Source document: https://docs-lawep.s3.us-east-2.amazonaws.com/1694842002726.pdf (Pakistan)
Asima Ihsan Associate Research Fellow Dr. Novaira Junaid Associate Research Fellow Ume Farwa Assistant Research Fellow Punjab Economic Research Institute POLICY BRIEF THE ECONOMIC COST OF SUBOPTIMAL/ NON-BREASTFEEDING IN PUNJAB A non-breastfed child is 14 times more likely to die in the first six months than an exclusively breastfed child (The Lancet, 2008) July, 2020 Y R A M M U S Punjab, despite being the literate and most populous province in Pakistan, has the suboptimal breastfeeding rates; around 9.5% of mothers start breastfeeding their babies within the first hour of birth, with another 42.1% exclusively breastfeeding their children in 6 months of age.
The rates of exclusive breastfeeding in Punjab are increasing but at a slow rate.

The suboptimal level of breastfeeding is associated with many healthcare and economic cost.

It is evident that substituting any other feeding method for infants and young children comes at a significant cost to the child, mother, family, community, and the national economy.

Policy brief has estimated the direct cost of suboptimal/non-breast- feeding in Punjab.
It is estimated that the suboptimal level of breastfeeding leads to more than 61 thousand deaths amongst infants in Punjab.

The total cost incurred for the health care system amounts to US$ 77.7 million annually.

The cost of formula milk feeding is about US$ 63.71 million.
The data generated in this brief will be helpful for policy making, particularly in the context of improving breastfeeding support in hospitals, community, and maternity leave programs, raising awareness about the financial burden incurred by poor breastfeeding practices, and highlighting a new area for research in Punjab.

Adding the argument of economic cost is expected to make breastfeeding messages more persuasive.
INTRODUCTION The Global Strategy for Infant and Young Child Feeding (IYCF) jointly developed by the World Health Organization (WHO) and United Nations International Children’s Emergency Fund (UNICEF) underscores the significance of good nutrition practices for infants and children growth and development.1 Promotion and integration of good breastfeeding practices alongside social practices are essential components of the IYCF Global Strategy.
The benefits of breast feeding for the health and nutrition of infants are incontrovertible.

Available literature (Martin et al., 2005) (Horta et al., 2015) suggests that those who are breastfed have lower mean blood pressure, lower total cholesterol, and show improved intelligence test results.

Overweight/obesity and type-II diabetes are also less observed among them.

.
.

Conversely, poor feeding practices have adverse life-long impact including poor school performance, reduced productivity, and impaired intellectual and social development2.

Pakistan voted in favor of the International Code of Marketing of Breast milk substitutes during the World Health Assembly in May 1981 and enacted legislation for the protection of breast feeding in 2002 titled the ‘Protection of Breastfeeding and Child Nutrition Ordinance 2002’.
A National Infant Feeding Board (NIFB) to monitor the implementation of the Ordinance was constituted after in July 2010.

After devolution under the 18th Constitutional Amendment, Punjab adopted the 2002 Ordinance and notified it as the ‘Punjab Protection of Breastfeeding and Child Nutrition Act 2012.3,4 An Infant Feeding Board was constituted in 2014.
Post devolution interventions introduced by the Punjab Government to improve infant IYCF and nutrition included the integration of reproductive, 1World Health Organization (WHO).

Global Strategy for Infant and Young Child Feeding http://www.who.int/nutrition 2Horta et al.

Evidence on the long-term effects of breastfeeding systematic reviews and meta-analyses.
World health Organisation http://apps.who.int/iris/ bitstream/10665/43623/1/9789241595230_e ng.pdf 3https://www.savethechildren.net/sites 4https://extranet.who.int/nutrition/gina/sites Acknowledgement: We would like to express our special thanks to Dr.Muhammad Nasir (SUN Secretariat P&D Board), Dr. Shahid Adil (Director, PERI), Dr. Muhammad Avais Tahir (Chief of Research, PERI) and other members of review committee for their active guiadance and expert advice toward the completion of this policy brief.
maternal, newborn, child health, and nutrition programs i.e.

the (IRMNCH&NP); development of Punjab Multi-Sectoral Nutrition Strategy (MSNS) by the Planning and Development (P&D) Department; CM’s Stunting Reduction Program in Punjab; establishment of Multi-Sectoral Nutrition Centre (MSNC) at the P&D Department; and establishment of nutrition treatment sites.

All these policies and interventions aimed at increasing the breastfeeding rates.
Empirical evidence has also suggested that lower breastfeeding rates lead to higher economic costs in terms of economic growth (Smith, 2013), work and productivity (Siregar, 2018), (Siregar, Pitriyan, & Walters, 2018) as well as the social cost in terms of both infant and maternal mortality (Alison, 2009).

High breastfeeding rates decreased the incidence of multiple diseases in both breastfed babies and breastfeeding mothers, reducing healthcare costs.
Several researchers have calculated the economic costs of healthcare systems in various countries while using different measure of estimations but no attempt has yet to be made in Punjab.

This policy brief aims at highlighting the direct economic cost of suboptimal breastfeeding practices in the province of Punjab.
MEASUREMENT OF ECONOMIC COST OF SUBOPTIMAL/ NON-BREASTFEEDING IN PUNJAB Breastfeeding is benefited for both mother and child but some of the mothers do not initiate breastfeeding due to different reasons (Ogbuanu et al.

2009).

The current pace of an increase in the prevalence rate of exclusive breastfeeding under six months of age is not very impressive in Punjab.
The measurement of economic cost of non-breastfeeding may put some additional appreciation to its importance for the children, families as well as the society.

In the context of Gross National Product (GNP), value of other substitutes or non-breastfed items such as formula milk, non-milk liquids, and other supplements is calculated.

The measurement of the cost of total non-breastfed items used in Punjab and its impact to the economy can be measured based on some assumptions.
Non- breastfeeding sometimes leads the child and mother to morbidity and mortality (Alison Stuebe, 2009).

The diagnosis and treatment of these illnesses result in medical care use.

According to the Pakistan Social and Living Standards Measurement Survey (PSLM)/ Household Integrated Economic Survey (HIES), 2018 data, the monthly out of pocket expenditures (OOPEs) on healthcare are about 3 percent of the total household expenditures in the province of Punjab.
These OOPEs put burden on families which are already PAGE | 1 living in poverty.

These expenditures may likely to be reduced living in poverty.

These expenditures may likely to be reduced with successful breastfeeding promotion.

To estimate the economic with successful breastfeeding promotion.

To estimate the economic cost of suboptimal/not breastfeeding in Punjab, we have used the cost of suboptimal/not breastfeeding in Punjab, we have used the living in poverty.
These expenditures may likely to be reduced following data sources and indicators.

living in poverty.

These expenditures may likely to be reduced following data sources and indicators.

with successful breastfeeding promotion.

To estimate the economic with successful breastfeeding promotion.

To estimate the economic DATA SOURCE AND METHODOLOGY cost of suboptimal/not breastfeeding in Punjab, we have used the living in poverty.
These expenditures may likely to be reduced cost of suboptimal/not breastfeeding in Punjab, we have used the DATA SOURCE AND METHODOLOGY following data sources and indicators.

with successful breastfeeding promotion.

