Malnutrition among children continues to be one of the major public health problems globally with majority of cases residing in Asia. Within this region, Pakistan is among the countries with the highest burden of child malnutrition as 28.9% children are underweight, 40.2% are stunted and 17.7% suffer from wasting. Among the key contributors towards malnutrition in early years of life, inappropriate breastfeeding and complementary feeding (CF) practices are most appropriate There is a need to explore the factors responsible for poor feeding practices to address the gaps for designing evidence-based interventions focusing on social, cultural, and economic aspects of CF practices.We, therefore, aimed to understand how the cultural and social context in Pakistan influences the CF practices and the key social, cultural and economic drivers of change that need to be considered when shaping future policies and development interventions.
We conducted secondary analysis on the qualitative data collected through formative research as a part of the National CF Assessment (NCFA) conducted in 2018 across Pakistan by United Nations Children’s Fund (UNICEF) and the Pakistani Ministry of National Health Services, Regulation and Coordination (MoNHSR&C). In-depth interviews and focus group discussions conducted with mothers and fathers of children aged 6 to 23 months were included in the analysis. Framework analysis approach was applied to analyze the data.
Financial barriers included limited finances and unemployment of the father, cultural barriers included restricted female mobility, heavy workload on mothers and dietary misconceptions whereas large family size, inaccess to food, inadequate knowledge and poor perception on CF, use of shelf foods, preference of child to certain foods, and harsh environmental conditions were reported as social barriers. Financial enablers included sound economic conditions of the household whereas joint family system, multiple sources of income, kitchen gardening, home based poultry, counseling by lady health workers and health care providers were among the social enablers.
Considering CF practices in Pakistan are inadequate therefore strategies are to be put on removing barriers to adequate CF. This can only be achieved if efforts are indicated from the policy level down to the community.