CAMPAIGN N EW S T R A I L U P DAT E S O N T H E C H N C A M PA I G N I N T H E P H I L I P P I N E S
Volume 2 Issue 2
April - September 2013
INSIDE THIS ISSUE GLOBAL CAMPAIGN Closing the Gap in breastfeeding through an online petition 3 PHOTO NEWS
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NEWS Pressure in Philippines to end ban in milk aid 5 FEATURED PRACTICE QC barangays require breastfeeding stations 7 First LGU-run human mik bank 8 NATIONAL CAMPAIGN In defence of the Milk Code 8
Representatives from government agencies, civil society, health workers, and multilateral organization lead the ceremonial signing of commitment for the Philippines to join the SUN Movement, which was the higlight of the National Nutrition Month 2013 launch event.
Philippine gov’t ties with civil society, sets out to join SUN
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orld Vision with civil society nutrition-focused group Koalisyon para Alagaan at Isalba ang Nutrisyon (KAIN) continues its support to Philippine membership to the Scaling Up Nutrition Movement, following an encouraging government pronouncement at the start of the National Nutrition Month in July. Speaking for the Health Secretary in the Nutrition Month event End Hunger Summit, David Lozada enjoined all sectors to “work together drastically to end hunger and malnutrition in the soonest time possible.” Lozada reiterated government intent to join SUN, realizing this as an opportunity to “help mobilize resources to scale up nutrition action and nutrition sensitive development programs at the national down to the community level.” He further said that nutrition secretariat National Nutrition Council (NNC) was instructed to “accelerate registration of the Philippines to the SUN Movement,” and revitalize the Philippine Plan of Action on Nutrition.
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NATIONAL CAMPAIGN Philippine gov’t ties... (continued from page 1) This is to “ensure that they (sic) are able to ac- The CHN call to action anchors on recommencelerate the slow progress reducing hunger and malnu- dations from the Nutrition Barometer Report jointtrition in our country,” stresses Lozada. ly published by World Vision and Save the Children in Prevalence of underweight in children below five 2012. The report provides a snapshot of national govis one measurement for both hunger and malnutrition ernment’s commitments and progress in addressing nustatus- 2011 data shows that one in every five children trition and child survival. in the Philippines are underweight and three out of 10 In the report, the Philippines fared sound on are short for their age, an occurrence called stunting. outcomes but frail on commitment. Commitments inThe trend for the MDG to halve underweight children dicated how much national government does to address below five in the country has medium probability only nutrition in terms of policies, participation in global into be met in 2015, the end of the MDG target. itiatives, and allocation of adequate resources to nutri The government pronouncements of support tion-specific and related interventions. for the SUN Movement were given in series of events At the November 2012 launch of the Baromecelebrating the national nutrition month in the Philip- ter Report in a forum hosted by World Vision, governpines. Organized by NNC in partnership with the civil ment’s global commitment to movements like the SUN society coalition KAIN, the nutrition month thematic was reiterated as a necessary step to improve nutrition focus vowing to end hunger and malnutrition was there- status. fore an appropriate springboard to usher in the coun- In June, World Vision hosted the KAIN stratetry’s SUN membership. gic planning workshop and proposed Philippine com “Like the 40 countries that signed up and now mitment to SUN as one of the coalition’s priority adbenefitting from the gains, the membership can bring in vocacies. When NNC gave pronouncements about its global partners to support the country and also high intents to register the country as a SUN member, the level support to the scaling up nutrition action,” added coalition has been seeking support from its global partNNC head Maria-Bernardita Flores. ners for support in order to ably assist the government Seven multisectoral representatives led by Lo- in the membership process. The Philippine Plan of Aczada, reinforced the announcement of Flores through tion on Nutrition was also circulated by NNC to World commitment statements and signing of sectoral support Vision and others of the 12-member KAIN coalition for to SUN registration, and the signing of multisectoral review and inputs. declaration of support to end hunger and malnutrition. KAIN represented the civil society in the ceremonial statement of support and signing of commitment. “KAIN members can leverage on their programming so they can complement government in terms of addressing issues on undernutrition,” says World Vision Interim Country Director Filomena Portales at a press conference, elaborating on the individual and unified strength of non-government organizations considering their dedicated work and resources for nutrition, with global support from their networks. Government’s membership and commitment to the SUN movement is the primary call to action of World Vision through the Child Health Now campaign, looking at it as an opportunity to muscle WVDF Interim Executive Director Minnie Portales (rightmost) asnwers high level leadership in government to im- media queries on behalf of the KAIN coalition of NGOs at the press conference during Nutrition Month. prove nutrition outcomes.
