“The 1919 International Labour Organisation convention giving nursing mothers the right to two half-hour breaks a day without loss of pay had been ratified by eighteen countries by 1951 and many more by 1975. This is more honoured in the breach, for in most of the free market economies few women dare demand these rights from employers who are only too eager to show women as unsuitable employees. In the US women's groups have rejected moves for better maternity protection on the grounds that this will lead to further discrimination. Much female employment is in the fringe economy anyway and workers may be laid off at the slightest show of assertiveness.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 182).

“The movement of production from the home to the factor changed the situation for women for ever. … 'Work' became something that men did outside in the big wide world. If women wanted to participate, their roles as mothers and partners to men were of no concern to the employer. … Reproducing the workers was necessary, but if one women lost all her babies because she went back to work too early or conditions of her work discouraged the possibility of a breastfeeding baby accompanying her, it did not affect the economic unit of the large factory. Within a household economic unit, poor health and dead babies hindered production, with industralised production workers are replaceable and the employer has no economic motive to concern himself with the welfare of the workers. This situation persists to this day and improvements in welfare have only evolved because of many decades of struggle through painstaking and painful organisation and solidarity. The strength for the worker in the new system was in numbers and many men and women resisted, organised, suffered and died to achieve the few basic standards of decency which exist in some parts of the world today.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 183).

“The companies who boasted about their 'ethical' instruction 'To be used only under the direction of a physician', in the US, abandoned this directive when they expanded their promotion into the Third World. They used every method they knew to persuade mothers to use their product: billboards, radio and newspaper advertising and 'milk nurses'. These were saleswomen: 'Nestle nurses, these girls dressed as nurses, dragging a good lactating breast out of the babys mouth and pouring in baby milks.' Milk nurses were sometimes trained nurses, but whether they were qualified or not was irrelevant because they were employed by the infant food companies to visit new mothers in the hospitals or at home in order to sell them baby milk. The recruitement of qualified nurses drained emerging health services of badly needed staff. They were usually paid on a commssion basis and they earned more than any trained nurse in the health service, and they still carried the prestge of a qualified health worker. An investigation in Nigeria in the early 1970s showed that 87 per cent of mothers used artificial milk because they believed they had been advised to do so by hospital staff who in reality had been milk nurses allowed into the hospital.
…..
Many mothers were convinced that artificial milk was a sort of medicine, especially as it was endorsed and distributed through channels of health care. The fact that it was an imported product and was already used by the colonial elite added to its status.

No single baby milk company had a monopoly on immoral promotion, but the giant food company Nestle was the world leader in baby milk sales and had been the boastful innovator of some of the most effective techniques:

'The advent of television as a universal means of communicating with the shack as well as the mansion permits the standardisation to an increasing extent of advertising and promotion. Nestle uses the medium extensively wherever it can. Where it still can't, the company relies on newspapers, colour magazines, billboards and other outdoor displays.

In less developed countries, the best form of promoting baby food formulas may well be the clinics which the company sponsors, at which nurses and doctors in its employ offer childcare guidance service.

In the less developed countries, effective distribution may call for unusual, imaginative techniques.'

These claims were made in 1970 and were not confined to baby milk. … Nestle had already been informed of the dire effects of baby milks in the developing countries. May health workers wrote to Nestle during the 1960s and 1970s explaining the problems. The complaints were usually ignored unless adverse publicity was threatened such as newspaper coverage or questions in Parliament, as happened in Jamaica in 1965. Many doctors expressed anxiety at the increasing numbers of younger infants arriving at the hospitals with diarrhoea and malnutrition. 'Bottle-baby disease' was increasing in areas where the only real breastfeeding problem was death of the mother and in those cases a foster mother was usually willing to feed.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 228-231)

“Catherine Wennen described the problem in Nigeria where she worked during the 1960s. While trying to cope with the increasing number of babies sick from bottle-feeding, she was confronted with the widespread, aggressive publicity. She noticed the radio slogans, the giant billboards from which huge, healthy cardboard babies smiled down, the 'milk nurses' and the brochures and posters. She knew that this could not be attributed to lack of awareness of the risk for, as she noted, the companies had initially refrained from promoting to the 'unsophisticated market'. She became aware of the excellent pubilc relations between the companies and top figures in the medical profession, the free baby milk for doctors and gifts to the hospitals. She approached the Nestle Manager in Lagos 'to point out the sad consequences of their indiscriminate sales promotion', but he did not want to talk.

