Source: The Star Online Blog
Posted by: cygnus_lyra, 26-Dec-2008A subject that is close to my heart.
It is no surprise that the rate of breastfeeding (up to 6 months) in Msia is low. In fact, there are many Asian countries where breastfeeding rates are less than desirable.
The government has recently taken the stance of changing formula milk advertising as a step towards encouraging breastfeeding. Although this move is most welcomed, I doubt it will deliver the impact we desired.
Like obesity and tackling the increasing rate of C-Sections in countries like Msia, the issue of breastfeeding (or lack of it) is far more complex than a simple change in advertising laws. It involves education, support from everyone from the mother and her family to the environment, change of work and health policies etc.
Ask any mother in Malaysia and you will find that the most common reasons they'll give for not breastfeeding their babies till 6 months are:
1) No milk.
2) Need to go back to work.
3) Body image - eg. if breastfeed, breasts will sag more etc
4) Mother-in-law or mother or relatives or friends recommended formula milk (of certain brands) as being more superior because it contains omega 3 fish oils, supplemental vitamins, probiotics etc.
5) Formula milk has better satiety than breastmilk, so baby can last longer before next feed.
6) Status value
I will attempt to answer these points in accordance to my professional opinion as well as my personal experience of being a mother myself.
1) No milk.
This is a common occurance, especially with Asian mothers. Could be genetics, could be cultural, could be the food we eat or do not eat etc... but it is a well-known fact that more Asian mothers "suffer" from this particular problem compared to, say, a Westerner.
However, it is also important to know that it is common for the mother to stay "dry" for up to 48 hours or even longer. Some women will have a few drops of colostrum while others are simply dry. This is commonly the source of stress for new mothers, especially when the baby is crying and you are not producing milk. Therefore, many mothers gave in and gave formula milk to their babies.
This is where education and support comes in. It is important to educate the mother than it is OK for the baby to loose weight up to 10% of his or her birth weight in the first week of life. In fact, this is expected, as the baby sheds his/her fluid and fat stores from living in the womb. Secondly, it is important to provide support to the mother to continue trying. It is no secret how milk comes in - it involved lots of stimulation (from the baby or even from using a breast pump) and determinance on the mother's part.
My own experience was that my milk did not come until after the 7th day, despite all the pumping and sucking from my baby (my first child). And even so, I had to take some drugs (eg. Dom Peridone etc) to stimulate the lactation process. This is also one of the methods (of all else fails) to help lactation and used quite a lot in many first world countries where breastfeeding rates are much higher. Perhaps the Msian government should look into subsidising and making this drug available for all mothers who need it (only as a last resolution and not as a "quickie" fix). For my second child, my milk did not come in until the 5th day and I did not need to rely on drugs.
Once breastfeeding is established, we will then run into the next problem....
2) Need to go back to work
This is when breastfeeding goes from predominantly an individual-family decision to one that involves the community and work sector. Due to the maternity leave policy in Msia and the work ethics of the Msian community, many mothers need to go back to work after the 1st month of confinement, some a bit later. In many countries where breastfeeding rates are higher, mothers tend to stay at home for at least 6 months to 12 months after the child's birth. In these countries, maternity or parental (includes paternal) leave policies and work ethics differ greatly than those in Msia, making it a more "breastfeeding friendly" environment. If the government in Msia is serious about increasing the breastfeeding rates, they should also be seriously looking into work and leave policies that are more friendly towards establishing a "breastfeeding" friendly environment. For example: longer paid leave, employers are not allowed to fire a mother who takes leave up to 6 months to 1 year (position guaranteed after leave), allowing the father to share parental leave to care for the children, making public areas and work places "breastfeeding friendly" by providing places for mother or employees to breastfeed or express and store their breastmilk etc.
On individual level, mothers should be educated on how to properly express, store and re-heat breastmilks.
All these changes are required to make breastfeeeding sucessful when the mother returns to the workplace.
3) Body image issue
This is a problem that stems from misconception of body image and unrealistic expectation of self from self or from the community as a whole. First of, there is no evidence so far to show that breastfeeding can cause your breasts to sag more. This is a myth.
Secondly, there is more evidence to show that your breasts will be saggier if you do not wear proper bras and more than half of the female population is guilty of this "crime", thus making this one of the biggest reason why breasts sag. Now, imagine you are breastfeeding and your breasts are obviously heavier than usual....and imagine you wearing a bra that does not provide good support or possibly not even your right size and cup....how do you think this will affect the condition of your breasts? So, ladies, the problem is not breastfeeding, but rather, "poor support". Solution: get professionally fitted by people who are trained to find the right size, type, support and cup of bra for you.
Thirdly, many mothers I had talked to are also guilty of what I call "self critism". For some reasons, women tend to be much more aware of the condition of their bodies AFTER marriage, AFTER kids, AFTER 40, AFTER...whatever benchmark they want to measure against. The truth is, as we age, our breasts will naturally lose its firmness. This is part and parcel of ageing and unless you are rich enough to invest on implants, this is something you must accept because it does not suddenly happen after marriage, or after kids, or after 40....it is a gradual and continuing process. The only reason why women begin to take notice of this change at a certain milestone was because of the "meaning" attached to these milestones..and women always attach "meaning" to most of the things in their life. Therefore, women reacts strongly against these milestones.
Well, ladies, if it helps keep your mind to rest...it is not just us who age, men age too and they face problems such as lost of virility etc. The only difference is, men do not usually react to these problems as strongly and as emotionally as us women.
