Thursday, December 6, 2007

AlJazeera reports on Milk Code violations in Indonesia

In November 2007, AlJazeera aired a report on Milk Code violations in Indonesia. If you've seen "Formula for Disaster" by UNICEF Philippines, the scenes will be familiar ... and equally disturbing.

What the milk companies are doing in the Philippines, they are also doing in other low-income countries. And the poor formula-fed babies are dying everywhere.

Wednesday, November 14, 2007

The total effect of infant formula advertising

By accepting "total effect" as a standard for screening ads, promotional and marketing materials for breastmilk substitutes and related products, did the Supreme Court effectively ban these materials altogether?

Section 13 of the Philippine Milk Code's Revised Implementing Rules and Regulations (RIRR) sets "total effect" as a standard with which the Interagency Committee (IAC) would screen all advertising, promotional and marketing materials for products under the scope of the Milk Code. (Note: The IAC is composed of the Department of Health, Department of Social Welfare and Development, Department of Justice, and Department of Trade and Industry.)

The milk companies alleged that "total effect" was too vague to be a standard. However, the Supreme Court decided that it is "a viable standard against which the IAC may screen such materials before they are made public."

Section 13 states:

"Total Effect" - Promotion of products within the scope of this Code must be objective and should not equate or make the product appear to be as good or
equal to breastmilk or breastfeeding in the advertising concept. It must not in
any case undermine breastmilk or breastfeeding. The "total effect" should not
directly or indirectly suggest that buying their product would produce better
individuals, or resulting in greater love, intelligence, ability, harmony or in
any manner bring better health to the baby or other such exaggerated and
unsubstantiated claim.

What exactly does it mean to use "total effect" as a standard for evaluating a piece of advertisement or other promotional material? It could mean that an advertisement does not have to make health and nutrition claims, or to use words like "close to mother's milk", to be disapproved. Even without these obvious elements, if the "total effect" of the ad is to portray bottle-feeding as equal to or better than breastfeeding, or to undermine breastfeeding, then the ad should be disapproved.

Using "total effects" as standard, it is not possible to create an ad or promo or marketing material for breastmilk substitutes without undermining breastfeeding. As David Clark, UNICEF Programme Officer, says: such materials aim to achieve a two-step process: first, they must convince a mother to lessen or stop or not begin breastfeeding; then second, they must convince the mother to buy a particular product to replace her breastmilk.

Therefore, the "total effect" of any material that advertises, promotes and markets breastmilk substitutes is to undermine breastfeeding, and any such material should be disapproved by the IAC.

Thursday, November 1, 2007

Breastfeed/be breastfed to prevent cancer

The World Cancer Research Fund/American Institute for Cancer Research has given their 10 recommendations to prevent cancer ("Food, Nutrition, Physical Activity and the Prevention of Cancer: a Global Perspective"). Recommendation number 9 is -- you guessed it -- "mothers to breastfeed; children to be breastfed."

The other recommendations are:

  • Be as lean as possible within the normal range of body weight.

  • Be physically active as part of everyday life.

  • Limit consumption of energy-dense foods. Avoid sugary drinks.

  • Eat mostly foods of plant origin.

  • Limit intake of red meat and avoid processed meat.

  • Limit alcoholic drinks.

  • Limit consumption of salt. Avoid mouldy cereals (grains) or pulses (legumes).

  • Aim to meet nutritional needs through diet alone.

  • Cancer survivors: Follow the recommendations for cancer prevention.

The report says:

The evidence that lactation protects the mother against
breast cancer at all ages is convincing. There is limited evidence
suggesting that lactation protects the mother against
cancer of the ovary. Having been breastfed probably protects
children against overweight and obesity, and therefore
those cancers for which weight gain, overweight, and obesity are
a cause. Overweight and obesity in children tend to track
into adult life.

Thus, the report recommends exclusive breastfeeding for the first six months
of life, and thereafter, continued breastfeeding with complementary food.
The report explicity states that it supports the UN Global Strategy on
Infant and Young Child Feeding.

The report further says:

This recommendation has a special significance. While
derived from the evidence on being breastfed, it also indicates
that policies and actions designed to prevent cancer
need to be directed throughout the whole life course, from the beginning of life.

And the rest of the recommendations apply to complementary feeding, when babies start eating foods other than breastmilk.

Thursday, October 11, 2007

Media confusion on Philippines Milk Code

The long-awaited Supreme Court decision on the Revised Implementing Rules and Regulations (RIRR) of the Philippine Milk Code was finally issued on Tuesday, 9 October. What followed was a stream of news reports claiming that the Supreme Court decision was a blow to breastfeeding advocates. "Supreme Court lifts ban on advertising of breastmilk substitutes," the headlines screamed. Nothing could be farther from the truth. There never was such a ban, because as soon as the RIRR was promulgated, the milk companies asked the Supreme Court to place it on temporary restraining order, which the Supreme Court GRANTED. The RIRR had been suspended all this time, milk companies continued to market and advertise and peddle their products with impunity ... until last Tueday.

In fact, the Supreme Court decision was in favor of the respondent, the Department of Health. The Supreme Court lifted the temporary restraining order on the RIRR -- with a few exceptions -- which means that the RIRR is now in effect. The Supreme Court ruled largely in favor of the Health Department:

"Except Sections 4(f), 11 and 46, the rest of the provisions of the RIRR are in consonance with the objective, purpose and intent of the Mllk Code, constituting reasonable regulation of an industry which affects public health and welfare and, as such, the rest of the RIRR do not constitute illegal restraint of trade nor are they violative of the due process clause of the Constitution."

Sections 4(f) and 11 call for the prohibition of the advertising, promotion or sponsorships of infant formula, breastmilk substitutes and other related products. Section 46 imposes administrative sanctions for the violation of the Milk Code, including fines higher than what the Milk Code originally specified. Unfortunately, media reports have focused on the loss particularly of the provision banning the advertising of breastmilk substitutes.

What the Supreme Court upheld

Other than than these, the rest of the RIRR can now be implemented! And the rest of the RIRR calls for significantly tighter regulation on the marketing of breastmilk sustitutes and related products, most notably:

* The Milk Code's coverage is not limited to children 0-12 months old. Rather the Supreme Court upholds that the Milk Code's scope covers all breastmilk substitutes including those to be used by children aged over 12 months. (The Milk Code defines "breastmilk substitutes" as "any food being marketed or otherwise represented as partial or total replacement of breastmilk whether or not suitable for that purpose.")

* Advertising, promotion or other marketing materials for breastmilk substitutes need to be approved by the Inter-Agency Committee and should not contain, among others, terms like "close to mother's milk", pictures or texts that idealize infant and milk formula. Any health and nutrition claims, false or misleading information or claims of products are prohibited.

* Breastmilk substitutes have to follow labeling requirements, in both English and Filipino, which include a message on the "health hazards of [the use] unnecessary or improper use of infant formula and other related products including information that powdered infant formula may contain pathogenic microorganisms and must be prepared and used appropriately."

* Milk companies are prohibited from giving financial or material inducements or gifts of any sort to promote products to health workers and to any member of the general public. They cannot give donations to the general public, hospitals, health facilities, their personel and members of their families.

* Milk companies are prohibited from conducting or being involved in any activity on breastfeeding promotion, education and production of materials on breastfeeding, or to act as speakers in classes or seminars for women and children's activities, and to use these venues to market their brands or company names. Neither can milk companies have point-of-sale advertising, give away samples and other promotional items, etc. directly to consumers at retail level.

* Milk companies shall not form part of any policymaking body involved in the advancement of breastfeeding.

These are but a few of the "gains" that breastfeeding advocates have obtained through the Supreme Court's ruling. One of my favorite sections in the Milk Code is the little-known and little discussed Section 56, Extending Prohibition for Brandnames and Company Logo Identification. It says, "The Department (of Health) shall periodically review whether or not to allow or prohibit the use of brandnames or company logos of products within the scope of this Code which are similar to the brandnames or logos utilized for products not covered by this Code, including the physical appearance of the container...."

So you see, contrary to what the press has been reporting, we breastfeeding advocates have gained much more than we lost. All in all, the Supreme Court decision was a victory for breastfeeding in the Philippines.

Now we face the work of ensuring the implementation of the RIRR of the Milk Code.

