China’s strug­gle to wean moms off for­mula

Gov­ern­ment cam­paigns aren’t chang­ing the coun­try’s wide­spread belief that breast-feed­ing is un­safe

The Washington Post Sunday - - THE WORLD - BY C. F. THOMAS for­eign@wash­post.com

HONG KONG — An over­whelm­ing num­ber of young women in China are reach­ing for for­mula over breast milk pre­ma­turely to feed their new­borns, de­spite gov­ern­ment-led cam­paigns to pro­mote breast-feed­ing as the ex­clu­sive diet of in­fants un­til 6 months of age.

As a re­sult, China has one of the world’s low­est breast-feed­ing rates, as low as 2 per­cent for in­fants at 6 months, de­spite a food safety scan­dal in 2008, in­volv­ing do­mes­tic pro­duc­ers of pow­dered milk and in­fant for­mula, that sent more than 50,000 ba­bies to the hos­pi­tal and killed three.

Con­sumer ac­tivists, health ad­vo­cates and oth­ers blame ag­gres­sive lob­by­ing and mar­ket­ing cam­paigns by China’s baby for­mula in­dus­try, and a long-held prej­u­dice by health work­ers, for new moth­ers’ re­luc­tance to use their own milk.

Sup­port for breast-feed­ing by moms-to-be in China is sparse, as Me­gan Wang, a 26-year-old grad­u­ate stu­dent who gave birth to her son Oliver in Hong Kong three months ago, found out.

Inspired, like many young moth­ers, to pro­vide the best for her son, Wang be­gan re­search­ing post­na­tal ad­vice but found lit­tle in­for­ma­tion from do­mes­tic Chi­nese sources she trusted. “I sought ad­vice from my ob­ste­tri­cian, but most of the time I re­lied on Web sites like the NHS and Baby­Cen­ter,” Wang said, re­fer­ring to Bri­tish and Amer­i­can Web sites, re­spec­tively. “The sources and in­for­ma­tion from U.K. and U.S. Web sites are more re­li­able than those from China.”

From those over­seas sites, Wang learned the World Health Or­ga­ni­za­tion has for nearly two decades rec­om­mended that moth­ers ex­clu­sively breast-feed their ba­bies un­til the six-month mark. De­spite her best in­ten­tions to fol­low the rec­om­men­da­tion, Wang said she con­tin­ues to sup­ple­ment her 3-month-old son’s diet with baby for­mula.

“I just didn’t know whether my milk sup­ply was enough or not,” Wang said.

Chi­nese gov­ern­ment health of­fi­cials have long aimed to raise the coun­try’s breast-feed­ing rates, most re­cently an­nounc­ing a tar­get of 50 per­cent of ba­bies ex­clu­sively breast-fed un­til the sixth month by 2020.

That’s be­cause health ex­perts say breast milk is es­sen­tial for new­borns and is shown to re­duce child mor­tal­ity rates, par­tic­u­larly from deaths caused by in­fec­tious dis­eases.

China also has one of the world’s high­est lev­els of child mor­tal­ity, ac­cord­ing to a 2014 re­port by UNICEF. Last year, an es­ti­mated 236,000 chil­dren un­der the age of 5 died in China, mainly from pre­ventable in­fec­tions such as pneu­mo­nia.

In poorer ar­eas of China where rates of in­fec­tious dis­eases are high, chil­dren un­der 5 are more than six times more likely to die than those in large cities.

A 2010 study by UNICEF into the use of breast-feed­ing ex­clu­sively to pre­vent in­fec­tion re­lated in­fant deaths in China found that the pro­mo­tion of for­mula in hos­pi­tals was ram­pant and desta­bi­lized pro-breast­feed­ing ini­tia­tives. Breast­feed­ing pro­grams would likely “pre­vent death and dis­abil­ity due to in­fec­tious dis­eases in child­hood,” the study said.

But while China pushes for moth­ers to put for­mula on the back burner, those with first­hand ex­pe­ri­ence on China’s preg­nancy cir­cuit say it is un­likely to hap­pen if the baby for­mula in­dus­try re­mains as in­flu­en­tial in shap­ing public per­cep­tions.

“One of the big­gest pres­sures preg­nant women face is from peo­ple who aren’t knowl­edge­able,” said Louise Roy, a lac­ta­tion coun­selor and doula based in Shang­hai. “And that mis­in­for­ma­tion of­ten comes from advertising cam­paigns that pro­mote things as ‘just as good as’ or even ‘ bet­ter’ than breast milk.”

