Human milk offers a window into mammary gland function—and its links to infant growth

NYU Langone Health / NYU Grossman School of Medicine

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A study led by researchers at NYU Grossman School of Medicine identified shared molecular patterns in human milk that link maternal nutrition, mammary gland biology, and infant growth.

Researchers analyzed thousands of molecular measurements from human milk collected across three geographically and nutritionally diverse populations of mothers. They identified shared patterns in milk composition associated with both maternal nutritional status and infant growth, and asked whether these patterns could also provide insight into the mammary gland functional state.

Published online October 8 in the journal Science, the study examined this state, which involves three interconnected aspects of mammary gland function: milk synthesis and secretion, epithelial barrier and tissue remodeling, and immune and repair activity. Milk synthesis and secretion describe how mammary cells produce the components of milk and release them into milk; barrier and tissue-remodeling functions regulate what passes between the bloodstream and milk while reshaping the milk-producing tissue; and immune and repair activity helps protect the gland and restore tissue after stress or injury. 

By mapping molecular patterns in milk onto these biological processes, the researchers asked not only what is present in milk, but also what its composition may reveal about the function of the mammary gland that produces it.

“Human milk gives us a rare, non-invasive window into the biology of the lactating mammary gland,” said Liat Shenhav, PhD, senior author of the study and an assistant professor at NYU Grossman School of Medicine, with appointments in the Institute for Systems Genetics, the Department of Microbiology, and the Department of Obstetrics and Gynecology. “By looking at molecular patterns across diverse populations, we can begin to identify shared features of mammary function and understand how maternal nutritional and metabolic state relates to milk composition and infant growth.”

Despite its central role, how the functional state of the gland shapes milk composition—and how that variation relates to infant growth—remains poorly understood. Human milk contains thousands of nutrients, metabolites, proteins, immune factors, and other molecules, but research has often examined these components one at a time rather than as an integrated biological system. 

Across 1,543 human milk samples from three cohorts in Canada, Pakistan and Burkina Faso, the researchers combined multiple molecular layers—including metabolites, proteins, micronutrients (e.g., vitamins), macronutrients (e.g., carbohydrates), and human milk oligosaccharides — with growth data and computational approaches including machine learning, a form of artificial intelligence. 

In two randomized nutritional trials, maternal supplementation promoted recovery or stability among infants at higher risk for poor growth. Multi-omic analyses – which integrate information across several molecule types, such as proteins and metabolites, to provide a complete picture of a biological system - also revealed a shared pattern of milk composition associated with both maternal supplementation and infant growth.

The researchers then examined which molecules most consistently contributed to these shared nutrition-growth patterns. Their analysis identified seven candidate biomarkers linked to maternal nutritional status, infant growth and biological programs related to mammary gland function. Together, these markers captured aspects of mammary biology that extend beyond established measures of blood-milk barrier permeability.

Four of the markers—C2, C3, C4 and C5—were short-chain acylcarnitines, molecules that help cells process nutrients for energy. The remaining three were lysine, an amino acid; 6′ sialyllactose, a human milk oligosaccharide; and selenium, a mineral. Together, the seven biomarkers captured complementary aspects of mammary biology, including milk synthesis, tissue remodeling, and immune response activity.

Short-chain acylcarnitines showed the strongest links across mammary functional domains, with C5 emerging as a particularly prominent signal. Higher C5 levels were associated with reduced milk synthesis signatures and with biological patterns related to tissue remodeling and immune activity.

Because C5 emerged as a central metabolic signal, the researchers examined nutritional factors that might help explain variation in acylcarnitine levels. Acylcarnitine metabolism depends on coenzyme A (CoA), a central molecule in energy and lipid metabolism synthesized from pantothenic acid, or vitamin B5. Drawing on associations across cohorts and established metabolic biology, the researchers propose that low vitamin B5 availability may constrain CoA-dependent metabolism and contribute to altered acylcarnitine profiles, including accumulation of C5.

“Our findings demonstrate the intimate link between maternal nutrition, metabolic health and mammary function, highlighting the importance of an integrative approach to supporting maternal and infant health,” said first author Dr. April Jauhal of the Shenhav lab at NYU Grossman School of Medicine. "One plausible route linking maternal nutrition to mammary metabolism in our data is via the pantothenic-CoA-C5 metabolic pathway, and we are currently investigating the functional role of this pathway in mammary biology and lactation.”

