Don't interfere with breast-feeding: Experts

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).