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reast-feeding campaigners have called for tougher supervision and law enforcement amid rampant advertising and marketing for infant formula.

'€œOur laws and regulations stipulate the importance of exclusive breast-feeding, including punishment for those who obstruct it or violate those principles. However, there is a lack of supervision and law enforcement in the [law'€™s] implementation,'€ Asteria Aritonang, the campaign director at Jakarta-based Wahana Visi Indonesia, a NGO focused on children'€™s welfare, said recently.

She mentioned the complicated mechanism to report violations as one of the drawbacks of the regulations.

'€œHealth Ministerial Regulation [Permenkes] No. 15/2014 on sanctions stipulates that an individual or group can report health workers who breach ethics and regulations to the regional health agency and private companies to the health minister.

'€œThen, the authorities should follow up reports by establishing an ad hoc team to investigate the report. However, the mechanism is too complicated and who has the motivation to do such things?'€ she said.

Exclusive breast-feeding and breast milk substitutions are regulated in Law No. 36/2009 on health, Health Ministerial Decree No. 237/1997 on breast milk substitution marketing, Permenkes No. 15/2014 on mechanisms to give sanctions to health workers, health facilities, nursing schools, and producers and distributors of infant products who obstruct efforts to promote exclusive breast-feeding; and Government Regulation (PP) No. 33/2012 on breast-feeding.

Law No. 36/2009 on health stipulates that all babies are entitled to receive exclusive breast milk during their first six months and until two years after birth, and that all stakeholders, including health workers, family, the central and regional governments, are obliged to support the mother to breast-feed exclusively. Those who violate the clause may face a maximum of one year in jail and
Rp 100 million (US$7,426) in fines.

Asteria also lamented the lack of training given by relevant authorities to health workers, such as midwives, regarding the regulations and breast-feeding itself as regulated by PP No. 33/2012 on breast-feeding.

'€œA lot of health workers might not understand the regulations because there are not enough sufficient programs that disseminate the information. We need to be involved to push for tighter control and law enforcement,'€ she said, adding that her group had trained over 1,400 health workers to become proper lactation consultants.

Utami Roesli, a pediatrician and lactation consultant at St. Carolus Hospital in Central Jakarta, acknowledged the lack of awareness among health workers, particularly midwives, regarding the support for breast-feeding.

'€œThere are not many nursing schools that incorporate a thorough study of lactation in the curriculum and not all health facilities support the effort to promote breast-feeding. Last but not least, there are rampant unethical and aggressive campaigns [for infant formula] introduced by companies,'€ Utami said.

She acknowledged that cases of individual or groups reporting violations to the authorities were very rare,

Nia Umar, the Deputy Chairwoman of the Indonesian Association of Nursing Mothers (AIMI), said although her association provided a channel to report violations; lapor@aimi-asi.org, none of the cases end up being reported to the authorities.

'€œWhen we ask them [people who report] whether they are willing to file a report to the authorities, they back down because they are worried they will end up like Prita,'€ Nia said, referring to Prita Mulyasari, a housewife who was jailed after losing a defamation case filed by Omni International Hospital in Tangerang against her in 2009. The hospital sued Prita after a private email she wrote complaining about her alleged misdiagnosis when she was a patient at the hospital in 2008 went viral.