Article Sidebar

Download
Download Article

Main Article Content

Abstract

The significant gap between the recommendation for exclusive breastfeeding and its implementation in practice—where many infants still receive formula milk without clear medical indications—highlights the need for more comprehensive regulations and medicolegal oversight to safeguard the health rights of children aged 0–2 years. This study aims to analyze the legal framework and medicolegal aspects of using formula milk as an alternative to breastfeeding for children in this age group. Using a normative legal research method, the study employs statutory, conceptual, and historical approaches, drawing on primary and secondary legal sources, including relevant laws and government regulations. The findings reveal that although national rules, such as Law No. 17/2023 on Health and Government Regulation No. 28/2024, affirm the right to exclusive breastfeeding and restrict formula use to medical indications, gaps remain in implementation and understanding among healthcare professionals. The use of formula milk is permitted only when there is a medical indication, with priority given to donor breast milk. In such cases, formula use must meet AFASS (Acceptable, Feasible, Affordable, Sustainable, and Safe) criteria, be supported by written parental consent, and adhere to strict health protocols. This research contributes to the discourse on child protection, health law, and ethical medical practice, while encouraging the development of stronger operational policies and public education on the responsible use of formula milk based on children's rights and public health safety.

Keywords

Breastfeeding Policy Children's Rights Formula Milk Health Law Medicolegal Aspects

Article Details

Creative Commons License

This work is licensed under a Creative Commons Attribution-ShareAlike 4.0 International License.

How to Cite
Widiastuti, W., Ropii, I., & Carolina. (2025). A Medico-Legal Study on the Use of Infant Formula as an Alternative to Breastfeeding for Children Aged 0–2 Years. Golden Ratio of Law and Social Policy Review, 5(1), 44–61. https://doi.org/10.52970/grlspr.v5i1.1463
Download Citation
Endnote/Zotero/Mendeley (RIS)
BibTeX