There were many doctors witnessing the same practices around the world and their increasing concern led to a meeting of the UN Protein Advisory Group ad hoc Working Group (its name a reflection of the protein obsession described in Chapter 7) in 1970 where paediatricians, industry and UN agency representatives discesses the problem. The proceedings were never made public, but it is known that the industry would not accept that the promotion and availability of baby milk had any impact on the decline of breastfeeding.
…..
Further Protein Advisory Group meetings which, needless to say, no breastfeeding women from developing countries attended, resulted in a soft of marketing declaration for artificial milk: 'In any country lacking breastmilk substitutes, it is urgent that infant formulas be developed and introduced…' Governments should support investment, promotion and measures which disseminated the use of these products. From industry's viewpoint the meeting had gone well. By 1979, a World Health Organisation survey found that fifty brands and 200 varieties of infant feeding substitutes were being distributed across 100 countries. About half the companies had established factories in developing countries and their distribution networks were spaced across a broad economic spectrum.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 232-233)

“Then in 1973 the magazine New Internationalist published an interview with two paediatricians with long experience in Africa, David Morley and Ralph Hendrikse, who described the problem in everyday language. Ths was followed in 1974 by a publication called 'The Baby Killer', produced by the British charity War on Want. It explained the issue in clear and simple language, and had pictures of the daily conditions of African life as well as of the promotion and its appalling results. The cover design conveyed the pain and the problem in the powerful visual message of a marasmic baby inside a feeding bottle. … Twenty thousand copies of The Baby Killer in English were distributed and it was widely translated.

In response, a British company criticised in The Baby Killer, Cow & Gate, sent an investigative team to both Asia and Africa and offered to withdraw its products from these areas, but government authorities and paediatric experts advised against this, claiming that 'better techniques of education and better controls on promotional activities were required.' … The paediatric 'experts' were usually western-trained and consequently ignorant about breastfeeding. Many might genuinely believe that artificial milk filled a 'breastmilk gap', but a withdrawal of this and bottles and teats would have saved many lives.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 233-234)

“Within two months of publication, 'The Baby Killer' had been translated by the Third World Action Group in Berne, Switzerland (AgDW, Arbeitsgruppe Dritte Welt), as 'Nestle Totet Babys' which means 'Nestle Kills Babies', and Nestle filed a libel suit against the group. … In 1948, they had been convicted in Swiss courts of false labelling of condensed milk sold to the Red Cross and of a chicory/coffee product, Nescore. During the preparation of their libel suit, Nestle offered to settle out of court if the AgDW apologised, destroyed the report and paid all costs. AgDW refused and the case proceeded. Nestle had originally issued proceedings on four counts, namely: the title, the charge of immoral and unethical practices, of responsibility for the death or damage of babies through its sales promotion policy, and of dressing their saleswomen as nurses to give a false scientific credibility. However before the final hearing, Nestle withdrew the last three charges. The judge found the AgDW members guilty of libel in the title because:

'The adequate causal connection between the sale or any other type of distribution of powdered milk and the death of infants fed with such products is interrupted by the action of third parties, for which the complainant, in terms of criminal law, cannot be held responsible. In this sense, there is no negligent or even intentional killing.'

