讓嬰兒重回母親「懷抱」

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1992 / 10月

文‧陳雅玲 圖‧邱瑞金


成為全球經濟「模範生」的台灣,若翻開其社會體檢表,卻可以發現一項世界排名殿後的小項目——初生嬰兒的母乳哺育率。

 

這項指標的逐年下降,過去一直未被重視;但在我們立穩根基,要求更好生活品質的今天,卻受到民間、官方一致關注。

 

這是怎麼回事?


帶著四個月大的兒子返台度假的劉庭芬,這天由妹妹陪著到台北東區一家百貨公司逛街。在六樓嬰兒用品區一角,她像發現新大陸般叫了起來:「總算被我找到一間餵奶室了。」自兒子出生起就親自哺乳的她,看看餵奶時間也差不多到了,便拉著妹妹向內走去。

沒想到堶接徆A寬敵的躺椅上,幾個小寶寶全捧著奶瓶吸奶;一旁原本專為餵母乳者所闢的房間,門上卻加了一把鎖。年輕的護士小姐不好意思地趕緊過來解釋:「對不起,因為太少人餵母奶,這個房間的使用率太低,漸漸變成售貨小姐的倉庫了。」

三小龍敬陪末座

根據行政院衛生署統計,目前台灣地區的母乳哺育率(包括母乳、嬰兒奶粉混合食用者)只有百分之廿六;純以母乳哺育者,則一百人中只有五人。「這個比例是全世界最低的」,有人根據世界小兒科學會統計,公開在媒體上指出。

針對這樣的說法,主管機關衛生署保健處一科科長劉丹桂表示,在沒有看到聯合國正式的統計之前,她不承認。「我就不相信香港、新加坡的母乳哺育率會比我們高」,她說。

從香港南華早報今年五月的一篇報導看來,香港餵母奶的媽媽確實只有百分之廿,比我們還低六個百分點。

「香港常是一間公寓三個房間住三家人,怎麼會方便餵母奶?何況他們職業婦女比台灣普遍,也不利於母乳哺育」,市場包括香港、大陸、台灣的一家美商藥廠台灣分公司董事長張鐘聲指出,香港「幸而」還有許多婦女不上班的洋人家庭,提升了平均母乳哺餵率;否則,統計數字還要更低。

經濟起飛,母乳消失

儘管台灣的母乳哺育率不是「全世界最後一名」,但它在過去廿五年的下降速率,卻首屈一指。

根據統計,民國五十六年時(當年的初生嬰兒如今已廿五歲),台灣的母乳哺餵率高達百分之九十五。也就是說,一百個小嬰兒中,只有五名是喝奶粉長大的。僅僅相隔十四年,到了民國六十九年,吃母奶的比例只剩下百分之五十;如今,更降至百分之廿六,幾乎每個小朋友都對電視廣告「我就是喝××奶粉長大的」既熟悉又認同。

對照這段期間台灣的經濟發展軌跡,不難看出其中巧合。民國五十六年,正是台灣經濟起飛前夕,平均國民所得約二百五十美元,農業人口最多,佔就業人口的百分之四十二;到了六十九年,平均國民所得增加為二千一百美元,變成工業人口最多,巧的是也佔了百分之四十二;如今,國民所得即將邁入一萬美元,服務業人口已高居就業市場首位,佔百分之四十八。

「這個階段又同時發生大家庭解構,許多育兒、哺乳的知識,不再像過去世世代代由婆婆傳給媳婦;哺餵母奶的天賦,便從此遭到埋沒」,國防醫學院公共衛生系主任陳麗美指出。民國七十四年衛生署做的一項全國性調查就發現,「奶水不足」是城鄉婦女放棄哺餵母乳最重要的原因,分別高佔百分之四十三及卅一。「那堿O人類退化了?這只是許多生產前後哺乳的相關知識,例如奶脹疼痛怎麼辦、吃什麼有助發奶等等,沒有人教而已」,她說。

哺乳喪失女性魅力?

