Poverty and ignorance a fatal formula for Afghan infants
Arish is Magul Naseem's third child, but the first one to force the 27-year-old Afghan mother to get admitted to the emergency nutrition ward of the Indira Gandhi Children's Hospital in Kabul.
Two-month-old Arish is visibly stunted and severely malnourished. For nearly half his short life, the undersized infant has been on a breast milk substitute. 'I've just not been able to produce enough milk,' Ms Naseem says.
Psychological problems, incorrect breastfeeding techniques, and harmful dietary traditions ensure that many Afghan mothers fail to properly nurture their newborn children. In a recent survey by the US Centres for Disease Control, 84 per cent of Afghan women were found to be suffering from anxiety or depression.
Public health officials, in association with Unicef, launched a vigorous nationwide campaign earlier this month to educate Afghan mothers on breastfeeding.
'In Afghanistan, most mothers adopt incorrect breastfeeding techniques, which results in sore nipples, breast pain and milk deficiency,' says Dr Zakia Maroof, a Unicef childcare expert in Kabul.
But the problem goes much deeper, and is rooted in the poverty and prejudice that blight the land.
Since a majority of Afghan women are stunted due to childhood malnourishment, families deliberately deprive expecting mothers of nourishing, high-protein food such as meat and fish - even when they can afford it - to ensure the fetus doesn't become large and obstruct delivery. (Most deliveries are performed by midwives at home with no provision for caesarean operations.)
Afghanistan's maternal mortality ratio is one of the highest in the world, with 50 female deaths every day due to complications in pregnancy and childbirth. (In 2002, the world's worst maternal mortality ratio ever - 6,500 deaths per 100,000 live births - was recorded in northeastern Badakshan province.)
To make matters worse, for 40 days after delivery the mother is not given fruit, vegetable or yoghurt, in the belief that such food prevents healing of her 'injury'. She subsists mainly on tea and bread.
But the worst manifestation of harmful, traditional dietary beliefs is the practice of not breastfeeding a newborn baby for the first three days, the period during which the mother produces a thick yellowish fluid known as colostrum, which is rich in antibodies, vitamins and minerals, and helps develop a child's immunity.
Afghans believe colostrum is harmful for the infant. 'Instead, during the first three days, oil and butter is given in the belief that this 'cleans' the baby's stomach,' says Dr Maroof.
Poverty, the lack of hygiene and of safe drinking water further complicate the picture. 'As a result, [our] public health status indices are among the worst in the world,' says Dr Abdullah Fahim, adviser to the Public Health Ministry.
Now, with democracy bringing in the free market, doctors and public health officials are concerned that multinational corporations may further add to the problem of child malnutrition by aggressively promoting infant formula and baby food to ignorant Afghan mothers.
The Ministry of Public Health and Unicef have already stopped two commercials - one on radio and one on TV - advertising infant formula.
A private, non-profit corporation set up by a Nestle USA nutritionist, who claims its aim is to tackle chronic malnutrition among Afghan mothers and children, had to apologise for its 'ignorant act' after its volunteers, including a paediatrician, distributed free infant formula in northern Mazar-i-Sharif city and nearby villages.
'They gave infant formula not only to doctors, but also to mothers in a hospital malnutrition ward, which is against World Health Assembly guidelines,' says an angry Unicef nutritionist, Fitsum Assefa, a Somalian with long experience of working in Afghanistan.
However, Nestle's nutritionist, Dr Steven Kwon, insisted in an e-mail message from Pasadena, California, that 'there was no intention to promote infant formula against breastfeeding. Simply, it was a humanitarian effort'.
Formula is now being sold in Afghanistan by Swiss, Belgian, Dutch, German, Japanese and Chinese multinationals, with some companies also selling baby food cereal meant for children up to two years.
Alarmed by the invasion of baby food multinationals, the Public Health Ministry has now drafted a Code of Marketing of Breast Milk Substitutes, in keeping with international norms. 'Once it becomes law, the sale of infant formula will be restricted to pharmacies, and that also on a specialist doctor's prescription,' says Dr Mohibullah Wahdati, director of the ministry's Nutrition Department.
'Our objective is to promote exclusive breastfeeding up to six months, and Afghan family food [instead of tinned baby food] up to two years,' he says.
An estimated 700 children under the age of five die every day, many of them from diarrhoea. Nearly two-thirds of all children are affected by low weight for age, stunting and wasting. Micronutrient deficiency is common - iron, vitamins A and C, besides iodine.
When little Arish was brought to the malnutrition ward of the Kabul hospital, doctors threw away his feeding bottle, and instructed his mother to give him extra milk only with a spoon.
Ms Naseem is also being taught how to breastfeed more efficiently, so that Arish can get the full nutritional benefits of her milk.
'Poverty and ignorance are the biggest problems affecting the health of Afghanistan's children,' says Dr Abdul Rahman, a doctor in the malnutrition ward.