Download the entire Supreme Court decision here:

Download the UNICEF official statement here:

And here's Atty. Ipat Luna's take on the Supreme Court ruling:

Sunday, October 7, 2007

A tiny woman who moved mountains

"We allowed the companies to touch the lives of our babies, not because we did not care, but because we did not realise the consequences of granting such a privilege. How to change all that? How to break the ‘friendly’ stranglehold that we had allowed the milk companies to have on our hospital?

I closed the door of the nursery to the milk companies. We stopped giving our babies the starter dose of infant formula. Down came the colourful posters and calendars; in their place we hung the "baby killer’ posters which show an amaciated baby inside a dirty feeding bottle. Would the milk companies sue me, I wondered. Everything that was conducive to bottle feeding was removed not only from the nursery, but from everywhere else in the hospital. I myself rejected samples and donations from the milk companies. How else could we be credible?"

Dr. Natividad Clavano, 1932-2007

Thank you very much to Patti Rundall (Baby Milk Action) for sending the above quote of Dr. Clavano.

Below are some more tributes and memories of Dr. Clavano, coming in from different parts of the world.

From Prof. David Morley, MD, CBE of University College London-Institute of Child Health:

Natty came to the Institute of Child Health concerned to learn more about Asthma. However with only a little persuasion she came to see the great need of the underprivileged in her country. She returned to set up the Under Five's Clinic and also started a large study in Breast Feeding in the local Hospital in Bagnio north of Manila in the Philippines, which I had an opportunity to visit. The success of her study on Breast Feeding came to the notice of UNICEF and the support of Jim Grant whose Baby-Friendly Hospital initiative she was one of the earliest to successfully implemented.

She had great drive and was a wonderful person not least because she came from the more wealthy in Philippine society but appreciated the needs of the poor and underprivileged.

From Anwar Fazal, grassroots activist and recipient of the Alternative Nobel Peace Prize, Malaysia:

Dr. Natividad Clavano, this tiny woman moved mountains. To those who said it could not be done i can hear her saying " get out of the way of those of us who are already doing it!"At the Baguio Hospital in the Phillipines, she gave us a shining model that inspired two generations of activists and health professionals. Her competence and her courage was legendary.

And just last year she called me to say she wants to do more and to call her if we needed her for anything. She spawned energy and confidence and was there for us, always. How would Dr Clavano, a dear friend for over 30 years,be like to be remembered? I thought she would have liked to share this poem by Margaret Powers:

Do not stand at my grave and weep.

I am not there. I do not sleep.

I am a thousand winds that blow.

I am the diamond glint on snow.

I am the sunlight on ripened grain.

I am the gentle autumn rain.

When you awaken in the morning's hush,

I am the swift uplifting rush of quiet birds in circled flight.

I am the soft star that shines at night.

Do not stand at my grave and cry:

I am not there. I did not die.

We are glad that through her great work she will always be with us. That how she you would want it to be and thats how it will be. Salams, sister clavono and thank you...

More from Innes Fernandez, in behalf of Save Babies Coalition:

Dr. Nativid Relucio-Clavano October 04 at the Makati Medical Center in metroManila. We will miss our breastfeeding doctor-warrior who bravely testified against milk companies insidious marketing that caused bottlefeeding menace. She talked openly about how Nestle in a meeting in Geneva tried to bribed her in exchange for dropping her remarkable study. She conducted an intensive research studies on breastfeeding and how it save thousands of babies' lives. It also exposed the consequences of bottlefeeding and diarrhea in the 70's and 80's. It was a global reference. She continued to pursue another thorough study on complementary feeding. She was one of the few brave woman-doctor who despite her lingering illness gave breastfeeding trainings anywhere and anytime especially last year. On media interviews, she dared to tell the public about milk companies advertising lies, she is one of few doctors unafraid of the multinational giants.

She awaited for the Philippine Supreme Court long standing (2 years) final verdict on the revised Implementing Rules and Regulation of our Milk Code law. The multinational milk-pharmaceutical companies composed of Mead Johnson, Wyeth, Abbott-Ross, Glaxo-Smithkline, Novartis etc. formed an NGO called PHAP-Pharmaceutical Healthcare Association of the Philippines who sued the Department of Health officials for passing a strong rules covering a ban on advertisement on babyfood for babies below 2 years old etc.

Dra. Naty R. Clavano could no longer wait for it. She bid the world goodbye. She is an inspiration for us, a moving spirit behind our babyfood issue struggles.

From Virginia Thorley, OAM, PhD, IBCLC, Member, WABA's International Advisory Council Lactation Consultant (original cohort of 1985). Cultural Historian of the History of Medicine. Brisbane, Queensland, Australia:

I send my condolences to all in the Philippines who worked with Dr Clavano in her campaigns to support the health of mothers and babies and defeat the attacks of breastfeeding. I hope her example will inspire others to take up the work.

From Dr. Marina Ferreira Rea, Senior Researcher, Institute of Health Of Sao Paulo, Brazil:

Dear Ines, Beautiful and sweet letter. I make your words my words. I was with Dr Clavano last time I was there in 2006 and could see how the national authorities supported her.

Please, if you have opportunity to see the family tell them that we - even farway in Brazil - wish she rests in peace. Much love to you and our wonderful filipino friends.

Thursday, October 4, 2007

Tributes to a breastfeeding icon

More tributes to Dr. Natividad Clavano are pouring in. Please check back on this post often for new tributes.

From Dr. Nicholas Alipui, Country Representative, UNICEF Philippines

It is with anguish and a deep sense of loss that I received the news about the passing away of our dear friend and colleague, Dr. Clavano. My wife Ana Mabel and I composed the following personal tribute for her:

Today 3 years since we got to know you we realize once and for all that the time has really come for us to release you into the bosom of the Lord Almighty and we do so in humility and in thanksgiving for your wonderful and enchanted life. In your passing, we remember you for your beauty, your warm friendship, your deep intelligence and above all how full you have been of life, passion and ideas, and how in life you have always put the Rights and welfare of others above your own comfort. You had that simple way of giving yourself completely for the happiness of others. And in your search for justice for infants and young children, you gained international recognition and worldwide praise for your breastfeeding promotion work.

Once, every so often in our lives, we meet rare and extraordinary people who leave indelible marks in our memory and few who actually touch the core of our humanity with their own human spirit. We are very happy to say that you have been one such friend and colleague for us and for many others with whom you worked for children here and all over the world. It has been a delight knowing you and a real priviledge sharing the same podium with you sometimes. We are happy that already in life while you were still here with us, we have had the priviledge of letting you know just how high our regard and admiration has been for you and for all your achievements. Together, we have enjoyed warm light moments as well as the passion and intense advocacy and practical work for children's Rights. You have been a worldwide icon for breastfeeding and a tireless defender of the Right to food security for infants and young children. You have not lived long enough to witness in this life the verdict of the Supreme Court in the ultimate challenge in the defence of the Right to breastfeed for young Filipino children but your work continues to inspire and motivate us all. We have learned so much from you and hope that in some small way we too in our interactions with you have managed to impart some joy and happiness to you.

Thank you for your love. Thank you for your friendship. We will miss you very much. But your work lives on. Ate Sempre! A Luta Continua! Dr. Clavano descanse em paz eterna!

Patti Rundall, Policy Director, Baby Milk Action, sent an email and a picture of her, Prof. David Morley and Dr. Clavano taken in 1989 during the IBFAN-BUNSO Convention in Manila. "She was such an important person and a huge inspiration. Her story has been an inspiration to many of us because she so honestly examined what was going wrong with the health worker practices and was prepared to do something about it. Her actions have huge relevance today for health professionals everywhere a the "friendly" stranglehold continues," Patti wrote.

INFACT Canada wrote the following tribute in its newsletter:

INFACT Canada was dismayed today to hear of the death of eminent Filipino breastfeeding activist Dr. Natividad R. Clavano. Our national director, Elisabeth Sterken, had met Clavano, who will be long remembered in the Philippines and around the world for saving the lives of many, many children.

INFACT Canada would like to extend our condolences to Dr. Clavano’s family and friends. She not only saved the lives of many infants, but also convinced thousands of others to work towards the protection of infant health. She and her work will live on in those she inspired.

From Innes Fernandez, Executive Director of Arugaan and convenor of Save Babies Coalition:

Dear Dra. Clavano,

You have lived a great life, an inspiration for us whom you left behind to continue the struggle for the rights of mothers and babies for the protection of breastfeeding.