其實從文化的層面來看,母愛雖被稱誦,母親親自哺乳一事,卻一直沒有受到傳統社會對等的重視——無論中外,都有「奶媽」的存在。

在中國,有錢人家少奶奶生產後,多藉助中藥退奶,並從鄉下找個身體強壯、奶水充足,而且容貌端整——中國人相信,孩子吃誰的奶水,長相也會受其影響——的貧苦人家婦女當奶媽。西方情況大致相同,英文裡,稱奶媽為wet nurse(『濕』的保母),概因婦女哺乳期,乳汁分泌旺盛,胸前衣服常被弄濕——這也是有錢人家婦女逃避親自哺乳的原因之一——她們認為餵奶不但被孩子「綁住」行動不便,而且有礙觀瞻、乳味四溢,女性「魅力」盡失矣。

或因如此,自從女性投入勞動市場,經濟獨立後,追求「自我」、不甘心做媽媽的潛意識也浮出檯面。據名婦產科醫師崔玖觀察發現,愈是受過高等教育、自我意識愈強的婦女,愈有在懷孕期害喜、生產時難產,及產後奶水不足、無法忍受乳頭疼痛,而致放棄親自哺乳的情形。

另一種身分地位的象徵

若說這是「女性自覺」高張,其中又存在著矛盾的吊詭——不少婦女因為聽說餵母乳會使乳房下垂,惟恐失歡於先生,而決定改用奶粉餵寶寶。

孩子最近剛滿月的李真玉就是一個例子。在傳播界工作的她,對母乳好處知之甚詳,原來打算生完孩子親自哺乳,卻在聽說好友因餵奶乳房下垂,花了十萬元動手術美容後,打消了初衷。

「我想想自己沒那預算,還是放棄吧!」她坦然說道。

奶粉是西方的發明,過去一般人惑於「現代科技」,有「奶粉比母奶好」的觀念,也是使奶瓶打敗母奶的原因之一。

「以前喝得起奶粉的都是有錢人家,加上奶粉廣告影響,許多老一輩總認為,吃奶粉的孩子白白胖胖較健康」,主婦聯盟秘書長林玉珮指出,一次在南部舉辦的座談會上,她很驚訝聽到,現在竟還有婆婆因「怕別人笑我們喝不起奶粉」,而堅決反對媳婦餵母乳。

其實,這樣的例子並非絕無僅有。根據衛生署的調查,因認為嬰兒奶粉營養比母乳高而放棄哺乳的,在鄉村中每十一人便有一人;在都市這種情況較少,但也有百分之一.四。從使用的品牌來看,價格昂貴的歐美品牌在都市的市場佔有率高達百分之六十;在鄉下,竟也高達百分之四十二,把價格較低的日本及國產品牌遠遠拋在後面。

也難怪,不過十幾年間,一般人探望產婦的問語已由「妳餵母乳還是奶粉?」變成「妳餵什麼牌子的奶粉?」;同事、親友生孩子,想送份最實用最受歡迎的禮品,一打嬰兒奶粉準沒錯。

奶粉殺嬰事件

從打電視廣告,舉辦健康寶寶比賽,到「贊助」免費的奶粉樣品、奶瓶、嬰兒床供醫院使用,給予醫護人員促銷獎勵、在婦產科開授「奶瓶哺餵」公衛課……,嬰兒奶粉在台的促銷可謂不遺餘力。目前,這個市場大餅一年高達新台幣三、四十億元。

嬰兒奶粉的地位也已根深柢固。儘管九年前曾發生一家國產品牌奶粉鈣磷比例錯誤,造成嬰兒抽筋、昏迷事件,輿論聲討過一陣,但比起國際過去廿年間的「反嬰兒奶粉傾銷運動」,此地消費者的覺醒和行動實在有限。

早在五○、六○年代,西方也曾經視奶粉為時髦象徵,只是,面對廠商誇大不實的廣告,始終有民間團體強大的抵制運動;到了七○年代英國公益團體發起「奶粉殺嬰」的警告,更引起國際重視。

由於奶粉公司在低度開發地區的傾銷廣告,造成嬰兒奶粉優於母乳的錯誤假象,但限於經濟能力,當地婦女只好將沖泡的濃度稀釋,造成嬰兒營養不良;再加上沒有安全、乾淨的水,消毒又沒做好,以致發生極高的嬰兒死亡率。