To estimate the economic following data sources and indicators.
The data of the Multiple Indicator Clusters Survey (MICS, 2017-18), cost of suboptimal/not breastfeeding in Punjab, we have used the DATA SOURCE AND METHODOLOGY The data of the Multiple Indicator Clusters Survey (MICS, 2017-18), Punjab has been used.

In this brief, we have used three categories DATA SOURCE AND METHODOLOGY following data sources and indicators.

of indicators for reflecting the cost of suboptimal/non-breastfeeding Punjab has been used.
In this brief, we have used three categories DATA SOURCE AND METHODOLOGY including; The data of the Multiple Indicator Clusters Survey (MICS, 2017-18), of indicators for reflecting the cost of suboptimal/non-breastfeeding The data of the Multiple Indicator Clusters Survey (MICS, 2017-18), Punjab has been used.

In this brief, we have used three categories including; Punjab has been used.

In this brief, we have used three categories The data of the Multiple Indicator Clusters Survey (MICS, 2017-18), 1.
Cost of child mortality due to suboptimal breastfeeding of indicators for reflecting the cost of suboptimal/non-breastfeeding of indicators for reflecting the cost of suboptimal/non-breastfeeding Punjab has been used.

In this brief, we have used three categories including; (This cost represents the possible benefit to a country's economy including; 1.
Cost of child mortality due to suboptimal breastfeeding of indicators for reflecting the cost of suboptimal/non-breastfeeding from future earnings over a person's productive years that will (This cost represents the possible benefit to a country’s including; 1.

Cost of child mortality due to suboptimal breastfeeding be missed as a result of premature death due to not 1.
Cost of child mortality due to suboptimal breastfeeding economy from future earnings over a person’s productive (This cost represents the possible benefit to a country's economy breastfeeding (Dylan D Walters, Linh T H Phan, Roger (This cost represents the possible benefit to a country's economy 1.
Cost of child mortality due to suboptimal breastfeeding years that will be missed as a result of premature death from future earnings over a person's productive years that will (This cost represents the possible benefit to a country's economy from future earnings over a person's productive years that will Mathisen, 2019).
due to not breastfeeding (Dylan D Walters, Linh T H Phan, be missed as a result of premature death due to not be missed as a result of premature death due to not from future earnings over a person's productive years that will Roger Mathisen, 2019).

breastfeeding (Dylan D Walters, Linh T H Phan, Roger be missed as a result of premature death due to not 2.
Health system and household costs due to child morbidity breastfeeding (Dylan D Walters, Linh T H Phan, Roger with suboptimal breastfeeding practices breastfeeding (Dylan D Walters, Linh T H Phan, Roger 2.

Health system and household costs due to child morbidity Mathisen, 2019).

Mathisen, 2019).

with suboptimal breastfeeding practices Mathisen, 2019).

with suboptimal breastfeeding practices with suboptimal breastfeeding practices with suboptimal breastfeeding practices milk.

3.
3.

Economic costs of breastmilk substitutes or infant formula milk.

2.

Health system and household costs due to child morbidity 2.

Health system and household costs due to child morbidity 2.

Health system and household costs due to child morbidity 3.

Economic costs of breastmilk substitutes or infant formula In the studies published in literature on measuring the cost of non- breastfeeding such as Bagriansky J, Voladet S, (2013), Bagriansky J, 3.
Economic costs of breastmilk substitutes or infant formula milk.

3.

Economic costs of breastmilk substitutes or infant formula milk.

3.

Economic costs of breastmilk substitutes or infant formula milk.

(2014), Walters et al., (2016) have also used the same indicators for In the studies published in literature on measuring the cost of In the studies published in literature on measuring the cost of non- measuring economic cost of non-breastfeeding.
Simple method of In the studies published in literature on measuring the cost of non- nonbreastfeeding such as Bagriansky J, Voladet S, (2013), Bagriansky In the studies published in literature on measuring the cost of non- breastfeeding such as Bagriansky J, Voladet S, (2013), Bagriansky J, multiplication, division, addition and subtraction in excel have been breastfeeding such as Bagriansky J, Voladet S, (2013), Bagriansky J, J, (2014), Walters et al., (2016) have also used the same indicators breastfeeding such as Bagriansky J, Voladet S, (2013), Bagriansky J, (2014), Walters et al., (2016) have also used the same indicators for (2014), Walters et al., (2016) have also used the same indicators for (2014), Walters et al., (2016) have also used the same indicators for used for calculation in each of the indicator.
for measuring economic cost of non-breastfeeding.

Simple method measuring economic cost of non-breastfeeding.

Simple method of measuring economic cost of non-breastfeeding.

Simple method of measuring economic cost of non-breastfeeding.
Simple method of of multiplication, division, addition and subtraction in excel have multiplication, division, addition and subtraction in excel have been Figure 1: Indicators reflecting the cost of suboptimal/non-breastfeeding multiplication, division, addition and subtraction in excel have been multiplication, division, addition and subtraction in excel have been been used for calculation in each of the indicator.

used for calculation in each of the indicator.


used for calculation in each of the indicator.

Figure 1: Indicators reflecting the cost of suboptimal/non-breastfeeding Figure 1: Indicators reflecting the cost of suboptimal/non-breastfeeding Figure 1: Indicators reflecting the cost of suboptimal/non-breastfeeding in in in in to age groups to age groups table 1.

There is table 1.

There is table 1.

There is table 1.
There is CHILD MORTALITY ATTRIBUTED TO SUBOPTIMAL BREASTFEEDING PRACTICES CHILD MORTALITY ATTRIBUTED TO SUBOPTIMAL CHILD MORTALITY ATTRIBUTED TO SUBOPTIMAL BREASTFEEDING PRACTICES BREASTFEEDING PRACTICES Suboptimal to World Health Organization, According CHILD MORTALITY ATTRIBUTED TO SUBOPTIMAL CHILD MORTALITY ATTRIBUTED TO SUBOPTIMAL includes all non-exclusive breastfeeding breastfeeding practices, BREASTFEEDING PRACTICES to World Health Organization, According Suboptimal BREASTFEEDING PRACTICES According to World Health Organization, Suboptimal breastfeeding practices and it intimidate the child and mother life.
The relative includes all non-exclusive breastfeeding breastfeeding practices, risk associated to optimal and suboptimal level of breastfeeding practices and it intimidate the child and mother life.
The relative practices, includes all non-exclusive breastfeeding practices and it Suboptimal to World Health Organization, According Suboptimal to World Health Organization, According risk associated to optimal and suboptimal level of breastfeeding least is given to age groups according includes all non-exclusive breastfeeding breastfeeding practices, intimidate the child and mother life.
The relative risk associated to includes all non-exclusive breastfeeding breastfeeding practices, to age groups least is given according chance of death in children who are exclusively breastfed since practices and it intimidate the child and mother life.

The relative optimal and suboptimal level of breastfeeding according to age groups practices and it intimidate the child and mother life.

