Breastfeeding

GET REAL
A serious health issue


By Solita Collas-Monsod
Inquirer
Last updated 02:34am (Mla time) 06/09/2007


MANILA, Philippines -- One reads (Inquirer, 6/7/07) where Supreme Court Chief Justice Reynato Puno is continuing to make waves -- the first time with his stern reminder against corruption in the Court of Appeals, and now with his determination to use the Court’s power under the Constitution to protect human rights. All of which is very reassuring.

It is in this light that one wishes to call his attention to the fact that it has been about 10 months now since the Court put on hold, via a temporary restraining order, the attempt of the Department of Health (DOH) to prevent needless infant deaths (16,000 in 2000) and sickness that make the number of extrajudicial killings/disappearances look puny. Deaths are deaths, whether they are caused by sins of commission (by the military or others) or omission (by the Court’s not lifting the restraining order).

The 16,000 figure refer to the number of child deaths (under 5 years of age) in the Philippines -- out of a total of 82,000 for 2000 -- that, according to the international scientific community, can be traced to inappropriate feeding, including the use of infant formula. Aside from the deaths, there are other costs to such inappropriate feeding, all enumerated in a fact sheet: 1.2 million more illness episodes from diarrhea and acute respiratory infections (ARI), plus 10 million more days ill, plus 450,000 more health facility visits, plus 36,000 more infants hospitalized.

All these have financial implications: P320 million for funeral expenses, P1 billion in lost wages caring for sick infants, P100 million of out-of-pocket expenses for health facility visits and basic drugs, P50 million for out-of-pocket expenses for hospitalizing the infants, P230 million in government expenditures on hospitalization. The worst part is the estimated P21.3 billion used to purchase formula, most of which could be saved because it doesn’t cost a centavo for mothers to breastfeed their infants.

How did the DOH get involved? Because of the 2003 National Demographic and Health Survey which showed that only 16.1 percent of our infants are exclusively breastfed up to 5 months of age (19.1 percent for the United States). It also showed that 13 percent of infants were never breastfed; that 39 percent of infants used instant formula in their first 12 months; that half stopped exclusively breastfeeding by the third week of their lives.

The record of the Philippines in breastfeeding, among the 56 countries that have conducted National Demographic and Health Surveys in the past 10 years, is deplorable: We have the most infants below 2 months of age who are not breastfed. We rank No. 4 when it comes to infants below 6 months who are not breastfed. And we have the worst not-breastfeeding rates in all of South and Southeast Asia.

Which is why the DOH considered it high time to tighten up the implementing rules and regulations (IRR) of the Milk Code (Executive Order 51) approved by then President Cory Aquino in view of the importance of breastfeeding in preventing infant deaths, sickness, malnutrition, underweight problems, etc. And it proceeded to do so, in consultation with industry and community groups, as well as the World Health Organization and Unicef. In May last year, it promulgated the revised IRR, which covered information and education, research, quality and standards, marketing and advertising of milk products and breast-milk substitutes.

And came up against the Pharmaceutical and Health Care Association of the Philippines (PHAP), which promptly went to the Supreme Court, asking for a temporary restraining order on the implementation of the revised IRR.

The Court turned PHAP down, and PHAP promptly appealed. Now I have absolutely no doubt that the timing was coincidental, but within days after President Gloria Macapagal-Arroyo received a letter from the president of the US Chamber of Commerce protesting the revised IRR, the Court handed down its decision to indeed grant the TRO. Yet, scarcely three months later, the UN Special Rapporteur on the Right to Food, officially congratulated the Philippine government on the DOH’s revised IRR.

What rule did the PHAP object to? It objected to the ban on the advertising and promotion of milk substitutes for children up to 2 years old, with an absolute ban on false health and nutritional claims. The Department of Justice apparently took exception to the practice of the milk companies (all foreign-owned) of making false claims about the nutritional and other benefits of their breast-milk substitute products, all under in the guise of promoting breastfeeding. Plus their practice of giving incentives to health workers (doctors, nurses and midwives) to promote these substitutes.

What is galling is that these companies would not dare make those claims in the developed countries where they operate, but they do it with impunity here. Worse, the claims, in the absence of contrary information, are lapped up by gullible mothers who think that the breast-milk substitutes will make their children talented, intelligent, taller, etc.

It is also highly suspicious that these milk companies have often recalled their products, mostly in developed countries, because of evidence of contamination and quality defects, but not in the Philippines.

PHAP would have the Court believe that what the DOH is doing is in restraint of trade. Nonsense. This is not a trade issue, this is a health issue. In this case, the DOH is on the side of the angels. And the Department of Trade and Industry is on the other side.

-- This is an article written by Solita Monsod for the PDI June 8, 2007 issue. Breastfeeding is certainly not a trade issue. We have prostituted ourselves so much to foreigners that even our newborns suffer. We wonder why up to now Filipinos have colonial mentality. Could it be because of the milk formula we are given? All the infant formulas are imported. We have got to take action. Families who cannot even buy food for their table are mind set to buy formula for their infants, not thinking that breastmilk if free, readily available and appropriate than any cow's milk formula.

When I was studing in Malate, I saw a pimp with his family on a curb in Remedios as usual waiting to pry on tourists. He immediately approached a unwilling tourist and offered his wife for five dollars. The tourist said no. Thinking that the tourist might prefer males, he called to his eldest a twelve year old and said he can have him for four dollars. The tourist declined again, looked up to the stop light praying it will soon turn green. The pimp then grabbed the arm of her six year old daughter thinking the tourist might prefer them young. "Two dollars just take her for two dollars." The tourist declined again trying to move farther from the family. "Okay the pimp said, here take my three month old daughter you can have her for a dollar." When the tourist declined, the pimp said "Okay you can have her for free. Just take her."

We, Filipinos have been sold all of us from our flesh to our spirits. And like the pimp we were sold by our leaders on a losing bargain all the time.