It really frustrates me the number of heart-ache stories that I hear from friends who’ve been totally convinced by the Japanese mass media that their breasts aren’t good enough for their babies. Just as depressing are the number of stories that I’ve heard where mothers in Japan who had previously believed that breast is best, have been convinced by their doctors (after only a few weeks of trying) that they’re not making enough milk and switched to formula or a mix of formula and breast milk. Whereas 90% of Japanese mothers when surveyed before giving birth suggest that they want to raise their child on breast-milk, only 3~40% of them are still exclusively feeding their babies breast milk by their three month check up. That is lower than most countries in Asia, and is extremely low when compared even with developing countries – what makes Japanese mums feel so unhealthy/unqualified that they can’t breastfeed properly? It’s not because they are rushing back to the work force, the vast majority are dedicated (and motivated) stay-at-home mothers. It’s because a combination of dated medical practices and an advertising dollar focused publishing industry has lead Japanese mothers to believe that there is a good chance that their breasts won’t be making enough milk. If you introduce me to another Japanese mum who cries to me that her breasts are 出が悪い (degawarui, don’t make enough milk) then I think I will take to her doctor with a knife! While I profess to have no official medical background, I’m hoping that my views as a novice Daddy-san in Japan will be able to save a few couples from resorting to an unnecessary evil. (This is the second article in this “Daddy-san” series. Make sure to also read part one).
To be very clear, I have absolutely no qualms with mothers using formula for lifestyle reasons: because they want to go back to work, because they want more freedom or because their husband wants to be a stay-at-home Dad, etc. I know many people who were raised exclusively on formula and they have been able to function as normal human beings. I’m angry because there is a significantly large number of mothers out there who want to feed their babies breast milk but are actively discouraged by (a) their pediatrician, (b) mass market literature claiming to offer information on bringing up babies, (c) stealth marketing by infant formula companies and (d) their parents (who grew up in a time where formula was erroneously thought to be better than breast milk.) Let’s be very clear about this. There is absolutely no doubt that breast milk is the best thing that your baby should be drinking. Your baby can and should be fed exclusively with breast milk (that also means no water) for approx. 6 months. Even after you gradually introduce real foods from 5~6 months onwards, your baby is best drinking breast milk at least until 12 months of age if not longer. The list of the benefits of breast milk over formula is very long and growing. My favorite is that despite it being totally free, it also provides higher immunity and hence lower medical expenses for the child’s entire life. You can find a long list of the benefits all over the web and in most English books on child rearing.
The Japanese deception starts the moment your wife begins reading the pregnancy magazines by Benesse and the like. Have you ever wondered why these publishers can afford to publish so many magazines on pregnancy so regularly despite Japanese mothers giving birth to less and less children every year? A healthy advertising budget from the infant formula companies help. Whereas English books often focus on the potential difficulty of breast-feeding and the need for support from the father, Japanese magazines seem to paint the world as if it is totally normal for a mother not to be able to make enough breast milk and that to top-up with formula is the norm. This is called kongo (混合, mixed) and refers to feeding your baby part breast milk and part formula.) Perhaps it works because of the perennial Japanese complex of having small breasts (which is known to be totally irrelevant) or perhaps it is just because first time mothers are lacking in confidence and hence willing to believe what they read in a magazine written by a company that runs English language schools (Benesse owns Berlitz remember!). Someone please explain to me – If the human race has survived for so many thousands of years, why on earth would breast milk not be enough to raise your child? Needless to say, I’m yet to see a Japanese book written by an academic that doesn’t paint the picture accurately. For some reason, it’s the colourful magazines written by editors – not academics – that survive on advertising and sales of other products to their readers, that have become the trusted source of information for Japanese mothers. If you are a new gaijin Daddy, I definitely recommend that you come to your own conclusions about breast feeding after reading a book or two written by an academic. Here are some great ones:
The New Father: A Dad’s Guide to the First Year by Armin Brott or
Baby Love: Everything You Need to Know About Your Baby’s First Year by Robin Barker
Unfortunately, “information” magazines are only the tip of the stealth marketing iceberg when it comes to Japanese formula companies. Most of the professionals that you have trusted (yes, your sanfujinka too) are probably on their pay-rolls. One of the key conditions for becoming a baby friendly hospital (BFH) is not to accept free samples or other forms of financial assistance from infant formula companies. Given that 70% of Japanese public hospitals are loss making, I guess you can’t blame them for seeking out private sector subsidies like this but is it fair to sacrifice the health and well being of our children while doing so? (See our article on BFHs in Japan for where to find one – they’re few and far between).