The problem with body image often stems from unrealistic expectations and this can come from the individual, someone close to the individual, the community or culture...but the fact is, to tackle this problem, you will need to address it at all of these levels.
4) Recommendations of formula milk from people you know.
This is where the mother finds it hard to reconcile the knowledge she learned from health professionals (that breastfeeding is the best) and the knowledge she gets from people she knows or even other health professionals (who are selling formula or pro-formula). The fact that different health professionals in Msia are saying different things is in itself, a great problem that needs to be tackled first. There should be a standard policy for all health professionals with regards to breastfeeding. Everyone in the health sector, should be dancing to the same tune.
Restricting advertising and revising the formula advertising codes (like what the government is currently attempting to do) helps to tackle the issue of advertisement from companies to individuals... but it does not help the issue of 'advertising' between individual to individual (eg: from mother to daughter, from friend to friend etc). To tackle the individual level, education is needed. Also, using advertisement to your advantage is another strategy. Advertise the benefits of breastfeeding and do that as well (and effective) as private companies' advertisements of their formula milk. Mothers should also be educated to know that even though they should respect the advice of elders or other experienced mothers, the decision to breastfeed or not to breastfeed is a personal decision that will affect the mother and her child and should not be done lightly.
5) Formula milk has more satiety effect
Unfortunately, this is true. This is because formula milk has a different sort of protein profile and higher energy content per mL or breastmilk. Babies on formula milk tend to be heavier than babies on breastmilk too. In fact, there are plenty evidences to show that babies on formula milk are more likely to grow up to be overweight compared to babies on breastmilk, thus contributing to the increasing rate of adult obesity. And given that many mothers are 'expected' to produce cute and chubby babies (as a sign that baby is healthy), it is no wonder, many opted to use formula milk. Another dimension to this is the issue of control.
A mother has control over how much her baby drinks when on formula milk. She is able to tell how many mLs of milk her child had drunk. However, with breastfeeding, there is no way for her to tell how much her child has drunk. This gets worst when compared to other children, her child is lighter and less "chubby". People starts to judge her as a "bad mother" because her child is not feed enough etc etc. This gives added pressure for the mother to switch to formula milk.
From the above example, we can see that the issue of control comes with the issue of self-confidence or what I term as "maternal self efficacy". Many studies have found that poor breastfeeding rate is related to poor maternal confidence or self-efficacy. Again, this is a problem that can be tackled with education and support. Poor maternal confidence is also related to lack of trust on the child's ability to feed. When a mother lacks trust that her child will feed enough without having to visibly see how much the child had drunk, issues of control comes in. Mothers should be educated that all healthy babies will not consciously starve themselves. Babies are born with very strong survival instinct and unless a baby is ill, there is no possibility that a baby will starve itself.
It is also worth knowing that the current growth chart used in Msia are based on populations of formula fed babies....and because breastfed babies tend to be lighter, results from this growth chart can be easily mis-interpreted by those without proper training and understanding on how growth charts for babies and toddlers are developed.
If it helps to rest your minds, even though breastfed babies tend to be lighter than formula fed babies, they tend grow up to be adults with normal/healthy weight.
Lastly, mothers who use the excuse that formula is fuller and therefore they do not need to feed their babies more often should be given support by their husbands and families to continue breastfeeding. Yes, it is time consuming but the reward is priceless. Your baby's optimum health, your health and your bond with your child... these are things you can't buy with time and money.
6) Formula as status value
This is the most mis-conceived idea of the century! But sadly, many mothers do believe that if they are able to buy and give the best formula in the market for their child, it signifies higher status than the mother who has no choice but to breastfeed her child. Breastfeeding has been given a lower social status!
The fact is, no matter how much money you have, you can NEVER get a formula milk that is equal to its nutritional value as breastmilk. Formula milk is an IMMITATION of breastmilk. It is a great wonder to me how something that is man-made, an immitation (like piracy) and synthetically synthesised, can rival the REAL thing (breastmilk). This, mostly, comes from successful advertising of formula milk and loads of commercial brain-washing. To this date, no formula milk has been able to immitate 100% the content of breastmilk. And although formula milk moanufacturer do not tell you this, most of the nutrients in formula milk have poor bio-availability compared to nutrients in breastmilk. This means, nutrients from formula milk (although higher in content) are not as well absorbed and mostly excreted in urine or feces. This increased the kidney load on the babies, which is why breastmilk is much gentler and more suitable for babies than formula milk. The benefit of breastmilk far exceeds just its nutritional content, it also has socio-emotional value (eg. mother-child attachment and bonding) as well as developmental value (eg, development of proper oro-motor coordination, speech development etc).
With the current problem with tainted milk, this bring to attention again, the safety of formula milk and how formula milk will always be man-made and therefore subject to much errors in production while breastmilk is natural. If only all those babies were breastfed....they would have been fine now!
To tackle this problem, again, education and support.
So, you can see now how complex and multi-dimensional this issue is. Not only does it concern the mother and child, but her family, her partner, her workplace, the community, government policies etc.
I can honestly say, all my professional knowledge in this subject would have been nought if there is no support from everyone on my decision to breastfeed. If I were to be in Msia when I gave birth to my children, I am most certain that I would have stopped breastfeeding much earlier. Thank God I am overseas and there is plenty of breastfeeding support where I am now and I was able to persevere and breastfeed my children much longer.
Time we pull our resources together and give our babies the best start in life. I end with the breastfeeding motto: "Breast is Best!"