References

  1. Abdulahi, M., Fretheim, A., Argaw, A., & Magnus, J. H. (2021). Initiation and Exclusive Breastfeeding Practices in an Ethiopian Setting. Nutrients, 1(1), 1–15. https://www.mdpi.com/2072-6643/13/4/1204
  2. Agbozo, F., Ocansey, D., Atitto, P., & Jahn, A. (2020). Compliance of a Baby-Friendly Designated Hospital in Ghana With the WHO/UNICEF Baby and Mother-Friendly Care Practices. Journal of Human Lactation, 36(1), 175–186. https://doi.org/10.1177/0890334419848728
  3. Ahmad, G. A. (2024). Critical Analysis of Anti-SLAPP Regulations in The Field of Criminal Law in Indonesia. Golden Ratio of Law and Social Policy Review, 4(1), 32–37. https://doi.org/10.52970/grlspr.v4i1.920
  4. Ambarwati, S. D., & Lailul, L. M. (2023). Policy Implementation of Exclusive Breastfeeding (ASI) Case Study in Bligo Village, Candi District, Sidoarjo Regency. UMSIDA Preprints Server, 1(1), 1–10. http://dx.doi.org/10.21070/ups.1735
  5. Apriningsih, Hanifah, L., & Nasrulloh, N. (2024). Exclusive breastfeeding practice during the COVID-19 pandemic in West Java, Indonesia: A cross-sectional study. PLoS ONE, 19(5), 1–12. https://doi.org/10.1371/journal.pone.0303386
  6. Athbi, H. A., & Ali, H. N. A. (2020). Risk factors of acute otitis media among infants in Kerbala Pediatric teaching hospital: A case-control study. Medico-Legal Update, 20(1), 766–771. https://doi.org/10.37506/v20/i1/2020/mlu/194417
  7. Atukunda, P., Eide, W. B., Kardel, K. R., Iversen, P. O., & Westerberg, A. C. (2021). Unlocking the potential for achievement of the unsustainable development goal 2 – 'zero hunger' – in Africa: Targets, strategies, synergies and challenges. Food and Nutrition Research, 65(1), 1–11. https://doi.org/10.29219/fnr.v65.7686
  8. Bassey, E. A., Ekrikpo, U. E., & Ekanem, A. M. (2020). Knowledge, Attitude and Practice Survey of the Recommended Infant Feeding Guidelines for HIV Positive Mothers by Primary Health Care Workers in Uyo, Nigeria. Asian Journal of Research in Infectious Diseases, 4(4), 23–34. https://doi.org/10.9734/ajrid/2020/v4i430154
  9. Bergé, J. S. (2024). The Vocabulary of A Priori in and Around the Law. Revista Amagis Jurídica, 16(1), 231–274. https://doi.org/10.2307/3087875
  10. Caroli, M., Vania, A., Tomaselli, M. A., Scotese, I., Tezza, G., Verga, M. C., Di Mauro, G., Antignani, A., Miniello, A., & Bergamini, M. (2021). Breastfed and formula-fed infants: Need for a different complementary feeding model? Nutrients, 13(11), 1–14. https://doi.org/10.3390/nu13113756
  11. Central Government. (1999). Law (UU) Number 39 of 1999 concerning Human Rights. https://peraturan.bpk.go.id/Details/45361/uu-no-39-tahun-1999
  12. Central Government. (2012). Government Regulation (PP) Number 33 of 2012 concerning Exclusive Breastfeeding (Patent No. 33).
  13. Central Government. (2023). Law Number 17 of 2023 concerning Health (Patent No. 17).
  14. Central Government. (2024). Law (UU) Number 4 of 2024 concerning the Welfare of Mothers and Children in the First 1000 Days of Life.
  15. Chang, M. R., Tetarbe, M., Barton, L., Ramanathan, R., & Cayabyab, R. (2024). Transient Hypoglycemia and Biochemical Differences in Infants Less Than 1,250 G at Birth Fed Human Milk with Human Milk-Derived Fortifier versus Cow Milk-Derived Fortifier. American Journal of Perinatology, 41(1), 2824–2831. https://doi.org/10.1055/a-2164-7957
  16. Ching, C., Zambrano, P., Nguyen, T. T., Tharaney, M., Zafimanjaka, M. G., & Mathisen, R. (2021). Old tricks, new opportunities: How companies violate the international code of marketing of breast-milk substitutes and undermine maternal and child health during the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 18(5), 1–29. https://doi.org/10.3390/ijerph18052381
