Why Hong Kong needs to do more for breastfeeding mothers
Originally published at the South China Morning Post on December 10, 2016.
On a corner bench at Victoria Park, Season Choi breastfeeds her 15-month-old daughter under a nursing cover. Despite her efforts to be discreet, she still receives a few glares from pedestrians – reactions she shrugs off as “common”.
“Once when I was breastfeeding at a park, an old woman told me to go home or hide in the toilet. Older people are more traditional,” 28-year-old Choi says. “In Asia, public acceptance of breastfeeding still lags behind places like the West.”
While Hong Kong has made recent efforts to normalise and promote breastfeeding, advocates say more should be done to raise awareness among medical practitioners and the public, as well as to provide adequate facilities and practical support.
The issue was highlighted earlier this week after allegations surfaced of a taxi driver secretly photographing a breastfeeding passenger and posting the picture online, sparking widespread criticism from users and the city’s health minister. The driver was arrested Thursday for accessing computers with criminal or dishonest intent.
Exposed and vulnerable, Choi gently strokes her youngest daughter as the baby wriggles underneath the nursing cover. She’s fed both of her children breast milk, and she says that while people have become more open, she still faces discrimination, particularly when she doesn’t use a blanket.
“When breastfeeding, women expose themselves. But it’s not for the public, it’s for the baby,” Choi says.
When Choi had her first child two years back, she says it was hard to find facilities to nurse or pump breast milk in private, and waiting times were long.
It is more challenging for working mothers in Hong Kong because they have to juggle the workload and time spent pumping breast milk, as well as finding a private place at the office, Choi adds.
She is now a housewife but was still working when she had her first child. Thankfully, her company then was supportive and allowed her to use the conference room.
In May, a Unicef Hong Kong survey found that 40 per cent of mothers have had an unpleasant experience breastfeeding in public – 90 per cent said they received stares and 30 per cent were asked to go elsewhere. Of those who did not breastfeed in public, about 77 per cent cited concerns about the perception of others and embarrassing loved ones.
Last year, a Health Department survey found that while 89 per cent of 2,000 respondents supported breastfreeding friendly workplaces, only 18.6 per cent worked in places with such policies. As of June, there were 271 baby care rooms on government premises, a department spokesman said.
Although the benefits of breastfeeding are well-documented, the city’s drop-off rate remains high. The World Health Organisation recommends exclusive breastfeeding for up to six months with continued breastfeeding for up to two years.
Yet according to the Health Department’s latest statistics, the breastfeeding rate for Hong Kong infants born in 2014 fell from 86 per cent at the time of hospital discharge to 25 per cent when babies reached 12 months old. From one month to six months of age, the exclusive breastfeeding rate also dropped from 31 per cent to 1.2 per cent. About 24 per cent were fed breast milk and solid food.
Dr Patricia Ip Lai-sheung, vice-chairwoman of the Baby Friendly Hospital Initiative Hong Kong Association, says the numbers are due to the fact that not all mothers are exclusively breastfeeding while in hospital, and many do not receive enough support after they are discharged.
“If they have already started on milk formula [for their babies] before they go home, the chances are they will continue to use formula more and the breastfeeding will stop,” Ip says, adding that the public may not be informed about the benefits of breastfeeding over formula because the government has yet to regulate milk formula advertising. “What [people] see everyday are ads for formula.”
According to Ip, not all medical practitioners are looking after newborns in a way that supports breastfeeding. Exclusive breastfeeding rates at a number of private hospitals are quite low, which means mothers are turning to formula even before they go home.
While public hospitals are now joining the association’s scheme by training staff and shifting facilities to support breastfeeding, no private hospitals have come on board thus far, Ip adds.
When Jennifer Lam Suet-ying, 40, had her first baby in 2008, nurses pressured her to top up with formula after nursing. “They just push you the bottle. I didn’t know what to do as a first-time mother so I topped up with formula all the time until I left the hospital,” Lam says.
“Spouses and families [have an excuse] to say ‘it’s okay, I can help you top up.’ It creates more pressure for mothers intending to exclusively breastfeed.”
Hong Kong Breastfeeding Mothers’ Association chairwoman Jannie Leung Hoi-ting says that there was a big push for milk formula in the 1970s and 1980s that normalised it over breastfeeding. Public awareness of breastfeeding benefits has been growing in recent years, but there is still insufficient information and practical support for mothers who encounter problems during the process, she adds.
