Don't interfere with breast-feeding: Experts

By Peter Kerr

JAKARTA (JP): The 1997 Indonesian Demographic and Health Survey showed that 44.3 percent of children aged two to three months were breast-feeding exclusively, but by four to five months this had dropped to 23.9 percent.

A survey last year by Jakarta-based Helen Keller International showed that exclusive breast-feeding varied throughout Indonesia but was lower in urban areas, particularly Jakarta.

The midwife argued that the marketing and availability of formulas, being more pervasive in cities, was largely responsible for the drop away from exclusive breast-feeding.

She was aware of incidences where hospitals charged mothers for a sample tin of milk formula after infants had been given one or two bottles, often put on their bill without their consent.

This raised the question of whether hospitals were putting the profit motives of infant formula sales before the health of newborn babies.

Dien Sanyoto, a pediatrician with the Indonesian Breast- feeding Promotion Foundation (YASIA), said many companies violated the International Code by promoting their products in health facilities.

Once the formula was provided to hospitals, it was more than likely it would be given to babies.

"If from the beginning you give formula, the baby will want that for the next year," Dien said.

"In these first days, it is very critical that you don't interfere with this process (of breast-feeding)."

According to the midwife, hospital staff often gave babies formula in a bottle before allowing them to breast-feed.

Huzna Zahir, of the Indonesian Consumers Foundation (YLKI), said her organization was still investigating such a complaint from a mother last year.

She said the YLKI was working with a foreign non-governmental organization to monitor formula promotions in Surakarta, Central Java, by checking hospitals, pharmacies and advertising. A similar monitoring program would be introduced in Jakarta soon.

Dr Utami Roesli, a pediatrician at St Carolus Hospital's Breast-feeding Enhancement Institute, said it was common for formula makers to sponsor medical seminars, provide hospitals with medical equipment, and offer to pay for midwives to finish their education.

Cash-strapped hospitals could not refuse the offer of equipment such as humidicribs, while many midwives badly needed the financial support.

"We cannot forbid them to do that (accept the help of companies) because they really need it," said Utami, pointing out that St Carolus no longer received infant formula supplies or donated equipment.

"I cannot blame my colleagues, I cannot even blame the midwives.

"What we have to do is educate them so they think before they give infant formula, so they know that it is nowhere near as good for babies as breast milk."

Annelies Allain, coordinator for the International Code Documentation Center based in Switzerland, said it was "fairly certain" the code was being broken in Indonesia by two major international companies and a local company linked to one in Japan.

In a report last month, IBFAN named 16 companies it claimed was breaking the International Code by "pushing their products directly to mothers, in health care facilities and shops ...".

Indonesia was not one of the 14 countries surveyed by IBFAN, but several baby food companies it named operate here including Nutricia, Nestle and Abbott-Ross.

The marketing director for Nutricia Indonesia, Rob Versloot, said Nutricia supplied gift packs to hospitals "in some cases".

"These gift packs do not contain samples of infant milk formula for children between 0 and 12 months of age," he said.

"Gift packs in general contain useful information for mothers, may contain noninfant milk formula samples, and in some cases also products of other companies (such) as diapers and baby care products."

Other promotional measures such as discounts and gift schemes "are not applied to infant milk formulas for children between 0 and 12 months of age".

Versloot said every Nutricia product and label in Indonesia was registered with the health ministry, which checked whether it met local legislation.

"All Nutricia's products in Indonesia have been found in accordance with the relevant legislation."

One product in Indonesia designed for children from 0 to 12 months, and displaying a cuddly bear on its packaging, is Similac Advance produced by Abbott.

"If you are referring to the bear on the label, there is never a picture of a bottle -- we treat breast milk as the best option," said Vivek Mohan, commercial director of Abbott Laboratories.

"If the doctor prescribes formula milk, we just want to be the best choice."

Mohan said Abbott had made gift packs available in Indonesia but these were for products such as Mama's Best, a nutrition supplement for mothers.

The company also had had mailing lists that gave information to mothers, but never for Similac.

Nestle, which was named by IBFAN as one of the major offenders worldwide, was asked to comment but it had not responded by publication.

Two advertising companies which market infant formula in Indonesia -- Ogilvy and Mather (Nestle's Dancow, for children older than one year) and TBWA (a range of Nutricia products) -- said they upheld the advertising ban on products for children under 12 months.

Spokeswomen for the companies said they were unaware of any specific advertising restrictions on products for children older than one year.

Budhi Yahmono, head of the health ministry's legal affairs and public relations department, said rules governing infant formula marketing came primarily under Law No 69 of 1999.

According to this law, food advertising directed at babies under one year was prohibited except in the print media when it concerned health, and then only after approval from the ministry. The advertisement must also point out that the food is not a replacement for breast milk.

Also relevant was the health ministry's Decree 237 of 1997, based on the International Code.

"It has been recognized that the decree should be revised and perfected ...," Budhi said in a written statement.

He said the ministry's concern about current provisions was reflected in its efforts to revise the decree. These involved discussions with the YLKI, the Coordinating Group on the Increase of Breast milk (BP-PPASI), Saint Carolus Hospital and the Food and Medicine Safety Supervisory Board (BPOM).