Mothers target of battle over bottle
In this and related articles on Page 7, The Jakarta Post's contributors Peter Kerr and Maria Kegel discuss the aggressive marketing campaigns launched by infant milk formula producers to the detriment of babies and breast-feeding practices.
JAKARTA (JP): Soon after giving birth earlier this year in a major Central Jakarta hospital, Indra received from the nursing staff a pack containing infant formula milk, a measuring cup and other gifts provided by one of the big international baby food companies.
Three months later, when she felt she was having difficulty breast-feeding, she started giving her baby the formula.
Lisa, a European woman living in Indonesia, gave birth in a major South Jakarta hospital last July. She was surprised and confused soon afterwards to receive in her VIP maternity room a similar gift pack, prepared by a different baby food manufacturer. It contained a tin of formula milk for babies aged three to six months, along with a range of information and gifts.
Lisa intended continuing to breast-feed her baby, and could not understand why the hospital was giving her infant formula products. Did this mean the specialist staff thought she should change over from breast-feeding as soon as possible?
Stories like these, told by women who asked that their real names not be used, are a common frustration for health workers trying to promote the benefits of breast-feeding.
International regulations forbid providing samples of infant formula or related products to new mothers, but the practice appears to be widespread in Indonesia.
Many hospitals desperate for funding also accept medical equipment and other support from the makers of infant formulas, according to health professionals. While not against regulations, this may be seen to compromise hospitals and subtly pressure them to use the companies' products.
Pediatricians, midwives and consumer groups also claim that many baby food companies are breaching the World Health Organization's marketing code in the way products are packaged.
They say many formulas for children under 12 months are "idealized" by using cartoon infants or cuddly animals on the label, and that information on the packaging is often inadequate or misleading.
Formula companies reject these charges of improper practice, insisting they abide by international and national regulations.
One of the biggest battles in Indonesia at present, however, is over "follow-on" formulas, made for children older than six months.
Indonesia last year banned advertising of all formula products for children aged below one year. Companies are aggressively advertising food products for children beyond that age.
Meanwhile, a business lobbyist acting on behalf of the Indonesian Baby Food Manufacturers' Association is challenging the ban above the age of six months.
"This sort of interference with the sovereign law of a nation is deplorable as it puts profits before the health of infants and young children," said Yeong Joo Kean, a legal advisor in Penang, Malaysia, for the International Baby Food Action Network (IBFAN).
Manufactured baby milk is big business, estimated by IBFAN to be worth at least US$8 billion a year worldwide.
Figures for Indonesia are unavailable publicly, but one company spokesman said total market volume for the four months from January to April this year was 6.7 million kilograms.
This equates roughly to $12 million, or $36 million annually.
No one, the formula manufacturers included, denies that "breast is best" for babies, although health workers complain that marketing practices often undermine the principle.
Last month the World Health Assembly of the World Health Organization (WHO) agreed unanimously that the recommended period for "exclusive" breast-feeding -- when a baby receives nothing other than breast milk -- be increased from four months to six months.
Indonesia has yet to adopt this new recommendation.
"There is nothing that equals breast-feeding in providing proper nourishment for infants," says The Code Handbook, a guide to the WHO/UNICEF International Code on marketing breast-milk substitutes.
"Breast-milk has the additional advantage of containing antibodies that help protect the baby against many common childhood illnesses.
"It is safe and clean, always at the right temperature, inexpensive and nearly every mother has more than enough for her baby."
Health professionals say it is rare that a woman cannot fully breast-feed her baby, so the need for infant formula should be minimal.
Production of breast-milk is also linked to demand. So when a baby stops suckling, as it does to drink formula, a mother's breast-milk will begin declining.
Meanwhile, studies show that mothers who start using formula usually continue buying the same brand, hence the big advantage to companies getting their product into hospitals.
The health benefits of breast-milk are generally greater the longer babies drink it exclusively, while babies who switch early to formula have higher rates of death and disease.
In developing countries, infants who do not breast-feed in the first three to four months have 10 to 15 times greater risk of dying than babies who drink only breast-milk. This is mainly due to a higher rate of gastrointestinal infection.
Health professionals say poorer mothers, convinced that their babies need formula, will often buy it before feeding the rest of their family properly, or cause other problems by "watering down" the formula to make it last longer.
"I say to mothers that it is the difference between giving your child a bajaj and a Mercedes Benz," said a midwife and lactation consultant in Jakarta who asked not to be named.
"In Indonesia the initiation of breast-feeding is high but exclusive breast-feeding is low, and we know from studies that it is exclusive breast-feeding that protects against morbidity (illness) and mortality (death)."