Mothers in Hong Kong are breastfeeding more than ever. It is estimated that about 87% of mothers initiated breastfeeding, up from 19% in 1981. Despite these successes, we still see a big drop in the number of women exclusively breastfeeding up to the recommended 6-month mark by the World Health Organization. We at Healthy Matters reviewed the latest progress Hong Kong has made and specifically looked into why rates of breastfeeding cessation remain high.
Breastfeeding historical context in Hong Kong
In Hong Kong and around the world, there was a big push for formula feeding from the early twentieth century until the 1980s. Formula manufacturers aggressively marketed directly to the medical community, pushing their agenda through physicians’ expert voices. Use of breast milk substitutes became associated with scientific authority and breastfeeding rates dropped around the world. The social stigma ignited by, in part, the marketing of breast milk substitutes remains today, especially in older generations.
Breastfeeding progress in Hong Kong
The number of women who initiate breastfeeding in Hong Kong has made great strides in the past thirty years. The recently passed amendments extending maternity leave to 14 weeks and prohibiting direct and indirect discrimination on the ground of breastfeeding is a new contribution to breastfeeding progress. Public health campaigns have championed the benefits of breastfeeding, and the Hong Kong Hospital Authority has pledged that all public hospitals with maternity wards will comply with the Baby-Friendly Hospital Initiative (BFHI) by 2022.
The BFHI is a joint initiative between the WHO and UNICEF launched in 1991 to encourage maternal facilities to help mothers initiate breastfeeding for the first time, encourage breastfeeding on demand, give babies no food or drink other than breast milk and foster the establishment of breastfeeding support groups for mothers after hospital discharge.
In April 2010, all public obstetric wards in Hong Kong stopped accepting free breast milk substitutes or formula. Suddenly, formula was not given so readily to newly breastfeeding mothers. The rates of exclusive breastfeeding during postpartum hospital stays in four public hospitals increased from 17.7% in 2006/2007 to 41.3% in 2011-2012. In the year 2018, Hong Kong has also seen an increased breastfeeding rate on discharge from hospitals, which was 87.7%. After 3 years since implementing the Baby-Friendly Initiative (BFI), it was found in a breastfeeding survey (2019) that, there was a mean increase of 2.5% (maximum 5.7%) breastfeeding at 4 months, and a mean increase of 3.5% (maximum 5.4%) breastfeeding at 6 months.
Which Hong Kong hospitals are breastfeeding-friendly?
As of August 2020, nine public maternity wards have registered their intent to become a designated Baby-Friendly hospital within 5 years. Comparatively, as of 2020, more than 20,000 hospitals worldwide had been designated Baby-Friendly Hospitals, including 6,000 in Mainland China.
There are five steps to become a Baby-Friendly Hospital and in Hong Kong, eight public hospitals with maternity wards are at various points along the designation process.
Until late 2016, only Queen Elizabeth Hospital was actually a Baby Friendly Hospital. In January 2018, Queen Mary Hospital was also certified as Baby-Friendly. A number of other public but also private hospitals (such as Gleneagles Hospital Hong Kong) have joined the movement.
Updated information can be found here and below is a list of hospitals who pledged to be baby-friendly (as of August 2020).
|Name of Hospital||Achieving Level of Designation||Date|
|Queen Elizabeth Hospital|
Award of Baby-Friendly Hospital
Revalidation of Baby-Friendly Hospital
|Queen Mary Hospital||Award of Baby-Friendly Hospital|
|Prince of Wales Hospital||Award of Baby-Friendly Hospital||July 2019|
|Pamela Youde Nethersole Eastern Hospital||Award of Level 2 Participation||September 2019|
|Tuen Mun Hospital||Award of Level 1 Participation||May 2019|
|Kwong Wah Hospital||Award of Level 1 Participation||May 2019|
|United Christian Hospital||Certificate of Commitment||November 2017|
|Princess Margaret Hospital||Certificate of Commitment||September 2019|
|Gleneagles Hong Kong Hospital||Certificate of Commitment||October 2019|
What is stopping women in Hong Kong from breastfeeding?
While impressive strides have been made to encourage breastfeeding initiation, the rates of women adhering to the WHO and HKDoH‘s recommendation of exclusive breastfeeding at 6 months is still low at 27.9%, with most women discontinuing within the first few months. As of 2019, there is still a wide range of exclusive breastfeeding rates; among public hospitals it ranged from 21% to 36%, while in private hospitals, it ranged from 0.3% to 63%.
Breastfeeding in Hong Kong is hard. Most women who discontinue breastfeeding don’t stop voluntarily but because of breastfeeding issues. Breastfeeding is natural but that does not mean it comes naturally to mom and baby. It is a learning process. Below are some barriers cited by women in a study conducted by Dr. Marie Tarrant and colleagues in 2014 who stopped exclusively breastfeeding before the recommended six-month mark.
Reason #1: Preparation – Most women in Hong Kong take some kind of prenatal class but many report that they simply do not feel adequately prepared for the challenges of breastfeeding.
Reason #2: Lack of in-hospital support – The public hospitals are pro-breastfeeding but in reality, midwives in Hong Kong public hospitals can be quite busy and may not have the time to provide individualised support.
Reason #3: Lack of post-birth support – Maternal and Child Health Clinics offer breastfeeding support, but require mother and baby to travel to the MCHC location to access support. Many women find it difficult to travel far outside the house in the initial period post-birth and miss out on getting help during a crucial period.
Reason #4: Maternity leave – Maternity leave in Hong Kong is short. Ten weeks is considerably shorter than many other countries. Women in other countries find flexible or part time working arrangements, but here in Hong Kong, the high cost of living necessitates a lot of dual income families. Combine that with a lack of part time opportunities here and most women are back to work after 8-12 weeks.
Reason #5: Lack of breastfeeding friendly workplaces – Expressing enough milk in the workplace to maintain supply and continue to exclusively breastfeed is a major challenge for Hong Kong women. An increasing number of workplaces are committing to being a Breastfeeding Friendly Workplace, but for many women, taking the time out of their workday to express milk remains a barrier.
This article was reviewed and updated on August 4, 2020.
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