Sindh asks DRAP to withdraw infant formula advertising guidelines, warns against undermining breastfeeding

KARACHI: A new disagreement between federal and provincial health authorities has brought Pakistan’s infant nutrition policies into focus, with the Sindh Health Department formally urging the Drug Regulatory Authority of Pakistan (DRAP) to withdraw recently issued guidelines concerning the advertisement of infant formula and breast milk substitutes.

The provincial government says the guidance risks weakening decades of efforts aimed at protecting breastfeeding and conflicts with existing legal provisions that prohibit the promotion of formula milk products for young children.

Concerns over recent DRAP guidance

According to an official statement issued by the Sindh Health Department, authorities have expressed serious reservations over DRAP's recent communication regarding formula milk advertising and called for its immediate withdrawal.

Sindh officials argued that the promotion and marketing of breast milk substitutes are restricted under both federal and provincial laws and stressed that a strict "zero tolerance" approach should be maintained.

They maintained that advertisements, promotional campaigns, sponsorships and indirect marketing activities related to infant formula products are prohibited in Sindh for children up to three years of age.

The department warned that violations could attract penalties, including imprisonment and substantial fines under applicable laws.

Breastfeeding protection remains a public health priority
Health officials reiterated that exclusive breastfeeding during the first six months of life remains the gold standard for infant nutrition and is critical for healthy growth, immunity, and cognitive development.

The Sindh Health Department said any relaxation in restrictions on formula milk advertising could discourage breastfeeding and potentially reverse gains achieved through public health campaigns promoting maternal feeding practices.

Senate panel had earlier called for warning labels in advertisements

The controversy comes against the backdrop of discussions held earlier this year by the Senate Standing Committee on National Health Services, which directed DRAP to ensure that formula milk advertisements and packaging prominently state that mother's milk is the best source of nutrition for infants. The committee also opposed efforts to dilute regulatory oversight and called misleading claims by formula manufacturers a matter of “life and death” for infants.

Similarly, a Senate committee meeting in 2025 supported DRAP's position that infant formula should remain under its regulatory framework but emphasized that advertisements must clearly state that powdered milk is not a substitute for breast milk.

Global standards discourage marketing of breast milk substitutes

Pakistan's laws are rooted in the principles of the International Code of Marketing of Breast-milk Substitutes adopted by the World Health Assembly in 1981.

According to the World Health Organization (WHO), breast milk substitutes should be available when medically necessary but should not be promoted through advertising or commercial marketing. WHO states that inappropriate promotion can negatively affect breastfeeding practices and infant health.

The international code discourages public advertising, gifts to healthcare professionals, free samples, sponsorship activities, and promotional campaigns that could influence feeding choices.

Formula milk marketing remains a challenge

Recent reports by WHO and UNICEF have highlighted continuing challenges worldwide in regulating formula milk promotion.

Pakistan has also faced criticism over gaps in enforcement and the growing use of digital marketing channels by manufacturers. A recent WHO-UNICEF assessment noted that many countries continue to struggle with loopholes that allow indirect advertising and industry influence.

Concerns regarding formula milk promotion have surfaced repeatedly in Pakistan. Earlier this year, child health experts questioned the presence of a formula milk company at a symposium hosted by a public healthcare institution in Karachi, describing it as inconsistent with breastfeeding protection laws.

Why exclusive breastfeeding matters

The WHO and UNICEF recommend exclusive breastfeeding for the first six months of life, followed by continued breastfeeding alongside complementary foods up to two years of age or beyond.

Breastfeeding has been linked to lower risks of infections, improved immunity, and better long-term health outcomes for children, while also providing health benefits for mothers.

Public health experts warn that aggressive marketing of breast milk substitutes may undermine parental confidence in breastfeeding and influence feeding decisions, especially among first-time mothers.

Debate highlights broader questions over infant nutrition policy

The latest exchange between Sindh and DRAP highlights the continuing challenge of balancing access to medically necessary infant formula with policies designed to protect breastfeeding.

While formula milk remains essential for some infants who cannot be breastfed for medical reasons, health authorities and international organizations continue to emphasize that commercial promotion should not interfere with breastfeeding support programs.

With infant nutrition increasingly recognized as a critical component of child health, experts say regulatory clarity and stronger enforcement will remain essential to ensuring that parents receive unbiased, evidence-based information.

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