Volume 2 Issue 2 April - September 2013

CAMPAIGNNEWSTRAILU P D A T E S O N T H E C H N C A M P A I G N I N T H E P H I L I P P I N E S

INSIDE THIS ISSUEGLOBAL CAMPAIGNClosing the Gap in breast-feeding through an online petition 3

PHOTO NEWS 4

NEWS Pressure in Philippines to end ban in milk aid 5

FEATURED PRACTICEQC barangays require breastfeeding stations 7

First LGU-run human mik bank 8

NATIONAL CAMPAIGNIn defence of the Milk Code 8 World Vision with civil society nutrition-focused group Koalisyon

para Alagaan at Isalba ang Nutrisyon (KAIN) continues its sup-port 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 hun-ger and malnutrition in the soonest time possible.” Lozada reiterated government intent to join SUN, realizing this as an oppor-tunity 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.

(continued on page 4)

Philippine gov’t ties with civil society, sets out to join SUN

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.

Continued on page 2

2

This is to “ensure that they (sic) are able to ac-celerate the slow progress reducing hunger and malnu-trition in our country,” stresses Lozada. Prevalenceofunderweightinchildrenbelowfiveis one measurement for both hunger and malnutrition status-2011datashowsthatoneineveryfivechildrenin the Philippines are underweight and three out of 10 are short for their age, an occurrence called stunting. The trend for the MDG to halve underweight children belowfiveinthecountryhasmediumprobabilityonlyto be met in 2015, the end of the MDG target. The government pronouncements of support for the SUN Movement were given in series of events celebrating the national nutrition month in the Philip-pines. Organized by NNC in partnership with the civil society coalition KAIN, the nutrition month thematic focus vowing to end hunger and malnutrition was there-fore an appropriate springboard to usher in the coun-try’s SUN membership. “Like the 40 countries that signed up and now benefittingfromthegains,themembershipcanbringinglobal partners to support the country and also high level support to the scaling up nutrition action,” added NNC head Maria-Bernardita Flores. Seven multisectoral representatives led by Lo-zada, reinforced the announcement of Flores through commitment statements and signing of sectoral support to SUN registration, and the signing of multisectoral declaration of support to end hunger and malnutrition. KAIN represented the civil so-ciety 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 individ-ualandunifiedstrengthofnon-governmentorganizations considering their dedicated work and resources for nutrition, with glob-al 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 high level leadership in government to im-prove nutrition outcomes.

The CHN call to action anchors on recommen-dations from the Nutrition Barometer Report joint-ly published by World Vision and Save the Children in 2012. The report provides a snapshot of national gov-ernment’s commitments and progress in addressing nu-trition and child survival. In the report, the Philippines fared sound on outcomes but frail on commitment. Commitments in-dicated how much national government does to address nutrition in terms of policies, participation in global in-itiatives, and allocation of adequate resources to nutri-tion-specificandrelatedinterventions. At the November 2012 launch of the Barome-ter Report in a forum hosted by World Vision, govern-ment’s global commitment to movements like the SUN was reiterated as a necessary step to improve nutrition status. In June, World Vision hosted the KAIN strate-gic planning workshop and proposed Philippine com-mitment to SUN as one of the coalition’s priority ad-vocacies. When NNC gave pronouncements about its intents to register the country as a SUN member, the coalition has been seeking support from its global part-ners for support in order to ably assist the government in the membership process. The Philippine Plan of Ac-tion on Nutrition was also circulated by NNC to World Vision and others of the 12-member KAIN coalition for review and inputs.

NATIONAL CAMPAIGNPhilippine gov’t ties... (continued from page 1)

WVDF Interim Executive Director Minnie Portales (rightmost) asnwers media queries on behalf of the KAIN coalition of NGOs at the press conference during Nutrition Month.

