In January 2005, the United Nations Children’s Educational Fund (UNICEF) sounded the alarm.
The trigger was a radio program featuring an interview with Press Secretary Ignacio Bunye. During the show he announced the top three consumer commodities in the country at the time: formula milk, cell phone cards, and beer. When UNICEF Country Representative Dr. Nicholas Alipui heard this, he was appalled. He immediately published a call for help from NGOs, government agencies, and individuals. The situation was, according to him, no less than a death sentence for Filipino children. The reason? The top consumer commodity in the country is, literally, a killer.
The response, both locally and internationally, has been inspiring. Among those who have expressed support for the Philippine breastfeeding campaign are a former president and a former Supreme Court chief justice, religious groups such as the Catholic Bishops Conference and the United Church of Christ, 80 NGOs, global advocacy groups such as Baby Milk Action, World Alliance for Breast-feeding Action, and the International Baby Food Action Network, the United Nations Commission on Human Rights, and individuals from the United States, Canada, New Zealand and the United Kingdom including an Oscar award-winning actress and the former Bishop of Coventry.
But what many do not know is that breastfeeding advocates and groups such as the Arugaan Foundation, headed by Ines Fernandez, Children for Breastfeeding, Inc. (CfB), founded by Dr. Elvira Henares-Esguerra, and Nurturers of the Earth, Inc., headed by Nona Andaya-Castillo, have been fighting the battle against the bottle for decades now. And as in any other epic saga, they are waging war against a daunting opponent: the multinational milk and pharmaceuticals industry represented by the Pharmaceutical and Healthcare Association of the Philippines (PHAP).
The breast things in life
That breast milk is best for babies is an incontestable truth. Countless books, studies, articles, and websites have discussed the benefits of breastfeeding—the complete nutrition and critical boost to the immune system it gives the baby, plus the benefits not just to the mother’s health but to her finances. The dangers of breast milk substitutes or “follow-on” infant formula are as well-documented. Among other things, babies given infant formula are more prone to infections, diarrhea, respiratory diseases, allergies, diabetes, and malnutrition. Moreover, infant formula has been found to contain bacteria such as Enterobacter sakazakii and Salmonella enterica. An April 24, 2007 Philippine Star article cited in the Philippine Council for Health Research Development website states: “Even milk companies admit that nothing comes close to breast milk as the best nutrition for babies.”
Despite this, breastfeeding in the Philippines has been losing out to infant formula through the years. According to UNICEF, only 16 percent of children four to five months old are exclusively breast-fed, while 13 percent are not breast-fed at all, a significantly lower figure compared to 25 percent in 1998. And the World Health Organization (WHO) has estimated that 16,000 children die every year from illnesses and complications caused by improper feeding practices, including the use of infant formula.
This is where breastfeeding advocacy comes in.
Resistance fighter
“We asked ourselves, what can we do to revive the breastfeeding culture?” Esguerra says. She and Castillo, both UP graduates, are also two of the country’s five International Board-Certified Lactation Consultants. “It’s very difficult because you get so much resistance. You get resistance from advertising and [the milk companies’] vested interests. You get resistance from mothers who are convinced that powdered milk is good enough. Then you have to teach children to keep them from imbibing the formula-milk culture. It’s a heavy burden.”
She cites the three prongs of breastfeeding advocacy: protection, promotion, and support. “Protection means you fight those people who are fooling us. Promotion, that you make mothers want to breastfeed. And support, because even mothers who want to breastfeed need to be supported. They don’t have models to guide them; their own mothers didn’t do it anymore. And people around them are using bottles. So even if mothers decide to breastfeed, if there is nobody to help them, they end up succumbing to social pressure.”
