Professor Zulfiqar Ahmed Bhutta

Professor Zulfiqar Ahmed Bhutta
Aga Khan University, Principal Investigator, Translation of Research-Based Breastfeeding Knowledge: Making the Latest Science Accessible

This project aims to do more than bring peer-reviewed publications from behind paywalls – what is the intent? 

One of the reasons we took this project on is that it was unique and had very ambitious objectives: to translate a lot of evidence-informed, high-quality scientific information into easy-to-digest, understand and share syntheses, which would be largely of use to the non-scientific community, so-called “laypeople”. That’s always challenging, but I think as a global community of health professionals and academicians, we are becoming better at it over time, when we recognize that some of the best impact of any research is its translation into simple, understandable language. So that’s one of the attractions here, because there isn’t anything comparable other than websites which have prior positions and are focused much more on advocacy than scientifically valid information.

The idea here was to have a one window operation where a potential knowledge portal could bring together some of the most important, but also some of the most useful and user-friendly information. With breastfeeding and breastmilk, there are lots of questions that people have, and some of those questions are also specific to knowledgeable communities, working women, women who are influenced by some of the alternative sources of information out there. So it’s very important that this be tailor made to some extent for lay audiences. 

The challenge that I perceived at the time when I took this, in terms of translation of knowledge to practices, is that some of the countries at greatest risk of non-receipt of breastmilk, or receiving breastmilk substitutes, are also countries where knowledge portals are limited. People don’t have as much access to the Internet, and literacy rates are generally lower. So one has to be very focused on what’s the best means of communication, and ask should you be pushing out things versus people passively accessing your information sources and their validity? That’s the challenge that we haven’t quite addressed yet, but it is an important one.

How are you translating scientific information for impact in practice? Where are the challenges?

As the first step, in partnership with the Foundation, we came up with a conceptual framework as to how we should organize the various stakeholder groups which are important, ranging from healthcare professionals to people who are much more on the policy arm – district level managers, oversight folks, monitoring and evaluation – to breastfeeding advocates, and importantly, to people who are not yet convinced that breastfeeding is the best, and there are many out there who aren’t. There are also policy levers that would need to shift with lactating mothers being aware of their rights and best practices across the world.

Obviously it’s very challenging to be everything for everybody. So we had to make some choices in terms of how we prioritize and which messages should be selected, and for which stakeholders. One of the first things that we have done, and again in discussion and partnership with the Foundation, is to come up with an additional framework to organize this knowledge into various categories. Some of them will be much more science based: What is the best scientific information that we can provide on breastfeeding practice, breastmilk content, objective data on outcomes? 

But also, we have spent some time looking to cover the entire journey from science to impact and provide materials to aid the scale-up breastfeeding in various contexts. Both in peaceful circumstances where there is no consideration other than your daily activity and jobs and also circumstances that currently engulf about 40-45% of the world, which is people who are dealing with polycrises at any given point in time – climate change, conflict, cost of living and the risks of pandemics from which we have just recovered from one. So we have developed an organizational framework to help us in this task.

Which next steps are you excited about?

We are currently in the process of identifying what kind of questions would percolate up organically in that framework, and some that we would purposefully put in there because we think that they are important. The next step is to ask stakeholders from a variety of settings, regions, geographies, contexts what they think is the biggest need.

We need to have a good balance between supply and demand. It’s on the demand side that these interviews would be very important in terms of finding what people perceive as the biggest gaps in knowledge or the biggest barriers to implementation, where additional information presented in the right manner would be useful.  

I think the proof of the pudding would be in eating it, when we get to that stage with the Foundation that we have done some collation, some curating of the evidence and we know what 20, 30, 40 topics are important. Then developing the products from those topics is the next big challenge. That we haven't got to yet. The Foundation has indicated to us that it would bring on board some of the best people who are communication experts and know how to translate disparate information into clear knowledge sound bites that people would retain and remember. And that, to me, is a really exciting next phase that I'm looking forward to. 

