She
explained: “Breastmilk is not as good as they
would have you believe. After six months your baby
needs more than your breastmilk can provide.”
I agreed. “Yes, after six months, we should
supplement our baby’s milk with solid food…”
Except that what the pediatrician really meant and
had me repeat till I got her right was that I should
stop breastfeeding and give my baby milk formula instead.
I couldn’t believe my ears. I also asked her
what made her declare that my daughter was “nearly
malnourished.” She took out her weight chart
but it showed that my daughter was well within the
prescribed weight range for her age.
“So, she’s not malnourished. She’s
healthy, in fact,” I told the doctor who swiftly
hid her chart.
“But the heavier weight in her range should
be our target,” she replied.
Oh, I just want my daughter healthy, thank you. Not
fat, as she’s obviously not wired that way.
I never returned to that clinic and I went on breastfeeding
my daughter. But I worried for the rest of the parents
who had eavesdropped on the pediatrician’s pronouncements.
How many are they, I wondered, doctors like those?
I hope it was just my misfortune to have run into
one anti-mom’s milk pediatrician. I hope it
wasn’t indicative of a trend. And yet when I
just delivered my baby more than a year ago and had
her “room-in” with me, a group of resident
doctors tried to bamboozle me into giving my baby
milk formula from their nursery.
They asked me why I allowed my daughter to cry when
I could have just given her formula; they implied,
in the process, that I was a bad mother for failing
to recognize the obvious. They got to me and I almost
wavered in my resolve to breastfeed.
When I recovered from this momentary doubt, I reported
the incident to my obstetrician. We agreed that if
the hospital is seriously baby-friendly, they should
teach the new mothers the basics of breastfeeding.
Instead of shoving formula on moms who were still
awkwardly coaxing their babies to suckle properly,
hospitals should help new mothers initiate breastfeeding.
If not, they should at least be more encouraging.
Giving formula to a newborn sabotages breastfeeding
– the baby won’t learn to suckle and the
mother’s body will not register a demand for
milk and thus, will not produce it. |
Frustrated
Milk Code
Unfortunately, my personal run-ins aren’t isolated…or
legal. They actually violate the provisions in the
Philippines’ Milk Code.
The National Milk Code or Executive Order No. 51 entitled
“The National Code of Marketing of Breastmilk
Substitutes, Breastmilk Supplements and Other Related
Products” was signed into law by Corazon Aquino
in 1986 to protect and promote breastfeeding in the
country. It was the Philippines’ answer to the
International Code on the Marketing of Breastmilk
Substitutes and Other Related Products issued by the
World Health Organization and United Nations’
Children’s Fund (UNICEF) in 1981.
Under the Milk Code, health facilities (such as the
hospital where I delivered my baby and the clinic
of my neighborhood pediatrician) should not allow
infant formula or milk representatives, feeding bottles
and teats as well as posters and leaflets on infant
formula, bottled complementary foods and other Milk
Code’s regulated products within its facilities.
Health workers and members of their families are also
directed not to promote infant formula or other products
regulated by the Milk Code. Pediatricians and such
shouldn’t accept formula samples or supplies
as well as financial or material incentives to promote
infant formulas. Furthermore, the Milk Code prohibits
health workers from giving away samples or selling
infant formula and other regulated products.
Digging into the Milk Code’s history, I discovered
that it was Filipino pediatrician Dr. Natividad N.
Relucio Clavano who figured largely in galvanizing
world breastfeeding advocates to action after she
pioneered her “baby-friendly hospital initiative”
at the Baguio General Hospital in 1975. Her innovation
became the template for hospitals in 192 other countries
to follow suit. Dr. Relucio Clavano banned infant
formula milk from the maternity ward and enforced
a regime of “rooming-in” for babies. Rooming-in
is the practice of having newborn babies in the same
room as their mothers instead of being isolated in
nurseries.
In 1978, Dr. Clavano brought the results of her 10,000-baby
study to a hearing of a US Senate Subcommittee chaired
by Senator Ted Kennedy. It showed that the total elimination
of baby milk formula bottles and teats from maternity
wards resulted in a dramatic reduction of infant mortality
by 95 percent. The reaction to her study was as dramatic
as the findings. Sen. Kennedy himself publicly demanded
that the World Health Organization do something about
it. Three years later, the WHO came out with the International
Code on the Marketing of Breastmilk Substitutes and
Other Related Products, and five years later the Philippines
released its own National Milk Code.
