Health authorities in China reported this week that nearly 53,000 children have become sick after consuming tainted infant formula. As the effects of these contaminated dairy products become more widespread, many are discussing the alternative to formula — breastfeeding.

The scandal erupted earlier this month when Sanlu, China's top-selling infant formula manufacturer, publicly recalled its products. The baby formula was deliberately contaminated with melamine, an industrial chemical that can cause kidney problems. Since then, thousands of children have become sick and the milk powder has been blamed for the deaths of four infants. The crisis has not only raised questions about food safety, but also about why so many children are being fed formula in the first place, instead of being breastfed.

Thanks to its numerous health benefits, the World Health Organization recommends that children be breastfed exclusively for the first six months of life. However, despite a long tradition of breastfeeding in China, rates have declined as more mothers turn to milk formula. The rates of exclusive breastfeeding during an infant's first four months decreased from around 76 percent in 1998 to 64 percent in 2004. At six months, the percentage of babies being exclusively breastfed is only 51 percent.

Many blame China's shift away from breastfeeding on formula companies who aggressively target the 17 million babies born each year in China. Mr Dennis says:

“With the recent tainted formula scare in China I immediately became suspicious – why are so many Chinese using formula anyway? It is a poor country, surely they would be breastfeeding? Sure enough, just like in the West in the 40s and 50s, formula is being promoted in China as better than breast milk.”

He goes on to cite a report that blames the marketing of formula:

“Under Chinese consumer protection regulations, ads can’t claim or hint that a product is a replacement for breast milk. Nor are ads permitted to use images of breastfeeding women and babies. Nonetheless, infant formula companies often flout these regulations.”

Mike Brady, blogging for Baby Milk Action, also blames formula companies and their unethical advertising tactics.

“Consider a little further why there is a growth in formula use in China. It is undergoing rapid industrialisation and urbanisation, but that does not have to mean the fall in breastfeeding rates that is being experienced. Part of the cultural change is prompted by western companies. For example, Nutricia, now owned by Danone, promoted its ‘Kissing my Baby’ formula in China in 2004 with this gift CD with children's music.”

Some say that this push to use formula comes from doctors themselves. This despite the fact that China has banned the promotion of breast milk substitutes in hospitals since it launched the Regulation of Human Milk Substitutes Distribution in 1995. One article claims that almost 63 percent of babies receive formula in Chinese hospitals anyway. The same regulation also says that doctors must promote the advantages of breastfeeding.

Covenofovens, commenting on this article, shares his story of pushy doctors:

“We breastfed our baby exclusively for a year (breast milk and water only for the first 4 months, then breast milk, water and food after that)…This is not to say that we had formula pushed on us by doctors – especially the doctor that came to check on my wife a week after the birth. She brought a sample pack of formula produced close to Shenzhen (where our son was born), which sat on the shelf until we eventually threw it away.”

Nase, blogging from Malaysia on My Solitude of Space, says that the moms in his local Chinese community are less likely to breastfeed. He asked his mother as to the reasons why.

“Apparently (according to my mom and many Chinese moms), the main concern is about sagging breasts (quote from momma Rose: If I'd breastfed all five of you rascals, I'll be walking on four legs now!)…Other less convincing reasons given by my momma Rose was that due to inconvenience, as moms also need to work and care to other whims of their older children and husbands too!”

minipumpkin agrees that body image is an issue, but also blames a lack of time and the misconception that formula is healthier:

现在很多年轻的母亲怕身材变形、担心没有足够的个人时间，明明奶水很足，却生生地没有喂自己的孩子一口奶。面对市场上琳琅满目的奶粉以及大肆宣传的广告，妈妈们可能觉得没有了母乳照样有营养丰富的配方奶粉，冲调方便，孩子吃了还那么白胖，何乐而不为呢？我不想去批评不哺喂母乳的妈妈，她们当中确有因先天因素奶水不足而不得以人工喂养的，我只是为自己的决定而庆幸，而且通过这次三鹿问题奶粉事件，我本来打算周岁断奶的决定也延后了，再喂一段时间吧。

kakb2006, quoted from Hong Kong's newspapers, points out that working can be an especially large obstacle to breastfeeding for migrant workers.

目前，由於大量的農村人口出外打工，其中，許多婦女生了小孩後不久，就要離家繼續到城市打工，嬰兒在無母乳餵餔下，主要營養品就只能來自奶粉，也因為經濟條件相對較差，不少人買不起貴價奶粉，因此，便宜的奶粉近年一直在農村大有市場。

Some Chinese researchers have said that the shift back to breastfeeding will require greater promotion of its benefits. Hoyden About Town adds that this change will only happen if breastfeeding is supported financially, socially and practically. Perhaps the infant formula scandal will start pushing this change to happen in China. A post from the South China Morning Post reports:

“A lack of nursing skills, breastfeeding rooms, and public awareness are among the scores of reasons mainland mothers have abandoned breastfeeding over the years, but the melamine milk scandal is one factor forcing many to reconsider. Hospitals have been packed this week with scared mothers asking about breastfeeding, while the topic has become the most popular source of discussion on maternity and childcare websites.”

Image of Breastfeeding Allowed posted by Topinambour on Flickr.

Oiwan Lam contributed translations of quotes from Chinese to English for this post.