  17. Compte, M. V., Hernández-Cordero, S., Ancira-Moreno, M., Burrola-Méndez, S., Ferre-Eguiluz, I., Omaña, I., & Pérez Navarro, C. (2021). Breastfeeding at the workplace: a systematic review of interventions to improve workplace environments to facilitate breastfeeding among working women. International Journal for Equity in Health, 20(1), 1–21. https://doi.org/10.1186/s12939-021-01432-3
  18. Conway, R., Esser, S., Steptoe, A., Smith, A. D., & Llewellyn, C. (2023). Content analysis of on-package formula labelling in Great Britain: Use marketing messages on infant, follow-on, growing-up, and specialist formula. Public Health Nutrition, 26(8), 1696–1705. https://doi.org/10.1017/S1368980023000216
  19. Cordero, S. H., Compte, M. V., Litwan, K., Mejia, V. L., Velazquez, N. R., Moreno, M. A., Aguilera, M. S., & Armijo, F. C. (2022). Implementing Breastfeeding Policies at Workplace in Mexico : Analysis of Context Using a Realist Approach. International Journal of Environmental Research and Public Health, 19(4), 1–20. https://www.mdpi.com/1660-4601/19/4/2315
  20. Diana, D., & Aswari, A. (2024). Legal Arrangements and Remedies for Abandoned Land: A Normative Study. Golden Ratio of Law and Social Policy Review, 2(2), 23–33. https://doi.org/10.52970/grlspr.v2i2.293
  21. Dierikx, T., Berkhout, D., Eck, A., Tims, S., van Limbergen, J., Visser, D., de Boer, M., de Boer, N., Touw, D., Benninga, M., Schierbeek, N., Visser, L., Knol, J., Roeselers, G., de Vries, J., & de Meij, T. (2022). Influence of maternal antibiotic administration timing during caesarean section on infant microbial colonisation: a randomised controlled trial. Gut, 71(9), 1803–1811. https://doi.org/10.1136/gutjnl-2021-324767
  22. Doherty, T., Pereira-Kotze, C. J., Luthuli, S., Haskins, L., Kingston, G., Dlamini-Nqeketo, S., Tshitaudzi, G., & Horwood, C. (2022). They push their products through me: health professionals' perspectives on and exposure to marketing of commercial milk formula in Cape Town and Johannesburg, South Africa - a qualitative study. BMJ Open, 12(4), 1–11. https://doi.org/10.1136/bmjopen-2021-055872
  23. Draper, C. E., Yousafzai, A. K., McCoy, D. C., Cuartas, J., Obradović, J., Bhopal, S., Fisher, J., Jeong, J., Klingberg, S., Milner, K., Pisani, L., Roy, A., Seiden, J., Sudfeld, C. R., Wrottesley, S. V., Fink, G., Nores, M., Tremblay, M. S., & Okely, A. D. (2024). The next 1000 days: building on early investments for the health and development of young children. The Lancet, 404(10467), 2094–2116. https://doi.org/10.1016/S0140-6736(24)01389-8
  24. Eccles, R., Du Toit, M., De Jongh, G., & Krüger, E. (2022). Breastfeeding Outcomes and Associated Risks in HIV-Infected and HIV-Exposed Infants: A Systematic Review. Breastfeeding Medicine, 17(2), 112–130. https://doi.org/10.1089/bfm.2021.0107
  25. Escamilla, R. P., Tomori, C., Hernández-Cordero, S., Baker, P., Barros, A. J. D., Bégin, F., Chapman, D. J., Grummer-Strawn, L. M., McCoy, D., Menon, P., Ribeiro Neves, P. A., Piwoz, E., Rollins, N., Victora, C. G., & Richter, L. (2023). Breastfeeding: crucially important, but increasingly challenged in a market-driven world. The Lancet, 401(1), 472–485. https://doi.org/10.1016/S0140-6736(22)01932-8
  26. Farah, E., Barger, M. K., Klima, C., Rossman, B., & Hershberger, P. (2021). Impaired Lactation: Review of Delayed Lactogenesis and Insufficient Lactation. Journal of Midwifery and Women's Health, 66(5), 631–640. https://doi.org/10.1111/jmwh.13274