重近憂,輕遠慮

這問題逐漸引起歐美慈善、宗教團體,甚至製片家的重視。在媒體不斷披露下,社會大眾對奶粉公司進行杯葛抵制,法院展開訴訟,最後聯合國兒童基金會與世界衛生組織制訂「母奶代用品銷售國際規約」,嚴禁奶粉公司透過廣告,以及以免費樣品及促銷獎金入侵醫療體系的傾銷行為。

如今,丹麥的母乳哺育率已高達百分之九十五,荷蘭有百分之七十五,連鄰國日本也有百分之七十。如果我們回頭比較,更會發現奶粉銷售在七○年代的先進國家遭到強力抵制,而台灣的奶粉市場卻在同時急速擴張。為什麼此地聽不見任何抵制傾銷的聲音?

「過去嬰兒奶粉在台灣,並沒有像在其他開發中國家一樣造成重大問題,所以政府在施政的優先順序上,一直把它排在比較後面」,劉丹桂科長解釋,在台灣,水質、經濟問題都不存在,嬰兒奶粉不但沒有變成「殺手」,反而支持婦女走出家庭,對經濟發展作出重大貢獻。因此,政府除了限制六個月內的嬰兒奶粉廣告,過去並未對日益下降的母乳哺育率採取積極行動。

「站在衛生署立場,具有急切性的新生兒篩檢、預防接種,才是嬰幼兒健康的重點工作」,劉丹桂表示。

陳麗美也指出,急切性不同,確實將台灣的醫療資源導引到其他更亟待解決的問題上。例如人口成長的控制、嬰兒死亡率的降低,及全世界最高的產前檢查率。這些公共衛生的成績,絕對足以傲視國際。「重急切性問題,也可能跟衛生署高級主管過去都是醫師出身有關」,她說。

母乳也是「綠色」食物

母乳哺育率的低落,若不是最近受到外來刺激,一般人也早已習焉而不察。

今年六月,國內環保人士紛紛組團赴巴西參加地球高峰會,及其會外會「地球論壇」,也帶回了「國際嬰兒食品行動網」的一些新觀念。他們從嬰兒配方食品對環境生態的衝擊作訴求,主張人類應大力提高母乳哺育率。

奶粉和環保有什麼關係?從一開始種植牧草,就要砍燒森林。以墨西哥為例,每十一公斤奶粉的產出,要燒毀十二.五平方公尺的林地;牛隻的排洩物產生大量甲烷,加劇地球的溫室效應;由牛乳製成乾燥的奶粉,要消耗大量能源;包裝要消耗浪費許多鐵、錫、塑膠等資源,例如美國一年要丟掉五億五千個嬰兒奶粉鐵罐,台灣則丟棄約五百萬個。之後,運送到消費者手中要利用船隻、汽車等交通工具;促銷要廣告;沖泡時要燒開水,奶瓶及奶嘴需煮沸消毒……,在在須耗費珍貴的自然資源、能源。

反觀母乳,生產過程不造成污染、不必包裝、不需消毒、有求必應,更不需把錢花在廣告、文宣上。

重建母乳文化

「該組織告訴我們,台灣的情況實在很荒謬,國民所得已接近已開發國家水準了,卻仍然是嬰兒奶粉的天堂」,林玉珮說。

在世界衛生組織及聯合國兒童基金會的支持下成立的「世界母乳哺育行動聯盟」,訂今年八月一日至七日,為第一個「世界母乳哺育週」,打算藉助宗教、媒體、社區、醫界、學校各方面力量,在各開發中國家及新興工業國重新建立「母乳文化」。

台灣目前雖然仍非會員,但主婦聯盟、綠色和平組織等民間團體決定與其同步舉辦座談會等活動。對於旁人質疑他們的主張——「為提高母乳哺育率,政府及企業應延長職業婦女產假,給予育嬰假」——是否值得及可行?林玉珮的答辯是:「台灣社會已經發展到不是為求『生存』,而是思考如何才能『生活』得更好;不只考慮這一代,還要考慮下一代。」

牛喝牛奶,人喝人奶

確實如此。哺餵母乳,除了有助於「身外」的生態保育,更與母子身心健康有密切關係。

「懷孕時一位學醫的朋友告訴我,即使餵一、二個月母乳,都能使得乳癌的可能性降低一半。否則我大概和大家一樣,一生完就打退奶針了」,在一家電腦公司擔任軟體工程師的魏碧玲說。

