Thitima did not know how the company got her telephone number or knew she had given birth. She accepted the gift. But using it never crossed her mind, as she was breastfeeding.

The company called again when her son was six months old. The nurse who called talked her into believing it was time for Thitima to stop breastfeeding and start feeding him child formula. Again, the company offered more of its product free.

But she was determined to breastfeed her child as her mother had her. Unlike many mothers, she did not use the formula. She was aware there is no better infant nutrition than breast milk.

But the formula company did not give up. Three months ago Thitima's boy turned one. The same nurse called again and told Thitima to stop breastfeeding and switch to the food supplement. The nurse even claimed breast milk was no longer useful for children age one or more.

Thitima's experience reflects the aggressive approach formula companies take to sell their products, explained nutritionist Sa-nga Damapong, who is vice president of the Nutrition Association of Thailand.

Meanwhile, the low incidence of breastfeeding among mothers in Thailand worries experts.

According to dentist Sirikiat Liengkobkij of the Thai Health Promotion Foundation, a 1996 United Nations Children's Fund, or Unicef, survey revealed Thailand had one of the lowest rates of breastfeeding.

Compared with countries including Bangladesh, Poland and South Africa, Thailand was at the bottom. The survey was taken at a time when Poland was not a signatory to the International Code of Marketing on Breast Milk Substitutes. Thailand was, said Dr Yupayong Hangchaovanich, vice chairperson of the Thai Breastfeeding Centre.

The World Health Organisation and Unicef prepared the international code. It was adopted in 1981 by the World Health Assembly (WHA) as a "minimum requirement" to protect infant health and promote breastfeeding.

Worried that breastfeeding was a threatened practice, it sought to ensure the appropriate marketing of breast-milk substitutes, feeding bottles and teats.

The WHA comprises international health ministers and their countries' public health experts.

Yupayong claimed formula companies lured young mothers with offers of free products. This was largely to blame for Thailand's poor showing in the survey.

The survey revealed that of mothers who did breastfeed, almost eight out of 10 quit for formula after just one month, she said.

The same 1996 survey found 50 per cent of mothers using infant formula received it from hospitals and healthcare professionals. Yupayong said the recommendations of doctors and nurses influenced mothers to feed children with formula.

When Thailand's adoption of the breast-milk substitute code was monitored in 2003 it was found that up to 80 per cent of hospitals and clinics — mostly private — broke the code by accepting free formula for its patients. "Breastfeeding in private hospitals has improved since then following an intervention programme. But the situation in private hospitals is still a concern," Yupayong said. "It means mothers from wealthier families are more likely to become victims of formula-milk marketing strategies."

"You might not believe this. I had to change hospitals six times before finding one that fully supported breastfeeding from birth," Thitima said. Hospitals insisted on feeding infants formula for test periods immediately after birth before even considering natural breast milk.

Arthit Khwankhom

The Nation