  27. Fitriani, D., Sartika, M., & Sayekti, W. N. (2024). The Role of Family and Workplace Support in Sustaining Exclusive Breastfeeding Among Working Mothers : A Scoping Review. Journal of Current Health Sciences, 4(2), 111–118. https://doi.org/10.47679/jchs.2024105
  28. Gouni, O., Jarašiūnaitė-Fedosejeva, G., Akik, B. K., Holopainen, A., & Calleja-Agius, J. (2022). Childlessness: Concept Analysis. International Journal of Environmental Research and Public Health, 19(3), 1–45. https://doi.org/10.3390/ijerph19031464
  29. Government of the Republic of Indonesia. (2014). Law Number 35 of 2014 concerning Amendments to Law Number 23 of 2002 on Child Protection. In Child Protection Law (p. 48).
  30. Government Regulation. (2013). Regulation of the Minister of Health of the Republic of Indonesia Number 39 of 2013 concerning Infant Formula and Other Products (Patent No. 39).
  31. Government Regulation. (2024). Government Regulation (PP) Number 28 of 2024 concerning the Implementation of Law Number 17 of 2023 on Health.
  32. Hall, M., Valencia, C. M., Soma-Pillay, P., Luyt, K., Jacobsson, B., & Shennan, A. (2024). Effective and simple interventions to improve outcomes for preterm infants worldwide: The FIGO PremPrep-5 initiative. International Journal of Gynecology and Obstetrics, 165(3), 929–935. https://doi.org/10.1002/ijgo.15269
  33. Hutasoit, E. L., Siagian, F. J. C., Zulkifli, S., & Noor, T. (2024). Perlindungan Hukum bagi Anak Luar Nikah di Indonesia; Studi Komparasi Putusan Mahkamah Konstitusi Nomor 46/PUU-VIII/2010 dan Hukum Islam. Jurisprudensi: Jurnal Ilmu Syariah, Perundang-Undangan Dan Ekonomi Islam, 16(2), 420–437. https://doi.org/10.32505/jurisprudensi.v16i2.8938
  34. Jiravisitkul, P., Thonginnetra, S., Kasemlawan, N., & Suntharayuth, T. (2022). Supporting factors and structural barriers in the continuity of breastfeeding in the hospital workplace. International Breastfeeding Journal, 17(1), 1–15. https://doi.org/10.1186/s13006-022-00533-1
  35. Kamata, M., Pereira-Kotze, C., Kerac, M., & Sibson, V. (2025). Formula Labelling in the United Kingdom: Manufacturers' Compliance With the Code, UK Law and Guidance Notes. Maternal and Child Nutrition, 1(1), 1–15. https://doi.org/10.1111/mcn.13794
  36. Keleş, Y. E., Arisoy, A. E., Arisoy, E. S., & Correa, A. G. (2023). Breastfeeding and maternal parasitic infections. In Breastfeeding and Metabolic Programming (pp. 415–429). https://doi.org/10.1007/978-3-031-33278-4_31
  37. Khotimah, K., Putri, I., Azizah, D., & Amalia, I. (2024). The Law on Burying Two Bodies in One Grave According to the Perspective of Islam and the Ulama. Nalar Fiqh: Jurnal Hukum Islam, 15(1), 1–11. https://www.shariajournals-uinjambi.ac.id/index.php/nalarfiqh/article/view/1309
  38. Kusumasastra, R. M. (2023). Analisis Implementasi Kebijakan Pemberian Asi Eksklusif Dan Penyediaan Ruang Laktasi Pada Ibu Bekerja Di Kabupaten Kudus (Studi Kasus: Pt Djarum). Jurnal Ilmu Keperawatan Dan Kebidanan, 14(2), 411–424. https://doi.org/10.26751/jikk.v14i2.1993
  39. Li, K. M. C., Li, K. Y. C., Bick, D., & Chang, Y. S. (2021). Human immunodeficiency virus-positive women's perspectives on breastfeeding with antiretrovirals: A qualitative evidence synthesis. Maternal and Child Nutrition, 17(4), 1–18. https://doi.org/10.1111/mcn.13244
  40. Maxwell, C. V., Shirley, R., O'Higgins, A. C., Rosser, M. L., O'Brien, P., Hod, M., O'Reilly, S. L., Medina, V. P., Smith, G. N., Hanson, M. A., Adam, S., Ma, R. C., Kapur, A., McIntyre, H. D., Jacobsson, B., Poon, L. C., Bergman, L., Regan, L., Algurjia, E., & McAuliffe, F. M. (2023). Management of obesity across women's life course: FIGO Best Practice Advice. International Journal of Gynecology and Obstetrics, 160(S1), 35–49. https://doi.org/10.1002/ijgo.14549
