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In the United States, the breast milk versus formula debate tends to center on what works best for the mom and what is most nutritious for the baby. In many impoverished parts of the developing world, the stakes are even higher — and breastfeeding can be a matter of life or death.
That’s because in the absence of breastfeeding, the water available to mix with formula is often contaminated and can cause a host of health problems for infants, including diarrhea and infection. Poor families tend to dilute the amount of formula they put in each bottle, which can cause a baby to become even more malnourished.
Research has shown an estimated 1.4 million child deaths could be prevented each year around the world if babies were properly breast-fed.
In Indonesia, where malnutrition rates are high and fewer than a third of babies are exclusively breastfed until they are 6 months old, the government is taking legal steps to ensure that breastfeeding is made as culturally acceptable as possible.
A new law stipulates that all babies should be breastfed for the first six months of life, and anyone who prevents a mother from doing that — a company, coworker, family member, etc — can face up to a year in jail and $11,000 in fines. The law also prohibits formula companies from promoting their products to mothers of babies who are less than a year old.
The government does not intend to lock up mothers who don’t breastfeed according to Minarto, director of nutrition for the Indonesian Ministry of Health.
“This law is intended to provide support to them,” said Minarto, who like many Indonesians goes by one name. “Women should be able to breastfeed in public areas — in an airport, an office. Owners should provide rooms for the mothers.”
In Indonesia the stunting rate for children under 5 hovers around 40 percent, and breastfeeding rates have been falling in recent years. Minarto says the government has set a goal of having 80 percent of babies exclusively breastfed by 2015.
Dr. Utami Roesli, a senior pediatrician and cofounder of the Indonesian Breastfeeding Center in Jakarta, said exclusive breastfeeding will help reduce the mortality rates for children under five.
“Every day more than 550 children age five and under pass away in Indonesia. That means one big jumbo jet of children crashes every day. By doing this very simple thing we can reduce 27 percent of deaths,” Roesli said.
Roesli, who has been on the front lines of the breastfeeding movement in Indonesia for more than 20 years, says the new law was necessary to combat aggressive advertising campaigns by formula campaigns.
“The information that mothers get here in Indonesia about breastfeeding is very, very little compared to what they get about formula because the formula companies are so powerful,” he said. “This law tips the scales back to breastfeeding.”
Nestle, the largest formula company in Indonesia, declined to comment for this story, and the Indonesia Baby Food Producers Association had not responded by the time this piece was published. But last year Nestle provided a statement to the BBC which read, in part, “We strongly disagree with any such accusation that Nestle actively and aggressively promotes our infant formula products in Indonesia. Nestle believes that breast milk is best for babies, and we support exclusive breastfeeding for six months from the baby’s birth.”
Until a few years ago, new mothers at the Koja District Hospital in North Jakarta received very little information about breastfeeding and were given free formula samples as they left the hospital. But all that changed after a 2007 diarrhea outbreak in the community sickened a number of infants, and local health officials realized many families were giving them formula bottles made with dirty water.
The hospital now runs a model program, said Fransiska Erna Mardiananingsih, a senior health and nutrition adviser for the U.S. based charity group Mercy Corps, which has been supporting the hospital’s efforts and breastfeeding programs throughout Indonesia.
“The standard protocol in Indonesia was for a baby to be separated from its mother after birth for several hours while the mom recovered and the baby was given a check-up,” says Fransiska. “But at Koja Hospital all healthy babies are now placed on their mother’s chest immediately after birth and encouraged to breastfeed.”
During a recent visit, nurses in the hospital’s maternity ward, wearing pins on their uniforms saying “Breastfeeding Ask Me,” were busy showing new moms how to correctly latch their babies using dolls as props. Mita, a 20-year-old first time mom, said she hadn’t heard about the benefits of breastfeeding until she got to the hospital.
“It’s painful,” she said. “But I am going to try to keep doing it.”
Mita is unemployed and plans to stay at home with her daughter, but many women work in Indonesia and it remains to be seen how employers will respond to the new law, and whether the government will actively pursue those who are in violation of it.
Minarto from the Ministry of Health says the specific regulations of the law are still being worked out by his office, but he hopes to have them finalized by the first week in August, which is also World Breastfeeding Week.