The Symbol of Breastfeeding: Golden Bow

When Stan and I were brainstorming about the poster for his photo exhibit, he asked me what the symbol of breastfeeding was.  I was stumped.  The "pink ribbon" was the widely known symbol for breast cancer however, I couldn't remember what was the symbol of breastfeeding.

A quick internet search brought me to this UNICEF page on the golden bow, which I immediately shared on Facebook.

see the golden bow?

Decoding the Monster Bill - Part 2

Read Part 1 HERE. 

*Please note that when I wrote this post, it was originally based on the May draft.  There is now a July 9 draft and you can see the quick comparison here - https://docs.google.com/a/chroniclesofanursingmom.com/spreadsheet/ccc?key=0AhSdlPvu96IKdFRqYjVkSmZEMldRSTZHaGxzYmJhUXc#gid=0

The monster bill also seeks to limit the advertising restrictions to products targeted to babies 0-6 months (Sec. 32).  This means that for products for babies 6 months and up, advertising and promotions shall be freely allowed.  There are just so many things WRONG with this provision.  Under the current laws, all advertising, promotions, etc. require prior approval or permit from the IAC.  Here is the position of the Save the Babies Coalition on this matter:

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.

Decoding the Monster Bill - Part 1

*Please note that when I wrote this post, it was originally based on the May 2012 draft.  There is now a July 9 draft and you can see the quick comparison here - https://docs.google.com/a/chroniclesofanursingmom.com/spreadsheet/ccc?key=0AhSdlPvu96IKdFRqYjVkSmZEMldRSTZHaGxzYmJhUXc#gid=0

My Facebook and Twitter accounts have been flooded with updates and messages about killing the monster bill.  But I realized that not everyone really understood what it was.  You can read the text of the monster bill HERE.  The monster bill is a consolidation of 4 bills - namely HB3396 (Bondoc bill which is the good bill), HB3525 (Gunigundo Bill), HB3527 (Noel/Rodriguez Bill) and HB3537 (Mercado/Torres Bill).  Click the names of each HB to get to the actual document from the House of Representative (HOR) website. The HOR website also has a summary and flowchart on how a bill becomes law.

Why milk product donations shouldn't be allowed during disasters

In the 23 February 2012 edition of the Inquirer, a letter to the editor was sent by Corazon del Mundo, chair of Women Involved in Nation-Building, directing the readers' attention to the Sendong disaster and listing down reasons why donations of milk products should be allowed and be coursed through government agencies.  This letter was in response to the column by Rina Jimenez-David on milk and malnutrition where she wrote about the perils of donations of powdered formula or milk.   

This brings us to the problem of donations of powdered formula or milk, which are among the first and most common items sent in response to disasters. “In the confusion that surrounds emergencies, these products are often distributed in an uncontrolled way and used by mothers who would otherwise breastfeed their babies,” says Unicef, adding that indiscriminate use of donated milk “results in unnecessary illness and death for infants.”

STEP UP for Breastfeeding

Did you know that the Implementing Rules and Regulations of Republic Act No. 10028 or the Expanded Breastfeeding Promotion Act of 2009 has been signed last 22 August 2011?  You can download a copy here.  The IRR was published on 28 August 2011 and will be effective on 12 September 2011.  This means that establishments are now required to have lactation stations and workplaces must set up their lactation programs!

After the successful launch of the Breastfeeding Welcome Here Program, UNICEF, WHO, DOLE, DOH and ILO has another exciting project in the works! Remember my series of posts on setting up a workplace lactation program? Well, the consortium has made things even more easier with their S.T.E.P. Up for Breastfeeding Program!

Breastfeeding + HIV is possible!

Sharing this joint statement I just received via email on the recommendations on breastfeeding, particularly for HIV-infected moms. This was published in the International Journal of Gynecology & Obstetrics.    Relevant portions on HIV provided below. 


IPA/ICM/FIGO joint statement on breast-feeding, including breast-feeding by HIV- infected mothers (June 2011)


Breastfeeding under special conditions such as HIV infection of the mother: 
In light of the changing evidence on transmission risks and recommendations on the use of anti retroviral drugs for treating pregnant women and preventing HIV infection in infants, we welcome the new recommendations on HIV and infant feeding: 

Breastfeed Anytime, Anywhere!

Last Tuesday, the Millennium Development Goals Achievement Fund/Philippines launched the Spotted: Mommy, Mama, Inay and Me, a photo exhibit to support, promote and protect exclusive breastfeeding and appropriate complementary feeding for a healthy child, family and community.

