Nursing falls out of favor despite benefits

Lee Su-min, 5 months old, nurses at her mother's breast, a picture of utter bliss. She gazes peacefully into her mother eyes, oblivious to the stirring and suckling of more than 100 other babies in a packed auditorium at the Seodaemun Cultural and Sports Center in northwestern Seoul.

The babies, ranging in age from 5 to12 months, were entered in the "Healthy Breast-Fed Baby Contest," a first such event ever organized by a district office in an effort to promote breast-feeding. About 16 percent of Koreans mothers breast-feed at three months, according to the Planned Parenthood Federation of Korea. In Japan, the figure stands at about 50 percent. While in Europe, 70 percent are breast-feeding at three months.

Su-min's mother, Lim Ok-kyung-27, did not appear the least bit self-conscious as she nursed in public last Thursday. Su-min feeds every three hours and, inevitably, Ms. Lim has to breast-feed outside the home. "Sometimes I get off at a subway station to feed when the baby gets too fussy on the train," she said, adding that she always carries a piece of cloth to cover herself in public places.

Ms. Lim is not embarrassed, but breast-feeding seems to bother some people, she noted. "People quickly turn the other way when they see what I am doing. Some will have these looks on their faces that say, 'How could she?'"

Ms. Lim decided early in her pregnancy to breast-feed. "I knew about the nutritional benefits, but what compelled me was the suggestion that breast-fed babies tend to have a happier, more relaxed personality," she said.

Although Su-min was fed formula at the hospital, Ms. Lim began breast-feeding when they were discharged two days after the birth. She finds breast-feeding convenient because she does not need to prepare bottles and formulas. She also appreciates the close emotional bond she feels with the baby when she is nursing. However, there have been some difficult moments as well. "When I had mastitis and could not lift my arms, I was tempted to give up," she said. Watching her daughter in such pain, Ms. Lim's mother told her to discontinue breast-feeding.

She persevered, however, and Su-min, born 3.5 kilograms, now weighs a hefty 9.3 kilograms, a bit heavier than average for her age group. "Su-min is a lot more relaxed than her cousin, 20 days older, who is bottle-fed," said Ms. Lim.

Lactation specialists stress the importance of proper education and support in getting mothers to breast-feed. "There is a huge gap in the number of women who say they would like to breast-feed -- nearly 90 percent of pregnant women -- and the number of women who actually breast-feed after the birth," said Lee Jeong-mi, a Planned Parenthood official.

Ms. Lee said many mothers believe that infant formulas are better than mother's milk because of commercials hyping their benefits.

Quite the contrary, according to experts. The American Academy of Pediatrics recommends breast-feeding at least for the first 12 months, and says that breast milk alone provides ideal nutrition for the first 6 months of life.

Breast milk contains the correct proportion of carbohydrates, protein and fat. It also provides minerals, vitamins and hormones, as well as digestive enzymes. Essential fatty acids such as DHA (docosahexaenoic acid), essential to cognitive development and visual acuity, are also in breast milk. So are the antibodies from the mother that can help the baby fight infections. The composition of breast milk changes as the baby grows and its protection against illness is most evident during a baby's first six months.

A study published in the September issue of Pediatrics, a journal published by the American Academy of Pediatrics, suggests that breast-feeding may provide long-term cardiovascular benefits. Researchers found that cholesterol levels were lower in adults who had been breast-fed, suggesting that early exposure to mother's milk may reduce the risk of cardiovascular disease later in life.

Breast milk is also associated with higher IQs. Babies who were breast-fed exclusively for the first six months had IQs at 5 years of age that, on average, were three points higher than those who were breast-fed for 12 weeks or less, according to a recent study of more than 500 children born in Norway and Sweden.

Despite these benefits, most Korean women remain reluctant to nurse their babies. The lack of a supportive environment may be one reason. At most Korean hospitals, babies are automatically given bottles, foiling chances for successful breast-feeding. "Once a newborn is fed formula in a bottle, the game is as good as over," said Planned Parenthood's Ms. Lee. "It takes about 60 times as much effort for a baby to suckle from a breast than an artificial nipple. Once a baby knows that it can feed more easily from a bottle, it will reject the breast."

A program aimed at promoting breast-feeding at hospitals was launched by UNICEF and the World Health Organization in 1991. According to the "Baby-Friendly Hospital Initiative," a maternity ward can be designated as "baby friendly" when it meets a set of criteria, including the implementation of 10 steps to support successful breast-feeding. Among the requirements: helping mothers initiate breast-feeding within a half hour of birth; giving newborns only breast milk -- no food or drink -- unless medically indicated; allowing mothers and infants to be together around the clock; and not giving pacifiers to suckling infants. Five Korean hospitals were designated baby friendly this year.

The increasing number of working mothers has also contributed to the decline in breast-feeding in Korea, which reached a high of 59 percent in 1985. "It is very difficult for working mothers to continue breast-feeding when they return to work after the 90-day maternity leave," said Ms. Lee. Many mothers believe it is too much trouble, and very few are aware that the law requires employers to provide two 30-minute breaks a day for mothers breast-feeding children under the age of 1.

It is possible to continue breast feeding after returning to work. Milk expressed at the office should be stored in a clean container and kept chilled until ready to feed. The milk should be used within 24 hours if possible, and milk refrigerated more than 72 hours should be discarded. If placed in the back of the freezer, breast milk will last for at least one month.

"It can be done," said Ms. Lee. "However, employers are not required to provide lactation facilities, and it is a tremendous challenge to find a place to express milk. You can't very well do it in the bathroom."

by Kim Hoo-ran