3

The time of defending the Milk Code is appar-ently 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 at-tempts 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 formu-la milk and other substitutes to breastfeeding, to the detriment of their young children. Breastfeeding is es-timated to prevent deaths of 1 in every 5 under-five children in developing countries, but minimal breast-feeding increases the risk of dying in the first 2 years of life. The Milk Code does not need amendments- in-stead, 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 un-der five children, to protect and promote their nurtur-ance and from which may depend their very survival.

A gap between preventive strategies and the high burden of undernutri-

tion has become apparent in the Phil-ippines, more than ever. In one end is 20.2% underweight and 33.6% stunted children in their crucial growth and de-velopment years. This state makes the Philippines one of the 36 high-burden countries in undernutrition, contribut-ing 90% to the world’s population of undernourished children under the age offive. 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 naturalimmunityfrombreastfeedingaloneinthefirstsixmonths of life. Which is logical why undernutrition is the biggest underlying factor in child mortality in the Philip-pines. A study by WHO in 2013 mentions evidence showing that advertising and other marketing techniques influencethedecisionofmothersandfamiliesonhowtofeed 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.

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/op-pose-any-amendment-that-will-water-down-the-milk-code-eo-51

4

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 Sum-mit, 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 coali-tion members in one of its meetings that WVDF hosted at the National Office.

5

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

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 evacua-tion centres even though they are banned under the country’s “Milk Code”. The Department of Health singled out infant for-mula maker Nestlé Philippines, issuing a cease-and-desist order requesting it to stop donating milk products to typhoon survi-vors. The problem was not the company, insisted Nestlé spokes-woman Meike Scmidt, but rather “kind-hearted private individu-als and organizations” who donated products of their own will. “We have the industry’s toughest system in place to en-force our policies governing the marketing of breast-milk substi-tutes,” she told IRIN. “Our monitoring procedures include con-trol 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 (IP-NAP) which is trying to change the country’s Milk Code. One of the proposals is to allow unrestricted donations of breast-milk substitutesduringcrises.Activistshaveralliedtofightwhattheycharacterize as the “diluting” and weakening of the current Milk Code, allegations that Nestlé dismisses.

Milk of life

Medical studies have linked formula donations to in-creased diarrhoea during crises, as was the case during Indone-sia’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); over-all, the rate of diarrhoea among infants aged 12-23 months was fivetimeshigherthanbeforetheearthquake,whichresearcherslinked to breast-milk substitute donations. Some 80 percent of the 832 surveyed surviving house-holds had received donated infant formula, 76 percent commer-cial porridge and 49 percent powdered milk. Pre-earthquake only 32 percent of the infants had ever had breast-milk substi-tutes, a rate that rose to 43 percent at the time of the survey, “Uncontrolled distribution of infant formula exacer-bates 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 Bo-pha (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) ty-phoon 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 Depart-ment regulations prohibiting the distribution of milk products to women and children. The memo stated such donations by “well-meaning, but misinformed donors” were unnecessary. Thechallenge,saidUNICEFnutritionofficerforemer-gencies 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 communi-ties.Monitoringatthelocallevelisdifficult,”hesaid. Even with health officials’ vigilance to keep out milkproducts, the disaster took a heavy toll on nutrition in affected areas: Aid groups estimate 95,600 persons will be at risk of mal-nutrition in 2013 including nearly 67,000 children under the age offiveand29,000pregnantandlactatingwomen. The youngest are the most vulnerable. One month af-ter the typhoonhit,of thenearly500childrenunderagefivesurveyed, 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 for-mula 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.

Compostela Valley, 30 April 2013 (IRIN) - Health au-thorities in the Philippines were vigilant in keeping out infant formula donations when Typhoon Bopha hit last December, but activists are concerned the in-fant 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 breast-feeding. Breastfeeding - especially during emergencies - has been medically linked to improved child survival due to the incomparable nutrients and antibodies hu-man 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.

IRIN is a news and analysis service of the UN OfficefortheCoordinationofHumanitarianAffairs (OCHA).