母乳的防癌效果也擴及孩子。根據醫學專業雜誌Lancet於一九八八年十一月號上發表的一篇論文顯示,曾吃過母乳至少六個月的孩子,在十五歲以前得癌症的機率,是吃奶粉長大的孩子的一半。特別是淋巴癌,奶粉寶寶的罹患率是母乳寶寶的五.六倍。

「儘管嬰兒奶粉一再改良,但母乳,尤其是頭一、二個月的初乳中有許多成份,包括避免嬰兒消化道及呼吸道感染的多種免疫球蛋白,以及有助於嬰兒腦部發育的特殊氨基酸及亞麻脂酸,都不是人為科技模擬得來的」,榮民總醫院小兒科醫師吳子聰表示,牛奶是給牛喝的,只有人奶才是給人喝的。

有奶便是娘

從人性及母子親情的角度來看,母乳更不是奶粉所能望其項背。

日前在國內上映的美國恐怖懸疑片「推動搖籃的手」中,女主角因醫師丈夫被婦產科女病人控其性騷擾自殺身亡,而決定化身為保母,到女病人家展開奪子行動。她的計策是偷偷用自己的奶餵寶寶,到最後果然破壞了女主人母子關係,使其家庭籠罩在重重疑雲中……。

許多年輕人看了電影,對這段劇情直呼荒謬,但站在專業醫生的立場來看,「有奶便是娘」一點也不奇怪。

「臨床醫學發現,現代嬰兒身心症——包括一天到晚吵鬧、啼哭不止——明顯增加,這和現代人哺育孩子的方式有關,奶瓶、嬰兒車、學步車,都在疏離母子關係」,淡水馬偕醫院精神科醫師陳質采指出,一個在印度村莊做的調查顯示,新生兒死於急性症的例子雖然較多,但身心不適的情形卻遠比都市為低。

美國一位醫師的研究也發現,母子早期的肌膚接觸愈頻繁,媽媽會愈捨不得把孩子交給他人,有助於母子間建立起強固的情感(mother-infant bonding)。

「現代母子間缺少親情維繫,不必等孩子進入青少年,他只要大到有行動能力,就開始反父母了」,一直在親友間傳播「母乳福音」的家庭主婦林純惠指出,美國現在已經出現pre-teen(八、九歲孩童)問題。

幸福指標之一

「從幼兒保健的立場來看,母乳哺育率低落確實是個問題」,婦產科權威醫師,現任台北市立婦幼醫院院長的李鎡堯承認,「過去醫界太忽視了」。

政府主管機構的態度也已有所改變。現任衛生署長張博雅不但本身是女性,而且是學公共衛生出身,她對這個問題相當重視,決定將母乳哺育推廣計畫,列入配合六年國建的「國民保健六年計畫」中,預計在這一階段將台灣的母乳哺育率提昇到百分之四十。

「先進國家把母乳哺育率當作人民的幸福指標之一」,劉丹桂指出,這在我們希望追求真正的生活品質的今天,值得大家好好想想。

〔圖片說明〕

P.76

上一代媽媽把孩子一個個奶大,如今小孫兒卻躺在無菌的嬰兒室裡,由護士以奶瓶哺餵。這是更進步了?還是退步了?

P.77

現在只有百分之廿六的嬰兒享受到母親溫暖的懷抱。(嬰兒與母親雜誌提供)

P.77

其他百分之七十四的寶寶都只碰觸過奶瓶。

P.78

燒開水、消毒奶瓶,雖然確保了嬰兒的飲食衛生,卻也消耗不少水與能源。

P.79

偏遠的鄉下地方,母乳哺育率也年年下降。

P.80

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Getting Infants Back to Mother's Breast

Elaine Chen /photos courtesy of Diago Chiu /tr. by Phil Newell

Taiwan, which is at the head of the class when it comes to economic growth, nevertheless can be found down near the bottom of one social indicator: the rate of women who breast-feed their newborn infants.

This indicator, which has been declining for years now, never has gotten much attention. But today, stable and prosperous, with quality of life increasingly in demand, it is getting wide attention from the government and the people.

