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.

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.

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:

http://youtube.com/watch?v=SNYDPKQOVUE

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:

http://www.babymilkaction.org/CEM/cemnov06.html

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

"Formula for Disaster" is now on YouTube!

Watch it at:

http://youtube.com/watch?v=SNYDPKQOVUE

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

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:

http://www.who.int/child-adolescent-health/publications/NUTRITION/ISBN_92_4_159523_0.htm

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.

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.