Breastfeeding Faces Challenges in China

Upon hearing her baby wail, Zhang Shuyi finds herself at her wit's end. Although she was previously confident that she would be able to breastfeed her child properly, she worries that she might not be able to give her baby enough milk.

After giving birth to her son two years ago, 35-year-old Zhang, a doctor at the Capital Institute of Pediatrics in Beijing has continued to practice exclusive breastfeeding in strict accordance with international standards.

"Exclusive breastfeeding" is defined as feeding an infant with only breast milk for the first six months of life, then continuing to breastfeed as a supplement to increasing amounts of solid food for at least the first two years of life.

Although her son looks healthy, he is somewhat slimmer than other babies his age, which has displeased both Zhang's and her husband's parents. Older Chinese often believe that it is good for infants to be fat. Her parents have urged her to switch to formula.

Only a small proportion of Chinese mothers undertake truly exclusive breastfeeding. Before 2007, China's definition of exclusive breastfeeding allowed mothers to also give water, making it different from the international definition. Therefore China lacks representative statistics about the rate of true, exclusive breastfeeding before that year.

David Hipgrave, chief of health and nutrition at UNICEF China, says that only a few areas of China have assessed exclusive breastfeeding rates before 2007. In one study in east China's Zhejiang Province, the rate of truly exclusive breastfeeding for six months was extremely low. The highest rate in rural infants was only 7 percent, whereas the rate in urban infants was below 1 percent.

But, some experts estimate that the rate stands at less than 30 percent currently.

Many studies have shown that breast milk is the most hygienic and nutritious food for infants during the first six months of life. After six months, when babies begin to eat solid food, breastfeeding should continue for up to two years and beyond because it is an important source of nutrition, experts say.

There is evidence that breastfeeding protects infants against sudden infant death syndrome (SIDS), allergies, acute respiratory infections and ear infections. A WHO-led global study shows that adults who were breastfed as infants had lower blood pressure and cholesterol, as well as a lower prevalence of obesity and diabetes.

"Although I have obtained a lot of knowledge about breastfeeding, I still worry whether my milk is enough for my baby," Zhang says.

Zhang's husband, Liu Huan says "I received some child-rearing training before my son was born. I know that breast milk is the best for our child, so I always encourage my wife to breastfeed our baby. Sometimes, it's very hard for her."

Zhang says that the first month after her baby was born, as well as the time she returned to work after maternity leave, were the hardest times for her to breastfeed. During the first month after her child's birth, she worried that she couldn't feed him enough. After resuming work, she became very tired, which also affected her ability to produce milk.

Zhang continued to breastfeed her baby after he reached his first birthday, a time when most Chinese mothers choose to wean their children. "Many people have criticized me. I do remember one time, this old woman saw me feeding my son and said 'what a fortunate child.' I felt so happy to hear that; if only more people could give us encouragement," she says.

Many of the children who were born during the emergence of China's one-child policy are now parents themselves. It hasn't been hard for them to understand and follow international standards regarding breastfeeding, but they have still faced some difficulties.

An Jiangqun, 32, was still receiving calls from work when she was making her way to the hospital delivery room. After her daughter was born, she found herself more tired than she ever had been before. Her seven-month-old daughter drank formula milk on the day she was born because An couldn't produce any milk.

However, An has breastfed her child every day since then, even hiring a nurse to give her massages in the hope that she can produce more breast milk. When An resumed her work after her maternity leave, she found that she has little time to continue breastfeeding.

"I've been a bit indecisive about continuing breastfeeding, especially since I've been feeling so much pressure from work. But I've managed to persist," she says.

She relocated to a new home closer to her office and purchased an electric bicycle, allowing her to make quick trips during her lunch break to breastfeed her baby. On days when she can't make it home, she carries a breast pump and an icebox to collect and store the milk for her baby to drink later. Her goal is to keep breastfeeding through her child's first year of life.

"Although my daughter is slimmer than other babies her age, she could stand up on her own much earlier than others. She plays by herself and doesn't like to cry," An says.

An often browses online parenting forums, encouraging other parents to practice breastfeeding and swapping tips with other mothers.

Hipgrave says that breastfeeding is not always in China. Women often regard breastfeeding as a very private activity, finding it difficult to breastfeed in public places, most of which have no private nursing rooms.

Women who reenter the workforce often find it difficult to continue breastfeeding as well. Still others believe that they cannot produce enough milk to feed their children properly, although studies have shown that virtually all women are capable of producing a sufficient amount of milk.

He noticed the pervasive presence of advertisements for baby formula, and sales promotions for breast milk substitutes, have shaken the determination of many young mothers to breastfeed.

An says she doesn't know how the milk powder companies get her telephone number. They often call her to offer her promotions for their products. During public parent-child activities and holidays, the companies are quick to make their presence known, setting up booths and handing out free gifts.

Although China issued a regulation to prohibit the advertisement and promotion of breast milk substitutes in 1995, the regulation is not well enforced.

According to an investigation conducted by the China Consumers Association in 15 cities, including Beijing, Chongqing and Shenyang, hospitals, malls and supermarkets are the key areas where formula manufacturers promote their products.

Experts say formula milk powder makes children more prone to infections, asthma, obesity and diabetes. Low-quality milk powder and formula substitutes are often marketed in poor rural areas, where many parents have been forced to leave their children in the care of their grandparents while they work in the cities.

Although the breastfeeding rate in remote rural areas is much higher than that of the cities, rural people have many misunderstandings regarding breastfeeding.

Ye Yan, a village doctor of Baizi in southwest China's Yunnan Province, says more than 90 percent of the women in the village breastfeed their children until they are one year old.

But at the same time, she says the mothers are encouraged to add supplementary food as early as the fourth month..

For remote and poor regions, another problem is more pressing. Malnutrition is common among infants over the age of six months as a result of the improper introduction of non-nutritious supplementary food.

According to a 2009 UNICEF report on nutrition, China is home to 13 million of the world' s 177 million stunted children. Although rates have declined, China still has more stunted children than any country in the world other than India. Most of these children reside in poor rural areas.

Chen Chunming, an expert with the China Disease Prevention and Control Center, says many children under the age of two suffer from anemia because most traditional Chinese diets lack fresh meat, which leads to iron deficiencies.

The rate of anemia among urban infants is over 20 percent, and the figure is higher among rural infants, Chen says..

UNICEF is cooperating with the Chinese government to provide food supplements to address nutritional problems. Families in 550 rural counties will be provided with free daily supplements, which contain a mixture of nine vitamins and minerals in a soybean-based powder.

Counties in the provinces of Gansu, Shaanxi and Sichuan have already seen a 30-percent reduction in new anemia cases since the introduction of the supplements in 2009.

(Source: Xinhua)