The defendants were fined 300 Swiss francs (US$150) each, but the judge took the opportunity to state that Nestle's advertising in developing countries went considerably further than in industrialised countries:

'The need ensues for Nestle company fundamentally to rethink its advertising practices in developing countries concerning bottle-feeding, for its advertising practice up to now can transform a life-saving product into one that is dangerous and life-destroying. If the complainant in future wants to be spared the accusation of immoral and unethical conduct, he will have to change advertising practices.'
…..
… they [Nestle] refused to admit to unethical practices.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 235-236)

“In 1975, a group of Catholic nuns, the Sisters of the Precious Blood, filed a suit against Bristol Myers, an American company, charging them with 'making misstatements in its proxy statement'; in plain English, lying. When the nuns, as shareholders, had challenged the company to provide detailed information about its promotional practices abroad, they were informed that there was no promotion where chronic poverty or ignorance could lead to product misuse. Bristol Myers marketed in Latin America, in countries such as Guatemala where only 51 per cent of the population have access to drinking water. Forty per cent of Enfamil (a Bristol Myers baby milk) sales were outside the US and in 1974 advertising and promotion had cost them $296 million, almost three times as much as they spent on research and development. Other investors could see the contradictions between the evidence found by the Interfaith Centre for Corporate Responsibility (ICCR), an organisation set up to monitor church investments, and the Bristol Myers statements, but the company refused discussion. The nuns, together with the ICCR, collected evidence from eighteen different countries which proved the falseness of Bristol Myers statements. However, the judge dismissed the case because the nuns had not suffered irreparable harm from the company's statement, implying that only malnourished babies themselves could bring a suit and that companies were free to lie if it did not hurt their shareholders. The sisters gathered support from other shareholders and appealed. They also had the backing of the US Securities and Exchange Commission, the statutory body which governs shareholder transactions. Eventually Bristol Myers decided to settle out of court, and agreed to send shareholders a report of the nuns' evidence and to halt direct consumer advertising and the use of 'milk nurses'.” (Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 238)

“In spite of the publicity and the lawsuits, the companies, including Nestle, continued their widespread promotion. Then the release of Peter Krieg's film 'Bottle Babies' in 1975 made a profound impact. Many people, having read descriptions of the problem, have explained that they neve really felt involved until they saw the shot of the woman scooping water up from a visibly filthy pool with which to mix her baby's milk, or the wasted baby screaming as a drip was placed through a vein in her head. This film was shown to hundreds of study groups and organisations concerned with world poverty, who felt exasperated by the companies' indifference. From the country where some of the most energetic marketing methods had evolved, the US, came the commitment and the ideas to challenge them. Whenever 'Bottle Babies' was shown, a spontaneous reaction was a declaration to boycott Nestle products. In Minneapolis, a group had formed who had called themselves the Infant Formula Action Coalition (INFACT) and in response to these avowals, they decided to co-ordinate a boycott which was launched in July 1977. It was one of the few actions they could take, for at that time only Swiss nationals could own shares (a Nestle shareholder group did in fact try to bring about changes in marketing), US citizens could not use investor influence. The mainstream support for the Nestle boycott in the US came from the churches, many of whom had direct contact with the developing countries through their missionary work and could verify the facts of the marketing abuses. INFACT's demand to Nestle was that it should halt all promotion of baby milk. This meant no milk nurses, no free samples and no direct advertising. The boycott spread to Europe, New Zealand and Canada.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 239-240)

“As concern grew, Edward Kennedy, chairman of the Senate Sub-Committee on Health and Scientific Research, proposed and set up a hearing on the promotion and use of infant formula in developing countries and this brought the issue into the public spotlight. Representatives from industry, the health field and non-governmental organisations (NGOs) gave evidence. Oswaldo Ballerin, President of Nestle Brazil, was questioned by Kennedy as to whether his company should market a product in areas without clean water and where people were illiterate. Ballerin evaded the question by reciting the nostrum that all the instructions were on the tin, but Kennedy persisted and Ballerin stated, 'But… we cannot be responsible for that.' Kennedy asked if Nestle were able to investigate the use of their products in poor areas and Ballerin agreed that it was, but that they had not. Then Ballerin declared, 'The US Nestle Company has advised me that their research indicates that this [the boycott] is actually an indirect attack on the free world's economic system.' This statement provoked laughter and Kennedy explained that a boycott was 'a recognised tool in a free democratic society'.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 247-248)