Because human milk can be collected repeatedly, it provides a non-invasive way to study mammary gland biology over time. Viewing milk as a window into mammary gland biology also places lactation within a broader continuum of maternal physiology that begins during pregnancy. During gestation, the mammary gland undergoes extensive hormonal differentiation, tissue and immune remodeling, and metabolic programming, while its major functional phenotype—lactation—becomes apparent only after delivery.

In this sense, the mammary gland can be viewed as a postnatal maternal-infant interface: an organ programmed during pregnancy that subsequently connects maternal biology and nutrition with the developing infant. Like the placenta during pregnancy, it sits at a critical interface between mother and child—but human milk provides a way to study that interface repeatedly and non-invasively after delivery.

Building on this work, the Shenhav Lab is now developing an integrated computational and experimental framework to test potential nutritional bottlenecks that may constrain mammary metabolism and milk production, including the vitamin B5–coenzyme A–C5 pathway. The lab is also studying colostrum and transitional milk to understand how mammary functional states emerge during the transition from pregnancy to mature lactation, and whether early molecular changes in milk reflect the emergence of mammary metabolic, barrier, and secretory function.

The study is one of two complementary papers published in Science arising from the International Milk Composition (IMiC) Consortium, an international research effort conducted in collaboration with Meghan Azad of the University of Manitoba and funded by the Gates Foundation.

IMiC brought together more than 1,000 mother-infant pairs and profiled more than 25,000 molecular features in human milk. While the NYU Grossman School of Medicine-led study asked what milk composition can reveal about mammary gland function and its relationship with infant growth, the companion study asked a complementary question: Which components of human milk can be changed through maternal nutrition?

The companion study found that supplementation during lactation increased several B vitamins in milk, while many other milk components remained comparatively stable. Together, these studies aim to determine how maternal nutritional and metabolic state during pregnancy and postpartum shapes mammary function, how that state is reflected in human milk, and how these processes relate to infant development.

“The studies show that human milk is neither fixed nor simply a reflection of what a mother eats,” said Dr. Shenhav. “Some components respond to maternal nutrition, while others remain stable or appear to reflect broader biological states within the mammary gland. Understanding that distinction is essential if we want to design interventions that meaningfully support maternal and infant health.”

“Ultimately, we want to understand milk in the context of the biology that produces it,” said Dr. Shenhav. “The mammary gland sits at a critical interface between maternal physiology and the developing infant. By understanding how maternal metabolism influences mammary function and milk composition, we can begin to uncover the biological pathways linking maternal nutritional status with infant growth.”

The study was funded by the Gates Foundation (INV-001734, OPP1179727, and OPP1175213), the National Institutes of Health grant DP2AI185753, the Canadian Institutes of Health Research, the Allergy, Genes and Environment Network, Networks of Centres of Excellence (AllerGen NCE), Health Canada, Environment Canada, the Canada Mortgage and Housing Corporation, the Vital Pakistan Trust; the Burroughs Wellcome Fund; the March of Dimes; and the Alfred E. Mann Foundation.

Along with Drs. Shenhav and Jauhal, study authors from the Shenhav Lab at NYU Langone Health included Bianca Cordazzo-Vargas, Daniel Sunko, and Pratima Niroula of the Institute for Systems Genetics and Department of Microbiology.

