20 Dec Influx of Baby Food Supplies Swamped Central
Sulawesi Emergency Camps in Indonesia
Influx of Baby Food Supplies Swamped Central Sulawesi Emergency Camps in Indonesia, Undermining Breastfeeding and Optimal Infant and Young Child Feeding
(Information and images in this article are provided by IBU Foundation)
Beachfront of Palu, Sulawesi in the aftermath of Tsunami
IDP camps in Sulawesi
The care and feeding of infants and young children are compromised in emergency situations such as droughts, floods, earthquakes, tsunamis, epidemics and war, which often lead to high rates of disease and death. On September 28th 2018, a 7.4 SR earthquake hit Sulawesi Province in Indonesia, followed by a 3-6 meter tsunami which devastated the coastal area of Palu. Approximately 2 million people have been affected by this disaster, of those, there were 2087 recorded deaths, 1,084 people missing, 211,000 internally displaced people (IDP), 4,400 people sustained major injuries and 68,000 homes were damaged. Even before the crisis, exclusive breastfeeding rate was low (13.4% in Sigi and 35% in Palu, according to survey conducted by Ministry of Health in 2017), with limited access to breastfeeding counselors for lactating mothers. Currently there are around 25,000 under-fives living in IDP camps. According to reports from IBU Foundation, a NGO that has been working on the ground in Central Sulawesi, exclusive breastfeeding was not practised and most mothers were mixed-feeding or exclusively formula feeding their babies in the IDP camp in the district of Sigi. The lack of access to electricity, fuel, and clean water in these camps mean the unsanitary conditions pose huge risks to babies’ health and survival, with major concerns such as diarrhea and acute respiratory tract infections. Some NGOs have also pulled out their support after the initial crisis period, and food security has become an additional concern.
Conditions of IDP camps in Sigi
Supplies in emergencies and the International Code
In such circumstances, emphasis should be on protecting, promoting and supporting breastfeeding and ensuring timely, safe and appropriate complementary feeding (exclusive breastfeeding for 6 months and continued breastfeeding with nutritionally adequate and safe complementary feeding starting from 6 months up to 2 years of age or beyond). The International Code (and relevant WHA resolutions) which protect optimal infant and young child feeding are especially relevant, and should be complied with in the context of emergency situations. However, reports from IBU Foundation revealed that there was large influx of donated formula milk products and complementary foods in the IDP camps in Central Sulawesi.
Reports as such also point to the bigger picture of how emergencies and crisis situations are often exploited to provide unsolicited supplies in the form of charitable donations or discounted products. Not only are these convenient avenues to promote a goodwill image to the public, these supplies and donations – whether low-cost, free, unsolicited or solicited – create dependence on the products and thus a potential market. And in some cases, donations are made with good intentions but donors and recipients are unaware of the harm such donations can do.
These products not only undermine optimal breastfeeding practices and contribute to outbreaks of preventable diseases in camps, they are in violation of Article 5.1 of the Code which forbids advertising and all other forms of promotion of products under its scope; and Resolution WHA63.23  which calls on governments to ensure adherence to and implementation of the Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE Version 3.0, last updated in 2017,). The OG-IFE is an evidence-based key policy guidance document developed by the IFE Core Group for those concerned with emergency response to meet their responsibilities regarding infants and young children and their carers in emergencies. It draws on technical guidance, empirical evidence, and experience from past emergencies. Key provisions of the Code have been integrated and built upon, to respond to the particular challenges that emergencies pose to Code implementation. The Operational Guidance on IFE goes further than the Code and clearly states that donations of breastmilk substitutes, complementary foods, and feeding equipment should not be sought or accepted in emergencies. Supplies for those who need the products* must be purchased through proper channels based on assessed needs, and distributed and used according to strict criteria. The OG-IFE also stresses that promotion of infant formula at the point of distribution, including the displays of products and items with company logos, are strictly prohibited.
Supplies found in IDP camps in Sigi
SUN cereal products in bulk amount were found in the IDP camp in Sigi. Infants as young as 3 months were given the product. According to the OG-IFE, supplies of complementary food should not be sought or accepted.
Donated supplies of SGM infant formula found in IDP camp in Sigi.
Why are supplies not allowed?
There is a general lack of awareness that such donations can do more harm than good. These donated supplies may not meet nutritional and safety standards, and the lack of basic infrastructure and inadequate conditions compound risks linked to their preparation and use. For donations of formula milk products, there are concerns of spillover of breastmilk substitutes to those who are or can be breastfed, thus undermining breastfeeding. Meanwhile the unregulated complementary food supplies may not be culturally appropriate and therefore may undermine local food use and recommended IYCF practices. It is very difficult to ensure proper use of donated products in these situations, and the associated risks further compromise the health of babies. For instance, it was observed in these IDP camps that infants as young as 3 months (an age when babies should be exclusively breastfed) have received baby cereals which are marketed as suitable for 6-24 months of age. Since it is difficult to control the amount and duration of donated supplies, it hampers proper planning around the distribution of products, and causes problems with availability for those who are in need of breastmilk substitutes** and spillover effect for those who are breastfed.
Unsanitary conditions in the Sigi camp make breastfeeding a much safer option to ensure babies’ survival.
Many Code violations in emergencies have been perpetrated by baby food companies, international and national NGOs, governments, charities/donors and individuals. This typically reflects either poor awareness or blatant disregard of the International Code, and failure in monitoring. Principles of the Code and relevant resolutions are critical in protecting infants and young children – therefore health workers, programme managers, relevant government officials and policy makers ought to be trained to be proficient in preventing, identifying and monitoring Code violations in emergencies to carry out their duties to protect the lives of babies in these dire situations.
For more information on infant and young child feeding in emergencies:
IBU Foundation has been supporting emergency responses in Indonesia for over 14 years, and is still working on the ground in Central Sulawesi. To find out more: http://ibufoundation.or.id/
The Emergency Nutrition Network (ENN)
The ENN is the coordinating agency of the IFE Core Group. For more information on the IFE Core group members and materials, see www.ennonline.net.
To report Code violations to IBFAN-ICDC:
*,**In emergencies as in other situations, there are infants who cannot be breastfed. These include infants who have separated from their mothers, infants whose mothers are ill or have died, those whose mothers’ milk production has become very low, or babies who were already artificially-fed before.