key to women’s liberation, formula makers began to look for new markets in the countries of the South. In 1975, 95% of infants in Pakistan were breastfed at 12 months. In 1986, years of campaigning by Western formula makers helped bring that percentage down to 86%. today only 38 percent of Pakistani mothers practice exclusive breastfeeding for just six months, despite high rates of stunting – a condition characterized by short height for child’s age, poor cognition and other developmental delays development. Breastfeeding has proven beneficial for cognitive development and long-term protection against chronic disease, research that has led to an increase in breastfeeding in wealthy countries in recent decades. Currently in the United States, almost 60 percent infants are breastfed at six months. From close 34,000 certified lactation consultants worldwidemore than half are in the United States.

“The village women I spoke to thought that not giving formula to their babies was the worst thing they could do,” Kurji said, recalling her early days as a community nurse in the rural Sindh province in the 1990s. “These poor women will do anything to buy infant formula, even if it means borrowing money and going into debt because they believe the only way to make sure that their babies become like the beautiful chubby child they see on formula cans is to supplement with formula. milk.” Traditional practices – such as feeding infants water, ghee, honey and herbal teas – and employers’ lack of accommodation for working mothers also discourage breastfeeding initiation.

Nida Keshwani, a Karachi-based early childhood educator who knew the benefits of breastfeeding, gave birth to her son in March. When he was not progressing according to her doctor’s expectations, she was pressured into providing formula.

“The pediatrician felt that my baby had lost a lot of weight, so he suggested I give him formula three times for two nights and then come back to see him,” she said. “I kept insisting that I was totally against formula feeding.” It was only when Keshwani herself suggested that there might be a problem with her child’s latch or her milk supply that he referred her to a lactation specialist. The next morning, Keshwani met Kurji.

“Dr. Kurji examined me and taught me how to put the baby to the breast correctly,” Keshwani said. the most fat and that by expressing the last few drops of milk, she could help her baby gain weight. bottle feed him.” She credits breastfeeding with helping to strengthen the bond with her son and giving him peace of mind during one of the most difficult phases of new motherhood.

For new mothers, this external support can make all the difference. Kurji was late in her second pregnancy when she enrolled in the Aga Khan University School of Nursing and Midwifery. Her daughter was born on the first day of school, but unlike her first pregnancy, this time her decision to breastfeed was supported by those around her. The school dean encouraged Kurji to bring his newborn to class, even offering her a private room where she could breastfeed.

“I was the first student in college history to bring my baby to class,” Kurji said. “My classmates used to do group homework with me in the dining hall so that I wouldn’t fall behind in my studies. My colleagues were very supportive of my decision to breastfeed and other students soon started using the room for their own lactation needs. She breastfed her daughter for over two years. A few years later, she traveled to Texas to complete her international lactation consultant certification. “You couldn’t take the exam in Pakistan back then,” she said.

Families and healthcare professionals are beginning to recognize the benefits of the practice. In August 2020, Kurji established Pakistan’s first dedicated breastfeeding clinic, at the Aga Khan University Hospital, to support mothers who choose to breastfeed. Online networks like the one in Lahore LactNationa breastfeeding advocacy group established in April 2020 that has over 23,000 members on Facebookalso give mothers the tools and knowledge to successfully breastfeed.

But as breastfeeding rates increase in urban areas, women in villages and rural areas of Pakistan, where children are most at risk of stunting and malnutrition in the first years of life – still do not have access to accurate information. “The next step for our clinic is to raise awareness about these issues among the middle and lower classes of rural Pakistani people,” Kurji said. “We need to expand these initiatives…in secondary hospitals and health care facilities working directly with their communities. This is where the need is greatest.

Meanwhile, more and more women in Karachi are seeking help for their breastfeeding problems. After consulting Kurji, Rizvi started using a non-toxic nipple ointment that she could apply while breastfeeding, expressing her milk by hand, and wearing nipple shields that helped ease her pain. “I was very lucky to have Dr. Kurji to motivate me through this tough time,” Rizvi recalls. “Otherwise, I would have given up breastfeeding my son.”