Widespread usage of infant formula in China: a major public health problem

Background: The potential health risks of infant formula feeding are well established. This study investigated the opinions and perceptions of mothers and recommendations by hospital staff with respect to infant formula usage in China.

Methods: A cross-sectional survey of 726 mothers within 6 months postpartum and 241 hospital staff, using structured questionnaires, was conducted in Hangzhou and Shenzhen, China.

Results: Overall, 474 of 726 (65.3%) infants aged within 6 months had consumed some infant formula. About 40.0 percent of mothers chose a hybrid brand of formula (manufactured in China but owned by a foreign company), over imported (< 32.0%) and domestic brands (< 28.0%), despite their higher level of confidence on the quality of imported brands. Perceived insufficient breastmilk production (86.2%) was the most common reason for giving infant formula, followed by return to work (24.6%). Of the 241 hospital staff, 97 (40.2%) gave no recommendation about infant formula brand for infants at any age. However, 47.2 percent of the remaining staff recommended a hybrid brand in combination with an imported and/or a domestic product.

Conclusions: Perceptions by mothers and recommendations from hospital staff appear to contribute to the widespread usage of infant formula in China. It is important to ensure breastmilk substitutes are prescribed to Chinese infants strictly for medical reasons. Maternal education programs incorporating information on food safety issues and establishment of breastfeeding-friendly workplaces could curtail the common practice of formula feeding in China.