China's Growing Breastfeeding Problem
Two years ago, the British medical journal the Lancet published a study arguing that higher rates of exclusive breastfeeding could be even more effective than improved sanitation at preventing "a large proportion of child deaths and disease” in developing countries. It's unclear whether Chinese officials ever saw that research, but they seem to have arrived at the same conclusions.
This week, Beijing announced that it was considering a ban on infant milk formula advertising in hopes of changing the country's dire nursing statistics. In 2014, fewer than 16 percent of urban Chinese women exclusively breastfed their babies through the World Health Organization’s recommended period of six months. In rural China, the rates were higher -- around 30 percent. But in both cases, they continue to decline.
China deserves credit for acknowledging this problem, but it’s unlikely an advertising ban will make much of a difference. China's breastfeeding problems trace back to cultural practices and economic trends that don't have an easy fix.
Among the cultural factors, perhaps none is more influential than zuo yuezi, the traditional 30-day postnatal “confinement” period during which a new mother is expected to remain home to recover and rest while receiving assistance from family and (if she can afford it) hired help. The cultural expectations surrounding this practice tend to shift the burden of feeding away from the mother. In bygone days, families that could afford help would hire wet nurses to spare a resting new mother the labor of breastfeeding. These days, a can of formula suffices. In both cases, mothers lose an early opportunity to begin breastfeeding their newborn children, and rarely resume an exclusive breastfeeding regimen.
Economic factors also play a role. Due to higher doctor and hospital fees associated with the procedure, Chinese women deliver via caesarean in roughly 50 percent of all births. Yet, according to studies, caesarean deliveries in China are strongly correlated to low breastfeeding rates, because they produce delays in the onset of lactation. (There's also the simple fact that post-operative mothers are unlikely to start breastfeeding immediately.)
Moreover, it's not a coincidence that the growth of China's formula market since the 1980s has paralleled the breakneck development of China’s economy. The hundreds of millions of migrant laborers who moved from China’s agricultural regions to its manufacturing hubs on the eastern coast left behind tens of millions of children for grandparents (primarily) to raise for extended periods of time. For the youngest children of migrant laborers, formula was the preferred and often only food choice.
The extraordinary power of these cultural and economic factors was underscored in the summer of 2008, when authorities discovered that some of China’s largest dairy firms were producing formula powder from milk contaminated with plasticizer. By the time the government had resolved the resulting crisis, six infants had died, some 50,000 were hospitalized, and more than 300,000 had fallen ill. Yet rather than spur a shift to breastfeeding, China’s milk powder scandal simply set parents off in a mad search for formula manufactured outside of China. Today, international airports that serve large numbers of Chinese passengers prominently stock formula in duty free shops, alongside cigarettes and scotch.
One consultancy expects China's market for formula to grow to $30 billion by 2017, from around $21 billion today. Manufacturers haven't refrained from exploiting that insatiable demand. In 2013, China fined six infant formula manufacturers -- five of which were foreign -- a total of $109 million for price-fixing their formula. Far more serious, from a public health standpoint, are the well-documented efforts by formula makers to circumvent China's existing regulations against marketing formula (including, by giving away free samples) in hospitals and other health-care environments.
China is right to restrict such exploitative marketing. But extending those efforts to formula manufacturers' broader advertising campaigns will only have a marginal effect on breastfeeding rates.
It would be far more important for Beijing to dedicate itself to the task of creating public awareness, via public education, of breastfeeding’s importance to children. When it comes to emphasizing the benefits of breastfeeding, it’s just a matter of the government devoting sufficient resources to the issue. Although even then, a bit of patience would help, too.
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