Two Bills on Breastfeeding

AT LARGE
Two bills on breastfeeding

By Rina Jimenez-David, Inquirer
August 14, 2007

MANILA, Philippines — It’s Breastfeeding Month, and to celebrate the occasion, Sen. Pia Cayetano, who chairs both the committee on health and the committee on environment, has chosen to re-file the Expanded Breastfeeding Promotion Act.The draft law was passed in the Senate during the previous Congress but failed to reach third reading in the House of Representatives. It has been re-filed in the Senate as Senate Bill 761, with an additional provision on the establishment of milk banks.

The bill seeks to establish a national policy on breastfeeding and thus reverse the decline in breastfeeding rates in the country. It reinforces the National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Other Related Products, also known as the Milk Code.As the senator tells it, the impetus behind the bill is an experience she underwent when she had to leave her child, who was still breastfeeding at the time, at home while she took a work-related trip abroad. “I had to express milk to keep up my supply,” she recalls, “but I had a difficult time looking for a private space where I could do it. At airports, I had to lock the door of baby-changing stations for some privacy, but the incessant knocking of other people wanting to use the room rattled me.”

From this personal experience, Cayetano has come up with a measure that would “mandate the establishment of lactation stations in workplaces and public spaces,” as well as require employers to provide “compensated breaks or lactation periods” to allow their employees who are nursing mothers “reasonable compensable time during the day to either breastfeed or express their milk.”

The bill would also allow establishments which set up lactation stations (such as the SM malls) to use the designation “mother-friendly” in their promotional materials.

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BEYOND lactation stations, the bill would also mandate the health department to “develop and provide breastfeeding programs for working mothers” which even the private sector could adopt, as well as to “conduct training for all health workers involved in obstetrical and pediatric services to ensure that they are knowledgeable about the advantages of breastfeeding and risks associated with breast-milk substitutes.”

The bill also seeks to “encourage health workers and institutions to provide pregnant and lactating mothers the necessary support, proper information and training on breastfeeding and to primarily recommend breastfeeding and only recommend breastmilk substitutes where, after explaining the advantages of breastfeeding and risks associated with breastmilk substitutes, a mother still opts to give formula to her newborn.”

Indeed, anecdotal evidence suggests that doctors, nurses and midwives exert an extraordinary amount of influence over mothers who are at their most vulnerable and gullible immediately after delivery. An indifferent or even skeptical health service provider could easily erode a new mother’s determination to breastfeed. “I was already a lawyer,” recalls Sen. Cayetano, “but after I gave birth I even had doubts about the wisdom of my choice to breastfeed because my ob-gyne wasn’t so encouraging.”

Thus, the senator would also want breastfeeding education integrated in all relevant subjects at the elementary, high school, and college levels, including medical and allied medical courses, as well as in technical/vocational education.The bill also encourages health institutions to set up milk banks for the storage of breast-milk donated by mothers and which has undergone pasteurization, while recommending that the stored breastmilk “be primarily given to children in neonatal intensive care unit whose own mothers cannot produce, or do not have enough breastmilk.”

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THE SENATOR also has another pending bill which would address the main issue raised by infant-formula manufacturers in their case, currently before the Supreme Court, against the revised rules and regulations of the Milk Code promulgated by the Department of Health.If passed, the bill would ban “advertisements, sponsorships, promotions and other marketing materials for breast-milk substitutes for infants and young children (expanded to include three year olds).” The bill will also ban “names, color schemes, and graphics of breast-milk substitutes for children up to three years old” which are “identical or confusingly similar” to brands for infants and young children.Other marketing activities, especially those involving health workers are also included in the ban, and would create a “fund” from the milk manufacturers which could be used to promote the benefits of breastfeeding.

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The Expanded Breastfeeding Promotion Act

FAST FACTS ON SENATE BILL NO.2490

“Expanded Breastfeeding Promotion Act”

Approved as an amendment to RA 7600 or the “Rooming-in and Breastfeeding Act of 1992”

• Approved on Third Reading on December 21, 2006 while the House is expected to pass its version soon.

• Principal Authors: Cayetano, Flavier, Ejercito-Estrada J., Lacson

• With amendments introduced by Angara, Ejercito-Estrada L., Pangilinan

• Establishes a national policy on breastfeeding and seeks to reverse the decline in breastfeeding rates. It reinforces the “National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Other Related Products” (Executive Order No. 51), also known as the Milk Code, that was enacted in 1986 to control the unethical marketing practices of milk companies

• Lactation Stations shall be established and maintained in Workplaces and in Public Places. Lactation Stations must be private, clean and well-ventilated, adequately equipped with a sink or lavatory for hand-washing and cleaning of equipment unless there is an easily accessible lavatory nearby. There must also be refrigeration or appropriate cooling facilities for storing, electrical outlets for breast pumps, a small table, comfortable seats and such other items which the Department of Health (DOH) as implementing agency may determine to be necessary.

