Making breast-feeding a righ

By Maria Endah Hulupi

JAKARTA (JP): After giving birth to a healthy baby at a hospital in East Jakarta, Wati (not her real name) was immediately deprived of her right to breast-feed by the hospital's nursing staff.

At feeding hours, Wati was told that she was too weak an was not allowed to leave her third-floor room to go to the infant ward on the ground floor to breast-feed her baby. Meanwhile, the nurses refused to take the baby to her room.

The hospital staff assured her that her baby was being properly fed with formula milk, however, to her surprise, she found that her baby was incredibly weak and had lost 300 grams of body weight due to diarrhea.

Indah Suksmaningsih, an activist with the Indonesian Consumers Foundation (YLKI), said that Wati's case is just one of several types of violations against mothers' rights to breast-feed their babies, which are mainly committed in general hospitals and maternity hospitals.

There is no official data but Lukman, a staff member at the University of Indonesia's School of Public Health, estimated that the country's annual birth rate is six million. With two million of those babies being born in the general hospitals and maternity hospitals, those facilities are a captive market for formula milk producers.

Indah revealed that violations within hospitals have shifted from hospitals facilitating the provision of gift packs containing formula milk products to new mothers, to manufacturers encouraging health practitioners to prescribe formula milk for new mothers.

All are done in exchange for funding or medical equipment, she said.

"We'd like to stress that it is the mothers' right to breast- feed their babies," Indah said on the sidelines of a seminar on the marketing of breast milk substitutes, held by the foundation.

Aside from the financial and practical advantages of breast- feeding, breast milk is highly nutritious and helps strengthen a baby's immune system. It also ensures healthy physical and psychological development as it is proven that physical contact during breast-feeding is a natural way to establish bonding.

While stating that the foundation is facing difficulties in educating the public on these benefits, Indah also pointed out that breast milk substitute manufacturers adopted various tactics to sell their products through practitioners and other marketing initiatives.

"Control should be applied here because it is difficult to educate people about the importance of breast-feeding while the producers bombard the public with various creative promotional activities," she said, stressing that sanctions should be imposed against those found violating regulations governing the marketing of milk substitutes.

The most deplorable thing is, Indah said, that the Food and Drug Control Board (BPOM) fails to enforce the regulations, as stipulated by Ministerial Decree No. 237/1997.

However, Indah explained that the decree contains loopholes that were often exploited for the interests of manufacturers, which often breach the WHO/UNICEF International Code on marketing breast milk substitutes. The code underlines that "there is nothing that equals breast-feeding in providing proper nourishment for infants".

Separately, Tien Gartini of the Directorate of Food Safety Evaluation with BPOM admitted that there have been violations by manufacturers in the promotion and sale of their products.

"The transgressions include giving free samples of formula milk, sponsoring events or activities in exchange for product promotion, or they relate to product discounts and advertisements," she said.

However, she declined to elaborate on the actions taken by the agency for such violations.

Juanto Rasjidgandha, vice president of the Indonesian Baby Food Manufacturers' Association (APMB), which groups 14 local and international manufacturers, said that its members have to properly inform the public through pediatricians about breast milk substitutes.

"We are not allowed to educate the public directly but we have to educate pediatricians, as practitioners in the field, on the benefits and the importance of breast milk substitutes," he said, adding that if any violations were found, the association could issue warnings and revoke the manufacturers' association membership.

National Board of the Indonesian Society of Pediatricians president Jose Batubara explained that breast milk substitutes are needed for babies with certain health problems, those refusing their mothers' breast milk, or babies whose mothers were unable to breast feed them due to any of a number of reasons, such as inadequate breast milk production or other health problems.

He urged BPOM to be more active in monitoring violations and misleading product information often shown in ads and promotional activities.

"This is important because some parents are loyal to a brand because the ads describe it as penetrating the brain to ensure smart children," he said.

In an effort to protect mother's rights to breast-feed, Jose said the government should provide a private place in offices for working mothers to pump their milk and store it before it is sent home or they return home.

"Mothers are only given three months of maternity leave, but this way will ensure that their babies are exclusively fed with breast milk until their fourth month," he added, while stating that to fulfill babies' daily nutritional requirements, infants should be breast-fed and given weaning food until they reach two years old.