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he recent graft issue between a local pharmaceutical company and physicians has led to discussions on how companies influence health care. An investigative report by Tempo magazine found verifiable evidence showing correlation between the physicians'€™ prescriptions and incentives they received from the pharmaceutical company. The issue then led to a follow-up meeting between the Corruption Eradication Commission (KPK) and the Health Ministry discussing the possible bribes

Similar practices also occur in different forms throughout the world of infant and young child nutrition. There are many nutrition or public health programs sponsored by the baby food industry, such as health or nutritional programs, research, scientific seminars, workshops, or even posyandu (community health posts) programs allowed under a 2012 government regulation on exclusive breastfeeding, with specific conditions.

The most recent program is Duta 1,000 HPK (ambassadors of the first 1,000 days of life), a health and nutritional education program that supports the national commitment to improve the nutritional status of infants under 2 years old.

Such support should be called manipulation. The baby food industry provides assistance and creates a relationship with doctors, midwives, scientists, researchers, professional organizations, or even the government to promote their products. They market their products to enrich themselves at the expense of infant and young children nutrition.

Most of us might see this assistance as generous support. However, a long time ago when similar tricks commonly appeared in Philippines, the physician Cosme Cagas warned that those sponsors drive a hard bargain in exchange. As a result, they dominated the programs and controlled those they supported. Moreover, a breastfeeding advocate from the International Baby Food Action Network (IBFAN), Arun Gupta, states that sponsors expect whoever receives their support to promote their products or remain silent whenever anything goes wrong.

Such assistance undermines the concept of optimal breastfeeding and implies harmful consequences to child nutritional status and health. One example from the former Duta 1,000 HPK educational material is the missing information that exclusive breastfeeding means simply giving breast milk only, without any additional foods.

Interestingly, the material included a page with pictures of food like banana, porridge, honey and so forth that tells us they are not allowed to be given to babies under 6 months old '€” but there is no information that infant formula is not suitable for a baby under 6 months old.

This information potentially misleads those who read it. Officials disagree over whether the education material is a draft and others say that the material has been introduced in training sessions for local health workers. Such content is part of a smart marketing strategy to get around the International Code of Marketing of Breast-milk Substitutes and other laws developed to protect breastfeeding.

In fact, the code and the national laws regulate the marketing of any products that substitute breast milk, because breastfeeding is a natural way to feed babies and also because formula feeding carries health risks for mothers and babies.

It'€™s about money, not nutrition. Billions of dollars spent by the baby food industry for such programs is absolutely about money, not infant and child nutrition nor public health.

The code and the national laws regulate the marketing of any products that substitute breast milk.

A report from Euromonitor International 2013 suggested the
Asia-Pacific region is currently the main growth market for the baby food industry, accounting for over US$20 billion of the $36 billion global growth since 2003. Indonesia has become one of the world'€™s largest markets for infant formula and this reflects the aggressive baby food marketing in the region.

Meanwhile, poor sanitation leading to unclean bottles, for instance, and high levels of poverty leave infant formula companies in a very risky position, with their products linked to infant mortality.

A study published in the Lancet medical journal in 2013 suggested that globally, 800,000 babies die each year, mainly in Asia, because they are prematurely weaned from breastfeeding.

 In early October, the Health Ministry temporarily suspended the Duta program due to suspected conflicts of interest. While we are waiting for the final decision on whether the Ministry will completely stop the Duta 1,000 HPK program, the detrimental effects of programs funded by the baby food industry should be deeply considered.

The health interests of infants should not be undermined by commercial pressures imposed by baby food businesses for which inherent conflicts of interest continually arise between necessary profit-making and social, nutritional, and public health considerations.

 Strong and clear national infant and young child nutrition policies must be advocated, promoted, and implemented. Medical and public health education curricula should be revised and be more relevant to real-life problems. Topics such as the interactions between society, the medical professions and/or associations and regulators or public health policymakers and the baby food industry should be incorporated in the curriculum.

 Furthermore, political will is crucial from the government. It needs to take public health principles into consideration before initiating any nutritional public health policies for the best interest of the young generation. For instance, the principle of '€œdo no harm'€ reminds us to only implement infant and young child nutrition programs with no negative consequences towards infant and young children'€™s health.

It is time for public health policy makers to use the momentum and partner with the KPK to ensure that public health programs are clear from gratification, bribery, fraud and other negative forms of collusion.

Therefore the government must stop the Duta 1,000 HPK program and many other health and nutritional assistance programs supported by formula or baby food industries, its affiliated associations or foundations, to anticipate the conflict of interest that is dangerous for the health of Indonesian children.
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The writer is a breastfeeding advocate and a doctorate student at the Health Education and Behavior Studies Department, Teachers College, Columbia University