Most admirable was your being a doctor- warrior who spoke strongly against the abuses of the multinational milk companies in either media interviews or in any arena of learning. You have reached 2 Senates to testify on the unethical milk marketing correlating your intensive research studies that bespeaks of bottlefeeding menace that wreak thousands of lives. The first one was at the USA Senate Inquiry under Senator Ted Kennedy 3 decades ago and lately at the Philippine Senate on the Milk Code Inquiry.

I can never forget how you bravely told the story on how Nestle officials tried to bribe you in Geneva meeting in exchange for stopping your breastfeeding research study that became a global reference. And how you rejected them in disgrace.

Also, how you kept saying that the enormous work you have done was first recognized by the international community and only after that the local recognition came later.

God is the witness to your valuable work.

I am blessed to have worked with you at the last trainings you gave for the UNICEF initiated testing of the breastfeeding manual in Tagaytay and Davao 2 years ago. I vividly remembered your advise with regards to poster making addressed to me and Jing in your house in Baguio: "Mapaiba naman" (make it different). You showed an article from the Inquirer about ads impact. Then you got some banner photos of breastfeeding mothers and remarked that " sawa na ang public seeing the same photos" and you brought out the slide where yellowish milk colostrum drips and you said," tingnan mo this has an impact, people will pay attention to this precious life saving mother's milk" . I told myself that if I got the chance with funds, indeed I will make use of this colostrum poster and create one for the public.

And how you pointed to me while I was giving lecture on breastfeeding and working women management, you corrected me that there is no need to sterilize the cup in keeping the preserved breastmilk. The cup just needs to be washed with soap and water and kept clean. You emphasized to the participants that it is the artificial rubber teat that is the culprit of contamination.

In Davao, I could sense the frailness of your health but you persevered and continue to 2 do things simultaneously hopping from one training to the other as resource person for the breastfeeding seminar and the nutrition event.

You are a character that no one can match. Full of life despite vulnerabilities. Unafraid of giants.
As you jokingly said, " I am small but like big, look at my husband, and I like big study to undertake thousands of respondents".

Dato Anwar Fazal pioneering founder of WABA and IBFAN described you as " a tiny woman but moved mountains".

In sadness and in sympathy, we pray for your peaceful journey in heaven. Knowing fully well that you will be our guardian angel and guide the Supreme Court Justices to see the pot of gold in breastfeeding not the green bucks of the milk companies and prod them to sign the passage of the final verdict on the revised IRR of the MIlk Code( en toto) as Christmas gift. Sorry Dra. Clavano even if you are already in heaven you still have favors to bring for us.

Innes in behalf of the Filipino mothers and babies and the world's activists for food- health security and sovereignty.

Wednesday, October 3, 2007

Goodbye to a breastfeeding champion

We at UNICEF were deeply saddened today to hear of the passing of Dr. Natividad R. Clavano, a passionate breastfeeding champion and advocate. By instituting a breastfeeding-only policy and eliminating infant formula in Baguio General Hospital, Dr. Clavano saved many children's lives: the hospital's newborn death rate dropped by 95 per cent!

Below, I repeat the citation made in honour of Dr. Clavano when she received the Order of the Golden Heart from President Gloria Macapagal-Arroyo on 14 August 2006.

The Order of the Golden Heart is conferred to Dr. Natividad R. Clavano for her pioneering work in breastfeeding advocacy, and infant and young child feeding

Dr. Natividad N. Relucio Clavano is hereby awarded the Order of the Golden Heart in the field of Pediatrics, where she pioneered in Young Child Feeding with her work in the "Under-Five Clinic National Program," and in Infant Feeding with her work on the "Baby-Friendly Hospital Initiative" (subsequently replicated in 192 countries) which made her famous all over the world, where she banned infant formula milk from the Maternity Ward of Baguio General Hospital and enforced a regime of "rooming-in" of the infant.

She graduated as a Doctor of Medicine from the University of Sto. Tomas, and took her post-graduate Studies in Pediatrics in the Institute of Child Health (1974-75), London University; consequently she was given a travel grant to travel to East and West Africa, India and Thailand to observe Child Health practices; secured a fellowship in Human Milk Banking in Paris and London, got a scholarship for Lactation Management in the United States.

Dr. Natividad Clavano became the first and foremost Breastfeeding Advocate in the world, having started her involvement in the movement in 1975. In May 1978, Dr. Clavano of Baguio General Hospital in the Philippines traveled to Washington DC to attend a hearing of a US Senate Subcommittee under the chairmanship of Senator Ted Kennedy, where she galvanized the entire world with 10,000-baby study in her hospital by the total elimination of baby milk formula bottles and teats, from the maternity wards, resulted in a very dramatic reduction of infant illness and mortality. Senator Ted Kennedy joined the crusade against the milk companies and publicly demanded that the World Health Organization (WHO) do something about it. In 1981, three years later, the WHO/UNICEF passed the International Code on the Marketing of Breastmilk Substitutes and Other Related Products. The passing of the International Milk Code in 1981 is traceable to the appearance of Dr. Clavano in the Kennedy Subcommittee. In 1986, five years later, the revolutionary government of President Corazon Aquino signed into law Executive Order 51, known as the National Milk Code.

News of Dr. Clavano's passing spread far and fast among the breastfeeding advocates. Mian, my co-worker in UNICEF who is now in UNICEF East Timor, sent this email:

This news really saddens me. She has really had a great impact on my life. It
was through her that I truly understood, learned and believed about breastfeeding. I remember back in the early eighties when I joined UNICEF, I trooped along with the health section, DOH and NGOs to Baguio. And I sat through her lecture on breastfeeding. Her facts were mind openers and her intense passion convinced me that I shall breastfeed my children when I will have them [Mian breastfed all of her three children]. Dr. Clavano is a rare character. I am sure we shall all miss her.

And here's an SMS from Ines Fernandez of Arugaan and Save Babies Coalition:

Our breastfeeding doctor warrior passed away awaiting the Supreme Court's final verdict on the Revised Implementing Rules and Regulations of the Milk Code.

Monday, October 1, 2007

Reaction to Dr. Silvestre's paper

Below is the exchange of emails from the SaveBabies email group, reacting to my post on Dr. Mianne Silvestre's paper about the benefits of breastfeeding:

Dear Colleagues,
Greetings! Alexis and Ines (in a previous email), thank you very much for your acknowledgment. Very humbling naman . . .

I guess that, in my work as a neonatologist, I am just so lucky to be able to witness all the amazing capabilities of the newborns and mothers and contribute to protecting breastfeeding from the magical first hour :-) And I am just picking up the work that Drs. Natividad Clavano and Gloria Ramirez started way back and that Dr. Lester Lora and others continue with but just in a different arena. More and more pediatricians and some obstetricians and anesthesiologists are changing their hearts and minds about breastfeeding. We just have to keep the messages clear, consistent and resounding :-)

As educators, we dream to put breastfeeding at the CORE of pediatric (and for that matter, all medical and paramedical) education where it should rightfully be. Admittedly, we are having to chip away at long decades of the opposite. Currently, bottle feeding is the routine, the ordinary, the commonplace in many health facilities and homes with the breastfeeding as an outlier. Our target is to reverse this and make breastfeeding the routine.

More strength and energy to all of us, in our little corners,

Hello Mianne,

Thank you for the compliment in including me as one of the fighters
for the milk code implementation. When I was at the inauguration of
our Lady of Caysasay Hospital in Lemery Batangas, I talked with
Secretary Duque who told me to continue fighting for the breastfeeding
campaign. I hope I can be with you some other time to implement the
breast milk cup feeding in the hospitals.

God bless,
Dr. Lester Lora

Dear Dr. Mian Silvestre,

Maraming Salamat!

Your concise article on breastfeeding benefits science-based is truly valuable. I thank God for having you with our e-group save the babies coalition. I will have it as part of our information kit and will be disseminated to our forthcoming forum and training seminars:

1. AMA School of Medicine and Nursing " Breastfeeding at the heart of Maternal and Child Health" on October 15
2. Cebu Forum and Seminar Training with Educators Network and Media on October 18-20
3. Zamboanga Forum and Seminar Training with Bangsa Women Lawyers,Educators and NGOs on November after the All Souls's Day
4. Barangay Leaders and Mother Counsellors in Barangay Vasra, Quezon City on October 11
5. La Salle students sponsored by La Salle University Department of Psychology on October 02

All of the above will highlight the breastfeeding issue and the Milk Code rIRR. It will be under the food and health security macro issue.

