POSITION PAPER on House Bill No.

-- introduced by Representatives Rufus Rodriguez, Josephine Veronique R. Lacson-Noel et al. titled: An Act Promoting A Comprehensive Program on Breastfeeding Practices and Regulating The Trade, Marketing and Promotions of Certain Foods For Infants and Young Children or short title "Breastfeeding and Milk Regulation Act Submitted by Save the Babies Coalition comprised of four big NGO Coalitions namely Civil Society for Educational Reform, Ecowaste Management Coalition, Partnership of Philippine Support Service Agencies Inc., Health Justice and Mother Support Groups nationwide. In principle the Save the Babies Coalition agrees with some of the general objectives (A-K attached) of the consolidated Bill culled from the Mother Bill of Representative Ana York-Bondoc Bill because it reflects the culture, history and values of the Filipino people backed up by 30 years of scientific evidence-based studies endorsed by WHO/World Health Assembly Resolutions. But Save the Babies Coalition strongly register to the House of Representatives of the Philippines our vehement objections to the majority of the provisions Sections 20, 21, 23, 25, 28, 32, 35, 37, 38, 42, 43, 46 from the present consolidated Bill espoused by Representative Rufus Rodriguez because it does not serve the interest of the Filipino people rather it propogates the commercial interest of the multinational milk companies represented by IPNAP (Infant Pediatric Nutrition Association of the Philippines) led by Nestl. It will destroy the innate power of breastfeeding that aims to protect the Filipinos next generations health and wealth. Herewith the Save the Babies Coalition response to the detailed provisions of the recent consolidated Bill: 1.) The proposed Bills provision on: Chapter IX Marketing of Breastmilk Substitutes, Breastmilk Supplements and other Covered Products Section 32. Advertising and Promotions - When Allowed. Advertising and promotions of follow-on formula, growing- up milk supplements and other products covered by this Act intended for children over six (6) months of age shall be allowed. This is against more than 30 years of scientific evidence that has shown that marketing and promotion of such products should not be allowed, as properly stated in the 1981 International Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Related Products, by the Convention on the Rights of the Child (1990) and eventually upheld by

the 1986 Executive Order 51 and its 2007 revised Implementing Rules and Regulations. Allowing promotions for products for six (6) months and above, will cause an irreparable damage to the growth and development of our country. Allowing this does not protect and support breastfeeding but it only favors milk industry gains and commercial interests. This was already surfaced by the late US Senator Kennedy, in 1978, when he himself called for a senatorial investigation on the review of marketing and promotional practices of the milk industry that resulted in requesting UNICEF and WHO to help member countries in developing appropriate measures that will regulate and if necessary prohibit certain marketing practices. Its legal soundness has been approved by our late President Corazon C. Aquino last 1986 signed into law E.O. 51 (Executive Order 51) known as Milk Code. In October 2007 as clearly stated by the Supreme Court en banc did not limit the coverage of the law to a specific age bracket. The spirit of the Milk Code reflects the objectives A-K (page 13) as attached in the recent consolidated Bill. Furthermore, Save the Babies Coalition object to the provision on allowing advertisement and promotions of follow-on-formula, growing up milk supplements and other products intended for children above six (6) months of age. It will damage and endanger breastfeeding culture that ensures food security, health protection to both mother and child, empowerment of women to nurture naturally a God given resource. Insidious marketing through advertising and promotions of babymilk/food products undermine the confidence of the mothers on her innate ability to sustain breastfeeding because of the seduction of sophisticated advertisements exposure that is heard and seen every thirty minutes daily over mass media. Highly paid known actresses have been used for product testimonials knowing the undue influence on the consumers. The multinational milk companies have spent P1 Billion ($1=P42.00) for advertising outlay in the Philippines. In effect, this wreck on the Philippine economy consequently exacerbating poverty. The Philippines importation of milk amounted to approximately US$500 million annually. Instead of securing breastfeeding protection for infants 2

