Sejarah Penyusuan Ibu

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====== British: Pasca Pendudukan Jepun (1940-1957) ======

===== Ringkasan =====

Selepas Pendudukan Jepun dan kembalinya pentadbiran British, kadar kematian bayi menurun secara mendadak. Faktor-faktornya ialah peningkatan mutu kesihatan awam dan sanitasi, pengawalan wabak malaria, penambahan inokulasi bayi, pengawasan bidan-bidan (ordinan 1954), penjagaan perubatan dan khidmat nasihat oleh klinik kesihatan ibu dan anak: //"After World War II: Infant mortality rate dropped radically. Factors: improvements in public health & sanitation, malaria control, increased inoculation of infants, supervision of midwives (ordinance 1954), medical care & advice by maternal and child health clinics."//

(Sumber: Lenore Manderson, International Journal of Health Services, Vol. 12, No. 4 (1982), pp. 597-616 (20 pages): {{ ::buku:jstor-org-stable-45131579.pdf ||}}[[https://www.jstor.org/stable/45131579|"BOTTLE FEEDING AND IDEOLOGY IN COLONIAL MALAYA: THE PRODUCTION OF CHANGE"]]).

{{:gambar:ibu-bayi-1950an.png?600|}} \\
//"Figure 10. Unknown photographer, Cover of New Village in Malaya (Set of 12 Plates) (London: COI, 1953). LOT 7301 (G), Prints and Photographs Reading Room, Library of Congress, Washington, DC."// (Taylor, J. E. (2022). History of Photography, 46(2–3), 164–183: {{ :makalah:humanising_the_squatter_photography_in_the_service_of_resettlement_in_emergency-era_malaya.pdf ||}}[[https://doi.org/10.1080/03087298.2023.2199651|"Humanising the Squatter: Photography in the Service of Resettlement in Emergency-era Malaya"]], m.s.178).

===== UNICEF: Pemberian Susu Percuma =====

//"Seiring dengan perkembangan bioperubatan, teknologi-sentrik, termasuk DDT, antibiotk dan vaksinasi, Pertubuhan Kesihatan Sedunia (WHO) menyalur bantuan dalam penjagaan kesihatan awam di bawah panji-panji 'bantuan teknikal' kepada negara-negara kolonial termasuk Tanah Melayu. Dari tahun 1950, ramai jururawat di bawah panji-panji WHO direkrut dan berkhidmat di Tanah Melayu, terutamanya sebagai pengajar. pada tahun 1953, WHO membiayai sejumlah USD$ 47,000 untuk pembinaan pusat-pusat kesihatan di luar bandar, dengan memberikan 'kepentingan luar biasa' untuk projek ini 'nilai potensi yang sangat besar' walaupun pada masa tersebut, badan dunia tersebut menghadapi kekangan kewangan. Hal ini kerana semasa Perang Dingin, dekad-dekad 1940-an dan 1950-an, negara yang mempunyai taraf kesihatan yang daif dimomok-momok oleh kuasa Blok Barat yang diketuai oleh Amerika Syarikat boleh membawa kepada 'pencambahan dan perkembangan komunisme.' Malah bantuan peruntukan dalam perkhidmatan kesihatan awam ini sering dilihat sebagai 'aspek yang boleh melunakkan politik sesebuah negara' dan 'menawan hati dan minda masyarakat' terutama ketika negara-negara Asia dilihat tidak bersedia memperuntukkan sejumlah besar dalam aspek kesihatan awam (Farley 2008)."// (Koo Boon Dar, 2022. "Wanita dan Sejarah Kejururawatan di Tanah Melayu: 1800-1957," dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.241).

{{:gambar:myfoto365637_kmh-1-9_wh2273.png?600|Pusat Kebajikan Bayi di Kuala Lumpur, 1954}} \\
Pusat Kebajikan Bayi di Kuala Lumpur, 1954: //"5th October 1954, Registration of babies at Babies Welfare Centre during the Activity at Medical Research Institute and Outside Division Building at Kuala Lumpur."// (Jabatan Penerangan Malaysia (JAPEN), 1954 @ UNICEF, 2024: {{ :laman:unicef_malaysia_70_years_of_prioritizing_children_unicef_malaysia.pdf ||}}[[https://www.unicef.org/malaysia/unicef-malaysia-70-years-prioritizing-children|"UNICEF Malaysia: 70 years of prioritizing children"]]).

