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Thursday, December 20, 2012

Mother's milk--and others' milk--in Japan

Any sharp-eyed person reading this blog will probably have noticed that I am raising my daughter, Little Seal, in Tokyo. I've never really talked about Japanese breastfeeding culture on this blog--probably because, in the self-perpetuating metaworld of the Internet I blog primarily about stuff I read about online (in English). Nevertheless, the "Japanese breastfeeding experience" has been one factor shaping my attitudes towards breastfeeding and breastfeeding advocacy; here are a few things that might be interesting to outsiders.

Breastfeeding is normal: As the International Breastfeeding Journal comments, rates of babies receiving "any breastfeeding" in Japan are quite high. Rates of exclusive breastfeeding, however, are lower than in many comparable countries. This fits with my own observations, which are that nursing is normal here, but giving the odd bottle of formula is common as well.

Public breastfeeding, however, is not: On the other hand, Japan is not Norway where apparently women whip their boobs out everywhere without a thought. Nursing in public is not common here.That said, I've seen more NIP in the last couple of years, maybe partly as a result the increased popularity of those much-despised nursing capes which every Japanese baby store now carries. Incidentally, ..I've have had zero issues with NIP in 21 months, and have never heard of anyone being harassed or told to stop. People just ignore you...

A room of one's own: Nursing rooms (bonyuushitsu)--equipped with sofas, changing mats and sometimes bottle-making facilities--are found in most department stores and stations. I made occasional use of them (they are useful for distracted babies or if you want to get comfy), but mostly I just couldn't be bothered dragging all the way there--I'd rather nurse under a cover. I like to think that every woman who nurses in public in Japan makes it easier for other women--Japanese or foreign--to be a bit braver and give it a try.

Hospitals--mixed report: Considering Japanese hospitals' fixation with natural, vaginal birth (thank God Cecile was breech and came out the safety hatch), you might think that this would be Baby Friendly Hospital territory. Nope. My own hospital--not Baby Friendly but definitely breastfeeding friendly--was wonderful, but the majority of hospitals appear to be stuck in 1963: compulsory rooming-out 24/7, strict three-hour schedules, and formula in a bottle for the baby until your milk comes in. Since you stay in the hospital for 5-7 days, these things matter. A friend of mine had a baby who, after latching on just fine, wanted to feed all night and sleep all day in defiance of the feeding schedule. My friend was told that this meant there was a "latch problem" (there wasn't) and that she should start pumping and sterilizing bottles. She was collapsing with exhaustion by the time she got home. What a mess.

Post-partum seclusion: Japanese custom dictates that the first four to six weeks postpartum are a period of rest, where you are supposed to focus on healing from birth and getting used to motherhood while your parents, in-laws or other relatives take care of the house and help with the baby. This custom is called satogaeri bunben ("hometown-return delivery), although these days it's becoming more common for the woman to stay in her own house while the relatives come to her.

Extended nursing: Japanese culture reveres the mother-child bond, and close and prolonged physical contact--breastfeeding, bed-sharing, bath-sharing--is seen as completely normal. These cultural expectations definitely have their downside--Japanese culture is still not very supportive of mothers who work outside the home. On the bright side, however, I have never had any weird reactions for nursing a toddler here, including from my mother-in-law. My British parents, meanwhile, are a different story.

Dayweaning before nightweaning? Japanese people are mildly surprised to learn that Little Seal sleeps through the night in her own room, because it's really common for children to sleep with their parents here. Perhaps for this reason, a lot of Japanese mothers continue to breastfeed their toddlers throughout the night even when they are no longer doing so during the day--especially in the case of boys. This is odd to me, because I tend to think of nightweaning as something that happens before day weaning. I remember explaining the concept of nightweaning to a Japanese mum at a La Leche League meeting... she was astonished!

Nipple pinching and breast massage: Japanese midwives and nurses are very... "full on" when it comes to manhandling your breasts (with or without permission). Breast massage in Japan is believed to improve milk quality; it was also inflicted on me to unclog a clogged duct. My God, it was painful.

Food and drink: While under the nurse's dominatrix-like hands (and therefore in no position to argue) I was also scolded for eating too much chocolate and fatty foods and thus causing the clogged duct in the first place. The Japanese are convinced that everything you eat and drink is powerfully connected with your milk. Japanese mothers tend to be stunned to hear that I will nurse after drinking a couple of beers.

Earthquakes! Japan is a notoriously disaster-prone country, a fact that was brought home to me by the fact that I gave birth the day after the 11 March 2011 earthquake. I can still remember the sinking feeling in the pit of my stomach as I opened my Facebook page from my hospital bed and saw my newsfeed was full of reports of Tokyo shops being stripped of baby formula as parents began to engage in panic-buying. Followed by an official warning not to use tap water for making up bottles due to excessive levels of radiation. Ten months later, there was a recall of formula due to high cesium levels. What gives?

Incredibly, however, RTF liquid formula is impossible to find here, and formula feeding families keep bottled water, regular feeding bottles and powdered water in stock as earthquake preparation--hardly adequate, especially since parents are now advised to scald formula powder with hot water for young babies even in non-disaster conditions. Following 3/11, RTF had to be flown in from overseas. The advantages of RTF were discussed in the national press following 3/11, but nothing happened and the subject has since been dropped. A poster on my mother's group suggested that Japan's low fertility and high breastfeeding rates mean the market here may be too small to support such a product. I really think Japan needs to sort this issue out, however. The 3/11 earthquake hit mostly aging and depopulating areas; if/when the big one hits Tokyo... well, we have a lot more babies here.

Closing thoughts
Breastfeeding in Japan is very "normal" in every sense: it's commonplace and always has been, but that also means that you don't really get the fervent lactivism politics that you get in the west--especially in the United States and Britain where breastfeeding is still trying to recover from its nadir in the 1950s and 1960s and is surrounded by a lot of bristly insecurity as a result. So nursing to me felt like the usual and expected thing to do. The earthquake experience certainly gave me a new awareness that breastfeeding can have some real safety advantages even in the developed world.

I do think it's interesting that breastfeeding rates are basically high in spite of the dodgy hospitals, the widespread use of supplementation and the fact that so many women feel they can't nurse publicly. One possible explanation is that these factors may be less important than generally thought. Alternatively... a doula I have met in Tokyo once suggested to me (regarding Japanese hospitals) that Japanese society is so supportive of nursing in other ways that this enables mothers to overcome the rocky start they get at the hospital, and perhaps this is true of the other things as well. Maybe offering bottles of formula whenever you are out in public is likely to prang your supply if you also cosleep, for example, because you make up for it with more nipple stimulation at other times? Who knows? Some research might be interesting.

I suppose this is part of the reason why I don't have a lot of patience with the more extreme and dogmatic forms of lactivism which have been widespread in the west in recent years; because I have seen with my own eyes that you can have widespread and "normalized" breastfeeding without obeying every point of the "correct breastfeeding" checklist. I nursed in public and never gave any formula but used a crib and sleep trained and worked; most Japanese mothers cosleep and don't go to work, but send their babies to the hospital nursery and give a bottle in public. Somehow, we all make breastfeeding work for us... most of the time.

Further reading: Factors Associated with Exclusive Breast-feeding in Japan



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