Breast Is Always the Best – DOH

Owing to the successful advertising and promotion of breastmilk substitutes intended for infants and young children, 98.6 percent of Filipino infants are formula-fed with cow’s milk. At six to seven months of age less than two percent of Filipino infants are exclusively breastfed.

By Maria G. Salamat

When Tina, a first-time mother, was awkwardly practicing her newborn to suck at her breast without much success, three roving resident doctors ordered her to get milk from the hospital nursery instead. They argued that the day-old baby was crying because he’s dissatisfied with her milk.

Despite Tina’s grogginess—she just woke up from a drugged sleep after delivering her baby—she asked the doctors if that milk they want her to give her baby was breastmilk. No, the doctors said, surprised she even asked. They berated her for letting her baby cry when there’s milk in the nursery. It happened in a “child-friendly” hospital that advertises support for breastfeeding.

Tina persisted in breastfeeding her son. She had done her homework while pregnant, she knew her son needed little milk so far, but this little amount was exactly what they both needed at the time. She to heal faster and the child to get stronger. But the doctors had got to her. She felt guilty thinking she’s making her baby work harder; she felt inadequate and doubtful of breastfeeding.

Fortunately, her husband and ob-gyne (obstetrician-gynecologist) arrived to reassure and support her. Had she followed the resident doctors’ orders, it would have been disastrous for her milk production—her body must first register a demand before the milk supply comes out, and only a baby’s suckling can do that.

Milk Code

Now that the Department of Health (DOH) has finally signed an implementing rules and regulations for the country’s 20-year old Milk Code, a controversy has openly raged between the DOH and advocates of breastfeeding on one hand, and the milk companies on the other hand.

What happened in Tina’s case was actually a violation of the country’s Milk Code, but it was nothing new and just one among the many that had been documented.

The Milk Code has existed for a “frustrating” 20 years, according to the DOH. The main producers of infant formula and other breastmilk substitutes have repeatedly violated it.

The milk companies are specially chafing at the new implementing rules’ section 11 which states that “No advertising, promotions, sponsorships, or marketing materials and activities for breastmilk substitutes intended for infants and young children from 0-24 months or beyond, shall be allowed, because they tend to convey or give subliminal messages or impressions that undermine breastmilk and/or exaggerate breastmilk substitutes, replacements, or supplements, and other related products within the scope of this Code.”

Breastfeeding advocates tasted initial victory when the Supreme Court denied last week the milk companies’ petition for a temporary restraining order of the new implementing rules and regulations of the Milk Code. DOH Undersecretary Alex Padilla said the Supreme Court’s quick and decisive response vindicated the efforts of the advocates of breastfeeding.

But ushering in a revitalized era of breastfeeding in the Philippines has still a long way to go. By now the breastfeeding culture in the Philippines has tragically diminished, said the non-governmental organization Children for Breastfeeding, Inc. Much needs to be done to revive breastfeeding. The most crucial is for breastfeeding to get massive support and information drive.

Tragic statistics

Owing to the successful advertising and promotion of breastmilk substitutes intended for infants and young children, 98.6 percent of Filipino infants are formula-fed with cow’s milk. At six to seven months of age less than two percent of Filipino infants are exclusively breastfed. (Source: National Demographic and Health Survey)

Cow’s milk infant formula is the best-selling consumer product in the Philippines, said Rep. Anna York P. Bondoc, a doctor and author of a bill for breastfeeding and for strengthening the country’s Milk Code. Formula-feeding costs a minimum of P2,000 a month per infant. To save on costs, some families over-dilute the formula or use other kinds of milk, leading to malnutrition, illnesses and death. Last year alone, 82,000 Filipino children under five years old died— 16,000 of these deaths can be traced to formula-feeding, said the WHO.

But whether infant formulas are used properly or not, there’s no substitute whatsoever for breastmilk for humans, according to Unicef studies. Aside from lacking antibodies and immune factors that are present in breastmilk, infant formula is not sterile or safe. In fact, 22 infant formula products had been recalled between 1982 and 1994, seven of which were classified as “potentially life threatening.” Source: US Food and Drug Administration)

Filipino advocates of breastfeeding even charged that some milk companies are dumping defective or inferior milk products into the Philippines.

