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Promoting 'Early and Exclusive' Breastfeeding

Indonesia, April 18, 2008

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  <span class="field-credit">
    Caitlin Carlson/Mercy Corps  </span>
    Five-month-old Efa is held by her father, Mahfudin, outside their home in one of North Jakarta's poorest neighborhoods. Formula feeding is so revered that Mahfudin and his wife, Nur, ran away from Nur's grandmother's home so they could continue to breastfeed their newborn. Photo: Caitlin Carlson/Mercy Corps

Tugu Utara, Jakarta — Little Efa lives in one of the poorest and dirtiest sections of Indonesia's crowded capital, but she's as happy and healthy as any 5-month-old girl you'd meet. That may be partly because she is breastfed.

Efa's mother, Nur Komaria, 21, and her husband, Mahfudin, 25, were encouraged by their Mercy Corps-trained midwife to breastfeed their first child. Nur's grandmother, who hosted the couple at the time, had other ideas. She incorrectly thought that formula quieted infants, and tried to impose her will on the new parents. Instead, Nur and Mahfudin ran away to live on their own so they could continue to breastfeed their newborn.

"My neighbors always comment on how fat and healthy Efa is," says the soft-spoken Nur. "When I tell them it's because I breastfeed her, they don't believe me. They've always been told it's better to feed formula to their babies."

The unregulated influence of formula companies in Indonesia has led to widespread distrust of breastfeeding. Yet exclusive breastfeeding in the first six months has proven benefits. Dozens of studies have linked breastfeeding with lower infection, allergy and illness rates, and greater emotional and intellectual development.

Since 2006, Mercy Corps has taken an active role in promoting the benefits of breastfeeding to Indonesian women. These programs train health officials and 300 midwives in North Jakarta on the importance and benefits of the practice.

As part of the program, Mercy Corps brought together 1,001 mothers and midwives from across Jakarta in January 2008 to make a public statement on the importance of breastfeeding, and to help educate Indonesians about the risks of formula. The event — which was attended by Jakarta's Governor, its Minister of Woman Resources, other government officials and breastfeeding experts — attempted to dispel some of the widespread misinformation about formula feeding and breastfeeding.

Dr. Fransiska Mardiananingsih, Mercy Corps' Healthy Start program manager, says formula companies have persuaded hospitals and clinics to encourage formula rather than breastfeeding. "Their aggressive marketing has convinced many mothers and health providers that formula feeding is just as healthy for infants," she says, "but in fact it has significant negative effects on children's health."

Mardiananingsih says formula companies go as far as to deliver gift baskets to new mothers to encourage the continued use of their product.

Many in Jakarta can ill-afford the cost of formula. Mahfudin, Efa's father, earns $60 a month from his janitorial job. Rent payments on their small, one-room apartment consume half of his monthly income. Formula costs another dollar or two per day, which would leave the family nothing for food or other necessities.

This financial stress can add to the other disadvantages of using formula. Since many poor families don't have enough money to buy all the formula they need, they often dilute what they are able to buy with Jakarta's unclean water. This robs their children of vital nutrition and can cause severe cases of diarrhea and dehydration.

In addition to training health officials and midwives, Mercy Corps is working with local government leaders to spread the word about the benefits of breastfeeding. Over time, Mercy plans to work in 40 villages across Jakarta and train 200 community members to become breastfeeding support group facilitators, who will in turn reach a total 4,000 mothers each year.

Iqbal, a village leader in Tugu Utara, is among the government leaders who have been mobilizing their communities to attend these breastfeeding support groups. "Mercy Corps has been working to create breastfeeding support groups in my village since 2006," he says. "It's helped my community better understand what is best for their health and, more importantly, for the health of our children."

Staying healthy can be difficult in Tugu Utara, where trash is piled in open sewers and even the shortest rainfall floods the streets with contaminated water. As a young couple trying to start a new life here, Nur and Mahfudin face many challenges. But because of the information and support they've received from Mercy Corps, worrying about the healthy development of their daughter Efa isn't one of them.