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Sunday, September 17, 2006
Battle for the breast
By Stella A. Estremera
IN A secluded space outside the barangay's health center is a woman trying to hush her baby with a bottle of thin milk. Emaciated, both of them, the baby's eyes had that somber expression of malnutrition very different from the curious glints in the eyes of babies that we love to play peek-a-boo with.
The health center was still closed, work hours hasn't started yet, but the surroundings are starting to fill up with women with their toddlers and children.
A better-dressed woman, dyed hair and all, arrives, a teenage girl tagging along carrying that baby kit bag -- those plastic, cushiony bags that come in pastel shades, and decorated with tiny flowers -- and shaking a freshly-made baby formula bottle. The better-dressed woman motions to the teenage girl with a wide sweep of her hand, calling the attention of those around as well, and quite loudly asks whether she alrady needs to buy another can of a certain brand of milk formula (the one that prides itself about making gifted children).
"Show off," I mumbled.
A teenage mother arrives, her baby suckling on her breast, not meeting anyone's eye. Whether it's because she's too young to be a mother or because her breast is bared, I wouldn't know. One thing for sure, she doesn't have the put-on flair of the better-dressed woman.
Out there in a well-provided neighborhood, tucked outside the prying eyes of neighbors, a young mother lets her firstborn suckle on her breast, too, as she talks with her friends -- middle-class young parents -- who are likewise boasting about how they breastfed their babies and even underwent lamaze classes.
Something wasn't right, I thought. And then the two scenes, two weeks apart in two different places -- a middle-class neighborhood and a health center in the blighted inner city area -- painted an unsettling picture...
The better-educated ones know about the benefits of breastfeeding, their poorer cousins, however, seem to regard breastfeeding as the means of last recourse suited for young teenage mothers who cannot afford much. The better-off proudly lugging around their baby bottles in the plastic, cushiony pastel-colored baby kits.
"It's good for the brain, right?" a mother said when I asked what brand of milk formula she fed her baby, "and I only want the best for my child."
One other mother described her brand of milk formula as a complete food supplement with taurine for brain development.
The reasons for the choice of milk formula were ringing brand names, complete with video images and marketing blurbs. Mothers who see milk formula as the ultimate food for their babies sound like television commercials, as familiar as "Tide is mirakol."
This is situation is not foreign to Dr. Nicolas Alipui, the country representative of the UN Children's Fund (Unicef) in the Philippines. In fact, that "off" scene is causing him a lot of stress, made more so by the very strong lobby of milk formula companies against the implementation of the Milk Code of the Philippines (Executive Order No. 51).
"Over the years, the milk formula industry has killed breastfeeding," Alipui said in an exclusive interview with Sun.Star last Thursday.
"The milk companies are glamorizing infant formula to the point that many people are willing to spend P2,000 to P4,000 a month for these products when breastmilk is for free," he added. "They make it look like formulas are superior to breastfeeding and that breastfeeding is primitive, pass‚. They reinforce these misconceptions by propagating false health claims."
The health secretary explains
Dr. Alipui has reason to be exasperated. Twenty years since the Milk Code was issued the legal battle is still on.
The breastfeeding advocates were rejoicing early this year because finally, after 20 years of battle with milk companies to push breastfeeding and put teeth into the campaign, a revised implementing rules and guidelines was approved. It was published in a newspaper last June 24, 2006, the 20-year-old Milk code was supposed to have been effective July 15.
Included in the code are provisions banning the use of the health care system for the promotion of infant formula and the other related products; banning donations, samples and other giveaways by milk companies to health workers and the general public; requiring special labels for infant formula; requiring intensified training of health workers; and regulating advertisements of all products covered by the code.
The implementation, however, hit a snag.
As Health Secretary Francisco T. Duque wrote in his letter addressed to Foreign Affairs Department Secretary Alberto Romulo dated September 5, 2006, the Pharmaceutical and Healthcare Association fo the Philippines (PHAP) sought for a temporary restraining order last June 28 with the Supreme Court. The SC denied the issuance of the TRO on July 11 and ordered the DOH and all undersecretaries and assistant secretaries to submit their comments.
The PHAP responded to this by filing a motionfor reconsideratino "without requesting the respondents (the DOH) to comment.
"The Supreme Court in a resolution promulgated last 15 August 2006, granted the motion for reconsideration. In so doing, the Court accordingly issued a TRO against the Department so as not to implement the RIRR 'until further orders from the Court' and after the petitioner had posted a bond in the amount of P500,0900," Duque wrote.