The relative chance of death in children who are exclusively breastfed since early six months of their life.
Children who are not breastfed are risk associated to optimal and suboptimal level of breastfeeding is given in table 1.

There is least chance of death in children who are risk associated to optimal and suboptimal level of breastfeeding early six months of their life.

Children who are not breastfed are least is given according more likely to consume unsafe water (such as mixed in formula milk) least is given according exclusively breastfed since early six months of their life.
Children more likely to consume unsafe water (such as mixed in formula milk) chance of death in children who are exclusively breastfed since and may less develop immune system, this makes them more chance of death in children who are exclusively breastfed since who are not breastfed are more likely to consume unsafe water (such and may less develop immune system, this makes them more early six months of their life.
Children who are not breastfed are vulnerable to pathogens that cause diarrhoea and pneumonia5.

The early six months of their life.

Children who are not breastfed are as mixed in formula milk) and may less develop immune system, this vulnerable to pathogens that cause diarrhoea and pneumonia5.

The more likely to consume unsafe water (such as mixed in formula milk) consequences will last a lifetime.
The Meta data and systematic more likely to consume unsafe water (such as mixed in formula milk) consequences will last a lifetime.

The Meta data and systematic makes them more vulnerable to pathogens that cause diarrhoea and and may less develop immune system, this makes them more review of both developing and developed countries conducted and may less develop immune system, this makes them more review of both developing and developed countries conducted pneumonia5.

The consequences will last a lifetime.


The Meta data vulnerable to pathogens that cause diarrhoea and pneumonia5.

The report by the World Food Programme Pakistan, 2017 in a in a report by the World Food Programme Pakistan, 2017 vulnerable to pathogens that cause diarrhoea and pneumonia5.

The and systematic review of both developing and developed countries consequences will last a lifetime.

The Meta data and systematic suboptimal risk indicated risk suboptimal indicated consequences will last a lifetime.
The Meta data and systematic conducted in a report by the World Food Programme Pakistan, 2017 review of both developing and developed countries conducted breastfeeding practices lengths not only during the first 6 months of breastfeeding practices lengths not only during the first 6 months of review of both developing and developed countries conducted indicated that the relative risk of life with suboptimal breastfeeding report by the World Food Programme Pakistan, 2017 in a child life, but also up to 2 years of age.
The study quantified the child life, but also up to 2 years of age.

The study quantified the report by the World Food Programme Pakistan, 2017 in a practices lengths not only during the first 6 months of child life, but suboptimal that indicated and child mortality age infant to infection-specific pathways and child mortality age infant to infection-specific pathways that suboptimal indicated also up to 2 years of age.
The study quantified the infection-specific 0-6 months and 6-23 months with different level of suboptimal breastfeeding practices lengths not only during the first 6 months of 0-6 months and 6-23 months with different level of suboptimal breastfeeding practices lengths not only during the first 6 months of breastfeeding practices.

According to results of the study, the risk of pathways to infant and child mortality age 0-6 months and 6-23 child life, but also up to 2 years of age.
The study quantified the breastfeeding practices.

According to results of the study, the risk of child life, but also up to 2 years of age.

The study quantified the and child mortality age to infection-specific pathways mortality in children aging 0-6 months with breastfeeding is 10.53 months with different level of suboptimal breastfeeding practices.
mortality in children aging 0-6 months with breastfeeding is 10.53 and child mortality age to infection-specific pathways 0-6 months and 6-23 months with different level of suboptimal According to results of the study, the risk of mortality in children percent for diarrhea and 15.13 percent for pneumonia, while the 0-6 months and 6-23 months with different level of suboptimal percent for diarrhea and 15.13 percent for pneumonia, while the breastfeeding practices.
According to results of the study, the risk of aging 0-6 months with breastfeeding is 10.53 percent for diarrhea and relative risk of mortality with pre-dominant and partial breastfeeding breastfeeding practices.
According to results of the study, the risk of relative risk of mortality with pre-dominant and partial breastfeeding mortality in children aging 0-6 months with breastfeeding is 10.53 15.13 percent for pneumonia, while the relative risk of mortality with in diarrhea is 4.62 percent and 2.28 percent respectively.

The children mortality in children aging 0-6 months with breastfeeding is 10.53 in diarrhea is 4.62 percent and 2.28 percent respectively.
The children pre-dominant and partial breastfeeding in diarrhea is 4.62 percent and percent for diarrhea and 15.13 percent for pneumonia, while the 6-23 months old with non-breastfeeding are at risk of mortality percent for diarrhea and 15.13 percent for pneumonia, while the 6-23 months old with non-breastfeeding are at risk of mortality 2.28 percent respectively.

The children 6-23 months old with non- by 2.1 percent in diarrhea and 1.92 percent in pneumonia (table 2).
relative risk of mortality with pre-dominant and partial breastfeeding relative risk of mortality with pre-dominant and partial breastfeeding by 2.1 percent in diarrhea and 1.92 percent in pneumonia (table 2).

breastfeeding are at risk of mortality by 2.1 percent in diarrhea and in diarrhea is 4.62 percent and 2.28 percent respectively.

The children in diarrhea is 4.62 percent and 2.28 percent respectively.

The children 1.92 percent in pneumonia (table 2).


5https://www.unicef.org/niger/stories/no-water-breastfeed-only 6-23 months old with non-breastfeeding are at risk of mortality 6-23 months old with non-breastfeeding are at risk of mortality 5https://www.unicef.org/niger/stories/no-water-breastfeed-only by 2.1 percent in diarrhea and 1.92 percent in pneumonia (table 2).

