Introduction
The historiography of infant feeding provides a vital lens for examining the co-production of biomedical knowledge and socio-political order. While the World Health Organization (WHO)’s current recommendation of exclusive breastfeeding for the first six months represents a global health consensus, this policy paradigm emerged through centuries of contested transformations in nutritional science and maternal ideologies.Footnote 1 Western feeding practices underwent not linear progress but renegotiations between competing epistemic regimes—where industrial formula marketing coexisted with maternalistic revival movements.Footnote 2 Attitudes towards breastfeeding exhibited significant regional variation among health professionals.Footnote 3
Rima D. Apple’s seminal analysis reveals how the American transition to bottle-feeding emerged as a collaborative project between medical elites and infant food manufacturers. Through an examination of advertising campaigns, newspaper editorials, and popular science publications, Apple demonstrates how these sectors collectively constructed a discursive framework that naturalised artificial feeding, and thereby shaped women’s perceptions of ‘scientific motherhood’ within modern consumer culture.Footnote 4 Amy Koerber’s immunological rhetoric analysis further complicates this narrative, revealing how the scientific valuation of breastmilk shifted from caloric measurement to bioactive compound profiling, exposing the malleability of medical authority claims in service of socio-political agendas.Footnote 5
These developments intersected with China’s unique historical trajectory following 1949. The founding of the People’s Republic of China coincided with global decolonisation movements that reimagined primary health care as a nation-building technology. The Alma-Ata Declaration’s (1978) concept of ‘appropriate technology’—emphasising context-specific, cost-effective, and culturally acceptable interventions—found empirical validation in China’s breastfeeding practice.Footnote 6 This study contends that China’s breastfeeding policies during 1949–1965 epitomised what Saha terms ‘hybrid medical modernity’—a synthesis of international scientific currents (e.g., Soviet paediatrics), anti-feudalist discourse, and pragmatic adaptation to economic scarcity.Footnote 7
China’s post-1949 period witnessed a complex interplay of ideological, economic, and cultural forces shaping infant feeding practices. Breastfeeding advocacy became entangled with socialist modernisation imperatives. In 1949, when the People’s Republic of China was established, feudal ideologies remained pervasive throughout society, and the general populace exhibited low levels of scientific and cultural literacy. During the 1950s, under the influence of the Soviet Union’s ‘Big Brother’ model, industrial production was elevated as a national priority while being ideologically intertwined with the women’s liberation movement. Chinese women, regarded as a vital human resource in this socialist framework, were expected to fulfil dual roles: fulfilling maternal responsibilities within the family sphere while actively participating in collective productive labour.
As leftist ideological tendencies intensified through successive political campaigns—including the Great Leap Forward (1958–1960), the People’s Commune Movement, and the subsequent Three Years of Difficulty (1959–1961)—the scarcity of raw materials for infant formula production created significant challenges. Combined with these systemic pressures, the nation faced acute shortages of substitute milk products, including infant formula. Against this socio-political and economic backdrop, this article examines how medical discourses on breastfeeding and corresponding practical recommendations evolved during this transformative period, particularly analysing the characteristics of such discourses and measures in response to the material constraints and ideological imperatives of the era. Paediatricians promoted breastfeeding while navigating contradictions between traditional practices, female labour participation, and the ideological imperative to eradicate ‘feudalist exploitation’ of wet-nursing.Footnote 8 The medical community’s recommendations were moulded by these unique circumstances: Soviet-inspired industrial milk substitutes and official policies on breastfeeding competed with residual Confucian wet-nursing traditions, while state feminism simultaneously mobilised women as productive workers and ‘scientific mothers’.Footnote 9 This study argues that breastfeeding policies during 1949–1965 constitute a microcosm of China’s broader modernisation struggles—where socialist ideals collided with material realities, and medical expertise became a contested terrain for ideological legitimation.
While extant scholarship has examined breastfeeding through the prisms of women’s identities, body politics and societal roles, significant gaps remain in understanding how the Chinese medical authorities conceptualised and promoted breastfeeding during the 1950s to 1960s. Previous research has illuminated various aspects of this complex issue. Fengxian Wang’s study on urban women’s breasts in modern China explored the influence of ‘hygiene’ and ‘nutrition’ concepts on feeding practices, highlighting the intertwining of scientific discourse with nationalistic narratives. The interweaving of scientific discourses and cultural practices in modern China unfolded against the backdrop of Western scientific ideas entering the country. Fears about bacterial contamination, the underdevelopment of the infant formula industry, and the ideological pursuit of ‘strengthening the nation and its people’ collectively catalysed transformative changes in breastfeeding ideologies and practices. Notably, breastfeeding by biological mothers gained scientific validation through this process, displacing traditional practices such as hiring wet nurses and using animal milk.Footnote 10 This intellectual encounter with modernity also reshaped Chinese infant-rearing practices. As China engaged in global dialogue during its modernisation journey, debates between formula feeding and breastfeeding emerged as pivotal discourses. Concepts like colostrum feeding and scheduled breastfeeding not only transformed breastfeeding methods among Chinese women—particularly urban dwellers—but also redefined gender roles within the framework of modern scientific governance. Xiaojing Ke has conducted pioneering research on the evolution of children-raising knowledge in modern Chinese through interdisciplinary sources, including women’s magazines, autobiographies, memoirs, and oral histories. Her work examines critical aspects of early modern child-rearing practices, ranging from prenatal care theories to hygienic protocols during breastfeeding, thereby mapping the intellectual trajectories of scientific motherhood in Republican China.Footnote 11 Shuying Lu’s work utilised diverse sources to illustrate transformations in maternal roles due to the popularity of cow’s milk feeding during the Republican period, especially debates around infant feeding entangled with discourses of scientific modernity, feminism and hygiene.Footnote 12 Research on wet nursing has predominantly focused on historical circumstances of ancient wet nurses, modern feeding concepts, the professional development of wet nurses, as well as studies on public health and welfare in modern times.Footnote 13 Notably, however, these studies focus primarily on pre-1949 Chinese society, leaving unexamined the transformation of medical discourses on breastfeeding in the People’s Republic era.
Recent historiography of breastfeeding has incorporated insights from sociology and anthropology, examining contemporary Chinese women’s dilemmas in breastfeeding practices and policies promoting breastfeeding.Footnote 14 Studies on infant food changes in post-1980s China have revealed complex factors influencing feeding choices within a globalised economy.Footnote 15 While scholars like Bingzhen Xiong have outlined breastfeeding methods in ancient Chinese medicine, there remains a gap in our understanding of how the medical community in China conceptualised and promoted breastfeeding during the critical period from 1949 to 1965.Footnote 16
This research bridges this historiographical gap by focusing on the medical community’s role in shaping breastfeeding practices during 1949–1965. By analysing professional medical journals, policy documents, and propaganda materials, we seek to uncover the underlying factors that influenced infant feeding choices in mid-twentieth-century China. This analysis will contribute to our understanding of how medical knowledge, social changes, and political ideologies intersect to shape infant feeding practices in a rapidly changing society, thereby enriching our comprehension of the complex interplay between medicine, society, and culture in modern China.
