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.

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.