  41. Meek, J. Y., Carmona, C. A., & Mancini, E. M. (2022). Problems of the Newborn and Infant. In P. M. Paulman, R. B. Taylor, A. A. Paulman, & L. S. Nasir (Eds.), Family Medicine (pp. 223–244). Springer International Publishing. https://doi.org/10.1007/978-3-030-54441-6_163
  42. Modak, A., Ronghe, V., & Gomase, K. P. (2023). The Psychological Benefits of Breastfeeding: Fostering Maternal Well-Being and Child Development. Cureus, 15(10), 1–10. https://doi.org/10.7759/cureus.46730
  43. Mulyaningsih, H., Suyanto, B., & Sugihartati, R. (2020). Discourse and breastfeeding practice in urban communities in Indonesia: A Foucauldian perspective. Jurnal Studi Komunikasi (Indonesian Journal of Communications Studies), 4(3), 597. https://doi.org/10.25139/jsk.v4i3.2452
  44. Oliveira, M. I. C. de, Boccolini, C. S., & Fonseca Sally, E. de O. (2021). Breastmilk Substitutes Marketing Violations and Associated Factors in Rio de Janeiro, Brazil. Journal of Human Lactation, 37(1), 158–168. https://doi.org/10.1177/0890334420978405
  45. Pei, Z., Lu, W., Feng, Y., Xu, C., & Hsueh, A. J. W. (2022). Out-of-step societal and Darwinian adaptation during evolution is the cause of multiple women's health issues. Human Reproduction, 37(9), 1959–1969. https://doi.org/10.1093/humrep/deac156
  46. Pimentel, A., Pissarra, S., Rocha, G., & Guimarães, H. (2021). How and when maternal viral infections can be a contraindication to breastfeeding: a narrative review. Journal of Pediatric and Neonatal Individualized Medicine, 10(1), 1–12. https://doi.org/10.7363/100130
  47. Pramono, A., & Hikmawati, A. (2024). Donor human milk practice in Indonesia: a media content analysis. Frontiers in Nutrition, 11(1), 1–10. https://doi.org/10.3389/fnut.2024.1442864
  48. Pramono, A., Hikmawati, A., Hartiningtiyaswati, S., & Smith, J. (2025a). Breastfeeding Support and Protection During Natural Disaster and Climate-Related Emergencies in Indonesia: Policy Audit. Journal of Human Lactation, 41(2), 231–242. https://doi.org/10.1177/08903344251322770
  49. Pramono, A., Hikmawati, A., Hartiningtiyaswati, S., & Smith, J. (2025b). Breastfeeding Support and Protection During Natural Disaster and Climate-Related Emergencies in Indonesia: Policy Audit. Journal of Human Lactation, 41(2), 231–242. https://doi.org/10.1177/08903344251322770
  50. President of the Republic of Indonesia. (2002). Law of the Republic of Indonesia Number 23 of 2002 concerning Child Protection (Patent No. 23). Child Protection. https://peraturan.bpk.go.id/Details/44473/uu-no-23-tahun-2002
  51. Quitadamo, P. A., Comegna, L., & Cristalli, P. (2021). Anti-Infective, Anti-Inflammatory, and Immunomodulatory Properties of Breast Milk Factors for the Protection of Infants in the Pandemic From COVID-19. Frontiers in Public Health, 8(1), 1–29. https://doi.org/10.3389/fpubh.2020.589736
  52. Robb, L., Walsh, C., & Nel, M. (2020). Knowledge, perceptions, and practices of HIV-infected mothers regarding HIV and infant feeding. South African Journal of Clinical Nutrition, 33(1), 23–29. https://doi.org/10.1080/16070658.2018.1503810
  53. Rollins, N., Piwoz, E., Baker, P., Kingston, G., Mabaso, K. M., McCoy, D., Ribeiro Neves, P. A., Pérez-Escamilla, R., Richter, L., Russ, K., Sen, G., Tomori, C., Victora, C. G., Zambrano, P., & Hastings, G. (2023). Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. The Lancet, 401(10375), 486–502. https://doi.org/10.1016/S0140-6736(22)01931-6
