The story of Sim Ark helps explain a problem in Cambodia that has health experts concerned: fewer Cambodian women are breastfeeding their babies.

Before giving birth to her second child, Sim Ark said she did not think much about what a workplace needed to support a new mother.

After her first child was born, she stayed at home. But now the 29-year-old works at the You Li International factory in Bavet city, in Cambodia.

"I want to have a daycare facility right in my workplace so that I can visit my baby while working," Sim Ark told VOA.

She had been working at You Li before giving birth to her son Ham Ya Oudom. After her son was born, her supervisors began calling her. Within three months she returned to work because she did not want to risk losing her job.

Since she was not at home during the day, Sim Ark was unable to breastfeed her newborn son. Instead the child received a breastmilk substitute, known as formula, from a bottle. At night, he changed back to breast milk unless Sim Ark worked overtime, which she said causes her milk to stop flowing.

On average, a 10-week-old baby consumes seven containers of infant formula within a month. Each container costs about $12. Most workers in the clothing industry earn about $182 each month. Sim Ark and other workers would like to be able to breastfeed their children until they are at least 6 months old, as doctors recommend. But they do not know how to raise the issue with their employers.

"I'm not sure how it (would) look like if we had [a daycare facility in a factory]. Maybe a family member could come and help [in the facility] to look after the baby," Sim Ark said, only to add, "Then nobody would be available to do the work at home."

Sim Lat, 40, carries her nephew Ham Ya Oudom on a walk while waiting for his mom to come back from work, at Svay Ta Yean commune, Svay Rieng province, Cambodia, Oct. 11, 2019.

Her return to work helps explain why the rate of breastfeeding is decreasing in Cambodia, a change that worries child development experts.

United Nations Children's Fund, or UNICEF, said government data shows that 74 percent of Cambodia's children younger than 6 months old were breastfed in 2010. By 2014, the most recent year for which information is available, that number had fallen sharply. The country went from having one of the highest rates of breastfeeding to a midlevel rate of 65 percent.

Cristian Munduate is a UNICEF representative in Cambodia. She called this change a major decrease. She also described breastfeeding as "the best practice for a child during its first 6 months of life — the first natural vaccine that a child receives."

UNICEF suggests that correct breastfeeding practices could prevent an estimated 823,000 child deaths every year worldwide. The medical publication The Lancet reports that breastfeeding improves mental development, success in school and future earning potential.

Alive & Thrive is an international effort to support mother and infant health. It released a report on the costs of not breastfeeding in Cambodia. It said three major illnesses in children and mothers could sharply rise because of the fall in breastfeeding. Diarrhea and pneumonia in children and type II diabetes in mothers are believed to be kept under control by the practice.

The Alive & Thrive report also suggests Cambodia could lose $83 million a year because of future mental development losses linked with a lack of breastfeeding.

Several reasons for fall in breastfeeding

UNICEF warns that a lack of community and government support for breastfeeding is leading to the decrease. The UN agency also blames the difficulty of balancing infant care with a job, and the aggressive marketing of infant formula.

Cristian Munduate says there are about 2.4 million women ages 15 to 34 in the country's labor force. Cambodia has a law guaranteeing many women the chance to breastfeed.

But the law and reality are two different things, said Lim Buyheak. The 35-year-old is studying clinical psychology at Vietnam National University.

She has breastfed her daughter since she was born five months ago. She bought an electronic breast milk collection device for $145 and tried to use it to gather and store her breast milk. It turned out to be so difficult, she gave up. She now works on her studies from home to be able to breastfeed her daughter.

Lim Buyheak formed a group with other mothers on the social media service Facebook in November. It now has about 160 members who discuss breastfeeding and support each other."At first, I felt a little bit shy," she said. "Now I feel very good to have support from my friends."

The formula industry is international and growing. In 2014, reports suggest formula sales reached about $44.8 billion worldwide. The World Health Organization expects that sales will have increased to $70.6 billion by the end of the year.

Activist groups say these sales are supported by marketing campaigns that are banned in some countries.

In July, Helen Keller International and World Vision International published a report on information found on containers of formula in Cambodia. The two non-governmental organizations said that 92 percent of formula containers had information on them that supported formula use or did not support breastfeeding. This, the groups said, violates the Cambodian government's policy to support infant breastfeeding.

"These products are often marketed with misleading claims," said Mary Champeny, a nutrition researcher from Helen Keller International.

In 1981, the World Health Assembly agreed to an International Code of Marketing Breast-milk Substitutes. That agreement called on nations "to protect and promote breastfeeding." It also called for the supervision of marketing formula to mothers.

And I'm Pete Musto.

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