Take a look at these pictures taken in our nearby hospital (you can click to see a large version of them).
I guarantee you that there is not a single mother (or father, or grand mother or 3rd cousin twice removed) who doesn’t check out the photo of their loving little baby who’s just been born into this world. Better yet, this sign is right near the front entrance so even patients coming for other illnesses are likely to have a peek. What better subliminal messaging could you hope for than a rather unsubtle add from Meiji for their infant formula called hohoemi (ほほえみ) when you first see the face of the newest member of your clan? This hospital is known in our area to be highly respected for its sanfujinka (産婦人科, Ob/Gyn). With a reputation like this, why does it have to stoop to paid advertisements from one of Japan’s major formula manufacturers? Or is this hospital just like many other hospitals in Japan where the male Ob/Gyn’s claim that they can stimulate breast milk production through special Zen breast massages before resorting to formula when they proclaim that it is the mother’s fault as her breasts don’t produce enough milk. Rather than focusing on the joys of breast massaging, we need Japanese doctors to spend more time explaining how difficult breast feeding can be. Let’s face it, it’s not easy and it doesn’t come naturally to the baby or the mother.
Historically mankind have had grandmothers around to teach breastfeeding to the rookie Mums. But because the baby boomer generation decided that formula was “better” than natural breast milk, we can’t necessarily rely on the elder generation anymore. While America was just as guilty of throwing out the breast in the 70s, they’ve also come to the rescue of the younger generation with lactation consultants to take their place. We had a lot of trouble with breast feeding. My baby refused to grow in line with the pediatricians expectations for most of the first month of his life which was very stressful. Ironically, this is not that uncommon. It takes different babies (and mothers) different lengths of times to get into the swing of breast feeding – very few people get it right in the first week or so. We were lucky enough to have the support of two lactation consultants who helped my son and wife latch better. There is a vast shortage of internationally accredited lactation consultants in Japan so if you’re expecting or have just given birth you should book one ASAP (see the link below).
I’ve heard of some very unsettling stories in Japanese hospitals that have even resorted to giving formula to babies within the first few days of their lives. Even perfect breasts do not manufacture milk for 2~3 days after the baby has started suckling. You’re lucky if you get more than a teaspoon of a liquid called colostrum during that time. That is totally natural and your baby can survive for a few days on the fat stores that he built up in the womb. More to the point, the colostrum has vital nutrients to boost your babies immunity that are sacrificed if the Mother gives up breast feeding from day one (reference). While none of this is obvious, it only takes some caring advice from a responsible midwife to calm the first-time mother who is worried that it’s taking “too long” for her milk to come in. Then, except for a very small percentage of women, the amount of breast milk slowly increases as your child suckles on the breast, creating oxytocin. Oxytocin not only stimulates breast milk production but it also speeds up the recovery of the Mother’s body which is why mothers of formula fed babies are less likely to have a smooth and quick physical recovery.
Ironically, when your baby isn’t growing “fast enough” in the first few weeks of his life, your pediatrician is not necessarily the best person to rely on for information. He is there to ensure that your baby meets certain growth targets which are deemed to be “normal.” He’s not a lactation consultant and he hasn’t studied very much about the female body. It’s no surprise that he’s going to be quick to suggest a “boost” of formula to help your baby hit his growth targets. When we were in that situation, our lactation consultant kindly explained to us that we could sakunyuu (搾乳, express) milk from my wife’s breasts and feed it to him via a bottle or syringe (we actually elected for a blunt syringe as we didn’t want to promote nipple confusion). Unfortunately, in the vast majority of cases in Japan, the doctor is more likely to portray a “now or never” need of urgency and bully mothers into adding formula to boost their babies weight. Sure that is the easy option but it is rarely the only option. Less than 2% of the population actually have breasts that cannot produce “enough milk”. Make sure that you’re wife is seeing a lactation consultant from day one so you have the option to express before you’re forced into using formula. While it is a tiring process, expressing gives your baby a few more weeks to learn how to suckle independently. Better yet, you don’t have to worry about your babies weight-gain in the interim. If you are going to try it out, make life easy and go straight for the automatic ‘milking’ machine (for want of a better term). We rented ours from Medela after battling with a manual pump for way too long (you can find your closest rental agent on their homepage). I can’t stress enough, you should be able to supplement your babies milk intake with expressed breast-milk before you have to resort to formula top-ups. You’re wife is only going to have the confidence to do so if she’s been talking to a lactation consultant from day one.
