The responsible thing to say about breastfeeding is that breast is best. And of course, breastfeeding is best, depending on how you define best I guess. Studies show that hundreds of thousands of babies could be saved each year if breastfeeding practices were initiated at birth. According to all credible international health organizations, breastfed babies do better nutritionally, emotionally, psychologically, and developmentally. When doing graduate research work in Papua New Guinea, I witnessed first-hand the havoc that can be caused when breastfeeding is abandoned for the modern convenience of bottle feeding. The sad truth is, in the face of unsanitary conditions and poverty, babies who don’t breastfeed fare much worse.
In China over the last thirty years, many political, economic, and social changes have occurred to affect breastfeeding rates. This includes women entering the workforce, family planning policies, migration and the “left-behind child” phenomenon. While I have never spoken to a Chinese person who isn’t adamant that yes, breast is clearly best, the decision making process around infant feeding remains much more complex. While mothers remain the main caregivers for infants in Western countries, in China it is other family members (mainly grandparents) who shoulder the responsibility for infant feeding and caretaking.
Breastfeeding and Biomedicine in The West
Cultural contexts of breastfeeding do not, of course, start and end with infant health. Breastfeeding has been medicalized, moralized, commoditized and embody-tized. Infant nutrition research is often seen as an objective, neutral science, but of course has its own discourse and cultural history.
In the U.S and many Western countries, for example, motherhood is seen as an intensely personal, individual duty that women must take on. Westerners live in social patterns that focus much attention on individuality, and “good mothering” campaigns use this to their get their message across. Mothers are easy targets for any campaign promoting good parenting, and are judged by society before the child is even born. Are they drinking alcohol? Smoking? They want to have their baby where? I’ve heard sentiments equating formula feeding to child abuse, pointing the finger staunchly at the mother for subjecting her suckling babe to the horrors of “that poison” (true story).
In breast is best-esque campaigns in the West, the emphasis is always on the baby’s health. Society is less than concerned with structural barriers set up against mothers in these campaigns, and more concerned that women just do whatever it takes to breastfeed that baby!
Breastfeeding in China: A Family Affair
As my interest lies in infant feeding patterns, I have spent many an afternoon in breastfeeding support group meetings in China, both among ex-pats and Chinese people. Among the ex-pats, women and their infants show up to these support groups, where they typically sit in a circle (with the baby’s playing with toys or simply crawling around in the center), discuss issues of breastfeeding, and swap advice on how to deal with this or that associated with breastfeeding and child-rearing in general. It’s casual, it’s relaxed, and we usually end up brunching afterwards.
Among the Chinese breastfeeding support group, however, women and their children are accompanied by husbands, grandpas, grandmas, aunts, housekeepers, and other family members who’s relation I am never quite sure of. It is held at a hospital, is more lecture style, very formal, with a physician at the front discussing the benefits of breastfeeding. It includes Q&A, where family members ask questions regarding night feedings, going back to work, allergies and milk supply. Fathers, surprising to me, are active participants, and discuss “let-down”, mastitis, and hind milk without batting an eye.
Historically in China, breastfeeding was commonplace up through twelve months and later. In recent years, however, there has been a decline in breastfeeding rates in both rural and urban areas, even as the BIB campaign has gained momentum here. Because of this, many factors involved in infant feeding and outcomes research are currently being explored in China, including inadequate household resources, economic constraints (i.e. the mother is working outside of the home and is unable to breastfeed), migration, the effects of the media, and a lack of policy and educational programs directed toward the public.
But something that is not quite being explored here is the notion of self and personal responsibility. Because in China, a mother does not raise a child; the family does. The Chinese society rests on the principle of the yin and the yang, where nothing exists independent of anything else. Through these manifestations, Chinese mothers are entrenched in a system where they are part of a whole.
In a study I’ve been observing for the last eight months in an urban Shanghai clinic, upwards of 40 percent of infants are exclusively fed by grandparents. Another 30 percent are fed jointly. When discussing this with my Chinese colleagues at Shanghai Jiaotong University School of Medicine, they thought that rates in rural areas might be even higher, that the mother would have even less resources to be able to breastfeed or be involved with the care of her infant, if she’s there at all.
Interesting note about some of my observations in this clinic: adult to infant ratio was pretty stable day-to-day at about 3.5 to 1. And that’s an average. Once I counted 14 adults in the room for 3 babies. Not including the physicians. When discussing breastfeeding with these families, the physicians I work with would many times elicit the response “Mother stopped breastfeeding due to work/not enough milk.” All the while grandma was holding the baby, grandpa was holding the baby’s things, and nanny was answering the questions.
When perusing the Internet to find Chinese language information on breastfeeding and breastfeeding promotion, it is also interesting to note that most websites talk about “Western science” and “women in Western countries”. This website shows a European woman breastfeeding, although the site is clearly geared to a Chinese audience. While it’s unclear how Chinese women as a whole view these breastfeeding campaigns, it is obvious to me that the jury is still out on the future of breastfeeding here. Many families are terrified at recent milk scandals and go to great lengths to nurse their infants.
New Paradigm For Infant Feeding
Western concepts of motherhood, family, and “the individual” continue to have little to do with everyday reality of the Chinese mother. Not that breastfeeding is a “Western” concept anyways. Breastfeeding is, of course, a biological way to feed a baby. And Chinese mothers are by no means passive players in the decision-making process surrounding infant feeding. Believe me, Chinese women have much to say about their experiences in child-rearing. But Chinese society has undergone some incredible changes over the last thirty years, and traditional practices may no longer hold relevance in their new economic, political, or social system. Add to this a terrifying infant milk scandal, the rural-to-urban migration of young women, and family planning policies where there is one child, 2 parents, and 4 grandparents, it is unsurprising that a new discourse of infant feeding is currently taking place in Chinese cities, villages, clinics and businesses.
In Dorinne Kondo’s 1990 ethnography Crafting selves: Power, gender, and discourse of identity in a Japanese workplace, Kondo speaks about the socially constructed “concept of self”, and discusses how identity is a “creative process”, where “human beings create, construct, work on, and enact their identities…”. In China, this self is always “crafted” in relation to the family, to the collective, to the whole. Yes, women are the ones who breastfeed, and no, usually grandma’s and husband’s can’t breastfeed for them. But the fact of the matter is in China, infant caregiving remains a communal activity. In the face of economic constraints, busy work schedules, and little social support outside of the family system, grandparents are taking over the role as primary caregiver.
Having grandparents and primary caregivers doesn’t mean that mothers in China can’t breastfeed. Of course, millions of women in China breastfeed, and find the support of their families to be incredibly comforting in the face of the many fast-paced challenges and changes happening in their country. Any woman will tell you, breastfeeding is never easy, and never what they expected. How much better if your husband, mom, aunt, husband’s mom and the nanny were with you to support you and shoulder this responsibility with you?