Award-winning nurse/researcher Shela Hirani works to dismantle barriers
By Laura Eggertson
September 25, 2023
Shela Hirani’s efforts to support and promote breastfeeding have taken her from a mountain top in Pakistan to Canadian university campuses — and the mountaintop trip almost ended her life.
It was 2018, and Hirani, a registered nurse and lactation consultant, had travelled to a disaster relief camp in Chitral, northern Pakistan.
As part of the research for her PhD in nursing, Hirani was interviewing women struggling to breastfeed their babies amidst deprivation and danger.
Despite warnings about the region’s political and geological instability, Hirani was determined to hear first-hand from women about what they needed to give their babies the best possible start in life, even in dire circumstances.
“I was at the top of a mountain, sitting on the floor of a tent with a mom to interview her, when an active earthquake happened,” remembers Hirani, now an associate professor at the University of Regina.
Inside the tent, full of women, children, and sheep, some people began reciting religious verses for the dying. Others started to run.
“I had the feeling that this was probably the last moment of my life,” Hirani says. “I just closed my eyes and prayed that if my life ended, [at least] I was doing good work.”
Shaped disaster relief policy
Hirani and the woman she was interviewing survived the earthquake. Her research into the conditions lactating women encounter during disasters helped to shape support programs for displaced mothers in that region, she says.
All over the world, when disasters strike, governments, aid agencies and individuals rush to provide large supplies of formula among their donations, Hirani says.
Without access to clean water or bottles or the ability to afford formula once the donations run out, however, the women receiving formula are worse off, she says.
“Actually, mothers should be provided with breastfeeding support and good nutrition, rather than formula,” Hirani says.
Following her research, Hirani helped relief organizations understand they should provide mothers with nutritious food, hygiene products and online breastfeeding support, rather than formula.
She also advocated with the humanitarian relief agencies for telecommunications towers in disaster-affected areas, so women can access support via mobile phones.
“My work has led to changes in many practices,” Hirani says.
Developed assessment tool
In an example of Hirani’s influence, the World Health Organization (WHO) published and cites the paper she wrote based on her fieldwork with internally displaced mothers in Chitral. In 2020, the WHO also recognized her as one of 100 outstanding women nurse and midwife leaders from around the world.
Even before she conducted her PhD research, Hirani developed the Perceived Breastfeeding Support Assessment Tool (PBSAT). Health-care professionals, clinicians and researchers can use the tool to measure working mothers’ perceptions about the availability of breastfeeding support from their social network and workplace.
Since Hirani grew up and spent her early career in Karachi, Pakistan, and worked in the Aga Khan University as an assistant professor, it has been rewarding for her to know Pakistan is among the countries using her tool to assess breastfeeding support and expand services to nursing mothers.
When Hirani moved to Canada, she found to her surprise the challenges and barriers nursing mothers face have universal components. As a PhD student at the University of Alberta, she discovered other students and staff members struggled to sustain their breastfeeding practices while on campus.
“If there are no on-campus breastfeeding policies, no flexibilities, no private rooms — those are some of the initial barriers mothers with young babies face,” she says.
Working with the other students and staff, Hirani helped to create a public breastfeeding movement still active at the University of Alberta today.
The University of Toronto also turned to her for advice when that institution wanted to create breastfeeding-friendly policies for students and staff on campus. Her work has resulted in breastfeeding rooms on that campus as well as a new mother and baby-friendly policy in many post-secondary institutions, she says.
Breastfeeding in public
Hirani does not limit her advocacy to campuses, however. Her current research and teaching focuses on the concerns immigrant and refugee women, as well as other vulnerable populations. She wants to ensure they have information, support, and safe places to nurse their children.
“I’m advocating for breastfeeding in public places like parks, restaurants, shopping malls, airports, and all the other facilities where mothers are with babies,” Hirani says.
She is passionate about ensuring breastfeeding policies do not require women to express their milk in private or relegate them to nursing their children in restrooms.
“It’s not a normal thing for an adult to eat in a washroom,” she points out. “So why are we discriminating for babies? Breastfeeding in washrooms is not ideal.”
Hirani has also identified a lack of cultural competency in health-care settings as a barrier to breastfeeding and to good maternal and child health.
From ensuring Muslim women have halal food in hospital, to accommodating their requests for female physicians and making breastfeeding materials available in many languages, Hirani is working with the Saskatchewan Health Authority, individual health-care institutions, and settlement organizations in Saskatchewan to improve mother and baby-friendly practices.
For example, new residents to Canada are often offered formula samples in doctor’s offices or community settings, instead of follow-up, community care and encouragement to breastfeed, she says.
As part of her work to improve care for women and children, Hirani has created animated videos and other teaching modules for nurses and other health-care workers caring for immigrant and refugee women.
She also created a video early in the pandemic to explain safe ways to continue breastfeeding, including using a mask while nursing if a woman has tested positive for COVID-19.
Provide culturally sensitive care
Hirani’s goal is to make sure that “future generations of nurses get to know in advance who they are going to be dealing with, and how to be critically conscious and non-judgmental and provide culturally sensitive care here,” she says.
As a lactation consultant, Hirani also provides free one-on-one support to nursing mothers, either in person or via Zoom. She responds to 5-10 requests for help each month, she says.
Hirani has received multiple awards for her leadership, including the Saskatchewan Multicultural Leadership Award in 2022, the YWCA Nutrien Women of Distinction Award in 2022, and the Queen Elizabeth II Platinum Jubilee Medal earlier this year.
Her most satisfying rewards, however, are the smiles and feedback from new mothers who say her coaching has helped them resume or continue breastfeeding.
“That’s how I keep myself motivated — by helping the community for my own internal satisfaction,” Hirani says.
Whenever she works with a nursing mother, Hirani remembers her own struggles to keep breastfeeding.
Although she nursed her daughter for eight months, Hirani then had to stop because her workplace at the time — a hospital — did not have supportive policies or a private room where she could express and store her milk, Hirani says.
“The quantity of my breastmilk used to get smaller and smaller and wasn’t feeding her well — so I wasn’t able to sustain my breastfeeding,” she says. “That’s my biggest regret in life.”
Today, her daughter is 18, and planning to be a nurse herself, inspired by her mother’s example.
Spending time with her daughter and husband on road trips, at cultural festivals, and listening to and playing music are among the ways Hirani nurtures herself and renews the energy required to mentor other nurses and health-care professionals as well as the mothers she helps and encourages.
Throughout her work, her guiding principle is to help make the world a different place, one that “offers more opportunities for positive changes in the lives of marginalized women and children.”
Laura Eggertson is a freelance journalist based in Wolfville, N.S.