BEIJING (AFP) - Unregulated, aggressive promotion of formula milk, poor medical advice, short maternity leave and workplaces hostile to nursing mothers mean that China has among the lowest breastfeeding rates in the world and is falling well short of its own targets, experts warn.
Just one in five of the nation's babies are exclusively breastfed for the first six months of life, a recommendation set by the World Health Organisation (WHO). This is less than half the global average, according to Unicef's 2019 breastfeeding scorecard, and far below the Chinese government's aim to have 50 per cent of mothers nursing by this year.
Authorities are now launching a push to promote practices including building more baby care rooms in public places such as parks and railway stations as well as teaching doctors and nurses about the benefits of breastfeeding. Experts and mothers, however, say this is not enough.
Ms Mary Zhang stopped nursing after one month. She developed mastitis - a painful inflammation of the breast that can lead to fever, infection, and in some cases hospitalisation - but doctors gave her inaccurate information on how to treat it, leaving her in agony and struggling to feed her infant.
"Nothing worked. I was in pain and my baby was crying," recalled Ms Zhang. "So my mother started giving formula. Once the baby got used to the bottle, he refused to latch. I couldn't breastfeed."
Only 12 per cent of babies in China are born in hospitals where staff have lactation knowledge, according to Unicef.
But the biggest challenge comes from relentless and misleading formula advertising after the government repealed a code of conduct, set by WHO, regulating its marketing.
Authorities abandoned the guidelines, which restricted the marketing of substitute milk and prohibited health workers from promoting it, even after brands selling baby food - including Danone - were found to be offering money to doctors to push their products.
Dr Fang Jin, secretary-general of government-backed think tank China Development Research Foundation, said there is "intense commercial pressure" from a powerful formula lobby keen to tap the world's biggest market.
China's infant formula market was valued at US$27 billion (S$37 billion) last year and is set to grow 18 per cent to about US$32 billion by 2023, according to Euromonitor.
"Infant formula is now advertised as having the same nutrients as breast milk, which is a total lie," Dr Fang added.
It is also now marketed in hospitals and clinics.
"Most women bring milk powder tins when they come to give birth. They are afraid they might not produce enough milk. It's a myth propagated by the formula lobby," explained Ms Liu Hua, a nurse at Beijing Obstetrics and Gynaecology Hospital.
Pregnant women rarely get information on breastfeeding during prenatal visits and turn to smartphone apps or websites - often funded by formula firms - for advice, she added.
China's patriarchal structure exacerbates the issue, Ms Liu said, because husbands "rarely help with co-feeding" or other household chores so grandparents assist instead.
But as that generation were the first to get "brainwashed" by formula ad slogans of the 1980s making misleading claims such as "only hungry babies wake up at night", it can exacerbate problems, Dr Fang said.
"In the first few days after giving birth, my mother-in-law blamed me for not having enough milk, and insisted I give formula. It made me doubt myself. I got very depressed... I felt so inadequate" recalled Ms Ran Qian, a mother from Suzhou.
The Dairy Association of China, which includes many formula firms, did not respond to requests for comment.
New mothers must also battle medically unsound traditional customs that can interfere with breastfeeding, including giving brown sugar or sweet rice wine to newborns.
"Pressure from misguided grandparents to give formula or water or follow old traditions is one of the main reasons that China has a very low rate of exclusive breastfeeding in the first six months of life," Ms Liu said.
Previous government attempts to improve the situation have failed woefully. In the 1990s authorities set an ambitious target to get 80 per cent of babies exclusively breastfed but this was dropped by the year 2000. It was revised to 85 per cent consuming breast milk alongside formula - but even this could not be reached.
There are no figures yet for 2020, but Dr Fang and other experts say the current target to have 50 per cent of babies breastfed for their first six months will be missed.
A study by The Lancet found that the lives of 800,000 children and US$300 billion in healthcare costs could be saved globally each year, if all infants were exclusively breastfed to six months.
The same research found that China could save US$223.6 million in treatment for early childhood illnesses such as pneumonia, diarrhoea and asthma if 90 per cent of babies were exclusively breastfed.
WHO advocates nursing in combination with food after six months to two years or beyond, citing the immunological boost it provides as well as the nutritional benefit - but just 5 per cent of mothers in the country do so.
Breastfeeding also protects the mother from diabetes, breast and ovarian cancers, heart disease and postpartum depression, Unicef said.
A lack of awareness has led to stigma against nursing in public.
Nursing mother Wang Chao said she was heckled by a man at a restaurant when nursing her four-month-old. The man thought it was "unsightly".
Shanghai-based mother Chao Anya was branded a prostitute by a stranger who accused her of "flaunting nipples" as she breastfed her baby on a bus. "China is still a hostile place for nursing mums," she conceded.
Mothers are guaranteed only around four months of paid maternity leave under Chinese law. And while women are allowed to take an hour to express milk or nurse at work, there are few provisions in place.
Some fear being penalised for taking "time off" to do it.
"There is a certain level of discrimination from company management," said associate professor Tang Kun, a public health researcher at Tsinghua University.
Ms Maggie Rui, a human resource manager at a film studio in Beijing, said she was forced to express milk in a washroom. "Those who say don't cry over spilt milk have never pumped," Ms Rui added, recalling how the cramped, unhygienic cubicle afforded little space, meaning she often knocked over her milk.
China's National Health Commission last month issued a notice urging hospitals to establish breastfeeding hotlines and classes for new parents, and ran a series of advertisements on social media, television and newspapers urging women to breastfeed "to protect their baby".
But Prof Tang insists that a systemic overhaul is needed, warning that the government's approach is "not going to help because people have to be taught the skills to breastfeed".
"Policy makers need to focus on the lack of lactation specialists at hospitals, peer education, and how to create a supporting family environment," he said, adding that authorities also need to regulate formula firms to protect new parents.
Education is vital, he added, suggesting workshops for the entire family during prenatal visits, and even using popular TV dramas to deliver the right information without pressure.
For some, the case is clear. Ms Chao takes her child to client meetings and is not afraid to nurse "any time, anywhere".
She said: "Some clients are shocked, but others support my behaviour. I just tell them, my breastmilk is the best I can give my child and I won't settle for anything less."