What's going on?


Liu Ting-fen, who brought her four-month-old child with her on a return visit to Taiwan, went one day to a large department store in the Eastern District with her younger sister. In the infants department on the sixth floor, she suddenly exclaimed, as if just discovering the New World, "I've finally found a feeding room!" Having been feeding her baby mother's milk ever since its birth, and seeing that feeding time was just rolling around, she pulled her sister along and went in.

Little did she expect that on the comfortable little bassinets there would be several babies sucking bottles of infant formula, and the adjoining room which had originally been reserved for natural feeding had a lock on it. The young nurse in charge hurried over and, embarrassed, explained, "I'm sorry, but because too few women breast-feed, the rate of use of this room was too low, and it has been turned into a place for the salesgirls to keep their things."

"Dragon" behind: According to statistics of the Department of Health of the Executive Yuan, at present the proportion of women who feed their children with mother's milk (including those who feed them a combination of mother's milk and formula) is only 26%. Indeed, only five in 100 feed their children only mother's milk. "This is the lowest rate in the world," some have pointed out in the media, based on statistics from the World Pediatrics Association.

Vis-a-vis this conclusion, Nancy Dan-kwei Lin, section chief in the Bureau of Health Promotion and Protection in the DOH, which is in charge of this area, says that before seeing the formal statistic of the United Nations, she does not acknowledge that it is correct. "I don't believe that the rate of natural feeding in Hongkong and Singapore is higher than ours," she suggests.

And indeed, from the looks of a report in the South China Morning Post from May of this year, Hongkong's proportion of new mothers who breast feed is only 20%, six percentage points lower still than in Taiwan.

"Often in Hongkong you find three families living in a three bedroom apartment, so when would it ever be convenient to do breast-feeding? And what's more, career women are much more common there than in Taiwan, which is also no help to breast-feeding," says Brian Cheung, managing director of the Taiwan subsidiary of a certain large American pharmaceutical manufacturer whose market includes Hongkong, mainland China, and Taiwan. Hongkong has the "good fortune" to also have many resident foreign families whose mothers do not work, which raises the average, otherwise the figures would be even lower.

The economy takes off, mother's milk takes a powder: Although Taiwan's proportion of women who use natural feeding is not, after all, the absolute lowest, the rate at which this figure has dropped over the past 25 years has been at the top.

According to statistics, in 1967 (whose babies are now 25), the rate of breast-feeding was all the way up to 95%. That is to say, of every hundred babies born in that year, only five grew up drinking infant formula. After a mere 14 years, by 1980, only 50% of children still suckled at their mother's breast. Today it has plunged even further to 26%, and nearly every child can identify with the TV ads that proclaim, "I grew up drinking something-or-other baby formula!"

It's not hard to see the coincidence when one looks at the curve for Taiwan's economy over the same period. Taiwan was just on the eve of economic takeoff in 1967, with per capita GNP at US$250. Most people still worked in agriculture, accounting for 42% of the employed population. By 1980, per capita GNP was up to US$2,100, with industry accounting for most of the labor force with--coincidentally--42% of employed people. Today, per capita income is approaching US$10,000, and the service industry has taken over first place in the employment market at 48%.

"This period was one of the disintegration of the extended family, and a lot of information about raising children and breast-feeding was no longer as in the past passed on from generation to generation, and the natural gift of mother's milk began to disappear from this point," states Chen Li-mei, director of the School of Public Health at the National Defense Medical Center. In a national survey she did in 1985 for the Department of Health she discovered that the major reason why women in both city and country abandoned natural feeding was inadequacy of milk, with the figures being 43% for the city and 31% for the country. "Is it that mankind has regressed? Actually it's just that no one has taught them basic information about breast-feeding and preparation for it either pre- or postnatal, such as what to do if one's breast swells, or what to eat to enhance milk production in the body, and so on," she avers.

