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.
Irma
Hidayana
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.
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