Additional study authors were Lishi Deng, Laeticia Celine Toe (also affiliated with Unité Nutrition et Maladies Métaboliques, Institut de Recherche en Sciences de la Santé in Burkina Faso), Carl Lachat and Trenton Dailey-Chwalibóg in the Department of Food Technology, Safety and Health, Faculty of Bioscience Engineering, Ghent University in Belgium; Ameer Muhammed of the Vaccines and Other Initiatives to Advance Lives (VITAL) Pakistan Trust in Karachi; Aneela Pasha, and Muhammad Imran Nisar in the Department of Paediatrics and Child Health at the Aga Khan University Hospital in Karachi; Yasir Shafiq of the Center of Excellence for Trauma and Emergencies and Community Health Sciences, Aga Khan University; Naveed Iqbal and Waqasuddin Khan  of the CITRIC Center for Bioinformatics and Computational Biology, Department of Paediatrics and Child Health, at Aga Khan; Fyezah Jehan of the Department of Paediatrics and Child Health Medical College, Aga Khan; Andrew Mertens and Alan Hubbard of the Division of Epidemiology, School of Public Health, at University of California Berkeley; Kelsey Fehr and Melissa Manus of the Department of Pediatrics and Child Health, University of Manitoba, Winnipeg, Canada; Joann McDermid, a consultant from Charlottesville, Virginia; Chi-Hung Shu, Megan Beggs, and Nima Aghaeepour of the Department of Anesthesiology, Pain, and Perioperative Medicine at Stanford University School of Medicine; Daniela Hampel and Setareh Shahab-Ferdows of the Institute for Global Nutrition at the University of California Davis; Kim Lagerborg and Mohit Jain of Sapient Bioanalytics in San Diego; Mark DeBoer of the Department of Pediatrics at the University of Virginia School of Medicine; Jennifer Van Eyk of the Smidt Heart Institute, Advanced Clinical Biosystems Research Institute and Barbra Streisand Women's Heart Center, Cedars-Sinai Medical Center in Los Angeles; Natalie Rodriguez of the Office of the Vice-Principal Research and Innovation, University of British Columbia in Vancouver, Canada; Theo Moraes and Padmaja Subbarao of the Translational Medicine Program, Research Institute, at The Hospital for Sick Children in Toronto; Lars Bode in the Department of Pediatrics, Larsson-Rosenquist Foundation Mother-Milk-Infant Center of Research Excellence, Human Milk Institute, University of California San Diego, La Jolla; Lindsay Allen of the Department of Nutrition, University of California Davis; Donna Geddes of the School of Molecular Sciences, The University of Western Australia, Perth, Australia; and Michelle Kay McGuire of the Margaret Ritchie School of Family and Consumer Sciences at the University of Idaho.

About NYU Langone Health
NYU Langone Health is a fully integrated health system that consistently achieves the best patient outcomes through a rigorous focus on quality that has resulted in some of the lowest mortality rates in the nation. Vizient Inc. has ranked NYU Langone No. 1 out of 122 comprehensive academic medical centers across the nation five years in a row, and it continues to have the most No. 1– and top 10–ranked specialties among medical centers in the United States, according to U.S. News & World Report. NYU Langone offers a comprehensive range of medical services with one high standard of care across seven inpatient locations, its Perlmutter Cancer Center, and more than 400 outpatient locations in the New York City area and Florida. The system also includes two tuition-free medical schools, in Manhattan and on Long Island, and a vast research enterprise.

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Journal

Science

DOI

10.1126/science.aee7240

Method of Research

Experimental study

Subject of Research

People

Article Title

Shared Patterns of Human Milk Composition Link Mammary Gland Function to Infant Growth

Article Publication Date

8-Oct-2026

Related News Releases

• Human milk offers a window into mammary gland function—and its links to infant growth
  (NYU Langone Health / NYU Grossman School of Medicine)

 

Traumatic brain injury in Pakistan linked to poor long-term survival

Weill Cornell Medicine

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Dr. Junaid Razzak

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Credit: Weill Cornell Medicine

Traumatic brain injury (TBI) in Pakistan is associated with a high risk of death and disability long after the initial injury, even in mild to moderate cases, according to two new studies in JAMA Network Open led by Weill Cornell Medicine researchers. While most TBIs occur in low- and middle-income countries due to road traffic accidents, long-term patient outcomes remain poorly understood.

To shed light on this critical issue, the researchers analyzed data from a trauma registry of all injured patients from two care centers in Karachi, Pakistan, from December 2021 to May 2024. The studies followed patients for a year after injury, providing one of the most detailed pictures to date of what happens after TBI in a resource-limited setting.

The first study, published Aug. 11, focused on patients with severe to moderate TBI. A second paper, published Aug. 13, looked at outcomes of mild traumatic brain injuries. Together, the studies found that the consequences of brain injury depend on more than severity at admission and many patients remain vulnerable after leaving the hospital.

“We found that TBIs are responsible for a high number of trauma-related deaths in Pakistan, even with more mild to moderate injuries, which we were not expecting,” said senior author Dr. Junaid Razzak, professor of emergency medicine at Weill Cornell and an emergency medicine physician at NewYork-Presbyterian/Weill Cornell Medical Center. “Patients are falling through gaps in the trauma care system before, during and especially after hospitalization.”

The study suggests that many deaths and disabilities could potentially be prevented in Pakistan and similar low- and middle-income countries with stronger trauma systems, including faster access to appropriate care, structured post-discharge monitoring and expanded rehabilitation services.