The stealth marketing of the formula companies does not end there. One of my friend’s mother works at the local shopping center. She visits the baby section once a week or so to hold sessions for mothers on baby nutrition. If you’ve ever been to a Jusco or a big shopping center, you’ll know what I mean. In the area where they have the nappy changing tables and the baby scales, they often have a room which is used for these nutrition seminars. Sometimes it is once a week, sometimes once a month but local mothers come to get a free checkup on their baby’s health and to “learn” about how they should be feeding their child. What a great idea, huh? Apparently the advice that my friend’s mother give ranges from how many mls of miruku to feed your child each day and how to prepare solids for slightly older babies. Hold on a second. Did you say miruku? Yes, and that is specifically miruku (ie. formula milk) and not the natural stuff (母乳, bonyu). On further questioning, it turns out that my friend’s mother is not even employed by the local supermarket, she is employed (and trained!) by Otsuka Pharmaceutical Co. (大塚製薬). Yes, the company that makes the biggest selling brand of formula in Japan, Beanstalk (for some reason pronounced beanstark (ビーンスターク) but don’t get me started on that). How stealth is that? I guarantee you that every week, huge numbers of innocent, unsuspecting mothers around the country are being fooled into believing by their local “baby nutritionist” that they should be substituting their own breast milk for formula. Not only are the hospitals and the publishers working against us, but the supermarkets are, too. I guess it makes sense. The supermarkets get a free “entertainment act” that not only attracts shoppers but also promotes shopping, not to mention that this likely boosts formula sales right after the deed. Who can we trust?
So as a new-chum gaijin parent in Japan, what should you do? The simple answer is education. Read up a lot in English yourself and do your best to subtly pass on the more important messages to your Japanese partner. Try to find a lactation consultant and better yet find some decent literature in Japanese written by a medical professional. If you’re wife is struggling with breast feeding or not totally on board with the idea, I personally recommend this book (cover pictured here):
(Bonyuu nohoga raku data? Oppai de rakuraku sukusuku ikuji, “Breast feeding is easier?! Raising your healthy child on the breast with a minimum of effort”)
It’s written by an internationally accredited lactation consultant (Kitano Sumiyo, 北野寿美代) who realized one day after retiring as an official 助産婦 (josampu, midwife) that she’d spent her entire life focusing on babies and how the baby could get more nutrition while ignoring the mother completely. She then decided that there must be an easier way of breast feeding that was enjoyable and rewarding from the Mother’s perspective. That lead her to studying more about international standards of lactation and her ultimately coming up with this book which mixes the best of both Japanese and Western methods.
Finally, let me leave you with a list of the ingredients of Meiji’s Hohoemi formula – yes the one that advertises in my local hospital (See baby pics, with ads above). This is just taken from the back of the pack, I’m not sure if it includes the 30 different additives that the Japanese government approves for including in infant formula. (source: オーガニック食品最前線) or not. While I know that thousands of Japanese babies drink this every day and still grow up to be strong and healthy adults, I ask you – do you really think that this could be better than breast milk? Ironically, hohoemi means smile. I wonder who it is that is smiling.
Hohoemi Milk Formula Ingredients: Lactose (乳糖)、adjusted edible oils (調整食用油脂)、refined soy bean oil (大豆白絞油)、palm kernel oil (パーム核油)、fractionated pig fat (yummo!) oil (豚脂分別油)、refined fish oil (精製魚油)、milk serum protein (乳清たんぱく質)、butter milk(バターミルク)、casein (カゼイン)、fructooligosaccharide (フラクトオリゴ糖)、dextrin (デキストリン)、salt (食塩)、milk phosphatide extract (乳リン脂質抽出物)、yeast (酵母)、iron pyrophosphate (ピロリン酸鉄)、calcium phosphate (リン酸Ca).
If you have any stories about breast feeding in Japan, either happy or sad ones, we’d love it if you could share it with us in the comment section below so that hopefully the broader community of gaijin Dads (and Mums) can benefit.
Here are some more handy links and contacts that might help your breastfeeding challenge:
• La Leche League Japan (English), ラ・レーチェ・リーグ日本 (Japanese)
• Japanese Association of Lactation Consultants (NPO法人日本ラクテーション・コンサルタント協会)
• Japan Breast Feeding Association (日本母乳の会)
• Japanese Midwives’ Association (日本助産師会)
• Unicef: Ten Steps to Successful Breastfeeding (English), ユニセフ:母乳育児成功のための１０カ条 (Japanese)