==== MILK AND CHARITY ====

//"In Malaysia, advertising of all milks continued to increase until the Second World War when breastfeeding rates went up because of the unavailability of artificial milk. The infant mortality rate dropped during this time of 'hardship', but when the British administration resumed control they saw a 'need' for large-scale imports of milk and intensive advertising was resumed. ... The inheritance of the colonialists' medical ignorance and harmful marketing practices deprived both the Malaysian and Singaporean babies of breastmilk to this day."// (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 219)

//"After the Second World War, dried, skimmed milk was 'a fortunate by-product of a domestic surplus-disposal problem'. It was more satisfactory in every respect to dump it in developing countries than to have to bury it, which was contemplated by the US Department of Agriculture at one point. Besides the planning of dried skimmed milk distribution, elaborate plans and committees were formed to manufacture 'protein-rich' food supplements from dried skimmed milk, but in the end they proved to be commercial failures so were abandoned. During these post-war years an obsession with the 'world protein gap' and the 'impending protein crisis' led to the allocation of resources into ways of combating this 'problem'. ... \\
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It was during the phase of the imaginary 'protein gap' that the international agencies embarked on distributing tons of dried skimmed milk around the world. The attitude of the nutritional establishment was this: \\
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'Largely through the good offices of UNICEF, many thousands of tons of DSM have been distributed to children in countries which are short of daily cattle. The improvement of health of children receiving this milk has been demonstrated in controlled experiments and vast numbers of children have benefitted. (my italics)'. \\
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As I explained in Chapter 2, milk, though a useful product, is not an indispensible food, and after infancy children stay healthy on diets without it. In poor countries, many children do not get enough food and any 'controlled' experiment where children were given more to eat would show improvement in health. The idea of countries being 'short of dairy cattle' illustrates the ethnocentric bias of nutritional scientists many of whom have strong links with the food production system of the industrialised world. ... It was cheap dried skimmed milk, though, not the whole dried milk that was favoured for worldwide distribution, because there were non-nutritional advantages. 'We aim not only at improving the standard of nutrition but also, as a necessary corollary, at expanding the market for milk.' ... This milk obsession went hand in hand with scorn for breastmilk. A World Health Organisation consultant who visited Nigeria in 1955 referred to mothers' 'impoverished milk', and as mothers were confronted by health workers and told to reduce the number of breastfeeds, they were encouraged to supplement with substitute milks. \\
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In the Caribbean, mothers had been positively discouraged from prolonged breastfeeding (called 'over-nursing') by the Colonial Health Administration for years:... the attitude was still around in 1952 when clinic nurses were advising mothers that seven to nine months was the desirable length of time for breastfeeding."//

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 222-224)

