When Amy Chan gave birth to her daughter at a government hospital in February, the maternity ward was covered in posters proclaiming 'breast is best'. It was encouraging and indicated that she would get the right help to breastfeed her baby. Chan knew the benefits of breast milk compared with formula feeding - better immunity, less likelihood of respiratory or gastrointestinal infections and allergies and in the long-term, protection against many illnesses. But the days following the birth did not go as she expected. Chan says the nurses were too quick to recommend manufactured formula. They told her she didn't have enough milk and forced her to stick to scheduled feedings. When they felt she had failed to satisfy her baby with her milk, they fed her 9ml of formula milk with a syringe. 'I don't feel public hospitals encourage breastfeeding at all,' says Chan. 'I was very disappointed and I feel the nurses only wanted their 'job' done by feeding babies with formula. I don't think they truly know how important breast milk is.' Leslie Ryang had a similar experience at a private hospital where, she says, staff made breastfeeding almost impossible. 'Even if they saw me breastfeeding, they would say, 'Which formula do you want to finish off with?' They somehow couldn't believe it possible to breastfeed exclusively,' she says. In addition, Ryang says her baby was not allowed to stay in her room - something recommended by experts to facilitate breastfeeding. Eventually, a frustrated Ryang checked out early, despite having paid for a five-day package. On her way out, she was handed a can of the same formula milk the nurses had been dishing out in the ward. Through their actions, the two hospitals appear to have gone against expert advice. In handing Ryang a sample of branded milk, the private hospital also violated an international voluntary code backed by the World Health Organisation and Unicef on the marketing of breast milk substitutes that forbids health workers from giving free supplies of formula milk to pregnant women or new mothers. And the two hospitals are not the only ones with form in this regard. The code also states that free or low-cost supplies of formula milk should not be given in hospitals - yet it's a common practice in most (though not all) Hong Kong hospitals, according to the International Baby Food Action Network, an organisation that monitors the code's application. 'This is totally against WHO recommendations,' says Patricia Ip Lai-sheung, vice chairwoman of the Baby Friendly Hospital Initiative Hong Kong Association. 'There's a conflict of interest when your organisation is promoting breastfeeding but you are receiving free formula to give out to mothers. You're telling the public you approve of the use of the formula, and especially certain types.' It's not surprising, says Ip, that the breastfeeding rate drops rapidly from seven out of 10 women leaving hospital to one in 10 around four to six months later. 'That's a big drop. So Hong Kong is nowhere near the WHO recommendations of exclusive breastfeeding for the first six months, followed by the addition of complementary food about that time and continued breastfeeding for up to two years and beyond.' Maggie Holmes, a counsellor at La Leche League Hong Kong, which seeks to encourage women to breastfeed, ridicules the neglect of the practice. 'We tend to talk about breastfeeding as a little extra - like giving a child violin lessons. But it's much more important,' she says. 'We're talking about the health of all Hong Kong's babies and our future generations.' The Hospital Authority and the Department of Health say they're putting much effort into promoting breastfeeding in public hospitals and at the Maternal and Child Health Centres. They say the breastfeeding rate among mothers leaving hospitals rose from 49 per cent in 2000 to 71 per cent last year. Since it was formed in 1998, the Hospital Authority's Breastfeeding Promotion Committee has sought to make hospitals more 'baby-friendly' by encouraging the practice of allowing babies to stay in the same rooms as their mothers 24 hours a day (rooming in) and improving staff training. A spokesman for the Hospital Authority says free formula milk is accepted by hospitals and is done in a fair and transparent manner. Although options such as charging mothers for formula have been considered, no decision on an alternative practice has been made, he says. The Health Department says it has addressed breastfeeding in its code for private hospitals. It has also reminded milk formula manufacturers of their obligation to comply with the international code adopted by the World Health Assembly in 1981 to stop harmful marketing of their products. Spokesmen for Matilda Hospital and Adventist Hospital, both private, say they are committed to promoting breastfeeding and rooming in. Matilda Hospital has 10 lactation specialists on its staff. The Baptist Hospital says it follows the international marketing code but that for infection control, it allows only the babies of single-room patients to room in. Other mothers are asked to feed their babies in the nursery and mothers who wish to breastfeed get help. However, it declined to comment on an allegation that it handed samples of formula milk to a breastfeeding mother, saying it needed her written consent because of the Personal Data (Privacy) Ordinance. But the hospital says brands of formula are used in rotation and it has no preference for one or another. Ip says the practice of hospitals accepting free supplies of milk formula means it becomes an easy option for those on tight budgets and for busy staff, especially those lacking adequate training. 'When there are so many other things happening, it is so easy and less labour-intensive to give out formula milk rather than finding out how mothers are doing with breastfeeding,' says Ip. This gets breastfeeding off to a bad start. Once they're back home, mothers face other challenges, such as a lack of support, she says. 'Community nurses have been taken away from mothers. The staff at the Maternal and Child Health Centres are very well-trained, but what mother wants to trot down to the clinic with her baby very soon after giving birth?' says Ip. Advertising by formula milk manufacturers has created a favourable image of formula feed, says Ip. Some people fall for the marketing of micronutrients that are implied to make children brighter. 'Parents feel that, for immunity, breastfeeding may be better, but that for IQ, formula is better,' Ip says. 'But there is no evidence to show that these additions will improve a baby's IQ. It is the babies who are breastfed who are found to perform better.' Working mothers have extra challenges, as most get 10 weeks of maternity leave rather than the 14 weeks recommended by the International Labour Organisation, and 16 weeks for breastfeeding mothers recommended by the WHO. Holmes, of La Leche League, says: 'Unfortunately, not many Hong Kong companies have a breastfeeding policy. We need employers to say, 'We'll support you if you want to continue breastfeeding, we'll give you breastfeeding breaks, we'll provide you with a private room with an electric socket so you don't have to express milk in the toilet'.' Holmes says that on the whole the situation is improving for breastfeeding mothers in Hong Kong, especially in public hospitals. But both she and Ip say more needs to be done and that the private hospitals also have issues they must address. 'I know women who have checked out of private hospitals because they weren't allowed to be with their babies,' says Holmes. 'At private hospitals they may feel they want to give the opportunity for the mother to rest after having her baby. It's almost seen as part of the service.' Ip says the government should create a central breastfeeding committee, as recommended by Unicef, to promote the practice all over Hong Kong. Many departments including education, health and labour, as well as the Consumer Council, need to be involved. Hong Kong ought to follow the lead of countries such as the US and set goals for breastfeeding rates, she says. The recent melamine scandal, in which at least four babies have died and more than 50,000 have been made ill by tainted milk, has made the promotion of breastfeeding all the more important, says Holmes. 'At the moment there's a lot of concern about melamine being in formula, but even the formula milk products that don't have melamine in them are still an inferior product for your baby.' 'I'd like to see one big push from the government to make sure everyone knows breast really is best.'