Natural goodness: Despite the arguments in favor of breast-feeding, the number of women who breast-feed has dropped in the past 10 years. JP/J. Adiguna
It seems fairly simple: After a woman delivers a baby, her breasts start producing a wondrously nutritious substance and the baby latches on, feeding on that gift of nature called breast milk.
But the world has become more complex, where a mother’s relationship with her baby is suddenly everyone’s business. So when it comes to breast-feeding, the perennial antagonist is exactly that: the formula business.
Arima Dharmasarie, now a grandmother, still recalls what appeared on her medical bill after she gave birth to her first son.
“It stated several doses of formula milk, even though I clearly remember that I was breast-feeding my baby and had no problems. No one ever asked my permission to give him formula,” said the 59-year-old, who at that time gave birth at a private hospital in South Jakarta.
That was decades ago, but 28-year-old Poppy Caroline’s story reveals that not much has changed since.
“Despite following the early initiation process, my daughter was only latching a bit on one nipple and I had a problem of not being able to produce milk for the first few days,” said the mother of one.
“My pediatrician insisted that she had to be given formula [to supplement] my small amount of breast milk, otherwise she’d turn yellow.”
But Poppy, like Arima, had already planned to breast-feed her baby no matter what. At home, both women managed to exclusively feed their babies breast milk, despite intervention in favor of formula.
Febe, Poppy’s daughter, was breast-fed until she was 10 and a half months old. Arima’s son was weaned at 18 months.
On paper and in public, no one will disagree that breast-feeding is the best way for mothers to nourish their children. Nevertheless, commercial interests often interfere with the process, supported by uninformed mothers and medical staff.
Invented as a supplement for infants of mothers who could not breast-feed, formula milk used to be just an extra. If a woman could breast-feed well — up until her child was four years old, if need be — her toddler had no need for it.
But since the early 20th century when physician Thomas Rotch published his recommendations for a mixed diet of breast milk, cow milk, water and other substances at a specific ratio for babies, research on formula milk has developed, growing into a massive industry by the end of the century.
With more than 4.4 million births annually, Indonesia is one of the world’s most lucrative potential markets for formula milk producers. Currently available for purchase are 24 brands of formula milk, 29 of advanced growth milk and 19 other kinds of baby food.
According to a Health Ministry report on the industry, nearly 40 percent of babies under 12 months old have been given formula instead of breast milk at least once; almost half of these received it in hospitals and clinics during the first few days after birth.
With or without the mother’s consent.
“We are only concerned about the baby’s health,” said Mulia Pakpahan, a 35-year-old pediatrician at a private hospital in West Java’s Depok. “Its first month is the most crucial period when it requires proper nutrition.”
“Proper nutrition” often includes formula in the menu when a doctor believes that a mother is not producing enough breast milk. This policy is not officially endorsed by Mulia or the hospital where she works, but the substance is easily within reach in its pharmacy department.
Formula milk producers claim that they support a movement to promote breast-feeding up to the age of six months, as stipulated in a 2003 ministerial decree. And at a glance, they do not appear to be violating any of the WHO regulations on the marketing of breast-milk supplementary products.
“We strictly follow the regulations and support 6-month exclusive breast-feeding. Whether a mother chooses to continue it up until the baby is three years old is her own decision,” Frisian Flag corporate communications manager Anton Susanto said.
“We [the formula milk industry] are not trying to replace [breast milk] with formula. That’s wrong. What has been our concern is after breast-feeding [for six months or three years depending on the mother], a child can continue to drink milk,” he added.
So why, then, is formula milk appearing to be pushed through clinics and hospitals?
Some blame it on a lack of knowledge about how to help a mother breast-feed properly; others claim medical staff often take the easy way out by giving formula milk to babies considered in need of it.
Jack Newman, an expert in breast-feeding, said there are many misconceptions.
“It is thought by many that there is ‘no milk’ during the first few days after the baby is born, and that until the milk ‘comes in’ some sort of supplementation is necessary. When in fact the problem is that no one notices that it’s not feeding properly,” he explained.
“Unfortunately, even medical staff are ill-informed about these kinds of things.”
According to Utami Roesli from the Indonesian Lactation Clinic, with proper help, a baby has no need for formula, except in rare cases — about one in 1,000.
Breast milk, Utami explained, is irreplaceable. The colostrum contains immunoglobulin A, which protects babies from infectious diseases, and is high in vitamin A and carbohydrates but low in fat.
Breast milk has a specific ratio of the proteins whey and casein that is more suitable for babies than that of cow milk. And don’t imagine that the inclusion of polyunsaturated fatty acids such as AA or DHA is something special in formula milk: They too exist naturally in breast milk.
Despite the undeniable benefits of breast-feeding, nationally the rate of breast-feeding dropped to 32.4 percent in 2007 from 42.4 percent 10 years ago, according to government data. The rate of bottle-feeding rose from 21.1 percent to 27.9 percent during the same period.
The government even tried to limit companies’ marketing through a 1997 ministerial decree on formula milk marketing.
The Indonesian Association of Breast-Feeding Mothers (AIMI) is currently drafting a petition requesting a law to protect the rights of breast-feeding mothers and their babies, AIMI chairwoman Mia Sutanto said.
One of the group’s aims is to provide a legal basis for stricter monitoring and supervision of the industry, and penalties for any company found breaking the marketing rules.
But even if they make headway against the vigorous marketing by formula producers, that is only one aspect of the very complex world of breast-feeding.
“If one wants to advocate for breast-feeding, what first needs to be done is to increase the availability of information and support on the issue,” said Meutia Chaerani, one of the founders of AIMI. “Don’t blame mothers if they end up resorting to formula because that’s all the information that they get.”
And for multitasking mothers who have to juggle between taking care of their children and working, limited maternity leave is another problem.
“Currently, we notice only one company that allows their employees to take 12 months’ maternity leave, three months of which is paid,” said Mia, adding that most companies even insist a pregnant woman start her leave a month before her due date.
The absence of proper facilities in the workplace for a lactating mother to pump her breast milk and store it for her child’s later consumption means most working mothers stop giving their babies breast milk after their leave ends.
“I don’t want to risk giving my baby contaminated milk if the only place available at the office is the toilet,” said architect Yuanita Dewindra, now a mother of two.
The list of inhibiting factors goes on and on, including the intangible but equally important socio-cultural aspects.
“Here, it’s still considered inappropriate to breast-feed in public, as if the mother is intentionally showing off her breast for public display,” Rani said.
From mothers’ perspective, recent mounting social pressure on those who do not breast-feed ironically adds another item to the list.
The idea of a breast-milk bank to replace formula is still a dream for breast-feeding advocates because of religious and cultural aspects.
“For Muslims, they have their own rules according to the Koran. So the best we can do is just set up a database of people who can donate breast milk and others who need it. Once they have found what they are looking for, they can contact the person,” Mia explained.
“It’s sort of like breast-feeding match making.”
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