“This paper examines infant feeding and weaning practices in Peninsular Malaysia, drawing on data collected from five states in 1978-1979. The data suggest that whilst the majority of women still breastfeed, their propensity to do so, and to do so for a prolonged period. appears to relate to and thus be influenced by the general social and cultural environment. Standard socio-economic indices such as income, education and the occupations of both the woman and her husband do not seem to relate directly to infant feeding and are generally not statistically significant indicators of infant feeding practice. However general effects of modernisation, industrialisation and development, indicated in the data by state, appear to be significant. Again depending on residence, the data suggest that the supplementation of breast milk with artificial milk is increasingly common. and that also women increasingly use commercially manufactured as well as home-made weaning foods.
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A general summary of traditional practice among Malays is as follows. In the supportive atmosphere of her natal home, with the let-down of milk proper, a young mother established a demand pattern of breastfeeding. This continued following the postpartum confinement of around 44 days, when the woman returned with her infant to her marital home and resumed the full range of domestic responsibilities and other productive activities. Breastfeeding continued until the child was around 2 years, although children were at times fed into their third or fourth year or until the mother became pregnant again [2]. Milk supplements were not given traditionally but, as shall be discussed below, have featured in infant diets throughout the twentieth century. Other data on supplementation vary. Rosemary Firth reports that supplements of cornflour, rice paste or mashed banana were fed to infants from birth, whilst colostrum was being expelled, as the only nutriment [3]. McArthur reports a sugar solution or ‘in the old days’ mashed banana as the first food, and soft rice the usual supplement in the past. At the time of her study (1958-1959), infants received either a rice, cornflour or wheat flour porridge (bubur) or bread or biscuits softened with water and sometimes flavoured with sugar or soy sauce; she notes that from around 6 to 7 months the infant would be given well cooked rice (not porridge) with a little flavouring [4]. However, supplementation does not appear to have occurred for all children. Millis’ study [5] found that only 12% of infants received solids in the first month, and 67% at 6 months; McArthur [6] reports that among infants under the age of 6 weeks, only 14% in Melaka and 57% in Perak received food other than breast milk. Similarly, Thomson [7] reports that 68% of the Perak children she studied were fed solely on breast milk to 1 year; the others received rice and sugar supplements. In general, however, some food in addition to breast milk appears to have been introduced early, with the gradual introduction in the second year of other ‘hard’ adult foods, including as well as bubur and later steamed rice, fresh or dried fish, some green leafy or root vegetable and tea or coffee. Weaning occurred gradually, although in some cases, especially if the mother was pregnant, bitter herbs would be applied to the nipples to hasten the process.

The protein and vegetable foods constitute only a small side-dish to the rice base, and hence the intake of non-carbohydrate foods by toddlers appears to have been very low. Sometimes, too, a child would be restrained from taking too much of the side-dish of expensive foods [8]. Further, folk beliefs limited the range of foods given to infants and toddlers. Fish and eggs were believed by many Malays to cause worms and were therefore restricted or proscribed; other fish, classified as ‘itchy’, were believed to cause infection of childhood sores and scratches and to cause or exacerbate viral diseases such as measles and chicken pox. Most fruit and vegetables classified as ‘cold’ or ‘windy’ were also limited, to avoid wind, stomach aches, diarrhoea; in addition, in Kedah at least, parents believed that ‘cold’ food would frighten worms from the child’s stomach to its eyes, causing serious eye disorders [9]. Thus a wide range of foods which were readily and cheaply available and which would have provided infants and toddlers with important nutrients were tabooed; many of these foods were avoided also by lactating mothers at least for the first 3-6 months, in the belief that the quality of food ingested by the mother would be transferred in the breast milk to the infant.
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As noted above, cow’s milk as either an infant or adult food was not traditional to the region. However, condensed and powdered milk was available, albeit expensively, from the 1880s; infant formula was advertised and marketed a decade later. This was significant because elite women were able to bottle feed rather than breastfeed. thereby establishing a powerful model of modern and preferred practice. But there is evidence too that poorer women also were early using condensed and powdered milks and infant formulae. In 1917, for instance, in Kelantan, at the time relatively removed from urban and European influence, the high infant morbidity and mortality rate was attributed in part to the availability and use of sweetened condensed milk as an infant food; reports from the Straits Settlements (Singapore, Melaka and Penang) and the Federated Malay States in the 1920s and 30s continually refer to the increased incidence of artificial feeding amongst both urban and rural populations as a significant contributing factor to the high infant mortality rates [17].