Laying down the law
The basis for protection was set in 1981 when the World Health Assembly adopted the International Code of Marketing of Breastmilk Substitutes as a minimum standard for governments. Among other things, the Code forbids milk companies and their representatives from directly or indirectly contacting medical personnel and mothers or pregnant women; distributing free samples of substitute milk in hospitals or health centers; producing advertisements for baby foods aimed at infants younger than six months; giving promotional gifts to health workers; and utilizing any promotional devices to induce sales at the retail level. Formula labels must be printed in simple terms, must state that the product should be used only on the advice of a health worker, and must include instructions on the correct preparation as well as a warning against the risks of inappropriate preparation. Certain words, pictures of babies, or any pictures or texts idealizing the use of infant formula are also prohibited. In the year of its adoption, 118 countries, excluding the US, signed the Code.
Thanks to vigorous lobbying by NGOs, Executive Order 51 or the National Code was signed in 1986. It soon became evident that stricter rules were needed to give EO 51 some teeth against the tactics of milk companies to circumvent the law. Breastfeeding advocates, with the support of the WHO and UNICEF, again lobbied in 2004 for the Revised Implementing Rules and Regulations (RIRR) for EO 51. Twelve versions later, the advocates met with success. In May 2006, Department of Health (DOH) Secretary Dr. Francisco Duque passed the RIRR, which includes a ban on the advertising and promotion of milk substitutes for children up to two, with an absolute ban on false health and nutritional claims. “The new rules would restrict entry of infant formula and sample products into hospitals,” DOH Undersecretary Alex Padilla says in an article published in the Sydney Morning Herald on February 3, 2007. “It will not prohibit all ads, only ads that make false claims, like ‘drinking this formula will produce geniuses who are loveable and affectionate.’”
Fact versus fiction
It’s easy to see why milk companies disliked the RIRR. Stroll through any supermarket or watch TV for an hour and you are bound to see plenty of Code violations, ranging from improper labels to mass retail-selling to advertisements of milk formulas touting things like prebiotics, nucleotides, taurine, and additives that supposedly produce a gifted child. “Researchers have been studying the components of breast milk, and milk companies are attempting to copy this,” Castillo explains. “But the taurine in a mother’s breast milk is intended for human babies. Where exactly does formula milk get its taurine?” Contrary to what the ads say, milk formula, which is derived from cow’s milk, just can’t cut it. “You don’t see any gifted cows. You don’t see any cows playing chess or the piano.”
The ads are spurious. Unfortunately, they are profoundly influential, especially with the masses. “That’s the problem with unethical marketing practices,” Castillo says. “The ads make poor mothers feel deprived because they can’t afford to buy infant formula. They will breastfeed their children because they have to, but if they get money, they will buy what is touted as a good product.” Middle- and upper-class mothers have access to books and the Internet, where they can learn the facts about infant formula and breastfeeding. But poor mothers rely mostly on the ubiquitous TV, where formula ads are aired, day and night, for information. The result is a deeply ingrained belief that expensive, imported, and artificial is better than free, ideal, and natural. “The sad part of the advocacy is hearing mothers say ‘I am breastfeeding because I am poor and I cannot buy this product’,” says Castillo. “Some even resort to stealing, and when you go to groceries you see pictures of mothers who were caught stealing cans of formula milk. It’s actually painful.”
Bad medicine
Equally powerful is the voice of the medical profession, which has come under the influence of the milk industry too often for comfort. UP graduate and Tanggol Kalikasan President Atty. Maria Paz Luna, who represents her fellow breastfeeding advocates in Arugaan and CfB in the legal battle against PHAP, describes a regrettably common trend cited in a recent UNICEF documentary. “When a doctor tells a mother she cannot breastfeed because she is sick, which is not true most of the time, she will buy the proper infant formula to start with. But after a week or so, when money gets tight, she will try to save by diluting the formula. The baby will get less than its nutritional requirements, while her breast milk dries up because the baby is too full to suck. As more time passes, the mother will start buying cheaper formula because, after all, milk is milk. She’ll end up with Bear Brand, which is available at every sari-sari store at P22 a pack. This is simply insufficient for the baby’s needs. The blame lies not just with the milk industry, but also with doctors who, for the flimsiest reasons, prescribe milk formulas.” The situation, she adds, represents a clear conflict of interest on the doctors’ part.
