A successful campaign to confiscate and ban donations of infant formula milk during the recent Taal disaster response was spearheaded by the National Nutrition Council (NNC), Department of Health (DOH) Calabarzon and the Regional Nutrition Cluster (RNC). When the RNC visited the evacuation centers, infant formula milk donations received were pulled out and endorsed to the Municipal Health Officers with the help of the camp managers and Nutrition Action Officers.
Furthermore, the RNC monitored the implementation of Guidelines for Infant and Young Child Feeding In Emergencies (IYCF-E) for Evacuation Centers Relative to the Taal Volcano Eruption in the Province of Batangas (Issued in January 17, 2020 by the the DOH Office of the Secretary). The guidelines support the strict enforcement of EO 51 or the “Milk Code of the Philippines,” and its revised Implementing Rules and Regulations.
Camp managers were also given posters on EO 51 (to be affixed in front of the evacuation centers) and copies of the guidelines issued by the DOH. Members of the RNC and Nutritionists-Dietitians in local government units continually also messaged Facebook users (who were asking for formula milk donations) to inform them about the Milk Code. In coordination with health education and promotion units (HEPU), they also created a health advisory about the Milk Code and about breastfeeding during emergencies.
The Campaign Supports the National Call for Continuous Supply of Breastmilk
The success of the campaign was followed by an increasingly high demand for pasteurized donor breastmilk. This supports the national call for continuous supply of breastmilk.
To ensure the continuous supply of pasteurized donor breastmilk, the DOH issued a national call for more breastmilk donations in Luzon. They created eight (8) breastmilk drop-off points to facilitate collection and transport, namely: Soroptomist KaBatangueña; Batangas Medical Center, Philippine General Hospital Human Milk Bank, Makati Human Milk Bank (Fabella / Quezon City General Hospital), Cavite BabyDuDuDocs, Latch Los Baños, Ace Global Philippines and Arugaan Peer Mom.
Thousands of liters of pasteurized donor breastmilk came from donors/partners which includes: Human Milk Bank Association of the Philippines (Fabella Hospital, Philippine General Hospital, Taguig Pateros District Hospital), Breastfeeding Ala eh, PPS-Southern Tagalog Chapter, Kalusugan ng Mag-Ina, Arugaan, Tagaytay Moms, CavMoms, South Pinanays (SPIN), and the Community Health Team of Pagsanjan, Laguna.
Batangas Medical Center Human Milk Bank received a total raw milk collection of 188,490 ml, dispensing and distributing a total of 33,600 ml of pasteurized human milk among evacuation centers from January 13 to 30, 2020. The City of Taguig alone, in coordination with Senator Pia Cayetano, donated 50.5 liters of pasteurized breast milk to Batangas Medical Center.
DOH Calabarzon also identified nine (9) areas that currently have pasteurized breastmilk. They are: Batangas Medical Center, Lipa City Health Office, Tanauan City Health Office, Santo Tomas City Nutrition Office, Calaca Municipal Health Office, Lian Health Office, Bauan Technological Highschool, as well as the Batangas and the Cavite Provincial Health Offices. Nearby evacuation centers needing pasteurized donor breastmilk could source their supply from these sites.
Evacuation centers without a proper storage facility were given storage boxes and freezers by DOH Calabarzon. They also assigned a focal person to man the distribution of pasteurized donor breastmilk, as well as monitor its use and inventory.
The enforcement of EO 51 was complemented by the conduct of IYCF counselling / nutrition education classes for pregnant and lactating women, and the mobilization of the Mothers Support Group Batangas Ala Eh, thus ensuring the presence of Mother-Baby in ALL evacuation centers.
Lesson from the Major Challenges
During the volcanic eruption, there was a sudden emergence of donations, calls for donations, and actual distribution of infant formula milk and breastmilk substitutes in most of the evacuation centers in the province of Batangas. The donations came from private citizens and companies who wanted to extend help to the afflicted families with infants and young children.
However, camp managers as well as health and nutrition workers in the evacuation centers accepted the donations because they had inadequate knowledge of EO 51. This happened despite many efforts by national government agencies like the DOH and the NNC (and its regional counterparts) to ensure the EO’s implementation on the ground. To add, there was no task force in place to monitor the strict enforcement of EO 51 – a situation that spells drastic danger for the target population of the milk products.
