By INA ALLECO R. SILVERIO
MANILA — Breastmilk is and will always be best for babies.
This is the message of the Association for the Rights of Children in Southeast Asia (ARCSEA) delivered in a recent milk letting activity in Manila as it appealed to the public and to all Filipino mothers with newborns to breastfeed their children.
Arcsea is a a child-focused non-government organization and breastfeeding advocate. During its activity in Manila, it invited nursing mothers from communities in Tondo, Manila City who donated their breast milk for infants confined at the University of the Philippines-Philippine General Hospital (UP-PGH). The mothers are all members of the Samahan ng Maralitang Kababaihang Nagkakaisa (SAMAKANA), an association of urban poor women all over the Philippines, Arcsea’s partner in the said activity.
“Breastfeeding advocacy has been a lifelong commitment of Arcsea. During the first few years of our existence, we have been implementing projects and activities which promoted the value of breast milk as compared to formula or bottled milk,” said Arcsea executive director Madella Santiago.
Santiago said their milk letting is part of a year-long campaign of Arcsea on breastfeeding. “We want to educate women of reproductive age not to be fooled by misleading and deceptive advertisements of multinational milk companies,” she said.
As of latest statistics from the Department of Health (DOH), only 54 percent of Filipino mothers breastfeed their newborns and that only one of every six infants are exclusively breastfed for the first six months of life.
An uphill battle
In the last five years, groups advocating for breastfeeding like Arcsea have been fighting an uphill battle against milk corporations and the Department of Health’s apparent weakness in pushing for the full implementation of a genuine Milk Code or “National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplement and Other Related Products.” The Milk Code is the set of rules and guidelines the DOH enforces in support of its campaign to promote breastfeeding; it was first passed into law in 1986 under Executive Order No. 51 of the Corazon Aquino administration. It was in line with the International Code of Marketing of Breastmilk Substitutes adopted by the World Health Assembly in 1981.
The Milk Code is different from the breastfeeding promotion act, which was originally Republic Act No. 7600 or “The Rooming In and Breastfeeding Act of 1992.” RA 7600 is the law being amended by Republic Act No. 10028 or “Expanded Breastfeeding Promotion Act of 2009”.
In May 2006, then Health Secretary Francisco Duque passed the Revised Implementing Rules and Regulations of the Milk Code (RIIR). The RIRR was crafted to strengthen the Milk Code, and make sure that it has teeth to protect the health and nutrition of children, especially newborns.
Two months later in July that same year, the Pharmaceutical Health Care Association of the Philippines (PHAP) filed a suit against DOH. lawyer Fely Aquino, wife of Senator Joker Arroyo. Arroyo was one of the lawmakers who signed the Milk Code into law in 1986.
The PHAP petitioned the Supreme Court for a temporary restraining order against the RIRR. The High Court first turned down the petition, but later on overturned its own decision. In the end, the SC nullified certain important provisions of the RIIR, specifically provisions that imposed an absolute ban on the promotion and advertisement of breast milk substitutes.
Former Justice Ma. Alicia Austria Martinez penned the decision, and in it the SC ruled that while the DOH is authorized by the Milk Code to control information on breastmilk in relation to breastmilk substitutes, the power is not absolute.
“The power to control does not encompass the power to absolutely prohibit the advertising, marketing, and promotion of breastmilk substitutes,” the High Court ruled. With the ruling, the SC granted partially the petition filed by the Pharmaceutical and Health Care Association of the Philippines (PHCAP) as it declared the DOH’s May 12, 2006 administrative order on the Milk Code’s stand against milk substitutes null and void for being ultra vires or beyond the authority allowed by law.
The administrative order No, 2006-0012’s Sections 4(f), 11, and 46 on the Milk Code’s RIIR was nullified when the SC said that it was against the ” constituting reasonable regulation of an industry which affects public health and welfare.”
This, the SC said, constituted illegal restraint of trade nor are they violative of the due process clause of the Constitution.
In justifying his concurring opinion, the former chief justice Reynato Puno seemingly defended the right of the milk companies to advertise and make claims about their milk substitute products.
“The advertising and promotion of breastmilk substitutes properly falls within the ambit of the term commercial speech… a separate category of speech which is not accorded the same level of protection as that given to other constitutionally guaranteed forms of expression but is nonetheless entitled to protection.”
