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 guideline, Wang said she still supplements 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-breast-feeding initiatives. Breast-
feeding 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 BabyNes, 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 southwest province of Yunnan that provide “education on proper feeding and nutrition practices for families with young children,” according to a corporate annual report.
After 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 firms can conduct in a country.
But critics say those rules don’t go far enough and are easily manipulated to mislead consumers.