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GLOBAL CAMPAIGN
Closing the Gap in breastfeeding through an online petition
The following petition letter is found online in this link
http://www.change.org/en-GB/petitions/oppose-any-amendment-that-will-water-downthe-milk-code-eo-51
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gap between preventive strategies and the high burden of undernutrition has become apparent in the Philippines, more than ever. In one end is 20.2% underweight and 33.6% stunted children in their crucial growth and development years. This state makes the Philippines one of the 36 high-burden countries in undernutrition, contributing 90% to the world’s population of undernourished children under the age of five.
In the other end of the balance is breastfeeding practice, the topmost known preventive strategy against undernutrition. And yet, in the 2011Family Health Survey, only 27% infants were exclusively breastfed. This means that 7 out of 10 didn’t get the best nutrition and natural immunity from breastfeeding alone in the first six months of life. Which is logical why undernutrition is the biggest underlying factor in child mortality in the Philippines. A study by WHO in 2013 mentions evidence showing that advertising and other marketing techniques influence the decision of mothers and families on how to feed infants and young children. This is aggravated by the poor regulation of advertising of milk products, and the full implementation of the Milk Code. Unfortunately, the Milk Code has had a long battle with the milk industry even before it was enacted into law in 1986, for an industry call to less stringent regulation of marketing of breastmilk substitutes. Up to this day, the industry has took to the national legislative bodies with attempts to amend the Milk Code. Amending the Milk Code even before achieving the full effect of the law would bring further detriment to breastfeeding practice. Thus, World Vision embarked to gather public support for a ‘no amendment’ stand for the Milk Code amidst four pending bills before the Senate and the House of Representatives in the newly opened 16th Congress.
The time of defending the Milk Code is apparently far from over. Two months after the opening of the 16th Congress this year, a bill has been passed and more are apparently looming, to continue attempts of amendments that did not prosper in the 15th Congress. We call on you to be steadfast in saying no to amendment attempts to the Milk Code as these will undermine breastfeeding practice. Milk companies have been investing heavily on advertisements and promotional strategies which influenced mothers to feed their babies with formula milk and other substitutes to breastfeeding, to the detriment of their young children. Breastfeeding is estimated to prevent deaths of 1 in every 5 under-five children in developing countries, but minimal breastfeeding increases the risk of dying in the first 2 years of life. The Milk Code does not need amendments- instead, there should be a consolidated, stronger will to enforce it. We reiterate our call on you, our legislators at the Senate and the House of Representatives, to do your due diligence and oppose any effort to amend the Milk Code. As duty bearers and stewards of the state, you owe it to your people, especially the helpless under five children, to protect and promote their nurturance and from which may depend their very survival. 3
PHOTO NEWS
Canada Support Office and APRO point persons for CHN Philippines meet with the cross-functional team in May to discuss progress of the campaign.
Newly elected Senator Grace Poe-Llamanzares meets WVDF Interim Executive Director Minnie Portales for the first time at the Hunger Summit in July.
WVDF Board Chair Liwayway Vinzons-Chato and Interim ED Minnie Portales pose for the camera at the Hunger Summit, the culminating event for the Nutrition Month.
At the End Hunger Concert, the second of the series of national celebrations for the Nutrition Month, WV Advocacy staff Gem Santos-Macanan signs her pledge to end hunger.
Member organizations of the Koalisyon para Alagaan at Isalba ang Nutrisyon (KAIN) which includes WVDF, partnered with government for the Nutrition Month launch event, which was highlighted by government’s intent to join the Scaling Up Nutrition Movement.
WVDF Interim ED Minnie Portales welcomes KAIN coalition members in one of its meetings that WVDF hosted at the National Office.
