Bottle-Feeding Asian Mothers Risk Infant Health

Last May, a young mother got onto a Hong Kong bus with her baby and kicked off a viral frenzy on the Internet. At the rear of the vehicle, she covered the baby and her body with a nursing blanket and began to suckle the child, only to have a fellow passenger film the scene on his smartphone and paste it on Facebook.

Comments like “So shameless to breastfeed on a bus. You must be from mainland China” accompanied the posting, which generated larger numbers of respondents supporting the woman.

Such ignorance and jaundice towards breastfeeding partly explain the low breastfeeding rate in Hong Kong. Although 84 percent of Hong Kong’s new mothers were willing to breastfeed their newborn babies in 2013, only 22.1 percent were still breastfed exclusively at one month. That drops to just 2.3 percent at six months.

That seems to be the attitude across much of Asia. For instance, according to UNICEF, of Filipino children under the age of 3, only 6 percent were breastfed exclusively. In Thailand the rate is six percent for babies under the age of six months and in Vietnam it is about 10 percent. In comparison, in the US exclusive breastfeeding rates at one month and at 6 months were 48.6 percent and 16.4 percent respectively, while in Taiwan the rates were as high as 66.9 percent and 27.9 percent respectively.

“Hong Kong people are just too used to the idea of feeding a baby with baby formula,” said Dr. Patricia Ip, the Vice-chairman of the UNICEF Baby Friendly Hospital Initiative Hong Kong Association.

Indeed, there is a baby formula marketing frenzy in Hong Kong. “DHA added in this formula makes your baby super smart,” says Hong Kong pop singer Jackey Cheung, holding a baby lovingly in a TV advertisement during the break of a T VB episode.

Baby formula manufacturer spent over HKD 2.7 billion (US$348 million) in marketing in 2013. Such aggressive marketing that has been going on for a long time leads Hong Kong parents to believe that certain brands of baby formulas, supposedly superior to breast milk, have magical power empowering their babies intelligently and physically.

That is not true. Dr. Ip says babies who are fed breast milk only for three or more months are associated with 36 percent and 49 percent lower risk of hospital admission in the first six months of life for respiratory and gastrointestinal infections respectively. Breast milk also helps to prevent chronic conditions such as cardiovascular diseases, diabetes and allergies in babies’ later stages. Furthermore, exposure to longer duration of breastfeeding is associated with an average increase of 3.5 points in intelligence tests.

Baby formula is merely a not-that-successful imitation of breast milk, containing artificial elements that breast milk carries naturally. Most importantly, breast milk has critical components such as antibodies that contribute hugely to babies' immune systems, something that baby formula cannot provide.

Responding to the advantages claimed by breast milk and aggressive marketing of baby formula makers, the World Health Organization released the International Code of Marketing of Breast-milk Substitutes as long ago as 1981, in which advertising to the general public of breast-milk substitutes and pictures of infants on formula containers were explicitly prohibited. Yet Hong Kong and Mainland China seriously lag the global community on the implementation of the code.

“The first time I went to a maternal and child health center, more than 10 marketing representatives of different baby formula brands were waiting outside the door,” said Vicky Tsang, a Hong Kong mother of a two-year old. “They rushed to me with free gifts and samples in hand. I was overwhelmed by all the baby formula promotional literature disguised as maternal health materials.”

Getting to know the advantages of breastfeeding and being concerned about the potential pollution in formula that has struck China, Tsang finally decided to breastfeed her son exclusively. But there were more challenges ahead.

Tsang went back to work after the maternity leave of 10 weeks stipulated by Hong Kong law, while the International Labor Organization says at least 14 weeks of maternity leave should be guaranteed. The short maternity leave is a critical obstacle for Hong Kong moms to breastfeed their babies. But Tsang persisted in pumping breast milk at work breaks for her baby.

Not wanting to miss any moment of her baby’s early life, she finally quit her job to become a full-time mother. But that was far from the end of all problems in her breast-feeding life.

“There were very few moms breastfeeding on the streets two years ago,” Tsang said. “The first time I breastfed in a store, my parents and husband felt embarrassed about the possibility of exposing my breasts in public even though I used the nursing blanket for cover.”

But heavier pressure came from strangers. When she breastfed her baby under the nursing blanket in public, people asked why she was covering the baby. “They would be even more surprised when they found out I was breastfeeding since they rarely saw anybody doing it.” Tsang said, “Also other moms complained that there would be ill-intended males hanging around when they were breastfeeding, which made them extremely uncomfortable.”

Facing all the pressure of breastfeeding in public, many Hong Kong mothers turn to baby formula in supermarkets, where they astonishingly found that most of the time the shelves had been denuded by Mainland China families and parallel traders who carry the formula over the border and sell it at astonomical prices.

Toxic formula scandals, together with the high percentage of working mothers and low public awareness towards the advantages of breastfeeding, and advertising geared to middle-class families to Hong Kong, inevitably exasperate local parents of newborns, and to a broader extent, the general Hong Kong public.

“Had both Chinese and Hong Kong governments done better in appropriating the code into their legal systems, or more hospitals at both sides observed the baby-friendly standards to facilitate breastfeeding instead of providing formula milk to the newborns, such tension could have been very much assuaged,” says Dr. Ip.

Nevertheless, progress is gradually being made. The Hong Kong government is processing a not legally-binding code encouraging infant food manufacturers to discipline their marketing behavior, while the Hong Kong public is gradually embracing the idea of breastfeeding.

Back to late May when that insulting post about the breastfeeding mother was made, a large number of Hong Kong netizens wrote despising the photo taker’s behavior and were overwhelmingly supportive of the mothers who had the courage to breastfeed in public, commenting that “using the nursing blanket shows enough respect for others.”

At the center of this war stand the breastfeeding mothers. Vicky Tsang now works part-time as a UNICEF HK Baby Friendly Angel, helping other new mothers deal with difficulties in breastfeeding.

“For both our babies and ourselves, we have to fight for the right of breastfeeding,” Tsang said. “Mothers need to be physically in public and breastfeed our babies. This is the only way to educate the public: breastfeeding is natural, not the other way around.”

Chen Yajiao is a summer intern for Asia Sentinel