Keep on with your God given resource as genuine gifted child. Keep on writing and speaking on the protection of breastfeeding anytime, anywhere.

Sincerely, Innes

Tuesday, September 25, 2007

A neonatologist tells why to breastfeed

Dr. Mianne Silvestre, a neonatologist who practices in Philippine General Hospital and St. Luke's Medical Center, sent us an abstract of lectures she delivers about the benefits of breastfeeding. Unlike the medical doctors I posted about earlier, Dr. Silvestre is very knowledgeable about breastfeeding and gives real support to mothers and their babies. As a neonatologist, she cares for pre-term babies with many health complications and problems. Yet Dr. Silvestre is able to support both mother and child to have a successful breastfeeding relationship. She has a video wherein she is assisting a newborn delivered via cesarean to latch on to its mother. More doctors should be like Dr. Silvestre!

You can read Dr. Silvestre's paper by downloading it here:

Dr. Silvestre says that, according to evidence, "what occurs in breastfeeding is not just a mere transfer of nutrients and antibodies but a complex relaying of immunologic memory and interaction." She further gives evidence for the following recommended practices:

Why early latching on:

  • Colostrum colonizes the newborn's digestive system with good bacteria, which protects against infection

Why exclusive breastfeeding:

  • Even small amounts of infant formula or solids disturbs the optimal colonization of a newborn's intestines
  • Each mother produces breastmilk with antibodies against bacteria in her environment. Therefore, baby is protected from disease-causing bacteria to which it is exposed. Infant formula cannot do this. "Breastfeeding works its wonders even in the harshest, dirtiest, most economically deprived of environments," Dr. Silvestre says.

Why exclusive breastfeeding for six months and up to two years or beyond:

  • Because breastfeeding continues to protect children from infections and death due to infections long after the first year of life.
  • In a two-year study of 9,942 children in Cebu City, children who were not breastfed in the first six months of life had an 8- to 10-fold higher risk of dying from diarrhoea. According to the WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality, babies who were not breastfed have a six-fold greater risk of dying from infection in the first two months of life.
  • As published in The Lancet, the Bellagio Child Survival Study Group estimates that exclusive breastfeeding for six months can reduce underfive deaths by 13%.

Dr. Silvestre concludes, "indisputably, breastfeeding is the single most cost-effective intervention for saving child lives."

Friday, September 21, 2007

On the importance of fathers

Got this email from Ines Fernandez, Executive Director of Arugaan and founder of Save Babies Coalition. Ines is one of the foremost breastfeeding advocates in the Philippines. WABA awarded her earlier this year -- but that's for another post. Here's Ines' email:

Happier to share with you that the Father Support Summit "Fathering the Mother" will be held on Sept. 23 on Sunday at 1-4pm at the University of the Philippines Small Scale Industry - UPSSI in Diliman, Quezon City.

Kindly join us and actively participate. We need your sharing of your insights and experiences for the next new fathers to be. Help them in their fathering journey with your stories as map guide. Make them successful with their breastfeeding mothers and babies. Let us no longer contribute to the hefty 22 billion milk sales yearly and not be part of the guilt for seeing Filipino babies asthmatic as a consequence of not breastfeeding.

Please invite your friends: male or female, youth,young professionals, single or married, young at heart who still wish to have babies, age does not matter, after all they have women in the family who will be the nurturers of the next generation. Men support is very crucial for prepared participatory birthing and breastfeeding.

It is a free interactive forum " Fathers Support Summit" come September 23.

Hopeful and thankful to see you, your family and friends.

Sincerely, Innes

below is the invitation and program.

We would like to invite you to participate with us at the forthcoming Father Support Summit titled " Fathering the Mother". It will be an interactive sharing of insights and experiences on the role of men as partners in parenting, understanding pregnancy, involvement in birthing, facilitating successful breastfeeding and nurturing care.

Below is the program:


1:00 -1:15 Registration
1:15-1:30 Welcome and Introduction
1:30-1:45 Sharing from an active partner in birthing
1:45-2:00 Video show
2:00-2:15 Overcoming Difficulties in the world of pregnancy and birthing
2:15-2: 30 Facing the challlenges in infant feeding choices
2:30-2:45 Consequences of choices: life stories
2:45-3:00 Shared Parenting: Ups and Down and Way Forward
3:00-3:15 Snacks
3:15-3:30 Open Forum
3:30-3:45 Suggestions: Action Plan
3:45-4:00 Summit Series for October: "Mothering the Father"

What: " Fathering the Mother" Father Support Summit 1

When: September 23, 2007 Sunday 1-4 PM

Venue location: Virata Hall, 1st Floor Theater, University of the Philippines Small Scale Industry -UPSSI

(turn left road as you enter UP before the Oblation (statue) UPSSI is beside Bonifacio Hall/Solair

This gathering "Father Support Summit" is a free interactive forum. Kindly join us and be an active partner in this new undertaking for new young fathers to be and for those who want to be involved in their fathering role as partners in life.

Looking forward to see you and your spouse, friends and families including young men,wise men, young at heart.


Ma. Ines Av. Fernandez and Jonathan Adam Roxas
Executive Director Focal Point
Father Support Summit

Thursday, September 13, 2007

Wrong again, Doc!

I don't like telling people that their medical doctor was wrong, or gave them bad advice. After all, I am no medical doctor; I'm not even a nurse or midwife or lactation consultant. I am merely a mother who breastfed two children and is currently breastfeeding a toddler. And I am a passionate breastfeeding advocate (lactivist?) in both my personal and professional life in UNICEF.

But sometimes, I simply have to state a fact: a medical doctor, trained for years in human anatomy, diseases and their treatment, has erred yet again in counseling a mother in the most natural act of breastfeeding.

Just recently, a working mother of a two-month-old was apologetically explaining to me why she was mixed-feeding her baby. She never had enough milk, she says. "Oh, and something happened when my baby was a newborn," she recalls, "My baby had diarrhea. She had a bowel movement after almost every feeding, up to six times a day! So my doctor told me to put her on 'tummy rest'."

"What do you mean, 'tummy rest'?" I had never heard the term before.

The mother explains, "Oh, I stopped breastfeeding for 24 hours. Instead, I gave my baby infant formula."

As you can expect, I could not help myself: "Your doctor was wrong!"

Tummy rest? It was tummy "stress", I protest! Nothing is easier for the baby's tummy to digest than breastmilk (assuming the mother is not eating anything that the baby is allergic to). So instead of giving her baby's tummy a rest, she put her under more stress. "Besides," I say, "your baby was not having diarrhea. It's perfectly normal for a breastfed baby, especially a newborn, to have a bowel movement after each feeding."

The sad part is, this is not the first time I have heard of medical doctors and nurses giving wrong advice to a breastfeeding mom. Here are some other instances I can recall:

  • When my second baby was 7 months old, a doctor told me I had to stop breastfeeding because he was going to put me on antibiotics. I asked if he couldn't give me a safe medicine for a lactating mother. Nope, he claimed, and even showed me the entry in PIMS where it says that the medicine wasn't safe for breastfeeding women. "Besides," he said, "at 7 months your baby is only breastfeeding for emotional reasons." Near tears, I consulted an expert in WHO who reassured me that I could continue breastfeeding even while on medication. In fact, the very same medicines prescribed to me are sometimes prescribed to babies, in pediatric formulation, of course.

  • One colleague was told by her doctor to stop breastfeeding because she had colds and a fever. "Or else you'll pass the virus on to your child," the doctor warned.

  • A new mother was told by nurses to give her baby glucose water, while her breastmilk hadn't yet come in. Fortunately, this first-time mother had read enough breastfeeding books before childbirth to stand her ground and say, "No, thank you, I'm breastfeeding my baby!"

  • Another first-time mother, who was having trouble latching her baby on, was advised by hospital staff to pump her milk instead. Today, this mother is a master pumper, pumping enough breastmilk for both her son and a niece. But directly breastfeeding her baby remains a challenge.

Last June, I had the priviledge of meeting Dr. Audrey Naylor, physician and CEO of Wellstart International. Dr. Naylor said that in all her years of training in some of the most prestigious Ivy League universities in the States, she did not learn about breastfeeding at all. Thus, Dr. Naylor founded Wellstart "to advance the knowledge, skills, and ability of health care providers regarding the promotion, protection, and support of optimal infant and maternal health and nutrition from conception through the completion of weaning."

