The Jakarta Post
Two years ago (on Dec. 22, to be exact), the government of Indonesia officially joined the global movement
Scaling Up Nutrition (SUN).
The initiative aims to eliminate stunting in babies and infants, which is running at a high rate of 36 percent among children under 5 years of age in Indonesia.
By joining SUN, the government committed to addressing chronic and acute malnutrition, anemia, low-birth weight and obesity problems affecting the first 1,000 days of a child's life.
A feature of the SUN initiative is its focus on government partnership with the private sector. Although a set of principles to engage with the private sector is in place, we need to ask: What are the main considerations when taking up a private partnership ' especially with a baby food company ' in matters of child nutrition?
I have isolated four key considerations, the overall conclusion being that extreme caution should be taken.
First, potential risks. The private sector's contributions can be both beneficial and harmful to health. What we need to remember is that the private sector's goal is to gain profit, not to improve public health.
There is a huge potential risk if the government partners with baby food companies, mainly because they gain access and influence in terms of policy making. The decision to continue to breastfeed or to 'switch' to manufactured product is of particular concern.
Partnering with baby food companies will enable the company to work closely with maternal and child health workers and to influence policy making, including on matters relating to mothers' decisions in baby and infant feeding, which is against World Health Assembly Resolution 63.23 and Government Regulation No. 33/2012.
The significant effects of 'line extension' marketing methods on mothers' decisions to use infant formula and toddler complementary feeding packages have been noted in a recent Australian study.
Second, the partnership with baby food companies in matters of baby and infant feeding is contradictory in many ways to existing efforts to promote breastfeeding practices.
We know from many studies that breastfeeding is the single most effective intervention to improve infant nutrition and prevent mortality from infection.
Exclusive breastfeeding, the introduction of nutritious homemade complementary foods and continuation of breastfeeding up to the age of 2 years should be promoted instead of opening the door to what are essentially less nutritious, more expensive alternatives.
Third, it is likely ineffective. The notion of program intervention in public health should not harm anyone and should be beneficial for people. It is likely that partnerships with baby food companies provide benefits in certain matters related to nutrition programs.
For example, fortified foods with micronutrient technologies that have been acknowledged by some reputable institutions such as the International Business Leaders Forum at Harvard University may give benefits in improving nutrition knowledge and programs for
Indonesia. Another benefit is the opportunity to create jobs through the production of fortified foods.
Although these two benefits will likely to have valuable advantages in the country, they will not directly address malnutrition problems.
Since the SUN program is aimed to eliminate stunting cases, the primary intervention should be focused on improving infant and young child feeding. Benefits to the private sector should not obscure the SUN initiative's core objective.
Fourth, by partnering with the baby food company, it could reduce the government's cost to ending malnutrition. But, there are several issues that we must consider.
Although the central government has allocated US$70 million per year for the SUN program, and provincial governments have also allocated resources, that total is insufficient to cover a comprehensive program.
The reach of health workers is also limited, which some argue could be extended by effective private sector support. Private sector partnership will help the government to fill in the funding and resource gaps.
However, the cost to cover the drawback is even bigger. Importantly, the engagement of the baby food company represents a direct threat to the future production of local nutritious foods in Indonesia, which already makes a significant contribution to our health, communities and ecosystems.
If the local food will no longer sustain, families will definitely need to spend more money to buy baby food products from the market. Thus, there is no cost effective impact in the long-term effect of the program.
The fact that this contribution is largely 'hidden' in our health statistics and is not accounted for in 'dollar terms' should not disguise the fact that local wisdom and local food production are intrinsic to the health of our economy and societies. Indonesia is an agriculture country, where 60 percent of the land is involved in agricultural production.
As such, the decision to develop public-private partnerships in matters of baby and infant nutrition needs to be carefully considered. We know from experience and numerous studies that breastfeeding is the best option for young children and that developing our traditional wisdom in nutrition is empowering for communities and local economies.
Thus, in commemorating the second year of Indonesia's involvement in the SUN movement, I urge the government to not partner with baby food companies.
The writer, a member of Indonesia's Breastfeeding Counselor Association (IKMI), is a USAID scholar at Montclair State University, New Jersey.
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