Breastfeeding in Taiwan is on the rise. According to a Department of Health announcement reported in the Taipei Times today, the rate of breastfeeding in Taiwan rose dramatically from 5.4 percent in 1989 to 61.8 percent in 2010.
The Department of Health attributed the higher breastfeeding rate to affirmative government policies — especially the establishment of breastfeeding rooms in public places. Taiwan has put in place comfortable breast-feeding rooms at 17 MRT (subway) stations (with average usage of 691 visits a month), at highway rest stops and in other public places such as department stores. Even Costco has a breastfeeding room. This is in response to legislation passed in November 2010 that makes it illegal to prevent anyone breastfeeding in public, and which also compels the establishment of breastfeeding rooms in public places.
Having dedicated places to breastfeed is a positive development, but I wonder if this alone has led to such a large increase in breast-feeding rates. A more likely source is the outcry over the melamine milk scandal that affected Chinese babies in 2008. While Taiwan was not affected by infant formula to the same degree as mainland China, contaminated milk also infiltrated across the Taiwan Straits. Global milk prices were high, and some food outlets had imported cheaper Chinese milk powder to make a range of Taiwanese delicacies from pearl milk tea to street=stall food such as custard or red-bean flavoured wagon-wheel popovers.
The whole melamine milk scandal left a sour taste in Taiwanese consumers mouths, so to speak. Consumer power was always strong, but since then consumer groups began to demand higher-quality standards for both domestically produced and imported food. This had an impact on everything from US beef imports containing ractapomine to lower-than international standard minimum residue levels for grain imports including wheat. Imported food substances containing any contraventions were derided by the press as ‘unsafe’, while the organic foods are becoming more popular with health food chains such as ‘Cotton Land’ branching out all over Taiwan.
And Taiwanese mothers are becoming more influenced by Western notions of parenting. There is now more awareness of the health benefits of breast milk, and how it can help facilitate a baby’s healthy development. This is quite different from say forty years ago, when women chose not to breastfeed because they were worried about sagging breasts. (According to my doula, Penny Lin, this remains a consideration for some image conscious women.)
But still there are challenges to maintaining breastfeeding amongst Taiwanese mothers beyond the first confinement month. The report notes that breastfeeding rates decline significantly as babies get older, dropping to 50.9 percent at two months, 39.7 percent at four months and only 24.2 percent at six months. According to lactation specialist Dr Cynthia Mao from Pojen General Hospital, most Taiwanese women begin with the intention to breastfeed but are discouraged when they encounter problems.
One of the key factors in the high-drop off rate is the fact that most mother’s return to work 56 days after commencing maternity leave. With high property prices and increasing living costs in Taiwan (especially Taiwan), most families require two incomes to maintain their lifestyles. I have met many mothers who resolutely pump milk at work to continue to feed their babies, but for some the pressure of juggling work and breastfeeding soon becomes too much.
While postpartum confinement (坐月子, zuo yuezi) is designed to encourage lactation, some women emerge from their 30 to 45 days of seclusion finding they have little milk left to feed baby. The problem is not the special foods that the women consume during their confinement, but rather a lack of close and constant contact with baby. The focus in many confinement centers is on ensuring the mother relaxes and recovers from childbirth, and she does not always spend much time feeding and bonding with her child — especially during the evening, as prolactin (which helps produce breastmilk) is highest at night milk mothers are sleeping. According to doula Angela Chang, many carers in confinement centers (or well-meaning family members) offer to look after baby to allow new mums to get sleep, but this actually prevents the mothers from producing enough milk.
Additionally, the influence of infant formula companies is still pervasive. Most birthing classes are run by pharmaceutical or infant formula companies, so parents receive biased advice from the outset. Television and other commercials sprout the line that their product will help increase intelligence and make babies strong; I have noticed that there do not seem to be the same restrictions on formula advertisements that are in place in Australia and other countries. And recently, I heard from a well-placed source that hospital staff can receive up to NT$2,000 (around US$60) for each baby that samples formula while in hospital. One Taipei hospital had their government subsidy reduced after it was found that they had developed an overly close relationship with formula companies.
For me, I had so many breastfeeding problems with my first, premature baby that it gives me strength to persevere with the comparatively minor problems I am experiencing with my second, fussy baby. And while I do not want my child raised on formula, I am thankful that some was made available to him in hospital before my milk came in. Taiwanxifu Baby was dehydrated, lost weight and developed jaundice. So a bit of formula in his case, before I could produce enough to pump for him, was a blessing. Everything in moderation and in its place.