“The aftermath of the Kennedy hearing was the involvement of the World Health Organisation and the United Nations Children's Fund, and the convening of the WHO/UNICEF Meeting on Infant and Young Child Feeding in October 1979. This was welcomed by everyone involved in the controversy.
…..
The baby food industries were put out that some of the participants at the WHO/UNICEF meeting besides themselves were from the very groups (the Berne Third World Group, ICCR, INFACT, IOCU (International Organisation of Consumer Unions) OXFAM and War on Want) who criticised them. … The outcome of the meeting was the decision to form an International Code of Marketing of Breastmilk Substitutes. Though accepting the idea in principle, industry expressed doubts about an international code, as opposed to lcoal codes, because it might lead to a loss of national sovereignty… Another outcome of the meeting, though it happened outside it, was the evolution of the International Babyfood Action Network (IBFAN) which enabled the various groups struggling to halt the aggressive marketing of baby foods to maintain the links they had forged during this period of hard work.

A set of recommendations came out of the WHO/UNICEF meeting which led to the drafting of a code. At this stage WHO, whose task is to improve world health, and UNICEF, which is concerned with the welfare of children, fell into the role of mediators between the pressure groups and the industry rather than defenders of infant health in their own right. This diversion of their skills gives an insight into the vulnerability of these international agencies. They have to be cautious about taking strong stands on sensitive issues because they are beholden to the world's most powerful groups for their survival. This is not a direct relationship, … but it is significant that the United States pays 25 per cent of WHO's budget and that the other major industrialised countries make up 70 percent altogether. … As the United States government represents the interests and principles of transnational enterprise it is unlikely that it would support moves that restricted the activities of these companies. Nestle may have been Swiss, it may have been the market leader in baby foods in the Third World, but it was only doing what the US-based companies wanted to do, namely, dominate the market.

After a year of revision and consultation between governments, infant feeding experts, the baby food industry and the non-governmental organisations, the WHO/UNICEF International Code of Marketing of Breastmilk Substitutes (the WHO/UNICEF Code) was produced. At the World Health Assembly in May 1981 it was overwhelmingly approved by 118 countries. There were three abstentions and one vote against it. The US delegate, Dr John Bryant, under orders from the US State department, reluctantly voted against the Code. This was where the corporate/political fusion of US politics was brought to light. … The US government's decision shocked and embarrassed many US citizens. There was extensive newspaper coverage, two leading USAID (United States Agency for International Development) officials resigned in protest, public demonstrations were held and 10,000 letters and telegrams were received by the White House and the State Deparment. Both the House of Representatives and the Senate approved resolutions expressing dismay at the vote.

The pretext for the US vote was that the Code's provisions would 'cause serious and constitutional problems for the US itself'. The WHO/UNICEF Code of Marketing of Breastmilk Substitutes is a recommendation which means that each country is free to implement it according to their customary methods. Neither WHO nor UNICEF are law-enforcing bodies, no coercion would be brought to bear on any country to implement the Code, so that there were no possible constitutional problems. The Code does not restrict the sale of baby milk and it allows industry sponsorship of conferences on condition no promotion is done. It forbids all advertising but permits the provision of scientific and factual information for health professionals.
…..
History has shown repeatedly that the baby food industry has never controlled itself voluntarily and that the medical profession, in spite of its supposed authority, lacked the solidarity, the will or the skill to deal with the marketing practices alone. It took the energy and dedication of a mixed band of people, brought together through their common sense of reponsibility… and to do something.”

(Sumber: Gabrielle Palmer, 1988. The Politics of Breastfeeding, m.s. 250-253)

“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.
…..
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.
…..
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).