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.

How the bottle ‘sabotages’ breastfeeding

How the bottle ‘sabotages’ breastfeeding

By Tessa Salazar
Published on page B4 of the August 12, 2006 issue of the Philippine Daily Inquirer

Last updated 11:28pm (Mla time) 08/11/2006

GIVE THE feeding bottle in the early hours after birth, and you seriously compromise a baby’s chance to successfully breastfeed. The mother is bound to fail (to breastfeed) if not corrected right away by somebody who knows how to support breastfeeding.”This was how Dr. Maria Asuncion A. Silvestre, chair of the breastfeeding committee and member of the board of trustee of the Philippine Society of Newborn Medicine, described how the feeding bottle gave mothers a false sense of security.

Silvestre, who recently spoke to members of the media during a PCP Health Forum, added that the amount of milk from the bottle is also disproportionate to the feeding capacity of the baby. The size of the newly born baby’s stomach is like that of a large marble that’s not designed to accommodate one to two ounces of milk formula or water from a feeding bottle. So how come the baby seems to calm down while taking the entire contents of a feeding bottle in? When you force the bottle’s nipple — or even pacifier — in the baby’s mouth, he or she will instinctively start suckling. The baby stops crying, again giving mothers that false sense of security.After being used to bottle feeding, what comes next is that when the baby is then finally breastfed by the mother, the latter would most likely feel uncomfortable about the process. Silvestre explained that as a result of getting used to the artificial nipple, the baby would develop a different way of sucking the mother’s breast — a way that would most likely be painful, would cause soreness or even infection of the mother’s nipples. Continue reading

Breastfeeding is core program of US health campaign

THE CONSUMER
Breastfeeding is core program of US health campaign
 

By Linda Bolido
Published on Page C2 of the August 17, 2006 issue of the Philippine Daily Inquirer

Last updated 00:40am (Mla time) 08/17/2006 

“WALANG KUKURAP.” If you do, you may miss the reminder in television advertisements for children’s milk that breast milk is best for babies up to six months of age. It is apparent that the one-liner is, for many milk ads, an afterthought, a grudging concession to a legal requirement to inform people that breast milk should be preferred to infant formula. Most TV milk ads use some 99.999 percent of visual and audio material touting features that will turn kids into future Einsteins, Michelangelos, Shakespeares or Beethovens. After all the hype, with viewers so fired up they feel like rushing to the nearest store to buy the products even if they don’t have an infant, the commercials end with that one-liner about breast milk that is gone in the blink of an eye. Ironically, in the Philippines where existing conditions point to the need for breast-feeding as the safer, healthier and cheaper guarantee of young children’s health, advocates of the practice have to use so much energy and time to be heard. What are those conditions? Lack of access to potable water for a large segment of the population, absence of hygienic facilities for preparing and storing milk, and the high cost of formula (a small can costs more than P100) are just a few of them. Recently, coming home from the United States, I saw at the airport pre-departure lounge a slim, blonde 30-ish woman give her breast very discreetly to her son who was about a year old. Her blouse had overlaps that made it possible to feed in public without exposing herself.
In contrast, many women who sleep on the streets of Manila give their very young children bottles containing liquids that look like extremely watered-down milk. Usually, since infant formula is expensive, the watered-down drink that these infants get is condensed milk, which has more sugar than what’s good for a growing child. Between that blonde, who could travel from San Francisco to Reykjavik, Iceland (that’s where the flight she boarded was going) with her three children, and a woman who lives on the street, the latter would benefit more from breast-feeding as she would not have to buy milk nor worry about finding clean water to mix with the milk or to wash the bottle with. It would also be easier for her to keep her breast clean for her suckling child. And now, while the Philippines still struggles to make women return to breast-feeding, the New York Times has reported that the US’ new public health campaign, Healthy People 2010, would have breast-feeding as a core program. Roni Rabin, who wrote the story, said one of the unambiguous messages of the new campaign would be: “Public health officials have determined that not breast-feeding may be hazardous to your baby’s health.” This follows a recent announcement by the World Health Organization that breastfeeding should be the “biological norm” for infant nutrition. Although there are some disagreements about the extent of breast milk’s disease-preventing and growth-promoting benefits, there is generally a consensus that it is still superior to formula. Rabin reported, “Scientific evidence supports the contention that breastfed babies are less vulnerable to acute infectious diseases, including respiratory and gastro-intestinal infections, experts say. Some studies also suggest that breastfed babies are at lower risk from sudden infant death syndrome and serious chronic diseases later in life, according to the American Academy of Pediatrics.”

