1992 / 10月
Elaine Chen /photos courtesy of Diago Chiu /tr. by phil Newell
Whether mother can really outdo the milk bottle, and whether infants will return to their mother's "embraces," is a hard-fought battle that will continue to be fought.
Raising the rate of women who breast-feed their infants, which has reached an all time low, is now official government policy. Private groups and the medical profession also share this view. The next question, then, is--how can we go about doing this?
The first thing everyone thought of was to attack powdered infant formula, by limiting promotional activities. "You absolutely can't look at infant formula as if it were just another product. It is a substitute for when women are unable to breast-feed on their own, and it should be subject to the same oversight as medications," says Lin Yuh-pei, secretary-general of the Homemakers' Union and Foundation.
Peaceful coexistence: "Everybody blames the problem on the formula manufacturers--this is really unfair," says Brian Cheung, managing director of the Taiwan subsidiary of a well-known American pharmaceuticals company. For example, in Taiwan a professional woman's maternity leave is the second shortest in Asia after the Philippines, and most places of employment lack nurseries or feeding rooms, making a mockery of Article 52 of the Labor Standards Law which says, "Wherever there are infants under the age of one who require breast-feeding by the mother, the employer must provide two feeding periods per day, each one thirty minutes in duration." "So working mothers really have no way to feed their infants. If the children don't drink infant formula, would you rather have the babies go without?" he retorts.
Nancy Liu, section chief in the Bureau of Health Promotion and Protection at the DOH, also believes there is no point in "annihilating" formula. "Working women definitely need it. We just have to make sure that the formula companies do not affect the willingness of mothers to breast-feed on their own, then both methods can peacefully coexist," she notes. The goal the Department of Health is now promoting is not for children to exclusively drink mother's milk; for now it would be quite good if the mother could just breast-feed the baby for the first two months.
Formula companies promoting mother's milk? In fact, some European and American corporations have long understood that to stay alive in the advanced country markets, they would have to encourage natural feeding to improve their own images.
Why would the formula companies play Mr. Nice Guy? Brian Cheung says baldly, "Children don't consume much from the first to the third month, so why should we worry about earning the small profits from this period? But how many mothers can breast-feed their children until they are one or two years old?"
Pharmaceutical companies well-versed in market survival have recently commissioned an advertising company to invite the leading pediatricians and obstetricians in the country to make a promotional film for breast-feeding. It will be screened in hospitals, libraries, and such places for public viewing.
The Breast-Feeding Promotion Plan of the Department of Health aims at the least to get the formula manufacturers to stop sending free samples to expectant mothers, and is requesting that hospitals stop displaying formula products. They are also using subsidies to encourage hospitals and clinics to undertake education about mother's milk. The plan also stipulates that in the future public health insurance will no longer cover the costs of lactation suppression shots (which stop the production of milk in new mothers).
"A great many doctors ask the patients if they want the shot even before the baby has been born. This simple question right away reduces the willingness of many mothers to do breast-feeding," states Lin Yuh-pei.
No secret formula: Based on vast differences in the figures for the rate of mothers who do natural feeding from the hospitals in Taipei City, the hospital is definitely decisive.
The rate of 70% or 80% breast-feeding at the private Adventist Hospital in Taipei is due to the foundation laid down by G.A. Gryte, the foreign doctor who heads the Department of Pediatrics, who insists on "naturalism."
The hospital has set up a class lasting three weeks, meeting twice a week, which teaches the Lamaze Method and breast-feeding. Dr. Gryte has a special rule: He will not help deliver the baby of anyone who does not plan to breast-feed. Moreover, he checks the rooms of the patients daily, and even if lactation in the mother is at first not quite up to par, he absolutely forbids the nurses or mom secretly sneaking in some formula to compensate.
Taipei Municipal Hospital for Women and Children, the best among the public hospitals, with the help of the National Defense Medicine Research Plan, used the method of "learning by doing," providing women who agreed to participate in their study with adequate information and techniques for breast-feeding. The study showed that 60% of women who had originally not planned to breast-feed their children did so after undergoing hospital instruction, with the success rate being far higher than for mothers who had not undergone the instruction.
