A Duty to Our Mothers and to Our Nation
AMSA-Philippines Position Statement on the “Breastfeeding and Milk Regulation Act”
The importance of breastfeeding cannot be overstated. Even though the Worlwide Breastfeeding Awareness Week is only held from August 1 - 7, its effect to society is present throughout the years. Building the child's immunity, promoting maternal health and boosting the child's intelligence are but a few of the benefits. Moreover, it has also been cited as an important and priceless component in alleviating poverty and achieving health for all by "being an unequalled way of providing ideal food for the healthy growth and development of infants".(1)
Supported by more than thirty years of research, the thirty-fourth World Health Assembly, the decision making body of the WHO, emphasized the importance of breastfeeding and regulating the sales promotion of infant formula through the adoption of the "International Code of Marketing of Breast-milk Substances" in 1981 as endorsed by the Executive Board of the World Health Organization. The code stipulated the responsibility of the governments in educating the community regarding breastfeeding, the restriction of persons employed in the marketing of infant from participating in such educational activities, the prohibition of distributing samples of infant formula and the proper labelling of infant formula among others.
In response to the resolution, the Philippines have passed appropriate legislations reaffirming the essence and goal of the aformentioned code. In 1986, Pres. Corazon Aquino adopted Executive Order 51 or the "Philippine Code of Marketing of Breastmilk Substances". Aside from the substance already said in the International Code, the Philippine Code mandated the creation of an inter-agency committee with the Minister of Health as Chairman to implement the provisions of the said order (2). In 1992, Republic Act 7600 also known as "The Rooming-In and Breastfeeding Act" was approved with further aims to improve maternal health with the provisions on rooming-in and on facilities for breastmilk collection and storage. (3) During the next few years, a battle ensured regarding the Implementing Rules and Regulations (IRR) of the said code. A temporary restraining order on the revised IRR was even given on the eve of the retirement of Chief Justice Artemio Panganiban on August 15, 2006.
Nonetheless, a sweet victory among breastfeeding advocates was ensured with lifting of the TRO in the following; thus, producing "one of the most stringent regulations ever imposed on Milk Companies, a recommended template to follow."(4) The IRR included provisions such as the regulation of "ALL milk advertisements and flow of information, regardless of age classification", the use of both English and Filipino in the labelling of infant formula and the prohibition for Milk Companies to sponsor conventions, maternity classes or to give travel grants and free samples to doctors. The culmination of this history of the breastfeeding law in the Philippines was even supplemented by the passing of Republic Act 10028 also known as the "Expanded Breastfeeding Promotion Act" in 2009 which amended the existing R.A. 7600. The amendments include the establishment of lactation stations even in non-health facilities, the inclusion of paid lactation periods of at least forty minutes for every eight hour working period, the integration of breastfeeding in the curriculum, the declaration of August as the "Breastfeeding Awareness Month" and the maintenance of a list of "Working Mother, Baby Friendly" companies. (5)
However, the increases of exclusive breastfeeding rates in our country as recently released by the Food and Nutrition Research Insititute of the Department of Science and Technology (FNRI-DOST) may be reversed with a bill currently pending in one of the technical working groups in the House of Representatives. Supported by six house representatives, namely, Reps. M. Gunigundo, J. Lacson-Noel, R. Rodriguez, A. Bondoc, L. Mercado-Revilla and L. Torres, the "Breastfeeding and Milk Regulation Act" is consolidated from House Bills 3525, 3527, 3396 and 3537. If passed this will effectively, reverse the current positive trends in our efforts in increasing rates of breastfeeding. "The bill, in a gist, would:
1. narrow down the application of the milk code only to artificial feeding products for the age group of 0 to 6 months instead of the current 0 to 36 months;
2. lift all restrictions on donations of breastmilk substitutes at the time of emergencies;
3. make lactation breaks for breastfeeding mothers at work unpaid;
4. allow samples of breastmilk substitutes to be distributed in the health care system and access to health workers, by sales and marketing staff of milk companies; and
5. remove the dual language (English and Tagalog) messaging on packaging of breastmilk substitutes, which explains the superiority of breastfeeding for up to 2 years and beyond." (6)
In addition, the bill would create an inter-agency committee composing of the Department of Helath and Department of Trade and Industry as co-chairs; thus, citing the true essence of the bill which is mostly for profit and not for the universal health of the people. It would also effectively lower the sanctions of individuals who would be penalized under the bill. Passing this into law would in effect thwart over a decade's worth of informing the thousands of mothers across the Philippines of the importance of breastfeeding. This issue is now at utmost importance with even the United Nations taking a stand against it for what is at stake now is not just a mere policy but "the health and nutritional status of children in the Philippines, and the quality of human resources of the country in the future."(6)
The main lobbying forces of the bill comprise of leading milk formula companies through the IPNAP (Infant Pediatric Nutrition Association of the Philippines) led by multinational milk companies such as Nestle,(7) aiming to increase their profits at the expense of misleading the women of our nation and risking the development of the next generation of Filipinos. It is both unfair and an injustice to the women in our nation to allow the passing of such a bill which would ignore all the efforts of passing and implementing a breastfeeding legislation for more than twenty years.