Later ethnographic and medical reports provide substance to these claims. Williams drew attention to the medical effects of artificial feeding in a public lecture in 1939 [18] and later, in an article on the incidence of rickets in Singapore, referred to artificial feeding as a ‘serious problem’ among wealthy Chinese and a ‘fearful scourge’ amongst the poor [19]. Thomson’s survey [20] in Perak indicated that only 6.5% of her sample were exclusively bottle fed, but that a further 16.5% received artificial milk, most often sweetened condensed milk and usually from birth, as a supplement to breast milk; 38% of toddlers received some condensed milk in their diets, for example in coffee. McArthur. writing soon after, reported that 62.5% of her sample received cow’s milk, again usually sweetened condensed milk and less often Lactogen, either to enable the mother to work or because of partial or complete failure of lactation [21]. Milk supplements were usually not given to children beyond the age of 18-20 months, and thus the duration of artificial feeding appears to have been shorter than for breastfeeding [22]. She notes that boiled water was added to the product and fed to the infants lukewarm. and adds that bottles and teats “seemed never to be boiled or even rinsed with boiled water before use,. the prepared bottle was left exposed before or between feeds, especially if feeding was left to children” [23]. Women did not necessarily follow instructions regarding quantity in preparing the milk. Thomson similarly notes that milk was often diluted to a ‘sweetened watery drink’ and that “the detail is far from easy to carry out satisfactorily in good home surroundings. in rural kampong houses almost impossible” [24].

In recent years there has been further research on infant feeding and child health, particularly on the use of artificial milk. which provides additional evidence of changes already in process during the first half of the century. Infant and toddler mortality rates among rural Malays especially remain high [25] and indicate at least moderate under-nutrition. The data suggest that Malay children in rural areas are still likely to be breastfed, but that urban women from upper socio-economic groups and particularly Chinese and Indian women are more likely to bottle feed exclusively or to introduce a mixed regime [25]. Chen’s study [27] of hospitalised infants suggests the greater vulnerability to malnutrition of infants fed with sweetened condensed milk rather than infant formula. and the greater vulnerability of both groups to infection compared with breastfed infants. Dugdale [28] suggests no relationship between type of feeding and the frequency of either diarrhoeal or respiratory complaints: but a recent study of gastroenteritis admissions to the Kuala Lumpur General Hospital suggests that bottle feeding, regardless of the product, is implicated in alimentary complaints [29]. However. studies of the relationship between infant feeding and morbidity patterns remain few and inconclusive; studies of other than hospital populations are fewer still. There remains a need for further detailed research [30].”

(Sumber: Lenore Manderson, Social Science & Medicine, Volume 18, Issue 1, 1984, Pages 47-57: "‘These are modern times’: Infant feeding practice in Peninsular Malaysia", m.s.47-49).

“Since, as discussed above, artificial milk has been readily available including in rural areas of the peninsula for the past 70-100 years, and other baby food products have been around almost as long, then it is perhaps false to construct prolonged and exclusive breastfeeding as ‘traditional’ and bottle feeding as ‘modern’. Many young mothers are feeding their infants ‘traditionally’, precisely according to the methods adopted by their mothers and grandmothers as well as those promoted as the ‘modern way’ to ensure infant health. Increasingly too, despite the apparent very low incomes of some of the women in this study, commercial baby food is not beyond the budgets of most households, and quickly prepared foods release a village woman to undertake other reproductive (domestic) and productive activities as much as they free an urban woman to work in paid employment. Moreover, the women of this study, like other Malaysian women, have constantly received different messages regarding infant feeding. Until 1979, milk companies were free to promote their products directly with mothers in hospitals, clinics, and in the home; recent studies by the Consumers’ Association of Penang [40] suggest that these practices continue despite legislative controls. Earlier, clinics began to promote breastfeeding and the use of locally available fruit and vegetables as weaning foods, and clinics include a display cabinet of these foods. But still, milk supplements have not always been discouraged, particularly when lactation appears problematic or where the infant’s health status appears equivocal. Occasionally, education serves further to confuse. This was evident when I attended a film on breastfeeding with some fifty rural women leaders (of local Women’s Institute branches), who were by no means encouraged or confident to encourage others to lactate after they had been instructed to nurse for ten minutes on alternate breasts, burping the infant between. Thus one of the women noted: “I must have done it wrong; I didn’t feed my baby like that-will it be alright?”” (Lenore Manderson, Social Science & Medicine, Volume 18, Issue 1, 1984, Pages 47-57: "‘These are modern times’: Infant feeding practice in Peninsular Malaysia", m.s.55-56).