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NEWS Pressure in Philippines to end ban on formula milk aid *lifted from http://www.irinnews.org/report/97943/pressure-in-philippines-to-end-ban-on-formula-milk-aid
Compostela Valley, 30 April 2013 (IRIN) - Health authorities in the Philippines were vigilant in keeping out infant formula donations when Typhoon Bopha hit last December, but activists are concerned the infant formula industry will succeed in pushing through legislative changes that will allow formula donations in future emergencies, making it harder to convince women in those crises to continue exclusive breastfeeding. Breastfeeding - especially during emergencies - has been medically linked to improved child survival due to the incomparable nutrients and antibodies human breast milk offers. But emergencies are also the hardest time to convince women that breast milk can keep their children alive, due to myths about stressed or malnourished women not being able to breastfeed. Cease-and-desist When Typhoon Washi (locally known as Sendong) hit the southern Philippines’s Mindanao Island in December 2011, breast-milk substitutes, including formula, turned up in evacuation centres even though they are banned under the country’s “Milk Code”. The Department of Health singled out infant formula maker Nestlé Philippines, issuing a cease-and-desist order requesting it to stop donating milk products to typhoon survivors. The problem was not the company, insisted Nestlé spokeswoman Meike Scmidt, but rather “kind-hearted private individuals and organizations” who donated products of their own will. “We have the industry’s toughest system in place to enforce our policies governing the marketing of breast-milk substitutes,” she told IRIN. “Our monitoring procedures include control measures that prevent donations of breast-milk substitutes during emergencies, and those control measures are routinely audited.” Yet the company is now part of a formula interest group called the Paediatric Nutrition Association of the Philippines (IPNAP) which is trying to change the country’s Milk Code. One of the proposals is to allow unrestricted donations of breast-milk substitutes during crises. Activists have rallied to fight what they characterize as the “diluting” and weakening of the current Milk Code, allegations that Nestlé dismisses. Milk of life Medical studies have linked formula donations to increased diarrhoea during crises, as was the case during Indonesia’s 2006 earthquake in Central Java. A 2012 UN Children’s Fund (UNICEF) study found one-week diarrhoea incidence among those who received milk substitutes after the earthquake was more than twice as high
as those who did not (24.5 percent versus 11.5 percent); overall, the rate of diarrhoea among infants aged 12-23 months was five times higher than before the earthquake, which researchers linked to breast-milk substitute donations. Some 80 percent of the 832 surveyed surviving households had received donated infant formula, 76 percent commercial porridge and 49 percent powdered milk. Pre-earthquake only 32 percent of the infants had ever had breast-milk substitutes, a rate that rose to 43 percent at the time of the survey, “Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies,” concluded the study, a message aid agencies are still struggling to publicize. Doing things differently Almost one year after Typhoon Washi hit, Typhoon Bopha (local name Pablo) hit Mindanao Island again, this time taking out entire villages in Compostela Valley and Davao Orientale along the island’s northern and eastern coasts. Some 2,000 are dead or missing. Five days after the Category 5 (winds up to 250km) typhoon made landfall on 4 December, the regional health director for Davao Region (heart of affected zone) circulated a memo to all governmental and aid agencies working on health, water and sanitation urging them to enforce and uphold Health Department regulations prohibiting the distribution of milk products to women and children. The memo stated such donations by “well-meaning, but misinformed donors” were unnecessary. The challenge, said UNICEF nutrition officer for emergencies in the Philippines Paul Zambrano, is reaching aid groups that bypass any donation coordination structure such as local NGOs and faith-based groups. “They go directly into communities. Monitoring at the local level is difficult,” he said. Even with health officials’ vigilance to keep out milk products, the disaster took a heavy toll on nutrition in affected areas: Aid groups estimate 95,600 persons will be at risk of malnutrition in 2013 including nearly 67,000 children under the age of five and 29,000 pregnant and lactating women. The youngest are the most vulnerable. One month after the typhoon hit, of the nearly 500 children under age five surveyed, 66 percent had some illness (most often accompanied by a fever, cough and diarrhoea). Breast-milk substitutes increase the risk of these illnesses due to unsafe water used to mix formula and lack of fuel to sterilize products. The proposed Milk Code changes are pending review as parliament is on recess until 1 July, and the country prepares to elect new parliamentarians in 13 May elections.
IRIN is a news and analysis service of the UN Office for the Coordination of Humanitarian Affairs (OCHA).
