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INDONESIA: Breastfeeding regulations to target formula companies

GENTENG PARAKAN, 16 September 2011 (IRIN) - For Naslima, a mother of two in the fishing village of Genteng Parakan, there was never any doubt over how to feed her babies.

"It's better to breastfeed than to give formula. Babies that breastfeed are healthy," Naslima, who like many Indonesians goes by only one name, told IRIN, outside a local health centre in Indonesia's West Java Province.

Indeed, Naslima's two daughters, now seven and 12, were rarely sick with diarrhoea and had a healthy weight, testament to the well-documented benefits of breast-milk.

But Naslima is also an exception in Indonesia. Exclusive breastfeeding is rare in the world's fourth most populated nation; a source of concern for a country that suffers from high rates of malnutrition and stunting among children.

Only 14 percent of Indonesian babies are exclusively breastfed, according to the Indonesian Demographic and Health Survey from 2002 and 2003. A more recent survey conducted by the Health Ministry showed rates of breastfeeding dropping by 10 percent between 2007 and 2008.

In fact, in larger urban areas where Indonesian women have higher levels of disposable income or are working, an increasing number favour formula over breastfeeding.

"When they see the ads on TV that say formula A has DHA and vitamins, mothers think it is better," Elin Liani, a midwife said, referring to docosahexaenoic acid (DHA), an omega-3 fatty acid, which occurs naturally in breast-milk and is considered important for brain and eye development.

In a bid to reduce the influence of formula companies on women, and more importantly, reduce the high levels of infant and child mortality and malnutrition, Indonesia will soon pass regulations that prevent milk formula companies from targeting babies younger than one.

Although a law promoting exclusive breastfeeding has been in place since 2009, it lacks any penalties for violations. The new regulations will lay out exactly what those penalties will be and require employers to allow mothers regular breastfeeding breaks.

Moreover, it penalizes anyone who "intentionally hampers exclusive breastfeeding" with jail terms of up to one year or maximum fines of US$32,000, Iip Syaiful, a nutrition expert from the Ministry of Health, said.

The fines and punishments, which could come into effect as early as the end of September, are currently under review by the Justice and Human Rights Ministry.

The government estimates some 30,000 young children could be saved if their mothers exclusively breastfed them for six months, then continued breastfeeding with supplemental foods until the age of two.

Studies suggest wider promotion of exclusive breastfeeding could prevent 1.4 million child deaths under the age of five, as well as improve child nutrition, a 2008 Lancet report said. 

According to the UN Children's Fund (UNICEF), 37 percent of Indonesian children suffer from moderate stunting, which delays a child's mental and physical development and makes children more susceptible to other diseases.

Formula companies adjust

But according to infant formula company SGM - part of the French food conglomerate Danone and one of Indonesia's largest sellers of infant and toddler milk and foods - the new regulations will not affect its marketing strategy, as it has already modified its TV advertisements to only feature babies older than one.

''The Health Ministry admitted many health workers had not received the knowledge about the importance of exclusive breastfeeding''
"We've been doing this for quite some time, only advertising our growing-up milk, which is for babies one year and above," Arif Mujahidin, communications manager for SGM, maintained.

Over the past three years, sales of infant formula have dropped in Indonesia, while sales of milk for one-to-five-year-olds have grown steadily, he added.

In 2010, Indonesia's infant formula market was valued at $136 million, with zero growth from 2009 to 2010, while the country's growing-up milk market was worth $1.15 billion in 2010, a growth of 9 percent on 2009, according to AC Nielsen data.

Questions of influence

But despite the 2009 law banning health professionals from promoting formula and handing out formula to new mothers, the practice remains rife, breastfeeding activists say.

"In the hospitals they give the women formula straight away if they have any problems at all breastfeeding. I never hear them tell women in the first three days, 'don't worry if your milk hasn't come in, it will'," Eka Yuliana, a community breast-feeding promoter with Bumi Sehat, a Bali NGO, said, referring to the small amounts of breast milk women typically produce just after birth.

"If doctors would support breastfeeding 100 percent, that would be better," Yuliana added. She believes doctors have been unduly influenced by the formula companies' marketing as well.

The Health Ministry admitted many health workers had "not received the knowledge about the importance of exclusive breastfeeding".

mk/ds/mw

Theme (s): Children, Health & Nutrition,

[This report does not necessarily reflect the views of the United Nations]

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