Tuesday, July 26, 2016
Indonesia - Breastfeeding rates: Is baby formula marketing to blame?
Currently, 96 percent of Indonesian children under age 2 are breastfed, according to the latest national figures. It seems a fantastic number.
Unfortunately, the percentage does not reflect optimal feeding practices among infants and young children. This is because “sometimes breastfed” in the first two years, as cited by the national data, won’t meet the nutritional needs of a young child to grow. To do so, optimal breastfeeding is required.
Optimal breastfeeding means a child should be immediately breastfed within the first hour after delivery and exclusively breastfed, with no water, fruit, air tajin (rice water), formula milk or other foods for the first six months.
Then, breastfeeding should continue from six months to two years or beyond and be complemented with other safe and nutritionally adequate foods, as recommended by the Health Ministry, the UN agency for children, UNICEF and the World Health Organization.
Early initiation and exclusive breastfeeding not only helps children survive but also allows them to thrive and develop their full potential. Breastfeeding is the foundation of good nutrition. It provides many substances that benefit a baby’s immune system, including antibodies. It also reduces the risk of malnourishment in early childhood and the risk of obesity later in life. Many studies have found that breastfeeding supports healthy brain development, improves cognitive performance, and is associated with better educational achievement at age 5.
Yet, among those who ever breastfed (96 percent), only 42 percent of infants were exclusively breastfed, 55 percent were still given breast milk for two years, and only 37 percent were appropriately fed based on UNICEF and WHO recommendations for optimal infant and young child feeding practices. We could have done better than this, given the health benefits of breastfeeding, but as documented by the Indonesia Demography Health Survey every five years, breastfeeding rates only rise slowly from time to time.
A new report by UNICEF, WHO and the International Baby Food Action Network (IBFAN) has found that the aggressive marketing of baby foods or formulas is likely to contribute to the low rates.
The report on “Marketing of breast-milk substitutes” released last month revealed that to a certain extent, the promotion strategies and advertising of milk formulas and milk for children aged less than 3 years old can be blamed since the strategies and ads continue to undermine efforts to improve breastfeeding rates.
Many independent studies have also found that “line extension” marketing methods — in which each brand applies a similar design to all of its baby food products — have significant effects on the mothers’ decisions to use infant formula and toddler complimentary foods.
Indonesia with its large population of young children has been found to be an attractive target for multinational baby food corporations to market their products.
Recent data gathered by UNICEF in Indonesia showed that the sales of breast-milk substitute products are projected to reach Rp 25.8 trillion this year, which sounds impactful enough to persuade mothers to choose products as substitutes for breast milk.
Studies have found that substituting breast milk may increase the risk of chronic conditions.
Unfortunately, the risks of giving breast-milk substitutes, including infant formula, are not widely well communicated. Infant formula and other foods or beverages that substitute breast milk can lead to weight loss and poor growth resulting from diarrhea and other infectious diseases. Abundant studies have found that substituting breast milk may increase the risk of chronic conditions, such as obesity, diabetes, heart disease and cardiac risks later in life, compared to infants who are breastfed.
Thus, it is imperative to support and protect the infant and young child feeding practices with strong legislation that protect and promote optimal breastfeeding.
For example, the 2012 exclusive breastfeeding decree 2012 should be amended to be the “optimal breastfeeding decree”, which covers protection from the first hour of a child’s life until the child is 2 years or beyond.
Another urgent step is to fully adopt the international code of marketing breast-milk substitutes into legislation, such as laws regarding labeling and advertising of breast-milk substitutes.
As strongly recommended in the above Report we need laws that explicitly prohibit all advertising and other forms of promotion of breast-milk substitute products to the public, including contact with pregnant women and mothers.
This includes a ban on the promotion of such products through the internet, social media and other electronic means of communication, as well as within the health system, to protect infants and young children from the hazardous effects of the marketing of breast-milk substitutes.
By having strong, supportive and protective national legislation on breastfeeding, the number of breastfed children is likely to increase, which, according to recent research by the Padjajaran University, UNICEF and Alive and Thrive, could save more than 5,300 Indonesian children from illnesses such as pneumonia and diarrhea and Rp 3 trillion in health costs every year.
It does not stop here, however. With potential improvements in cognitive abilities a result of improved breastfeeding, increased earnings are estimated to bring trillions of rupiah in economic benefits each year.
The writer is a scholar on an Indonesian government LPDP scholarship at the PhD program of the Health Education and Behavior Studies Department, Teachers College, Columbia University, New York, US.