Don't interfere with breast-feeding: Experts<\/p>\n
By Peter Kerr<\/p>\n
JAKARTA (JP): The 1997 Indonesian Demographic and Health
\nSurvey showed that 44.3 percent of children aged two to three
\nmonths were breast-feeding exclusively, but by four to five
\nmonths this had dropped to 23.9 percent.<\/p>\n
A survey last year by Jakarta-based Helen Keller International
\nshowed that exclusive breast-feeding varied throughout Indonesia
\nbut was lower in urban areas, particularly Jakarta.<\/p>\n
The midwife argued that the marketing and availability of
\nformulas, being more pervasive in cities, was largely responsible
\nfor the drop away from exclusive breast-feeding.<\/p>\n
She was aware of incidences where hospitals charged mothers
\nfor a sample tin of milk formula after infants had been given one
\nor two bottles, often put on their bill without their consent.<\/p>\n
This raised the question of whether hospitals were putting the
\nprofit motives of infant formula sales before the health of
\nnewborn babies.<\/p>\n
Dien Sanyoto, a pediatrician with the Indonesian Breast-
\nfeeding Promotion Foundation (YASIA), said many companies
\nviolated the International Code by promoting their products in
\nhealth facilities.<\/p>\n
Once the formula was provided to hospitals, it was more than
\nlikely it would be given to babies.<\/p>\n
\"If from the beginning you give formula, the baby will want
\nthat for the next year,\" Dien said.<\/p>\n
\"In these first days, it is very critical that you don't
\ninterfere with this process (of breast-feeding).\"<\/p>\n
According to the midwife, hospital staff often gave babies
\nformula in a bottle before allowing them to breast-feed.<\/p>\n
Huzna Zahir, of the Indonesian Consumers Foundation (YLKI),
\nsaid her organization was still investigating such a complaint
\nfrom a mother last year.<\/p>\n
She said the YLKI was working with a foreign non-governmental
\norganization to monitor formula promotions in Surakarta, Central
\nJava, by checking hospitals, pharmacies and advertising. A
\nsimilar monitoring program would be introduced in Jakarta soon.<\/p>\n
Dr Utami Roesli, a pediatrician at St Carolus Hospital's
\nBreast-feeding Enhancement Institute, said it was common for
\nformula makers to sponsor medical seminars, provide hospitals
\nwith medical equipment, and offer to pay for midwives to finish
\ntheir education.<\/p>\n
Cash-strapped hospitals could not refuse the offer of
\nequipment such as humidicribs, while many midwives badly needed
\nthe financial support.<\/p>\n
\"We cannot forbid them to do that (accept the help of
\ncompanies) because they really need it,\" said Utami, pointing out
\nthat St Carolus no longer received infant formula supplies or
\ndonated equipment.<\/p>\n
\"I cannot blame my colleagues, I cannot even blame the
\nmidwives.<\/p>\n
\"What we have to do is educate them so they think before they
\ngive infant formula, so they know that it is nowhere near as good
\nfor babies as breast milk.\"<\/p>\n
Annelies Allain, coordinator for the International Code
\nDocumentation Center based in Switzerland, said it was \"fairly
\ncertain\" the code was being broken in Indonesia by two major
\ninternational companies and a local company linked to one in
\nJapan.<\/p>\n
In a report last month, IBFAN named 16 companies it claimed
\nwas breaking the International Code by \"pushing their products
\ndirectly to mothers, in health care facilities and shops ...\".<\/p>\n
Indonesia was not one of the 14 countries surveyed by IBFAN,
\nbut several baby food companies it named operate here including
\nNutricia, Nestle and Abbott-Ross.<\/p>\n
The marketing director for Nutricia Indonesia, Rob Versloot,
\nsaid Nutricia supplied gift packs to hospitals \"in some cases\".<\/p>\n
\"These gift packs do not contain samples of infant milk
\nformula for children between 0 and 12 months of age,\" he said.<\/p>\n
\"Gift packs in general contain useful information for mothers,
\nmay contain noninfant milk formula samples, and in some cases
\nalso products of other companies (such) as diapers and baby care
\nproducts.\"<\/p>\n
Other promotional measures such as discounts and gift schemes
\n\"are not applied to infant milk formulas for children between 0
\nand 12 months of age\".<\/p>\n
Versloot said every Nutricia product and label in Indonesia
\nwas registered with the health ministry, which checked whether it
\nmet local legislation.<\/p>\n
\"All Nutricia's products in Indonesia have been found in
\naccordance with the relevant legislation.\"<\/p>\n
One product in Indonesia designed for children from 0 to 12
\nmonths, and displaying a cuddly bear on its packaging, is Similac
\nAdvance produced by Abbott.<\/p>\n
\"If you are referring to the bear on the label, there is never
\na picture of a bottle -- we treat breast milk as the best
\noption,\" said Vivek Mohan, commercial director of Abbott
\nLaboratories.<\/p>\n
\"If the doctor prescribes formula milk, we just want to be the
\nbest choice.\"<\/p>\n
Mohan said Abbott had made gift packs available in Indonesia
\nbut these were for products such as Mama's Best, a nutrition
\nsupplement for mothers.<\/p>\n
The company also had had mailing lists that gave information
\nto mothers, but never for Similac.<\/p>\n
Nestle, which was named by IBFAN as one of the major offenders
\nworldwide, was asked to comment but it had not responded by
\npublication.<\/p>\n
Two advertising companies which market infant formula in
\nIndonesia -- Ogilvy and Mather (Nestle's Dancow, for children
\nolder than one year) and TBWA (a range of Nutricia products) --
\nsaid they upheld the advertising ban on products for children
\nunder 12 months.<\/p>\n
Spokeswomen for the companies said they were unaware of any
\nspecific advertising restrictions on products for children older
\nthan one year.<\/p>\n
Budhi Yahmono, head of the health ministry's legal affairs and
\npublic relations department, said rules governing infant formula
\nmarketing came primarily under Law No 69 of 1999.<\/p>\n
According to this law, food advertising directed at babies
\nunder one year was prohibited except in the print media when it
\nconcerned health, and then only after approval from the ministry.
\nThe advertisement must also point out that the food is not a
\nreplacement for breast milk.<\/p>\n
Also relevant was the health ministry's Decree 237 of 1997,
\nbased on the International Code.<\/p>\n
\"It has been recognized that the decree should be revised and
\nperfected ...,\" Budhi said in a written statement.<\/p>\n
He said the ministry's concern about current provisions was
\nreflected in its efforts to revise the decree. These involved
\ndiscussions with the YLKI, the Coordinating Group on the Increase
\nof Breast milk (BP-PPASI), Saint Carolus Hospital and the Food
\nand Medicine Safety Supervisory Board (BPOM).<\/p>",
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