Focusing on the First Month After Discharge

Clinicians use the Glasgow Coma Scale (GCS), a 15-point measure of eye, verbal and motor responses to gauge how alert patients are after a head injury. Severe TBI, a score of 3 to 8, means people cannot follow commands or respond to pain and may have trouble with their airway. Moderate TBI, a score of 9 to 12, means patients may be confused but can still respond to simple commands.

The first study focused on 819 registry patients diagnosed with moderate (45%) to severe (55%) TBI based on the GCS. As expected, patients with severe injuries faced the greatest risk of death and disability. However, researchers were surprised by the poor outcomes among patients with moderate injuries, who would typically be expected to have a better chance of recovery.

Many deaths occurred during the first month after discharge, suggesting that patients remain vulnerable during the transition from hospital care to life at home. At 12 months, mortality reached nearly 60% in patients with moderate TBI and almost 88% among those with severe injury. In comparison, a previous study in high-income countries found respective mortality rates of 9% and 30%.

For both studies, the researchers found that older age, no surgical intervention and greater injury severity were associated with a higher risk of death.

Telehealth and regular remote follow-up may be a practical way to monitor recovery and identify complications early, proposed the authors.

Reconsidering How "Mild" TBI Is Defined

The second study assessed 602 registry patients with mild TBI, defined as a GCS of 13 to 15. These patients tend to be awake and can follow commands but may experience brief confusion or memory loss.

The researchers found that not all mild TBIs had the same prognosis. Some patients at the lower end of the GCS mild range experienced substantially worse outcomes, including higher mortality and poorer quality of life during recovery, than those who scored 15. Potentially, some injuries classified and treated as mild may have actually been more serious, said the authors. In addition, premature hospital discharge may have contributed to this finding, as patients stayed approximately two days.

Overall, the 12-month mortality rate was 14% for all groups in the second study, which is relatively high, compared to higher-income countries in the published literature.

“My hunch is that even people with mild disabilities, who are already living at the edge of poverty, fall below the poverty line when they can't work or perform basic tasks,” Dr. Razzak said. “Then their access to basic healthcare and ability to take care of themselves drops significantly.”

Future Research

“A broken 'chain of survival’ exists, in which bystanders don't know how to respond to an accident, ambulance drivers don't know which hospitals have open beds and emergency room healthcare providers race against the clock,” Dr. Razzak said. “Treatment in the first 48 hours is critical for better outcomes.”

Dr. Razzak plans to research how trauma care systems can be designed and better equipped to get patients to the right facilities. “By making this issue more visible to the government, we hope these gaps can be fixed, saving a significant number of lives," he said.

 

This research was funded by the Fogarty International Centre of the National 3 Institutes of Health under award No. D43TW007292—The Aga Khan University Trauma and 4 Injury Research Training Program; this funding solely supported data collection.

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Journal

JAMA Network Open

Nutrition support during pregnancy improves birth outcomes, global study finds

George Mason-led research finds that food-based prenatal supplements improve birth weights across Africa and South Asia.

George Mason University

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In parts of the world where daily nutrition is unstable, pregnancy and newborn health are more precarious. A new study led by epidemiologist Dongqing Wang of the George Mason University College of Public Health adds to the evidence that improving maternal nutrition during pregnancy may be a key intervention to improve birth outcomes.

Looking across eight clinical trials across Africa and South Asia, the study finds that balanced energy and protein (BEP) supplements—food-based products like beverages or nutrient-dense pastes designed to increase calorie and protein intake—are associated with healthier birth weights and fewer high-risk newborns in low- and middle-income countries. The findings were published in PLOS Medicine.

“In settings where pregnant women can’t access sufficient calories and protein, it is important to act early,” said Wang, an assistant professor of epidemiology in the Department of Global and Community Health. “Improving maternal nutrition can reduce the risk of vulnerable birth outcomes.”

Why this matters

Maternal malnutrition puts infants at higher risk of death, illness, and developmental delays.

Interventions have often focused on micronutrient supplements, but this study shows that food-based approaches to increase calorie and protein intake may better support fetal growth. BEP supplements can also be delivered through existing maternal health programs, making them a practical solution to scale. Wang is also currently conducting further research in Ethiopia that examines the cost-effectiveness of different approaches to BEP supplementation.