Car­i­ane Knud­sen, an Amer­i­can ex­pa­tri­ate who gave birth to both of her sons in Shang­hai, said it is rou­tine for hos­pi­tals in China, both public and pri­vate, to foster doubts about breast-feed­ing.

“I have had friends told in the hos­pi­tal that they were starv­ing their baby and needed to sup­ple­ment, that for­mula helps jaun­dice bet­ter than milk, that af­ter the first year breast milk will poi­son a baby,” Knud­sen said. “I’ve only ever heard this in China.”

Such mis­in­for­ma­tion has led to wide­spread misun­der­stand­ing about breast milk in China, ac­cord­ing to Roy, and con­sumers’ pref­er­ences for for­mula.

“Women are be­ing told their breast milk has tox­ins or poi­sons be­cause of pol­lu­tion,” Roy said. “Even if they’re told that breast is best, at the same time they’re told that some moth­ers don’t pro­duce enough milk or milk with enough nu­tri­ents in it — even though that type of sit­u­a­tion is ac­tu­ally re­ally rare.”

Marie Tar­rant, an as­so­ciate pro­fes­sor at the Univer­sity of Hong Kong’s School of Nurs­ing, agrees with Roy.

In a pol­lu­tant-rich en­vi­ron­ment such as China, it’s baby for­mula that poses a higher risk to in­fants, ar­gues Tar­rant, whose re­search fo­cuses on in­fant feed­ing.

“If there are sub­stan­tial pol­lu­tants in the en­vi­ron­ment, in­fant for­mula would likely in­crease the ex­po­sure as the wa­ter with which it is mixed is also highly likely to be con­tam­i­nated,” she said. “In a pol­luted en­vi­ron­ment, the in­fant would also be ex­posed through mul­ti­ple other sources. Breast milk would prob­a­bly be the least con­cern­ing of all ex­po­sures.”

For­eign for­mula com­pa­nies are cap­i­tal­iz­ing on con­sumer fears, pour­ing re­sources into mar­ket­ing and in­vest­ment in China.

“In the past 10 years and es­pe­cially since the tainted milk scan­dal in China, the in­ter­na­tional for­mula man­u­fac­tur­ers have launched huge cam­paigns to pro­mote their brands of for­mula as the safe and healthy al­ter­na­tive,” Tar­rant said.

Se­duc­tive advertising cam­paigns that ven­er­ate for­mula feed­ing are widely ac­cepted. A prod­uct called Baby Nes, for ex­am­ple, makes baby for­mula at the touch of a but­ton — not un­like its bet­ter-known adult coun­ter­part, the Ne­spresso, Nestlé’s high-end cof­fee and espresso ma­chine.

The Wi-Fi-en­abled ma­chine prom­ises “pre­ci­sion nutri­tion at the touch of a but­ton” and that it can “track your child’s nutri­tion and growth curve.”

For­mula com­pa­nies are in­flu­en­tial via in­vest­ment as well. In­dus­try leader Mead John­son Nutri­tion, which has an es­ti­mated 40 per­cent share of China’s in­fant nutri­tion mar­ket­place, spon­sors train­ing pro­grams in the south­west­ern province of Yun­nan that pro­vide “ed­u­ca­tion on proper feed­ing and nutri­tion prac­tices for fam­i­lies with young chil­dren,” ac­cord­ing to a cor­po­rate an­nual re­port.

Fol­low­ing a 6.5-mag­ni­tude earth­quake in the province last year, Mead John­son sent re­lief work­ers to pro­vide af­fected vil­lages with nearly half a mil­lion dol­lars’ worth of its in­fant nutri­tion prod­ucts.

Mead John­son did not re­spond to re­quests for com­ment.

China’s baby for­mula in­dus­try is val­ued at nearly $18 bil­lion and is forecast to grow to $30 bil­lion by 2017, ac­cord­ing to the mar­ket re­search firm Euromon­i­tor.

Some re­stric­tions on baby for­mula advertising in China do ex­ist. China is a sig­na­tory to the World Health Or­ga­ni­za­tion Code, an in­ter­na­tional set of ethics and stan­dards that tries to limit the scope of mar­ket­ing that for­mula com­pa­nies can con­duct in a coun­try.

But crit­ics say those rules don’t go far enough and are easily ma­nip­u­lated to mis­lead con­sumers.

C.F. THOMAS FOR THE WASHINGTON POST

Me­ganWang ofHong Kong holds Oliver, her 3-month-old, in­May. She re­lied on U.S. and Bri­tishWeb sites for breast-feed­ing ad­vice.

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