Lily Ma, a 36-year-old lawyer and mother of two, had to hire a lactation consultant while she was in hospital after the birth of her first child.
“The doctors were supportive but they couldn’t offer any practical assistance,” Ma says. “Everyone says it’s really good and you should try it, but how? It doesn’t come naturally ... and you’re really tired after giving birth too. It’s an emotional roller coaster. The information is not readily available so by the time mothers go back to work a lot of them would have given up because it’s just too hard.”
Although Ma’s workplace has a nursing room, there is always a long queue. She now wears hands-free nursing wear and pumps at a stationery storage room near her desk while at work. The government should extend Hong Kong’s maternity leave – currently at 10 weeks – to make it easier for working mothers to commit to breastfeeding, she adds.
Jane Lau Yuk-yin, chief executive of Unicef’s Hong Kong committee, says other countries have stronger labour policies supporting breastfeeding mothers and clearer rules against discrimination. Taiwan implemented legislation in 2010 making it illegal to prevent women from breastfeeding in public and requiring places such as department stores to provide a breastfeeding room.
But things may slowly be changing in Hong Kong. In March, the Equal Opportunities Commission proposed legislative reforms to protect breastfeeding women against discrimination. Nursing rooms are also more common in public areas and workplaces, Lau says.
“The first step is encouraging a positive attitude,” she adds. “Many mothers have said they would breastfeed if they can overcome these obstacles.”
What some mothers in urgent situations are doing to breastfeed away from public scrutiny and ire:
A working mother resorted to paying for a HK$180 taxi ride in order to pump breast milk in privacy, local media reported in August. In a Facebook post, the taxi driver wrote that the woman entered the vehicle outside a Central office building and asked the driver to drive along the road before returning, according to Apple Daily. The woman told the driver that there was no space at work to pump, according to standnews.com.
Since there was no designated place for nursing mothers to pump at her school, teacher Jessica Kuwata often resorted to pumping inside a tiny closet that stores boots and jackets. “The problem with this broom closet is that it smells really bad and mouldy [and] there is no lock. At least once, somebody [will] walk in,” Kuwata said. She said the government should legislate on providing sanitary, lockable spaces for mothers to use at work and in public areas.
Senior human resources officer Emily Shiu Tsz-ling used to hide in dirty toilet cubicles at work to pump breast milk, the Post reported in March. “I couldn’t touch anything while I was pumping milk, the hygiene was so bad,” Shiu said. “I would feel stressed when there were people lining up outside [to use the cubicle] and produced less milk as a result.” Her company later converted an interview room into a nursing area.
Jennifer Lam Suet-ying, a 40-year-old mother, had to hide inside her husband’s car while parked outside on the street because she couldn’t find a private place. “It was so hot ... we had to switch the engine on. I was in a stationary car, and I was hiding, because I couldn’t even find a seat,” she said. “Malls may just have one [nursing] room on one level, or just two in the whole mall. I would prefer something simple like a big room where there are curtains.”
Following public outcry condemning a taxi driver who allegedly posted a secretly taken photo of a breastfeeding passenger, the Post interviewed Hongkongers for their opinions on breastfeeding in public:
Wong Wai-lun, father to a 10-month-old, said “finding places to breastfeed is quite a struggle for parents,” adding that he would love to see more nursing rooms in MTR stations and ferry piers. “Mothers would quite consciously cover their breasts with the towel. But overall, I think mothers should be able to breastfeed their babies anywhere they want.”
Fun Sang, who is in his 60s, said people have perverted views about public breastfeeding “because our society is seeing an overflow of pornographic images”.
“On the mainland, breastfeeding in public is normal. In other countries, it is also acceptable,” he said. “We are making too big a fuss here.”
Lam Ho-yin, 23, said that it is a mother’s responsibility to breastfeed. “When a child is crying for food, a mother has no other choice but to feed him,” he said, adding that if she wants to do so in a taxi, she should inform the driver who might want to keep the car tidy. “It’s about mutual respect. It is similar to eating in a taxi.”
Chung Shan-chan, in his 60s, said that mothers should be able to breastfeed anywhere but added that “the Chinese are conservative and so people are uncomfortable with breasts being exposed [in public]”.
“I think most people are okay with people breastfeeding in public. They are just not okay with people exposing too much in public,” he said. “I usually walk away [when I see breastfeeding] not out of embarrassment but to give them privacy.”
Additional reporting by Josh Ye