It’s hard to imagine anything less ethical than gambling
with the lives of newborn babies. But the profit motive reigns
supreme in Indonesia as in the rest of the world.
Extensive research conducted over many years proves conclusively
that breast-fed babies are healthier and more resistant to
disease. According to the Executive Director of UNICEF, “Exclusive
breast-feeding is one of the most powerful tools we have to
combat child hunger and death.” Breast milk contains
hundreds of health-enhancing antibodies and enzymes that stimulate
the immune system and help prevent a long list of diseases
including asthma, allergies, childhood cancers, diabetes and
ear infections while promoting cognitive development. In Brazil,
it was found that breast-fed babies were smarter than bottle-fed,
with a projected 10 – 15% advantage in wage-earning
potential. As adults, their blood pressure and cholesterol
levels are lower. Mothers who breast-feed are also protected
from breast and ovarian cancer and bone disease. Bottle-fed
babies get sick more often. In the United States, the cost
of hospital treatment for bottle-fed babies is 15 times higher
than the cost of treating breast-fed babies. But misleading
advertising has convinced even mothers in developed countries
that formula is as good as or better than breast milk -–
an outrageous and dangerous fallacy.
Indonesia produces about 4.5 million babies a year. Breast-feeding
is by far the safest and most economical option for these
mothers. But the infant formula industry wages an aggressive
campaign for breast milk substitutes. Because the bottle is
easier to suck and formula contains sugar, the babies tend
to prefer it. Nurses and midwives are encouraged by the formula
industry to give newborn babies breast milk substitute immediately
after birth. Once hooked on the bottle, the babies refuse
the breast and the mother’s milk soon dries up. Then
the parents are committed to purchasing formula at a cost
which is often a large percentage of the family income; a
high quality formula can cost Rp 500,000 a month.
Despite an international Code established in 1981 that bans
all advertising and promotion of formula and samples and gifts
of the product to mothers and health care workers, infant
formula enjoys a high profile in Indonesian hospitals and
clinics. In Bali, hospital management works closely with formula
producers to push their products on the maternity floor. One
source estimates that hospitals receive about Rp 200,000 for
each baby they introduce to formula feeding. (In one Bali
clinic a new mother was forbidden to breast-feed by the staff;
another was denied access to her new baby for 36 hours.) Balinese
pediatricians who promote the products to their patients are
gifted with new cars and motorcycles by the formula industry.
Infant formula companies also court midwives, hosting conferences
and offering cash incentives, televisions and other gifts
to midwives who ensure that the first milk a newborn tastes
is from a bottle. Underpaid health workers who influence young
mothers are a prime target for this strategy. All this is
in blatant violation of the law.
As usual, it’s the poor that suffer most. Cheap magazines
for low-income earners entice mothers to buy formula for their
new babies. Often they can only afford the cheapest, (sometimes
counterfeit) formula that contains mostly rice flour. Combined
with unsafe drinking water, bottle-fed babies are 25 times
more likely to die of diarrhea. In spite of this, 20 - 35%
of Indonesian babies between 1 and 3 months old are bottle-fed,
increasing to 45 – 70% by four to five months. One mother
near Ubud gave birth to twins in a nearby hospital and was
told that she wouldn’t have enough milk to feed both.
She could afford formula for only one, and gave it to the
more culturally valuable boy. When both children fell ill
with diarrhea, only the breast-fed girl survived.
Here’s a nice story. A group of nuns concerned about
one infant formula producer’s marketing tactics in the
Third World paid a call on company executives. According to
an observer, one of the nuns asked, “Tell me, if you
stop selling to people who are too poor to use the product
safely, will you still make a profit?” After a pause
one of the corporate executives replied, “That is the
crux of the problem.”
So, what’s the bottom line in this highly profitable
though largely unnecessary industry? The numbers are mysteriously
murky. 2001 was the last year that the producers of infant
formula transparently stated their sales. Even doctors in
North America can’t get hold of current statistics.
But the biggest markets are countries like Indonesia where
a combination of non-compliance with the code protecting women
from inappropriate marketing of breast milk substitutes and
profit-motivated hospitals and doctors play into the hands
of infant formula producers. We can safely assume that this
is a multi-billion dollar industry.
Yayasan Bumi Sehat, a natural childbirth clinic outside of
Ubud, continues to crusade for gentle, natural births and
exclusive breast-feeding. So unique is this mandate in Indonesia
that rock star Oppie Andaresta chose to give birth to her
first child at Bumi Sehat in May. Why would a celebrity who
can afford to give birth in her choice of modern Jakarta hospitals
with the best obstetrical care choose a small, rural birth
center like Bumi Sehat Bali which serves the poorest women
in the area? “She knew that in a hospital she wouldn’t
be able to control the situation,” explains Bumi Sehat
advisor Robin Lim. “Oppie and her husband wanted a gentle,
natural birth with no possibility that she and her baby would
be separated after birth or that her baby would be given formula.”
A Bumi Sehat team gave presentations on the merits of breast-feeding
to two large jewellery businesses in Ubud, which now send
their pregnant female staff to the clinic instead of to the
local hospital where the Caesarean section rate was close
to 100% for their insured employees. Bumi Sehat also produces
a comprehensive booklet on breast-feeding targeted to expectant
fathers.
Ubud-based Jungle Run Productions recently filmed Mothers’
Milk, a documentary about big business versus breast-feeding
in Indonesia. It was aired on Al Jazeera International current
affairs series People and Power in early November and can
now be viewed at http://english.aljazeera.net/NR/exeres/BA1B6C12-846C-46F0-BFD4-6C1CB4652EE4.htm
Education is power. If we all explain to our staff and friends
about the economics behind the pressure to use substitute
breast milk, they can at least make an informed choice. As
Robin says, “The only thing wrong with breast milk is
that no one can make money from it.”
Yayasan Bumi Sehat’s excellent work in promoting natural
childbirth and exclusive breast-feeding is supported entirely
by donation. Please visit www.bumisehatbali.org for information
on their programs and how to contribute.
