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:

PHAP vs. Duque decision.doc 296 Kb

Download the UNICEF official statement here:

UNICEF statement.doc 120 Kb

And here's Atty. Ipat Luna's take on the Supreme Court ruling:
http://ipatluna.multiply.com/journal/item/80

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.

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.

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.

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,
Mianne


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.

Kudos!
Sincerely, Innes