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Report on National Survey Into Factors Influencing Breastfeeding

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Report on National Survey Into Factors Influencing Breastfeeding Report on National Survey into Factors Influencing Breastfeeding (Conference Version) China Development Research Foundation February 2019 China Development Research Foundation “Breastfeeding Promotion Initiative” Team leader: Fang Jin Team members: Qiu Yue, Wang Xiaobei, Li Jia Written by: Wang Xiaobei, Li Jia Table of Contents Table of Contents ..............................................................................................................I Section I. Background ...................................................................................................... 1 Section II. Subjects and Methods ...................................................................................... 3 I. Purpose and General Framework ................................................................................... 3 II. Sampling................................................................................................................... 3 III. Questionnaire ........................................................................................................... 5 Section III. General Information of the Samples ................................................................ 5 Section IV. Breastfeeding for Infants under One Year of Age .............................................. 9 I. Breastfeeding among infants within the first six months ................................................... 9 II. Addiction of other foods or fluids to the diet of nonexclusively breastfed infants up to 6 months of age ......................................................................................................................... 10 III. Regional variations in infant feeding within the first six months .....................................11 IV. Breastfeeding among 6-11m infants .......................................................................... 12 V. The rate of immediate SSC and early breastfeeding after childbirth ................................ 13 Section V. Analysis on Factors that Influence Breastfeeding.............................................. 13 I. Personal factors......................................................................................................... 15 1. Maternal and infant health ...................................................................................... 15 2. Perception of breastfeeding..................................................................................... 16 II. Institutional factors................................................................................................... 24 1. Supports from medical and health institutions ........................................................... 24 2. Supports from family ............................................................................................. 27 3. Supports from workplace and employment ............................................................... 27 4. Supports from public places.................................................................................... 29 III. Social Structural Factors .......................................................................................... 30 1. Regulation of breast-milk substitutes market ............................................................. 30 2. Maternity leave policies ......................................................................................... 31 Section VI. Discussions and Policy Suggestions ................................................................ 34 I. Promoting the knowledge popularization and technical support for breastfeeding .............. 34 II. Improving relevant laws and regulations and tightening the regulation of the marketing of breast-milk substitutes................................................................................................... 37 III. Improving the maternity leave policy and maternity services policy............................... 39 IV. Encouraging employers and public places to provide desirable environments and conditions for breastfeeding .......................................................................................................... 42 Section VII. Conclusion .................................................................................................. 44 References ..................................................................................................................... 47 I Report on National Survey into Factors Influencing Breastfeeding Section I. Background With the continuous socioeconomic progress, child nutrition and health have attracted growing public attentions. Improving nutrition and health during childhood underpins the goal of promoting overall human development, enhancing quality of human capital and ensuring socioeconomic sustainability. An increasing number of research has shown that infancy from birth to two years of age is a critical period for life-long health and nutrition[1]. Breastfeeding is the best source of nutrition for newborns and infants during this period, which is one of the most effective measures of keeping healthy development and growth of children[2]. Studies find that breastfeeding cannot be replaced[3,4]. The nutrients contained in breast milk can be readily digested and absorbed by babies, and have a significantly better biological availability than those in any other foods, so as to meet the babies’ physiological needs at different stages. Rich in anti-infective factors, breast milk can guard babies against gastrointestinal and respiratory diseases, and decrease infant mortality rates effectively[5]. Previous studies have shown that improving breastfeeding behavior would annually save about 820,000 life, 87% of whom are less than 6 months of age[5]. In addition, breastfeeding has a positive impact on cognitive and non- cognitive development during early infancy. On the one hand, the presence of essential amino acids is of vital importance to brain growth, intelligence and learning ability. On the other hand, when breastfeeding, mothers’ voice, embrace and skin-to-skin care can stimulate brain response of babies, promote early intellectual and psychological development, and accelerate their adaptation to the extra-uterine life[3]. Breastfeeding is also good for infant health and postpartum recovery. For example, it helps decrease the risk of obesity and diabetes later in life[3,6]. Besides, a woman who breastfeeds has a decreased risk of breast and ovarian cancers and some cardiovascular diseases, and will have her uterus healed faster[6]. The benefits of breastfeeding for babies and mothers have become global consensus. The UN “Convention on the Rights of the Child” (《儿童权利公约》) has made it clear that good nutrition is a fundamental right of each and every child, and all state parties have a legal obligation to promote breastfeeding[7]. WHO and UNICEF, among other international organizations, have launched standards and policies about breastfeeding, including International Code of Marketing of Breast-milk Substitutes（《国际母乳代 用品销售守则》）, Innocenti Declaration（《因诺琴蒂宣言》） and Baby-friendly Hospital Initiative（《爱婴医院倡议》）, urging all countries to take effective measures to protect, promote and support breastfeeding. In 2002, WHO and UNICEF jointly developed the Global Strategy for Infant and Young Child Feeding（《婴幼儿喂养全 球战略》）, an initiative that aims to improve the nutritional status of infants and young children through optimal feeding [2]. It recommends that “infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond[2].” Fully Realizing the importance of 1 breastfeeding, relevant authorities of Chinese government have developed and implemented series of documents, such as the Law on Maternal and Infant Health Care (《母婴保健法》), Measures for Administration of Breast-milk Substitutes （《母乳 代用品管理办法》）, Advertising Law（《广告法》）, Outline for the Development of Children（《中国儿童发展纲要》）, National Strategy for Infant and Young Child Feeding（《中国婴幼儿喂养战略》）, and National Nutrition Plan (《国民营养计 划》), to support and promote breastfeeding over the years. Now, many national governments and international organizations like WHO have taken the rate of exclusive breastfeeding of children under six months as a major indicator of a country’s breastfeeding prevalence. The “Global Nutrition Targets 2025”（全球营养 目标 2025） endorsed by the World Health Assembly (WHA) in 2012 outlines six nutrition targets, one of which is to increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% by the year 2025[8]. The Outline for the Development of Children (2011-2020) （《中国儿童发展纲要（2011-2020）》）and National Nutrition Plan (2017-2030) （《国民营养计划（2017-2030 年）》）, promulgated by Chinese government in 2011 and 2017 respectively, set a clear goal of increasing the rate of exclusive breastfeeding among 0-6m infants to over 50% by 2020[10,11]. The National Nutrition Plan (2017-2030) expects a further 10% increase by 2030[11]. But things do not bode well in China. Studies have shown a descending rate of exclusive feeding among children under months as the economy and society advances[12]. According to the 1998 national food and nutrition survey of 40 monitoring sites nationwide, the rate of exclusive breastfeeding among children under 4 months reached 53.7%[13]. However, China National
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