Scientific and cultural disciplines: ‘breast milk as the optimal choice’
The modern scientific analysis of milk composition originated in eighteenth-century Europe alongside the development of modern chemistry. China, however, did not initiate comparable research until the 1980s.Footnote 17 Nonetheless, during the Republican era, knowledge of human milk composition was introduced to China alongside the broader dissemination of Western medicine. As reported in Chinese journals, comparative studies on the nutritional content of human milk and wet nurse milk—both derived from human sources—revealed minimal significant differences, while distinguishing human milk from other mammalian milk, particularly bovine milk.Footnote 18 Research in the 1930s quantified the moisture, protein, fat, carbohydrate, and mineral content of human and cow’s milk, establishing human milk’s superior nutritional benefits and digestibility.Footnote 19
The 1930s saw increased attention to the role of vitamins in human milk within the medical community.Footnote 20 For instance, vitamin C’s role in preventing infant scurvy was linked to maternal dietary intake. Concurrently, the classification of human milk components became increasingly refined, with distinctions made between ‘carbohydrates’ and ‘inorganic salts’ within the previously broad category of ‘ash content’.
Traditional Chinese medicine historically dismissed colostrum due to its pale-yellow hue and perceived ‘off’ flavour, labelling it ‘unclean’.Footnote 21 This view was challenged by emerging scientific research. In 1937, Meiyu Chen of Chongqing Central University documented in ‘Introduction on Nutrition’ the dynamic composition of breast milk, noting that initial postpartum secretion (within 1–2 days) is cholesterol-rich, facilitating waste elimination and immune protection.Footnote 22 Shoumin Yan, a pioneer of modern paediatrics in China, empirically demonstrated the characteristic functions of colostral bodies in 1938. His research identified that ‘epithelial colostral bodies are the main and permanent components of colostrum, whereas leukocyte-derived (typically neutrophilic) colostral bodies appear conditionally’.Footnote 23 Subsequent studies confirmed colostrum’s immunoglobulin content, elucidating its role in defending against pathogens.Footnote 24 By the late 1940s, the Chinese scientific community had elucidated that colostrum’s yellow colour was due to vitamin A precursors, rather than impurities, as put by Huang Jingjsheng, ‘Colostrum contains a higher amount of ‘vitamins A, B1, B2, C, D, etc.’ compared to mature milk. It also proves to contain a large quantity of ‘enzymes’ and ‘immune bodies’. In biological terms, it retains properties similar to serum’.Footnote 25 This understanding, combined with the recognition of colostrum’s rich vitamin and immune factor content, fundamentally transformed medical perceptions and gradually informed breastfeeding practices.
During the Republican era, human milk—particularly from biological mothers—became accepted as the preferred infant feeding method, grounded in three pillars: nutritional superiority, hygienic considerations, and emerging understanding of the psychological benefits.Footnote 26 Medical discourses increasingly framed breastfeeding as a hygienic alternative to contaminated wet nurse milk or formula. Modern analysis of the components of human milk scientifically explained why it is superior to other types of milk, particularly the in-depth understanding of colostrum components and their effects, which has not only changed the traditional medical perspective on colostrum but also significantly influenced methods of breastfeeding infants with human milk in later generations. Research analysing the components of human milk showed that the nutritional composition is most suitable for infants. ‘The proteins contained in human milk are mostly caseins, which are easy to digest. The fat globules are also smaller than those in cow’s milk, and there is rarely a deficiency of vitamin C’.Footnote 27 Furthermore, since breast milk is directly transferred from the breast to the infant’s mouth, this process reduces the opportunity for ‘bacteria and dust to mix in,’ which is why breast milk is considered ‘the cleanest liquid’. Therefore, human milk not only excels in nutritional composition compared to other types of milk but also has advantages in terms of hygiene and safety that are ‘absolutely unmatched by cow’s milk and other foods’.Footnote 28 Although the ancient Chinese medical practitioners already recognised the benefits of human milk based on observation and experience instead of chemical analysis, stating, ‘Human milk, the formula experts conceal its name, call it ‘immortal’s wine’… All medicinal uses take the milk from healthy women, the whiter and thicker the better… Consuming human milk greatly benefits the heart and Qi…’Footnote 29, the discourse was obviously non-scientific.
Interestingly, the Republican-era emphasis on human milk’s nutritional value persisted into the early 1950s, with little distinction made between a biological mother’s milk and a wet nurse’s milk. Medical authorities in the Republic of China uniformly advocated for human milk as the optimal feeding choice, reserving formula feeding and wet nursing for exceptional circumstances. As stipulated in official guidelines: ‘Infants should receive breast milk nutrition as the most appropriate method. If the biological mother is unable to breastfeed due to health constraints, alternatives such as hiring a wet nurse or using artificial nutrition may be employed, though wet nurse milk remains the preferred substitute’.Footnote 30 This nutritional paradigm directly informed the institutionalisation of breastfeeding promotion in the early PRC. The Handbook of Health Work (1951), published by Northeast China’s Health Ministry, explicitly prioritised biological mothers’ milk, designating wet nurse milk as a secondary option and artificial feeding as the least desirable.Footnote 31 The New Obstetric Science Curriculum (1952) further elaborated this framework, emphasising that direct breastfeeding not only provided superior nutritional benefits but also contributed to maternal recovery, infant psychological well-being, and cost-effectiveness.Footnote 32
During the movement of state feminism, the advantages of breastfeeding for the benefit of the mother were also emphasised in medical recommendations. For instance, ‘Breast milk can be provided sufficiently and at any time to meet an infant’s needs, fostering a sense of security that significantly contributes to the child’s psychological health’.Footnote 33 During the process of breastfeeding, the infant engages in direct, intimate contact with the mother: ‘The warmth and touch of the mother provide a sense of safety, which is greatly beneficial for the child’s mental health and overall development’.Footnote 34 For women themselves, breastfeeding was emphasised for aiding in the contraction of the uterus postpartum and expediting the recovery process. Additionally, during the breastfeeding period, the likelihood of conception is relatively low.Footnote 35
Given these socioeconomic realities characterised by constrained consumer purchasing power, cost-effective infant feeding methods were recommended as a practical necessity for ensuring child nutrition within the population’s material scarcity. Medical textbooks and academic journals reflected these realities. For instance, ‘the impoverished cannot afford to purchase cow’s milk or formula; thus, for those seeking complete nourishment without expense, breastfeeding is the most economical method’.Footnote 36 ‘It is best to ask the doctor for guidance’ when feeding other milk to the baby.Footnote 37 Because this is a feasible way and guarantees to protect the health of infants, ‘the stomach and intestines of young children can only function normally under the correct feeding of breast milk and milk (prepared by the doctor’s instructions)’.Footnote 38 Such approaches not only responded to immediate public health needs but also aligned with the broader developmental priorities of the early socialist era. Breast milk was also regarded as economically better than other types of milk or employing a nursing mother. According to official Chinese government statistics, the annual per capita consumption average in China was merely 76 yuan in 1952. This figure only exceeded 100 yuan by 1957, and by 1965 it had only risen to 125 yuan.Footnote 39 Meanwhile, the impressive list of troubles in hiring a wet nurse included the consideration of several factors before making a decision, ‘(1) One of the key factors to consider is whether she produces enough milk. (2) Does she have tuberculosis, syphilis, gonorrhea, or other infectious diseases? (3) Does she maintain proper hygiene?’Footnote 40 Therefore, before hiring a wet nurse to feed the baby, ‘the nurse should first have a physical examination and blood test to prevent the baby from getting infected milk’.Footnote 41 Whether it is feeding other milk to the baby under the guidance of the doctor, or asking the hired wet nurse to go to the hospital for a health check, these options both increased the time and money cost of feeding the baby.
