Economic and environmental impacts of commercial milk formula in Indonesia: estimates and comparisons using the Cost of Not Breastfeeding, Green Feeding, and Mothers' Milk Tools.

Abstract

Background: Sales of commercial milk formula products (CMF) are rising rapidly. This study analysed key economic and environmental impacts CMF feeding in Indonesia, which are often overlooked in policy discussions despite their relevance.

Methods: We assessed the economic and environmental impacts of CMF in Indonesia in 2020 using the Mothers' Milk Tool (MMT), the Green Feeding Tool (GFT) and the Cost of Not Breastfeeding Tool (CONBF). We compared the estimated values from these tools with calculations based on Euromonitor data on CMF retail sales in Indonesia.

Results: In 2020, according to the MMT, women in Indonesia produced around 455 million litres of breastmilk for infants aged < 6 months, which had an estimated monetary value of US$45.5 billion. The MMT and GFT shows substantial economic losses from displacement of breastfeeding in Indonesia; 62-96 million litres of breastmilk were lost in 2020 compared to the biologically feasible potential. The GFT tool calculates a carbon footprint of 215-274 million kg of CO₂ eq. and a water footprint of 93,037 million litres. The CONBF estimates that the annual cost to families of purchasing CMF for infants aged < 24 months was US$598.6 million. By comparison, Euromonitor retail sales data suggests that in 2020, the retail value of sales of CMF products targeting the age group 0-36 months was around US$2.25 billion. Euromonitor also reports 27,200 tonnes of CMF products targeting infants < 6 months were sold in Indonesia in 2020. We calculate a carbon footprint from these sales of 299-381 million kg CO2 eq. and a water footprint of 129,064 million litres, higher than the GFT estimate.

Conclusions: Breastfeeding's economic importance to Indonesia far exceeds the retail value of CMF sales. Displacing breastfeeding carries high but largely undocumented economic and environmental costs. Losses are greater when measured as a food resource than as health costs, lost lives, or cognitive decline. Environmental impacts based on sales data are higher than those from survey data. Our findings and the discrepancies between tools reveal a critical gap in national statistics and highlight the need to recognise breast milk as an economically valuable, healthy, and sustainable national resource in Indonesia.