Study details

Wang and his colleagues combined individual-level data from randomized controlled trials conducted in Nepal, The Gambia, Pakistan, and several other low- and middle-income settings. The team compared outcomes for pregnant individuals who received BEP supplements with those who did not.

Key findings include:

• BEP supplements were associated with higher birth weights and a lower risk of babies being born with low birth weight or small for their gestational age.
• The effects were particularly notable forbabiessmall for their gestational age, a group with elevated risk of neonatal mortality.
• Benefits appeared stronger among women who began supplementation earlier in pregnancy, particularly before20 weeks.

Wang worked with a global network of researchers from institutions including Harvard T.H. Chan School of Public Health, the Food and Agriculture Organization of the United Nations, Aga Khan University and partners across Europe, South Asia and Africa.

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Journal

PLOS Medicine

Article Title

The effect of prenatal balanced energy and protein supplementation on small vulnerable newborn types in low- and middle-income countries: A systematic review and meta-analysis of individual participant data

 

Severe childhood malaria linked to cognitive impairment later in life

Indiana University

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A mother and her child providing consent to participate in the Malarial Impact on Neurobehavioral Development (MIND) study.

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Credit: Photo courtesy Chandy John, IU School of Medicine

INDIANAPOLIS — Severe childhood malaria is linked to long-term cognitive impairment, according to a new study from Indiana University School of Medicine researchers and their collaborators at Makerere University in Uganda. 

The findings, recently published in JAMA, suggest children who survive cases of cerebral malaria and severe malarial anemia experience cognitive and academic impairment that persists into adolescence. The correlation highlights an urgent need for the development of better prevention strategies and more effective therapies to minimize the lasting effects of one of the world’s most dangerous diseases. 

The World Health Organization reported 282 million malaria cases in 2024, with children under 5 accounting for about 75% of 610,000 global deaths. 

"Cerebral malaria and severe malarial anemia, which affect more than a million children every year, are not only causes of death in children, but also associated with very long-term costs in terms of a child’s thinking and their academic achievement," said Chandy John, MD, the Ryan White Professor of Pediatrics at the IU School of Medicine, who co-led the study. "These costs, particularly in the area of math skills, can affect their ability to do well in school, to go to college and to get a good job."

Malaria is caused by mosquito-transmitted parasites, with symptoms ranging from mild to life-threatening. Severe cases can cause complications to blood cell production resulting in malarial anemia, and serious neurological issues leading to coma, which defines cerebral malaria. 

In the Malarial Impact on Neurobehavioral Development (MIND) study, children from two prior cohort studies of severe malaria were followed up four and 15 years after their initial episode, and their scores in cognition and academic achievement were compared to those of children in the community who did not have severe malaria. They found that children who survived cerebral malaria and severe malarial anemia experienced cognitive impairment, with cognition scores the equivalent of 3 to 7 IQ points below their community peers. 

Specific clinical factors in children with cerebral malaria or severe malarial anemia, such as the presence of acute kidney injury and elevated levels of uric acid, which is necessary for some body functions but can be toxic when present in too high levels, were found to be associated with worse long-term cognitive outcomes. 

The group’s future work will focus on determining if cerebral malaria and severe malarial anemia are causing the cognitive impairment, and how to prevent it. 

"Cohort studies can show an association, but they can’t prove that these illnesses caused the impairment," John said. "Instead, we can look at potential pathways in the body and the brain and see how they relate to cognition. That’s what we’re doing in our current study, SMART Brain."

SMART Brain, short for Severe Malaria and Risk to The Brain, will allow the scientists to use models of the brain to explore further the link between specific processes that occur in severe malaria and brain injury. 

"If we can identify pathways that lead to brain injury, then we can come up with interventions that may prevent brain injury, and test these in clinical trials," John said. "That could potentially protect the brain and improve cognitive and academic outcomes for hundreds of thousands of children in countries with malaria."  

IU School of Medicine’s Kagan Mellencamp, Jie Ren, Andrea Conroy, Dibyadyuti Datta, Christian Kautzman and Michael Goings are co-authors on the study. Additional authors include Paul Bangirana, Jacqueline Nakitende, Ruth Namazzi and Richard Idro from Makerere University, Robert Opoka from Aga Khan University and Bjarne Robberstad from University of Bergen. 

This research was supported by funding from the National Institutes of Health. 

