Title : Influence of cultural beliefs, traditional practices and intergenerational norms on breastfeeding decisions among mothers in Pakistan; A narrative review
Abstract:
Exclusive breastfeeding for the first six months of life, followed by continued breastfeeding up to two years or beyond, is strongly recommended by the World Health Organization and other international health agencies due to its proven advantages for infant growth, immunity, and maternal health. However, compliance with these recommendations remains poor globally, with significant gaps found in Pakistan. This narrative review explores how cultural beliefs (such as delayed initiation of breastfeeding, discarding colostrum, prelacteal feeding, and early supplementation consistently emerge as obstacles to EBF), traditional practices (Religious beliefs play a dual role by supporting the idea of breastfeeding in principle but sometimes restricting its practice in public due to modesty reasons) and intergenerational norms (particularly from mothers-in-law and grandmothers within extended family systems plays a powerful role in shaping infant feeding choices and may restrict maternal agency even when best practices are known) influence breastfeeding choices among mothers, with a particular focus on the Pakistani context while informed by evidence from diverse international settings. Intergenerational influence conversely, supportive engagement of fathers, peers, and informed family members is found to result in better breastfeeding outcomes. Structural factors, including maternal employment, rapid return to work, inadequate workplace lactation support, and aggressive marketing of breast milk substitutes, further contribute to early termination of exclusive breastfeeding. This review integrates evidence published between 2015 and 2026 in South Asia, Africa, the Middle East, and Western settings to examine the sociocultural, religious, familial, and structural factors that shape the initiation, exclusivity, and duration of breastfeeding. Through the lens of the collected evidence, the cultural construction of colostrum, prelacteal feeding (honey or ghutti), the perception of inadequate milk, and elder-led decision-making were found to be fundamental factors in early supplementation. The intergenerational authority of collectivist family structures was often a limiting factor in maternal autonomy, while the involvement of fathers and educated family members was linked to better Exclusive BreastFeeding (EBF) practices. Structural issues such as early maternal work return, short maternity leave, the unavailability of lactation facilities at work, and aggressive promotion of breast milk substitutes were also found to be contributing factors in suboptimal exclusivity and duration. Other evidence suggests that culturally appropriate communication, the involvement of community health workers, and family-centered education practices significantly improve the continuation of breastfeeding. Exclusive breastfeeding in Pakistan is a practice that is situated within cultural, religious, family, and structural contexts and not just a personal choice of mothers. Evidence from 2015 to 2026 suggests that for sustainable improvement, culturally appropriate and intergenerational approaches that involve family elders, fathers, religious leaders, healthcare professionals, and changes at the workplace are essential. A family-centered approach to public health is necessary to balance cultural values with evidence-based recommendations for breastfeeding.