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FEATURED PRACTICE *QC Barangays Require Breastfeeding Stations by Myrna V. Lapuz, RND, MPH
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arangay Sto. Cristo, Quezon City recently issued an ordinance requiring offices and establishments in the barangay with 20 or more women employees to provide a lactation station for the exclusive use of mothers for breastfeeding. This is in support of Republic Act. 10028 or the Expanded Breastfeeding Act of 2009. There are more than one hundred establishments in the barangay. The barangay included the lactation station as a requirement in the issuance and/or renewal of business clearance. The ordinance has been enacted on August 4, 2013 and shall take effect after the approval of the Sanggunian Panglungsod and its full text posted in two conspicuous places in the barangay. Meanwhile in Barangay Bagumbayan whose chairman, Dr Elmer Matunan, said that he will not make an ordinance or resolution because the said provision is already a law. He plans to conduct an advocacy campaign to put up breastfeeding stations in the more than a thousand establishments in his barangay. By the first quarter of 2014, he will revisit these establishThe barangay included the lactation ments and will begin imposing the law before issuing station as a requirement in the issuance barangay permits or clearances. and/or renewal of business clearance.
*First LGU-Run Human Milk Bank
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he first Department of Healthapproved human milk bank operated by a local government unit opened on March 5, 2013 at the fourth floor of Bangkal Health Center at E. Rodriguez Avenue in Barangay Bangkal, Makati City. Its objective is to provide susceptible infants with the healthiest, most economical and most accessible form of milk. Breastmilk has been smedically proven to reduce infant deaths.
Makati City Health Officer, Dr. Estela Barrios, said that the milk bank is fully furnished with essential equipment needed in the preservation and storage of breastmilk, including a human milk pasteurizer, a bio-refrigerator, two large freezers, a sterilizer and electric dishwasher. Human Milk Bank as defined in Executive Order (EO) 51 or The Milk Code, is a service established for the purpose of collecting, screening, processing, storing and distributing donated human milk to meet the specific medical needs of individuals
for whom human milk is prescribed. Section 18 of EO 51 mentioned that a human milk bank should only be used as a temporary solution when the mother and baby are separated. The milk bank may be a source of breastmilk for infants who are victims of health emergencies or disasters. According to Barrios, “The Milk Bank in Makati is operated by six personnel consisting of a doctor, a nurse, two midwives and two medical technologists who will handle lactation management and laboratory procedures. They are all capable and have undergone proper training under the Philippine Children’s Medical Center (PCMC).” PCMC is a DOH-accredited training institution on the management and operation of human milk banks and one of only two health facilities in the country that houses a DOH-approved human milk bank. The other health facility, also run by DOH, is the Dr. Jose Fabella Memorial Hospital (DJFMH).
* These articles on FEATURED PRACTICES are lifted from HEALTHbeat, the official magazine of the Department of Health. The complete special issue on breastfeeding may be6downloaded from http://www.healthbeat.ph
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FEATURED PRACTICES First LGU-Run Human Milk Bank...continued
Safety Measures H
WE’RE ON FACEBOOK! For more information and resources, check our page at
facebook.com/ChildHealthNowPhilippines Dont forget to
uman breastmilk is undoubtedly the single most important source of nutrition for babies. It is very rich in nutrients which artificial formula lacks and is lifesaving. Sharing breastmilk has its own risk, that is why donating mothers are screened and required to be in good health, able to breastfeed, presently nursing a less than one year old baby, must be willing to have a blood test to rule out certain diseases, and not using medication or herbal supplements (except for those using progesteron, birth control pills or injections, insulin, pre-natal vitamins, iron or calcium). Disqualified to donate milk are those who tested positive for illegal drugs, who are alcoholics, smokers, those positive for HIV, Hepatitis B. Mothers who wish to donate their milk can just go to the center for walk-in milk donation. Barrios explained, “A nursing mother can produce up to 600 ml each in one milk-letting session. If properly stored, the donated milk can have a shelf life of up to a year.” The Makati human milk bank follows the World Health Organization (WHO) standard of operations. The collected milk will be deep-frozen. In Makati, it is the duty of the health worker to encourage nursing mothers to voluntarily contribute their excess breastmilk to the milk bank. The donated breastmilk will be screened and pasteurized and will be made available to those who need them such as motherless infants, infants in the neonatal intensive care unit whose own mothers are seriously ill or infants whose mothers cannot produce for their needs due to some reasons. Health studies revealed that regular breastfeeding stimulates the mammary glands of lactating mothers to produce an abundant supply of breast milk that provides
us!