L.A.T.C.H. was one of the co-sponsors and I was able to get my husband Stan to take photos for the exhibit! It was no easy task since there were permits to get, schedules to coordinate BUT with Buding, Zeka and Anna at the helm of it, things fell into place and Stan was able to get wonderful photos of breastfeeding moms! I've heard to many moms say that they wish they could bring back their breastfeeding days and somehow have some memento of it. I'm proud to say that Stan has amassed more than a hundred photos of breastfeeding moms as I've emphasized that he needs to ask nursing moms if they'd like a breastfeeding photo every time he is commissioned for a family or portrait shoot.

I love the message being promoted by the exhibit - breastfeed anytime, anywhere. If we can eat anytime and anywhere we feel hungry, then there is no reason that nursing moms need to "hide" in bathroom to meet their babies' needs! The exhibit runs until 26 November 2010 at the SM Mall of Asia, Entertainment Mall (near Selecta Kids Station). Aside from Stan's photos, there are also photos taken by photography students of mothers in daycares and markets - doing their everyday activities, yet still being able to nourish their babies.

Meanwhile, I'm sharing a slideshow of "behind the scenes" photos and some of the photos not used for the exhibit.

L.A.T.C.H. has some more future projects involving photography and breastfeeding - so "LIKE" and stay tuned for further announcements in the L.A.T.C.H. FB page!

Breast Crawl

What is a breast crawl? According to Breastcrawl.org, "every newborn, when placed on the mother's abdomen, soon after birth, has the ability to find its mother's breast all on its own and to decide when to take the first breastfeed." This technique is being promoted by UNICEF, WHO and WABA and is part of the Ten Steps to Successful Breastfeeding.

As part of the L.A.T.C.H. module what to expect in the first 2 weeks, we usually present a video of a breast crawl. Previously, we used a video depicting an Indian mother filmed in 2005. We have been fortunate enough to obtain a video filmed in the Philippines likewise depicting a breast crawl. I'm still trying to obtain a copy of the video for uploading but in the meantime, I'm sharing the video of a Maharashtra mom and baby doing the breastcrawl.

Recently, fellow L.A.T.C.H.er Mec shared about the institution of the Essential Newborn Care protocol in Asian Hospital - where she's giving birth. The breast crawl is included in this protocol, which is said to reduce infant mortality. I'm not sure which other hospitals have instituted this protocol but this definitely something to consider when choosing which hospital to give birth at in the Philippines.

Update - 28 July 2010. Thanks to Claire for sharing the Philippine breast crawl video!

Medical Reasons for Breast Milk Substitutes

During the breastfeeding classes I've attended and conducted, it is always emphasized that from birth to six months, exclusive breastfeeding is best for babies, unless there medical reasons prescribing otherwise.

These “medical reasons” vary though from doctor to doctor, with some doctors even saying that moms who underwent caesarian births cannot breastfeed for x number of days!

In 2009, the World Health Organization and UNICEF released a 12-page publication entitled “Acceptable medical reasons for use of breast-milk substitutes”. According to WHO and the UNICEF, they first developed a list of medical reasons for supplementation in 1992, as an annex to the Baby-friendly Hospital Initiative tool package.

With new and emerging scientific evidence, WHO and UNICEF agreed to update the list with the participation of the departments of Child and Adolescent Health and Development and Nutrition for Health and Development. Other additional evidence sources used were (1) The Drugs and Lactation Database, a peer-reviewed and fully referenced database of drugs to which breastfeeding mothers may be exposed, hosted by the United States National Library of Medicine; and (2) The National Clinical Guidelines for the management of drug use during pregnancy, birth and early development years of the newborn, review of which was done by the New South Wales Department of Health, Australia in 2006.

The WHO and UNICEF posit that only a small number of health conditions of the infant or the mother may justify temporary or permanent cessation of breastfeeding. Further, these conditions concern very few mothers and infants. In recommending the cessation of breastfeeding, the WHO and UNICEF mandates that the benefits of breastfeeding should be weighed against the risks posed by the presence of the listed conditions.

