Breastfeeding Support in Hong Kong (Part 2)

The ‘Baby-Friendly Hospital Initiative’ (BHFI) sets out clear actions maternity services can take to ensure women and their babies have the best chance at breastfeeding success. It covers care that families receive in hospital as well as care in local health centres, from pregnancy to birth and the postnatal period.

Hospitals and health facilities registered as ‘Baby Friendly’ are committed to following this guidance to protect, promote and support breastfeeding families.

Does being ‘Baby Friendly’ mean facilities are against bottle feeding?

A common misconception is that being ‘Baby Friendly’ means families can’t bottle-feed their babies – this is not the case.

By being ‘Baby Friendly’, healthcare providers are dedicated to protecting and support families from predatory marketing from large multinational corporations looking to profit off sales to families.

As part of the guidance, if families want or have to bottle-feed, they must be provided with accurate and evidenced-based information on how to do so safely. This means families receive one-to-one education on any risks associated with formula, teats, or pacifiers; how to choose baby formula milk; how to make up and use baby formula milk safely; and how to bottle feed safely and responsively.

How do healthcare facilities become ‘Baby Friendly’?

Hospitals and health facilities become officially certified as ‘Baby Friendly’ by undergoing assessment by local associations – in Hong Kong this is the ‘Baby Friendly Hospital Initiative Hong Kong Association’ (BFHIHKA) set up in 1994. The certification requires continual assessment and re-validation to make sure facilities keep delivering high quality care.

There are five stages that facilities must pass assessment on to be awarded ‘full

accreditation’:

1. Registration of Intent – facilities make a written intention to show their

commitment to being accredited in the next 5 years

2. Certificate of Commitment – facilities have developed a formal infant

feeding policy (how babies should be fed in their facilities) and an action plan

of how they plan to become accredited

3. Level 1 – facilities have a system and people in place to carry out their action

plan

4. Level 2 – facilities have trained their staff with skills and knowledge so they

can care for babies in line with the infant feeding policy

5. Level 3 – Fully Accredited as a ‘Baby Friendly Hospital’ – when assessed,

families report they are receiving care that matches with what was set out in

the infant feeding policy

The BFHI is in place globally, and different countries have implemented it with varying success.

So what does the ‘Baby Friendly Hospital Initiative’ look like in Hong Kong?

There are currently 19 maternity hospitals in Hong Kong: eight public hospitals, and 11 private hospitals. As part of the Hospital Authority public hospital system, there are also 29 Maternal and Child Health Centres (MCHC’s) offering pre- and postnatal care across Hong Kong.

The public system in Hong Kong has had success with implementing the Baby-Friendly Initiative. As of June 2023, all eight public maternity hospitals were fully accredited as ‘Baby Friendly’ (Level 3) and of the 29 local MCHC’s:

• 15 have been fully accredited as ‘Baby Friendly’ Level 3

• 6 are accredited as Level 2

• and 7 are accredited as Level 1.

Families need to know that despite the Baby Friendly Initiative Association being registered in Hong Kong for more than 30 years – only one private hospital is currently accredited as ‘Baby Friendly’ (Gleneagles Hospital) and only one other private hospital has achieved ‘Certificate of Commitment’ (Baptist Hospital).

As of the latest update provided by BFHIHKA, no other private hospitals have registered interest in becoming baby friendly. This means that for families giving birth in the private sector, very few can guarantee they will receive care that offers the best start for breastfeeding.

Where do I get breastfeeding support when I go home?

Here in Hong Kong, we still do not have a dedicated service that follows up mothers and their babies once they go home.

This means routine check-ups are delivered by local MCHC’s in the public sector, and by private paediatricians and/or midwifery care packages in the private sector. Importantly, there are no services that will proactively check-in on new mothers and their newborns; families will only receive care if they seek it themselves. [*This is not the norm in places like Australia, the UK, the Netherlands, or Singapore where you will be automatically followed-up

by a dedicated maternal-child nurse service once you give birth].

Confinement nannies (pui yuets) are a core part of local postnatal care in Hong Kong, supporting mothers’ nutrition, social-emotional wellbeing, and helping women find their feet in their new roles as mothers.

As part of the BFHI accreditation, staff working in MCHC’s have received dedicated training on how to support and protect breastfeeding. This means the care families receive should be clinically accurate and focus on supporting breastfeeding and offering tailored advice on bottle-feeding as needed. But outside of these care facilities, there is no guarantee the care professional(s) looking after families and newborns have had any formal education or training in breastfeeding or bottle feeding. Unfortunately, the breastfeeding education available for paediatricians and obstetricians is limited and not part of routine training programmes.

Importantly, although Pui Yuets are experienced in feeding support, the overwhelming majority have not received any formal healthcare training and are not accredited International Board Certified Lactation Consultants – the only international accreditation that qualifies evidence-based breastfeeding support.

This means the care families receive may not be evidence-based or up to date with current best-practice.

So, what does all this mean for my family?

Just because a facility is not accredited as ‘Baby Friendly’ doesn’t mean you won’t receive good care. But it does mean you cannot guarantee the care and advice you get will be in the best interests of breastfeeding. To give yourself the best chance of success wherever you plan to give birth, here are a few simple steps you can take:

1. Join an antenatal breastfeeding education course:

   • Hong Kong hospital authority routinely offer breastfeeding education sessions in both English and Cantonese – you do not have to give birth in a public hospital to join these courses

   • Check whether your private hospital offers dedicated breastfeeding or infant feeding education workshops

   • Join an online education course e.g., Breastfeeding 101 by The Family Zone

   • Look for free and charity-based workshops online e.g., La Leche League, Association of Breastfeeding Mothers, Australian Breastfeeding Association etc.

2. Understand what ‘best care’ looks like: Baby Friendly Ten Steps to Breastfeeding Success

3. Watch out for and question ‘red flags’

Healthcare providers and support persons who are educated and trained in

breastfeeding support should follow advice and guidance set out by public health bodies – and offer care that is in sync with the ‘Baby Friendly’ guidance.

Look out for ‘red flags’ that suggest the care you’re receiving might not be up to date:

• Routinely offering bottles and/or formula with no clear clinical reason

• Restricting how much time you have to breastfeed

• Not allowing rooming in with your baby (keeping your baby by your side if you want day and night)

• Not allowing skin-to-skin contact

• Restricting the amount of time you can hold or cuddle your baby

• Promoting specific brand(s) of baby milk formula

4. Discover where you can go for breastfeeding support once baby is here

• MCHC (Maternal Child and Health Centre)

• Charities and Free Associations e.g., HA Peer Support Service / La Leche League

• The Family Zone (community based service)

• Private clinics e.g. Central Health or OT&P

If you have questions, or want to know more about how to better support your breastfeeding journey, get in touch.