for their baby’s primary needs. According to the Food and Nutrition Research Institute (FNRI) exclusive breastfeeding (giving babies only breast milk for the first six months of life which boosts the child’s immunity to diseases) has increased from 36 per cent in 2008 to 47 per cent in 2011. Infant breastfeeding one hour after birth has also increased from 32 per cent in 2008 to 52 per cent in 2011. In 1986, EO 51 prohibited the advertising of infant formula for infants under two years old. And in 2009, a law was passed that protects a woman’s right to breastfeed publicly, and requires private as well as public companies to allot time for breastfeeding. All public institutions have to provide lactation stations separate from bathrooms. The WHO recommends exclusive breastfeeding for babies for the first six months and encourages continued breastfeeding with complementary solid food up to two years old and even beyond. This is essential in addressing the problem of infant mortality in the country. To date, there are three large human milk banks located in the PCMC, DJFMH and the University of the Philippines-Philippine General Hospital in Metro Manila. Makati Mayor Jejomar Erwin Binay led the inauguration ceremony where it was witnessed by officials and guests from the WHO, DOH, and leading private hospitals in Metro Manila. Binay said, “The people of Makati are truly grateful to our health partners for putting up this facility, which brings up our community-based breastfeeding advocacy to a more noble level because mothers will have the chance to save lives by donating their breastmilk to the milk bank.”
Milk letting activity at Bangkal health Center and Lying-In in Makati City. Photo from The HEALTHbeat magazine of DOH. October 2013 issue.
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NATIONAL CAMPAIGN In Defense of the Milk Code
World Vision advocates for the protection and promotion of breastfeeding
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f breastfeeding is the internationally recommended sole source of nutrition from birth to 6 months, and essential part of young child nutrition over 6 months to 2 years and beyond, the current trend of breastfeeding in the Philippines indicates an alarming, opposing trend. Only 27 percent of infants are exclusively breastfed in the first six months. Undernutrition, including suboptimum breastfeeding, stunting, wasting, and deficiencies of vitamin A and zinc, cause 45 percent of child deaths. In the Philippines, undernutrition is considered as the underlying cause of preventable child deaths and continues to be a public health problem among children. In 2011, 20.2 percent of under-five children were underweight and 33.6 percent were stunted. This means that 3 in every 10 children under-five in the Philippines are stunted. The Country Implementation of the International Code of Marketing of Breast-milk Substitutes: Status Report 2011 released by WHO in 2013 mentions evidence showing that advertising and other marketing techniques influence decision of mothers and families on how to feed infants and young children. The report emphasizes that implementing the international code is critical to reduce if not eliminate all forms of promotion of breast-milk substitutes, including direct and indirect promotion to pregnant women and mothers of infants and young children. The landmark study of 1978 from the Philippines opened international discussions which spurred the WHO resolution International Code of Marketing of Breast-milk Substitutes and other Related Products in 1981 . The Philippines adopted the code in 1986 through the enactment of Executive Order 51, known as the Milk Code. Implementation of the Milk Code has had history of pressures from the industry however, intensifying in 2006, when the Revised Im-
www.milkcodephilippines.org is a government portal where violations of the Milk Code can be reported, and it also contains references on Executive Order 51.
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plementing Rules and Regulations (RIRR) was issued a temporary restraining order upon petitions of the milk industry to the Supreme Court. The ban on the RIRR was lifted in 2007, with the Supreme Court affirmation of provisions except for two articles, as the intent of the Milk Code is to regulate trade and marketing of covered products but not total ban. In 2012, a consolidated bill at the House of Representatives was filed, which intended to narrow down application of the Milk Code. The uproar it created rested after intense discussion at the joint committee hearing in Congress among legislator advocates and oppositions, which was also attended by the Department of Health, multilateral organizations, civil society, and milk industry representatives. At the early part of the new 16th Congress the following year however, four new bills were filed in both Houses. Most of these bills have the old intentions of the previous consolidated bill, i.e. to water down the essence of the Milk Code. At this period, what the state clearly needs to be concerned about is not so much on the provisions of the existing Milk Code policy, but on weak enforcement. Since 2006, there were only two reported violations with unclear actions taken. The Inter-Agency Committee is headed by the DOH with the Secretariat Food and Drugs Administration as secretariat. The IAC Secretariat, which is at the forefront of monitoring, has apparent difficulties in operations because of lack of resources including manpower. Support for the implementation of the Milk Code at the local governments is also weak; added to this is the zero to minimal CHN Campaign Newstrail is published awareness of the public bi-annually by Child Health Now Philippines and even parts of the World Vision Development Foundation, Inc. health sector about the 389 Quezon Ave cor. West 6th St. West Triangle, Quezon City Milk Code.