Tuesday, August 01, 2006

Breast is best

The advantages of breastmilk are legion, but I can summarize them in one sentence: It's free, it offers complete and superior nutrition, it provides protection against many diseases and health disorders.

Yet many Filipino couples choose to bottle-feed their infants. Sometimes the reason is that the mother has to return to work, and is unaware that she can refrigerate her breastmilk and have it given to the child. More often though, 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 relentlessmarketing campaigns of the milk companies.

The marketing campaigns could be even worse if it were not for the Milk Code, whose 20th anniversary we should be celebrating this year, given that it has saved the lives of countless children by regulating the promotion of infant formula.

Signed on Oct. 20, 1986 as Health Department Administrative Order 51, the Milk Code went by a mouthful of a full name: the National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements, and Related Products. These breastmilk substitutes are more popularly known as "infant formula" although that term is not very accurate since "infant" refers to children aged 1 and below, while the breastmilk substitutes andsupplements are available for children above the age of 1.

Twenty years after that law was passed, the health department has issued Administrative Order 2006-0012 with new Implementing Rules and Regulations (IRR). The department should be praised for the new IRR, as it clamps down on new forms of reckless marketing of the breastmilk substitutes.


Before 1986, there was no law regulating the promotion of breastmilk substitutes. It was a chaotic situation, with all kinds of marketing gimmicks for infant formula. The most notorious were the sales agents who would station themselves in hospitals, giving out free samples to mothers who had just delivered, and convincing them that the infant formula was better than breastfeeding. One mother told me she was told that she couldn't breastfeed because her breasts were too small. That's complete nonsense: breast size has nothing to do with breastmilk production.

The marketing was so effective that as early as the 1970s, I'd find infant formula in the sari-sari stores of the most remote villages, sold with those other blights of "civilization": cigarettes and soft drinks. Filipinos were convinced that infant formula was modern and healthy while breastfeeding was old-fashioned and inferior.
Local consumer and health groups joined a global campaign against the milk companies' marketing strategies. The groups pointed out that the infant formula, besides depriving babies of the benefits of breastmilk, was also killing babies.

Because it was expensive, parents would use less powder, which resulted in the infants' under-nutrition. In other cases, parents would prepare the infant formula with dirty water, which would result insevere diarrhea for the infants.

But under the Marcos dictatorship, the campaign to regulate infant formula moved slowly. The milk companies were all huge multinationals and exerted political clout that effectively barred attempts at regulation.

After the 1986 Edsa People Power Revolt, health groups used the new democratic space to campaign for public health reforms. The new health department, under Dr. Alfredo Bengzon, was more receptive to these reforms and one of the early victories was the passage of the Milk Code.

The Milk Code was revolutionary in the way it regulated advertising, and required all ads to state: "Breastmilk is best for babies." The milk manufacturers and advertising companies protested, but the Code pushed through. Later, a Rooming In Law was to be passed, requiring hospitals to keep the newborn infant with the mother as soon as the child was born so breastfeeding could be initiated.


Alas, through the years, there's been a noticeable backsliding in the implementation of the Milk Code. Milk companies aren't as aggressive in maternity wards, but they're still able to get hospitals to distribute free booklets to new mothers, supposedly so they can record milestones in their newborn child's life, but each page carries blurbs for an infant formula product.

The promotions have become aggressive with pediatricians and other health professionals but the worst effects come from advertising. The ads state that breastmilk is still best, but the token declaration is drowned out by all kinds of wild claims for the breastmilk substitutes. If we are to believe the manufacturers, we'd be a nation of geniuses and childprodigies.

The new IRR, which take effect this month, cracks the whip on these promotions. These new moves are not arbitrary, they're based on the recommendations of experts from the World Health Organization and Unicef that are stated in the IRR, among others:

First, exclusive breastfeeding, without any food supplements, is stillbest for infants from birth to 6 months.

Second, there is no substitute for breastmilk. The ones that are marketed can only approximate breastmilk, but can never be a complete replacement.

Third, breastfeeding remains appropriate for young children up to the age of 24 months, or beyond.

Fourth, infant or milk formula can be hazardous to a child's health.

Cows and humans
Invoking these principles, the health department has a number of rules and regulations to promote breastfeeding and to regulate the sales and marketing of the infant formula. There are quite a number of prohibitions, one of the most striking being an "absolute" prohibition on "all health and nutrition claims for products within the scope of the Code," including "any phrase or words that connote to increase emotional, intellectual abilities of the infant and young child." Let's see if such offending ads are pulled out now.

"Financial and material inducements" to promote the breastmilk substitutes are prohibited not just for health workers but also for members of the workers' families. Manufacturers are also prohibited from giving "gifts of any sort" to "any member of the general public, to hospitals and other health facilities."

I have to say I'm very impressed with the IRR, but worry about its implementation. Penalties for violations are fairly light, consisting of two months to one year imprisonment, and/or fines of P1,000 to P30,000, loose change for the companies.

Perhaps on our own then, as we stumble along with the present economic and political crisis, we might want to make a difference with the health and nutrition of children. There's much that needs to be done to promote breastfeeding, even as we become more vigilant about the ads and marketing campaigns. A catchy slogan to remember from the 1970s: Cow's milk is best for cows, human breastmilk is best for humans.

Michael Tan opinion column Pinoy Kasi Philippine Daily Inquirer pA15 Online link: http://opinion.inq7.net/inquireropinion/columns/view_article.php?article_id=10531