Every year, the first week of August is celebrated as World Breastfeeding Week. The official recommendation to breastfeed is exclusively for a baby’s first six months, up to two years alongside complementary feeding.
Breast is best
The benefits of breastfeeding have been clearly demonstrated. Nutritionally, it is said to be ‘tailor-made’ for the baby, responding to their growth needs – its composition even changes during a feed. Breastmilk also provides maximum protection for babies and early years against infections (through interactions with the baby’s saliva) and later risks of chronic diseases including obesity. It has also been found that breastmilk helps maximising the diversity of their microbiome.
Physiologically, breastfeeding releases the hormones prolactin and oxytocin which support mums slowly recover after birth and help develop positive ‘nurturing’ feelings towards the baby. It helps to contract the uterus, the energy cost to produce breast milk also means mums can use their fat stores built up during pregnancy, and for her to return to a healthy weight after birth. There is also strong evidence that it reduces breast cancer in later life. Environmentally, it saves the need to consume tins of infant formula, and is particularly important protection where there might be issues with access to clean water.
Breastmilk has long been referred to as the natural food for babies, but what is hugely lacking in this discourse is that it doesn’t come easy.
Seven years ago when my first baby came along and even as people have forewarned, I was shocked at what ‘feeding on demand’ was and the immense lack of sleep. Following birth complications, I was thankful to the midwives who not only gave me the necessary guidance, but also the encouragement, that ‘you are doing well’.
I also had nourishing foods cooked for me during this time as part of the Chinese custom of Zuo yuezi – mandated by my mum who was visiting at the time. Although it was a little full on being asked to eat and drink copious amounts of food, soups and teas, as a believer of the healing power of foods, it helped me get through the first couple of weeks – sending me off to a great start in breastfeeding.
Because I had 39 weeks of statutory maternity leave which I can extend up to a year, I did not need to worry about nursing without a huge rush to return to work. But this is not the case for many people whose statutory parental leave is short and not mandated.
According to the International Labour Organization’s summary on maternity and paternity policies in 2014 (p.133 to 140), most countries around the world seem to offer between 2 to 4 months of statutory leave and not all are fully paid. Some are nationally mandated, but some are dependent on local authorities, and even up to companies.
In Hong Kong for example, the amount of statutory maternal time off is 10 weeks in total. In fact ‘4 before and 6 after (in weeks)’ is also very much engrained in local pop culture. This will now be extended to 14 weeks, but even this small change barely reflects health recommendations on infant feeding.
Many of those who wish to continue breastfeeding will resort to pumping – often from the first week or so. It is hard work for many mothers who have returned to work, especially to keep up the supply. But mums would only be able to keep on breastfeeding or expressing breastmilk if there is shared responsibility of infant care, that is only possible for those with hired help. Breast is best is a strong message, but it might also cause those who are unable to do so – including adopting and surrogate parents – the feelings of guilt as well.
A health policy is only as good as a social policy if health outcomes are promoted through the investment of social good.
This is why infant formula companies are particularly thriving in places where statutory maternity pay is limited, so feeding a baby with infant formula is not an alternative, but the given. It is also not uncommon for formula companies to advertise with celebrity influencers – even for those who have said they have been breastfeeding, and the promotions are for follow-on milk, the brand endorsement is particularly strong. This has huge long-term effects too when mothers may second guess the quality of their own milk because of incessant marketing by formula companies.
It’s social behaviour
I don’t think we are lacking in the information on breastfeeding, and sometimes it can be exactly that – posing breastfeeding as a choice than normalising it – which can be quite problematic.
When our second baby came along – this time giving birth in Hong Kong – the breastfeeding advice had been less than inviting. In the public sector, nurses are in charged where they invite mums at ante-natal clinic to health talks as part of the check-ups. We were all given a baby doll and were ‘talked at’ for up to an hour about the benefits of breastfeeding – barely engaging but served more of a tick-box exercise to say the least. In an already stretched system, it seems unfair to place further demands on nurses. The technocratic way they communicated was partly cultural, but also because there are very few midwives in Hong Kong. As a result, maternal serves are very much medicalised.
Compared to antenatal advice, the support to women postpartum should be placed with a stronger emphasis. This includes breastfeeding and infant care, as the key concerns only arise and become pertinent when one experiences it. I remember two Health Visitors came to us after our first was born in London, but that seemed like a missed opportunity because most of the meeting was about questions about the baby, instead of checking in if mum was alright.
There could be a lot of unsolicited advice when it comes to women-women support, which can be stressful. Empathy, encouragement and a listening ear perhaps are most needed when it comes to supporting breastfeeding mums – not another leaflet or making women feel guilty for not doing it right.
In parts of Asia, postpartum help traditionally given by elders and other supporting family members at home are now privatised – offered by postpartum ‘nannies’ who provide daily visits or even stay overnight, or at specialist centres where mums stay for a few weeks. This is perhaps a new way to establish the ‘village’ and the thriving demand of this industry is difficult to ignore.
Health is also about culture
The cultural ideas of what a healthy weight means is another important consideration. Across the world, a big baby still means a healthy baby for many. More than once I have heard from friends who pride about their babies and grandchildren being ‘fat and fair （肥肥白白）’ Because breastfed babies are known to be leaner as they learn to regulate their appetite a little earlier than bottle-fed babies, also on infant formula, this may also influence the way mums feed their babies too.
Breastfeeding should be the norm, I agree. But I also think that a health policy is only as good as a social policy if health outcomes are promoted through the investment of social good. This needs to come from the government, but we also need to be aware of the cultural influences around feeding to be know how they affect infant feeding choices.
We are in an era where health information is all abundant – but the extent of engagement in these messaging remains unclear. This is partly because disciplines are silo-ed, but also very few health studies, and certainly nutrition, are multi-disciplinary.
We need to acknowledge that society and culture have important effects on health behaviours, and with breastfeeding being such an important topic nowadays, we must turn to the social sciences and humanities to understand what the key barriers are in promoting breastfeeding advice.
And these are exactly the key questions I am going to tackle in my research study in China that encompasses both global health and family health studies.