Duque further informed Secretary Romulo that they have alrady filed its "urgent motion to lift the TRO" last September 4.
International pressure
Now the question: why would a secretary of health be explaining about a revised implementing rules on milk substitutes to a foreign affairs secretary?
Simply because the milk industry is not just about babies; it is about big multinational companies and lobby groups earning as much as.
In the original letter by DFA Assistant Secretary for American Affairs Rey A. Carandang dated August 24, 2006 to Secretary Duque, he wrote, "The International Formula Council met with the officers of the Philippine Embassy in Washington, D.C., headed by Charg‚ d'Affaires Willy C. Gaa on 02 August 2006, regarding the Proposed Revised Implementing Rules and Regulations of the Milk Code (Executive Order No. 51). The Council stated that they support the position of the PHAP outlined in its position paper submitted to President Gloria Macapagal Aroryo on 12 January 2006."
In the same letter, Carandang said, the PHAP has indicated in its position letter that it does not support the RIRR.
It's not only the US's International Formula Council that has written to the government against implementing the Milk Code, an even more powerful person did -- the president and chief executive office of the US Chamber of Commerce, Thomas J. Donahue. This time, the letter was not just to the DFA but President Gloria Macapagal-Arroyo.
In his letter dated August 10 and transmitted to Secretary Duque's office on August 15 by Executive Secretary Eduardo R. Ermita, Donahue contended that the RIRR prohibits all marketing of infant formula to children up to three years of age, which he said, goes beyond both Philippine law EO 51 and the World Health Organization International Code of Marketing Breastmilk Substitutes. Donahue further bewailed that the RIRR "treats infant formula as a potential health hazard by requiring warning labels without any scientific justification".
Donahue pointed out that should any government agency be allowed to extend the reach of a regulation "beyond the intent of the law without due process", this will generate uncertainty among businesses that are thinking of investing in the Philippines. This, he said, places the "country's reputation as a stable and viable destination for investment" a risk.
"We know you would want to avoid such a situation occurring. The US Chamber of Commerce values highly the mutually beneficial trade relationship between our two countries, a relationship that has prospered under your leadership," Donahue wrote.
"We are really confronting a titanic struggle between private profit and public interest here," he said.
The international standard
Alipui had all the reason to be exasperated, after all, the WHO International Code of Marketing Breastmilk Substitutes have specific provisions about the marketing and information about infant formulas that the local industry is violating.
Article 4 on information and education states that all types of materials for breastmilk substitutes "should include clear information on all the following points:
1. the benefits and superiority of breastfeeding;
2. maternal nutrition, and the preparation for and maintenance of breastfeeding;
3. the negative effect on breastfeeding of introducing partial bottle feeding;
4. the difficulty of reversing the decision not to breastfeed; and
5. where needed, the proper use of infant formula, whether manufactured industrially or home prepared."
The code continues, "When such materials contain information about the use of infant formula, they should include the social and financial implications of its use; the health hazards of inappropriate foods or feeding methods; and, in particular, the health hazards of unnecessary or improper use of infant formula and other breastmilk substitutes. Such materials should not use any pictures or text which may idealize the use of breastmilk substitutes."
We only have to watch the television today and know that just about everything here is not being followed, and this is but one article in the international code. This does not even cover the prohibition on giving samples and health center materials.
In the breastfeeding facts gathered from Unicef materials, it noted that "rates of mortality in children who are not breastfed are four to six times higher than for those who are."
Calling all mothers
WHO estimates also that 1.5-million infant deaths worldwide could be avoided every year if rates of breastfeeding were higher.
The Philippines has the lowest breastfeeding rate among the so-called developing countries in Southeast Asia, including its neighbors Malaysia, Thailand and Indonesia.
Worse, there is a downward trend at that. "The average duration of exclusive breastfeeding in the Philippines went down from 1.4 months in 1998 to a mere 24 days in 2003 -- a far cry from the recommended six months," the Unicef reported.
Alipui thus urges mothers to join the struggle and redeem the poor image brastfeeding has earned after more than two decades of rabid marketing by infant formula companies.
"What we need is for ordinary people to write the Secretary of Health, your congressmen, and leaders to express support for the Milk Code," Alipui said. "We have to make people feel that this is really a public issue. We can't stop fighting for the protection of breastfeeding. The right to food starts with the right to breastfeeding. It starts with the right to mother's milk."
For Bisaya stories from Davao. Click here. (September 17, 2006 issue)
Write letter to the editor.Click here.
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