Nurfika Osman – Activists and nutritionists have urged the government to adopt an international code that bans the unethical promotion of breast-milk substitutes in a bid to increase breast-feeding rates.

"Babies are now getting sick and dying because companies are encouraging mothers to stop breast-feeding their babies," David Clark, a Unicef nutritionist, said in Jakarta. "The code prohibits unethical marketing practices that undermine breast-feeding."

The International Code of Marketing of Breast-Milk Substitutes, adopted by the World Health Assembly in 1981, stipulates that "there should be absolutely no promotion of breast-milk substitutes, bottles and teats to the general public; that neither health facilities nor health professionals should have a role in promoting breast-milk substitutes; and that free samples should not be provided to pregnant women, new mothers or families."

"Companies know this but they keep violating the code," Clark said. "If the government adopts clear legislation and has a clear monitoring system, we can work on this. We need an independent law to bring it into force and consumer advocacy organizations as watchdogs to watch the implementation."

Clark said countries such as India, Brazil and Bangladesh had adopted the code and had taken companies to court based on it.

According to the World Health Organization Web site, since the code was adopted, 65 countries have enacted legislation implementing all or many of its provisions and subsequent relevant World Health Assembly resolutions. More than 20 other countries currently have draft laws awaiting adoption.

Agus Pambagyo, from the Breast-Feeding Coalition, an NGO, said Indonesia had only a ministerial decree and regulation promoting six months of exclusive breast-feeding. He said the country needed clear legislation that carried criminal liabilities.

Utami Roesli, the head of the Indonesian Lactation Center, said the lack of legislation was part of the reason breast-feeding rates in the country were just 30 percent, which is considered low by international standards.

Utami said the core of the problem was that many people including health professionals like doctors, did not know about the code.

"The formula companies are taking advantages of this. They make mothers giving up breast-feeding, saying the milk substitutes have the same nutrition as their milk," she said.

"Breast-feeding saves babies and research has found that babies who are not breast-fed in their gold ages [0-6 months] are more likely to suffer health and mental problems in the future." Among these problems, Utami said, are social withdrawal, depression, anxiety and attention deficit disorder.

Agus said ideally babies would be breast-fed until the age of two. "We are facing a long and bumpy road to the full implementation of the code in Indonesia, but we have to continue trying," he said.

Utami said "there is no substitute for mother's milk." "Breast-feeding is the most effective preventive public health intervention to reduce infant mortality and morbidity," she said.

"Formula companies' promotions have reduced breast-feeding and increased the use of breast-milk substitutes."

Clark said that if mothers were suffering malnutrition, society should help them with nutrition so they could breast-feed. "Even though she is malnourished, her milk contains reasonable nutrition, so we just have to help her, feed the mother, not give the baby formula milk," the UN nutritionist said.