Birth and death

Birth and death 

By Rina Jimenez-David
Inquirer
Last updated 05:40am (Mla time) 06/24/2007

MANILA, Philippines—Birthing has always been a women’s ritual. Before the natural birth movement brought fathers not just into the labor room but in birth classes too, men were largely absent from the entire process of pregnancy and birth—except, of course, for donating the sperm (knowingly or unknowingly) that sets the women down that road.From the moment a woman finds out she’s pregnant, she finds herself cocooned in a circle of advice and counseling, helpful or otherwise, from other women, even those who have yet to be with child. She is told what she should and should not eat, how to have a good-looking child (by clipping a picture of a cute baby and placing it beneath her pillow), how to avoid stretch marks and unwanted pigmentation (usually useless), even when and how to have sex despite the watermelon in her belly.The sisterhood makes itself felt particularly during delivery. In the days before the “medicalization” of birth, a woman delivered at home, cared for by a birth attendant, and surrounded by women boiling water, preparing concoctions, washing linen and praying novena after novena for her and the baby’s survival.The father and his men friends and relatives would be waiting outside the delivery chambers or in the backyard or even at a nearby sari-sari store or bar. When hospital deliveries became common, fathers would be consigned to a waiting area, playing out the cliché of the anxious parent pacing back and forth and, when it was still politically correct, smoking stick after stick and littering the hospital floor with cigarette butts.Being absent from the scene, fathers often took the process for granted, or else took inordinate credit for the outcome. An old professor of mine, a mother of 12, has a favorite story about her late husband. As she swam out of the anesthesia after the birth of their oldest child, a girl, her husband looked lovingly into her eyes and said gently “We have a girl, but don’t worry, the next one will be a boy.”

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DESPITE the romanticism of the sisterhood looking after their own at the time of a woman’s delivery, the truth is that the moment of birth and the period immediately after it is fraught with risk for both mother and child.In a policy paper on “Saving Newborn Lives” published by Save the Children and the Population Reference Bureau, the authors posit that “Newborn survival is inextricably linked to the health of the mother. Nowhere is this more evident than the high risk of death for newborns and infants whose mothers die in childbirth.”For both newborns and mothers, says the paper, “the highest risk of death occurs at delivery, followed by the first hours and days after childbirth. The postnatal period (the time just after delivery and through the first six weeks of life) is especially critical for newborns and mothers.”More than two-thirds of newborn deaths take place by the end of the first week after delivery, with up to one-half of all newborn deaths occurring in the first 24 hours. Each year, four million infants die within their first month of life, representing nearly 40 percent of all deaths of children under 5.Similarly, approximately two-thirds of all maternal deaths occur in the postnatal period. Says the paper: “The time of highest risk of death is the same for mothers and for newborns—on the day of delivery and over the next few days after delivery.”These data, the authors say, “offer compelling evidence that integrated maternal and newborn postnatal care (PNC) during the first few days after delivery should be provided to all newborns and their mothers as a concerted strategy to improve survival of both.”Maybe that’s why a woman’s female relatives gather round her while she’s pregnant and during delivery. Perhaps there’s something in the female psyche that knows this is a time of awful risk and danger, for both mother and child.

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WHILE there is not yet “a standardized, evidence-based PNC protocol,” there is some consensus on some of the more effective (and commonsensical, it seems) elements of care. The WHO has long recommended that postnatal care for all newborns should include “immediate and exclusive breast-feeding, warming of infants, hygienic care of the umbilical cord, and timely identification of danger signs with referral and treatment.”For mothers, recommended care includes monitoring and referral for complications such as excessive bleeding, pain and infection; counseling on breast care and breast-feeding; and advice on nutrition during breast-feeding, newborn care practices and family planning. Among the most crucial elements of any PNC program is a corps of skilled health providers, including midwives and health workers, who can visit newly delivered mothers and babies at home for initial care and advice-giving. Home visits are a necessity especially in developing countries, like the Philippines, because most deliveries are made at home, and social restrictions and traditions may even prevent a mother from leaving her home (or her room) to seek treatment.As the authors put it: “In most developing countries … postnatal care may only occur if provided through home visits, because geographic, financial and cultural barriers typically limit care outside the home during the early postnatal period.” “The essential elements of postnatal care for newborns and for women are already known and established,” say the authors. The issues remaining largely concern the integration of PNC protocols into the existing health system and, dare I say, the political will of leaders to give priority (and a commensurate share of the budget) to saving the lives of mothers and newborns when it counts most.