In the early years of the People’s Republic of China, breastfeeding was established as a core public health strategy to safeguard maternal and infant health and to cultivate the next generation of socialists. During this period, the infant mortality rate became a key indicator for measuring the effectiveness of maternal and child health work, directly driving the formulation and implementation of breastfeeding policies. An investigation by the Shanghai Health Bureau in August 1949 showed that infants who were breastfed (including both maternal breastfeeding and wet-nursing) had a mortality rate more than three times lower than those fed with artificial milk.Footnote 42 This data provided empirical support for the public health value of breastfeeding. The ‘Common Program of the Chinese People’s Political Consultative Conference’, issued the same year, explicitly proposed the strategic goal of ‘protecting the health of mothers, infants, and children’, marking the formal inclusion of breastfeeding into the national health system framework.Footnote 43
Driven by both ideology and scientific discourse, breastfeeding was endowed with a socialist symbolism beyond its biological significance. As the Soviet Union was a model for the women’s liberation movement, the advocacy of breastfeeding by the families of Soviet leaders was introduced into China’s political discourse.Footnote 44 Medical textbooks consistently emphasised this view. For example, the 1952 ‘Public Health’ textbook highlighted that maternal and child health work not only concerned individual health but was also an important project that ‘directly affects the health of future generations and the strength of national defense’.Footnote 45 This narrative closely tied breastfeeding to national rejuvenation, constructing an identity of ‘breastfeeding mother—builder of socialism’, positioning breastfeeding as a biopolitical duty for the new socialist woman to fulfil her civic responsibilities.Footnote 46
To systematically promote breastfeeding practices, the medical community developed a scientific discourse system through multidimensional arguments, such as quantitative comparisons. The 1952 serialised article ‘Human Growth’ quantitatively compared the composition of breast milk and cow’s milk from a nutritional perspective, pointing out the natural advantages of breast milk in protein quality, fat structure, and carbohydrate ratios.Footnote 47 Statistical data were also used to persuasively demonstrate that breastfeeding could reduce the incidence of digestive system diseases such as vomiting and diarrhoea.Footnote 48 For less educated populations with insufficient medical knowledge, the focus was more on the immediate health benefits of breastfeeding, using direct and easily understandable language. In contrast, articles aimed at medical professionals were more inclined to describe the composition and effects of breast milk from nutritional and etiological perspectives. For instance, a 1955 article titled ‘Infant Feeding’ published in the Chinese Journal of Nursing stated: ‘Breast milk is rich in fat and sugar, thus providing higher energy content. The proteins it contains are not only complete but also easily digestible, and the fat and lactose content are most suitable. It is free of bacteria and contains enzymes, vitamins, and antibodies, which promote absorption and immunity’.Footnote 49
The government-led, multidimensional educational network effectively promoted the popularisation of breastfeeding. In 1952, the Practical Maternal and Child Health handbook included breastfeeding guidance as part of the grassroots maternal and child health service standards, requiring healthcare workers to provide personalised feeding advice during home visits, addressing issues such as ‘infant feeding problems’, ‘when to wean, and what to feed after weaning’, and so on.Footnote 50 The Routine Maternal and Child Health Work guidance compiled by the Shanghai Health Bureau went further, developing standardised breastfeeding plans for special groups such as newborns and premature infants.Footnote 51 This institutional intervention worked in synergy with the ‘changing customs’ propaganda strategy proposed by the People’s Daily in 1956. Through a tiered communication system covering different urban populations, the policy emphasized, ‘The publicity work of child-rearing knowledge is a long-term and detailed ‘changing customs’ effort, which must be based on reality, deeply investigate and study the masses, and according to different regions, conditions, and situations, use various opportunities and methods to teach child-rearing knowledge in a practical manner’.Footnote 52
Data show that in Shanghai’s key industrial and densely populated areas (including Putuo, Yangpu, Changning, and Yulin districts), the distribution density of breastfeeding promotional materials—for example the pamphlet The Benefits of Breastfeeding—was significantly higher than in other regions, reflecting the deep connection between industrialisation and the allocation of public health resources.Footnote 53
In summary, the introduction of Western medical practices since the advent of modern medicine provided a scientific rationale for the superiority of breast milk over cow’s milk. An in-depth understanding of the composition and benefits of human milk not only transformed medical perspectives on colostrum but also established a scientific theoretical foundation for the support of breastfeeding and specific recommendations by the medical community in China during the 1950s to 1970s. The justification for supporting breastfeeding by medical experts extended beyond the nutritional benefits of breast milk for infant growth; it also encompassed the protection of maternal and infant health and a consideration of the economic conditions of Chinese families. During this period, a mother’s direct involvement in breastfeeding was not merely a personal choice in parenting but was viewed as a social responsibility impacting national development. Consequently, both the medical community and the government placed significant emphasis on the promotion and dissemination of breastfeeding and its correct practices.
Balancing social production and maternal responsibilities
At the inception of the People’s Republic of China, all sectors of society were in a state of reconstruction, and the nation urgently required the active participation of the women’s labour force in socialist construction. Mobilising the enthusiasm of housewives—a latent productive force—to join the workforce became a crucial task for developing the socialist economy, building a great socialist state, advancing gender equality and women’s liberation, and striving to create a better life for all people.Footnote 54 Through ideological campaigns and political movements, ‘women’s liberation’ and ‘gender equality’ became dominant discourses across urban and rural China, with women widely mobilised to participate in socialised production.Footnote 55 Particularly after the climax of the agricultural corporatisation movement in 1955, Chairman Mao Zedong emphasised: ‘Women in China constitute a tremendous human resource. It is imperative to tap this potential to build a great socialist nation’.Footnote 56
Meanwhile, ‘feudal’ superstitions and ‘backwards’ customs persisted in Chinese society, and were perceived to pose serious threats to women’s and infants’ physical and mental health.Footnote 57 Consequently, professional opinions on breastfeeding focused on rectifying ‘outdated’ practices, superstitions, and harmful customs. Against the backdrop of policies aimed at liberating women’s labour force, medical recommendations on breastfeeding methods increasingly reflected an attempt to balance the dual demands of social production and maternal responsibilities within the socialist framework.
When to initiate breastfeeding?
Traditional Chinese medicine has a distinctive dynamic and dialectical understanding of the characteristics of breast milk. During the Qing Dynasty, the physician Shitai Yang noted, ‘If a person is calm and their diet is mild, their milk will be balanced; if the person is irritable, consumes alcohol, or eats spicy foods, or suffers from a heat-related illness, their milk will be hot’.Footnote 58 With the introduction of modern medicine, Chinese paediatric texts began to categorise human milk according to its secretion stages, including colostrum (from birth to 12 days), transitional milk (from 12 days to 1 month), mature milk (from 1 to 9 months), and late milk (from 10 to 12 months). Based on biochemical analysis, the differences in the composition of breast milk during these stages were noted: ‘colostrum has lower fat content and higher protein, transitional milk has the highest fat content, and mature and late milk are similar in composition. The milk expressed in the early stages is low in fat and high in protein. Subsequent expressions yield higher fat content, reaching levels two to three times higher by the end’.Footnote 59 Chemical analyses of colostrum indicated that it ‘is akin to the tissues of infants in terms of its composition and nutritional value. Its fat is rich in oleic acid, and it contains significant amounts of coagulated globulin, as well as immune bodies, enzymes, and hormones, making it the most suitable food for infants in the first few days after birth’.Footnote 60 This scientific classification fundamentally altered the traditional, vague understanding of breastmilk.
