Suda* is a mother of two who moved from New Zealand to Thailand only five months ago. Before relocating here, she breastfed her son until he was two-and-a-half years old. Now also breastfeeding her 15-month-old daughter in her homeland, Suda is shocked by the negativity she's experienced breastfeeding in public.
"It seems that baby formula has become a status symbol here [in Thailand], to the extent that breastfeeding is looked down on by the middle and upper classes as something only poor people do," she said. "I have heard that families limit the number of children they have because of the expense of formula."
Breastfeeding is not just a family issue here but also a public-health concern. Not breastfeeding, in fact, has a price to pay, as detailed in recent research that insists breastfeeding can save lives. At a presentation entitled "The Cost of Not Breastfeeding in Thailand", held in Bangkok late last month, the director-general of the Department of Health under the Ministry of Public Health Dr Wachira Pengjuntr said that increasing the rate of breastfeeding needs to be one of Thailand's top priorities.
Organised by Unicef, the Ministry of Public Health, the Alive and Thrive Programme and the Thai Breastfeeding Centre Foundation, the event highlighted new research from a breastfeeding series recently published in the UK medical journal The Lancet showing the practice can help improve the health of babies, mothers, the economy and society.
In Thailand, 46% of children are breastfed in the first hour of their lives and 12% are exclusively breastfed for the first six months of their lives. The World Health Organization (WHO) and Unicef both recommend children continue to be breastfed until they are two years old but, unfortunately, this only happens to 18% of Thai children.
"This is a very serious situation for us because we need to find ways to better improve the condition and health of Thai mothers," said Dr Wachira.
Thai women face barriers such as insufficient support by health professionals, a lack of breastfeeding-friendly facilities in the workplace, lack of adequate parental-leave law and the aggressive marketing of breast milk substitutes. Southeast Asia has the largest-growing infant formula market.
The evidence presented last month shows that if almost every mother breastfed her children, it could save about 820,000 lives globally each year -- nine out of 10 in infants under six months -- and that each year a mother breastfeeds reduces her risk of developing invasive breast cancer by 6%.
Breastfeeding could also save more than US$7.6 million in health-system expenditures to treat diarrhoea and pneumonia.
On the state side, in response to this, the Thai government has declared war against the aggressive infant-formula industry, with the Draft Control of Marketing of Infant and Young Child Food and Related Products Act having been approved in December of last year.
The Act aims to regulate laws around the marketing of breast milk substitutes to be more closely aligned with global recommendations.
"This is a golden period for us. We have a window of opportunity to advocate for breastfeeding in Thailand until September, because in December the National Reform Council will be revising the constitution and related laws," said Dr Wachira.
"I'm thinking in the next six months we can start a campaign after Mother's Day, to compete with the formula giants."
Sue Horton, a health economist and co-author of The Lancet series and the breastfeeding study, said the cost of infant formula -- even the cheaper brands -- is very significant.
"We tried to get data on urban minimum wages or wages for relatively low-level workers in the government, and compared that with what they would have to spend for economy formula for the first six months of their infant's life," she said.
"It was 25% of their income going to the formula, which is very expensive for providing a product inferior to breast milk."
Waoe Palin is among the many Thai mothers aware that breastfeeding has many health benefits for mother and baby, including special bonding time. But the situation in the capital city is totally different from her hometown of Pai in Mae Hong Son.
"In Pai, most mothers I know do breastfeeding," she said. "In Bangkok, most mothers feed their babies with breast milk in the bottle. In the countryside, they feed their babies with formula."
Seeing the benefits of breastfeeding, Wake is in strong favour of the Infant Marketing Law being passed.
"Milk formula has been promoted so much, on television and in local hospitals," she said. "And I think knowledge about breastfeeding should also be given to the people."
* This name has been changed.
FACTS FROM THE LANCET BREASTFEEDING SERIES 2016
One in eight infants in Thailand is being breastfed exclusively.
Breastfeeding is associated with higher intelligence. The costs of lower cognitive ability associated with not breastfeeding could cost the global economy US$300 billion.
The international study was aided by findings from the "Cost of Not Breastfeeding" report that was conducted in Thailand — which asserted that Thailand could prevent nearly US$192.6 million in annual wage losses by improving the learning abilities of children.
More than 400 deaths of mothers could be prevented in Thailand if they were able to breastfeed two years cumulatively over their lives.
In Thailand, US$7 million worth of health costs each year are attributed to inadequate breastfeeding.
Some Thai companies provide breastfeeding mothers with facilities where they can prepare supply of breastmilk for their babies while they are at work.