  54. Sabilla, M., Laksono, A. D., & Megatsari, H. (2025). Determine the promotion target of exclusive breastfeeding among low-income families in Indonesia. Clinical Epidemiology and Global Health, 32(1), 1–5. https://doi.org/10.1016/j.cegh.2025.101960
  55. Samosir, H. R., Saputri, F., Buulolo, E. S., Simangunsong, E. Z., Sitanggang, E. A., & Paninsari, D. (2025). Knowledge and Attitudes of Third-Trimester Pregnant Women Regarding Exclusive Breastfeeding Education. Journal of Pharmaceutical and Sciences, 8(2), 859–867. https://journal-jps.com/new/index.php/jps/article/view/836
  56. Sánchez, C., Franco, L., Regal, P., Lamas, A., Cepeda, A., & Fente, C. (2021). Breast milk: A source of functional compounds with potential application in nutrition and therapy. Nutrients, 13(3), 1–34. https://doi.org/10.3390/nu13031026
  57. Saragih, R. M. S., Sitorus, R. S., & Ginting, D. Y. (2024). Analysis of the exclusive breastfeeding policy implementation in the working area of Panombean Panei Health Center. Jurnal Kesmas Dan Gizi (Jkg), 6(2), 230–238. https://doi.org/10.35451/jkg.v6i2.1782
  58. Sokou, R., Parastatidou, S., Iliodromiti, Z., & Lampropoulou, K. (2023). Knowledge Gaps and Current Evidence Regarding Breastfeeding Issues in Mothers with Chronic Diseases. Nutrients, 15(13), 1–21. https://pmc.ncbi.nlm.nih.gov/articles/PMC10343612/
  59. Souza, C. B. De, Venancio, S. I., & da Silva, R. P. G. V. C. (2021). Breastfeeding Support Rooms and Their Contribution to Sustainable Development Goals: A Qualitative Study. Frontiers in Public Health, 9(1), 1–9. https://doi.org/10.3389/fpubh.2021.732061
  60. Susanti, L. (2021). Pengaruh Pendidikan Kesehatan Dengan Booklet Terhadap Pengetahuan Ibu Hamil Tentang 1000 Hari Pertama Kehidupan. Jurnal Delima Harapan, 8(2), 46–52. https://doi.org/10.31935/delima.v8i2.136
  61. Syahri, I. M., Laksono, A. D., Fitria, M., Rohmah, N., Masruroh, M., & Ipa, M. (2024). Exclusive breastfeeding among Indonesian working mothers: does early initiation of breastfeeding matter? BMC Public Health, 24(1), 1–10. https://doi.org/10.1186/s12889-024-18619-2
  62. UNICEF. (2023). Mothers need more support amid a decline in Indonesia's breastfeeding rates. https://www.unicef.org/indonesia/nutrition/press-releases/mothers-need-more-support-amid-decline-indonesias-breastfeeding-rates#:~:text=Only 52.5 per cent were, mothers to continue optimal breastfeeding.
  63. UNICEF. (2025). Elimination of mother-to-child transmission of HIV, syphilis, and hepatitis B. https://www.who.int/initiatives/triple-elimination-initiative-of-mother-to-child-transmission-of-hiv-syphilis-and-hepatitis-b
  64. Varghese, S., Krishnakumar, K., Panayappan, L., & Jayapraksh, K. (2017). A review on vaccine storage: keeping vaccines safe when in high demand. J. Bio. Innov, 6(4), 548–552. https://stjamespharmacycollege.in/wp-content/uploads/2021/01/SJCOPS-Publications.pdf
  65. Venter, C., Meyer, R., Bauer, M., Bird, J. A., Fleischer, D. M., Nowak-Wegrzyn, A., Anagnostou, A., Vickery, B. P., Wang, J., & Groetch, M. (2024). Identifying Children at Risk of Growth and Nutrient Deficiencies in the Food Allergy Clinic. The Journal of Allergy and Clinical Immunology: In Practice, 12(3), 579–589. https://doi.org/https://doi.org/10.1016/j.jaip.2024.01.027
  66. WHO. (2019). Feeding and Nutrition of Infants and Young Children. https://iris.who.int/bitstream/handle/10665/272658/9789289013543-eng.pdf
  67. WHO. (2024). Mothers need more breastfeeding support during the critical newborn period. https://www.who.int/indonesia/news/detail/01-08-2024-mothers-need-more-breastfeeding-support-during-critical-newborn-period