• Lactation periods shall be established to allow nursing female employees reasonable compensable time during the day to either breastfeed or express their milk.

• Establishments which set up a lactation station may use the designation “Mother-friendly” in promotional materials.

• The DOH, as the lead agency, shall be mandated to develop and provide breastfeeding programs for working mothers which employers are encouraged to avail of as part of their human resource development and which shall be disseminated to all city, municipal and barangay health centers.

• Breastfeeding education shall be integrated in relevant subjects in the elementary, high school and college levels, especially in the medical and allied medical courses, and in technical vocational education. The inclusion of breastfeeding in the curriculum will help counter perceptions brought about by the lack of information on breastfeeding to the public and massive advertisements of Breastmilk Substitutes by milk companies.

• The month of August in each and every year shall be known as ‘‘Breastfeeding Awareness Month.” A comprehensive public education and awareness program shall be undertaken in this regard.

 

International Treaties and Conventions Supporting Breastfeeding

Q: What are the international treaties and conventions supporting breastfeeding?

A:

I. International Code of Marketing of Breastmilk Substitutes and its resolutionsIn May 1981, the Code was overwhelmingly approved by the World Health Assembly by 118 votes to 1 including the Philippines. The lone vote against the Code came from the United States of America, which was concerned that the Code could have a detrimental effect on US business.

The Code applies to infant formula, other products marketed or represented as replacements for breastmilk, feeding bottles and teats.

Manufacturers and distributors of these products are subject to the following restrictions and obligations under the Code:

1. No advertising or other forms of promotion to the public.

2. No free samples to mothers (indirect or indirect).

3.No promotion within health care system.

4. No contact between marketing personnel and mothers.

5. No gifts to health workers; samples only under very limited circumstances. Product information for health professionals must be limited to scientific and factual matters.

6. No inclusion of sales volume in calculation of employee bonuses and other sales incentives. Marketing personnel are not to perform educational functions for mothers.

7. No pictures of infants or other pictures or text idealizing the use of infant formula on labels. Labels must clearly state the superiority of breastfeeding, include preparation instructions and include a warning about the health hazards of inappropriate preparation.

8. Unsuitable products such as sweetened condensed milk should not be promoted for infants. All food products must meet applicable standards recommended by the Codex Alimentarius Commission.

9. Independently of measures taken to implement the Code, manufacturers and distributors are responsible to monitor their marketing practices according to the principles and aims of the Code and to take steps to ensure that their conduct conforms at every level.This means companies should comply with the Code’s provisions even in countries that do not yet have national legislation or other measures based on the Code. It also means that, as the Code was adopted as a “minimum requirement”, companies must abide by it fully even if national measures are weaker.

II. Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding

In 1989, policy makers from the World Health Organization and UNICEF drew up the Innocenti Declaration on the Protection, Promotion and Support of Breastfeeding. It recommended that various obstacles to breastfeeding “within the health system, the workplace and the wider community” be removed. It also outlined several objectives, including the need for governments to “enact imaginative legislation protecting the breastfeeding rights of working women” (World Health Organization/UNICEF, 1990).

III. International Labour Organization (ILO)

The Philippines is a signatory to all ILO conventions and is an active member thereof

* C 103 Maternity Protection Convention, 1952

Article 5

1. If a woman is nursing her child she shall be entitled to interrupt her work for this purpose at a time or times to be prescribed by national laws or regulations.

2. Interruptions of work for the purpose of nursing are to be counted as working hours and remunerated accordingly in cases in which the matter is governed by or in accordance with laws and regulations; in cases in which the matter is governed by collective agreement, the position shall be as determined by the relevant agreement.

* C 183 Maternity Protection Convention, 2000 (Breastfeeding Mother)
Article 10

1. A woman shall be provided with the right to one or more daily breaks or a daily reduction of hours of work to breastfeed her child.

2. The period during which nursing breaks or the reduction of daily hours of work are allowed, their number, the duration, of nursing breaks and the procedures for the reduction of daily hours of work shall be determined by national law and practice. These breaks or the reduction of daily hours of work shall be counted as working time and remunerated accordingly.

* C 156 Workers with Family Responsibilities Convention, 1981

Article 1
The provisions of this Convention shall also be applied to men and women workers with responsibilities in relation to other members of their immediate family who clearly need their care or support, where such responsibilities restrict their possibilities of preparing for, entering, participating in or advancing in economic activity.