The following are the conditions for infants not to receive breast milk or any other milk except specialized formula:
1. infants with classic galactosemia (a special galactose-free formula is needed) – a rare genetic metabolic disorder that affects an individual’s ability to metabolize the sugar galactose (one of the components of lactose) properly
2. infants with maple syrup urine disease (an inherited disorder in which the body is unable to process certain amino acids or protein building blocks properly. If untreated, this leads to severe brain damage and death) – special formula free of leucine, isoleucine and valine is needed
3. infants with phenylketonuria (a genetic disorder that is characterized by an inability of the body to utilize the essential amino acid, phenylalanine) - a special phenylalanine-free formula is needed – some breastfeeding is possible, under careful monitoring

For all other infants, breastfeeding is best although the following infants may need other food aside from breast milk for a limited period:

1. a. infants with very low birth weight – weighing less than 1500g
2. b. infants born too early – at less than 32 weeks of gestational age
3. c. newborn infants who are at risk of hypoglycaemia by virtue of impaired metabolic adaptation or increased glucose demand, if their blood sugar fails to respond to optimal breastfeeding or breast-milk feeding

• preterm
• small for gestational age
• have experienced significant intrapartum hypoxic/ischaemic stress
• those who are ill
• infants with diabetic mothers

Just because a baby is premature, it does not mean that s/he should be given formula or any other fortifier (like Cell Life a.k.a. spirulina). WHO/UNICEF listed above specific instances when fortifiers are necessary.

As for maternal conditions that may justify permanent avoidance of breastfeeding, only one is listed – HIV infection, only if replacement feeding is acceptable, feasible, affordable, sustainable and safe (AFASS). WHO/UNICEF however recognizes that the most appropriate infant feeding option for an HIV-infected mother depends on individual circumstances – mother’s health status, health services available and most importantly whether there is replacement feeding AFASS.

Certain conditions justify the temporary avoidance of breastfeeding, such as severe illness that prevents a mother from caring of her infant (e.g. sepsis), herpes simplex virus-1, certain maternal medication (sedating psychotherapeutic drugs, anti-epileptic drugs, opioids, radioactive iodine-131, excessive use of topical iodine or iodophors (povodine-iodine), cytotoxic chemotherapy.

Meanwhile, the publication lists down certain conditions wherein breastfeeding can still continue, although health problems may be of a concern, namely: breast abscess, hepatitis B, hepatitis C, mastitis, tuberculosis, substance abuse. I highly recommend that you peruse the short publication to read the details on these conditions.

Clearly, there is a limited number of conditions for both infants and mothers to recommend the cessation of breastfeeding. I would definitely recommend that pregnant moms to read this WHO/UNICEF publication so they will be informed and know what questions to ask their pediatricians and ob-gynes. And if your doctor gets irritated when you ask questions, then I believe that it is time to look for a new medical provider.

World Breastfeeding Week 2010

Thanks to Claire for the heads-up! World Breastfeeding Week just released their theme for 2010: "Breastfeeding Just 10 Steps! The Baby Friendly Way". I checked their website but only the calendar is available for download.

In Protecting, Promoting and Supporting Breastfeeding: The Special Role of Maternity Services (a joint WHO/UNICEF statement published by the World Health Organization), ten steps are identified for succesful breastfeeding, which each facility providing maternity services and care, ideally should adopt. These are:

• Have a written breastfeeding policy that is routinely communicated to all health care staff.
• Train all health care staff in skills necessary to implement this policy.
• Inform all pregnant women about the benefits and management of breastfeeding.
• Help mothers initiate breastfeeding within half an hour of birth.
• Show mothers how to breastfeed, and how to maintain lactation even if they should be separated from their infants.
• Give newborn infants no food or drink other than breast milk, unless medically indicated.
• Practise rooming-in - that is, allow mothers and infants to remain together - 24 hours a day.
• Encourage breastfeeding on demand.
• Give no artificial teats or pacifiers (also called dummies or soothers) to breastfeeding infants.
• Foster the establishment of breastfeeding support groups and refer mothers to them on discharge from the hospital or clinic.

The World Alliance for Breastfeeding Action (WABA) has seen it appropriate to revisit the ten steps issued by the WHO in 1989 due to reports of "lack of commitment, deteriorating hospital practices, and inadequate training of health workers to counsel mothers." Although more than 20,000 maternities, or about 28% of all maternities in the world, have fully implemented the Ten Steps and have been certified by the Baby-friendly Hospital Initiative (BFHI), reduced BFHI programming worldwide, inadequate training, and weakened compliance with the Ten Steps in accredited maternities are contributing to stagnant or declining exclusive breastfeeding rates in many settings.

