It is distressing to read that many people believe that follow-on milk - formula milk for toddlers older than one - is a necessity (Boosting infant formula options; May 9).

Under the Sale of Infant Food Ethics Committee Singapore (Sifecs), infant formula - defined as "breast milk substitutes scientifically formulated to satisfy the nutritional requirements of infants up to six months of age" - is banned from being advertised to protect breastfeeding and the interest of newborn babies.

However, follow-on milk is so heavily promoted that even some health workers will encourage mothers to wean breastfed babies and to continue with follow-on formula milk instead, as the babies get older.

Just like the World Health Organisation (WHO), we also recommend that babies be breastfed exclusively for the first six months of life.

Babies who are not breastfed should receive formula milk until they reach six months of age, when their gut matures sufficiently to digest solid foods. This then complements the breastfeeding and/or formula-feeding until the babies turn one.

Contrary to popular belief, WHO deems follow-on formula to be unnecessary. Instead, it says that "local, nutritious foods should be introduced".

By introducing fresh and nutritious foods, babies receive most of, if not all, the required nutrients for healthy growth and development, instead of depending on artificially processed follow-on milk.

Here are our recommendations, which we hope will help reverse the unhealthy dependence of families on formula milk and the errant marketing practices of formula companies.

•Expand the Sifecs code to include milk for mothers and toddler milk, and have laws that punish formula companies that flout the code. According to Unicef, the laws to protect breastfeeding are not adequate in most countries.

•Insist that all hospitals with maternity wards achieve the Baby-friendly Hospital Initiative (BFHI) certification. This ensures that the hospital has a breastfeeding policy and all of its staff are knowledgeable about and support breastfeeding. Currently, only three hospitals are BFHI-certified.

•Increase community support for breastfeeding. With more information provided to the public, there will be greater awareness about how formula supplementation is unnecessary.

If these are acted upon, parents would be empowered to make informed decisions for their children, increase breastfeeding rates, and avoid a dependency on an unnecessary food item that will cost the family and the community as a whole.

Mythili Pandi (Dr)
President
Breastfeeding Mothers' Support Group