Where there is no weighing scale: Newborn nourishment and care in Pakistani Punjab

A third of babies in South Asia are born low birthweight, more than in sub-Saharan Africa. This epidemiological enigma has been linked to gender and generational inequalities and to poor health and nutrition over the whole of women's lives. High rates of breastfeeding initiation are accompanied by high rates of colostrum avoidance, the giving of prelacteal feeds and early supplementation with formula or animal milks as well as other substances. Meanwhile, in Pakistan – despite the extensive presence of public community maternal and child health workers – very few babies are weighed at birth. This paper draws on an ethnographic study conducted in 2014–16 in rural and urban Punjab, to shed light on the interpretation, nourishment and care of newborns who are identified to be kamzoor (weak), and to comment on the extent to which carers' efforts are influenced by community health workers, who are charged with spreading modern biomedical knowledge and practices. Kamzoori is understood to be caused by maternal depletion and is managed at home by augmenting breastfeeding and giving supplementary milks, and by keeping the baby warm and massaged. In cases where weak newborns do not recover weight, spiritual explanations are invoked and treated through a variety of home remedies/methods. There are often similarities between the interpretations of mothers, grandmothers, and health workers. The paper considers health workers to be engaged in complex cultural mediations.