World Breastfeeding Week 2010 also commemorates the 20th anniversary of the Innocenti Declaration that called for implementation of the Ten Steps in all maternity facilities. The Innocenti Delcaration was produced and adopted during the WHO/UNICEF policymakers' meeting on "Breastfeeding in the 1990s: a Global Initiative" held in Italy in 1990.

Among the objectives of this year's World Breastfeeding Week which I find particularly important would be: To ensure that health workers who care for mothers and babies are adequately trained to counsel and support them in optimal infant feeding. My recent experience with a Metro Manila hospital on breastfeeding wasn't too good.

Another objective which I think is also particularly important is "to inform people everywhere that protection, promotion and support of breastfeeding is a mother’s right, a child’s right, and a human right." We often take several weeks of childbirth preparation classes and spend an equal amount of (if not more) time shopping for baby's clothes, gear etc. However, reading or preparing for breastfeeding is relegated to a half day or even less.

For World Breastfeeding Week 2010, the WABA calls advocates to reassess and consider what needs to be done to revitalize and expand the Baby-Friendly Initiative. Some of the things they suggest that can be done would be:

1. Help your friends, colleagues and community to find the path.
2. Find out what the status of the Ten Steps and BFHI is in your country and advocate for changes in hospitals
3. Create change at the national level. Advocate for changes in hospitals, maternities adn in the wider health care system - health centers, primary care and communities.
4. Improve our world for mothers and children and for our future.

For World Breastfeeding Week 2009, we had a Breastfeeding Festival at my workplace and also started a Lactation Policy Program. However, the program has not yet been completed although a breastfeeding room has been estblished. This year, hopefully, we will finally be able to establish a permanent lactation program and execute it in time for Breastfeeding Week. I also hope that L.A.T.C.H. or Children for Breastfeeding or other breastfeeding organizations in the Philippines will be able to focus on hospitals and reestablish or reiterate the need to promote, support and protect breastfeeding especially to new moms!

Breast Milk for Haiti

Since the Haiti earthquake, I've been reading a lot of blogs and news about the call for breastmilk donations for children. Then came the news articles and more blogs on the "controversial call".

On 21 January 2010, the UNICEF issued a statement discouraging breast milk donations:

Human milk donations while safe when processed and pasteurized in a human milk bank also require fully functioning cold chains. Such conditions are not currently met in Haiti and human milk donations cannot be used at present. All queries and any donations that do appear should be directed to UNICEF, the designated nutrition coordinating agency in Haiti.

Then came the International Breast Milk Project and Human Milk Banking Association's calls for breast milk donations. About 500 ounces of milk was couriered on 28 January 2010 to the US Navy's ship called Comfort which was stationed near Haiti. However, this donated milk remains unused to date. Plus, the U.S. Navy spokesman has been promoting the use of infant formula rather than this donated milk!

But the staff on the U.S. Navy ship said they haven't used the milk out of concerns raised by OFDA and other agencies. Mothers aboard the Comfort are urged to nurse their own babies and there’s infant formula available to children whose mothers cannot or will not breast-feed, said Lt. David Shark, a U.S. Navy spokesman.

Comfort has been identified as the world's only nautical milk bank but apparently it is ill-equiped to handle the flood of breast milk donations.

Eager to do something to alleviate the suffering of the smallest, many lactating women are wishing the Comfort had more storage space to handle donated milk. At least one Navy staffer, who had to leave her 10-week-old baby behind when she deployed, was "pumping and dumping" — nursing slang for pumping then discarding milk. Now that there's a use for her milk, she's ferrying it to the ship daily from the mainland, where she is currently working. Beard Irvine has a name for that milk: "Comfort food."

It is just sad that instead of addressing the upgrade on the facilities or promoting relactation or cross nursing, Dr. Nune Mangasaryan, senior adviser on infant nutrition for UNICEF, instead promoted the use of ready to drink formula and this is despite the joint statement issued by WHO, UNICEF and WFP discouraging the donation and use of breastmilk substitutes or formula.

Dr. Mangasaryan: At this point what we recommend for them is ready-to-use infant formula, that's already in a liquid form, meaning no risk of contamination by mixing powdered formula with water, for example. It's already ready-to-use, and there are certain numbers already available in the country.

The Philippines faced a similar disaster (Ondoy and Parma) in October 2009. We were also involved in breastfeeding missions and brought donated, pasteurized breast milk in coolers to evacuation sites. But as I previously shared, out of the 15 liters (about 507 fl. oz.) of milk we brought, only 1.5 liters (50.72 fl. oz.) were used up. We wanted to leave the unused milk there but the health workers told us that they had no facility to keep the milk cool and prevent spoilage. So we ended up lugging it back to the milk bank.