//"By the early 1960s UNICEF was distributing 900,000 kilos of milk annually; this was going to babies as well as mothers and children all over the world and was frankly used as a means of enticing mothers to clinics, just as the infant milk depots had been used in Europe. In Sarawak in 1954, dried skimmed milk donated by UNICEF and government-supplied evaporated milk was seen by health workers as 'bait' to attract mothers to the clinics. In Singapore, 22,590 kilos of free powdered milk were given out by clinics in 1959. \\
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Dried skimmed milk is high in protein and calcium, but unless it is artificially fortified it lacks the fat soluble A and D vitamins. Rickets is not a widespread problem in sunny countries but vitamin A deficiency is probably the most widespread and serious nutritional problem of poverty. Its occurence is linked with frequency of diarrhoea, which itself is more likely with the use of dried skimmed milk. Xerophthalmia (eye damage leading to blindness due to vitamin A deficiency) is reported in seventy-three countries and in Bangladesh alone 30,000 children a year go totally blind because of vitamin A deficiency. Although vitamins A and D may be added to dried skimmed milk, these can deteriorate in storage. In 1991 the EC produced 40 per cent of the world supply of dried skimmed milk and sent out 83,500 tonnes as food aid. Many children who suffer from periods of marginal malnutrition recover and go through a phase of catch-up growth with no long-term ill-effects; eyesight has no comparable recovery. With all food aid it is notorious that any donated food inevitably replaces home meals. In many areas of the world where dried skimmed milk was distributed, the traditional diet included leaves, fruits and oil seeds ... which were high in vitamin A, and by zealously promoting this 'protein' supplement there might have been an accompanying reduction of other important dietary components such as vitamin A. \\
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Dried skimmed milk was distributed in countries where the use of milk after sevrage was not customary. As many children were suckled by their mothers for three or four years, they were not deprived of a balance of nutrients. In many societies any non-human milk is perceived as a replacement for breastmilk and donation is interpreted as a health message to give this to a baby instead of suckling, an idea often endorsed by the resident foreigners' custom of giving non-human milk to their own babies. Since the Second World War the 'normal' practice in most industrialised, milk producing countries has been for any breasfeeding to last for a token three to six months and then replacement by either whole or modified cows' milk. Health workers and milk distributors spread this pattern all over the world, to the delight of the baby milk industry who could then persuade mothers to replace the inferior dried skimmed milk with their expensive products. UNICEF is noe energetically promoting breastfeeding; sadly this is part of undoing its own terrible mistake made in the name of nutrition. They were not the only misguided organisations; all major charities, church missions and other relief agencies did untold damage to breastfeeding and to the economic and health independence of newly independent countries through energetic milk promotion. This practice persists to this day in refugee camps and other focal points of international aid which become sinks for dumping milk. This depresses local food production and purchase, discourages breastfeeding, and appropriate local dietary habits, creates a need for imported products and often a black market, and generally accelerates the economic and social breakdown which may have precipitated the refugee problem in the first place. ... When the baby milk industry protests that they are not wholly responsible for the decline in breastfeeding they are right; the aid agencies as well as medical misinformation prepared the market by helping to create a need. By the 1960s the marketing campaigns of Nestle, Cow & Gate, Wyeth, Bristol Myers and others were advancing all over a developing world where charity had helped map out the roads."//

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 225-227)

Infant mortality decreased steadily: Malaya: 83/1000, Singapore: 56.10/1000. 38,614 pounds of free milk (also hemanitic drugs, vitamins, cod liver oil) distributed free. Classes conducted at clinics. Medical Department Report include illustration of a clinic nurse with bottles, teats and a tin of Lactogen. Also reports second major cause of infant death was gastroenteritis associated with bottle feeding and weaning. However Gov introduced free milk program, supply dried full cream milk and baby food through infant welfare clinics, particularly to poor Malays north & east coast. Milk + cocoa in schools. Continued until mid-1970s (already prime cause).

===== Bantuan UNICEF di Borneo Utara =====

//"Pada tahun 1950, pertubuhan United Nations International Children's Emergency Fund (UNICEF) turut menjadi pemacu kepada skim kebajikan ini apabila ia telah memberi bekalan susu penuh krim dan susu tanpa lemak melalui klinik kebajikan yang sedia ada, kepada ibu-ibu mengandung, ibu-ibu yang menyusu dan kepada kanak-kanak. Bekalan susu ini mempunyai nilai zat yang sangat tinggi kerana diet tempatan umumnya kekurangan vitamin B (riboflavin) dan kalsium (Colonial Reports North Borneo 1950, 1951). Walau bagaimanapun, skim penyaluran susu ini mengecualikan kawasan bandar utama kerana masalah kekurangan nutrien tidak berlaku."// (Maureen De Silva, 2022. "Wanita dan Aspek Kesihatan di Borneo Utara Semasa Era Penjajahan British," dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.135).