Beauty and the Breast: In fact, on the cultural level, though a mother's love is much praised, the case of the mother doing breast-feeding herself was not seen as important in traditional society--"nursemaids" have always existed in both China and elsewhere. In China, after the daughter of a wealthy family had given birth, most used Chinese medicine to stop lactation in the mother. Then they would find a poor mother from the countryside to be nursemaid, making sure she was strong, produced a great deal of milk, and had a well-shaped face--since Chinese believe that the child's appearance will be affected by that of the person whose milk the child drinks. The situation in the West was basically similar. The term "wet nurse" in English derives from the fact that during the nurturing period, there is a great deal of milk produced, and often the clothing around the breasts would get wet. That is another reason why the women in wealthy families avoided the task of breast-feeding. Not only did they feel "tied down" by having to feed the children, it is unattractive, and the smell of the milk is everywhere, so that a woman's "allure" is thus forfeit.

Perhaps because of this, ever since women entered the labor market and became economically independent, the pursuit of "self" and a latent un willingness to be a mother have risen to the surface. The well known obstetrician Julia Tsuei has observed that the higher the level of education a woman has received, and the stronger the woman's self-consciousness, the more she is depressed during pregnancy and has difficult deliveries--and the more common is the situation that she gives up breast-feeding because of inadequate milk after giving birth, or unwillingness to endure the soreness of the nipples.

If you say this is the rise of "feminine consciousness," there is also an inherent paradox--many women decide to use formula to feed their infants because they have heard that breast-feeding causes the breasts to sag, and fear that they will become unattractive to their husbands.

Li Chen-yu, whose baby has just reached one month old, is a case in point. Working in the media, she is well aware of all the advantages of mother's milk, and originally planned on natural feeding after the birth of her child. But after she heard that breast-feeding caused her friend's breasts to sag, requiring NT$100,000 in cosmetic surgery, she gave up her original intention.

"I figured that I didn't have that kind of money, so I gave up!" she says frankly.

Another symbol of status: Baby formula was invented in the West, and people have tended to see it as "advanced technology." They think that "formula must be better than mother's milk." This is another reason why the bottle is winning out over mother's milk.

"In the past only wealthy families could afford formula. If you figure in the impact of advertising, many people in the older generation thought that children who grew up on formula would thus be plump, glowing, and healthy," says Lin Yuh-pei, secretary-general of the Homemakers' Union and Foundation. Once in a seminar in south Taiwan she was startled to hear that now some grandmothers forbid their daughters-in-law to breast-feed because they are "afraid that others will think we can't afford formula."

In fact, this is not an isolated case. According to a survey by the Department of Health, one person in eleven in the countryside gives up on natural feeding because they believe that formula is more nutritious than mother's milk. This situation is rarer in the cities, but still accounts for 1.4%. In terms of the brands purchased, the more expensive American and European brands account for 60% of the market in metropolitan areas; it is 42% in the countryside. Low-priced domestic and Japanese brands lag behind.

And no wonder. In less than two decades, the question people ask of recent mothers has gone from, "Do you use formula or mother's milk?" to "What brand of formula do you use?" And when coworkers, friends, or family have a birth, one couldn't go wrong in sending welcome and practical infant formula.

Hasta la vista, "baby": No method is over-looked in promoting sales of formula in Taiwan. These include television advertising and holding "healthy baby" competitions, to sending "sponsorship" free samples of formula or bottles for hospitals with maternity wards to use, to giving subsidies to hospital staff to push the product and offer "bottle feeding" classes at obstetrics departments . . . . This market is up to NT$3-4 billion per year.

Infant formula already has a firm foothold. Despite the occurrence of an incident nine years ago in which there was a mistake in the proportion of calcium and phosphorus in a domestically produced brand, leading to cramps and dizziness in infants--after which commentators talked about the issue for a while--local consumers have had only limited awakening or action. This is especially the case compared with the international "anti-formula dumping movement" over the last twenty years.

Back in the 1950s and 1960s, people in the West also saw formula as the fashionable thing. However, there were always private groups strongly resisting the exaggerated or false claims of the manufacturer's advertisements. The "infant formula kills babies" warning issued by a public interest group in England in the 1970s drew even greater international attention.

The promotion and advertising of formula in less developed nations has created the mistaken belief that formula is superior to mother's milk. Yet because of limited wealth, local women thin the formula out, so that children do not get enough nutrition. Also, there is no safe, clean water, and purification and disinfecting are inadequate, so the infant mortality rate is extremely high.