Doctors and other health care providers need to be part of the overall solution to the decline of breastfeeding in the Philippines. Mothers, fathers and other family members regard doctors highly and follow their advice. When doctors give the wrong advice, breastfeeding may be interrupted or come to an end altogether. The consequences are not to be taken lightly. A baby's sustenance in the first years of life has long-term effects that persist into adulthood. And we cannot turn back the hands of time to undo the harm that was done in infancy.

Our babies will never be this age again.

Sunday, August 5, 2007

Idol ng Breastfeeding

Last week, I met the Philippines’ first-ever “idol of breastfeeding”, Tessa Prieto-Valdez. Tessa is a fashion designer, columnist and socialite known for her flamboyant outfits. She also comes from the wealthy Prieto clan, who controls one of the largest newspapers in the Philippines, the Philippine Daily Inquirer. I was surprised that Tessa is quite diminutive, even smaller than me, that her first-born is 20 years old, and that she has quite a sense of humor. She said, “I never imagined that my small breasts would ever take center stage!”

It may seem strange that the Philippines would need to have a breastfeeding “idol”. But having breastfed two children and currently breastfeeding my 11-month-old baby, I can see the wisdom in it. Breastfeeding is no longer commonplace, and media only shows bottle-feeding as the normal way to feed a baby.

I owe some of my breastfeeding success to mothers who have modelled breastfeeding for me. I would like to dedicate this post to them, my very own breastfeeding idols:

Victoria, my sister. Vicky became a mother when she was only 20 years old and I was 15. Being the last-born child, I thought babies were alien beings, but through Vicky’s motherhood, I first fell in love with babies. Vicky produced copious amounts of breastmilk. She leaked through diapers, towels and anything else that she placed on her chest. I didn’t know it then, but this image was a powerful one for me. You see, Vicky and I are similarly endowed (that is to say, not well-endowed), and her nursing experience planted the idea in my subconscious that I, too, could produce a lot of milk.

Melen, former Executive Director of the Council for the Welfare of Children. Years before I even thought of marriage and motherhood, I attended meetings with Melen. In a few of them, Melen brought her baby and nursed her right then and there, in front of everybody, without apology, without a thought. Melen’s example showed me many things: that working women could breastfeed; that breastfeeding is something to be proud of; and, most importantly, that babies and their Moms should stay together as much as possible.

May and Mian, my UNICEF colleagues. When my fiancé and I were attending our pre-marital seminars at the City Hall, we saw a poster of a breastfeeding mother and child. It was May and her baby. May, who had four babies in four years, always gushed about having babies naturally and breastfeeding them. Mian also had natural childbirths and, in fact, was the one who introduced me to my ob-gyne when I was looking for someone who would let me give birth without drugs. Mian brought her babies to office outings, meetings and official trips even to Southern Philippines. May and Mian taught me that breastfeeding was one of the best things about motherhood, and that we could combine breastfeeding with our work in UNICEF. If there’s a will, there’s a way.

As a breastfeeding Mom, and one who works, I feel a responsibility to show off my breastfeeding. I nurse in public – at the mall, in Church, at work, on the street. I declare a little too loudly to the building security that the big black bag I am carrying is not a laptop but a “breast pump”. It’s important for other women to see breastfeeding as natural, enjoyable and doable even for a working Mom.

One of the best compliments I’ve ever received was when Yas, a woman I work with in the UNICEF-assisted media advocacy project, said about me, “she’s my breastfeeding model!”

Wednesday, August 1, 2007

Measuring Breastfeeding

In celebration of World Breastfeeding Week, the Pharmaceutical and Healthcare Association of the Philippines (PHAP) has published an ad expressing its support for breastfeeding. However, PHAP still refuses to recognize that breastfeeding rates are indeed on the decline, particularly exclusive breastfeeding in the first six months. The ad states that: the Philippines has a "commendable" 87% breastfeeding rate, 54% of mothers start breastfeeding within one hour of birth; 92% of 6-month-olds are breastfed at least 6 months in a 24-hour period, and over 30% of mothers breastfeed up to 23 months.

Do these numbers really add up to a rosy picture of breastfeeding in the Philippines?

Last month, UNICEF developed a little matrix for journalists, entitled, "Measuring Breastfeeding." It can be easy to look at a piece of breastfeeding statistic and, without knowing what the number really means, conclude that breastfeeding rates are high in the Philippines. Hopefully, this matrix will help set the record straight:

If one uses "ever breastfed" and "exclusively breastfed, below 6 months", one would conclude that: the majority of women breastfeed and one-third of all babies are exclusively breastfed. However, considering the recommendation by WHO and UNICEF for optimal breastfeeding, these numbers are virtually useless.

WHO and UNICEF recommend exclusive breastfeeding for the first six months. After this, breastfeeding should continue along with the feeding of nutritious complementary foods.

Therefore, it is not very useful to know that 86.5% of women have ever breastfed. This counts even those women who breastfed only once for even one minute or a few seconds!

The second statistic is not much help, either. It counts all babies, from 0 to six months old, who are being exclusively breastfed. This includes those who are being exclusively breastfed at one month of age, but who will no longer be so the next month. Therefore, it gives no indication of the total length of exclusive breastfeeding.

So the indicator that we use -- and it isn't perfect either -- is "exclusively breastfed, 4-5 months". This is a count of all babies who are 4-5 months old and being exclusively breastfed. It doesn't include those who go up to six months of exclusive breastfeeding, but it's the best that we've got. This number is small, merely 16.1%, and we can safely assume that the percentage of infants who do reach exclusively breastfeeding up to six months would be even lower.

The median duration of exclusive breastfeeding is even more dismal. Half of all infants in the Philippines are exclusively breastfed for less than 0.8 month or 24.8 days.

These last two indicators make it clear: very few babies in the Philippines are being exclusively breastfed for six months. And there lies the problem.

Note: All statistics are from the 2003 National Demographic and Health Survey.

Tuesday, June 26, 2007

The week that was

Whew, what a week that was!

On Monday, we had a press briefing for the justice reporters. Previously, the Milk Code issue was being covered by health beat reporters. We wanted to motivate justice reporters to cover the subject as well, particularly the Supreme Court hearing.

On Tuesday, we had the Supreme Court hearing. It was high drama all throughout. Our NGO partners, led by Innes Fernandez, organized a lightning rally in front of the Supreme Court. They bared their breasts to express their outrage that the Milk Code's RIRR was still being held hostage by the Temporary Restraining Order. Need I say that they made the headlines the next day?

The Philippine Daily Inquirer splashed a photo of the "militant breastfeeding mothers" on the front page on 20 June 2007:

Inside, the drama continued. One of the best reports was made by, again, the Philippine Daily Inquirer.

The article quotes the different Supreme Court Justices. My favorite is the description of Chief Justice Reynato Puno's line of questioning:

Chief Justice Reynato Puno for his part said the power of the DoH to formulate rules came from three sources -- the legislation of Congress, international covenants, and the police power of the state.

Illustrating the DoH’s police power, he said that if the department would find rotten milk being sold, it had the power to take it out of the market.

The Pharmaceutical and Healthcare Association of the Philippines and Department of Health have 30 days from 19 June to submit their memoranda to the Supreme Court. We're expecting the Supreme Court's decision shortly therafter, as Chief Justice Puno himself said in later interviews:

"It will not be too long, the issues are not that complicated."

That's what we have been thinking all this time.

On Wednesday, UNICEF and WHO had a joint press conference for the Asia Pacific Regional Consultation on Breastfeeding Protection, Promotion and Support. The reporters came in droves jokingly looking for the bare-breasted women again. The AFP covered the event and its report was published by The Manila Times, among others:

Now if you've read this far, thank you very much! But the week isn't over yet! Thursday evening, we had the premiere screening of "Formula for Disaster". Over 200 guests arrived. A panel of international experts gave their reactions to the video, after which we had a lively discussion with some of the guests. One of them was a member of the Philippine Medical Association, and when he spoke, he sounded very much like the petition that PHAP submitted to the Supreme Court. Of course, our NGO partners could not contain themselves. Dr. Elvira Henares-Esguerra, Executive Director of Children for Breastfeeding, countered by quoting Chief Justice Puno (see a few paragraphs back). And then Innes Fernandez, Executive Director of Arugaan and founder of Save Babies Coalition, Innes of breast-baring fame, gave her usual passionate response.

