A group of women in Sharjah are leading the charge to have mothers return to breastfeeding, and to provide the right environment for them to do so. There have been successes, but the biggest battle has yet to be waged and won - in the workplace.
UAE women lead charge on return to breastfeeding
They are women on a mission, trying to persuade new mothers to revive the culture of breastfeeding they say has been lost in modern times.
"Before 20 or 30 years it was very common. Everyone breastfed their children," says Mona AbdulRahman, a training coordinator at the Sharjah Baby Friendly Emirate Campaign, based at the Sharjah Supreme Council for Family Affairs.
"But then women started to work and leave the house and the formula companies had the chance to come into the communities and sell their products as a good alternative to breast milk. And women thought that because they were paying for it, it was better.
"We have a lot of work to do to go back to how it was."
The campaign, based at the Sharjah Supreme Council for Family Affairs, was launched last year.
It aims to make the whole emirate baby friendly, in accordance with World Health Organisation (WHO) and United Nations Children's Fund (Unicef) standards, by 2015.
For an area to baby friendly it must protect, promote and support breastfeeding, and provide women with comfortable and private areas to express or feed their children.
Other requirements are that laws governing maternity leave must be adhered to, and healthcare staff should be trained in teaching breastfeeding. Hospitals and clinics must also cut all ties with formula-milk companies.
The team, most of whom are UAE nationals, is responsible for accrediting public places, health centres, nurseries and workplaces as baby friendly.
It is also working with Breastfeeding Friends and the Sharjah Education Council to better educate women, children and healthcare workers about the benefits of breast milk.
Last week the education council announced primary, secondary and tertiary students would be taught about breastfeeding.
"Children need to get all the information before marriage," says Khawla Al Noman, chairwomen of the non-profit voluntary group Breastfeeding Friends, which visits schools during World Breastfeeding Week every November.
"If you give them the right information about breastfeeding, then they can manage after marriage."
Elsewhere in the UAE there have been successes. A report in July 2011 published in the academic journal The Practising Midwife discussed the challenges of implementing the WHO/Unicef Baby Friendly Hospital Initiative into the Corniche Hospital in the capital.
Referring to some of the barriers that discourage women from breastfeeding, it states: "Women depended on their extended family for advice and support, and practices such as mixed feeding and early weaning were the norm."
The report notes that it is common for babies delivered by caesarean section to be taken straight to the postnatal ward to be formula fed - even before the mothers had left the operating room.
Since then, staff training and better infrastructure have been put in place to help create a breastfeeding friendly environment and the rate of breastfeeding on discharge has risen from 50 per cent to 90 per cent over a two-year period.
The Sharjah Baby Friendly Emirate Campaign hopes to emulate some of this success through community education, but it also has formula milk companies firmly in its sights.
These companies, Mrs AbdulRahman says, have smart ways of sidestepping any laws or rules governing the marketing of their product. This issue has been hotly debated over the past 40 years.
In 1981, WHO and Unicef launched the International Code of Marketing of Breast-milk Substitutes to encourage countries to better regulate the marketing of formula.
Even in its earliest form - it has since been extended and amended - the 1981 code called for a ban on pregnant women or new mothers being given gifts or free products to promote breast milk substitutes.
It sought an end to health workers receiving samples of milk formula, other than for professional evaluation or research "at the institutional level".
It also stated that no public health centre should be used for the purpose of promoting infant formula or other similar products.
The UAE is a signatory to the code but many of its points are ignored, according to Dr Kamini Naik, the director of the implementation committee of the Sharjah campaign.
One of the main goals of the Sharjah campaign is to "protect the public from the unethical marketing of artificial-feeding companies" and protecting working mothers by introducing their legal maternity and breastfeeding rights.
"The formula companies still work with clinics here," Dr Naik says. "If a clinic says 'we need curtains and decorating', they come and do this for them but they use the motifs that they have on their formula. The staff don't realise that they do these things.
"They will do lovely decorations but with their company motifs, which children are attracted to."
Dr Naik is responsible for a team that implements the campaign across the emirate. She goes into public and private clinics to accredit health centres, nurseries, workplaces and public spaces as baby friendly.
For a health centre to be accredited it must be stripped of all breast-milk substitute promotional material and cut any other ties with the company.
"Sometimes you think it's a shame to take out the decorations but it is important to remove all the company logos," Dr Naik says.
"The companies also bring small gifts of even pay for doctors and nurses to go abroad for conferences, which they sponsor. This has to stop, according to the code."
Dr Hessa Khalfan AlGhazal, the Emirati executive director of the campaign, is determined to bring back some of the old attitudes towards breastfeeding.
"What's amazing is even the older generation who exclusively breastfed their own children now think it's too much to ask the new generation to rely only on breastfeeding," Dr AlGhazal says.
"They ask their daughters and daughters-in-law to introduce formula. They want to free the mother because she has to go back to work or study."
Government figures suggest most new mothers leave hospital breastfeeding, but within a year about half have given up.
About 97 per cent of infants in the UAE are breastfed at birth, according to the Situation Analysis of Children in the United Arab Emirates, produced in 2010 by Unicef, the General Women's Union and the Supreme Council for Motherhood and Childhood, using data from 2007.
The number of children who were breastfed for a year dropped to 46 per cent. The figures do not make it not clear whether this includes mixed bottle and breast milk.
Dr AlGhazal believes these figures are too high.
"I would say it would be closer to 30 per cent at six months, and at a year I don't expect it to be more than 10 per cent," she says.
Sharjah is conducting a comprehensive survey for more accurate figures.
Dr Al Ghazal and her team face a huge task in workplaces. To become a baby-friendly workplace, women must be given enough time to breastfeed or express in a comfortable and private room, the campaign says. It must, of course, also honour its legal obligations.
Women in government jobs have 60 days' paid maternity leave by law, compared with 45 in the private sector. They are also given two hours a day for the first six months to breastfeed.
Most women save these from the first four days of the week to allow them to take a three-day weekend.
In Sharjah, they are also given an hour a day for the next six months until their child is a year old.
It will take time, Mrs AbdulRahman says, for the country to fully adapt to having so many more women in the workplace than there was 20 or even 10 years ago.
"The country has just started to go through this in a very short time and it takes time to recognise the disadvantages," she says. "This is the time when we feel the problems and talking about it, so we can fix it."
The campaign also wants to see more nurseries or creches for working mothers.
The campaign's mission is to empower all mothers to breastfeed their babies for two years "to give them a right start in life as designed by our Creator."
"The best case is to start with 100 per cent for every newborn, at the time of discharge," says Dr AlGhazal.
"If we can encourage all women to just do breastfeeding, it would be wonderful for the emirate."