Letter to Philippines Secretary of Health from Three Philippines Breastfeeding Support Groups

December 02, 2013

Dr. Enrique T. Ona
Secretary of Health
Department of Health
Sta Cruz, Manila

Honorable Secretary Ona,


In behalf of the breastfeeding support groups namely Arugaan, Breastfeeding Pinays and Latchcomprising of 21,000 members, we strongly protest against the issuance of a new Administrative Order 2013 with Subject: Amending Section 51 of Administrative Order No. 20016-0012, Revised Implementing Rules and Regulations (IRR) of Executive Order No. 51, otherwise known as the “Milk Code”.

We are disturbed by this stipulation in you’re A.O. 2013 “allowing donations of milk and milk products, milk substitutes and infant formula would help reduce morbidity and mortality incidences in infants and children in affected areas, as well as help improve the poor state of nutritional level of the affected population in severely compromised and devastated areas in Leyte, Samar and its nearby provinces, including other affected regions in the country”.

In times of calamity and crisis, breastmilk ensures food security not only for the mom and baby but can also be shared for vulnerable groups. It stands as the sole source of nourishment replete with anti-bodies. God made it perfect and complete with water and micronutrients, not contaminated. Breastfeeding is zero waste, protecting the environment.

Example of donated formula and bottles from Nestlé.

All the available data, show that more than 90% of women in the affected areas initiated breastfeeding after birth and these areas have among the highest exclusive breastfeeding rates in the country.

Breastfeeding save and improve lives. It help reduce morbidity, more so in a situation where there is scarce availability of clean water, clean utensils and poor hygienic conditions. Since World War II, we are reminded of how breastfed babies where protected and supported and they were those that were less affected by the disaster.

We are disturbed of the DOH pronouncements broadcasted over the media for milk donations during thetyphoon Yolanda/Haiyan devastation. Consequently, victimizing the victims.

Volume of science evidence-based studies have concluded that breastfeeding saves lives. Breastfeeding averts 21 risks of formula milk feeding. (WABA and Infact Canada compilation) These are the following:

For the child: asthma, allergies, ear infections, high blood pressure and heart disease, respiratory infections, lower IQ and cognitive development, obesity, iron deficiency anemia, SIDS (sudden infant death syndrome), diabetes, digestive problems, childhood cancers, exposure to environmental contaminants, sleep apnea, dental problems and malocclusions, diarrhea

For the mother: diabetes, overweight and obesity, osteoporosis, breast, ovarian and uterine cancer, hypertensive and cardiovascular diseases, reduced child spacing

From your prescription of formula milk feeding for the babies survivors in Tacloban and in other towns of Leyte, Samar and other afflicted areas, what is your guarantee that their lives including the moms won’t be compromised by the 21 risks of formula milk feeding?

Just one bottle already exposes them to ill health. More than that just one bottle confuses the mom’s confidence to breastfeed. The Milk Code as a law was passed by President Noynoy’s mother, the then President Cory Aquino ensured the defense of breastfeeding rights: the right of the baby to breastfeed and the right of the mom to breastfeeding.

This is the critical moment to decide rightly to protect and support the breastfeeding mothers and child in the calamity areas. Especially the 12,000 pregnant moms who will give birth this month, exclusive breastfeeding must be initiated timely and facilitated with support. Exclusive breastfeeding means within 6 months and continued breastfeeding beyond 2 years.

In the case of typhoon Yolanda’s devastation of limbs, lives and livelihood, DOH is mandated to implement during emergency the 3 laws to protect breastfeeding (passed in 1986, 1992, 1989) simply bringing the mothers with infants and young children together in a tent or corner to start the relactation process. Empower the breastfeeding mom to continue breastfeeding and she can become the role model for the bottlefeeding moms.Cross nursing is the most effective way.

Formula companies Nestlé and Mead Johnson have exploited the typhoon tragedy to get formula to mothers despite WHO and UNICEF warnings against this marketing behaviour. (Donated Mead Johnson formula.)

The efficient intervention is for the breastfeeding mom to show how to position and latch properly by breastfeeding the bottlefed baby. While the bottlefeeding mom will breastfeed the experienced breastfeeding baby. Both ways they learn hands-on. This is a sustainable mother-to-mother support intervention. Part of the relactation process is for the donor’s expressed breastmilk to be dripped thru a spoon while the baby is learning to breastfeed. Also, expressed breastmilk through cupfeeding can be given to all children and the sickly to prevent starvation during emergency situation.