From these alarming statistics, Rep. Bondoc said the failure to promote breastfeeding is now a “public health emergency.”

Like battling Goliath

Dr. Elvira Henares-Esguerra, 50, has been breastfeeding her son for five years now. Since she began breastfeeding she also started to promote it actively with other advocates. Though they met high-profile positive results such as the Guinness World Record of Simultaneous Breastfeeding (Manila’s 3,541 last May shattered the Berkley, California record of 1,130 in 2002) and the breastfeeding stations in SM malls,

Dr. Elvira’s five-year experience at advancing breastfeeding caused her to liken the advocacy to David battling Goliath. She lamented the milk companies’ unabashed use of huge resources and clout in frustrating the projects of breastfeeding advocates and dishing out false and misleading info on both breastmilk and infant formula.

Hilarion M. Henares Jr., presidential consultant on national affairs and Dr. Elvira’s father, disclosed that milk companies have threatened newspapers they’ll withdraw advertisements if they print the truth on infant formula and breastmilk.

But perhaps even the DOH’s 20-year frustration in implementing the Milk Code would sound like an understatement to the two great Filipino women who will be awarded in Malacanang this month for their pioneering role in advancing indigenous foodstuff and breastfeeding.

In 1949, Manuela Garcia Maramba, public health nutritionist, opposed the Unicef’s proposal to import milk into the Philippines as part of the country’s nutrition program. She asked then: “Why let the Filipinos get used to milk which will be forever imported because the Philippines will never be a milk producing country?” Instead she encouraged Filipinos to eat indigenous foods that are just as good or even better sources of nutrients than imported milk. In a speech in Tokyo, she said “Unicef should not force countries to adopt western experiences; instead Unicef should adapt their policies to the culture of the countries they operate in.”

In 1975, Dr. Natividad N. Relucio Clavano, pediatrician, started to become the world’s foremost breastfeeding advocate. Her “baby-friendly hospital initiative,” pioneered in Baguio General Hospital, was replicated in 192 countries. She banned infant formula milk from the maternity ward and enforced a regime of “rooming-in” of the infant. In 1978 she brought the result of her 10,000-baby study (which shows that total elimination of baby milk formula bottles and teats from the maternity wards resulted in a dramatic reduction of infant mortality by 95%) to a hearing of a US Senate Subcommittee chaired by Senator Ted Kennedy. Her study was said to have galvanized world breastfeeding advocates into action.

Sen. Kennedy himself joined the crusade against the milk companies and publicly demanded that the World Health Organization do something about it. Three years later the WHO/Unicef passed the International Code on the Marketing of Breastmilk Substitutes and Other Related Products. Five years later in 1986, Corazon Aquino signed into law Executive Order 51, the National Milk Code. But rampant violations by the milk companies frustrated the aim of the Milk Code to encourage breastfeeding. So now, 20 years later, the Revised Implementing Rules and Regulations (IRR) on the EO 51 was signed.

However, even Dr. Elvira Henares-Esguerra says it is wistful thinking to imagine the milk companies will just swallow the ban quietly. After all, some P3.1 billion of infant formula is imported by the Philippines each year, and it is sold at seven times the import cost, or P21.5 billion. [Source: IRR, DOH]

So, breastfeeding advocates have slated activities for breastfeeding and are calling for support from Filipino families. To make breastfeeding more practicable, they’re urging the passage of laws that will provide lactation support programs in places of work for instance.

They’re also honoring the two great pioneers of indigenous foodstuff and breastfeeding, Maramba and Clavano; this week they will light candles in Makati, with the help of Mayor Binay and the Boy Scout of the Philippines, for the 16,000 infants who died due to formula-feeding, and, among others, they’re urging people to sign a petition in support of the IRR to urge President Arroyo to approve it in its entirety. Bulatlat

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