by 2.1 percent in diarrhea and 1.92 percent in pneumonia (table 2).
5https://www.unicef.org/niger/stories/no-water-breastfeed-only PAGE | 2 life with life with life with life with relative relative infant infant relative relative risk risk the the the the that that of of of of PAGE | 2 PAGE | 2 5https://www.unicef.org/niger/stories/no-water-breastfeed-only 5https://www.unicef.org/niger/stories/no-water-breastfeed-only PAGE | 2 PAGE | 2 Table 1: Relative risk for infant mortality by suboptimal breastfeeding behavior Table 1: Relative risk for infant mortality by suboptimal Children Table 1: Relative risk for infant mortality by suboptimal breastfeeding behavior breastfeeding behavior 6-23months Children 0-5 months from from from from 117,193,035 None None 117,193,035 None None 2.28 1.75 1.48 report “ The Economic Consequences of Children Children 6-23months 6-23months Partial Breast feeding Partial Partial 4.62 Breast Breast 2.49 feeding feeding 2.85 4.62 4.62 2.49 2.49 2.85 2.85 Children None None 6-23months None None 10.53 2.1 15.13 1.92 3.68 14.4 10.53 2.1 10.53 2.1 15.13 1.92 10.53 2.1 15.13 1.92 3.68 14.4 15.13 1.92 3.68 14.4 3.68 14.4 Table 2: Estimated Loss of neonatal, infant and under-2 lives in 2020 29.8 117,193,035 117,193,035 3,493,352 143,227 29.8 29.8 29.8 3,493,352 3,493,352 3,493,352 202,616 143,227 143,227 143,227 Table 1: Relative risk for infant mortality by suboptimal Children Predominant breastfeeding behavior Children 0-5 months breastfeeding 0-5 months Children Predominant 0-5 months Predominant Diarrhea 2.28 breastfeeding breastfeeding Partial Predominant 1.75 Pneumonia Breast breastfeeding All 1.48 Diarrhea 2.28 Diarrhea 2.28 feeding Mortality 1.75 Pneumonia Diarrhea 4.62 1.75 Pneumonia Source: E xtracted report “ The Economic Consequences of All 1.48 2.49 Pneumonia All 1.48 Undernutrition in Pakistan: An Assessment of Losses” by WFP Pakistan Mortality 2.85 All Mortality Mortality report “ The Economic Consequences of Source: E xtracted Source: E xtracted report “ The Economic Consequences of Age specific and disease specific direct estimates of neonatal, infant, Undernutrition in Pakistan: An Assessment of Losses” by WFP Pakistan Source: E xtracted Undernutrition in Pakistan: An Assessment of Losses” by WFP Pakistan and child mortality has been calculated on the basis of crude Undernutrition in Pakistan: An Assessment of Losses” by WFP Pakistan birth rate and crude death rates extracted from MICS, 2017-18 Age specific and disease specific direct estimates of neonatal, infant, Age specific and disease specific direct estimates of neonatal, infant, Age specific and disease specific direct estimates of neonatal, infant, data.
The estimated number of deaths in a year 2020 is given Age specific and disease specific direct estimates of neonatal, infant, and child mortality has been calculated on the basis of crude and child mortality has been calculated on the basis of crude birth and child mortality has been calculated on the basis of crude below and child mortality has been calculated on the basis of crude birth rate and crude death rates extracted from MICS, 2017-18 birth rate and crude death rates extracted from MICS, 2017-18 rate and crude death rates extracted from MICS, 2017-18 data.
The birth rate and crude death rates extracted from MICS, 2017-18 data.

The estimated number of deaths in a year 2020 is given data.

The estimated number of deaths in a year 2020 is given Table 2: Estimated Loss of neonatal, infant and under-2 lives in 2020 estimated number of deaths in a year 2020 is given below data.
The estimated number of deaths in a year 2020 is given below below Total Population in 2020 (according to below Table 2: Estimated Loss of neonatal, infant and under-2 lives in 2020 growth rate 2.13) Table 2: Estimated Loss of neonatal, infant and under-2 lives in 2020 Table 2: Estimated Loss of neonatal, infant and under-2 lives in 2020 Crude Birth Rate Total Population in 2020 (according to Total Population in 2020 (according to Total Population in 2020 (according to Total Births growth rate 2.13) growth rate 2.13) growth rate 2.13) Neonatal estimated total deaths at Crude Birth Rate Crude Birth Rate Crude Birth Rate NMR 41/1000 live births Total Births Total Births Total Births Infant Estimated Total Deaths at IMR Neonatal estimated total deaths at Neonatal estimated total deaths at Neonatal estimated total deaths at 58/1000 live births in 2020 (growth NMR 41/1000 live births NMR 41/1000 live births NMR 41/1000 live births rate of decline is estimated 1.6 percent Infant Estimated Total Deaths at IMR Infant Estimated Total Deaths at IMR Infant Estimated Total Deaths at IMR between 2003 to 2018) 58/1000 live births in 2020 (growth 58/1000 live births in 2020 (growth 58/1000 live births in 2020 (growth Under -2 Estimated Total Deaths at rate of decline is estimated 1.6 percent rate of decline is estimated 1.6 percent rate of decline is estimated 1.6 percent between 2003 to 2018) MR 64/1000 live births (growth rate of between 2003 to 2018) between 2003 to 2018) Under -2 Estimated Total Deaths at is estimated 3.17 percent decline Under -2 Estimated Total Deaths at Under -2 Estimated Total Deaths at MR 64/1000 live births (growth rate of between 2003 to 2018) MR 64/1000 live births (growth rate of MR 64/1000 live births (growth rate of is estimated 3.17 percent decline Source: Author’s Calculations Source: Author’ sCalculations is estimated 3.17 percent decline is estimated 3.17 percent decline between 2003 to 2018) According to the UNICEF, Pneumonia and Diarrhea are the major between 2003 to 2018) between 2003 to 2018) contributors of child deaths in Punjab (UNICEF, 2017).
A study Source: Author’s Calculations Source: Author’ sCalculations Source: Author’s Calculations Source: Author’ sCalculations conducted by Rana, S. M. (2011) estimated that 23.9 percent of According to the UNICEF, Pneumonia and Diarrhea are the major According to the UNICEF, Pneumonia and Diarrhea are the major According to the UNICEF, Pneumonia and Diarrhea are the major deaths occurred in Punjab by the Acute Respiratory Infection (ARI) contributors of child deaths in Punjab (UNICEF, 2017).
A study contributors of child deaths in Punjab (UNICEF, 2017).

A study contributors of child deaths in Punjab (UNICEF, 2017).
A study and 20.4 percent by diarrhea., by applying the same assumption, conducted by Rana, S. M. (2011) estimated that 23.9 percent of deaths conducted by Rana, S. M. (2011) estimated that 23.9 percent of conducted by Rana, S. M. (2011) estimated that 23.9 percent of the total deaths attributed to ARI and diarrhea are given in the occurred in Punjab by the Acute Respiratory Infection (ARI) and deaths occurred in Punjab by the Acute Respiratory Infection (ARI) deaths occurred in Punjab by the Acute Respiratory Infection (ARI) 20.4 percent by diarrhea., by applying the same assumption, the total table below.
Furthermore, it is estimated that in diarrhea and and 20.4 percent by diarrhea., by applying the same assumption, and 20.4 percent by diarrhea., by applying the same assumption, deaths attributed to ARI and diarrhea are given in the table below.
pneumonia related deaths, about 73.9 percent and 63.4 percent of the total deaths attributed to ARI and diarrhea are given in the Furthermore, it is estimated that in diarrhea and pneumonia related the total deaths attributed to ARI and diarrhea are given in the deaths in neonatal period are attributed to suboptimal breastfeeding table below.

Furthermore, it is estimated that in diarrhea and deaths, about 73.9 percent and 63.4 percent of deaths in neonatal table below.
Furthermore, it is estimated that in diarrhea and practices.

Similarly, 83.6 percent and 75.6 percent deaths in infants period are attributed to suboptimal breastfeeding practices.
Similarly, pneumonia related deaths, about 73.9 percent and 63.4 percent of pneumonia related deaths, about 73.9 percent and 63.4 percent of are attributed to diarrhea and pneumonia (World Food Programme 83.6 percent and 75.6 percent deaths in infants are attributed to deaths in neonatal period are attributed to suboptimal breastfeeding deaths in neonatal period are attributed to suboptimal breastfeeding diarrhea and pneumonia (World Food Programme Pakistan, 2017).

Pakistan, 2017).

practices.


