(formerly IRIN News) Journalism from the heart of crises

Diarrhoea takes deadly toll on toddlers consuming infant formula

Two-year-old Kayla and his carer in Jakarta. The Indonesian government is trying to encourage mothers to breast feed their babies.
Marianne Kearney/IRIN

Infants are suffering serious bouts of diarrhoea, and in some cases dying, from infant formula provided in emergency situations, according to a coalition of international aid groups and government agencies that is calling for the promotion of breast-feeding.

"Inappropriate use in emergencies of breast milk substitutes, often received as unsolicited donations, endangers the lives of infants and young children,” according to a statement issued after a March meeting in Bali, Indonesia.

The coalition, which includes the UN Children’s Fund (UNICEF), Save the Children (UK), Mercy Corps, Care, the World Health Organization (WHO), World Food Programme, International Organization for Migration, HOPE, Médecins Sans Frontières and health officials from Afghanistan, Bangladesh, Cambodia, Indonesia, Thailand and Sri Lanka, is urging all UN agencies, aid groups, and governments to ensure that women are not automatically given infant formula during an emergency and are encouraged to continue breast-feeding.

"A lot of the time the donations are well meant. There's a misconception that in emergency situations women's milk dries up," Kirsty McIvor, UNICEF Indonesia's spokeswoman, told IRIN. She said stress can cause women's milk to temporarily evaporate but it will return.

Giving out infant formula during emergencies is even more dangerous than in normal situations, she said, because survivors often lack access to clean water or do not have the facilities to properly boil the water. Using dirty water in the formula mix can prove fatal, causing debilitating bouts of diarrhoea, a leading cause of death in children under five.


Photo: Marianne Kearney/IRIN
Eighteen-month-old William and his mother in Jakarta. On average only 14 percent of Indonesian babies are exclusively breast fed

Health risks

A joint survey by UNICEF, the UN Population Fund (UNFPA), and the University of Gadja Mada in Indonesia after the 2006 earthquake in Yogyakarta, central Java, found a six-fold increase in rates of diarrhoea for children under two as increasing numbers were given formula during the emergency.

An additional concern of the coalition is that once mothers of infant children are given the formula during emergencies, they continue to use it. Some 70 percent of households with children in the region of the Yogyakarta earthquake had received formula, and the survey found a two-fold increase in its use, compared with regions unaffected by the quake.

In Central Java province, the most recent available data shows that fewer than 5 percent of children aged five months are still exclusively breastfeeding and that the trend is declining. This is far lower than the national figure of 14 percent of infants exclusively breastfeeding at four-five months.

Formula overwhelms Aceh

Aceh, the province worst hit by the 2004 Indian Ocean tsunami, was inundated with infant formula in the weeks after the disaster, according to Robin Lim, a midwife with a local NGO, Bumi Sehat.

She said aid workers reported frequent cases of babies being malnourished and failing to gain weight, or die, because dirty water was used to mix the formula. In addition, she said, the formula was usually given out with no instructions on sterilising babies' bottles, the correct ratio of formula to water, and the need to boil the water.

Breast is best

Officially, the Indonesian Ministry of Health, with UNICEF and WHO, recommends breastfeeding but only 14 percent of Indonesian babies are exclusively breast-fed, and then only for the first five months.

UNICEF told IRIN that part of the problem is the aggressive marketing of infant formula, with some companies making misleading claims that infant formula is better for a baby's brain development than breast milk. In response, the Indonesian Ministry of Health is drafting regulations to control the advertising of breast milk substitutes.

The director-general of community health has directed district health offices to only give out donated formula during emergencies to those who have no other option - orphans, children of mothers who cannot feed due to stress or injury, or to children who were already being fed formula before the disaster.

The Ministry of Health, with assistance from UNICEF, also said it would train breast-feeding counsellors to be deployed to disaster areas.

mk/bj/mw

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