On Friday, the regional breastfeeding consultation wrapped up in WHO. But before that, I brought David Clark, Project Officer (Legal) of the Nutrition Section in UNICEF New York, to be interviewed on the ABS-CBN News Channel. It was his most surreal interview, because the PHAP lawyer and a business consultant who's on PHAP's side, were interviewed before him. They questioned our statistics, insisted that the exclusive breastfeeding rate was 88% and not 16%, and dared us to produce a single child death that was directly attributable to infant formula. Well, I will do just that on another post.

Finally, the long and intense week was over. I did a phone patch interview for Radio Veritas on Saturday morning. In the afternoon, I barely made it to my godson's baptism (so sorry Mikael!). I got dizzy for a few seconds in the car and considered not going at all. I think it must have been the week of missed lunches, responding to the needs of journalists, and having a teething 9-month-old baby. I think it's called fatigue. But boy, was it worth it.

Monday, June 18, 2007

Today is D-day!

Today is the day!

In a couple of hours, the Department of Health (DOH) and the Pharmaceutical and Healthcare Association of the Philippines (PHAP) will be presenting oral arguments before the Supreme Court. We have been waiting with baited breath for this moment, and UNICEF and WHO have been working overtime the past couple of weeks to ensure media coverage of the issue. We have not been disappointed. Following our press briefing for Justice beat reporters yesterday, nearly all national broadsheets today have published reports about the Supreme Court hearing today. An example is the front-page report on Business Mirror published today:

Below is the Milk Code timeline, beginning in 1981 when the Milk Code was first drafted:

1981- Prof. Esteban Bautista of the UP Law Center drafted the Philippine National Code to regulate the marketing of breastmilk substitutes, breastmilk supplements and related products.

1981-1985 - NGOs, led by the National Coalition for the Promotion of Breastfeeding (NCPB), later named BUNSO, lobbied for the passage of the Philippine Code to the Batasan Pambansa lawmakers.

1983 - UNICEF supported the formation of the National Movement for the Promotion of Breastfeeding (NMPB), a conglomerate of government, NGOs and medical societies.

1986 - BUNSO staged a street march of breastfeeding mothers and babies, together with community leaders and doctors, lawyers and church representatives, in front of the offices of four milk companies: Nestle, Mead Johnson, Wyeth-Suaco and Abbott-Ross

1986 - Breastfeeding mothers and babies joined the final drafting of the Philippine National Code, popularly known as the Milk Code, along with the Department of Health and Malacañang Legal Team.

1986 - In October, President Corazon Aquino, joined by Executive Secretary Joker Arroyo, signed Executive Order 51 or the Milk Code. The ceremony was led by Health Secretary Alran Bengzon. It was graced by breastfeeding mothers and babies representing BUNSO and NMPB.

1987 - EO 51 took effect, Wyeth introduced follow-on formulas for six-month-old babies. When the Milk Code was still being drafted, follow-on formula was not yet invented.

1990s - Improvements on the Milk Code's IRR were made with the addition of a ban of follow-on formula that undermined breastfeeding as guided by World Health Assembly (WHA) Resolutions that stated: “follow-on or follow-up formulas are unnecessary because after six months, the baby starts to take complementary foods together with sustained breastfeeding.”

1992 - The Senate passed Republic Act 7600 or the Rooming-In/Breastfeeding Act. Breastfeeding mothers and their babies filed a petition and attended the public hearings. RA 7600 cited that breastfeeding could save the country valuable foreign exchange that would otherwise be used for milk importation.

1993 - The Mother- and Baby-Friendly Hospital Initiative was launched.

1994 - Task Force Milk Code was formed.

1999 - Task Force Milk Code actively proposed stringent implementation of the Milk Code.

2000 - Task Force Milk Code’s resolutions were overturned by an Administrative Order issued by then Secretary of Health, Alberto Romualdez. The Milk Code’s IRR were revised, allowing milk manufacturers to be engaged in all forms of breastfeeding activities such as education, production and development of breastfeeding materials.

2004 - The Secretary of Health, Manuel Dayrit, signed the National Plan of Action 2005-2010 on Infant and Young Child Feeding.

2004 - Task Force Milk Code began discussion and debate on the first draft of the revised IRR. Nestle represented the milk companies.

2005 - The 11th and12th drafts of the revised IRR were discussed in public hearings led by BFAD-DOH. Simultaneously, the Senate, Congress and Malacañang had public hearing inquiries on Milk Code.

2006 - The Pharmaceutical and Healthcare Association of the Philippines (PHAP) asked the Congressional Committee on Trade and Industry to conduct an inquiry on the Milk Code.

2006 - On May 15, the Secretary of Health, Francisco Duque III, signed the revised IRR of the Milk Code.

2006 - In July, the Pharmaceutical and Healthcare Association of the Philippines (PHAP) filed a suit against the Secretary of Health and all the undersecretaries and assistant secretaries who signed the revised IRR. PHAP petitioned for a temporary restraining order on its implementation. The Supreme Court denied PHAP’s petition.

2006 – On July 24, PHAP submits a motion for reconsideration to the Supreme Court, claiming that the milk industry would lose P9.96 billion, if the RIRR of EO 51 would be enforced.

2006 - On August 11, Thomas Donohue, President and Chief Executive Officer of the United States Chamber of Commerce, wrote to President Gloria Macapagal-Arroyo. The letter said that the RIRR “would have unintended negative consequences for investors’ confidence in the predictability of business law in the Philippines.”

2006 - On August 15, the Supreme Court overturned its previous decision and imposed a TRO on the RIRR. Representing PHAP was Atty. Felicitas Aquino-Arroyo, the wife of Senator Joker Arroyo, who was the Executive Secretary who signed the Milk Code in 1986.

2006 - In November, the Office of the Solicitor General petitioned the Supreme Court to lift the TRO. The Supreme Court denied this petition.

2007 - On 19 June, the Department of Health and Pharmaceutical and Healthcare Association of the Philippines (PHAP) will present oral arguments in the Supreme Court.

Friday, May 25, 2007

Boycot Nestle? Count us IN!

It's official: this Rodrigo family is boycotting Nestle.

When I joined UNICEF 13 years ago, I knew that Nestle was taboo, a company that UNICEF was never to work with or be associated with or even be said in the same breath. But even when I became a breastfeeding mother and a staunch breastfeeding advocate and somewhat of a breastfeeding counsellor, I never had a personal beef with Nestle. Until now.

So what happened? I had brought home a film from the office entitled, "Formula Fix." It's a 1989 report by the Australian Broadcasting Corporation on how milk companies in Pakistan and the Philippines were violating the International Code on the Marketing of Breastmilk Substitutes. I had begun watching the film in the office, but had gotten very upset to the point of crying in my cubicle. So at 2 am this morning, when my husband and I woke up hungry (I nurse round-the-clock; I don't know what his excuse is), we decided to watch it.

It is infuriating. Infant formula companies are intentionally marketing their products to the poorest of the poor. Families whom they know do not have access to clean water, do not have the resources to ensure that feeding bottles and nipples are sterilized, and do not have the money to keep buying the infant formula. They were doing it in the 80's and they're still doing it now. See for yourself; watch our latest documentary, "Formula for Disaster", now in YouTube:

The results are babies so weak, ill and malnourished that they can barely cry. They look like old men, all wrinkled up and thin. In the ABC report, I watched one baby die after suffering from repeated diarrhea. I looked at those babies and thought of Anton, with his chubby cheeks and his body so full of heft. Anton is so heavy I can no longer rock him to sleep. Those babies are a far cry from him and I could not help but mourn for all the babies who suffer, sometimes to the point of death, just because they did not get Mommy's milk. None of our children had ever had ear infections. My two older children only experienced diarrhea when they were already school-aged, and so far only once each.

So this morning, my husband announced to the kids: "Did you see the pack of Baby Ruth's in the refrigerator? Enjoy them now because this is the last time we're buying them. Starting today, we are boycotting Nestle."

If you want to learn more, please visit the website of Baby Milk Action. They have a page dedicated to the "fight for the breast" in the Philippines:

I urge you to sign the online petitions as well. In June, the Department of Health (DOH) will have its last chance to implement tougher restrictions on the marketing and advertising of infant formula. DOH will be presenting its oral arguments before the Supreme Court. At the same time, the Pharmaceutical and Healthcare Association of the Philippines (PHAP), who has challenged DOH's policies, will also be presenting in court. The Supreme Court suspended DOH's regulations because PHAP claimed that their members would lose billions of pesos if their marketing activities were restricted.