//"Pegawai Daerah dan Pegawai Perubatan yang menganggap budaya suka minum tapai, (sejenis alkohol yang diperbuat daripada beras atau ubi kayu yang diperam) dalam kalangan lelaki dan wanita peribumi juga telah mempengaruhi kesihatan mereka lantas menjejaskan kadar kelahiran dan kadar kematian bayi. Menurut laporan yang dicatatkan dalam minit mesyuarat SBUB pada tahun 1919, usaha untuk membendung budaya minum tapai ini adalah suatu usaha yang mencabar kerana ia menrupakan acara dalam setiap keramaian. \\
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'Any plans we may evolve will, I fear, run the risk of being defeated to some extent by the astonishing ignorance of some sections of the native community, especially in the Interior, where the pernicious habit of drinking rice liquor has been the ruling vice for generations, with lamentable results to the health of the natives. Old of age and sometimes even younger are compelled to drink this liquor (Seventy-Third Half-Yearly Meeting of the British North Borneo (Chartered) Company, 22 Julai 1919: 13).' \\
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Ini juga telah diilustrasikan oleh Oscar Cook apabila beliau menyatakan bayi yang sedang menyusu juga tidak terlepas daripada tapai kerana ibu-ibu akan membiarkan bayi mereka menghisap minuman tapai tersebut: \\
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'To a certain extent, it accounts for the high mortality rate of infantile mortality, since fond mothers frequently give babies at their breasts a long suck at the straw, with a remark such as 'Poor baby, of course he wants his tapai too!' (Cook 1923: 23)' \\
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Fenomena minum tapai dipercayai membawa beberapa implikasi kepada golongan wanita dan lelaki. Isu kemabukan dan kesan alkohol dikatakan mengurangkan perkahwinan yang subur (fertile marriage) di samping menjejaskan kesihatan bayi dalam kandungan dan kesihatan bayi atau kanak-kanak yang sedang membesar. Ketua-ketua kampung di Keningau didesak untuk melarang bukan sahaja kanak-kanak di bawah kategori umur empat tahun daripada minum tapai tetapi juga golongan wanita (termasuk isteri ketua kampung sendiri) turut dinasihatkan untuk menghadkan aktiviti minum tapai secara berlebihan."//

(Maureen De Silva, 2022. "Wanita dan Aspek Kesihatan di Borneo Utara Semasa Era Penjajahan British," dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.148-149).

//"Para pengkaji turut menekankan bahawa kadar keahiran rendah dan kadar kematian tinggi di kalangan wanita dan bayi adalah kerana berlakunya pengguguran, keguguran, kelahiran mati dan kematian ibu dan bayi akibat pendarahan serta kelahira yang tidak normal dan sukar (Clarke 1951). Terdapat pelbagai faktor yang menyebabkan keadaan ini berlaku. Antara faktor yang dipercayai mempengaruhi situasi ini adalah kekurangan zat makanan disebabkan oleh diet yang tidak seimbang dan kekurangan jumlah vitamin dan garam mineral yang diperlukan untuk ibu-ibu mengandung. Selain daripada Ride, penyiasat seperti Shircore dan Clarke memandang tinggi faktor ini sehinggakan ia menjadi salah satu pemangkin kepada perkembangan skim perkhidmatan kesihatan yang disediakan untuk ibu-ibu mengandung dan kanak-kanak bermula pada pertengahan kedua tahun 1930-an (Shircore 1937; Clark 1951). Ini juga yang telah mendorong bantuan susu daripada pihak UNICEF sebagai langkah untuk membekalkan nutrien kepada ibu-ibu dan kanak-kanak."//

(Sumber: Maureen De Silva, 2022. "Wanita dan Aspek Kesihatan di Borneo Utara Semasa Era Penjajahan British," dalam Azlizan Mat Enh, Zubaidah VP Hamzah (peny.), Wanita Dan Kesihatan Era Kolonial, Bangi, Selangor: Universiti Kebangsaan Malaysia, m.s.152-153).