and young children, it will pushed every Filipino family to spend P3,000.00 monthly for the purchase of formula milk alone. This is a toll to the working poor population which comprised the majority. Considering the fact that 4 babies are born every minute in the Philippines. The P30,000.00 expenses for ten (10) months per child could have been channeled to family food or educational needs of the children. Rather, it is contributed to the multinational milk companies coffers. Yearly, about conservative P42 Billion sales profit has been amassed by the milk industry namely Switzerland- based Nestl who recently acquired Wyeths babymilks and American companies Mead Johnson, Abbott and New Zealand Fonterra. Artificial milk feeding is a havoc to the countrys security in terms of food sovereignty, economy and local trade, womens empowerment, children and womens health, environment and climate change, education and human rights. This can be averted through a very simple, sustainable intervention: exclusive breastfeeding for infants 0-6 months old and continue breastfeeding with complementary feeding using micronutrient -calcium rich indigenous foods after 6 months of age and sustained breastfeeding beyond 2 years old. Sustained breastfeeding provides half of the food basket needed for complementary feeding replete with nutrient energy calories : 60-80% energy calories are provided for babies who are still breastfeeding actively at age six to nine (6-9) months 40-60% energy calories for breastfeeding babies ages one (1) year 30-40% energy calories for breastfeeding babies above two (2) years old Whereas, if babies are weaned from breastfeeding early, problem of malnutrition will beset the Filipino family consequently the countrys future is compromised. Sustained breastfeeding can be done even if the mother is working outside home through breastmilk expression and preservation. Without refrigeration, expressed breastmilk lifespan covers ten to twelve (10-12) hours under Philippine tropical climate. Therefore, breastmilk substitutes, breastmilk supplements are unnecessary products. They are creation of want not need.

Allowing advertisement and promotions of products targeted on babies ages above six months contravene the existing laws: Milk Code or E.O. 51 passed by Pres. Cory C. Aquino in 1986 to protect breastfeeding with the next generation, Breastfeeding and Rooming In Act or RA 7600 passed in 1992 to initiate breastfeeding after birth and the Act extolled on the countrys economy and recently the Expanded Breastfeeding Promotions Act or RA 10028 passed in 2009 for working women in the workplace. The Supreme Court upheld the Milk Codes revised Implementing Rules and Regulations (rIRR) in October 09, 2007 especially provisions on product donation prohibition, nutritional and health claims are not allowed, also disallowing total effect in advertising and promotions. The above provisions found in the Bill espoused by Cong. Rufus Rodriguez Sections 20, 21, 23, 25, 28, 32, 35, 37, 38, 42, 43, 46 contradict what the Supreme Court has upheld with the Milk Code. Further, the Supreme Court emphasized that the Milk Code scope meant products that undermine breastfeeding and does not underpin on age limit. In fact, Supreme Court cited explicitly that infants zero to twelve (0-12) months of age must be ensured with breastfeeding rights as well as pursue the protection of young children who are breastfeeding beyond two years of age. The risks of artificial milk feeding has already been established by longitudinal studies reviewed by reputable independent (no conflict of interests) scientists known as Cochrane Peer Library Review based in United Kingdom. a.) infant and young childs health risks: asthma, allergy, cognitive development , acute respiratory disease, altered occlusion (teeth distortion and gum infection) , infection from contaminated formula, risk of nutrient deficiencies (iron in formula milk is less absorbable and deficient),childhood cancers, chronic diseases, juvenile diabetes, cardiovascular disease, obesity, gastrointestinal infections, otitis media and ear infections, side effects of environmental and chemical contaminants b.) mothers health risks breast cancer, ovarian cancer, endometrial cancer, overweight, osteoporosis, natural child spacing, rheumatoid arthritis, stress and anxiety, maternal diabetes