Similarly, 83.6 percent and 75.6 percent deaths in infants practices.

Similarly, 83.6 percent and 75.6 percent deaths in infants Table 3: Projected neonatal and infant mortality due to suboptimal are attributed to diarrhea and pneumonia (World Food Programme Table 3: Projected neonatal and infant mortality due to suboptimal are attributed to diarrhea and pneumonia (World Food Programme breastfeeding practices in year 2020 Pakistan, 2017).


Source: Author’s Calculations Source: Author’ sCalculations According to the UNICEF, Pneumonia and Diarrhea are the major contributors of child deaths in Punjab (UNICEF, 2017).

A study conducted by Rana, S. M. (2011) estimated that 23.9 percent of deaths occurred in Punjab by the Acute Respiratory Infection (ARI) and 20.4 percent by diarrhea., by applying the same assumption, the total deaths attributed to ARI and diarrhea are given in the table below.
Furthermore, it is estimated that in diarrhea and pneumonia related deaths, about 73.9 percent and 63.4 percent of deaths in neonatal period are attributed to suboptimal breastfeeding practices.

Similarly, 83.6 percent and 75.6 percent deaths in infants are attributed to diarrhea and pneumonia (World Food Programme Pakistan, 2017).
Table 3: Projected neonatal and infant mortality due to suboptimal breastfeeding practices in year 2020 202,616 202,616 223,574 223,574 223,574 202,616 223,574 29,218 21,592 34,221 21,702 34,221 21,702 34,221 34,221 29,218 21,702 21,702 21,592 Table 3: Projected neonatal and infant mortality due to suboptimal Table 3: Projected neonatal and infant mortality due to suboptimal Total neonatal deaths attributed to ARI Total neonatal deaths attributed to ARI breastfeeding practices in year 2020 breastfeeding practices in year 2020 Neonatal Mortality by ARI due to suboptimal Neonatal Mortality by ARI due to suboptimal breastfeeding Total neonatal deaths attributed to ARI breastfeeding Total neonatal deaths attributed to ARI Total neonatal deaths attributed to diarrhea Total neonatal deaths attributed to diarrhea Neonatal Mortality by ARI due to suboptimal Neonatal Mortality by ARI due to suboptimal Neonatal Mortality by diarrhea due to suboptimal Neonatal Mortality by diarrhea due to suboptimal breastfeeding breastfeeding breastfeeding breastfeeding Total neonatal deaths attributed to diarrhea Total neonatal deaths attributed to diarrhea Total Infant deaths attributed to ARI Total Infant deaths attributed to ARI Neonatal Mortality by diarrhea due to suboptimal Neonatal Mortality by diarrhea due to suboptimal Infant Mortality by ARI due to suboptimal Infant Mortality by ARI due to suboptimal breastfeeding breastfeeding breastfeeding breastfeeding Total Infant deaths attributed to ARI Total Infant deaths attributed to ARI Total Infant deaths attributed to diarrhea Total Infant deaths attributed to diarrhea Infant Mortality by ARI due to suboptimal Infant Mortality by ARI due to suboptimal Infant Mortality by diarrhea due to suboptimal Infant Mortality by diarrhea due to suboptimal breastfeeding breastfeeding breastfeeding breastfeeding Total Infant deaths attributed to diarrhea Total monthly income/economic loss due to child Total Infant deaths attributed to diarrhea Total monthly income/economic loss due to child Infant Mortality by diarrhea due to suboptimal mortality (in USD) Infant Mortality by diarrhea due to suboptimal mortality (in USD) breastfeeding Source: Author’s Calculations breastfeeding Total monthly income/economic loss due to child Total monthly income/economic loss due to child mortality (in USD) mortality (in USD) Source: Author’s Calculations 48425 48425 2,828,799 30,701 30,701 41,333 41,333 48425 30,545 30,545 30,701 29,218 29,218 41,333 21,592 21,592 30,545 2,828,799 2,828,799 48425 30,701 41,333 30,545 2,828,799 Source: Author’s Calculations Source: Author’s Calculations The income/economic loss due to a child’s death have been calculated The income/economic loss due to a child’s death have been in terms of future earnings not generated by more than 61 thousand calculated in terms of future earnings not generated by more than 61 infants who died prematurely due to non-breastfeeding.
All the thousand infants who died prematurely due to non-breastfeeding.

All calculation has been made by using simple methods of addition, the calculation has been made by using simple methods of addition, subtraction, multiplication and division in excel.

The income loss subtraction, multiplication and division in excel.
The income loss is calculated from the year a child turns 18 until the earliest point is calculated from the year a child turns 18 until the earliest point between his/her expected retirement age i.e.

60.

According to between his/her expected retirement age i.e.

60.
According to calculations by using the neonatal and infants deaths data attributed calculations by using the neonatal and infants deaths data attributed to suboptimal breastfeeding (61,246 infant deaths) given in table 3 to suboptimal breastfeeding (61,246 infant deaths) given in table 3 and the average monthly income (PKR 7390 or USD 46 as per the and the average monthly income (PKR 7390 or USD 46 as per the HIES, 2018 data), the monthly loss amounts to 2.8 million dollars HIES, 2018 data), the monthly loss amounts to 2.8 million dollars with an annual loss of 33.9 million dollars.


HEALTH SYSTEM AND HOUSEHOLD FORMULA COSTS HEALTH SYSTEM AND HOUSEHOLD FORMULA COSTS Punjab incures high medical cost for treatment of diarrhea and pneumonia (UNICEF, Pakistan, 2017).

The annual average cost Punjab incures high medical cost for treatment of diarrhea and of non-breastfeeding-related diarrhoea and pneumonia care is pneumonia (UNICEF, Pakistan, 2017).
The annual average cost of calculated by multiplying the number of cases receiving outpatient non-breastfeeding-related diarrhoea and pneumonia care is calculated and inpatient services by the unit cost of treatment for infants.

by multiplying the number of cases receiving outpatient and (Dylan D Walters, Linh T H Phan, Roger Mathisen, 2019).

In inpatient services by the unit cost of treatment for infants.
(Dylan D Punjab, diarrhea prevalence is 19 percent and ARI is about 14 Walters, Linh T H Phan, Roger Mathisen, 2019).

In Punjab, diarrhea percent (MICS, 2018).

Based on the morbid population numbers prevalence is 19 percent and ARI is about 14 percent (MICS, 2018).

and the number of episodes of these two diseases (using MICS Based on the morbid population numbers and the number of episodes 2018), the total healthcare cost is calculated.
World Food Program of these two diseases (using MICS 2018), the total healthcare cost is (WFP), Pakistan in a study titled ‘The Economic Consequences of calculated.
World Food Program (WFP), Pakistan in a study titled Undernutrition in Pakistan: An Assessment of Losses, found the ‘The Economic Consequences of Undernutrition in Pakistan: An mean cost of diarrhea treatment US$ 7.91 per primary health Assessment of Losses, found the mean cost of diarrhea treatment US$ the same was found for pneumonia care consultation and 7.91 per primary health care consultation and the same was found for included all direct (cost of treatment.

