1992 / 10月
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]
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?