So the question is: which do we protect, corporate profits or children's lives?

What is YOUR choice?

* Graphic donated by Rebecca Clark to Baby Milk Action

Thursday, May 17, 2007

"Formula for Disaster" is now on YouTube!

Watch it at:

Make sure to watch all of the FIVE parts and let us know what you think!

Thursday, May 10, 2007

Long-term effects of breastfeeding

Our friend, Alessandro Iellamo, of WHO Regional Office in Manila, Philippines, shared with us a recently published study by WHO entitled, "Evidence on the long-term effects of breastfeeding."
The report looked at studies on the long-term effects of breastfeeding from MEDLINE and Scientific Citation Index databases, to assess if breastfeeding had long-term effects on a person's blood pressure, diabetes and related indicators, serum cholesterol, overweight and obesity, and intellectual performance.

The study concluded that:

The available evidence suggests that breastfeeding may have long-term benefits. Subjects who were breastfed experienced lower mean blood pressure and total cholesterol, as well as higher performance on intelligence tests. Furthermore, the prevalence of overweight/obesity and type-2 diabetes was lower among breastfed subjects. All effects were statistically significant, but for some outcomes their magnitude was relatively modest.

More specifically, the studies reviewed showed the following effects:
  • on blood pressure: Among studies that controlled for socioeconomic and demographic variables, systolic blood pressure was lower among breastfed subjects by 0.69-1.7, and diastolic blood pressure was lower by 0.10-1.12.
  • on serum cholesterol: Breastfed subjects had lower mean total cholesterol in adulthood, by 0.06 - 0.30 mmol/L. For children and adolescents, the association was not statistically significant.
  • on overweight and obesity: Breastfed individuals were 72-84% less likely to be overweight and/or obese.
  • on type-2 diabetes: Breastfed subjects were 45-89% less likely to present type-2 diabetes
  • on intelligence and schooling: Intelligence scores of breastfed subjects were 2.97-6.92 points higher

The study also compared the magnitude of the effects of breastfeeding with the effects of other public health interventions:

For blood pressure, the effect of breastfeeding was smaller than those derived from other public health interventions targeted at adults, such as dietary advice, physical activity, salt restriction, and multiple risk factor interventions. On the other hand, for total cholesterol among adutls, the magnitude of the breastfeeding effect was similar to that of dietary advice in adulthood. Similarly, for the prevention of type-2 diabetes, the magnitude was similar to that of diet and physical activity. Concerning obesity, whereas Summerbell et al (184) reported that combined dietary education and physical activity interventions were not effective in reducing childhood obesity and overweight, we noticed that breastfeeding was associated with a 22% reduction in the prevalence of overweight/obesity.

The study can be downloaded at:

Monday, May 7, 2007

The Philippines goes for another world record on breastfeeding

The Philippines is after another Guinness World Record on Breastfeeding, this time for the most number of mothers simultaneously breastfeeding in MULTIPLE sites. Last year, the City of Manila, Department of Health, Children for Breastfeeding, and UNICEF Philippines organised a record-breaking event that garnered for the country the Guinness World Record on Simultaneous Breastfeeding in a single site.

Last May 2, thousands of mothers in various day care centres breastfed their babies from 10:00 to 10:01 am. An estimated 4,000 mothers and their babies in over 100 sites all over the Philippines joined in the event. This time, Children for Breastfeeding again organised the event, in cooperation with the Department of Social Welfare and Development and TESDA.
Some quotable quotes:
"Our event is a prayer for those children who died as well as for those suffering because of [breastfmilk substitutes]."
Nona Andaya-Castillo, organizer, IBCLC
"Stop using formula milk. A baby deserves his mother's milk."
Dr. Francisco Duque III, Secretary of Health
"Unfortunately, through advertising, most Filipino mothers now believe that artificial forms of foods for babies are actually better than breastmilk."
Mr. Dale Rutstein, Communication Chief, UNICEF
We'll know in a few weeks if the Philippines has successfully obtained another Guinness World Record. If only we could get the world record for exclusively breastfeeding for six months, and not just for one minute!
Photo: Front-page article printed on The Philipine Daily Inquirer on 3 May 2007.

Wednesday, April 18, 2007

The trouble with growing-up milk

Since the Milk Code (EO 51) was passed in 1986, milk manufacturers have created milk products for older infants and children, presumably to avoid getting labeled as "breastmilk substitutes". Nowadays, there's milk for babies from 6 months onwards, from 1 year, 3 years, preschool-age, school-age, children who are hard to feed, etc. There's milk even for adults -- pregnant women, lactating women, diabetics and seniors! As pediatrician and breastfeeding advocate, Dr. Jack Newman, says, "We will all soon be on formula from birth to death."
The trouble with marketing these other milk products, albeit they are for children and not infants, is that they tend to create the notion in the public's mind that powdered milk is an ideal food for children. Mothers tend to go by brand names. Mothers in lower-income communities, especially, do not distinguish between powdered milk for infants, toddlers, children, etc. So when their budget gets too tight to buy infant formula, they easily switch to cheaper brands of powdered milk that are made for older children or even adults.

So marketing milk for older children seems to have the net effect of promoting powdered milk for young infants and babies as well. This image we scanned from a parenting magazine shows the promotional activities for Bonakid, a milk product supposedly for preschool-age kids. But look at the babies who are being brought to these events -- the photo clearly shows infants who should still be breastfeeding. Other photos on this spread show similar very young children and their parents participating in these events. This is a blatant violation of the Milk Code, which states that:

"Manufacturers and distributors shall not be permitted to give, directly or indirectly, samples and supplies of products within the scope of this Code or gifts of any sort to any member of the general public..." (Sec 6.b); and,

"Manufacturers and distributors shall not distribute to pregnant women or mothers of infants any gifts or articles or utensils which may promote the use of breastmilk substitutes or bottle feeding...." (Sec 6.d).

It's sad that those who have the power to ensure the strict implementation of the Milk Code do not see the trouble with "growing up" milk.
Photo: Scanned from "Mommy Academy Your Parenting Partner: Traditions Issue," p. 45.

Sunday, April 8, 2007

Support from Italy!

From Ines Fernandez, convenor, Save Babies Coalition, and Executive Director, Arugaan (NGO):

We have just learned that MAMI (Movimento Allattamento Materno Italiano), the Italian WABA association, and AICPAM (Associazione Italiana Consulenti Professionali prl'Allattamento Materno), the Italian Lactation Consultants Association, have agreed to express their support to our struggle against the milk companies.

We are not afraid of them. We continue to stage people's action in many creative ways despite the media block. We got only minimal press coverage even though we have attractive visual media impact. In fact almost all the media photographers and field reporters were present in our staged public events such as the 1000 slogans painted in umbrellas by 1000 breastfeeding defenders, intergenerational plea by 18 parents and 9 children marching in front of the Supreme Court to file our legal protest, and the March for justice by victims of bottlefeeding - 150 mothers and babies in front of the milk companies with loud angry banners exposing milk companies marketing deception.

Thank you to the Italian community for their support. We have here a staunch advocate of the breastfeeding who is generously supportive of our coalition building efforts. He is an Italian married to a Filipina nurse. He works at WHO Manila. The present leadership of WHO is committed genuinely for breastfeeding and very supportive of us in many kind ways with our coalition building to save babies. Likewise with UNICEF Manila leaders they also provide us with material resources when we stage public events.

We are very grateful from the bottom of our hearts, Gracie.

About the photo: Mothers decorated and displayed advocacy umbrellas during the People's Forum on Breastfeeding held in Quezon City, Philippines, in 2006. Photo @UNICEF/PHI/2006/Albert Garcia

Wednesday, April 4, 2007

Milk Code Violations

Infant formula companies claim to support breastfeeding and implementation of the Milk Code (EO 51). But data from the Bureau of Food and Drugs (BFAD) show that they have been violating the Milk Code.

From July 2001 to December 2004, a total of 63 violations of the Milk Code were recorded:
* The most common violation was the distribution of print ads without approval by the Inter-agency Committee (43% of violations)
* The number of violations increased from 11 in 2003 to 19 in 2004.
* The highest number of violations recorded was in 2002, with 22 violations.
* Other types of violations included: using the health care system to promote breastmilk substitutes; improper use of materials; product display; giving gifts of any sort to the public; giving samples to the public; putting up streamers in conventions; publishing print ads of infant formula; putting a false cover on magazines; and, raffle promo.

