Friday, January 30, 2015

Breastfeeding in Developing Countries: the Myths, the Problems, and the Progress

By To-wen Tseng. Originally posted on San Diego County Breastfeeding Coalition's Blog.

The critical importance of promoting the value of breastfeeding globally, nationally, and at the community level can never be highlighted enough. According to UNICEF, the potential impact of optimal breastfeeding practices is especially important in developing country situations with a high burden of disease and low access to clean water and sanitation.

Dr. Yvonne Vaucher (MD, MPH, FAAP), the Immediate Past-President of San Diego County Breastfeeding Coalition and Professor of Pediatrics at UC San Diego, recently discussed the problems and progress of breastfeeding in developing countries at the Coalition’s general meeting.

Dr. Vaucher talked about the impact of suboptimal breastfeeding on survival in developing countries, pointing out that suboptimal breastfeeding is a major cause of childhood death worldwide. She cited a 2006 study published by Public Health Nutrition, saying that suboptimal breastfeeding is the number three cause of childhood death globally, second only to malnutrition which causes 3.75 million deaths per year, and unsafe water, sanitation and hygiene which lead to 1.73 million deaths per year.

“Suboptimal breastfeeding is responsible for 1.45 million deaths per year,” said Dr. Vaucher, “that is 4,000 deaths per day, 165 deaths per hour, or 3 deaths per minute.”

The same study showed that optimal breastfeeding up to two years of age in developing counties would prevent 13%, or 800,000 of all deaths in children under five years each year. Unfortunately, “there are too many factors resulting in suboptimal breastfeeding,” said Dr. Vaucher.

Those factors include: delayed initiation of breastfeeding, prelacteal feeds, supplementation with water, teas, animal milks, formula feeding, health provider misinformation, commercial promotion of formula, maternal C-section, illness, or death, and infant low birth weight or illness.

Dr. Vaucher believes that early and exclusive breastfeeding is a cultural issue. “Some cultures appreciate other liquids like teas and animal milks,” she said. “Others accept water as compatible with early breastfeeding. Some cultures prescribe early feeding of solids at four to five months, or believe that a fat baby is a healthy baby."

Formula and breast milk supplements also contribute to the barriers to exclusive breastfeeding. In many developing countries, people believe that formula is “scientific” and “modern,” and symbolize economic and social success.

A risk of breastfeeding in developing countries is the transmission of infectious diseases such as HIV and Ebola. The New York Times reported in 2008 that “up to 48% of infant HIV in developing countries is from breastfeeding.” However, Dr. Vaucher said, “Protective factors including antibodies, cytokines, antiviral lipids, lactoferrin, and glucosoaminoglycans are also present in breast milk.”

There has also been a lot of discussion about Ebola. “The risk of transmission from mother to infant is very high based on close contact alone, not necessarily breastfeeding,” said Dr. Vaucher. “If possible, experts recommend to have anuninfected caretaker and alternative food source for infant.”

It is often assumed that breastfeeding is optimal in developing countries where it is the norm. This is a myth. There are actually many barriers to exclusive breastfeeding in developing countries. “The good news is,” said Dr. Vaucher, “breastfeeding rates in developing countries are no longer declining.”

She said that exclusive breastfeeding rates are improving in most developing countries, thank to increased government action to support and protect breastfeeding. Currently, world health organizations continue their breastfeeding initiatives in developing countries. Key components and interventions including controlling marketing of breast milk substitutes, and providing community-based counseling and support.

Research shows that breastfeeding rates increase when moms immigrate from developing countries to the U.S.


Wednesday, January 14, 2015

Many years after college, I’m still working my butt off for tuition

By To-wen Tseng. Originally posted on

Just a couple of months ago, I helped to translate Dr. Glenn Doman’s Fit Baby, Smart Baby, Your Baby to Mandarin Chinese. At the beginning of the book, Dr. Doman wrote, “The early development of mobility in newborns is a vital part of their future ability to learn and grow to full potential.”

When translating this sentence, I looked at my 20-month-old. Surely we all know that learning begins at birth and the brain develops faster between birth to age 3 than any other period of life. This is why early care and education is an important and critical development phase.

Actually, my husband and I are currently paying $19,000 per year for our little one’s day care. This is the biggest expense of our family, even bigger than our house mortgage.

I hold a Master’s degree in Broadcast Journalism from Boston University. That’s a private school and the tuition was $45,000 per year. With my scholarship, I still need three part time jobs to pay that tuition. I have done the coach tape for the university hockey team, worked the midnight shift at a convenience store, and as an assistant in a production company.

My husband holds a Doctorate degree in Computer Engineering from North Carolina State University. That’s a public school. Even though the rate for an engineering major is higher than other majors, the tuition was only $7,000 per year for residents and $21,000 per year for nonresidents. My husband was a teaching assistant, and it was fairly easy for him to afford that tuition.

Then we graduated, got good jobs. We never thought we’d ever have to work our butts off for tuition again.