About the Indiana University School of Medicine 

The IU School of Medicine is the largest medical school in the U.S. and is annually ranked among the top medical schools in the nation by U.S. News & World Report. The school offers high-quality medical education, access to leading medical research and rich campus life in nine Indiana cities, including rural and urban locations consistently recognized for livability. According to the Blue Ridge Institute for Medical Research, the IU School of Medicine ranks No. 15 in 2025 National Institutes of Health funding among all public medical schools in the country. 

Writer: Jackie Maupin, jacmaup@iu.edu 

For more news, visit the IU School of Medicine Newsroom: medicine.iu.edu/news  

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Journal

JAMA

Employee conduct

This approach is best illustrated in cases of employees prone to absenteeism, a leading source of misconduct the world over. 

Parvez Rahim 

Published December 20, 2025 

DAWN

The writer is a consultant in human resources at the Aga Khan University Hospital.

THE Industrial and Commercial Emp­loyment (Standing Orders) Ordinance, 1968, is the most critical and frequently referred to labour enactment in Pakistan. It contains provisions relating to the classification of workmen, mandatory issuing of appointment letters, payment of profit bonus, retrenchment, termination of employment and a standing order relating to punishments.

Standing Order (SO) 15, relating to punishments, is one of the most used provisions of labour laws, which classifies the offences committed by employees into two categories. The first is in the case of an employee guilty of offences that aren’t serious — the employee is liable to be fined a nominal amount. The other is in the case of an employee guilty of an act of commission or omission, which has serious implications for the organisation — that employee is liable to be dismissed from service.

There is a comprehensive list of ‘misconducts’ in the SO, for which an employee may either be (i) fined; or (ii) his increment or promotion withheld for up to one year; or (iii) relegated to a lower post; or (iv) dismissed from service.

The key misconducts include “willful insubordination or disobedience to any lawful and reasonable order of a superior; theft, fraud, or dishonesty in connection with the employer’s business or property; willful damage to or loss of employer’s goods or property; habitual absence without leave or absence without leave for more than 10 days; riotous or disorderly behaviour during working hours or any act subversive of discipline; and habitual negligence and neglect of work.”

Employers must adopt a reformative approach.

Where possible the employers should focus on the rehabilitation of offenders to reintegrate them as responsible employees. This reformative approach emphasises changing an individual’s behaviour by addressing the root causes of their disruptive activity through counselling, psychological treatment and the introduction of incentives. It contrasts with retribution and deterrence.

This approach is best illustrated in cases of employees prone to absenteeism, a leading source of misconduct the world over. Excessive absenteeism is rampant in in both the private and public sectors. The most common reason given is sickness. Illness can be feigned and neither the company doctor or some other medic can be sure whether the absence is related to sickness.

Absenteeism leads to escalation in the cost of running a business. There are hidden costs such as overtime to cover for sick employees, temporary help to replace absentees, supervisory time spent to find a person to cover, and lowered productivity on the part of those who have to work harder for someone who is chronically absent. As people do get sick, it is unrealistic to set a goal of zero absenteeism. The right objective is to have programmes that penalise those who abuse their sick leave privilege. It is also desirable to reward employees who have good attendance records.

Generally, employers have a zero-tolerance policy for fraud and dishonesty by employees. While there is nothing wrong in having such a policy, one must know the reasons behind such actions. Employees commit fraud due to pressure, opportunity and the belief that their behaviour is justified even if not appropriate. They are often driven by personal financial issues, a sense of being undervalued, and weak internal controls. Other contributory factors include addiction, a belief that they deserve more compensation, and sometimes an inability to distinguish between right and wrong actions.

Actions subversive of discipline by employees are also common. These stem from organisatio­nal shortcomings, psychological factors and personal issues. They invol­­ve lack of clarity, fairness and support at the workplace rather than malicious intent. Poor management, such as autocratic attitudes, favouritism, or a manager’s own failure to follow rules, can damage morale and encourage insubordination.

Employees indulge in disorderly behaviour due to feelings of unfairness, lack of support and poor management practices. This misconduct is frequently a symptom of deeper workplace issues. Managers often complain that a certain employee is consistently underperforming and recommend strict action. Unless precise allegations of habitual negligence against the employee are proved in an internal inquiry, action on the basis of vague statements by the supervisor will backfire.

Interestingly, cases of misconduct are far higher among men than women working in a similar capacity.