Puno said the absolute ban on advertising is restrictive and that to limit the advertising of milk substitute products to contain strictly information “cuts too deep on free speech.”
“The laudable concern of the respondent for the promotion of the health of infants and young children cannot justify the absolute, overarching ban,” Puno said.
For the Arcsea, the case remains an important landmark of how genuine the principles of corporate social responsibility are toward consumers. The Arcsea said the SC decision shows how the justice system in the country bends in favor of business interests and their profit objectives, “in this case, at the expense of the lives of at least 16,000 infants annually, especially those from the marginalized sectors of society.”
According to the Arcsea, the SC tried to pass off its decision as something that supports the breastfeeding program, but a closer look at the decision exposes it to be favorable to the milk supplement companies.
“The SC nullified very important provisions of the Milk Code. such as Section 4(f) on prohibition against the advertising, promotion, or sponsorship of infant formula, breast milk substitutes and other related products; Section 11 against advertising, promotions, sponsorships or marketing materials and activities for breast milk substitutes intended for infants and young children up to 24 months; and Section 46 which imposed administrative sanctions against any person, juridical or natural, found to have violated the provisions of the Code and the IRR. The same provision called for fines up to P1 million for repeat violations,” The group said.
Arcsea’s Santiago said the SC could have penned a milestone in Philippine jurisprudence by upholding the RIRR in full, “but it chose not to and buckled down under the pressure of profit-taking giant milk companies,” she said.
Exceptions to advertisements are now be allowed by an Inter-Agency Committee.
“Corruption remains a hot and real issue. It’s not unlikely that the Inter-Agency Committee will be unable to resist attempts of bribery to facilitate advertisements that undermine breast feeding practices, especially among poor and marginalized mothers.
Aggressive promotional campaigns for infant formula have been identified as a major reason why mothers are discouraged from breastfeeding their babies,” she said.
When she gave birth to her first child in a private hospital in 2008, Alexa Constantino was determined that she would breastfeed.
“I prepared myself for it for months. I read books, talked to friends who also breastfeed their children. I was prepared for the possibility that it would be painful and difficult because I had also read stories that breastfeeding could also hurt. I was determined to breastfeed my child because I was convinced that it was the best way to ensure her health,” she said.
The new mother was horrified to discover, however, that the hospital gave her baby formula without first asking her permission.
“The nurses didn’t even ask me. They didn’t even think to bring my baby to me when I had recovered soon after I gave birth. I got more than a little angry when they told me that I may not have enough milk — how could they have known that when they didn’t even let me try to breastfeed my child?”
The staff at the hospital nursery also warned her that if she takes her child outside the nursery or bring her to her room where she could be breastfed, the hospital would not be responsible for any health complications the baby could suffer.
“It was really like they were discouraging me from breastfeeding. When my husband and I finally took our baby home, the staff had the temerity to give me half a box of milk formula, saying that the hospital pediatrician recommended it despite my assertions that I was going to breastfeed,” she said.
As for the removal of the fine on violators, Santiago said, the SC replaced it with a mere slap on the wrist as penalty against milk companies.
“The strongest penalty imposed on violators at the moment is a criminal penalty of two months to one year imprisonment and a fine of not less than P1,000 ($23.25) , and not more than P30,000 ($698). A fine of P30,000 ($698) is a drop in the bucket in the face of how much Filipino mothers are estimated to spend annually on infant formula which is about $469 million. By pulling out the teeth of the RIRR, the Supreme Court sent a message to mothers, children, health care professionals, child rights advocates and the artificial infant milk industry that indeed, in the Philippines, the logic of profit rules at the expense of at least 16,000 infants a year,” she said.
It is not only children aged 0-12 months old that are covered by the Milk Code. The SC in its 1987 decision said that the Code covers covers all breastmilk substitutes including those to be used by children aged over 12 months. In the Code, breastmilk substitutes are defined as “any food being marketed or otherwise represented as partial or total replacement of breastmilk whether or not suitable for that purpose.”
The Milk Code stipulates that advertising, promotion or other marketing materials for breastmilk substitutes should first be approved by the Inter-Agency Committee. These ads and marketing materials are prohibited from including among its slogans or messages terms like “close to mother’s milk.” Neither can they include pictures or texts that idealize infant and milk formula. There is also the standing prohibition against the inclusion of any health and nutrition claims, false or misleading information or claims of products.