Short-term worries over long-term worries: This problem has gained the attention of charitable and religious groups, and even filmmakers, in the West. With frequent revelations by the media, there was a boycott undertaken in the general public and lawsuits brought in the courts. Finally, the United Nations' Children's Fund and the World Health Organization established an International Code for Promoting Breast-Milk Substitutes, strictly forbidding formula corporations to advertise or to use free samples or subsidies to penetrate hospitals and health care systems.

Today, the rate of mothers who breast-feed has already reached 95% in Denmark and 75% in Holland, and even in neighboring Japan it is 70%. If we look back and compare, it can be discovered that there was strong resistance to formula sales in the advanced countries in the 1970s, but Taiwan's formula market rapidly expanded at the same time. Why hasn't there been any voice of resistance here?

"In the past, in Taiwan infant formula had not caused such serious problems as it has in other developing countries, so it was rather low on the list of government priorities," explains Nancy Dun-kwei Liu. In Taiwan the water quality and financial problems did not exist, and not only has infant formula not become a "killer," it has helped women get out of the house and has made an important contribution to economic development. Therefore, besides prohibiting advertising aimed at infants less than six months old, there has been no positive action in the face of the constantly declining proportion of mothers who use natural feeding.

"From the point of view of the Department of Health, the main work of infant health has to be on emergency postnatal care and inoculations," explains Nancy Liu.

Chen Li-mei, notes that differences in urgency definitely diverted Taiwan's limited resources for health care to other problems in need of immediate solution. These include, for instance, controlling population growth, lowering the infant mortality rate, and the highest rate of prenatal checkups in the world. These public health success stories can rank with international standards. "An emphasis on short-term acute care is also perhaps related to the fact that high-ranking officials in the DOH have always been doctors," she adds.

Mother's milk--the environmentally sound drink: The decline in the rate of natural feeding might have gone unnoticed except for some recent jolts.

In June of this year, environmental activists from Taiwan organized a group to go to the Earth Summit in Brazil, and the "Earth Forum" that took place outside the summit. They brought back some new viewpoints based on the "International Infant Food Action Programme." Basing their appeals on the damage infant formula ingredients have on the environment, they urged all people to strive to raise the rate of natural feeding.

What's the connection between powdered baby's milk and the environment? First you have to cut down forests to create grazing land. In Mexico, for example, 12.5 square meters of forest are burned for each 11 kilograms of formula produced. Waste from the cows creates vast amounts of methane, adding to global warming. It requires a great deal of energy to manufacture dry powdered milk from the original milk. Packaging requires the expenditure and waste of large amounts of tin, aluminum, and plastic; for example in the U.S. 550 million empty formula tins are discarded annually, while Taiwan throws away about five million. On top of all that, one must use ships and vehicles to transport the stuff to consumers; sales takes advertising; mixing the formula requires boiling water, and washing and sterilizing of bottles and nipples . . . . Each step requires expenditure of precious resources and energy.

Mother's milk, on the other hand, creates no pollution when produced, requires no packaging, needs no sterilization, and is available on demand. Still less is money required for advertising or propaganda.

Rebuilding a culture of mother's milk: "That meeting told us that Taiwan's situation is quite ridiculous. Per capita GNP is approaching the level of developed nations, but infant formula is still king," says Lin Yuh-pei.

The World Alliance for Breastfeeding Action, formed with the support of the World Health Organization and the United Nations' Children's Fund, has set August 1-7 of this year as the first ever "World Breast-Feeding Week." They plan to enlist the help of religious organizations, the media, neighborhoods, the medical community and schools to rebuild a "mother's milk culture" in developing and newly industrialized nations.

Although Taiwan is still not a member, private groups like the Homemakers' Union and Green-peace plan to hold seminars and other activities in step with the Week. Some observers wonder whether their advocacy of the slogan "in order to raise the proportion of women who do natural feeding, the government and private sector should extend maternity leaves and provide infant care leave" is either worthwhile or practicable. Lin Yuh-pei's response is: "Taiwan's society has already developed to the point where we are not just pursuing 'existence,' but how to live even better. Also, don't just consider this generation, but also the next generation."

Cows drink cow milk, people drink people milk: That's really true. Besides the "external" benefits of environmental protection that come from drinking mother's milk, there is an even more intimate relationship with the health of the mother and child.