Breastfed babies are smarter babies based on longitudinal studies conducted in many countries with multi-intelligence score of eight (8) points higher compared to artificially fed babies. Fostering emotional security because of close bonding through breastfeeding makes a child confident and emotionally secured and better learner. This ensures economic and social investment. Ear infections encountered by artificially fed babies become a disability in school learning. Treatment cost of ear infections is costly for the family and burden to countrys health budget. 2.) The proposed Bills provision on: Chapter VI Information and Education Section 20. Information and Education (a.) The Department of Health shall ensure that objective and consistent information is provided on infant and young child nutrition. This responsibility shall cover the planning, provision, design and dissemination of information and the control thereof on infant and young child nutrition. (b.) The Department of Health should take appropriate measures to encourage and protect breastfeeding and promote the principles of this Act. It should give appropriate information, training and advise to health workers with regard to their responsibilities. (c.) Manufacturers, distributor or representatives of products covered by this Act are allowed to conduct or be involved in the promotion, education and production of Information, Education and Communication (IEC) materials on breastfeeding , infant and young child care and nutrition, as long as the programs and materials used are reviewed and approved by the Inter Agency Committee. Promotion of products intended for infants 0-6 months as covered by this Act will not be allowed in such venues. Save the Babies Coalition found the above provisions as very dangerous especially allowing the participation of the manufacturers, distributors or representatives to be involved in the breastfeeding and infant and young child nutrition activities such as education, communication, information as well as production of materials This is obviously COI (conflict of interest). The milk companies and its representatives presence and motive is to simply sell their products that compete and undermine breastfeeding. Their presence is to increase and push product sales and seek return of investment. This has happened in the past year 2000 onwards when a DOH Secretary issued an AO- Administrative Order and similarly provided the same provision. The DOH Secretary proudly claimed to be a former Nestle 5

consultant. Those years, the decline of breastfeeding dramatically dived and breastfeeding activities and actors were frozen comparatively with the past years before 2000. Inversely, milk companies profits increased lucratively at the expense of the Filipino childrens health and malnutrition swelled with artificial milk feeding practices. Sixteen thousand (16,000) infant and young child deaths yearly could have been averted if they were breastfed. All the Bills provisions cited a ban on product promotions intended for babies below six months of age but after six months of age, all marketing promotions are allowed. The Bill or Act used the term infant and young child but it does not respect the true meaning of infant zero to twelve (0-12) months neither the definition of young child age coverage one to three (1-3) years old in the Milk Codes rIRR terms of reference. Some of the provisions culled from the mother Bill of Congresswoman Ana York-Bondoc seemed sound outside the mentioned objectionable Sections 20, 21, 23, 25, 28, 32, 35, 37, 38, 42, 43, 46 of Cong. Rufus Rodriguez consolidated Bill Repeatedly, Save the Babies Coalition adhered to the WHO/UNICEF Global Strategy on infant and Young Child Feeding (IYCF) 2002 passed by the Ministries of Health around the world including the Philippines DOH translated action with the Five Year National Plan of Action on IYCF that profoundly defined infant 0-12 months and young child 1-2-3 years old and beyond (meaning continuously ages below 5). Any Bill must follow the international standard on health policy set by WHO and UNICEF. The Bill authored by Congressman Rufus Rodriguez et. al fractured the original mother Bill of Congresswoman-Dr. Ana York-Bondoc et al that ban promotions and advertisement of all babymilk/food products intended for infants and young children below 3 years old. The Bill of Cong. Rufus Rodriguez clipped the advertising ban of products targeted to babies below six months of age and henceforth allowed advertising and promotions of babymilk products with impunity for all ages.