The cost of treatment pneumonia treatment.


The cost of treatment included all direct (cost medicine and health facility) and indirect cost (family time and of medicine and health facility) and indirect cost (family time and travel).

The same cost of treatment is used in this policy brief travel).

The same cost of treatment is used in this policy brief for for calculations of total healthcare cost in both morbidities in calculations of total healthcare cost in both morbidities in Punjab.
After adjustment of inflation in 2019-20, the estimated cost increased Punjab.

After adjustment of inflation in 2019-20, the estimated cost as US$ 8.11 for both diseases.

According to the MICS 2018, some increased as US$ 8.11 for both diseases.

According to the MICS families did not seek treatment of diarrhea and ARI/Pneumonia at 2018, some families did not seek treatment of diarrhea and public or private health facilities.
A separate calculation has been ARI/Pneumonia at public or private health facilities.

A separate made in the WFP study to measure the cost incurred to families for calculation has been made in the WFP study to measure the cost treatment of diarrhea and pneumonia at home.

Based on their in- incurred to families for treatment of diarrhea and pneumonia at depth review of literature, they found the per unit cost US$ 4.01 for home.
Based on their in-depth review of literature, they found the diarrhea and US$ 2.29 for ARI for home treatment.

After adjustment per unit cost US$ 4.01 for diarrhea and US$ 2.29 for ARI for home of inflation, the estimated calculation is US$ 4.11 for diarrhea and treatment.

After adjustment of inflation, the estimated calculation is US$ 2.34 for ARI/pneumonia in 2019-20.
The total number of cases US$ 4.11 for diarrhea and US$ 2.34 for ARI/pneumonia in 2019-20. of diarrhea and pneumonia has been derived from the MICS survey The total number of cases of diarrhea and pneumonia has been 2018; the mother was asked if her child had diarrhea or pneumonia in derived from the MICS survey 2018; the mother was asked if her last two weeks.

It is evident from the literature that over the course of child had diarrhea or pneumonia in last two weeks.
It is evident from a year, children under-2 years of age suffer approximately 6 episodes the literature that over the course of a year, children under-2 years of diarrhea and 4 episodes of ARI (UNICEF, Pakistan, 2017).

of age suffer approximately 6 episodes of diarrhea and 4 episodes of Assuming the 2 weeks snapshot of prevalence of both diseases, ARI (UNICEF, Pakistan, 2017).
Assuming the 2 weeks snapshot of the total provincial burden of diarrhea with its average episodes is prevalence of both diseases, the total provincial burden of diarrhea approximately 6.3 million cases and ARI/Pneumonia cases are about with its average episodes is approximately 6.3 million cases and 2.24 million.

The population of under-2 children has been extracted ARI/Pneumonia cases are about 2.24 million.
The population of from the total population in Punjab (population in 2020 according under-2 children has been extracted from the total population in to growth rate 2.13) on the biases of percentage distribution of Punjab (population in 2020 according to growth rate 2.13) on the population by age (Labour Force Survey, 2018).According to the biases of percentage distribution of population by age (Labour Force WFP study, about 22 percent of diarrhea and 8 percent of ARI/ Survey, 2018).According to the WFP study, about 22 percent of Pneumonia cases can be attributed to suboptimal breastfeeding in diarrhea and 8 percent of ARI/Pneumonia cases can be attributed Pakistan in under-2 year of age.
By applying the same assumption, to suboptimal breastfeeding in Pakistan in under-2 year of age.

By the total cases attributed to suboptimal breastfeeding in diarrhea and to applying the same assumption, ARI/Pneumonia are 1.39 million and 0.179 million respectively.

It suboptimal breastfeeding in diarrhea and ARI/Pneumonia are 1.39 was also reported in MICS, 2018 that 65.7 percent mothers seek million and 0.179 million respectively.
It was also reported in treatment in health facilities for their children in the diarrhea cases MICS, 2018 that 65.7 percent mothers seek treatment in health and 74.7 percent in ARI cases.

It suggested that 0.92 million seeking treatment of diarrhea at health facility and 0.48 million seeking facilities for their children in the diarrhea cases and 74.7 percent in treatment of diarrhea at home.

Likewise, about 0.134 million mothers ARI cases.


It suggested that 0.92 million seeking treatment of seeking treatment of their children for ARI/Pneumonia at public diarrhea at health facility and 0.48 million seeking treatment of or private health facility and 0.045 million at home.

The total cost diarrhea at home.


Likewise, about 0.134 million mothers seeking of avoidable health care treatment of childhood diarrhea and ARI/ treatment of their children for ARI/Pneumonia at public or private pneumonia attributable to sub-optimal breastfeeding is about US$ 77 health facility and 0.045 million at home.

The total cost of million annually in Punjab.


avoidable health care treatment of childhood diarrhea and ARI/pneumonia attributable to sub-optimal breastfeeding is about US$ 77 million annually in Punjab.
total cases attributed the Table 4: Projected illness cases and healthcare cost due Table 4: Projected illness cases and healthcare cost due to suboptimal breastfeeding practices in 2020 to suboptimal breastfeeding practices in 2020 Total Population under-2 (4.77% of total population in Punjab) Total Diarrhea Cases in Punjab as MICS prevalence rate under- 2 (18.95%) and 6 episodes per year Total Diarrhea Cases attributed to suboptimal breastfeeding Total ARI Cases in Punjab as MICS prevalence rate under- 2 (10.05%) and 4 episodes per year Total ARI/Pneumonia Cases attributed to suboptimal breastfeeding Cost of avoidable health care treatment of childhood diarrhea attributable to suboptimal breastfeeding (US$) if seeking treatment at facility.
Cost of avoidable health care treatment of childhood diarrhea attributable to suboptimal breastfeeding (US$) if seeking treatment at home.

Cost of avoidable health care treatment of childhood ARI/Pneumonia attributable to suboptimal breastfeeding (US$) if seeking treatment at health facility.

Cost of avoidable health care treatment of childhood ARI/pneumonia attributable to suboptimal breastfeeding (US$) if seeking treatment at home.

Total health system cost of suboptimal breastfeeding (US$).
Source: Author’s Calculation 5,590,107 6,355,953 1,398,309 2,247,223 179,777 74,550,571 1,971,239 1,089,124 106,432 77,717,366 ECONOMIC ECONOMIC COST OF BREASTFEEDING SUBSTITUTES SUBSTITUTES BREASTFEEDING COST OF the lowest wealth quintiles.
Families pay The child is usually fed with formula milk when not breastfed, The child is usually fed with formula milk when not breastfed, the the ‘cost of formula’ for infants is significant for households ‘cost of formula’ for infants is significant for households especially for especially in the in the lowest wealth quintiles.

Families pay for infant formulae, formulae, feeding bottles, sterilizing equipment and fuel, infant feeding bottles, sterilizing equipment and fuel, etc.

in case of non- etc.


in case of non- breastfeeding.

In Punjab, the formula milk breastfeeding.

In Punjab, the formula milk prevalence under 6 months prevalence under 6 months of age is 19.7 percent as per MICS, of age is 19.7 percent as per MICS, 2018 data.

