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

Author

Green, Mackenzie, Pries, Alissa M., Hadihardjono, Dian N., Izwardy, Doddy, Zehner, Elizabeth, Moran, Victoria Louise, Green, Mackenzie, Pries, Alissa M., Hadihardjono, Dian N., Izwardy, Doddy, Zehner, Elizabeth, and Moran, Victoria Louise

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.

Published
2021

3. Promotions of breastmilk substitutes, commercial complementary foods and commercial snack products commonly fed to young children are frequently found in points‐of‐sale in Bandung City, Indonesia

Author

Hadihardjono, Dian N., Green, Mackenzie, Stormer, Ame, Agustino, Izwardy, Doddy, and Champeny, Mary

Subjects
education, Supplement Articles, Advertising, Prevalence, Humans, Health Policy, digestive, oral, and skin physiology, commercially produced complementary food, Infant, Newborn, breastmilk substitute, Infant, promotion, Marketing and Consumption of Commercial Foods Fed to Young Children in Low and Middle‐income Countries. Guest Editors: Elizabeth Zehner and Mary Champeny. Publication of this supplement was supported by the Bill & Melinda Gates Foundation, Legislation, Food, commercially produced snack food, stomatognathic diseases, Cross-Sectional Studies, Caregivers, International Code of Marketing Breast‐milk Substitutes, Indonesia, Child, Preschool, Supplement Article, point‐of‐sale, Infant Food, Milk Substitutes, Snacks
Abstract

Few studies have documented the marketing of commercial foods and beverages for infants and young children in West Java, Indonesia. To assess the prevalence of promotions at points‐of‐sale for commercially produced products commonly fed to young children in Bandung City, 43 small and large stores were visited in 2017. Promotions for breastmilk substitutes (BMS), commercially produced complementary foods (CPCF), and select types of commercial snack products were photographed and information recorded on promotion characteristics. There were 402 and 206 promotions observed with BMS and CPCF products, respectively. Sixteen promotions with BMS products for infants under 12 months were found in 42.9% of stores selling BMS, violating national regulations. Almost all BMS promotions (98.3%) included BMS products for ages 1 year and above (“growing‐up milks”). Of all BMS products available for sale, half of all infant/follow‐up formula and 77.2% of growing‐up milks were promoted. CPCF were found in 97.7% of stores, and 81.0% of these stores had promotions; 70.5% of all available CPCF products were promoted. Of the 2,451 promotions observed for commercial snack products, 17.3% used promotional techniques targeting young children or caregivers. Joint‐promotions were common, with BMS and CPCF marketed in combination with commercial snack products; 49.0% of BMS promotions were joint BMS‐snack promotions, and 80.0% or more of infant/follow‐up formula promotions included a commercial snack. Revising and enforcing infant food and beverage marketing regulations to ensure consistency with global standards are necessary to protect and promote optimal infant and young child feeding in Indonesia.

Published
2019

6. Commercially produced complementary foods in Bandung City, Indonesia, are often reported to be iron fortified but with less than recommended amounts or suboptimal forms of iron.

Author

Dreyfuss, Michele L., Green, Mackenzie, Agustino, Hadihardjono, Dian N., Izwardy, Doddy, and Huffman, Sandra L.

Subjects
ENRICHED foods, BABY foods, CONFIDENCE intervals, FOOD labeling, GRAIN, INFANT formulas, INFANT nutrition, INGESTION, IRON, RESEARCH funding, SNACK foods, FOOD portions
Abstract

Commercially produced complementary foods (CPCF) that are iron fortified can help improve iron status of young children. We conducted a review of 217 CPCF sold in 42 stores in Bandung, Indonesia, in 2017. There were 95 (44%) infant cereals, 71 (33%) snacks or finger foods (biscuits or cookies, puffs, and noodles or crackers), 35 (16%) purees, and 16 (7%) other foods for which we obtained label information. Nearly 70% of CPCF reported iron content on their labels, but only 58% of products were reported to be fortified with iron according to ingredient lists. Among iron‐fortified products, only one fifth indicated a specific type of iron used as the fortificant, but all of these were recommended by the World Health Organization for fortifying complementary foods. Infant cereal was more likely to contain added iron (81%) compared with snacks or finger food (58%) and purees (14%) and had higher iron content per median serving size (cereal = 3.8 mg, snacks or finger food = 1.3 mg, mixed meals = 2.7 mg, and purees = 0.9 mg). Infant cereal was most likely to meet the recommended daily intakes for iron (41% for infants 6–12 months of age and 66% for children 12–36 months) compared with snacks or finger food (infants = 14%, children = 22%), mixed meals (infants = 28%, children = 46%), or purees (infants = 9%, children = 15%). Regulations on fortification of complementary foods need to specify minimum levels and forms of iron and require reporting in relation to requirements by child age and serving size. Monitoring and enforcement of regulations will be essential to ensure compliance. [ABSTRACT FROM AUTHOR]

Published
2019
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