Breastfeeding and breastmilk substitute use and feeding motivations among mothers in Bandung City, Indonesia

Abstract

Suboptimal breastfeeding is common in Indonesia, with only half of infants 0-5 months of age exclusively breastfed and feeding of breastmilk substitutes (BMS) highly prevalent among infants and toddlers. Various factors influence these feeding practices, including social norms, limited health system support and BMS manufacturer marketing practices. This cross-sectional survey aimed to identify the prevalence of breastfeeding and BMS feeding among children aged 0-35 months, explore socio-demographic characteristics and motivating factors associated with these feeding behaviours and identify the prevalence of mothers' exposure to BMS promotions. Indonesian mothers of children <3 years of age (n = 595) were interviewed in Bandung City health facilities using structured questionnaires. Although all children were ever breastfed, half of children across all age groups received BMS in the previous day. Maternal employment outside the home and insufficient breastmilk production were associated with BMS use. The most important motivational factors for feeding BMS were perceived benefits for growth, intelligence and immunity.Despite Indonesian legislation restricting some BMS marketing, 93% of mothers reported observing a BMS promotion outside the health system, with television, social media and newspapers as the most common sources. Half of mothers (43%) reported observing a BMS promotion within the health system, and half (46%) reported receiving recommendations from health workers to use BMS. Such high prevalence of BMS marketing may be influencing caregivers' feeding choices; stronger national legislation and implementation of laws are needed to ensure mothers' ability to make feeding choices free from manufacturer influence.

Exclusive Breastfeeding and Factors Influencing Its Abandonment During the 1st Month Postpartum Among Women From Semi-rural Communities in Southeast Mexico

“…Another important thing to note is the fact that many women also attend private clinics and pharmacies when their child is ill, where they too receive infant feeding information. It has been documented both in Mexico and other countries that the promotion of breastmilk substitutes is a common practice in such facilities (8,66,67). For example, in a study in the Mexican states of Puebla and Chihuahua, authors documented that, when attending public and private health facilities, in 48.4% and 40.7% of cases, respectively, mothers of children younger than 24 months were recommended to give them a breast milk substitute.…”

Infant Feeding Practices That Substitute Exclusive Breastfeeding in a Semi-Rural Mexican Community: Types, Moments, and Associated Factors

“…These findings are consistent with the evidence from studies in Mexico and other low- and middle-income countries (LMIC). Working outside the home has been linked to the reduction in EBF [ 37 , 38 , 39 ] by introducing FM [ 21 , 40 , 41 , 42 ]. For example, in Bangladesh, most mothers with formal employment in ready-made garment factories introduced FM as early as two months, despite knowing that breast milk is the sole ideal food for infants [ 41 ].…”

“…The study also revealed that there was almost universal exposure to the marketing of breast milk substitutes. The authors proposed that health and nutrition claims from FM vendors may influence caregivers and their feeding choices [ 42 ].…”

“…However, we did not explore their exposure to inappropriate marketing strategies outside the health system, either through publicity in mass media, points of sale, or the presence of nutritional and health claims on the products’ labels. These are the places where most of the FM promotion has been observed in Mexico and other countries [ 42 , 44 ].…”

Violations of International Code of Breast‐milk Substitutes (BMS) in commercial settings and media in Bangladesh

“…Moreover, aggressive marketing of breast‐milk substitutes (BMS) play an important role in reducing the optimal duration of breastfeeding (Neves et al, 2021). Pervasive marketing of BMS have been shown to adversely impact knowledge, intention, beliefs, self‐efficacy and social norms related to breastfeeding (Green et al, 2021). COVID‐19 pandemic has created an additional threat to optimal breastfeeding, as BMS companies have capitalized on the fear of possible transmission of the infection through breast milk, to promote the use of BMS products (Ching et al, 2021).…”