The average daily 2018 data.


The average daily requirement of formula milk in requirement of formula milk in each month has been calculated by feeding each month has been calculated by reviewing reviewing the feeding guidelines given on national and international guidelines given on national and international brands of infant formula milk.

Similarly, the price of formula milk is calculated by brands of infant formula milk.
Similarly, the price of formula milk is taking average price of economy brand formula milks in Pakistan calculated by taking average price of economy brand formula milks through an online search for e-commerce vendors, the same in Pakistan through an online search for e-commerce vendors, the methodology has been using in a study conducted by Dylan same methodology has been using in a study conducted by Dylan D Walters, Linh T H Phan, Roger Mathisen, (2019).
As a D Walters, Linh T H Phan, Roger Mathisen, (2019).

As a result, the result, the average cost of artificial feeding per child per month average cost of artificial feeding per child per month is about PKR is about PKR 6809/- or US$ 42.56 (see table 5).

The minimum 6809/- or US$ 42.56 (see table 5).

The minimum monthly wage in monthly wage in Pakistan is PKR 17,500/- or US$ 109.37 per month.

Pakistan is PKR 17,500/- or US$ 109.37 per month.


The amount spent The amount spent on infant formula milk is equivalent to 39 percent of the minimum wages of a skilled labour.

In Pakistan, formula on infant formula milk is equivalent to 39 percent of the minimum manufacturing the wages of a skilled labour.

In Pakistan, formula manufacturing is a to volume of imports of formula milk is rapidly growing due multi-billion-dollar industry.

Besides, the volume of imports of this region.


highest sales of formula milk is rapidly growing due to highest sales of infant and According According to study conducted by Dylan D Walters, Linh child formula in this region.
According According to study conducted T H Phan, Roger Mathisen, (2019), the households spent 18.8 by Dylan D Walters, Linh T H Phan, Roger Mathisen, (2019), the income on formula milk to feeding percent of their nominal households spent 18.8 percent of their nominal income on formula their children in Pakistan.

Nationally, we spent US$ 1.2 billion on milk to feeding their children in Pakistan.
Nationally, we spent US$ purchase of formula milk for children (Alive & Thrive (A&T) The projected population for year 2020 is extracted data).

1.2 billion on purchase of formula milk for children (Alive & Thrive the from the sixth population and housing census 2017 on (A&T) data).
The projected population for year 2020 is extracted in age basis of percentage distribution of population by from the sixth population and housing census 2017 on the basis of the percentage population Labor Force Survey, 2018 percentage distribution of population by age in Labor Force Survey, total population.

By under one year of age 2018 that is the percentage population under one year of age is 2.33% applying the assumption of uniformity, we have 1.17 % of the of total population.
By applying the assumption of uniformity, we population in under six months.

The estimated population of have 1.17 % of the population in under six months.

The estimated In Punjab, under 6 months of age population of under 6 months of age is about 1,371,158.

In Punjab, it feeding, rate of according to prevalence the fed through is estimated according to prevalence rate of formula milk feeding, it is estimated artificial formula milk.

that 270,118 children are fed through the artificial formula milk.
is about 1,371,158. formula milk are infant and child formula is a multi-billion-dollar industry.

Besides, is 2.33% of children 270,118 that that in is PAGE | 3 PAGE | 3 The total expenditures on formula milk incurred to every family in six months (exclusive breastfeeding period) are about US$ 80 million.
Although, it is worth mentioning here that all cost of formula milk cannot be saved even in best practices of breastmilk since mothers need to consume additional food to account for the time additional caloric requirements.

But due to data and to data and to data and limitation, this cost is not measured.
The total expenditures on formula milk incurred to every The total expenditures on formula milk incurred to every family The total expenditures on formula milk incurred to every family family in six months (exclusive breastfeeding period) are about The total expenditures on formula milk incurred to every family in six months (exclusive breastfeeding period) are about US$ 80 in six months (exclusive breastfeeding period) are about US$ 80 US$ 80 million.
Although, it is worth mentioning here that all in six months (exclusive breastfeeding period) are about US$ 80 million.

Although, it is worth mentioning here that all cost of million.

Although, it is worth mentioning here that all cost of cost of formula milk cannot be saved even in best practices million.
Although, it is worth mentioning here that all cost of formula milk cannot be saved even in best practices of breastmilk formula milk cannot be saved even in best practices of breastmilk of breastmilk since mothers need to consume additional food formula milk cannot be saved even in best practices of breastmilk since mothers need to consume additional food to account for the since mothers need to consume additional food to account for the to account for the additional caloric requirements.
But due to since mothers need to consume additional food to account for the to data and time additional caloric requirements.

But due time additional caloric requirements.

But due data and time limitation, this cost is not measured.

time additional caloric requirements.

But due limitation, this cost is not measured.

limitation, this cost is not measured.

limitation, this cost is not measured.


J. in in in in Bagriansky References for policy making, particularly for policy making, particularly for policy making, particularly for policy making, particularly increasing breastfeeding practices could also be saved by practices at the most intimate level in Punjab.
This result will be the context of helpful breastfeeding support in hospitals, breastfeeding support in the community, and maternity leave programs, raising awareness about the financial burden incurred by poor breastfeeding practices, and highlighting a new area for research in Punjab.

Adding the economic cost argument is expected to make breastfeeding message more persuasive.
With strong advocacy, better communication, and interpretation of suboptimal breastfeeding cost to the mothers, the breastfeeding rates may be improved; The health system costs could be turned into health budget cost savings if breastfeeding rates increase.

Furthermore, formula feeding is neither effective for improving infant health or cognitive growth, nor is it affordable for the vast majority of Punjabi families living in poverty.
The cost of buying infant formula milk will be reduced as the breastfeeding rate improves in suboptimal breastfeeding practices could also be saved by increasing breastfeeding practices could also be saved by increasing breastfeeding practices could also be saved by increasing breastfeeding practices at the most intimate level increasing breastfeeding practices could also be saved by practices at the most intimate level in Punjab.

This result will be practices at the most intimate level in Punjab.


This result will be the context of helpful in Punjab.
This result will be helpful for policy making, the context of helpful the context of helpful breastfeeding support in hospitals, breastfeeding support in the breastfeeding support in hospitals, breastfeeding support in the particularly in the context of breastfeeding support in hospitals, breastfeeding support in hospitals, breastfeeding support in the community, and maternity leave programs, raising awareness about community, and maternity leave programs, raising awareness about community, and maternity leave programs, raising awareness about the financial burden incurred by poor breastfeeding practices, and breastfeeding support in the community, and maternity leave the financial burden incurred by poor breastfeeding practices, and the financial burden incurred by poor breastfeeding practices, and highlighting a new area for research in Punjab.
Adding the highlighting a new area for research in Punjab.

Adding the programs, raising awareness about the financial burden highlighting a new area for research in Punjab.

Adding the economic cost argument is expected to make breastfeeding message economic cost argument is expected to make breastfeeding message economic cost argument is expected to make breastfeeding message more persuasive.
With strong advocacy, better communication, and incurred by poor breastfeeding practices, and highlighting a more persuasive.