To the contemporary Chinese, the chemical understanding and immunological discussion of colostrum were revolutionary and disruptive. The introduction of this knowledge aimed to correct the public’s misunderstanding of the value of colostrum, which became a primary task after the founding of the People’s Republic of China, in establishing when to begin breastfeeding. That is to emphasise that colostrum was not only harmless but beneficial. In addition to emphasising the nutritional value of colostrum, ‘which is more adaptable to the infant’s physical constitution’, its fat is rich in oleic acid, and its protein contains a large amount of globulin. It was also emphasised that colostrum contains immune bodies, enzymes, and hormones, and ‘can help prevent infectious diseases such as typhoid and diphtheria’.Footnote 61 For rural women with lower education levels, a more straightforward approach was used, even borrowing from traditional Chinese medicine terminology. It was emphasised that ‘the first three to five days of milk after childbirth help expel the baby’s meconium’, and that colostrum has a ‘cleansing effect on the intestines, and it would be a pity to discard it’.Footnote 62 This promotional strategy laid an important foundation for educating the public on when to begin breastfeeding.
During this period, various regional breastfeeding initiation customs prevailed in Chinese rural areas. In Jiangsu, newborns were commonly administered decoctions of Coptis chinensis and liquorice root as ‘opening milk’, symbolising the cultural ideal of ‘suffering first to appreciate sweetness later’. In Zhejiang, infants underwent a multisensory ritual where they tasted vinegar, salt, C. chinensis, Uncaria rhomboides, and sugar sequentially, embodying the Confucian ethical concept of ‘enduring life’s bitterness, sourness, spiciness, to comprehend ultimate sweetness’. In northern Jiangsu, mothers mixed breastmilk with ink before feeding, believing this practice would cultivate ‘literary talent and erudition’ in infants. Some regions maintained complex kinship-based feeding traditions: female infants received colostrum from male-infant households, while male infants were fed by female-infant families, with strict avoidance of same-clan breastfeeding.Footnote 63 These traditions, rich in cultural symbolism yet lacking scientific validation, increasingly encountered critiques from emerging medical discourses. Health authorities explicitly condemned these customs as unhygienic and unsafe.Footnote 64
The WHO recommends initiating breastfeeding within half an hour after birth and breastfeeding on demand when the infant shows signs of hunger. Exclusive breastfeeding is advised for the first six months without any additional foods or water.Footnote 65 In contrast, Chinese medical recommendations from the 1950s to the 1970s varied widely, suggesting initiation of breastfeeding anywhere from 5 to 24 hours after delivery, with adjustments based on individual circumstances. During this period, the concept of ‘exclusive breastfeeding’ was not established, and some guidelines even supported the introduction of non-breast milk foods shortly after birth.
At that time, there were no unified regulations on the timing of breastfeeding initiation after birth, but there was generally a consensus among the professional community in China. According to A Concise Guide to Pediatrics (1950), it was suggested that there was no need for breastfeeding within 12–24 hours after birth. If the infant cried, a small amount of sweetened tea (two drops of a 10% saccharin solution added to 100cc of diluted tea) could be given several times.Footnote 66 Similarly, Lectures on Pediatrics (1954)officially issued by the Fourth Military Medical University of the People’s Liberation Army (now the Air Force Medical University of the PLA) advised that in the first 12 hours after delivery, both mother and child should rest, and there is no immediate need for breastfeeding. The book also mentioned that the milk supply in the first few days is typically low, and recommended the supplementation of 5% glucose water after each feeding.Footnote 67 In 1955, Shafen Zhang, an expert from the Beijing Military Commission Health Department (Now Peking Union Medical University) specialising in maternal and infant health, reported that infants may not display signs of hunger within the first 24 hours of life. Additionally, mothers may not produce milk immediately after birth and require rest, leading some infants to begin breastfeeding after 24 hours, while others may do so after 12 hours. Additionally, the timing of the first breastfeeding was allowed to vary based on the infant’s condition, with ‘premature infants needing to start breastfeeding within 6–8 hours… In cases of trauma, intracranial haemorrhage, or prolonged vomiting, the first feeding could be delayed until 18–24 hours, during which time sugar water and boiled water could be administered as needed.Footnote 68 Soviet medical texts also addressed the timing for initiating breastfeeding: ‘Healthy newborns should be breastfed starting 8–12 hours after birth’.Footnote 69 Similarly, paediatrician Zufei Su recommended: ‘In the first 6–12 hours postpartum, breastfeeding can be temporarily suspended to allow both mother and infant adequate rest. However, small amounts of water can be offered every two hours’.Footnote 70
As this medical advice suggests water, sweetened tea, or glucose solution was provided immediately after birth, in addition to introducing appropriate supplementary foods based on the infant’s age after one month. This recommendation stemmed from the belief that ‘breast milk alone is nutritionally insufficient’, therefore additional complementary foods should be introduced. At two weeks, for example ‘a small spoonful of persimmon juice can be given daily, gradually increasing the amount…’Footnote 71 Regardless of the feeding method employed, ‘supplementary foods should be introduced… This can begin after the infant’s first month. Initially, clear cod liver oil should be administered twice daily, starting with a few drops and gradually increasing the dosage. By the third month, half a teaspoon can be given per serving’.Footnote 72 As the infant grew, the nutritional content of milk becomes insufficient, necessitating the introduction of supplementary foods in addition to milk. After the first month, parents were advised, cod liver oil could be given twice daily, starting with two drops per serving and increasing monthly to one teaspoon of regular cod liver oil, to provide supplemental vitamins A and D.Footnote 73
Medical recommendations suggested that newborns could receive necessary nutrition from their mother’s body immediately after birth, potentially allowing for a delay in initial breastfeeding. These guidelines also considered the physical well-being of both the mother and infant after delivery, allowing them time to rest.Footnote 74 Some advice suggested that ‘ideally, the mother should breastfeed her infant five to six hours after delivery’ to incorporate an understanding of lactation mechanisms, as the infant’s suckling can aid uterine contractions and stimulate increased milk production in the mammary glands.Footnote 75
This approach to infant feeding in mid-twentieth-century China reflects a transitional period in paediatric nutrition, where traditional practices were being integrated with emerging scientific understanding. The recommendations demonstrate an awareness of the physiological needs of both mother and infant, while also revealing the contemporary limitations in understanding the complete nutritional profile of breast milk. These historical insights provide valuable context for the evolution of infant feeding practices and nutritional guidelines in China.
Rigid timed breastfeeding
Between 1949 and 1965, medical recommendations regarding breastfeeding frequency underwent a shift, transitioning from the emulation of Anglo-American practices to the adoption of Soviet models. Rigid scheduled breastfeeding emerged as the preferred method, advocated by paediatricians for its alignment with both infant digestive physiology and maternal lactation rhythms, while also accommodating women’s participation in socialist productive labour.
In the very early years of the PRC, Chinese paediatricians initially focused on Anglo-American infant feeding approaches; at least, no consensus on rigidly timed breastfeeding was reached among medical elites. For example, in 1949, Gongshao Ye published an article in People’s Daily criticising scheduled feeding as a vestige of older foreign milk-feeding practices, noting that ‘Western countries had already abandoned mechanical timetables in favor of demand-based feeding’.Footnote 76 Similarly, in 1950, paediatrician Mingtong Song highlighted growing international criticism of rigid feeding schedules as a ‘mechanical clockwork feeding method’; he also reminded readers that within American pediatric circles, ‘self-demand feeding’ had gained empirical support through psychological research.Footnote 77 This period witnessed active debate within the Chinese medical community about the merits of scheduled versus demand feeding, with some scholars questioning whether breastfed infants required strict temporal regimentation.