Nevertheless, lessons are to be learned from the incident. Pushing for campaigns to ban and pull out infant milk formulas during disaster and emergencies are of vital importance.
EO No. 51
EO No. 51 was signed into law on October 20, 1986 during the time of President Corazon C. Aquino. It set the Philippine Code for marketing breastmilk substitutes. The law drew upon the World Health Organization’s International Code of Breastmilk Substitutes by the World Health Assembly, which aims to stop the aggressive marketing of breastmilk substitutes that endanger the culture of breastfeeding.
The rationale of the Milk Code is to compel restrictions on advertising breastmilk substitutes, in order to encourage breastfeeding. The Milk Code also directs the intensification of efforts to disseminate information on breastfeeding and proper nutrition, while regulating the advertising, marketing and promotion of breastmilk substitutes and other products, including feeding bottles and teats. It prohibits the health care system’s use of these products, including the donation of promotional giveaways by milk companies to health workers and others in the healthcare system.
The issuance emphasized the observance of optimal breastfeeding practices and appropriate complementary feeding for infants and young children in evacuation centers in Batangas. Further, it stated that follow-on milk is not required for older infants (over six months old) and young children (12-24 months) – except for breastmilk and basic food commodities from their general rations in evacuation centers, micronutrient-blended foods, and additional nutrient-rich foods in supplementary feeding programs. Moreover, it also mentioned that pasteurized donor breastmilk must always be present and ready for dispensation and safe consumption in cases where direct breastfeeding and wet nursing is not possible.
The issuance also answered the issue of “Is formula milk allowed in emergencies and disasters?” DOH’s stand is that only after ALL options for breastfeeding practices have been exhausted, the provision of infant milk formula and milk supplements can be considered. However, this must follow a protocol which includes the following:
(1) National government agencies, civil society organizations, and individuals must NEVER solicit or accept unsolicited donations of any products covered by EO 51;
(2) General relief should NEVER include products covered by EO 51;
(3) Purchased infant milk formulas and/or breastmilk supplements for infants and young children should not be supplied / provided in its original packaging, and expiration should not be less than 12 months;
(4) Storage of infant milk formula as well as breastmilk and other milk supplements should be under the supervision of a government health worker accounting for it;
(5) The use of infant feeding bottles and artificial teats in an emergency setting should be actively discouraged; and
(6) The donated infant milk formulas and/or breastmilk substitutes should be collected by the municipal health officer, infant and young child feeding (IYCF) point person, and camp manager, and may be included as an ingredient of food prepared for adults.
This was a very clear directive, disseminated to the concerned local government units for their strict compliance.
Eye opener
Our experience with the Taal Volcanic Eruption response has served as an eye-opener – not just to the regional and local health and nutrition workers, but the general public as well. It is a constant reminder that we have a law concerning milk for infants and young children; that laws should never be ignored, for which information dissemination is key; that laws need mechanisms for dissemination even in or especially in emergency response; and that strict compliance / enforcement helps us save and protect our infants and young children from worsening nutritional status and even death.
Applying the same Principles During the ECQ
Now that we are faced with the Covid-19 pandemic, millions of Filipinos across all ages are affected. Food security among households specifically in the marginalized community demands long-term assistance and supply of food commodities. And since the Enhanced Community Quarantine (ECQ) was implemented, the earnings and daily living of most of Filipinos have been seriously affected. Same goes to food insecurity issues for families with infants and young children.
We want to enforce the milk code or EO51 and promote breastfeeding, but we are constantly being challenged by the milk code violators. The RNC, NNC and DOH conducts massive information dissemination on breastfeeding through policy guidelines and social media.
Again, we have to learn the lessons from the Taal Disaster Response experience. Pushing for campaigns to ban and pull out infant milk formulas during pandemics is also crucial .We need to further strengthen the efforts through vigilance of all Filipinos and not only the people involved in health and nutrition. We encourage everyone and all to help us in protecting and enforcing EO 51 by reporting these violators using the Mother Baby Friendly Philippines (MBFP) website and mobile app. The simple steps on how to report them can be viewed at https://youtu.be/PSUPgD_Huyg.
By: Lourdes Bulante-Orongan