In the meantime, the Milk Code also states that milk companies are prohibited from giving financial or material inducements or gifts of any sort to promote products to health workers and to any member of the general public. They cannot give donations to the general public, hospitals, health facilities, their personnel and members of their families.
At the same time, milk companies cannot conduct or be involved in any activity on breastfeeding promotion.They cannot provide education and production of materials on breastfeeding, or to act as speakers in classes or seminars for women and children’s activities and to use these venues to market their brands or company names. Milk companies cannot have point-of-sale advertising, or give away samples and other promotional items directly to consumers at retail level.
Finally, milk companies cannot be part of any policymaking body involved in the advancement of breastfeeding.
Lawyer, government employee, “mompreneur” and full-time Jenny of chroniclesofanursingmom.com explained that milk companies are supposed to be prohibited from any involvement in breastfeeding promotion, education, production of breastfeeding materials, seminars/classes for women and children’s activities.
“However, violations are still rampant due to lack of policing.
Milk companies have found new and creative ways to market their products such as partnerships with the Department of Social Welfare and Development (DSWD), forming trade associations allegedly for infant nutrition and more recently, joining the “Oh my Gulay” campaign. It is an uphill battle and milk companies will not give up the P20++billion annual spending on formula milk without a fight. This is why even though the Milk Code and RIRR are existing, milk companies continue to violate and unethically promote their products. What is P30,000 pesos fine compared to the P20++billion industry? Although the Milk Code has criminal penalties, no one has been convicted and punished with imprisonment,” she pointed out.
The breastfeeding advocate said mothers and the rest of the public should be be vigilant. Report violations and don’t support events or activities that have milk companies as sponsors, exhibitors or research speakers.
Four-time mother Andrea Rodriguez insists that milk companies continue to exploit loopholes in the law to promote their products.
“Their ads on television make all sorts of promises and claims — they say that if a young child drinks their milk, the child will grow smarter, more talented, stronger and more energetic than others. These milk companies target mothers’ deepest fears that their children will be less intelligent or less strong compared to other children of the same age. Sure these milk products are said to be for older kids, but the premise is already there: formula milk works wonders. There are no full-blown advertising campaigns on the benefits of breastmilk, and this is what the milk companies take advantage of,” she said.
Human milk bank at the PGH
ARCSEA also has supported the establishment of the Human Milkbank Project of the University of the Philippines- Philippine General Hospital. The project is being handled by the Lactation Unit, New Born Medicine Section of the UP-PGH’s Department of Pediatrics.
Acording to Santiago, the Milkbank Project was started in the last quarter of 2010 yb Arcsea together with the PGH Neo Natologists and Lactation Counselors. The stakeholders continue to work to secure additional medical equipment and supplies to ensure the further development and greater effectivity of the project.
“In support for the Milkbank activities, we’ve also begun efforts to build a database to manage and generate the flow of data which will be of great help to the doctors and Milkbank staff,” she said. In this effort, Arcsea is working with the Computer Professionals’ Union (CPU).
In the meantime, the group has also started to look for private companies for collaboration.
“This will help increase the impact of promotion and awareness on breastfeeding and donations to the Milkbank, which is directly for the benefit of the newborns in the PGH,” Santiago said.
Besides educating women on the importance of breastfeeding, Arcsea also emphasized the importance of helping infants confined at public hospitals who cannot be breastfed by their mothers. Santiago said that mothers can support Milkbank at the UP-PGH by donating their excess milk for sick babies.
“We are not stopping from doing anything that can help infants and children achieve their potential through nurturing them with the right nourishment in their early months and years,” she said. “We can also achieve zero malnutrition like Cuba if we unite and educate women and men. Together, we can fight the deception that formula milk companies are doing in the name of profit.”
Every year, 1.8 million babies are born in the country. It reportedly costs an average of P4,000 ($93) a month to feed a newborn to young baby, with the costs covering the prices of formula milk, bottles, and teats. If all these babies were breastfed exclusively for the first six months of their lives, each of their families would be able to save P24,000 ($558) for six months. Collectively, the savings amount to over P41 billion ($95,349 million).