Move, countermove
The milk industry was quick to react. In July 2006 PHAP filed suits against the DOH secretary and all his undersecretaries and petitioned the Supreme Court for a temporary restraining order (TRO) on the RIRR. The Supreme Court denied the petition. PHAP tried again, and in August 2006, right after the second celebration of World Breastfeeding Week in Malacañang, where advocates marked the 25th anniversary of the International Code, the 20th anniversary of the National Code, and the formal launch of the RIRR, the Supreme Court reversed its decision and issued the TRO.
There were other setbacks as well, such as the murder in early December 2006 of Assistant Solicitor General Nestor Ballacillo, who was handling the case and who was also a breastfeeding advocate, and the pressure exerted on the DOH and the President by the US Chamber of Commerce against the RIRR, which Secretary Duque called “subtle blackmail.” It was, Luna recalls, a nerve-wracking time for breastfeeding advocates.
The bottom line
The milk companies’ main objection to the RIRR is that it will restrict trade. “They cannot defend milk formula in terms of whether it’s better than breast milk,” says Luna. “They just say, we have a legitimate product we’re selling to those who can’t breastfeed, so allow us to sell. But the point is, we’re not stopping them from selling. We’re stopping them from unmitigated advertising that convinces mothers that their formula is the best.” Throughout the public hearings held over the RIRR, milk company lawyers picked on every technicality, from administrative fines to definitions of terms. “[I said], will you listen to yourselves? You are talking about babies who are dying, 16,000 deaths every year, more than any natural disaster. This is a public emergency, but nobody seems to be noticing because babies cannot speak for themselves.”
Besides, Castillo believes their trade restriction argument to be invalid. “What they mean is trade in their favor.” Advocates say otherwise; breastfeeding is the least costly and most far-reaching strategy for the alleviation of poverty. According to CfB, the National Economic Development Authority estimates that milk companies import P3.1 billion worth of infant formula milk and sell it to the people (often to those least able to afford it) at seven times the cost at or P21.5 billion every year. For a family earning P7,280, milk purchases constitute 30 percent of its income. “You can take that P21.5 billion and convert it into housing, classrooms, textbooks, salaries for teachers. You can pay a third of our country’s P60 billion-a-year foreign loans.” The benefits of breastfeeding should make national officials and policy makers sit up and take notice. It would be beneficial to our country’s trade and economy to protect breastfeeding.
The good news
Despite the efforts to stymie the breastfeeding campaign, Esguerra refuses to be discouraged. There are two other prongs in the advocacy, after all. “Maybe they were able to stop us in protection. But there’s promotion. Even if the protection is blocked, if the mothers themselves don’t want to buy the milk, that’s another story altogether.”
In the promotion aspect, breastfeeding advocates are racking up accomplishments. CfB, for example, has partnered with SM Supermalls in a project that aims to establish Breastfeeding Stations in all SM malls. The first Breastfeeding Station was launched in Megamall in March 2006. There were massive, media-covered events such as the two Sabay-Sabay, Sumuso sa Nanay gatherings, the first held in May 2006, which broke the Guinness World Record on the most number of people breastfeeding simultaneously in one location; and again in 2007, which set a new World Record for the most number of people breastfeeding simultaneously in multiple locations. The event is set to be held every May 1. The institutionalization of the World Breastfeeding Week celebration, through Presidential Proclamation 884, to be held every August 1 to 7, is also a milestone; plus of course the numerous exhibits, lectures, workshops, and activities each of the groups are holding on their own.
For support, Esguerra cites the Philippine Lactation Resource and Training Center, established by the CfB and Nurturers of the Earth in partnership with the Technical Education and Skills Development Authority (TESDA). The training center’s objectives are also three-pronged. “For promotion, our output would be breastfeeding advocates who can become event organizers in their own line of duty. Our second output would be breastfeeding counselors, for support. And for the third output, protection, we teach people to point out Code violations.”
The battle of the century
Despite the difficulties, there is no doubt in Luna’s mind about the task she and her fellow breastfeeding advocates have chosen. There is perhaps no other issue wherein the lines are as clearly defined. “I think this is the major consumer battle of the century,” she says. “You can’t choose a better issue—or a better opponent—than ours.”
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