Feature: China's unregulated breastfeeding massage market

Instead of going to the hospital, many breastfeeding mothers in China turn to a masseuse when their breasts are inflamed. The price for a one-hour massage can be as high as 600 yuan (100 U.S. dollars), while the safety risk is high.

"Eight masseuses kind of 'experimented' with my sore breasts, before I finally found a skilled masseuse to help me out," said Wang Chao, a breastfeeding mother from north China's Hebei province.

After not managing to breastfeed her baby for a short spell, the milk inside Wang's breasts deteriorated and they became painfully swollen. Antibiotics prescribed by a doctor at a local hospital did not work and she was told that, in the worst-case scenario, she might need surgery.

"If not for the masseuse, I could have been forced to stop breastfeeding a long time ago," Wang said. But she is now confident about feeding her baby naturally for at least a year.

The World Health Organization recommends exclusive breastfeeding for the first six months and continuous breastfeeding for two years or longer, for the sake of the baby's health. It also claims that, with support from loved ones, the healthcare system and society, all new mothers may succeed in breastfeeding.

To raise awareness of the values of breastfeeding, China's Health Ministry declared May 20 National Breastfeeding Day in 1990. The date, if rendered as "520" and read in Chinese, sounds like "I love you."

The status quo with breastfeeding in China, however, is far from romantic.

The latest available data from the ministry shows that only 30 percent of new Chinese moms achieved exclusive breastfeeding in the first six months, much lower than the country's 50-percent target.

Among the explanations for this are cultural misperceptions about the superiority of baby formula, an inconvenient environment for breastfeeding outside of the home, and forced termination after inadequate treatment of breast inflammation in hospitals.

That's how breastfeeding massage rose up to be a lucrative business across China. But the profession is not regulated. It has no standards or supervision whatsoever, leaving room for low-skilled or even unscrupulous operators.

Most breastfeeding masseuses are middle-aged women with no higher education or medical training. They usually start distributing business cards to expectant mothers in hospitals once they finish a few courses and obtain the basic massage certificate.

They could solve the real problem, or make things worse. There is just no guarantee.

"MAGIC HANDS"

At the reputable end of the scale is Shi Guilan, 52, a masseuse based in Beijing. She has served nearly 30,000 breastfeeding mothers in the past decade, and claims to have had 100-percent success in treating them.

"Many times, when other masseuses have made things worse and new mothers came to me, I have been able to fix it. But if I can't, I never pretend; I suggest they go to the hospital immediately," Shi said.

Shi is the founder and boss of a company comprising of 300 breastfeeding masseuses and nannies. Their incomes are comfortable, and Shi rewards the best-performing employees with holidays abroad.

"I am a career woman. My dream is to have massage studios for breastfeeding mothers across the country," she said.

Born and raised in east China's Shandong Province, Shi graduated from a local nursing school at 19 and worked as a midwife in a public hospital, until she had a second child, violating China's family planning policy at the time. With the public institution under pressure to sack her as a penalty, Shi quit. Her family of four came to Beijing in search of new income.

As a temporary nursing assistant, Shi could not help notice the troubles of many breastfeeding mothers. She took a two-year massage course and, in 2005, became a self-employed breastfeeding masseuse.

With money coming in and market demand soaring, Shi started her own firm to train apprentices. She has built up a healthy reputation personally and for her business over the years.

"My family members did not understand my job in the beginning. Now they are all employees of my company," Shi said.

AWKWARD STATUS

In the eyes of Shi, breastfeeding difficulties have become increasingly common for Chinese woman, due to a greasy diet, and domestic and professional stress. Demand for masseuses is huge, but clients remain suspicious because the industry is "a bit messy," she said.

There is no uniform qualification for a breastfeeding masseuse, so any one can claim to be one. The Ministry of Human Resources and Social Security once offered courses and certificates, but all programs ended in March due to a government reshuffle.

"The profession exists for good reason, but the service is overpriced. And when accidents happen, masseuses often flee to avoid facing the consequences," said Fan Yingyi, director of the galactophore department at a hospital affiliated to Beijing University of Chinese Medicine.

Some patients have needed surgery after their breast ducts were irreparably damaged by irresponsible masseuses, according to Fan, who warned that only when the deteriorated milk can be squeezed out, can a masseuse be part of the solution.

"Ideally, doctors and nurses should help all new mothers to achieve breastfeeding. In cases of breast inflammation and fever, the doctor should determine whether a masseuse is needed. The current system is just not that flexible," Fan said.

For now, most doctors and nurses in China have no time to learn massage and help breastfeeding mothers, thus leaving room for masseuses to make huge profits. A veteran masseuse in Beijing can earn over 20,000 yuan a month.

Many breastfeeding mothers also have difficulty getting accurate information about how to prevent breast inflammation and how to seek proper treatment, according to Fan.

"Our hospitals are not providing convenient, nice, helpful information or services," she said.

China has an official plan for developing community hospitals. In Fan's view, provision of affordable breastfeeding massage in these public institutions should be worked into it. Endi