So 21 years after the Milk Code that’s supposed
to espouse and protect breastfeeding, why is there
strong pressure to formula-feed our infants? Why do
people continue to harbor the mistaken notion that
formula can replace or even surpass the proven nutritional
benefits of breastmilk? Why is it hard to find someone
who can answer a clueless mother’s breastfeeding-related
questions? Why is it hard to find nursing clothes
in this country, even as department stores are overrun
with maternity wear? If there are clothes for growing
tummies, where’s the corresponding wear for
moms who would like to breastfeed discreetly, comfortably
and fashionably?
The breastfeeding culture in the Philippines has tragically
waned, said the non-governmental organization Children
for Breastfeeding, Inc. 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, according
to the 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.
Before the recent spike in prices of dairy products
particularly milk, formula-feeding was estimated to
cost 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. In 2005 alone, 82,000 Filipino
children under five years old died; 16,000 of these
deaths can be traced to formula-feeding, said the
World Health Organization.
But whether infant formulas are prepared properly
or not, there is still no substitute for breastmilk
for humans, according to UNICEF studies. Aside from
lacking antibodies and immune factors present in breastmilk,
infant formula is not sterile or safe. In fact, 22
infant formula products have been recalled between
1982 and 1994, seven of which were classified as “potentially
life threatening,” said the U.S. Food and Drug
Administration)
Filipino advocates of breastfeeding even charged that
some milk companies are dumping defective or inferior
milk products in the Philippines.
From these alarming statistics and accusations, Rep.
Bondoc said the failure to promote breastfeeding is
now a “public health emergency.” But for
the milk companies operating in the Philippines, apparently
not.
Acts for the Filipino Child
According to the Department of Health, the Milk Code’s
aim of protecting breastfeeding has been “frustrated”
for more than 20 years by rampant violations of milk
companies. Last year, the DOH and the breastfeeding
advocates launched high-profile pro-breastfeeding
actions, such as setting a Guinness World Book record
of 3,541 mothers simultaneously breastfeeding in Manila.
It was meant to facilitate the signing of the Implementing
Rules and Regulations (IRR) of the law protecting
breastfeeding.
But with P3.1 billion worth of infant formula imported
by the Philippines each year, milk companies will
not just roll over and play dead. There’s too
much money at stake, as formula is sold at seven times
the import cost, or P21.5 billion, according to the
Department of Health.
Milk companies especially chafed at Section 11 of
the Milk Code’s new rules, which states: “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.”
The new Milk Code rules were set for implementation
on July 7, 2006, but the Pharmaceutical and Health
Care Association of the Philippines (PHAP), composed
mainly of multinational companies that manufacture
milk for infants, petitioned the high court to stop
this on June 28, 2006. Although initially denying
PHAP’s petition, the court reversed itself on
Aug. 15, 2006 after an appeal from the pharmaceutical
group.
The hold order on the code’s implementing rules
continues to this time of writing will continue to
remain in question for another two months as the Supreme
Court, acting on PHAP counsel’s request for
deferment, has pushed back oral arguments on the matter
to June 19 this year. (Felicitas Aquino-Arroyo, wife
of reelectionist Joker P. Arroyo and one of the three
lawyers handling PHAP’s case, says she’s
busy with her husband’s campaign and lacks time
for what she calls the “extensive preparation
by the parties and proficiency with the intricate
details of the numerous medical and scientific data.”)
Thus shackled, the Milk Code remains unenforceable,
allowing milk companies to hold millions of parents
captive to advertisements that claim the superiority
of their product and in the process, create the impression
that formula surpasses breastmilk. They sure got to
my first pediatrician.
The hearings on the implementation of the IRR have
been postponed well until after the elections on May
14. But according to Nona Andaya-Castillo of Children
for Breastfeeding, “If it took 3,541 mothers
to breastfeed simultaneously to facilitate the signing
of the Implementing Rules and Regulations of the laws
that protect breastfeeding, we hope a nation of mothers
breastfeeding and praying simultaneously will catch
the attention of the Supreme Court that issued a Temporary
Restraining Order to the IRR.”
On May 2, they were once again scheduled to gather
all mothers to breastfeed but not in a single venue
as when they shattered the Guinness Record in 2006,
previously set by the City of Berkeley Women Infants
Children Program in California. This year, mothers
were asked to troop to daycare centers nationwide
for a coordinated plea to implement the IRR and support
breastfeeding.
On top of striving to give the Filipino children the
best start in life, Andaya-Castillo believes “we
need to shield our children from corporate greed and
crass commercialism.” ?
Amy Oliveros is a freelance writer whose stories appear
in The Manila Bulletin, Philippine Graphic, Total
Woman Fitness Magazine, What’s On and Expat
newspaper, and a magazine for OFWs in Japan. |
