When Time dared to put a photograph of a mother breastfeeding her three-year-old son on its cover in May, international media was thrown into a frenzy over the provocative image. It is not the first time breastfeeding has roused debate and it will not be the last, but in many discussions about whether breast really is best, an important piece of the puzzle is missing: where does the infiltration of misguided information by multinational companies pushing infant formula begin, and the mother’s ability to make an impartial decision end?
“Infant formula companies have a vested interest in babies not being breastfed and that is financial profit for their shareholders. Their motives are focused on product sales and not on infant health,” said Dr Jennifer James, a nursing and midwifery expert at Royal Melbourne Institute of Technology of University. “Breastfed babies need no other food or fluid for at least the first six months of life. Supplementation with infant formula is not necessary at any stage and can create a range of problems for babies and diminish breast milk supply.”
In 1986 the Philippines took steps to protect mothers from misinformation regarding infant formula in accordance with the World Health Organisation (WHO)’s international guidelines for marketing of breast milk substitutes.
The introduction of the Executive Order No. 51 – also known as the Milk Code – marks the Philippines as the only country in the region to implement legislation that substantially includes all provisions of the WHO’s international code, developed to ensure that women and childrenhave clear and unbiased information about the benefits of breastfeeding. It does not prevent breast milk substitutes from being sold – on the contrary, baby formula is widely available nationwide – but aims to ensure that milk formula marketing includes appropriate warnings and instructions.
“The Milk Code is the backbone of breastfeeding protection, promotion and support efforts in the Philippines,” said Mike Brady, Campaigns Coordinator for Baby Milk Action. “It also aims to ensure that health workers, parents and carers receive accurate, independent information about breast milk substitutes if necessary.”
Under the Milk Code guidelines for breastfeeding, substitutes for children under the age of 36 months cannot be advertised, health workers are prohibited from giving infant formula samples to mothers and family members, and strict labelling rules apply to include the use of both English and the local Tagalog language and a mandatory note that states breast milk is best for babies up until two years of age.
The initiative has paid off, with breastfeeding practices in the Philippines improving markedly over the past 25 years. From 2008 to 2011, breastfeeding within one hour of birth increased from 32% to just over half of all new mothers putting their baby to breast during the most crucial hours for a newborn’s health.
“The first milk is incredibly important for all babies,” said Dr James. “It coats the sterile gut lining with a protective layer, exposes the baby to maternal antibodies and provides the exact nutrients needed in those first few days.”
Exclusive breastfeeding for the first six months of life – which boosts immunity to childhood diseases – in the country also rose by more than 10% during the same period. However, despite advocacy efforts and the reported increases, statistics still fail to reflect the importance of mother’s milk in a country where malnutrition and more than half of young child and infant deaths are attributed to children who are not breastfed.
“Although breastfeeding practices in the Philippines increased in 2011 and are relatively high in Southeast Asia compared to other countries, we are afraid that these rates will go down and slow because of the aggressiveness of these multinational milk companies,” said Madella Santiago, executive director of the Association for the Rights of Children in Southeast Asia (ARCSEA).
The concern is not unfounded, with the milk formula industry aggressively fighting to protect advertising rights for as long as the regulations have been in place. After losing a Supreme Court battle to block the implementation of the Milk Code in 2007, multinational milk formula companies have been lobbying Congress to amend the code under a consolidated bill that combines previous proposals.
If passed, the recommended amendments would allow multinational companies to be involved with the education of breastfeeding, provide labelling only in English, and remove all warnings and current prohibitions for health and nutrition claims regarding the benefits of milk formula substitutes.
“The most vulnerable group is the infants and young children from 0-36 months, who will be put at great risks of dying or even [becoming] developmentally disadvantaged – both physically and mentally – before they reach their fifth birthday,” said Cora Acosta, from WHO in the Philippines.
The passing of the proposed bill by the House of Representatives was postponed in September after the Joint Committee on Health and Trade requested that all legislators present further amendments before it was reconsidered by Congress.
In the meantime, multinational companies in the Philippines continue the fight to engage consumers further by utilising legislation loopholes, investing an average of $100m annually to promote breast milk alternatives. An example of this is the industry’s interpretation of what constitutes ‘complementary’ foods for children aged six months and older.
“The scope of the law includes any food that is promoted as a partial or full replacement of breast milk [which is considered complementary],” said Brady. “The companies attempt to argue that complementary foods are not covered by the law, but it is the way they promote them that brings them into the scope of the law, undermines breastfeeding and puts babies at risk.”
Companies circumvent strict labelling guidelines by associating formula with ‘brain building blocks’ and using the term ‘eye Q’ to imply intellectual stimulation.
It is a practice that undermines progress made by breastfeeding advocates, proves confusing for consumers and ultimately jeopardises the healthy growth and development of Filipino children.
“The mentality of Filipino women, and even men, that formula milk is a better option than breast milk, brought about by influence of advertisements of formula milk companies, is a very big challenge,” said Santiago. “Raising awareness of breastfeeding while multinational milk companies are doing everything to promote formula milk is a very big problem and as a result mothers only become more confused about what is best for their baby.”