While one is not advising employers to refrain from taking action against employees guilty of serious misconduct, they should tighten financial controls and train managers in how to supervise employees with fairness. Companies managed professionally hardly encounter any cases of indiscipline.

The writer is a consultant in human resources at the Aga Khan University Hospital.

Published in Dawn, December 20th, 2025

Work at home

Parvez Rahim 

December 12, 2025 

IN Pakistan, we have two categories of individuals working within households — domestic workers and home-based workers. There is a difference in the work each does. Domestic workers, commonly refer­red to as ‘maasi’ are employed for regular household chores like cooking, cleaning and laundry. They can work either part-time or full-time, usually on the basis of informal verbal contracts. They may also be engaged to care for children, the elderly or the sick.

The number of domestic workers ranges from around 4.5 million to 8.5m. The ILO reports 8.5m, while another source estimates 4.5m. However, these figures cannot be authenticated as it is difficult to collect statistics for individuals working in homes, as they are widely scattered. There is also a strong likelihood that these numbers overlap with those of home-based workers.

The latter category is more formal and closer to the jobs performed by their counterparts in industrial and commercial est­ablishments. They perform a wide variety of tasks, primarily in manufacturing, ie, garments, carpets, footwear, jewellery, etc, and services including virtual assistance, customer service data entry, writing, etc. The work is often categorised as traditional, manual labour, intensive work, or modern skill-based professional activity.

Official estimates place the number of home-based workers in Pakistan at around 4.4m to 4.8m, while unofficial sources suggest the total could be as high as 20m. Out of the 20m, 12m are women, which comes to 60pc. Their output may not be less than that of men but they are still paid less than them.


Karachi’s women have played a notable role in forming the HBWWF.

A report in this paper says that “Globally, women make up about two-thirds of the health workforce but earn, on average, 20pc less than men and remain underrepresented in leadership positions”.

Karachi’s women have played a remarkable role in forming the Home-Based Women Workers Federation in December 2009. The HBWWF has been advocating for the rights of women with more vigour and enthusiasm than its male-dominated counterparts. It was officially registered with a membership of about 1,000 but now has over 4,500 members in Sindh, Balochistan and Punjab. There is also a broader union called the Federation of Sindh Home-Based Workers, which is a federation of various unions in Sindh.

HBWWF had persuaded the Sindh government to legislate the Sindh Home-Based Workers Act, 2018. This law relates to the protection of rights of persons who work in the informal or unorganised sector carrying out remunerative work within their homes or surroundings. The act stipulates that the wages of home-based workers will not be less than the minimum wages under the Sindh Minimum Wages Act, 2015. They are also eligible for “all those social, medical and maternity benefits, compensations and marriages and death grants” available under the labour laws.

Thereafter, the Punjab Domestic Workers Act, 2019, was enacted followed by the Islamabad Capital Territory (ICT) Domestic Workers Act, 2022. They provide for issuance of appointment letters to domestic workers, regulation of daily working hours, grant of sick leaves and festival holidays, maternity leave for female workers and minimum wages as per the law. Termination of employment is subject to a month’s prior notice in writing either by the domestic worker or employer and a month’s wages is to be paid in lieu of notice.

A dispute resolution committee will be formed to resolve disagreements between employers and workers. No one under 15 years will be allowed to work in households in any capacity.

These provisions, derived from various labour laws, have never been fully co­­mplied with by ent­repreneurs of industrial and comme­­r­-

cial establishments. How can we expect millions of households in Pakistan, with limited inco­mes and no knowledge of laws, to ad­­h­ere to them? In fact, these provisions sho­­uld be included in the act for home-based workers, whose nature of work and discipline are closer to that of factory workers. Consequently, neither the Punjab nor the ICT law has been implemented, nor have the respective governments tried to enforce them.

Recently, Saudi Arabia issued guidelines for the conduct of domestic workers and their employers. As domestic workers there belong to different nationalities, it is important for the government to regulate their conduct through these guidelines. Unlike Pakistan, where most laws go unhe­eded, the Saudi government will ensure their compliance in letter and in spirit from the beginning.

The Punjab government and ICT are advised to abrogate their respective acts and issue realistic guidelines to be followed by employers and domestic workers. It will also be convenient for the labour department to check compliance.

The writer is a consultant in human resources at the Aga Khan University Hospital.

Published in Dawn, December 12th, 2025