We call on the different Local Government Units and the Department of Health to continue their efforts in fully implementing our breastfeeding legislations which could help counter the increasing maternal mortality rates in our country as posted last year, 2011. As seen from the recent increase in exclusive breastfeeding in our country from 36 percent in 2008 to 47 percent in 2011 and the increase in initiation of breastfeeding within one hour of delivery from 32 percent in 2008 to 52 percent in 2011, our efforts are not put to waste. In addition, we ask them to continue their efforts in bringing reproductive health closer to those who need them with regards to their personal beliefs. With the nearing of the year 2015,the set deadline for the Millennium Development Goals (MDGs), now, more than ever, maternal and infant health is of utmost importance.
We call on the House of Representatives to suppress the said breastfeeding and milk regulation act. We also call them to pass more legislations which ensure the health of our mothers and infants. Amidst the discussions of the controversial RH Bill, we ask them to base their decisions on facts and principles. We hope that amidst the division caused by the debates surrounding the bill, people would see the importance of maternal and infant health as a major factor in the discussions. We hope that unity would ensue once the debates are done for the future of our country and for the health of our society.
We call on all potential and current health practitioners, to remind themselves of their absolute duty to act for the best interest and the greater good of our fellow countrymen and women, and not for the benefit of profit. We also call on the Filipino society in general to decide based on facts and personal beliefs and principles whenever such a decision is needed. Be aware with what is happening in our nation. Nonetheless, be critical with the information given by both sides of the issue.
Lastly, we call on all medical students, to be socially aware and to increase efforts in informing our communities of the benefits of breastfeeding and even rooming-in in the face of the daring situation we have right now. AMSA-Philippines believes in the power of the medical students to, as early as now, develop the trait and habit of educating our patients based on evidence-based medicine. AMSA-Philippines believes that nothing can be more effective and nothing is more urgent than our power to educate our patients.
We should also immerse ourselves in the discussions regarding health policies especially those concerning our nation. Though we are still just future health practitioners and framers of health policies, AMSA-Philippines believes that that alone should not stop us in protecting our current effective health policies and improving the health status of the Filipino people NOW.
The Asian Medical Students' Association-Philippines, as one of the biggest groups representing medical students in the country, currently stands on our position against the said "Breastfeeding and Milk Regulation Act". We stand on this issue today as the Supreme Court stood on their position a few years ago that "public interests must be upheld over business interests". With our current and future efforts in promoting breastfeeding in the country, we are hoping that the health of our country and the efforts for the greater good of our society be upheld.
Health for All!
National Officer for Public Health
Madison Morillo Dominguez
National Officer for Reproductive Health and AIDS
1 International Code of Marketing of Breast-milk Substances. World Health Organization. Geneva 1981.
2 Philippine Code of Marketing of Breastmilk Substances. Executive Order 51 of 1986.
3 The Rooming-In and Breastfeeding Act of 1992. Republic Act 7600.
4 Luna, Atty. Ipay and Hernares-Esguerra, Dr. Elvira L. The Philippines supports Breastfeeding with One of the Best Systems in the World.Children for Breastfeeding Inc. dated October 28, 2007.
5 Expanded Breastfeeding Promotion Act of 2009. Republic Act 10028.
6 Issues Related to the Latest Development of the Breastfeeding-Related Legislation in the Philippines. A Technical Note from WHO, ILO and UNICEF Philippines.
7 Position Paper of the Save the Babies Coalition on the "Breastfeeding and Milk Regulation Act".