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Why is Singapore still uncomfortable with breastfeeding?

Under 1% of new mothers are breastfeeding at the six-month mark. We look at why the take-up rate here remains in the doldrums

Today marks the start of the 24th World Breastfeeding Week, which is commemorated annually between Aug 1 to 7 in 170 countries and endorsed by major non-governmental organisations like the WHO and United Nations Childrens Fund (UNICEF).

The issue of breastfeeding remains a highly charged one in Singapore, where it struggles to be embraced by society. According to a nationwide survey on breastfeeding conducted by the Health Promotion Board in 2011 (the last comprehensive national survey conducted on this subject in Singapore), around 93 per cent of new mothers understood that breastfeeding is the best form of feeding for a newborn. Yet the percentage of new mothers here who breastfed their infants was around 50 per cent at the time of discharge, and fell dramatically to just below one per cent at the six-month mark. In comparison, approximately 15 per cent of mothers in the US and Australia are still breastfeeding exclusively at six months after childbirth.

This number is is still short of the 30 per cent target set by the World Health Organisation (WHO).

UNDENIABLE ADVANTAGES

WHO recommends that babies be fed breastmilk exclusively for the first six months at least. The proven benefits of breastfeeding are multifold: Health benefits for infants include protection from childhood infectious diseases like upper respiratory tract infection, lowered risk of sudden infant death and brain and eye development.

For mothers who breastfeed, there’s a lower risk of developing diabetes, breast cancer and aids with post-partum weight loss. The psychological and emotional benefits of the skin-to-skin contact of direct breastfeeding is less well-documented due to its complexity, but widely acknowledged as key to nurturing the maternal bond between the child and mother.

“Many are aware that there is a closer bond and reduced infection, but many mothers fail to appreciate that breastfeeding can change her and that (it) is about the continued relationship of a very dependent being that started in the womb. Breastfeeding is not about food, it epitomises motherhood, giving the baby the warmth, security, attention and stimulation to maximise their potential,” said associate professor Yong Tze Tein, senior consultant at Department of Obstetrics & Gynaecology at Singapore General Hospital (SGH).

“Whatever the mother’s choice, the baby’s choice is clear — direct breastfeeding. It is increasingly recognised that breastfeeding can affect the adult life of the child, offering protection from obesity and diabetes. Why should mothers dismiss such a wonderful gift of health?”

LACK OF AWARENESS AND MISCONCEPTIONS

Some of the main factors that account for mothers giving up exclusive or any breastfeeding are the general lack of awareness of the benefits of breastfeeding and widespread misconceptions about it, notes Dr Mythili Pandi, president of the Breastfeeding Mothers’ Support Group Singapore (BMSG). “The problem arises when the mothers return home (from the hospital) and they receive a lot of conflicting advice from all around them,” said Dr Pandi.

She points out that many established cultural and social practices — such as getting confinement nannies to take over night feeds during the confinement period with a bottle — have a big part to play in the fall in breastfeeding rates in the few months following childbirth. “I do think that the whole idea of confinement nannies needs to be revamped — confinement nannies help the mummies, not the babies,” she observed.

Social factors such as inadequate support from the workplace and communities, and embarrassment at breastfeeding in public spaces are also crucial contributing factors. “Allowing mothers to express milk or even breastfeed their babies when they return to work is a mark of how civilised a society we are,” said Dr Pandi, observing that the counselling hotline at BMSG has encountered many cases of mothers who are compelled to nurse or express breastmilk in inappropriate places such as public restrooms, or are told not to take too much time during working hours to express breastmilk.

GARNERING SUPPORT

Some local organisations are determined to change that. NTUC U Family organised last Saturday’s “The Big Latch On” event at the NTUC Centre, that featured talks by BMSG and Association for Breastfeeding Advocacy Singapore as well as a mass synchronised breastfeeding session. This is part of a global movement that calls on nursing mothers to show peer support to others.

KK Women’s and Children’s Hospital is partnering Japanese baby-care brand Pigeon in holding a similar event this coming Saturday at United Square Atrium titled The SG Mass Latch On.

Women’s advocacy group Aware also conducted a roundtable in March with the Breast-Feeding Friends (BFF) Singapore, a non-profit social campaign spearheaded by a group of four graduating students from Nanyang Technological University as part of their final-year project. This campaign was initiated in support of mothers breastfeeding their children in public spaces here, and the roundtable reflected on the findings of the survey in which most respondents said Singapore does not seem comfortable with either open or discreet breastfeeding in public, adding that they “never” or “rarely” saw breastfeeding in public spaces.

The founders of BFF Singapore were inspired to embark on this project after chancing upon an article on the benefits of breastfeeding and encountering instances of public discrimination against nursing mothers. “What really touched us and spurred us to start this project was the knowledge that mothers put in a lot more time and effort into breastfeeding their children than people perceive them to,” said Alyssa Teo, one of the founding members of BFF Singapore. “We really wanted to give these mothers a voice and to educate the general public more so that they can feel supported in their breastfeeding journey.”

The group has a website The BFF Finder, which features breastfeeding-friendly F&B establishments including Standing Sushi Bar, Fika Swedish Café and Bistro and Bar Bar Black Sheep. These cafes and restaurants have pledged to welcome and protect breastfeeding mothers on their premises, as well as offer gestures of support from offering breastfeeding mothers a glass of water and a chair with back support, to building a private nursing room.

“Presently, there is very little formal promotion and support of breastfeeding in the community, (so) accessible support for mothers after discharge and returning to work by community groups will increase the duration of breastfeeding,” said Wong Lai Ying, lactation consultant at NUH Women’s Centre.

MORE NEEDS TO BE DONE

However, more needs to be done on a national level, says assistant professor Yong: “I think it is important that events like these raise awareness and bring breastfeeding into the conversation but this is not enough. To optimise breastfeeding, we probably should have a nationwide approach.”

She advocates a nation-wide policy to promote breastfeeding, increased legislation and support for all maternity services to become accredited “Baby Friendly” and increased education for healthcare professionals, mothers and the public.

Another hurdle is in the widespread advertising and marketing of baby formula in Singapore, which contributes to the misperception of formula as an equivalent substitute for breastmilk, according to Dr Pandi. She added: “The government should halt all marketing of formula milk. Mothers who cannot breastfeed exclusively know that they have to buy formula anyway.”

 

CORRECTION: An earlier version of this report wrongly referred to the Nanyang Technological University as National Technological University. It has been corrected. We apologise for the error.

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