Letting baby and morn sleep together: "Ten Steps to Successful Breast-Feeding," put out by the World Alliance for Breastfeeding Action (WABA), also puts the main focus of attention on hospitals. These points include, for example, frequently informing hospital staff of breast-feeding policy; educating medical personnel about breast- feeding, including methods and techniques; helping mothers to begin breast-feeding within 30 minutes of birth; implementing a policy of joint mother-baby rooms 24 hours a day; not letting children suck on bottle nipples, and so on.
"For us, the hardest thing right now is the joint mother-infant room, because medical resources in Taiwan are inadequate, whether you are talking about manpower or space. If you want to get one-on-one, unless it's a small-scale hospital for the wealthy, it's unworkable. Also when Chinese go into the hospital for a birth, there are far too many people who want to visit, with Grandpa now holding the baby, then Grandma, so new-borns can easily be exposed to contagious illness," suggests Tigris Lee, superintendent of Taipei Municipal Hospital for Women and Children. There's no harm in having both systems available in each hospital, so that each mother can choose based on her economic and physical conditions.
Its really not the right way to go about it to compel people to follow one policy unconditionally. It is understood that at present the rate of breast-feeding in mainland China is nearly 50%, but in some big cities like Shanghai or Peking, the rate has already fallen to 10%. Mainland China is thus planning to get the rate of natural feeding up to 80% by the year 2000.
Interestingly, according to what Brian Cheung discovered in a survey of the mainland market, given the inadequacy of health and medical conditions there, they already have "mother and infant in the same room." The child's bassinet is suspended over the mother's bed with a rope, and when the child is hungry the mother just needs to pull the rope over to do the job. "But their infant mortality rate is very high!" he sighs with a shake of the head.
Don't intrude when a woman is breast-feeding: Besides it being impossible to fully implement a policy of keeping the mother and child in the same room, given Taiwan's society at present, there are all kinds of difficulties in the way of winning more maternity leave or nurturing time.
The compromise method of the Department of Health is to encourage all enterprises and public places to set up a feeding room, and let working mothers bring their own materials to take the milk they produce during working hours back home for the baby. If there were feeding rooms in public places, this would make it much easier for mothers to naturally feed their infants when out of the house. "Society is at the point where it cannot accept public breast-feeding, so now we have to start promoting it all over again; in the transitional period, there is definitely a need to provide a safe space where people can feel comfortable," says Nancy Liu.
Can these policies really bring the rate of breast-feeding, which has been falling steadily for 20 years, back up?
"The rate in the U. S. is now climbing back up from its low of 26% in the 1970s, and is up to 54% today. Moreover, it's still on the upswing," says Tzeng Min-su, section chief in the Bureau of Food Sanitation at the DOH, basing her comments on studies. Although the rate of breast-feeding in the countryside in Taiwan is still falling, in the cities it has already begun to shown signs of stabilizing and going back up.
Making mother's milk mainstream: "I am confident that the time is ripe for spreading the word and that we can definitely reach the target of 40%," contends Nancy Liu. If only everyone would work together and see this as a social movement, then mother's milk can once again become the mainstream.
Our society is in the midst of a reassessment. In its seminar tours of north, central, and south Taiwan, this year the Homemakers' Union and Foundation adopted a moving slogan: "Mother's milk is the first gift you can give to your child." Little did anyone expect they would be taken up on it by a mother from Taichung: She said that there is a Taiwanese folk saying that "each blade of grass carries its own food with it." That is to say, in plants which bud, the seeds already contain all the nutrients they need to blossom; when mammals in the animal kingdom give birth, the mother's nipple is ready and waiting. Mother's milk is something the infant brings along with it--it is an infant's "human right"--and no one, not the mother or society at large, has the right to deprive the child of it. So how could you say that this is some "benefaction" bestowed by the mother?
Her words silenced everyone. Today, we adults must truly think well how to give back to the child what belongs to the child.
Mother's milk is a gift of nature, but proper technique requires education and practice.
Feeding time is here! Taking baby to mom's room is, by and large, equivalent to making "joint rooms for mothers and children" commonly available.
Mothers-to-be practice the Lamaze method with their husbands to help with natural childbirths. But will these same mothers use natural feeding for their babies?
The Homemaker's Union has set raising the proportion of women who breast-feed their children as a long-term goal to be promoted. The photo shows a T-shirt they display put out by the World Alliance for Breastfeeding Action.