6

BarangaySto.Cristo,QuezonCityrecentlyissuedanordinancerequiringofficesandestablishmentsinthebarangay with 20 or more women employees to provide a lactation station for the exclusive use of moth-

ers 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 cam-

paign to put up breastfeeding stations in the more than a thousand establishments in his barangay. By the firstquarterof2014,hewill revisit theseestablish-ments and will begin imposing the law before issuing barangay permits or clearances.

FEATURED PRACTICE

* These articles on FEATURED PRACTICES are lifted from HEALTHbeat, the official magazine of the Department of Health. The complete special issue on breastfeeding may be downloaded from http://www.healthbeat.ph

*QC Barangays Require Breastfeeding Stationsby Myrna V. Lapuz, RND, MPH

*First LGU-Run Human Milk Bank

The 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 suscep-tible infants with the healthiest, most econom-ical and most accessible form of milk. Breast-milk has been smedically proven to reduce infant deaths. Makati City Health Officer, Dr. Estela Barrios, said that the milk bank is fully furnished with essen-tial 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

8

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 Maka-ti 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 Medi-cal Center (PCMC).” PCMC is a DOH-accredited training institu-tion on the management and operation of human milk banks and one of only two health facilities in the coun-try that houses a DOH-approved human milk bank. The other health facility, also run by DOH, is the Dr. Jose Fabella Memorial Hospital (DJFMH).

The barangay included the lactation station as a requirement in the issuance and/or renewal of business clearance.

7

Human breastmilk is undoubtedly the single most im-portant 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 test-ed 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 collectedmilk 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

for their baby’s primary needs. According to the Food and Nutrition Research In-stitute (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 contin-ued breastfeeding with complementary solid food up to two years old and even beyond.This is essential in addressing the problem of infant mortal-ity 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 grate-ful 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.”

FEATURED PRACTICES

8

First LGU-Run Human Milk Bank...continued

Safety Measures

Milk letting activity at Bangkal health Center and Lying-In in Makati City. Photo from The HEALTHbeat magazine of DOH. October 2013 issue.

WE’RE ON FACEBOOK! For more information and resources, check our page at facebook.com/ChildHealthNowPhilippines

Dont forget to us!

8

The Country Implementation of the International Code of Marketing of Breast-milk Substitutes: Status Report 2011 released by WHO in 2013 mentions evidence show-ingthatadvertisingandothermarketingtechniquesinfluencedecision 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 di-rect 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 Phil-ippines adopted the code in 1986 through the enactment of Executive Order 51, known as the Milk Code. Implementa-tion of the Milk Code has had history of pressures from the industry however, intensifying in 2006, when the Revised Im-

NATIONAL CAMPAIGN

CHN Campaign Newstrail is publishedbi-annually by Child Health Now Philippines

World Vision Development Foundation, Inc.389 Quezon Ave cor. West 6th St.

West Triangle, Quezon City

plementing Rules and Regulations (RIRR) was issued a tem-porary restraining order upon petitions of the milk industry to the Supreme Court. The ban on the RIRR was lifted in 2007,withtheSupremeCourtaffirmationofprovisionsex-cept 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 Repre-sentativeswasfiled,which intendedtonarrowdownappli-cation 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 organiza-tions, civil society, and milk industry representatives. At the early part of the new 16th Congress the following year how-ever,fournewbillswerefiledinbothHouses.Mostofthesebills 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 ofmonitoring,hasapparentdifficultiesinoperationsbecauseof 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 awareness of the public and even parts of the health sector about the Milk Code.

In Defense of the Milk CodeWorld Vision advocates for the protection and promotion of breastfeeding

If 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 27percentofinfantsareexclusivelybreastfedinthefirstsixmonths. Undernutrition,includingsuboptimumbreastfeeding,stunting,wasting,anddeficienciesof 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 healthproblemamongchildren.In2011,20.2percentofunder-fivechildrenwereunderweightand33.6percentwerestunted.Thismeansthat3inevery10childrenunder-fiveinthePhil-ippines are stunted.

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.