YELLOW PAD

By Emmanuella Iellamo

Aug. 7 is World Breastfeeding Day. It celebrates the 1990 Innocenti Declaration, a gathering representing 30 countries that decided on a global action plan to promote and protect breastfeeding.

Breastfeeding is a bond, a symbol of love, a source of health.

“There is no substitute for mother’s milk.” This statement has been a repeated phrase, an advocacy if you may, shared by both my parents, Alessandro and Efrelyn Iellamo. My father has been working as a breastfeeding consultant for quite some time and my mother has been practicing maternal and childcare in the academe. Needless to say, breastfeeding was a main subject matter during dinners.

My parents were very vocal about the importance of breastfeeding for nutrition and immunity of the baby. With books and journals lying around our home, I took my time to read and understand breastfeeding’s advantages. At the age of five, I remember supporting my mother and younger sister when they joined a mom and baby breastfeeding award contest. They won.

On the other hand, I was a very sickly kid and would have the flu three to four times a year and daily allergy attacks. My mother would often compare my immune system to my sister’s as she would only get sick once a year and it would only last for a day. In her words, “Breastfed baby si Graziella (my younger sister) kaya ganyan.” Though my mother did breastfeed me for three months, she switched to formula milk. This was due to lack of education and awareness at that time. My mom eventually realized that there is no substitute for mother’s milk. Hence my younger sister was breastfed until she was two years old.

To further my understanding, I read studies on infant formula milk. Milk formula companies promise that a child who takes formula is a smart and gifted child, a child protected from sickness. But data and evidence show the contrary. According to the World Health Organization (WHO), formula milk companies make false claims.

These false claims include the following: Formula products with added ingredients improve brain development and immunity. Formula products are needed after 12 months of age. Breast milk is inadequate for the nutrition of older infants and children. Formula milk keeps babies fuller for a longer time and therefore helps them sleep. And the quality of breast milk declines with time.

According to the National Library of Medicine, infants not being breastfed is associated with an increased incidence of infectious morbidity, including otitis media, gastroenteritis, and pneumonia as well as elevated risks of childhood obesity, type 1 and type 2 diabetes, leukemia, and sudden infant death syndrome (SIDS). Among premature infants, not receiving breast milk is associated with an increased risk of necrotizing enterocolitis (NEC). For mothers, failure to breastfeed is associated with an increased incidence of premenopausal breast cancer, ovarian cancer, retained gestational weight gain, type 2 diabetes, and metabolic syndrome.

My father, Alessandro Iellamo, wrote in “Breastfeeding knowledge of mothers in protracted crisis” (2021): “Exclusive breastfeeding for the first six months and continuing breastfeeding for two years or beyond may prevent under-five deaths, primarily from infections resulting in diarrhea, pneumonia, and neonatal sepsis. Beyond the first years of life, breastfeeding has been found to improve children’s quality of life by preventing various diseases such as leukemia, asthma, ear infections, allergies, and diabetes.”

Moreover, the economic burden associated with sub-optimal breastfeeding is huge. In the global setting, the economic burden was estimated at $240.6 million in 2015. This burden includes healthcare costs and the forgone workforce resulting from child mortality.

From a broad development perspective, the WHO says that breastfeeding is critical for the achievement of the Sustainable Development Goals (SDG). Breastfeeding improves nutrition (SDG2), prevents child mortality, decreases the risk of non-communicable diseases (SDG3), and supports cognitive development and education (SDG4). Breastfeeding also enables ending poverty, promoting economic growth, and reducing inequalities.

For all the reasons above, government health agencies of all countries, medical societies, and international organizations such as the WHO and United Nations International Children’s Emergency Fund (UNICEF) have given importance to breastfeeding advocacy. They and other stakeholders have pursued awareness programs and strategies to protect and promote a healthier community through breastfeeding.

The urgency for governments to emphasize breastfeeding was highlighted during the COVID-19 pandemic. The UNFPA (United Nations Population Fund) Philippines called on medical agencies to continue the efforts for breastfeeding education because exclusive breastfeeding is a vital measure for Infection Prevention and Control (IPC). With proper IPC, protection from infection becomes stronger, especially in challenging circumstances and in emergencies. Breastfeeding is associated with immunizing babies from COVID-19.

Breastfeeding is a public health responsibility and a health promotion strategy, says my mother, Efrelyn Iellamo, an Assistant Professor at the University of the Philippines. Governments must establish an enabling environment so that women are able to start breastfeeding right after birth and continue while at home and while working.

But the enabling environment for breastfeeding faces challenges, including the self-serving interference of the formula milk industry. A possible emerging policy, which still can be stopped, is the bill titled Corporate Social Responsibility (CSR) Act, recently passed on third reading in the House of Representatives.

According to the Southeast Asia Tobacco Control Alliance (SEATCA), this CSR bill provides a legal and public relations cover for companies in highly regulated industries such as tobacco manufacturing and commercial infant formula to conduct public health interference, If passed, this will bypass the Philippine Milk Code of 1986, which regulates the marketing of breast milk substitutes for children 0 to 36 months (0-3 years of age) and restricts the inappropriate marketing of breast milk substitutes.

Humanitarian response groups are concerned over the bill’s provision that may have the effect of displacing breastfeeding and thus worsening public health. A section of the CSR bill states: “All business organizations are allowed to donate products and services under their CSR-related activities for disaster relief and assistance, in accordance with the regulations to be issued by the appropriate government agency. All existing laws and regulations restricting or prohibiting the right of local government units under a state of calamity and/or during a national emergency to solicit or accept any donation of products and services under the CSR-related activities for disaster relief and assistance of a business organization are hereby amended.”

The controversial CSR bill also benefits the tobacco industry. Currently, there is a Civil Service Commission (CSC)-Department of Health (DoH) Joint Memorandum Circular that protects the bureaucracy from tobacco industry interference. The Circular limits interactions with the tobacco industry to those that strictly cater to necessary regulations and control. However, the CSR bill includes a repealing clause that will overturn all laws inconsistent with it.

The Philippine government’s duty is to promote and support breastfeeding programs, make available quality breastfeeding support services for all women and their children, and ensure effective compliance with the Philippine Milk Code. The CSR bill should reject any provision that allows industries like tobacco and formula milk to promote and, worse, donate products and services that are inimical to health or to public interest.

Emmanuella Iellamo is a health policy researcher of Action for Economic Reforms.