Breast milk ‘containers’ never rust

Breast milk ‘containers’ never rust 

By Rina Jimenez-DavidInquirer
Last updated 03:46am (Mla time) 06/23/2007

MANILA, Philippines — One thing you can say about breast milk — its containers will never “rust.” This brings to mind that old — and corny — joke about the advantages of breast milk, including the fact that “it comes in the most attractive containers.” Since I think the eroticization of the female breast and even of breastfeeding is one factor contributing to the ambivalent feelings some women have about suckling their young, I won’t go there. But I’m very sure that breastfeeding mothers won’t ever have to worry about their milk becoming contaminated, unlike mothers currently bottle-feeding and depending on “Bonna,” “Promil Kid,” “Promil” and “Progress Gold” for their children’s nutrition. As you are aware, the Bureau of Food and Drugs (BFAD) ordered earlier this week the recall of millions of cans of the above-mentioned milk brands, which had been found to be infested with molds and rusting outer rims.The milk brands are products of Wyeth, a multinational giant that has joined with other powdered milk manufacturers in the Pharmaceutical and Healthcare Association of the Philippines (PHAP) in contesting the Department of Health’s authority to issue revised rules and regulations on the marketing of breast milk substitutes. Perhaps, Wyeth should publicize how they propose to improve on the packaging of breast milk, which, unlike “Promil,” “Promil Kid,” etc., doesn’t have to be placed in metal cans and stored in weather-proof warehouses, mixed with clean boiled water and poured into feeding bottles that have been previously washed and sterilized.To be sure, Wyeth has engaged in an extensive damage-control media campaign, issuing clarifications that they had conducted tests on the milk in the affected cans and found that “the integrity of the milk powder was maintained.” Rightly, the BFAD has said it remains “unconvinced” about Wyeth’s claims. After all, the Wyeth labs are hardly a disinterested party in the recall.

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BUT this hue and cry over the allegedly damaged milk cans certainly points to the vulnerability of milk powder which, like other consumer products, is subject to spoilage, improper storage and contamination. Perhaps we should add these to the many reasons cited by experts who say that powdered milk is clearly inferior to breast milk.This would obviously be news to the millions of Filipino mothers who have chosen to bottle-feed their children. And the irony is, as the documentary “Formula for Disaster” shows, mothers are choosing bottle over breast mainly because they believe that powdered milk is the superior product, that it would make their babies not just healthier but also brighter. This is all foolishness, of course, but if the only information you get about infant nutrition is from radio, TV and print ads, as well as doctors, nurses and midwives pushing their own brands at you, you will come away thinking bottle-fed babies are fatter (which is, on the average, true but it is “bad” fat), healthier, stronger, more intelligent.

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I RECENTLY got into a heated (but friendly) discussion with two health professionals, a midwife and an obstetrician-gynecologist, about the merits and demerits of breastfeeding. It isn’t just misinformation or disinformation that explains many mothers’ preference for bottle-feeding, argued the midwife. It’s also the demands made on a mother’s time and convenience (and privacy) by breastfeeding.“I don’t think many mothers would bring their infants with them when they commute to work,” commented the doctor. “Imagine exposing a baby to all that pollution!”“When a mother returns to work,” said the midwife, “she usually has a hard time continuing to breastfeed. Just imagine,” she added, “a working mother having to ride the bus or stand in a jam-packed LRT [Light Rail Transit] car while lugging her breast pump and bottles, not to mention a cooler in which she will store the expressed milk.”In many work places, she added, breastfeeding mothers don’t even have a private space where they could breastfeed without interruption. And where could she store the expressed milk? Rare is the employer who would provide a refrigerator exclusively for storing expressed breast milk.

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FROM PERSONAL experience, while it is difficult to continue breastfeeding even after your maternity leave, it’s possible. All you need to do is to express milk after each feeding and store the milk in your freezer (properly labeled with the date of expressing). Thawed (but not heated) frozen breast milk allows your husband or nanny to continue “breastfeeding” your baby even when you’re away. But to keep up your milk supply, you need to express while at work.I know, too, about the inconveniences presented by breastfeeding or even expressing milk. “Imagine the mother tilling the field or selling fish in the market having to stop and express her milk,” argued the midwife.But then, I argued back, aren’t these precisely the mothers who can ill-afford to buy powdered milk for their babies and to meet all the demands of proper, sanitary bottle-feeding?

I think this is a “false dilemma.” It’s a dilemma only because we think breastfeeding is solely the mother’s (and baby’s) concern. But if the survival of infants is a social concern, then society will have to step up and do its part. Husbands will have to help with the housework so their wives could breastfeed as needed. Employers will have to provide breastfeeding rooms, breast pumps and refrigerators for hassle-free milk expression. Legislators can consider a longer maternity leave and penalizing employers who discriminate against women because of it. And the public should support mothers who choose to breastfeed — even if by force of circumstance they do this in public. The least you could do is not to stare or snicker.