With strong advocacy, better communication, and more persuasive.

With strong advocacy, better communication, and interpretation of suboptimal breastfeeding cost to the mothers, the interpretation of suboptimal breastfeeding cost to the mothers, the new area for research in Punjab.
Adding the economic cost interpretation of suboptimal breastfeeding cost to the mothers, the breastfeeding rates may be improved; The health system costs breastfeeding rates may be improved; The health system costs breastfeeding rates may be improved; The health system costs argument is expected to make breastfeeding message more could be turned into health budget cost savings if breastfeeding could be turned into health budget cost savings if breastfeeding could be turned into health budget cost savings if breastfeeding rates increase.
Furthermore, formula feeding is neither effective for rates increase.

Furthermore, formula feeding is neither effective for persuasive.

With strong advocacy, better communication, rates increase.
Furthermore, formula feeding is neither effective for improving infant health or cognitive growth, nor is it affordable for improving infant health or cognitive growth, nor is it affordable for and interpretation of suboptimal breastfeeding cost to the improving infant health or cognitive growth, nor is it affordable for the vast majority of Punjabi families living in poverty.

The cost of the vast majority of Punjabi families living in poverty.
The cost of mothers, the breastfeeding rates may be improved; The health the vast majority of Punjabi families living in poverty.

The cost of buying infant formula milk will be reduced as the breastfeeding rate buying infant formula milk will be reduced as the breastfeeding rate system costs could be turned into health budget cost savings buying infant formula milk will be reduced as the breastfeeding rate improves improves improves if breastfeeding rates increase.
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Retrieved September 12, 2020, from https://www.

pc.gov.pk/uploads/report/Economic_Consequences.pdf pc.gov.pk/uploads/report/Economic_Consequences.pdf pc.gov.pk/uploads/report/Economic_Consequences.pdf pc.gov.pk/uploads/report/Economic_Consequences.pdf World Food Programme Pakistan.

World Food Programme Pakistan.

World Food Programme Pakistan.

World Food Programme Pakistan.

(2017).

The Economic Consequences of Undernutrition in Pakistan:An Assessment of Losses.
Retrieved September 12, 2020, from https://www.

pc.gov.pk/uploads/report/ Economic_Consequences.pdf World Food Programme Pakistan.

World Food Programme Pakistan.

Policy and Planning, 31, 1107-16.
Source: Author’s calculation based upon the feeding guide of children given on national and international brands of infant formula milk *It is assumed that one bottle is sufficient for feeding in six months Total Cost Attributed to Suboptimal Breastfeeding *It is assumed that one bottle is sufficient for feeding in six months *It is assumed that one bottle is sufficient for feeding in six months *It is assumed that one bottle is sufficient for feeding in six months Total Cost Attributed to Suboptimal Breastfeeding Total Cost Attributed to Suboptimal Breastfeeding Total Cost Attributed to Suboptimal Breastfeeding Total Cost Attributed to Suboptimal Breastfeeding The direct economic losses included the future income loss due The direct economic losses included the future income loss due The direct economic losses included the future income loss due The direct economic losses included the future income loss The direct economic losses included the future income loss due to infant and neonatal mortality.
The treatment of diarrhea and to infant and neonatal mortality.

The treatment of diarrhea and to infant and neonatal mortality.

The treatment of diarrhea and due to infant and neonatal mortality.

The treatment of diarrhea to infant and neonatal mortality.

The treatment of diarrhea and pneumonia also involved high cost.

The projected total cost incurred pneumonia also involved high cost.

The projected total cost incurred pneumonia also involved high cost.
The projected total cost incurred and pneumonia also involved high cost.

The projected total pneumonia also involved high cost.

The projected total cost incurred to individuals, families, and society in year 2020 due to suboptimal to individuals, families, and society in year 2020 due to suboptimal to individuals, families, and society in year 2020 due to suboptimal to individuals, families, and society in year 2020 due to suboptimal breastfeeding is US$ 143.32 million.


cost incurred to individuals, families, and society in year 2020 breastfeeding is US$ 143.32 million.

breastfeeding is US$ 143.32 million.

due to suboptimal breastfeeding is US$ 143.32 million.
Table 6: The total cost of all three components Table 6: The total cost of all three components Table 6: The total cost of all three components Table 6: The total cost of all three components 33,945,588 33,945,588 33,945,588 33,945,588 Loss of future income due to infant and neonatal deaths Diarrhea Treatment (US$) ARI treatment (US$) Infant formula Milk (US$) Total Direct Cost due to suboptimal breastfeeding (US$) Loss of future income due Loss of future income due Loss of future income due to infant and neonatal to infant and neonatal to infant and neonatal deaths deaths deaths Diarrhea Treatment (US$) Diarrhea Treatment (US$) Diarrhea Treatment (US$) ARI treatment (US$) ARI treatment (US$) ARI treatment (US$) Infant formula Milk (US$) Infant formula Milk (US$) Infant formula Milk (US$) Total Direct Cost due to Total Direct Cost due to Total Direct Cost due to suboptimal breastfeeding suboptimal breastfeeding suboptimal breastfeeding (US$) (US$) (US$) 76,521,810 1,195,556 62,781,363 143,327,528 76,521,810 76,521,810 76,521,810 1,195,556 1,195,556 1,195,556 62,781,363 62,781,363 62,781,363 143,327,528 143,327,528 143,327,528 POLICY IMPLICATIONS The results generated in this brief showed that about 61,000 deaths of infants could be saved every year by increasing the breastfeeding practices.
Similarly, the cost incurred due to diarrhea and ARI/ pneumonia treatment, loss of future income due to infant and neonatal, cost of infant formula milk in suboptimal breastfeeding POLICY IMPLICATIONS POLICY IMPLICATIONS POLICY IMPLICATIONS POLICY IMPLICATIONS The results generated in this brief showed that about 61,000 deaths The results generated in this brief showed that about 61,000 deaths The results generated in this brief showed that about 61,000 deaths of infants could be saved every year by increasing the breastfeeding of infants could be saved every year by increasing the breastfeeding The results generated in this brief showed that about 61,000 of infants could be saved every year by increasing the breastfeeding practices.
Similarly, the cost incurred due to diarrhea and ARI/ practices.

Similarly, the cost incurred due to diarrhea and ARI/ deaths of infants could be saved every year by increasing practices.
Similarly, the cost incurred due to diarrhea and ARI/ pneumonia treatment, loss of future income due to infant and pneumonia treatment, loss of future income due to infant and pneumonia treatment, loss of future income due to infant and neonatal, cost of infant formula milk in suboptimal breastfeeding the breastfeeding practices.
Similarly, the cost incurred due neonatal, cost of infant formula milk in suboptimal breastfeeding neonatal, cost of infant formula milk in suboptimal breastfeeding to diarrhea and ARI/ pneumonia treatment, loss of future income due to infant and neonatal, cost of infant formula milk PAGE | 4 PAGE | 4 PAGE | 4 PAGE | 4 PAGE | 4