Sukabumi, West Java – For Naslima, a mother of two in the fishing village of Genteng Parakan, there was never any doubt about how she would feed her babies.
"It's better to breast-feed than to give formula. Babies that breast-feed are healthy," Naslima told IRIN news service outside a health center in the West Java district of Sukabumi. Indeed, Naslima's two daughters, now 7 and 12, were rarely sick with diarrhea and both had a healthy weight.
But Naslima is also an exception in Indonesia. Exclusive breast-feeding is rare in the world's fourth most populated nation – a source of concern for a country that suffers from high rates of malnutrition and stunting among children.
Only 14 percent of Indonesian babies are exclusively breast-fed, according to the Indonesian Demographic and Health Survey from 2002 and 2003. A more recent survey conducted by the Health Ministry showed rates of breast-feeding dropping by 10 percent between 2007 and 2008.
In fact, in larger urban areas where Indonesian women have higher levels of disposable income or are working, an increasing number favor formula over breast-feeding.
"When they see the ads on TV that say formula A has DHA and vitamins, mothers think it is better," Elin Liani, a midwife said, referring to docosahexaenoic acid (DHA), an omega-3 fatty acid that occurs naturally in breast-milk and is considered important for brain and eye development.
In a bid to reduce the influence of formula companies on women, and more importantly, to reduce the high levels of mortality and malnutrition among infants and children, Indonesia will soon pass regulations that prevent milk formula companies from targeting babies younger than one.
Although a law promoting exclusive breast-feeding has been in place since 2009, it lacks any penalties for violations. The new regulations will lay out those penalties and require employers to allow mothers regular breast-feeding breaks.
Anyone who "intentionally hampers exclusive breast-feeding" will also be penalized with jail terms of up to one year or maximum fines of $32,000, says Iip Syaiful, a nutrition expert from the Health Ministry. The fines and punishments, which had been expected to go into effect as early as the end of September, are currently under review by the Justice and Human Rights Ministry
The government estimates some 30,000 young children could be saved if their mothers exclusively breast-fed them for six months, then continued breast-feeding with supplemental foods until the age of two.
Studies suggest wider promotion of exclusive breast-feeding could prevent 1.4 million child deaths under the age of five, as well as improve child nutrition, a 2008 Lancet report said.
According to Unicef, 37 percent of Indonesian children suffer from moderate stunting, which delays a mental and physical development and makes them more susceptible to other diseases.
According to infant formula company SGM – part of the French food conglomerate Danone and one of Indonesia's largest sellers of infant and toddler milk and foods – the new regulations will not affect its marketing strategy, as it has already modified its TV advertisements to only feature babies older than one.
"We've been doing this for quite some time, only advertising our growing-up milk, which is for babies one year and above," said Arif Mujahidin, communications manager for SGM.
In 2010, Indonesia's infant formula market was valued at $136 million, with zero growth from 2009 to 2010, while the country's growing-up milk market was worth $1.15 billion in 2010, a growth of 9 percent on 2009, according to AC Nielsen data.
Still, despite the 2009 law banning health professionals from promoting formula and giving it to new mothers, the practice remains rife, breast-feeding activists say.
"In the hospitals they give the women formula straight away if they have any problems at all breast-feeding. I never hear them tell women in the first three days, 'Don't worry if your milk hasn't come in, it will,'?"
Eka Yuliana, a community breast-feeding promoter with Bumi Sehat, a Bali-based NGO, said, referring to the small amounts of breast milk women typically produce just after birth.
"If doctors would support breast-feeding 100 percent, that would be better," Yuliana added. She believes doctors have been unduly influenced by the formula companies' marketing as well.
The Health Ministry said many health workers had "not received knowledge about the importance of exclusive breast-feeding."