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Bottle does battle with the breast  South
China Morning Post - Page 21
Tuesday, May 12, 1992
IN Europe and America, most mothers breast-feed their newborn babies. In Hongkong, only one in five does. KATHERINE FORESTIER looks at the reasons why and meets woman who campaigns that mother’s milk is best.
LYDIA Ling, who chairs the Association for Maternal and Neonatal Health, has been trying for 15 years to convince women to do what was once the most natural thing in the world – to feed their own babies.
“I am really very disappointed, ” said Ms Ling, who is senior sister of the University of Hongkong’s health service. “The advantages of breast-feeding, and the disadvantages, even dangers, of bottle-feeding, have not got across to the public, especially in the lower social classes.”
Although most women in Europe and North and South America breast-feeding newborn babies, only one in five Hongkong woman did so last year. And most Hongkong women who did breast-feeding gave up within a few weeks.
Ms Ling is not giving up. She is looking for Chinese-speaking volunteers to help run a hotline to support breast-feeding mothers. She would also like to see seminars or workshops at which experts from around the world offer up-to-date information to medical professionals.
“Many medical professionals are not motivated to find out the detail of the advantage of breast-feeing and up-to-date technique – some of them think mild power is almost the same, “ Ms Ling said.
Dr. L.Y. Tse, the Family Health Service’s principal medical officer, is also concerned. “We have tried hard to promote breast-feeding but we cannot change the environment in Hongkong easily. We hope to encourage women to start, rather than feeding for a long time. Some breast milk is better than none. If a mother tried and she is satisfied, she may then go on for longer and recommend it to her relatives and friends. ”
Ms Ling was converted to breast-feeding only after she had bottle-fed her first two children. “ At that time, everyone bottle-fed.” She said.
When she was in her 40s, she had a third child, which she breast-fed for two-and-a-half years. “I think I must be one of the (few) Chinese women in Hongkong who has breast-fed a baby so long.”
Whether mothers breast-feed or not seems to depend largely on the hospital where they give birth. According to Department of Health’s Family Health Service statistics, just 6.4 per cent of babies born at the Precious Blood Hospital last year were breast-fed and only seven per cent at Tuen Mun and Pok Oil Hospitals.
 At the other extreme, 93 per cent of those born at Matilda Hospital and 83 per cent at the Hongkong Adventist, which both actively promote breast-feeding, were breast-fed.
“My mothers find people around them so negative, “ said Ms Ling. “Hospital policies are rigid and don’t facilitate breast-feeding. Due to lack of confidence, many doctors and nurses do not give adequate encouragement or support.”
Many professionals paid only lip service to the promotion of breast-feeding.
One new mother noted that nursing staff were all too quick to suggest bottle-feeding to women who ran into difficulties.
Hongkong’s 50 maternal and child health clinics do encourage breast-feeding. One mother was surprised when a clinic’s nursing staff told her she should switch feeding her six-month-old daughter from the breast to high-protein milk formula. (In fact, mother’s milk adjusts to increased protein needs.)
Breast-feeding does have disadvantages. Some women find it changes the shape of their breasts, and that breast milk leaks on to clothing. Ms Ling said it was best to wean gradually over a period of two to three months to stop any discomfort. She also recommends a well-supported nursing bra, worn day and night, to maintain a good shape.
Problems with lack of milk supply, she said, were due to women not breast-feeding enough, not getting enough rest or being over-anxious.
Another difficulty is the attitude breast-feeding mother face in Hongkong because it is not socially acceptable to feed in public. “but any inconvenience and problems are only temporary.”
Dr Tse said that one of the reasons for the rejection of breast-feeding was that young-modern Hongkong women were embarrassed by it.
Ms Ling agreed. “Lay people are out of touch with breast-feeding. It is something very remote from them. People’s attitudes need to be changed. They have to take breast-feeding as a normal, natural thing. They have the wrong idea. They think you have to expose your breast when you are feeding, which is not true.
“People usually blame working as a barrier to breast-feeding. Of course, it is good if you can stay with the baby for the first six months, but it is still possible to have mixed feeding.”
Working mothers can feed their babies with expressed breast milk of they can breast-feed only night and morning. In fact, 45 per cent of mothers do not return to full-time work after having babies.
As an antenatal teacher, Ms Ling supports many women in their efforts to breast-feed. Mrs Betsy Chan is one of her clients. “Most Chinese women are scared to breast-feed, ” said Mrs Chan, “They do not have enough knowledge. They try to when they find it is painful they give up. ”
For Mrs Chan, as for the vast majority of breast feeders, the initial discomfort quickly disappeared. “Now I have no problems. The only inconvenience is that I have to express milk for when I am at work..”
Mrs Chan does not find feeding her baby difficult in Hongkong. “I am not so shy so there is problem. I know it is good for the baby and for the mother. It is a very traditional thing to do.”
When the Family Health Service was first set up in 1932, 69 per cent of mothers discharged from Hongkong maternity units breast-fed units breast-fed their babies. The numbers then dropped dramatically to a low of five per cent in 1978 before the World Health Organization (WHO) and local regulations reined in the promotional activities of milk companies and before local efforts to promote breast over bottle began.
But despite a WHO ban, samples of infant formula are still being given to Hongkong maternity units, Ms Ling says. “Hospitals never lack samples to give to mothers. Very often when a baby cries in the nursery, the nurses will give them formula.”
She said that bottle-feeding is not only disadvantageous, but can be dangerous, and lacks many of the health benefit of breast-feeding.
"You cannot manipulate the content of breast milk. With traditional ideas that a fat baby is a healthy baby, some people will add extra spoons of concentrate. They baby then gets too fat or many get diarrhea. Bottle-fed babies tend to be obese, sucking more than they want because the mother wants to see the bottle empty."
There is also a danger of malnutrition. "Some mothers when they find a baby a bit constipated or are afraid of indigestion many dilute milk. In developing countries, mothers think that even diluted milk is better than breast. They are amazed by Western technology and therefore think it must be best, even if they cannot afford it.”
She said that many babies died during last summer’s floods in China because they were bottle-fed, and picked up diseases from the dirty water used to mix the formula. “They probably would not have died if they had been breast-fed.”
Evidence has linked the nitrosamine in rubber tears to an increased cancer risk. Nor can the purity of milk powders be guaranteed. A few days ago, unacceptable levels of aluminum and lead were found in milk powders in Australia and Malaysia.
A recent report by the National Academy of Sciences in Washington concluded that there was an overall lower death rate among breast-fed babies. The report recommended that babies should be breast-fed for at least four to six months.
According to a Family Health Service survey in 1989, 34 per cent of those who start breast-feeding give up within a week and a further 68 per cent within two months.
In 1975, the service stopped accepting milk powder. In 1978, the Government prohibited the advertising of infant formula in the media.
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