===== Kronologi Pemasaran Makanan Bayi =====

==== 1940-an: Galakan Penyusuan di Akhbar ====

- 1940-03-28 - end of 1941: Nurse Elizabeth @ 'Problems of Babies and Young Children': Letters from readers show diverse infant feeding practices: BF exclusive, BF+bottle, bottle-only (maternal ill-health). Disagreed on intervals, every baby needs to be considered individually (ST 1941-06-26, supplement, p.ii). BF strongly encouraged. Complementary & supplements discouraged, only necessary with dried / evaporated, not sweetened condensed milk: '[breast milk contains] plenty of all the vitamnis which baby requires, and he would be able to assimilate them far more easily if he receives them through your milk than he would if he were to take the preparation itself (ST 1941-06-26, supplement p.ii). Advised to re-establish lactation, with guides to establish & sustain lactation. Column resumed 1947: 'Mothers will realize, more than ever, the enormous importance of breast feeding their babies ... if the mother's own diet contains all the essentials she need have no fear, for her baby will thrive and develop perfectly' (ST 1947-06-17, p.5).

==== 1940-an: Hubungkait Susu Botol dengan Gejala Cirit Birit ====

Correlation of bottle feeding and jangkitan cirit birit pada bayinfantile gastroenteritis established by Levi and Alexander. Only since this time, doctors and governments became concerned with dangers of bottle feeding.

==== 1941: Pendudukan Jepun ====

Supply of manufactured goods disrupted (Japanese occupation) - women had to breastfeed. British Medical Officers associated with improved infant mortality rate.

==== 1945: Pengembalian Pentadbiran British ====

Reinstatement of British administration: Infant welfare & maternal health care resumed with medical & public health services. Limited cow's milk supply through government agencies, so majority infants breastfed. However, according to an official correspondence immediately after reinstatement of British Administration: Chief Nutrition Adviser, 1948-11 (10, folio 8): "70,000-80,000 tons of dried milk would be required ... for the expectant and nursing mothers, babies and children. Unfortunately the Nutrition Council, because of the cost of even this quantity of milk, feels this amount will have to be reduced still further. THe least additional quantity we can ask for is 10,000 tons ... The council recommends that this extra milk should be powdered, skimmed milk since this is probably more easily and cheaply obtained... We believe the importation of extra milk is necessary to prevent disease and unrest in the country." Regular supply resumed: Advertising returned.

==== 1946: Penurunan Kadar Kematian Bayi ====

Infant mortality: 92/1000: gov: 'improvement in maternal nutrition .. reduced consumption of overmiled rice, greater use of other foods due to food shortages, increase in breast feeding due to condensed milk shortage. Meanwhile in Singapore, only Indians breastfeed, bottle feeding serious problem among wealthy Chinese & poor. Due to ads, sweetened condensed milk used most, many could not afford sufficient quantity.

==== 1950-an: Iklan Untuk Khalayak Umum ====

Advertising start for the masses.

==== 1956: Peluasan Pesat Perkhidmatan Kesihatan Ibu dan Anak ====

Maternal and child health centers expanded dramatically. 72, 518 sub-health. Distribution of free powdered milk only if anemic/malnutrition. Gov: 'breast feeding is advised for all infants but when there is contraindication to breast feeding and when babies are older then powdered milk is given to those mothers who cannot afford to buy it'.

==== Akhir 1950-an: Iklan di Akhbar Melayu ====

Daily ads in Utusan Melayu: Cow and Gate, Lactogen, Klim, Every Day, Milkmaid. Also tonics, worm powders, chocolates, supplements, cough mixtures. In English press: Carnation Milk, Dutch Baby, Ostermilk (Glaxo) infant milks, compete with Cow and Gate & Nestle (Lactogen, Nestogen (low-fat infant food), Eledon buttermilk (premature underdeveloped babies), Gluco-B supplement, Nespray (older babies & general use), Nestum (cereal for weaning), Babex dehydrated fruit & vege (for weaning) ( e.g. ST 1959-07-07, p.4). New milk brands: Blue Cross, Baby Stork. New weaning fods: Farex, Barlova, Lacova. Pictures of Asian babies and testimonies from Asian mothers used. Ostermilk: 'especially suitable for babies in Malaysia' (ST 1957-07-16, p.7). Morinaga: 'good for infants, because it is just like mothers' own milk, and is especially suitable for Asian babies' (Berita Harian, 1963-09-16, p.15).