But now we are. As a computer engineer and a journalist, we are literally working our butt off for our 20-month-old’s day care tuition. We are both the first generation immigrants in America, and we have no family members here to help out. We both work more than 50 hours per week, my husband often brings work home, and I travel to Asia a lot for work. We moved into a smaller house so that we can pay for a decent day care.

But, still, we are grateful, because many of our friends cannot afford early education. Many of my girlfriends quit their job and become stay-at-home mom, because their salary doesn’t pay for the day care, especially when they become mothers of two or more children. As for us, to be honest, with this day care expense, we really can’t see the possibility for us to have a second child.

It doesn’t take a math major to see there is something really wrong here—the early education now costs even more than higher education! Day care is even more expensive than college!

I am a believer that all families should have access to high-quality, affordable options for their children’s early care and education, whether they choose to have their children to spend time at home, in childcare, or preschool. White House actually promotes early learning, because it is a good investment which boost our children and our economy. It makes the ridiculous high-price of childcare seem to be even more ironic. Sometimes I wonder if the leaders of the nation know that how much childcare costs these days.

I was in Taipei for a book tour last month when I received a calling-for-action e-mail from MomsRising. I was delighted to see the representatives of MomsRising were on Capitol Hill, delivering letters to Congress and letting them know that we need high-quality, affordable childcare that supports parents.

I regret not being able join these women. The good thing is, it’s never too late to take action! Check out the MomsRising's storybook:

Little one, 3 month old, first day to school.

Saturday, January 3, 2015

Building a breastfeeding friendly society

By To-wen Tseng. Originally posted on San Diego County Breastfeeding Coalition's blog.

During a recent business trip to Taiwan, I was surprised by what I saw: There are nursing rooms literary everywhere I went. Nursing rooms can be found in government buildings, in shopping malls, in libraries, even in metro stations.

I was surprised because this is not the Taiwan that I remembered. I was born and raised in 1980’s Taiwan. My mom did not breastfeed. When I was growing up I had never seen anyone breastfeed. As a child, I thought all the babies were born to be bottle fed.

And this is not my personal experience. This is a collective memory of all the Taiwanese people in my age. Actually, according to the Taiwanese government, infant formula marketing in Taiwan reached its peak in 1980. In 1989, only 5.8% newborns in Taiwan were breastfed.

Now the generation that was not breastfed, that has never seen anyone breastfeed as a child, grew up and became new parents of the next generation. Surprisingly, most of them choose to breastfeed. Currently in Taiwan, 72% newborns under 1 month old are exclusively breastfed; 45.6% infants under 6 month old are exclusively breastfed.

What happened in Taiwan during the past 30 years is amazing. The 5.8% low breastfeeding rate in 1989 shocked the Taiwanese government and medical professionals. Later in 1992, the government adopted “International Code of Marketing of Breast-milk Substitute” and decided to ban infant formula TV commercial and infant formula promotion in hospitals. But the breastfeeding rate did not go up.

Then in 1998, Taiwanese government started to promote Baby-Friendly Hospital Initiative, requiring all the hospitals to train its health care staff in the skills necessary to implement breastfeeding policy, helping mothers initiate breastfeeding within one hour of birth, and allowing mothers and infants to remain together 24 hours a day. Taiwanese breastfeeding rate went up after this policy.

On the other side of Taiwan Strait, it’s totally a different story in Mainland China. Back in 1998, more than 67% newborns in Mainland China were breastfed, but the current number is 27%. In 16 years, the breastfeeding rate in China dropped by 40%. China has became the world’s largest infant formula consuming country. Each year, Chinese parents spent $11.3 billion on infant formula. More and more Chinese mothers give up breastfeeding to formula feeding.

The “Breast is Best” poster can be found everywhere in all the hospitals China, but infant formula manufacturers can also freely promote their product anywhere in all the hospitals in China. While health care staff telling mothers “breastfed babies are the healthiest,” formula manufacturers tell mothers “breastfeeding is only for those who cannot afford infant formula.”

Baby-Friendly Hospital Initiative is not promoted in mainland China. Women’s right to nurse in public and pump at work is not protected by Chinese law.

The 2008 Chinese milk scandal did not change the situation any. According to a CCTV survey, more than 70% of Chinese parents lost confidence in Chinese-produced infant formula, but they did not switch to breastfeeding. Instead, they rushed to Hong Kong to purchase U.S.-produced infant formula. The situation got so bad that Hong Kong government passed a restriction order, requiring each mainlanders can only carry two cans of infant formula when leaving Hong Kong. Now Chinese parents are buying up infant milk everywhere they can get it, outside of China. And that has led to baby formula shortages in at least a half-dozen countries, from Netherlands to New Zealand.

The lesson from China and Taiwan is that, simply telling mothers “breast is best” is not enough to encourage mothers to breastfeed. Mothers need a real breastfeeding-friendly environment to comfortably nurse their babies, from a baby-friendly hospital to a baby-friendly public.

A nursing room in Taiwan Immigration Office.