5 SEPTEMBER 2006

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Despite several groundbreaking initiatives as the Milk Code of 1986 and the Rooming-in Act of 1992, formula-milk manufacturers seem to be winning the battle vs breastfeeding advocates.

by VINIA M. DATINGUINOO



BREAST IS BEST. Mothers and their babies set a new world record for simultaneous breastfeeding at the San Andres Complex in Manila last May 4, 2006. [photo courtesy of P. Repelente, DOH]
BREAST OR bottle?

That may seem a no-brainer to many, but it's a question that's still throwing mothers, activists, government officials, medical experts, milk manufacturers, and apparently even U.S. diplomats in the throes of deep distress. To think that two decades ago, health officials had considered the matter already settled with the passage of the groundbreaking Milk Code, which aimed to protect breastfeeding and regulate the promotion of breast-milk substitutes. Yet officials say that instead of seeing more mothers breastfeed, the opposite has been happening. And those who still breastfeed are doing so for shorter periods of time.

"The norm now is infant formula, not breastfeeding," laments health undersecretary Alexander Padilla. "The situation is tragic as it is desperate."

Health experts say that as a result, many children are being denied the best nourishment freely available to them. They add that these children are made more vulnerable to falling ill, and mothers themselves are unable to take advantage of the health benefits of breastfeeding.

Blame the aggressive marketing of manufactured milk products, say government officials and breastfeeding advocates. But both also admit that the lack of education about breastfeeding and a frail legal environment are contributing factors, too, to the feeding bottle's ever-growing popularity.

Yet the trend isn't exactly new. Medical anthropologist and health activist Michael Tan points out that in 1963, the average period of breastfeeding in the country was 14.5 months; by 1982, it had dropped to 12.1 months. Tan guesses, though, that these survey data likely referred to breastfeeding in general, meaning it includes the weaning period where other foods are introduced to the baby, and not exclusive breastfeeding.

Exclusive breastfeeding means breast milk is the only food and drink given to the infant; not even water is given. The international standard for how long this should last is six months. But based on the two latest rounds of the National Demographic and Health Survey, Filipino mothers hardly come close to reaching that. In 2003, the median period for exclusive breastfeeding in this country was a mere 1.4 months. By 2003, the figure has declined to 0.8 months.

In 1998, a quarter of Filipino mothers exclusively breastfed their children for the first six months. Today that proportion is down to 16 percent.

Health officials have been working double time to increase that number. They also want more mothers breastfeeding until their children turn two years old. Last July, in fact, more stringent implementing rules for the Milk Code known formally as Executive Order 51 would have taken effect. But then several milk manufacturers went to court, arguing that the health department had overstepped its bounds. It should have left rulemaking to Congress, said the milk companies. They also said they were being deprived of their right to unrestrained trade.

Initially, the Supreme Court ruled in favor of the health department. But just a few weeks later much to the consternation of health officials it reversed itself and granted a temporary restraining order on the implementation of the new Milk Code rules. Legal experts, though, predict that it may take some time before a clear winner emerges from the court battle.

TO MANY people, it had seemed like breastfeeding advocates had already won the war. When this writer undertook an informal poll among her friends in their 30s, for instance, all of the 15 mothers who responded had tried breastfeeding. Most of them also said they knew breastfeeding brought immense health benefits to their children. (See highlights of survey.)

One even felt guilty for being unable to feed only breast milk to her baby. "I didn't have enough milk to breastfeed him exclusively," said lawyer Andrea Pasion. "I've had guilt feelings about this. I even bought expensive feeding bottles, those with teats that are supposedly similar to real nipples. I really had very little milk and I had two breast pumps ha." She said she hoped it would be "better with my next pregnancy."

Since 1986, all infant formula ads, whether print or broadcast, have had to carry the message, "Breast milk is best for babies." It was no empty claim; the Department of Health (DOH) says breastfeeding could prevent up to 16,000 infant deaths each year in the Philippines. The UK medical journal Lancet has also said that breastfeeding can prevent over 10 percent of child deaths worldwide.

Under the Milk Code, all milk ads have had to be approved by an inter-agency committee, which monitors violations as well. In addition, baby-food companies cannot give away samples and supplies of their products and "gifts of any sort" to the general public, to health institutions (including hospitals), and to "personnel within the health care system."

Milk manufacturers are refrained from having containers and labels of their breast-milk "idealize" the use of infant formula. Containers and labels have to have a statement on the superiority of breastfeeding.

Since 1992, the Rooming-in and Breastfeeding Act has been in force, providing more push to the government's breastfeeding campaign. The law requires hospitals to room-in newborn infants with their mothers those delivered normally, within 30 minutes after birth, and those by C-section, within three to four hours so that breastfeeding could be initiated.

But the likes of Tan, along with health officials, say all these have been undermined by milk manufacturers, which have remained as aggressive as ever. Indeed, the Bureau of Food and Drugs (BFAD) says that between July 2001 and December 2004 alone, there were 63 violations of the Milk Code. Alessandro Iellamo, the World Health Organization's (WHO) nutrition consultant for the Philippines, says the BFAD tally "is even small, taken in the context of all the other violations that have gone on since 1986."

Most of the violations BFAD recorded involved the distribution of print advertisements without proper approval by the inter-agency committee. There were also companies that used clinics and hospitals to promote their products, gave out samples to mothers, or printed unacceptable covers in reading material.

Tan is aware mothers choose not to breastfeed for a variety of reasons. "More often though," he says, "Filipino couples think that infant formula is superior to breastfeeding, and spend hard-earned money up to P1,000 a week on the milk powder. The reason is simple: They're victims of the relentless marketing campaigns of the milk companies."

Still, health undersecretary Padilla himself concedes, "We have failed to implement the true intent and spirit of the law." But it is precisely because of this, he says, that a revision of the Milk Code's governing rules became crucial.

He also notes that when the health department, in consultation with WHO, the United Nations Children's Fund (Unicef), and local breastfeeding advocates, began a process of updating these rules more than two years ago, the milk companies were represented in the public consultations.

"There were always these diametrically opposed views," says Padilla, who chaired the committee that drafted the revisions. "We had to take a stand, and sometimes we had to compromise." (Read a transcript of PCIJ's interview with Padilla.)

The revisions were completed after 19 drafts. In May, the entire health council, headed by Health Secretary Francisco Duque III, signed the revised implementing rules through Administrative Order No. 2006-0012.

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