However, as the Sino-Soviet relationship entered a ‘honeymoon period’ in the 1950s, Soviet medical paradigms decisively reshaped Chinese medical practices, spanning both basic and clinical medicine.Footnote 78 Pavlovian theories became foundational for understanding physiological processes. According to Pavlov’s theory, the lactation and digestive functions of mammals were believed to follow a certain temporal pattern, and adhering to a specific feeding schedule was considered essential for promoting growth and development. Soviet research on neonatal nervous system activity also revealed that healthy newborns displayed advanced neural activity within 3 to 5 days postpartum, forming conditioned reflexes tied to the timing of breastfeeding.Footnote 79
This theoretical framework legitimised scheduled feeding as scientifically superior for Chinese paediatricians.Footnote 80 In 1956, the Chinese Ministry of Health organised a national training program for maternal and child health administrators, featuring Soviet pediatric experts who systematised feeding schedules according to infant age-specific requirements.Footnote 81 In 1958, paediatricians from Peking Union Medical College Hospital also reaffirmed scheduled feeding standards when responding to a reader’s letter in People’s Daily.Footnote 82 Mingtong Song’s 1960 textbook Medical Pediatrics provided detailed timetables specifying breastfeeding frequencies, intervals, and durations for different developmental stages. The text explicitly stated: ‘Correct scheduled breastfeeding establishes temporal conditioned reflexes essential for digestive gland regulation, ensuring periodic gastric acid secretion prior to nutrient intake and optimizing metabolic efficiency’.Footnote 83
During this period, domestic pediatric research on feeding intervals and child weight gain was carried on, providing empirical support for ‘timed feeding’. The research claimed the importance of regular feeding schedules for children’s overall health and development, which became a cornerstone of state-endorsed infant care policies.Footnote 84 This ideological and practical shift was manifested through three interconnected dimensions: medical discourse, workplace regulations, and national welfare programs.
Chinese paediatricians like Peiyao He and Rongwen Pan integrated Soviet Pavlovian theory into their analyses of breastfeeding practices. Peiyao He, trained at Hunan Yale Medical University and practising at Wuhan Military Medical Hospital, conducted a comparative study in 1957, as described in ‘The Feeding Regimen and Newborn Weight’. She classified feeding regimens into ‘timed’ and ‘untimed’ groups. She argued that timed feeding created conditioned reflexes beneficial for both mothers and infants: ‘Regular feeding schedules ensure synchronized milk secretion, orderly development of appetite and digestion, and efficient workforce management for nursing staff’.Footnote 85
Rongwen Pan’s comparative study (1957) of five vs. seven feeding regimens further legitimised timed feeding. By analysing hourly weight measurements and nursing workload data, he concluded that seven-time feeding reduced supplementary feeding requirements and labour costs without compromising infant health. She explained that ‘the feeding regimen can generally be divided into timed and untimed (feeding according to the newborn’s needs)’. However, she noted that ‘all newborns delivered in hospitals are fed on a timed regimen. Timed feeding creates a conditioned reflex for both the mother and the newborn. It ensures that milk is secreted at regular intervals, the newborn’s appetite and digestion develop in a regular pattern, and nursing staff can plan their work schedule. These are all advantages of timed feeding’.Footnote 86 This type of research has established that timed feeding based on Pavlovian theory is scientifically valid and practicable in practice. The recommendations for ‘timed feeding’ were not limited to hospitals.
These medical recommendations reflected two main considerations behind the emphasis on ‘timed feeding’: the infant’s digestive capacity and the mother’s milk production capacity. Moreover, ‘timed feeding’ also met the needs of women who were participating in production labour at the time, as ‘the feeding times were scheduled to coordinate with the mother’s work hours, ensuring infants would not be harmed… To some extent, the feeding schedule was determined by the mother’s commuting hours’.Footnote 87 Hence, ‘timed feeding’ could be adjusted according to the mother’s work schedule.
In 1953, A Basic Summary of the Women’s Movement in China over the Past Four Years and Future Tasks was published by Yingchao Deng, the wife of Premier Zhou Enlai and the chairperson of the National Democratic Women’s Federation. She emphasised the importance of integrating the women’s liberation movement with the nation’s and the people’s cause. In rural areas, initiatives were implemented to promote the development of family-owned businesses and handicraft production. Additionally, childcare centres and mutual aid groups were established voluntarily during busy farming periods to protect women’s interests and address their issues and difficulties.Footnote 88
Clearly, in the construction of socialism, the welfare and protection of women and infants were not neglected. With the surge in social production, providing childcare for female workers became a prerequisite for ensuring women’s active participation in production. Nurseries and breastfeeding rooms began to be built in large numbers in both urban and rural areas, for example, the text at that time contained the following statement: ‘The superior socialist system guarantees mothers’ breastfeeding time; factories arranged for breastfeeding breaks, and rural workers could return home during breaks to breastfeed’.Footnote 89 According to statistics published in the People’s Daily, by the second half of 1959, there were over 28,000 nurseries and breastfeeding rooms in factories and mines nationwide, with more than a million children enrolled. By the end of 1959, there were over 3.6 million nurseries and kindergartens in rural areas, with enrolled children accounting for approximately 60% to 80% of the total child population. Nurseries primarily for infants were mainly located in convenient places for mothers to breastfeed, such as workshops or fields.Footnote 90
In industrial factories, specific rules and regulations were established to ensure that mothers could breastfeed their infants on time without affecting production schedules. For example, at the Shanghai National Cotton Mill No. 7, before June 1953, the lack of proper protective measures for breastfeeding and pregnant female workers made it difficult for women to balance childcare responsibilities with production labour. This not only jeopardized the health of mothers and infants but also negatively impacted factory productivity, leading to wastage of materials and poor product quality. Therefore, for example, in July 1953, the National Cotton Mill No. 7 began to implement measures to protect breastfeeding and pregnant female workers. These included a ‘fixed substitute worker’ system, whereby designated personnel would replace breastfeeding female workers during their breastfeeding and pregnancy periods.Footnote 91
Similarly, the Qingdao National Cotton Mill No. 1 also established a ‘scheduled substitute breastfeeding’ system, and the experiences from these two textile mills influenced other factories as well. A certain cotton spinning factory’s weaving workshop trialed this system and created a ‘schedule for substitute mothers’ breastfeeding times’ to coordinate breastfeeding schedules for female workers within the factory. ‘After implementing the scheduled breastfeeding measures, not only was there a shift in the general workers’ perception of female workers who are mothers, particularly those who breastfeed, but the health conditions of breastfeeding workers also improved, leading to increased attendance… This greatly reduced production downtime and improved product quality. Moreover, by ensuring regular breastfeeding and timely supplementary feeding, the development and health of infants were also enhanced’.Footnote 92 Due to the positive results observed in practice, the ‘Interim Regulations on Special Protection for Pregnant and Breastfeeding Female Workers’ were officially promulgated in 1957.Footnote 93 These regulations applied to all female employees in state-run, locally-run, central cooperative, and local cooperative enterprises. The attention to the welfare of women and children enabled both urban factories and rural areas to create conditions and environments that facilitated breastfeeding through institutional regulations and the establishment of childcare organisations. This achievement balanced nurturing responsibilities with participation in production.