Unfortunately, I only have data up to 2004. It would be interesting to see the data up to present. Did the situation improve or worsen with the issuance of an indefinite temporary restraining order on the Revised Implementing Rules and Regulations of the Milk Code?

I can't wait until we are able to screen the documentary on Milk Code violations entitled "Formula for Disaster" (see my boss's post below). When I first saw it, I was enraged to see so many mothers in urban and rural poor communities completely convinced that powdered milk will make their babies healthier and smarter. Midwives and barangay health workers themselves sound like sales representatives for milk companies, touting the beneficial ingredients of this or that product.

It must be good business to sell powdered milk to the poor, who can ill afford them, much less the additional health costs that they will incur. I wish the milk company executives would visit these communities and see the dismal conditions in which their products are being prepared, and the disastrous results on children -- malnutrition, sickness, death.

Promoting powdered milk to these families should be considered downright criminal and immoral.

Tuesday, April 3, 2007

Breastfeed all together now!

Children for Breastfeeding and DSWD Launches Sabay-sabay, Sumuso sa Nanay Year 2

Children for Breastfeeding, Inc., and Department of Social Welfare andDevelopment (DSWD) in cooperation with Technical Education and SkillsDevelopment Authority (TESDA) and TESDA Women's Center invite you to the official launching of Sabay-sabay, Sumuso sa Nanay Year 2. With the theme: Uso ang Magpasuso! (Abreast with the Times), this year's event will create the first Guinness World Record on Simultaneous Breastfeeding in Multiple Sites.

The launch will be held on April 11, 2007, Wednesday, 11:00 a.m. at the Tandang Sora Hall, TESDA Women's Center. DSWD Secretary Dr. Esperanza I. Cabral, TESDA Director General Secretary Augusto "Boboy" Syjuco, Dr. Elvira L. Henares-Esguerra, Director, Children for Breastfeeding and TESDA Women's Center Executive Director Cecile B.Gutierrez will sign a Memorandum of Agreement to stage the event.

Conceptualized and organized by Nurturers of the Earth, the affair and the simultaneous breastfeeding will feature mothers and their children who will join the national prayer of thanksgiving for motherhood and breastfeedingon May 2, 10:00 a.m. in more than 40,000 daycare centers nationwide.

World Health Organization (WHO) and UNICEF recommend that infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development and health and should receive nutritionally adequate and safe complementary foods using indigenous foods while breastfeeding should continue for up to two years or beyond.

Listen to how mothers who are committed to follow this recommendation share their stories:

  • Dr. Belen Dofitas, a dermatologist, traveled to London as a Cochrane research scholar and returned to breastfeeding her four-year old son after three months of absence. She and her son will be in Banaue, Ifugao on May 2w here she will serve in a medical mission.

  • Mary Jane Guinto delivered her third child and was advised by her doctors not to breastfeed to stop the enlargement of a brain tumor. She underwent natural healing, delivered her baby safely and is now breastfeeding.

  • Nuriza Bungubung, businesswoman, former Miss Maja Philippines, board memberof Children for Breastfeeding, Inc., is 6 months pregnant with her secondc hild and she is still breastfeeding her three-year-old child. This is her second time to join Sabay-sabay, Sumuso sa Nanay.

  • Pamela Yap-Magallon, is an event organizer and a board member of Nurturers of the Earth, Inc. She breastfeeds her 2-year-old daughter despite her demanding schedule and breastfed her first child until 3.5 years old and gave him expressed breastmilk until he was six years old.

Last year, Children for Breastfeeding in partnership with the City of Manila broke the Guinness World Record on Simultaneous Breastfeeding in a Single Site when they gathered 3,541 mothers at San Andres Sports Complex and Civic Center in Malate, Manila. In cooperation with Nurturers of theEarth, UNICEF and the Department of Health, they broke the USA record of 1,130 mothers in Berkeley, California.

Contributed by:

Nona D. Andaya-Castillo, IBCLC

Director, Nurturers of the Earth, Inc.

0919-839-5555, 889-1105, 4444-716

About the photo: Over 3,000 mothers breastfed simultaeneously in Manila, setting a new Guinness Book world record. @ UNICEF/PHI/2006/Mike Alquinto

Sunday, April 1, 2007

Coming Soon: Formula for Disaster

UNICEF will very shortly release its new documentary film called "Formula for Disaster" (photo above was grabbed from the documentary) about National Milk Code (EO51) violations by powdered milk companies in the Philippines. The film offers a shocking catalog of shameless violations which show how the health system has been completely taken over by these companies.

As an American citizen I wanted to let people know that a lot of Western countries are now rediscovering the many benefits of breastfeeding. Its so ironic that the Philippines is going in the opposite direction! In fact, many highly educated American mothers are now informing themselves about the benefits of breastfeeding and making sure they are able to breastfeed their young children as long as possible. The US Government has also embarked on an intensive campaign to help educate mothers about breastfeeding. Readers of this blog might be interested to see how the US Government is promoting breastfeeding by visiting this site:

In addition this URL from the American Academy of Family Physicians contains very useful information about the relative risks of infant formula feeding versus breastfeeding:

And this URL from the American Academy of Pediatrics is also useful:

The Philippines Department of Health, WHO and UNICEF are hoping that more and more Filipina mothers will arm themselves with information and insist that their doctors and midwives provide every possible support to exclusive breastfeeding. Please become an advocate! The health of millions of Filipino children is at stake!

Dale Rutstein, Chief of Communication, UNICEF Philippines

Thursday, March 29, 2007

We have a new print ad!

Our second print ad for National Women's Month was published early this week. This time, it is about health risks of NOT breastfeeding for children. Our colleagues in the World Health Organization reviewed the available scientific literature and concluded that there was overwhelming scientific evidence for the following health risks for children who are not breastfed:
  • diarrhea and pneumonia - formula-fed babies get diarrhea & pneumonia more often and for much longer than breastfed children
  • asthma - formula-fed infants have 40-50% higher risk of developing asthma and wheeze than infants breastfed for 9 months or longer
  • food allergy - children breastfed the longest had lowest incidence of atopy, eczema, food allergy and respiratory allergy
  • reduced intelligence - formula-fed children have IQ 3-5 points lower than breastfed children (other studies found bigger differences)
  • infection from contaminated formula - powdered baby milk is not sterile
  • chronic diseases - formula-fed children have higher risk of developing diabetes, leukemia and other cancers, and obesity

The Philippine Center for Investigative Journalism (PCIJ) noticed our first print ad and wrote about it in their blog. You can read about it here:

It's sad that we can't afford to get this message to more mothers out there. Our communication budget, including those of partners in government and other international organisations, is a drop in the bucket compared to the advertising budget of milk companies. One media executive told me that from one milk company alone, his media outfit receives over P70 million (US$ 1.5 million) in advertising every year!

We at UNICEF can think of many better ways to spend P70 million, than to promote powdered milk.

Wednesday, March 28, 2007

Just the facts!

We are working to promote and protect breastfeeding in the Philippines. We come from different sectors and all walks of life, but we are united by this common cause. To see why, just look at these facts:

  • 6 months - length of exclusive breastfeeding recommended by WHO and UNICEF for the best infant growth, development and health

  • less than 24 days - length of exclusive breastfeeding in the Philippines for half of all infants, down from 1.4 months in 1998 (National Demogoraphic and Health Survey, 2003)

  • 16% - percentage of babies who are exclusively breastfed for 4-5 months (NDHS, 2003)

  • 16,000 - number of child deaths per year that can be traced to inappropriate feeding, including the use of infant formula (WHO)

  • P430 million - amount spent yearly for hospitalization, health consultations and medicines for illnesses due to formula-feeding (WHO)

Source: Breastfeeding by the Numbers, UNICEF

One of our biggest challenges is to rigorously implement the National Milk Code (EO 51), which was signed into law in 1986. As expected, the infant formula companies, through the Pharmaceutical and Healthcare Association of the Philippines (PHAP), have been blocking our efforts to regulate how they market and promote their products. Our ally, Mike Brady, of Baby Milk Action, has a good summary of our struggles in his blog:

About the photo: Urban poor mothers protest misleading advertising by milk companies in the Philippines.
Photo credits: UNICEF/PHI/2007/Joan Bondoc