For the purposes of this Convention, the terms dependent child and other member of the immediate family who clearly needs care or support mean persons defined as such in each country by one of the means referred to in Article 9 of this Convention.

Article 3
With a view to creating effective equality of opportunity and treatment for men and women workers, each Member shall make it an aim of national policy to enable persons with family responsibilities who are engaged or wish to engage in employment to exercise their right to do so without being subject to discrimination and, to the extent possible, without conflict between their employment and family responsibilities.

IV. 1989 United Nations Convention on the Rights of the Child (CRC)
(Philippines is a signatory)

Article 6
1. states Parties recognize that every child has the inherent right to life
2. states Parties shall ensure to the maximum extent possible the survival and development of the child

Article 18
For the purpose of guaranteeing and promoting the rights set forth in the present Convention, states Parties shall render appropriate assistance to parents and legal guardians in the performance of their child-rearing responsibilities and shall ensure the development of institutions, facilities and services for the care of children.

States Parties shall take all appropriate measures to ensure that children of working parents have the right to benefit from child-care services and facilities for which they are eligible.

Article 24
States Parties shall pursue full implementation of this right and, in particular, shall take appropriate measures:
(b) To ensure the provision of necessary medical assistance and health care to all children with emphasis on the development of primary health care;
(d) To ensure appropriate pre-natal and post-natal health care for mothers;
(e) To ensure that all segments of society, in particular parents and children, are informed, have access to education and are supported in the use of basic knowledge of child health and nutrition, the advantages of breastfeeding, hygiene and environmental sanitation and the prevention of accidents;
(f) To develop preventive health care, guidance for parents and family planning education and services.

V. Convention on the Elimination of all Forms of Discrimination against Women (CEDAW, 1979).
(Philippines is a signatory to this convention)

  • International bill of rights for women

  • Only human rights treaty which affirms the reproductive rights of women

  • Targets culture and tradition as influential forces shaping gender roles and family relations

  • Affirm women’s rights to non-discrimination in education, employment and economic and social activities (article 10,11,13)

  • The Convention also devotes major attention to a most vital concern of women, namely their reproductive rights

  • While CEDAW makes no distinct reference to breastfeeding, other than the need for governments to ensure women have adequate nutrition during pregnancy and lactation” [Article 12], Article 11 states that “State parties shall take appropriate measures to…introduce maternity leave with pay or with comparable social benefits without loss of former employment, seniority or social allowances.”

  • Article 5 (b): To ensure that family education includes a proper understanding of maternity as a social function and the recognition of the common responsibility of men and women in the upbringing and development of their children, it being understood that the interest of the children is the primordial consideration in all cases. Society’s obligation extends to offering social services, especially child-care facilities that allow individuals to combine family responsibilities with work and participation in public life.

  • Article 11.1 (f) The right to protection of health and to safety in working conditions, including the safeguarding of the function of reproduction.

  • Article 11.2 In order to prevent discrimination against women on the grounds of marriage or maternity and to ensure their effective right to work, State Parties shall take appropriate measures: (c) To encourage the provision of the necessary supporting social services to enable parents to combine family obligations with work responsibilities and participation in public life, in particular through promoting the establishment and development of a network of child-care facilities.

  • Article 16 (d) The same rights and responsibilities as parents, irrespective of their marital status, in matters relating to their children; in all cases the interests of the children shall be paramount.

VI. Beijing Declaration and Platform for Action, Fourth World Conference on Women (15 September 1995)

  • Preamble: Ensure equal access to and equal treatment of women and men in education and health care and enhance women’s sexual and reproductive health as well as education.

  • Number 107 (r) Promote public information on the benefits of breastfeeding; examine ways and means of implementing fully WHO/UNICEF International Code of Marketing of Breastmilk Substitutes, and enable mothers to breastfeed their infants by providing legal, economic, practical and emotional support.

  • Number 110 (g) Support health service systems and operations research to strengthen access and improve the quality of service delivery, to ensure appropriate support for women as health care providers and t examine patterns with respect to the provision of health services to women and use of such services by women.

  • Design and implement, in cooperation with women and community-based organizations, gender-sensitive health programmes, including decentralized health services, that address the needs of women throughout their lives and take into account their multiple roles and responsibilities, the demands on their time, the special needs of rural women and women with disabilities and the diversity of women’s needs arising from age and socio-economic and cultural differences, among others; include women, especially local and indigenous women, in the identification and planning of health care priorities and programmes; remove all barriers to women’s health services and provide a broad range of health care services.