3.) The proposed Bills provision on: Chapter VI Information and Education Section 21. Continuing Education, Re-education and Training of Health Personnel a.) The Department of Health with the assistance of other government agencies, professional and non-government organizations shall conduct continuing information, education, re-education and training programs for physicians, nurses, midwives, nutritionist, dietitians, community health workers and traditional birth attendants (TBAs) and other health personnel on current and updated lactation management, including their obligations under this Act. Information materials shall be given to all health personnel involved in maternal and infant care in health institutions. b.) Manufacturers and distributors of products under Section 3 of this Act may assist in the research, scholarships and continuing education of health professionals. Save the Babies Coalition objects to the manufacturers and distributors providing assistance to the health professionals in the field of research, scholarships and continuing education because the milk companies primordial motive is commercial interest in any sphere and the return of investment is their foremost objective. Thus, providing assistance is a marketing arm where the receiver becomes beholden to propagate their products. This exploits the Filipino trait of utang na loob (paying back in gratitude for the favors especially in times of need and vulnerability) . It is very important to remember that advertising and promotion, however good the controls, are not intended to provide information, they are intended to sell products. When baby food companies enter into so-called education initiatives, it is not out of kindness, but to sell products. Since 1981 member countries at the World Health Assembly have called for caution and firmly requesting that health workers should avoid any form of conflict of interest in their Resolutions. This proposed provision weakens our health system, opening the door to all sort and forms of inducements and financial assistance that will certainly be used to promote and market their own products by the milk industry. This is not acceptable. We must aim for our health system with integrity, able to perform without compromising their integrity and values. Government should step up resources and link with other partners (not milk companies or baby food manufacturers) to provide the necessary resources for our health care system, health professionals and health workers.

4.) The proposed Bills provision on: Chapter VI Information and Education Section 23. Classes for Mothers of Infants and Pregnant Women In health education classes for mothers of infants and pregnant women, health workers and community workers shall emphasize the benefits of breastmilk and the hazards and risks of the improper use of breastmilk substitutes particularly infant formula. Feeding with infant formula shall be demonstrated only to mothers who may not be able to breastfeed for medical or other legitimate reasons. Personnel employed in marketing products under Section 38 of this Act shall not, as part of their job responsibilities, perform educational functions in relation to pregnant women or mothers of infants. This should not be understood as preventing such personnel from being used for other functions by the health care system. Save the Babies Coalition does not concur that milk companies personnel shall perform any function in the health care system due to conflict of interest. Their mere presence meant sales aim and any opportunity is companys profitable avenue for market expansion. The milk companies representatives must be confined in marketplace not in healthcare system. 5.) The proposed Bills provision on: Section 25. Donations of Informational or Educational Equipment or Materials Donations of informational or educational equipment or materials by manufacturers or distributors should be made only upon written approval of the appropriate government authority. Such equipment or materials may bear the donating companys name or logo but should not refer to a proprietary product that is under Section 30 and should be distributed only through the health care system. Save the Babies Coalition believed that any form of donation by the milk companies is a marketing ploy. Therefore, it should not be allowed at all. 6.) The proposed Bills provision on: Chapter IX Marketing of Breastmilk Substitutes, Breastmilk Supplements and other Covered Products Section 35. Health and Nutritional Claims (a.) Health and nutritional claims for products within the scope of the Act are allowed as long as it is based on scientific and factual information upon review and approval by the IAC. 8