In summary, during the period from 1949 to 1965, influenced by Soviet medicine, scheduled breastfeeding swiftly gained support and endorsement from the medical community. Mothers were recommended to establish fixed intervals between feedings based on the patterns of lactation and infant digestion. Furthermore, there was a strong emphasis on having mothers breastfeed at set times in order to better coordinate social labour with child-rearing responsibilities.
When to wean?
When giving recommendations on weaning time, Gongshao Ye, a renowned expert in child nutrition, announced, ‘In the past, weaning infants at seven or eight months, as stated in textbooks, is a completely dogmatic imitation of the Anglo-American approach, which is not suitable for our current situation in China’.Footnote 94
When it came to recommendations for weaning, medical studies on the nutritional content of breast milk indicated that after one year, the milk produced by mothers may be deficient in essential nutrients. This deficiency could potentially result in anaemia in infants or lead to symptoms such as pale skin and poor development.Footnote 95 In the A Textbook of Public Health published in 1951, it was recommended that infants receive regular health checkups, including a ninth-month check where maternal and child health workers would provide guidance on weaning and nutrition.Footnote 96 In the Science of Public Health published in 1952, it was suggested that ‘the weaning period can be between 14 to 18 months, which is physiologically appropriate’.Footnote 97 As infants grow, the quantity of milk produced by mothers also changes: ‘most mothers who breastfeed for ten to fourteen months find that their milk supply has significantly decreased’. Even for mothers with ample lactation capabilities, extended breastfeeding may potentially impact their baby’s digestive capacity, potentially leading to nutritional deficiencies and other health concerns.Footnote 98 In 1954, Maternal and Child Nutrition, edited by Gongshao Ye, suggested that maternal and child health workers consider prolonging the breastfeeding period to one to one and a half years. This recommendation was made due to the challenges in accessing cow or goat milk in remote rural areas of China, making breast milk the optimal source of protein for infants.Footnote 99 In 1955, Fangwei Wang wrote several articles specifically addressing the importance of correct timing and methods for initial breastfeeding and weaning.Footnote 100
Although there was no unified consensus regarding the optimal time for weaning infants during this period, certain fundamental agreements existed. For instance, it was generally recommended that weaning should ideally occur during the cooler autumn months. If the appropriate age for weaning coincided with summer, it was advised to postpone weaning to mitigate the risk of infant illnesses associated with the process.Footnote 101 Moreover, as infants grew older, it was deemed crucial to introduce supplementary foods to complement their nutritional intake, simultaneously laying the groundwork for eventual weaning.Footnote 102
This evidence suggests that, based on their understanding of human milk composition, the Chinese medical community recognised the impact of both initial breastfeeding and weaning timing on maternal and infant health, offering relevant recommendations and rationales. While a consensus was reached regarding attitudes towards colostrum and the seasonal timing of weaning, there remained considerable flexibility in specific timing recommendations, allowing for adjustments based on individual circumstances. The guidelines concerning breastfeeding intervals reflected both a concern for maternal and infant well-being and an acknowledgement of practical realities in daily life.
This approach to infant feeding in mid-twentieth-century China demonstrates a nuanced understanding of the complexities involved in breastfeeding and weaning practices. It reflects a synthesis of traditional wisdom and emerging scientific knowledge, highlighting the evolving nature of paediatric nutrition advice during this period. The flexibility in recommendations underscores an awareness of individual variations in infant development and familial circumstances, suggesting a pragmatic approach to infant care that balanced idealized practices with practical considerations.
The emphasis on seasonal considerations for weaning is particularly noteworthy, indicating an appreciation for the potential impact of environmental factors on infant health during transitional feeding periods. This holistic view of infant nutrition, encompassing not only the composition of feeds but also the broader context of feeding practices, provides valuable insights into the development of paediatric care in China during this era.
Furthermore, the gradual introduction of supplementary foods alongside continued breastfeeding reflects an early understanding of the concept of complementary feeding, which has since become a cornerstone of modern infant nutrition guidelines. This historical perspective offers a compelling glimpse into the foundations of contemporary paediatric nutrition practices and the cultural factors that influenced their development in China.
Practicality and breaking with tradition: what is the best alternative?
Between 1949 and 1965, the confluence of intensifying ideological campaigns and the surging women’s liberation movement affected both the discourse and practice of infant feeding. Wet nursing, traditionally practised through paid breastfeeding arrangements, was portrayed as an outdated practice incompatible with socialist values. Influenced by Soviet medicine, state-sponsored ‘human milk collection stations’ (milk banks) were gradually established in China, which, to some extent, enriched the sources of human milk.
Medical discourse evolved significantly during this transformative era. Official guidelines transitioned from endorsing wet-nursing services to promoting breast milk bank utilisation, reflecting ideological alignment with collectivist principles. Concurrently, economic constraints and the limited nutritional efficacy of commercially available infant formula compelled healthcare authorities to develop regionally-tailored protocols of homemade substitutes. The recommendations for choosing breast milk substitutes also reflected a shift from feudal and backward methods to those that better met actual needs.
The liberation of ‘wet nurses’: a temporary human milk collection station
In the early 1950s, the practice of employing wet nurses was still prevalent, and medical advice often recommended it as a primary alternative to maternal breastfeeding. The 1950 publication Hygiene and Diseases of Infants stated: ‘Mothers should priorities the child’s interests and not forsake breastfeeding for personal comfort… Apart from mother’s milk, the best method for infant nutrition is to employ a wet nurse’.Footnote 103 The Maternal and Child Health Handbook suggests that in cases where a mother is unable to breastfeed, alternative options, such as using another woman’s milk through a wet nurse, can be considered.Footnote 104 Although not as optimal as breastfeeding from the mother, this method still provides numerous benefits compared to artificial feeding. In 1954, the editorial board of the Chinese journal Maternal and Child Health (Fuyou Weisheng) responded to a query from a reader named Yang Ye from Baoqing on the topic. Their response stated: ‘For infant nutrition, breast milk is optimal. However, in cases where the mother is unable to breastfeed due to illness, a wet nurse may be hired’.Footnote 105
However, ideological transformation and class struggle assumed central significance in socialist state-building and also served as a hallmark of women’s emancipation. The collective consciousness increasingly framed wet-nursing as a symbolic manifestation of class exploitation. Under the pre-socialist economic system, wet nurses constituted a marginalised proletariat group subjected to triple oppression. Wet nurses were forced to separate from their children in order to make a living, with their breasts transformed into profit-generating organs, sacrificing their own children’s right to breastfeed, while enduring exploitation and abuse from their employers. Therefore, employer households represented bourgeois appropriation of proletarian maternal labour in socialist China, which was not encouraged.Footnote 106 Such ideological positioning was institutionalised through state-sponsored cultural production, exemplified by the 1965 Rent Collection Courtyard clay sculpture ensemble. In one particularly striking tableau, a lactating woman is depicted being forcibly relocated to a landlord’s estate, serving dual didactic purposes: exposing the material realities of wet nurses’ oppression and problematizing bourgeois consumption patterns that commodified female bodies.Footnote 107
After the founding of the People’s Republic of China, the state placed great emphasis on women’s liberation, aiming to address and rectify such injustices. The socialist system provided favourable conditions for improving women’s status, granting unprecedented liberation to women who were no longer to be objects of oppression, enslavement, and bullying.Footnote 108 Consequently, in the new society, ‘it is neither principled nor reasonable to deprive one child of nutritional rights to solve another’s nutritional problems, and the new society does not allow such practices, unless the wet nurse’s child has died or been weaned’.Footnote 109
Furthermore, with the advent of socialist construction, women actively participated in social development. Supported by the ‘equal pay for equal work’ policy, both urban female workers and rural women increased their labour enthusiasm, leading to significant changes in Chinese women’s social status.Footnote 110 By the late 1950s, 80% to 90% of healthy rural women were estimated to be involved in fieldwork, with the number of working days per year significantly increasing.Footnote 111 The increase in job options for women meant they no longer needed to sell their breast milk for survival or to risk their own children’s health, contributing to the liberation and disappearance of wet nurses.
