Bullies

PINOY KASI
Bullies
By Michael Tan
Inquirer
Last updated 02:40am (Mla time) 07/28/2006

Published on Page A15 of the July 28, 2006 issue of the Philippine Daily Inquirer

LAST week, I wrote about the Department of Health's new implementing rules and regulations (IRR) that should end misleading advertising and unethical promotions of breast milk substitutes or milk formula.

When I wrote that column, I didn't know that the milk formula manufacturers, through the Pharmaceutical and Health Care Association of the Philippines (PHCAP), had filed a case against the DOH calling for a temporary restraining order (TRO) on the new IRR. Fortunately, the Supreme Court turned down the petition.

The PHCAP move was not surprising. This organization, composed mainly of multinational drug companies, has bullied Filipinos each time we proposed important public health reforms. Back in 1986, when they were still the Drug Association of the Philippines, they opposed the passage of the Milk Code, which was the first law we had to regulate the marketing of milk formula. Two years later, they fiercely opposed the passage of the Generics Law. Over the years, they have tried to block attempts to bringdown the costs of medicines, including filing a suit to block the government's importation of low-cost medicines.

They haven't been doing this alone, often recruiting the Philippine Medical Association (PMA) to oppose the reforms. Last month, the Inquirer published a letter from one of the PMA's past presidents, Dr. Santiago del Rosario, claiming that breastfeeding had many "limits."

Fortunately, the Inquirer published, last Monday, a rejoinder from Dr. Nicholas Alipui, Unicef's country representative, summarizing the vast scientific evidence to show breastfeeding's superiority as well as bottle-feeding's many risks and dangers.

Pro-life

Way back in the 1980s, I was already in touch with some of the breastfeeding advocates, the likes of Ines Fernandez of Arugaan and Sr. Pilar Verzosa of Pro-Life Philippines. I mention Sister Pilar because breastfeeding is a pro-life issue in its broadest sense. The DOH estimates that we could prevent up to 16,000 infant deaths each year simply through breastfeeding, because it gives better nutrition and protection against diseases, and all for free.

Yet breastfeeding has been on the decline over the years. I did some research and was amazed to find survey data going back to 1963, when the average period of breastfeeding in the Philippines was 14.5 months. By 1982, it had dropped to 12.1 months.

Those surveys probably referred to breastfeeding in general, to include the weaning period where other foods were introduced. From two recent National Demographic and Health Surveys, we know that the median period for exclusive breastfeeding -- which the World Health Organization and Unicef recommend for the first six months of infancy -- was a mere 1.4 months in 1998 and 0.8 months in 2003.

Personal battle

Let me share my personal battles here to explain why this is happening. When my Yna was born two years ago, I had to fight tooth, nail and claw, for her to be breastfed. Some of her aunts, her grandmother and great-grandmother had decided that Yna's mother could not breastfeed saying she was too "small," too sickly. Those are of course misconceptions, and I quote from Dr. Alipui's letter: "Virtually all mothers can breastfeed ... Mothers who are starving, sick, recovering from surgery including caesarian section, those who adopt and those with inverted nipples can breastfeed."

But even more shocking was the relatives' conviction that milk formula was healthier, and that bottle-fed babies would be more intelligent. It was clear they had been convinced by the misleading ads and marketing. When I looked into the bag the relatives had prepared for the mother, I found a feeding bottle.

I stood my ground about breastfeeding with the help of our obstetrician, Dr. Sylvia de la Paz. I was thankful we had a Milk Code that prevented sales agents from coming into the maternity wards to promote infant formula. But one of the nurses came by a few hours after Yna's birth and gave the new mother a "souvenir booklet" where she could list the child's developmental milestones, vaccinations and other health information. I was appalled by the booklet. It was produced by one of the milk manufacturers and filled with pictures of their products.

I knew I had to fight extra hard to make sure Yna would get her breast milk. Her mother had difficulty initially, but was pleasantly surprised when the milk began to flow. In the months that followed, she would complain about producing "too much" milk. Yna was on exclusive breastfeeding for five months, including refrigerated breast milk, until her mother had to leave to work overseas.

Yna turned two a few days ago, and has the height of a three-year-old. And her weight? I plead for mercy when she asks to be carried.

I do feel triumphant when the aunts ooh and aah and go, "Iba talaga ang breastfed" ["The breastfed are really different"]. But the victories can be hollow. When Yna shows how fast a learner she is, they go, "Iba talaga ang kaniyang gatas." (Her milk formula is different.)

Even breastfed babies will eventually have to go into milk formula and with all the manufacturers' claims about creating child geniuses through their products, people begin to attribute the rapid brain development in the child to the formulas. I have to keep reminding Yna's relatives that her intelligence comes too from breastfeeding, as well as the massive social stimulation she's been getting since birth, from mobiles (the hanging ones, not the phones), simple puzzles and building blocks to singing and dancing and reading and of course child's play itself.

One would think that on cost considerations alone, people would just vote for breastfeeding. Have you noticed the most expensive milk formulas are those intended for infants? As the child grows older, they graduate to new formulas, which become cheaper. (It's all a bit like schooling – these days, preschool and kindergarten can be more expensive than college!)

So maybe this is why the milk manufacturers are so adamant about targeting the newborn, who are the most vulnerable to the problems of bottle-feeding. If only these manufactures would recognize that if they could just be ethical and scientific about their products and their business practices, they might even expand their markets. Leave the babies to breastfeeding and more of them will survive.

But maybe I'm being naïve in believing that corporate social responsibility is possible with these companies. If they have a change of heart, well and good, but if they decide to continue to bully Filipinos, I hope our health department and the courts will stand their ground. All the talk about the Filipinos' love for children, about defending the defenseless, will mean nothing if we can't assure a child's right to be breastfed.