What is it like collaborating with the Foundation to bring the Knowledge Translation project to life? 

This is one of the most involved foundations that I work with, and I work with many, many foundations. Some days feel like a trip to the dentist. Other days are wonderful. Altogether, we have made much progress, so it's been a great relationship in terms of learning how to how to develop a project. 

I’ve been very grateful for their respectfulness and the fact that they are cognizant of the challenges of working in low middle income settings (LMICs) and with staff members who may not be like the University of Geneva graduates. You know, people have different skills sets, different languages, different communication skills. And slowly, steadily we’ve built a team that I think has now built momentum. We also have an advisory committee. One of the other challenges of this project is just chasing people for ideas and information, getting their time.  

Do you see potential to apply the knowledge translation approach in other areas of health and development?

The framework that we have is a very modern framework because I think it can be used for almost anything. It’s a framework that we are currently applying for one field which is breastfeeding and breastmilk, but that framework lends itself to possibly being used for any other question that you have. Let’s say you have a  question on climate, and you want to do the same exercise on looking at research prioritization, prioritization of questions, stakeholder engagement. I’d be very keen to apply this framework to climate change.

I think it has tremendous potential and obviously a lot of thought has gone into its development to-date. And we will work very closely with the Foundation to look at both pros and cons, because there could also be difficult areas where the framework does not quite lend itself to application. Maybe when you ask me in six months’ time I may have a different answer, but at this point everything looks good.

Is there anything that you would like to add? 

One of the big things to focus on and move towards is applying the framework and some of the end results of this exercise to real life settings in LMICs. I know that the Foundation has contacts in Ghana and elsewhere where I think we may have an opportunity to beta test it as well – take a sample from a different context, different geography, apply it in a country like Ghana and ask: Does this work, is it able to provide information to various people? 

My concern, of course, is that we want to reach populations at greatest risk and we’re using technology  and tools that are sometimes beyond the reach of a common person. We saw that in COVID. People at times have a very idealistic view of how information permeated to people during COVID, learnings, schools, education, children. The Internet was also a great divider because many people had access and many people didn’t. 

One big current challenge in global contexts with economic crises is that in many low-income populations, the poorest don't have access to information technology the same way as they had before. Hardly anybody is able to pay for data. I know of people who have actually changed their data plans because they can’t afford things anymore at the same level. So one big concern that I have still is at the end of the day when we produce something and put this out, what would be the best strategy for reaching people who need to be reached through alternative communication strategies than the digital format? 

I don’t have an answer to this yet. But I know that nearer the time, once we have our work done, this is one of the questions that I will raise with my friends at the Foundation because I think it’s an important question to address. We have to find innovative ways of convincing people and communicating with people. This whole issue of breastfeeding and breastmilk availability in many LMICs is so, so closely tied to levels of poverty and development. People sometimes forget that when you are poor and ultra poor, exclusive breastfeeding is challenging at times because women have to work, especially in circumstances where there is no paid maternity or parental leave.

There are tremendous gender inequities in working conditions of highly educated, successful and rich women, and the poor domestic who works in six households within a period of seven to eight hours. Professionals can afford to take their children to work where there are daycare centers and creche facilities, but poor women can't do that. They have to leave the baby with the grandmother or somebody else, sometimes elder children. I look at this all the time and this is one of the big challenges of walking the talk. How do you make things happen when the foundational underpinnings of many, many of these challenges are related to poverty, abject poverty? 

What we can do as part of the Foundation work is to highlight that those challenges exist, and they cannot be wished away, and identify solutions. Someone will have to put down the resources to help these women. Cash transfers and maternity leave that can be provided in certain setups,  equity and salaries and opportunities. Those kinds of things will help overall. Breastmilk and breastfeeding will only get their due priority when people understand the value and cost effectiveness. People just don't see the cost effectiveness at this stage as its considered a natural default.

I look forward to the foundation’s celebrations in due course. I think this is a good milestone to have. To have survived a decade, that's great. To have survived COVID, that’s even better. Thank you very much indeed for your help.