For example, in 1956, employees at Shanghai textile factories reported the following:
‘Since the upsurge of industrial cooperation, some workers’ family members, nannies, and wet nurses have been mobilized to return to their hometowns. Simultaneously, employment among workers’ family members has increased, resulting in a decrease in available nannies, wet nurses, and family members who can take care of household chores’.
As a result, the working conditions (including wages and living conditions) for nannies and wet nurses have seen improvements. The textile factory has put forward solutions to address obstacles in hiring wet nurses, such as offering temporary household registration for rural wet nurses in Shanghai.Footnote 112 The elimination of the ‘exploitation’ of wet nurses, coupled with increased labour participation and employment opportunities for rural and urban women, led to the disappearance of the social environment and practical demand for wet nursing based on employment relationships.
Meanwhile, the concept of human milk collection stations was introduced to China through translated works. In the book Childcare compiled and translated by Zhou Junshang in 1951, it was mentioned that countries like the Soviet Union, the UK, and the US had successfully established ‘human milk stations’ or ‘milk banks’ near major cities.Footnote 113 For example, in 1956, a popular magazine—Maternal and Child Health—advised the audience to: ‘organize and mobilize mothers with excess milk to express the surplus… collect their expressed milk to supply children who are lacking’.Footnote 114 Although human milk collection stations were not explicitly mentioned, it was indeed the logic of the human milk station.
Various medical recommendations began to include suggestions on how to organise human milk collection stations, and some hospitals began experimenting with collecting breast milk to feed premature infants. Necessary equipment, standardised operational procedures, and institutional regulations were introduced and established to sustain the quality of the human milk collected.Footnote 115 In 1956, the infant room of the First Hospital in Anshan (a major hub of steel production) regarded collecting breast milk to nourish premature infants as an important measure to improve care quality and reduce mortality rates.Footnote 116 An article titled ‘The Organization and Work of Human Milk Stations (Milk Collection Stations)’, published in the Chinese Journal of Pediatrics (the most important academic journal in this area) in 1958 provided a detailed introduction to the location, work procedures, equipment, sources of human milk, and distribution principles of human milk collection stations.Footnote 117 This journal also reported the pilot experience of the Nutrition Department of Shanghai First Medical College Pediatric Hospital in 1959, they ‘learning from Soviet advanced experience, within the existing manpower and material conditions’, successfully established a human milk station with ‘strong support from the communist party branch and hospital leadership and enthusiastic assistance from the health department’.Footnote 118 The report was later included in the Compilation of Materials from the National Medical and Health Technology Revolution Exhibition (Obstetrics and Gynecology volume). Footnote 119 This clearly demonstrated the medical community’s supportive attitude toward building human milk collection stations.
In the 1960s, to address the insufficient supply of breast milk for infants in rural areas, the national health authorities developed detailed regulations for human milk collection and storage based on regional differences.Footnote 120 It is important to note that during this period, breastfeeding remained the mainstream practice, and the use of milk banks was limited to special medical needs. From the perspective of institutional design, the initial purpose of milk banks in early New China had distinct characteristics of mutual aid and welfare: they aimed to redistribute social resources by adjusting the surplus and shortage of milk, reflecting the collectivist ideals of the planned economy system.
However, the actual operation of milk banks faced three major constraints: in terms of health management, a standardized screening system was needed to implement dual health monitoring for both milk donors and infants; in terms of milk processing, cold chain storage equipment and sterilization testing facilities were required; and in terms of infrastructure, dedicated storage space and cold chain transportation conditions were necessary. These rigid requirements created significant tension with the generally weak capacity of grassroots medical and health institutions at the time, particularly in economically underdeveloped areas, where the cost of establishing and maintaining milk banks far exceeded the economic benefits of traditional breastfeeding. The process of milk collection, transportation, sterilisation, and feeding inevitably caused time delays, which not only increased the risk of pathogen growth but also resulted in the loss of heat-sensitive nutrients such as whey proteins due to pasteurisation. This undermined the core advantage of milk banks from a nutritional perspective.
In conclusion, under the interaction of socialist ideology and the economic base, the traditional wet-nursing model rapidly exited the historical stage. On the one hand, collective labour reshaped the role of women, and the expansion of the professional female workforce reduced the space for private employment. On the other hand, the discourse derived from Soviet medicine, through authoritative medical narratives, established breastfeeding as a biopolitical obligation for the new socialist woman. It is noteworthy that although milk banks were frequently included as an alternative socialist welfare offering, their large-scale implementation was always constrained by the overall development process of industrialisation and the public health system.
Artificial feeding products: prioritising economic practicality
Western countries in Europe and America led the research on artificial feeding. After the second half of the nineteenth century, paediatricians and nutritionists successively established various rules for infant food preparation.Footnote 121 As people’s understanding of bacteriology, cow’s milk chemical composition, processing methods, and vitamins deepened, these rules were continuously revised, and ‘scientific principles’ gradually became applied to the humanisation of cow’s milk.Footnote 122 Driven by commercial interests, many infant formula companies, such as Nestlé, Horlicks, and Mead Johnson, were established in the late nineteenth and early twentieth centuries. Condensed milk products and breast milk substitutes (including milk powder and infant formula) also entered the Chinese market.
In ancient Chinese society, there were records of using animal milk to replace human milk for infant feeding. However, it was not until modern times that China developed a specialised study of dairy science, influenced by factors such as the impact of Western learning, domestic needs, and the development of nutrition science.Footnote 123 China’s dairy manufacturing industry also began in modern times, struggling to survive under war and foreign commercial impacts. After 1945, American brands like Klim and Golden Mountain dominated the Chinese market. It was only after 1949 that China’s dairy industry had a stable environment for development.Footnote 124
Cow’s milk was the preferred substitute for human milk, but in the early 1950s, China had few dairy cows, and ‘milk prices in various regions were extremely expensive, beyond the reach of ordinary families’. Moreover, fresh cow’s milk was difficult to preserve and inconvenient to transport, often causing inconvenience to travellers. As a result, various methods were invented to evaporate part or all of the water content in cow’s milk, turning it into a concentrated or dry dairy product that was easier to use, such as evaporated milk. Adding a large amount of sugar during evaporation allowed the milk to remain unspoiled for several days after opening.Footnote 125 In the 1950s, China translated several Soviet books on condensed milk production, inspection, and sterilisation techniques, which indirectly reflected China’s lack of production technology and methods, showing the need to learn from foreign countries.
