Promoting Breastfeeding: Factors and Strategies for Exclusive Breastfeeding up to 6 Months in Hong Kong

This reflective journal analyzes factors influencing exclusive breastfeeding (EBF) in Hong Kong and recommends strategies to promote EBF up to 6 months. The socio-ecological model is used to identify obstacles to EBF, including inaccurate information, negative attitudes, and harmful medical practices. Policy-level actions, community-based strategies, and communication campaigns are recommended to promote EBF.

Running Head: PROMOTING PUBLIC HEALTH
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Promoting Public Health
Public Health: promoting breastfeeding
(Student Details:)
10/11/2018

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Promoting Breastfeeding
The aim of this reflective journal is to classify factors manipulating breastfeeding
endorsement through socio-ecological model. Moreover, I will do analysis and describe
strategies to promote exclusive breastfeeding up to at least 6 months in Hong Kong while
writing this journal. Using this reflection writing, I will try to find main key reasons behind
dropped rate of exclusive breastfeeding from 31% to 1.2 % only.
As we know that WHO recommends exclusive breastfeeding up to six months (1).
Additionally, when infants with incompletely breastfed or never breastfed compared with
infants with exclusive breastfeeding (referred as EBF) during first six months, then later one
was having better nutritional intake, less micronutrient deficits, less contagious cases, less
hospital calls, better mental ability and lesser death (2). Additional evidence advocates that a
defensive effect of breastfeeding is the prevention of childhood adiposity and it also reduces
the probability of adult adiposity, any kind of diabetes, as well as hypertension (3).
Advantages of EBF include a lesser risk of gastrointestinal infection for the infant,
late return of menstrual periods, and rapid maternal weight loss post birth. Moreover, there
are no adverse effects on growth of the child because of exclusive breastfeeding for 6 months.
But in absence of EBF a decreased level of iron in the child has been observed (4).
Still, data and analysis presented that the breastfeeding frequency in Hong Kong
infants dropped from 73 per cent at one month old to 25 per cent at twelve months old (5). In
this journal, my objective is to find the main obstacles and factors influencing breastfeeding
in the population Hong Kong. I used socio-ecological model to find out the factors
influencing breastfeeding practices in Hong Kong. Socio-economic model of public health
depicts that health practices are affected by federal policy and community resources rather
than having only dependence on medical care as well as genes (5).
My primary approach to socio-economic model says that breastfeeding affecting
factors contain following aspects:
 Interpersonal primary groups: this factor affected through professional, personal
social network, most importantly social support systems like work group, family, and
friends group (7).

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 Intrapersonal reasons: this factor of socio-economic model depicted that self-
concepts, prior knowledge, and attitudes as well as behaviour affected EBF.
 Institutional factors: social institutions characteristics and formal rules and
regulations, also affect EBF.
 Community factors: these factors include relationships among organization, and
informal groups with defined boundaries.
 Public policy implementation: policies and laws made for local, state and country
public affect EBF (6).
As a result after my analysis through socio-economic model, main obstacles to EBF
were inaccurate information regarding its merits, absence of training and supervision, local
public negative attitudes. Some more reasons are miscommunication amid healthcare
providers (referred as HCPs) and patients, also some harmful medical practices like providing
free formula at clinics, and the conflict of interests among the infant food trade and the HCPs
(7).
Based on my analysis, I found some strategies and recommended actions to promote
EBF up to six months in Hong Kong and motivate progress in growing EBF. Out of all I have
analysed, following suggestion-based recommendations ought to be executed at larger scale
to attain progress on the EBF in Hong Kong.
First desired strategy in Hong Kong is to be implemented at policy level. The place
require to legislate policies which protect EBF and support women while they effort to
breastfeed their kids for the first six months. Additionally, facts shows that elongated
maternity leave is directly related with effective EBF, though its effects may be narrow in
nations where women are not mainly working in the formal sector. Thus, 6-month rewarded
maternity leave will allow Hong Kong’s women to endure to breastfeed extensively without
having to pick amid earning money and giving the best nourishment to their infant. Another
policy action includes the enacting, observing of legislation, enforcement related to The
International Code of Marketing of Breast milk replacements and following relevant World
Health Assembly resolutions (1).
Moreover, HCPs as well as Government of Hong Kong should deliberate prioritizing
the following recommended actions to grow the rate of EBF during the initial six months of
infant life to minimum 50 per cent:

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 They must provide hospital and health facilities which support EBF, comprising
revitalizing, institutionalizing, and expanding the infant-friendly hospital being an
initiative in health care systems (4).
 They must provide community-based strategies supporting EBF, comprising the
execution of communication promotion campaigns specially tailored for the local
community context.
 There is a need of limiting the destructive and inappropriate marketing of breast-milk
alternates considerably through firming the monitoring system.
 Empower women to EBF through enacting six-month compulsory paid maternity
leave within the work as well as in public.
 Effectively finance in training and capacity making in EBF protection, support and
promotion (8).
Additionally, communication strategies (referred as CS) implementation to rise
attentiveness, awareness and support for EBF is essential. For that, communication channels
should be suitably chosen to set, and taking EBF into consideration covering all literacy ranks
and entree to media (8). Further, behaviour change communications should preferably be
based on determinative research to classify barriers and implementers to EBF. Thus, mass
media behaviour change campaigns can also considerably improve EBF during the initial 6
months of infant life and is principally operative for reaching to the mothers with infants in
between 1 to 4 months of age (6).
Therefore, my study and critical analysis concluded that women of Hong Kong
community face various difficulties while breastfeeding showed by socio-economic model. In
my opinion, to enhance breastfeeding rates, many institutional and operational changes are
obligatory (7). I found that future strategies in Hong Kong must focus on certainly
influencing social rules supporting above recommended practices, and put emphasis on the
exact reasons behind those recommendations. Moreover, my suggestions for promoting EBF
are based on my research which recommend that future efforts and actions should take a
multi-targeted tactic through a variety of impacts, not only focussed on HCPs but also on
close family members, relatives, fathers and friends.

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References
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1. World Health Organization. World Health Organization. [Online].; 2012. Available from:
http://www.who.int/nutrition/topics/globaltargets_breastfeeding_policybrief.pdf.
2. Ara MA, Sudaryati E, Lubis Z. Growth and Development of Infants at the Age of 6-12
Months Based on Breasfeeding. International Journal of Public Health Science(IJPHS).
2018; 7(2).
3. Kelishadi R, Farajian S. The protective effects of breastfeeding on chronic non-
communicable diseases in adulthood: A review of evidence. Advanced Biomedical
research. 2014;: p. 3.
4. WHO. WHO. [Online].; 2018. Available from: http://www.who.int/nutrition/global-
target-2025/infographic_breastfeeding.pdf.
5. Bueno-Gutierrez D, Chantry C. Using the socio-ecological framework to determine
breastfeeding obstacles in a low-income population in Tijuana, Mexico: healthcare
services. Breastfeeding Medicine. 2015; 10(2): p. 124-131.
6. World Health Organization. World Health Organization. [Online].; 2017. Available from:
http://www.who.int/features/factfiles/breastfeeding/en/.
7. Wilson-clay B, Hoover K. The breastfeeding atlas Manchaca: LactNews Press; 2008.
8. Hedberg IC. Barriers to breastfeeding in the WIC population. MCN: the american journal
of Maternal/Cheild Nursing. 2013; 38(4): p. 244-249.
9. Swigart TM, Bonvecchio A, Théodore FL, Zamudio-Haas S, Villanueva-Borbolla MA,
Thrasher JF. Breastfeeding practices, beliefs, and social norms in low-resource
communities in Mexico: Insights for how to improve future promotion strategies. PloS
one. 2017; 12(7): p. e0180185.

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10. effective healthcare. Breastfeeding Programs and Policies, Breastfeeding Uptake, and
Maternal Health Outcomes in Developed Countries. [Online].; 2018 [cited 2018 10 11.
Available from: https://effectivehealthcare.ahrq.gov/sites/default/files/pdf/breastfeeding-
draft-report.pdf.
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