YSPH Student Launched Breastfeeding Movement in China

Before she had even heard the term “public health,” Yushi Zhang, M.P.H. ’23, was leading a national breastfeeding movement across China.

Trained as a journalist, Zhang became interested in breastfeeding when she had her first child in 2010. Driven by the simple belief that, as mammals, the majority of women should be able to breastfeed, she was excited to learn more.

However, resources in China were scarce. China’s exclusive breastfeeding rate was 21% in 2013, significantly under the already low global average of 44%. Using baby formula is deeply ingrained in the modern Chinese culture; doctors at the time barely had the chance to touch upon the topic of breastfeeding in their medical training, and some were paid to promote formula use. There were only six lactation consultants in the country around the time Zhang delivered, five of whom were foreigners. All had received their training abroad.

An investigator by nature, Zhang was undeterred, and she turned to non-Chinese resources to learn more. “My advantage at the time was really because I was able to read English,” she said.

As she sifted through information online, she discovered that many others shared her curiosity about breastfeeding. Within a year, that mutual interest coalesced into a network of 40,000 women across China. The group’s goals went beyond education to peer support. Experts were brought in from abroad to train network members as on-call volunteers (and later paid professionals) capable of supporting postpartum practices in their local communities.

Zhang’s work didn’t stop at the individual level—she wanted to get to the root of the problem in the system and the culture. Most women in China gave birth in hospitals, many of which favored baby formula over breastfeeding, she said. Lacking traditional scientific credentials, Zhang found it challenging to gain traction with such large institutions. Yet, she found power in numbers. In addition to the 40,000-person volunteer network, she had amassed countless additional followers who supported her work.

“With that, you could consider us a market—and with that market, you all of a sudden had the power to talk with hospitals,” she said. “Because now, the women were united and could demand breastfeeding support, facilities and services.”

Her team provided consulting services to help private hospitals reshape their birth protocols that heavily affect breastfeeding initiation. Her work broadened the focus of these maternity wards from the technical and medical side of labor and birth to a wider range of public health maternal and infant essentials. Soon after, public hospitals got involved, too.

Beyond hospital birth practices, she also strove to change norms. Zhang, and the network she helped create, held flash mobs of mothers nursing in public, installed infant-friendly waiting rooms at metro stops and campaigned to replace signs depicting babies holding bottles with babies accompanied by a caregiver.

“It was fun, these culture-shifting things,” she said. “They were really fun because people were like, ‘What’s the necessity of changing a sign?’ and then you open up a conversation.”

Zhang’s passion for breastfeeding advocacy solidified when she was helping with disaster relief after an earthquake in Sichuan, where she grew up. The affected community had strong breastfeeding practices but was shifting to formula after the earthquake. Babies had grown fussy from the natural disaster’s disruption, leading mothers to have concerns about milk supply. Many switched from breastfeeding to using infant formula that had been donated as part of relief efforts. Zhang was struck by the noticeable difference between babies who were fed on that low-quality formula and those who were breastfed.

“They have totally different eyes,” she recalled. “Seeing those babies with dull eyes, you could see what this might do to a whole population. Give it, say, another 50 years, and if there are still only three babies out of ten that are breastfed—what would this do to this species?”

Soon after, Zhang began partnering with UNICEF-Beijing as a special advocate for breastfeeding promotion to help implement UNICEF’s breastfeeding campaigns across the country. With Zhang and her community’s efforts, hospitals started to embrace donated breast milk for preterm infants and sick babies, and in 2013, the first two milk banks, in Guangzhou and Nanjing, were established. Fast-forward to today, and there are thousands of breastfeeding counselors, doulas and Chinese lactation consultants trained and working to support breastfeeding across China.

Despite national and international recognition, Zhang felt that she didn’t have enough of a scientific background to do her work to its fullest capacity. She moved to the U.S. to pursue a second bachelor’s degree in public health, management and philosophy at the University of Minnesota.

Now a first-year master’s degree student in the Social and Behavioral Sciences Department at the Yale School of Public Health, Zhang remains deeply involved in the field, both domestically and abroad. She is a mentor for the Pre- and Perinatal Psychology Education Program at the Association for Prenatal and Perinatal Psychology and Health and still has strong ties to projects she began while in Minnesota, from partnering with Minnesota nonprofits to starting a women’s shelter in China for survivors of domestic abuse to founding a program called Mother Tongue Doula that provides doulas for people who speak non-English languages.