Breastfeeding is 90% psychological and 10 % physical. The production of breastmilk is situated in the pituitary glands. Positive message “I have breastmilk” will enhance the release of the prolactin hormones to produce breastmilk. Likewise, the oxytocin hormone responsible for the flow of milk is dependent on the baby’s suckling correctly (proper latch). Oxytocin hormone is called love hormone because it provides a relaxing effect on the mom in times of stress.

A newborn baby’s stomach size is only half an inch. In a month’s time, it is the size of a double quail egg. Therefore, the baby need only small amounts of breastmilk. The myth on “no milk, less milk, inadequate milk” has been corrected with DOH slogan “Tama, Sapat, Eksklusibo Magpapasuso”. Practice makes perfect. Walk the talk.

For young children ages below 3 years old, breastmilk is a good source of micronutrient: 29% of energy requirements, 43% of protein requirements, 36% of calcium requirement, 75% of Vitamin A requirements, 76% of folate requirements, 94% of Vitamin B12 requirements, 60% Vitamin C requirements (Dewey 2001)

The estimated mean 24-hour milk intake was 548g for the 97% who were breastfed at 12 to 23 months and 312g for the 73% who were breastfed at 24 to 36 months. This represents an average daily intake at 41% and 23% of the safe recommended daily intake (400 RE) for Vitamin A respectively. (Pearson 1998).

Anti-bodies are abundant in human milk throughout lactation. In fact, some of the immune factors in breastmilk increases in concentration during the second year and beyond. (Hamosh 1991 and Goldman and Goldblum 1983) .

Where lies your responsibility with your prescription of formula milk feeding for the survivors who are destitute of resources?

Ironically, before typhoon Yolanda wrath, breastfeeding rates in Leyte and Samar provinces were registered highly compared to the 32 cities with low breastfeeding rates nationwide. Now in the midst of misery, you’re A.O. 2013 amending the Milk Code on emergency provision will not improve their health rather will propel milk and misery.

R.A. 7600 breastfeeding law has distinctly cited economy for the country. Yearly importation of breastmilk substitutes increasingly cost at $500 Million. Return of investment for the multinational milk companies profited a sales of Php 42 Billion or almost $1 Billion dollars contributed by captive Filipino families annually.

Your pronouncement for milk donations for the poor people trampled by typhoon Yolanda makes the milk companies grin with greed. Their act of charity is a marketing mask. They have been known to give starter formula as gift in the hospital system which the Milk Code forbids. It became formula for disaster. It undermines breastfeeding power. Mother’s milk dries up with formula milk competition.

Now, the milk companies found another marketing avenue in emergency disaster areas. Thegovernment will be budgeting milk purchases, water supply, soap and fuel for sterilization, bottles and teats for the formula milk feeding requirements. In addition , medicine and medical care will be another demand for sickly babies on formula feeding and your Department of Health will procure funds to be slashed from the people’s taxes.

WHO and UNICEF cited that 24 times the baby will be at risk of getting sick and hospitalized compared to breastfeeding counterpart.

Major recent earthquake disasters (Indonesia, Haiti) have shown how donations of breast milk substitute have displaced the breastfeeding culture and the use of the products was linked to the rapid increase of diarrhea cases in the evacuation centers. Why commit the same mistake?

We reiterate, this is the time to responsibly support and not disrupt a mother to breastfeed. Foremost this is the government’s obligation enshrined in our constitution.

Signing A.O. 2013 willdefy the health protection which the Milk Code and the Philippine Constitution defended. There is no compelling medical or legal reasons for you to invoke the emergency provision. The Filipino children who will be given formula milk will not be guaranteed an immunity from illnesses as you claimed in your plan A.O. 2013 for milk donations in calamity areas.

Therefore, act now to protect, promote and support breastfeeding to save lives without compromises.

We, the Breastfeeding Pinays, Latch and Arugaan Breastfeeding experts and counsellors came to therescue at the Villamor Airbase and set up the Nanay Bayanihan tent. We observed that every mom with a baby was automically given milk formula donation. We relactated those on bottle and bring them back to the breast and ensured the breastfeeding mom’s empowerment. We also sent preserved expressed breastmilk and generator for the Eastern Visayas Medical Center and loads of donor’s breastmilk (EBM) for the sick babies. As reported, the confined babies were on formula milk feeding. We can help you with Emergency Breastfeeding Respond, Rescue and Preparedness from now on as we helped you in the past with Breastfeeding Peer Counselling Training (Gumagabay sa Nanay sa Tamang Pamamaraan ng Pagpapasuso) in 20 cities.

We beg you to stop the issuance of A.O. 2013 allowing milk donations in disaster areas.


Ma. Ines Av. Fernandez

Atty. Jennifer Joy Ong

Engr. Velvet Roxas
Breastfeeding Pinays