Save the Babies Coalition strongly objected to all health and nutritional claims. Codex Alimentarius International Food Safety standard prohibits health and nutritional claims. Many Filipino mothers/parents became captive consumers of Wyeths Promils claim on gifted child showing genius children with the product. Likewise, Mead Johnsons Lactum product claiming 100% nourishment panatag/confidence by line using celebrities endorsers together with their children. Abbotts Gain product tagline on early learning and Eye Q, Nestl slogan Youre my Number 1 with singer actress and her kids singing the jingle of Nido product. Mead Johnson Alacta grows promise of All year round health. Filipino moms tend to follow their idols brand and advertising agencies exploit such vulnerability. For every 30 seconder advertisement shown on tv it cost approximately P 350,000.00 on prime time. Bombardment of TV and radio ads complemented thru billboards along highways psychologically seduced the mindset of the consumers and has proven effective marketing product promotions. Ironically, all the health and nutritional claims did not produced a population of gifted genius Filipino babies who were hooked on artificial milks all their growing up years. So much sufferings of illnesses characterized their growth charts because they missed the benefits of breastfeedings preventive healthcare. At the same time both WHA and Codex Alimentarius request countries not to allow health and nutritional claims. This was a major milestone achieved with the introduction of this provision in the 2006 revised Implementing Rules and Regulations of EO 51 (Executive Order 51). The Philippines should not allow health and nutritional claims, scientific evidence has proven that they are dangerous, deceptive and mislead our mothers, fathers and communities. The revised Codex Standard For Infant Formula And Formulas For Special Medical Purposes Intended For Infants (Codex Stan 72 1981) revised in 2006 and adopted in 2007 says: 9. Labelling The requirements of the Codex General Standard for the Labelling of Prepackaged Foods (Codex Stan 1-1985), the Codex Guidelines on Nutrition Labelling (CAC/GL 2-1985) and the Guidelines for Use of Nutrition and Health Claims apply to infant formula and formula for special medical purposes for infants. These requirements include a prohibition on the use of nutrition and health claims for 9

foods for infants and young children except where specifically provided for in relevant Codex Standards or national legislation.

7.) The proposed Bills provision on: Chapter IX Marketing of Breastmilk Substitutes, Breastmilk Supplements and other Covered Products Section 43. Infant Feeding Warning Food products under Section 28 of this Act marketed for infant feeding which do not meet all the requirements of an infant formula but which can be modified to do so shall carry on the label a warning that the unmodified product should not be the sole source of nourishment of an infant. Save the Babies Coalition calls on everyone to consistently adhere to the existing Milk Codes rIRR requirements on label warning on intrinsic pathogenic contaminants that is heat resistant that maybe found in powdered milk. WHO-FAO claimed that all PIF (powdered infant formula) is not 100% sterile at all (2005). The World Health Assembly 2006, clearly urged member countries to inform caregivers and parents of the instrinsic risks of contamination. That infant formula have, as per scientific review led by the FAO and WHO (2005), that clearly stated that infant formula its not a sterile product and may contain pathogenic microorganism all of possible threats to the survival of the infants affecting brain and nervous system. 8.) The proposed Bills provision on: Chapter X Donations Section 46. Donations Donations of products under Section 30 of this Act intended for infants 0-6 months from manufacturers and distributors shall be allowed upon the approval of the Inter-Agency Committee. Save the Babies Coalition condemn such disastrous donation provision. It does not help nor solve the problem but in fact contribute to compromising the lives of infants. It is a passport to malnutrition. The donation of babymilk product is a marketing trap. Donating artificial milk products during emergency or in times of crisis in the guise of charity is a public relations media act for the multinational milk companies. In the long run, the government will purchase the next product supply when the indigent mother has abandoned breastfeeding consequently drying up her breastmilk production in favor of the product gift sample as starter. The immunological properties of breastmilk is forsaken. In the end, she has no 10

choice but to settle for cheaper milk of any kind caught in a fix of respiratory disease, diarrhea and death. When this happened who is responsible for this malady? The donor milk pusher is scot free. International standards on emergency response, clearly states that no donation of such products should be allowed, this is to avoid disastrous perils like outbreak of diarrhea, pneumonia and eventually deaths. The Philippine government, thru its Department of Health has adopted clear and evidence based guidelines on how to respond in case of emergency, and the no donation policy of such product is one of the pillar to ensure the survival of the young victims. The Coalition, disagree with the propose provision, and request that the existing guidelines be upheld. In times of calamity, as a disaster response, mothers with infants and young children needs to be clustered together in one shelter and facilitate the mother to mother support by sharing breastmilk and relactation management for babies on formula feeding. RA 7600 law stipulated relactation, donors breastmilk and wetnursing, a Filipino tradition for breastfeeding management as a sustainable solution.