In order to address issues in condensed milk and milk powder production technology, active measures were taken by dairy factories across the country. In December 1957, a national dairy industry experience exchange conference was held in Beijing by the central government, where the flat pan milk powder operation method was introduced by the Shitouhe Dairy Factory. Various regions then learned from this valuable experience. During the ‘First Five-Year Plan’ (1953–1957), China built 25 dairy factories, and by 1957, dairy product output reached 12,700 tons, a 19-fold increase compared to 1952.Footnote 126 After 1958, ‘the national dairy industry flourished everywhere, leading to further growth and development in the sector.’ In the spirit of establishing enterprises quickly, efficiently, and economically, flat pan condensed milk and milk powder production methods became popular.Footnote 127
Despite its longer shelf life compared to fresh milk, condensed milk, which is also derived from cow’s milk, remained susceptible to spoilage and was relatively expensive.Footnote 128 Consequently, Chinese nutritionists actively pursued the development of soy-based milk substitutes as alternatives to cow’s milk-based products. In 1952, a proposal suggested that the nutritional value of soy milk is comparable to that of cow’s milk. For families with limited economic means, or in cases where infants faced difficulties in breastfeeding, or mothers were unable to provide sufficient milk for various reasons, soy milk could serve as an economical substitute for milk cakes, which was often more expensive and less nutritious. Notably, the nutrients in soy milk exist in a mixed or dissolved state, facilitating digestion and absorption. Thus, it was particularly suitable for supplementing infant and child nutrition, especially in rural areas of China.Footnote 129
In 1952, the Central Academy of Medical Sciences established a children’s food research group dedicated to studying infant nutrition.Footnote 130 Medical recommendations in the 1950s for milk substitutes included not only animal milk-based products such as cow’s milk, goat’s milk, whole milk powder, evaporated milk, yoghurt, and skimmed milk, but also soy milk. From a nutritional perspective, soy milk was considered a ‘milk substitute that adheres to nutritional principles’.Footnote 131 However, it was noted that ‘only infant cakes (powders) containing appropriate amounts of milk or soy protein can serve as true milk substitutes; otherwise, they can only function as supplementary foods’.Footnote 132
Between 1953 and 1954, the Central Academy of Medical Sciences conducted a comprehensive nationwide survey on commercially available milk substitutes. Based on this research, paediatricians and nutritionists further improved the formulation of milk substitutes, resulting in the development of the ‘5410’ infant food cake.Footnote 133 Clinical observations revealed that infants fed with the ‘5410’ formula displayed good appetite, proper digestion, and normal growth and development.Footnote 134 The primary ingredients of the ‘5410’ infant food cake were rice flour (45%), soy flour (28%), and cane sugar (16.5%). In cases where soybeans were unavailable, other peeled legumes could be substituted. For home preparation, a mixture of ‘1/3 roasted soybean flour and 2/3 millet flour (or other rice or wheat flour) with added sugar, steamed and made into a paste’ was recommended.Footnote 135
Based on the ‘5410’ formula, Shanghai Yimin Food Factory No. 1 produced the ‘Guangming Brand Infant Cake’, which was promoted nationwide. In 1955, China engaged in technical exchanges with Romania regarding the ‘5410’ formula, receiving international acclaim.Footnote 136 In 1958, the Ministry of Light Industry and the Ministry of Health jointly promoted the ‘5410’ infant food cake nationwide, convening a national conference on dairy and milk substitute products. They established departmental standards (including ‘Trial Standards for Milk Substitute Powder’ and ‘Trial Standards for Infant Food Cake [Powder]’) and hygiene regulations, further stimulating the production of milk substitutes.Footnote 137
From June 1957 to March 1959, the Beijing Children’s Health Center conducted a comparative study using Guangming Brand soy-based milk substitute powder and Hongxing Brand whole milk powder to feed infants, comparing their growth with predominantly breastfed infants. The results indicated that ‘infants fed with milk substitute powder and cow’s milk powder, when properly administered, exhibited normal growth in height and weight’.Footnote 138
However, the developing dairy industry failed to meet the enormous demand for infant food products. Milk powder shortages persisted, affecting infant feeding and causing public discontent. In Shanghai in 1956, there was a high demand for milk powder, with some parents going as far as bringing their infants to food company counters and refusing to leave without purchasing it. In response to this situation, the Shanghai Municipal Committee of the Communist Party of China proposed increasing dairy production, improving public education, and considering relaxing restrictions on rural women coming to Shanghai to work as wet nurses. This could potentially involve extending their temporary household registration until the infants were weaned.Footnote 139
The supply gap for dairy products, milk powder, and various milk substitutes remained unresolved by 1958. ‘Many mothers wrote letters or made phone calls to newspapers, people’s committees, and production and sales departments, some even attaching photos of their children.’ Paediatricians collectively called for the rapid advancement of the dairy industry to address the infant food crisis.Footnote 140
To further address the infant food issue, medical experts provided recommendations for milk substitute formulations tailored to different regions and economic conditions. By the late 1950s, various simplified milk substitute formulas were proposed and promoted. For example, in 1959, the Chinese Academy of Medical Sciences recommended a formula for use in rural areas.Footnote 141 By comparing the composition of soy milk with milk cakes, the Academy affirmed the positive value of soy milk in infant feeding, thereby expanding the range of available milk substitutes. The introduction of simple methods for preparing milk substitutes at home provided convenience for parents. It noted that ‘feeding infants with this type of milk substitute powder yields satisfactory results. Additionally, it is easy to prepare, using readily available ingredients, and is inexpensive, costing only about 0.2 yuan per jin (500 grams). It is worth trying both in households and nurseries’.Footnote 142
The development and promotion of milk substitute formulas in the 1960s significantly improved infant and young child nutrition.Footnote 143 The diversification of breast milk substitutes provided medical professionals with more options when recommending alternatives to breastfeeding. However, surveys from this period indicate that hygiene and nutritional issues persisted in the production of milk substitutes.Footnote 144 Overall, advancements in research on the nutritional composition of milk substitutes and the popularisation of home-prepared formula methods reduced the reliance on wet nursing when infants could not be breastfed by their mothers.
Conclusion
The transformation of infant feeding practices in China from 1949 to 1965 reflects a complex interplay of scientific advancement, political ideology, and socioeconomic change. This period witnessed a significant shift in the understanding and promotion of breastfeeding, firmly establishing it as the optimal method of infant nutrition. The influence of modern Western medicine led to a re-evaluation of human milk from biochemical and nutritional perspectives, elevating its status above artificial alternatives.
The Communist Party’s prioritisation of maternal and infant health in the early 1950s played a crucial role in shaping public health policies. The vigorous promotion of breastfeeding, coupled with the establishment of supportive institutions, demonstrates the state’s commitment to reducing infant mortality and nurturing a healthy socialist population. However, the flexibility in medical recommendations regarding breastfeeding practices highlights the pragmatic approach adopted to accommodate individual circumstances and societal demands.
The gradual disappearance of wet nursing during this period is particularly noteworthy. Initially considered the best alternative to maternal breastfeeding, wet nursing declined in prominence due to increased female employment opportunities and advancements in milk substitute technology. This transition exemplifies how changes in social structures and technological progress can profoundly impact medical practices and recommendations.
The evolution of infant feeding alternatives was not solely driven by medical considerations but was deeply influenced by broader societal factors. The interplay between political discourse, female labour participation, and the development of the milk substitute industry shaped the trajectory of infant feeding practices. This multifaceted approach underscores the importance of considering the broader historical context when examining changes in medical practices and public health policies.
This study contributes to our understanding of the history of medicine in China by illuminating how scientific knowledge, political ideology, and socioeconomic factors converged to shape infant feeding practices. It demonstrates that the development of public health policies is not a linear process driven solely by scientific advancement, but rather a complex negotiation between various societal forces. Future research could further explore the long-term impacts of these changes on public health outcomes and societal attitudes towards infant feeding in China.
Funding statement
Major Project of China National Social Science Fund: “History of Contemporary Infectious Disease and Database Construction” (Grant No. 20&ZD224).
Competing interests
The author has no competing interests to declare.
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