"When I was pregnant a friend who studied medicine told me that even if I only breast-feed for a month or two, I could lower my chances of breast cancer by half. Otherwise I'd probably be like everybody else, and just get a shot to stop milk production right after the baby was born," says Wei Pi-ling, a software engineer in a computer company.

The cancer prevention effects of milk extend to the child as well. According to the medical journal Lancet in an article printed in the November 1988 edition, children who had been fed mother's milk for at least six months had only one-half the chance of getting cancer before the age of 15 than children raised on powdered formula. In particular, for lymphoma, the rate for formula children is 5.6 times that of breast-fed babies.

"Despite constant improvements in formula, mother's milk--especially in the first two months, has many ingredients that just can't be reproduced by human technology, including several immunoglobulins which protect the digestive tract and breathing tracts from contagion, as well as some special acids which are important for the development of the brain," says Wu Tzee-chung, a pediatrician from the Veterans' General Hospital. Cows' milk is, after all, produced for calfs to drink, and only human milk is specially for human consumption.

Milk makes a mother: From the perspective of emotional attachment between the mother and child, mother's milk is even more beyond the challenge of infant formula.

In the recent American thriller The Hand That Rocks The Cradle, the female lead's doctor husband committed suicide after being accused by one of his patients of sexual molestation, so the wife decided to go pretend to be a live-in babysitter in the patient's house and try to steal the affections of her baby. Her plan was to gradually use her own milk to feed the baby and in the end destroy the emotional relationship between mother and child and cause doubts and suspicions in the household . . . .

Many young people found this part of the plot absurd, but from a medical specialist's point of view, there's nothing strange about the idea that "whoever gives the milk is the mother."

"Clinical medicine has discovered that psychosomatic and psychological illness, including constant activity or constant crying, has increased among modern children. This is connected to the way babies are fed by modern people. Bottles, strollers, and baby rockers all create distance in mother-child relations," says Chen Chih-tsai of the Department of Psychiatry at the Mackay Memorial Hospital in Tamshui. She adds that a survey done in a village in India revealed that although there were more cases of newborn infants dying of acute illness, the rate of psychological abnormality was far lower than in the urban areas.

A study by an American doctor also showed that the more frequent the touch of skin against skin between mother and baby in the early years, the more the mother couldn't bear to give the child to anyone else--this is helpful to mother-infant bonding.

"Today there is a lack of deep ties of affection between mother and child, so as soon as the child is old enough to act on its own, it will begin to rebel against the parents," contends Lin Chun-hui, a housewife who has long trumpeted the virtues of breast-feeding among family and friends. There is already a problem in the United States with "preteens" (8-9 years old).

An indicator of well-being: "From the point of view of health maintenance for the child, the decline in the proportion of mothers who do natural feeding is definitely a problem," says T.Y. Lee, an obstetrics authority and currently Superintendent of the Taipei Municipal Hospital for Women and Children. He adds, "But the medical profession ignores it."

There has already been some change in the attitude of the relevant government agencies. Chang Po-ya, current director of the Department of Health, is not only a woman, she has also studied public health. She takes this problem quite seriously, and has decided on a plan to promote breast-feeding to fit in with the "National Health Maintenance Six Year Plan" (part of the Six-Year National Development Plan). It is estimated that in this stage the proportion of natural feeding in Taiwan can be raised to 40%.

"Advanced countries treat the rate of natural feeding as an indicator of well-being," says Nancy Liu. Today, as we pursue true quality of life, this is worth giving some thought to.

The economy takes off, mother's milk disappears[Picture]

[Picture Caption]

Mothers of the last generation raised their children on natural milk; today small children lie in sterile nurseries and are fed by nurses from bottles. Is this progress?

Today only 26% of children enjoy the warm embrace of mother's breast. (photo courtesy of Baby and Mother Magazine)

The other 74% of babies only touch the cold formula bottle.

Boiling the milk and sterilizing the bottle protect the cleanliness of the infant's food, but also consume a lot of water and resources.

The rate at which mothers breast-feed is steadily falling even in the remote countryside.

A breast-fed baby is a new sign of well-being. Heycutie, are you one of the lucky ones?

 

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