In conclusion, the so called consolidated Bill does not reflect genuinely the best provisions. In truth, it bespeaks the milk companies intent and mission in the name of profit over health. It resounded Nestle representatives mantra 6 months over decades of debate in drafting the Milk Code and rIRR and related breastfeeding protection laws R.A. 7600 and R.A. 10028. The consolidated Bill spearheaded by Congressman Rufus Rodriguez et.al must not be passed as a law because it does not serve the interest of the Filipino people. It has created a vehicle to legitimize an expanded market for the multinational milk companies at the expense of womens worries, wages and work in the midst of poverty and malnutrition. Save the Babies Coalition calls for protecting the strength of the Milk Code (E.O. 51) and its revised Implementing Rules and Regulations (2007) concomitant to the Supreme Court mandate to upheld the revised Implementing Rules and Regulations 2006/2007. It will save the health and wealth of the Filipino nation.

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Refered A-K objectives of the consolidated Bill that originated from Cong. Bondoc Bill.

The Coalition agrees with the general objectives stated in the consolidated Bill because it is in line with the culture, history and values of the Philippines and the Filipino people and aligned with more than 30 years or evidence based Resolutions endorsed by the World Health Assembly as follows: A. To promote, protect and support exclusive breastfeeding as the means of nourishment for the first six (6) month of life; B. To promote, protect and support breastfeeding as the optimal and unparalleled means of providing safe and adequate nutrition for infants and young children; C. To promote and support proper and timely complementary feeding, which includes the giving of low-cost yet nutritionally-adequate indigenous food; D. To preserve and protect the integrity of the Philippine Healthcare System by a. regulating the marketing, promotional and sales practices and/or strategies of manufacturers, distributors and marketing personnel; E. To properly inform the general public about the proper use of breastmilk substitutes and breastmilk supplements and related products through adequate, consistent and objective information and appropriate regulation of the marketing and distribution of the said substitutes, supplements and related products; F. To promote a mother and baby-friendly environment in every healthcare institution, facility, healthcare organization and association, office, school and public place, conducive to the advancement of the breastfeeding culture; G. To ensure compliance with pertinent provisions of binding international commitments and covenants entered upon by the Philippines, including specifically, the 2002 Global Strategy for Infant and Young Child Feeding, the International Code on the Marketing of Breastmilk Substitutes, Breastmilk Supplements and Related Products and subsequent Resolutions of the World Health Assembly which the Philippines supports; H. To widely promote and protect breastfeeding as a simple yet cost-effective means of alleviating poverty and decreasing dependence on imports;

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I. To encourage the general public to form breastfeeding groups or associations to develop suitable programs and further the growth and empowerment of the country's women and children under an international ethical standard; J. To encourage the revival of wet and shared/cooperative nursing among mothers and for infants without mothers including but not limited to those in orphanages and other child care centers; K. To encourage the revival of Filipino indigenous practices that sustained breastfeeding in the past, such as the use of baby slings that keep the baby on an eye-to-knee level; massage techniques of healing touch that relaxes the mother, encouraging the production of breast milk; the complementary feeding of indigenous foods with more calcium and other essential nutrients than cows milk, reducing our dependence on the expensive importation on non-human milk; family and community support for breastfeeding mothers. (H.B. 3396-Bondoc)

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All the above scientific evidences were culled from the Supreme Court data archive submitted during the lawsuit filed by the PHAP (Philippine Healthcare Association of the Philippines) whose members were the American milk companies against the Philippine government Department of Health officials June 2006 - October 2007. Also references from UNICEFs Formula for Disaster documentary, Risks of Formula Milk Feeding, Infact Canada and WHO studies on advertisement impact on the consumers and economic burden of formula milk feeding 2012 scientific journal publication.

POSITION PAPER on consolidated House Bill No.

Submitted by Save the Babies Coalition:

-- introduced by Representatives Rufus Rodriguez, Josephine Veronique R. Lacson-Noel et al.

Ma. Ines Av. Fernandez Lead Convenor

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