Hong Kong lags behind in support for breastfeeding mothers

Mother-of-three Christine Wong had her first child in 2004 and her last in 2013, and says nothing much has changed in terms of support for breastfeeding mothers in Hong Kong.

Wong, who is still breastfeeding her 2½-year-old, says when her youngest was born via caesarean section at Union Hospital, she was refused both skin-to-skin contact immediately after birth and rooming in with the newborn (since she didn't have a private room). These are two of a number of measures that promote successful breastfeeding - the World Health Organisation recommends giving breast milk exclusively for the first six months of a baby's life.

"After delivery, I walked up and down the hospital corridor every two hours to feed my baby and spent the rest of my time in the room squeezing colostrum into a syringe," Wong says.

She also recounts two incidents where she was breastfeeding in a mall and was told she wasn't allowed to - even though she was using a nursing cover.

"Overall, in Hong Kong, it's very hard to be a breastfeeding mother. Things are slowly getting there, but it's taking a very long time," Wong laments.

Breastfeeding support should start right in the hospital when the baby is born, and continue whether the mother is at home, at work or in public. The lack of support in the city is a key reason why breastfeeding rates are so low among Hong Kong mothers.

Only 2.3 per cent of mothers exclusively breastfed their baby for six months, according to a 2013 survey of babies born in 2012 by the Department of Health.

Right after birth, 86 per cent of new mothers initiate breastfeeding, but by the day of discharge from hospital, only about 27 per cent are still doing it exclusively, according to the latest annual survey from the Baby Friendly Hospital Initiative Hong Kong Association (BFHIHKA) released last Monday during World Breastfeeding Week.

In contrast, in Singapore, 96 per cent of new mothers left the hospital still breastfeeding, with 50 per cent of infants being exclusively breastfed, according to a 2011 survey. The figures have likely risen since: three hospitals in the past two years have being accredited as "baby friendly" under the WHO and Unicef's Baby Friendly Hospital Initiative.

National University Hospital, the first in Singapore to be accredited in August 2013, saw exclusive breastfeeding rates on discharge rise to between 75 and 85 per cent.

The Baby Friendly Hospital Initiative was launched globally in 1991 to encourage maternity units to promote, protect and support breastfeeding. BFHIHKA was formed in 1992, and breastfeeding initiation rates among new mothers in Hong Kong have risen steadily from 19 per cent that year.

The initiative has a set of guidelines called "Ten Steps to Successful Breastfeeding" , and maternity units that implement these steps and comply with the International Code of Marketing of Breast-milk Substitutes can apply to be accredited as "baby friendly".

So far no hospital in Hong Kong has the accreditation, though Queen Elizabeth Hospital should be the first by next year, says paediatrician Dr Patricia Ip Lai-sheung, vice-chairman of the BFHIHKA. Hospitals such as Kwong Wah, Queen Mary and Prince of Wales have also registered their intention to gain accreditation, which will take five to six years to achieve.

In the meantime, Unicef HK and the government are collaborating on a campaign to increase support for breastfeeding mothers in the community, with initial focus on the workplace. Launched last week, the campaign called "Say Yes to Breastfeeding" encourages organisations to provide breastfeeding facilities to working mothers who are still nursing.

Unicef HK has trained a volunteer outreach team to visit and introduce the campaign to interested corporations and institutions, and to advise on how to provide breastfeeding support using existing resources and facilities.

More than 30 organisations have pledged their support for the campaign, including the Bank of East Asia and Macquarie Group. Since mid-October last year, BEA's two main buildings in Central and Kwun Tong have a nursing room each. One is a converted meeting room, the other an executive washroom.

"Space is always a challenging topic for employers, especially for offices in Central," says Daniel Lo Wai-sang, general manager and head of operations support at BEA. "But since we wanted to make it happen, we made a sacrifice. We want to provide a good workplace for our colleagues."

Over at Macquarie Group, a room was converted in 2013. "It's a win-win situation," says Hans Yeung, Macquarie's head of finance, Asia. "We can keep key talent and the employee faces less pressure about juggling work and breastfeeding. There's stability in terms of operations and efficiency."

Andrea Chan, who has an 11-month-old daughter Chloe, says not only the nursing room, but also an understanding boss, helped her return to work while continuing to breastfeed for eight months. She used the room to pump her breast milk two or three times a day.

"When I speak to other friends who are mothers, I realise most of them didn't have the same thing at work. I'm lucky," says Chan, who works in institutional equities at Macquarie. "I've heard of women in tears, pumping in the bathroom. I'm glad I didn't have to go through that."

The WHO/Unicef 10 steps to successful breastfeeding

Every facility providing maternity services and care for newborn infants should:

1. Have a written breastfeeding policy routinely communicated to all health care staff.

2. Train all health care staff in skills to implement this policy.

3. Inform all pregnant women about the benefits and management of breastfeeding.

4. Help mothers initiate breastfeeding within half an hour of giving birth.

5. Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.

6. Give newborn infants no food or drink other than breast milk, unless indicated otherwise by medical professionals.

7. Practise rooming-in - that is, allow mothers and infants to remain together 24 hours a day.

8. Encourage breastfeeding on demand.

9. Give no artificial teats or pacifiers (also known as dummies or soothers) to breastfeeding infants.

10. Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

Provisions at a baby-friendly workplace

A designated clean, private area for the mother to express breast milk

A comfortable chair, an electric outlet for a breast pump, and a sink for washing hands and equipment

A small refrigerator for safe storage of expressed breast milk

Permission for employees to express breast milk during short breaks

Encouragement of management and co-workers to have a positive, accepting attitude towards working women breastfeeding

Breastfeeding benefits

According to the WHO, breast milk is the ideal food for newborns and infants. It gives infants all the nutrients they need for healthy development. It is safe and contains antibodies that help protect infants from common childhood illnesses such as diarrhoea and pneumonia, the two primary causes of child mortality worldwide.

In the long-term, breastfeeding contributes to a lifetime of good health. Adolescents and adults who were breastfed as babies are less likely to be overweight or obese or to have type 2 diabetes. They also perform better in intelligence tests.

Breastfeeding also benefits mothers. Exclusive breastfeeding is associated with a natural (though not fail-safe) method of birth control (98 per cent protection in the first six months after birth). It reduces risks of breast and ovarian cancer, type 2 diabetes, and postpartum depression.