I learned that in times of calamaties such as this, what is more important or useful would not be breast milk donations but rather breastfeeding information - relactating, switch nursing, protection of milk supply, encouragement. As fellow LATCHer Mec also shared, sharing of strategies, loot bags and the use of wet nurses were also particularly useful.

I'm not saying that moms with extra milk should stop donating milk. Even without calamities, milk banks are continuously asking for donations. In fact, every time I call up the PGH Milk Bank, they always excitedly ask me if I have extra milk to give. Moms should continue to donate milk but just have an expectation that their milk may not be directed towards Haiti but to other needy babies within their locality. I'm not sure if it is feasible in evacuation centers in Haiti but instead on focusing on calls for milk donations or promoting ready-to-drink formula, maybe international organizations can instead focus in information drive with strategies, tips and tricks on relactating and the promotion of direct breastfeeding.

New WHO recommendations for Pregnancy and Breastfeeding

I recently received an email from Alex, a WHO/UNICEF consultant in the Philippines. He shared that the World Health Organization just released new recommendations for pregnancy and breastfeeding in the context of HIV. Alex shares:

In line with several recent clinical studies that have demonstrated the efficacy of (anti retro viral) ARVs in preventing HIV transmission from mother to child during breastfeeding, the new guidelines call on all HIV-infected pregnant women to begin ARV treatment during pregnancy and for the mother or baby to continue ARV treatment for the duration of breastfeeding.
The new guidelines encourage HIV-positive mothers taking ARVs to exclusively breastfeed their infants for the first 6 months, introducing appropriate solid foods while continuing to breastfeed for the first 12 months of life.
WHO states that there is now enough evidence to support the use of ARVs while breastfeeding.
"We are sending a clear message that breastfeeding is a good option for every baby, even those with HIV-positive mothers when they have access to ARVs," said Daisy Mafubelu, WHO's Assistant Director General for Family and Community Health.

You can access the full text of the release here.

Learnings from the Missions

Several breastfeeding missions have been organized over the past weeks and there were some lessons I learned

1. No expectations

During my first visit at Pasig, we brought 1 cooler chest full of pasteurized milk. There were probably about 77 bottles there but we only used 3 bottles. All of the mothers we talked to (with the exception of about 3-4 mothers) were breastfeeding. Although some of them were mixed feeding, these mixed feeders were lessening the formula milk intake of their babies and were slowly going back to exclusive breastfeeding (due to lack of clean water).

The 3 bottles of milk were used not because there were babies who needed the milk but because they had been thawed and couldn’t be re-frozen. The breast milk was instead fed to toddlers who loved the milk!

During the drive organized by the Philippine General Hospital a week before, the group brought 2 cooler-chests of milk. But as reported by my co-LATCHer Mec, a lot of moms were already breastfeeding exclusively or mixed. Thus the thawed milk ended up also being given to toddlers.

Apparently, breastmilk drive was not of utmost importance but rather it was the information or encouragement to go back to exclusive breastfeeding that was needed by the moms at the evacuation centers. Moms who were exclusively breastfeeding also needed to be praised and protected as there were some ignorant donors who were donating formula milk (see next paragraph!).

2. Just because they are an international organization doesn’t mean that they know what to do.

Going on breastfeeding missions is not included in the regular activities of LATCH. We are primarily a support group who counsel mothers. We were requested by a big international organization to work with them and the local government units to visit the evacuation centers as volunteers.

We were pretty new at this kind of thing so during our first visit, we were somewhat unprepared. We had our own transportation, made our own visuals and prepared our own giveaways.

For the second visit, we had more time to prepare and were able to make loot bags with laundry soaps, a child’s shirt and sanitary napkin, to give away. One of the LATCHers also prepared bihon for the participants. These may seem meager but money for these goods came from our own or our friends’ and families’ pockets -- and this was after most of us had donated to other civic organizations who earlier called for relief goods donations.

This international organization dictated the places we were supposed to go to. They even asked the volunteers to go to Sta. Rosa which is about 1.5 hours away from Metro Manila. Now, we are volunteer moms who have full-time jobs or run a business or take care of our houses. Some of the volunteers are community moms who need to work to put food on their tables for the next day. Thus, we asked that our transportation fees be reimbursed and that this international organization prepare the loot bags. For the community mothers, we asked that they be given at least P1,000 (roughly USD$20) for a day's work.

The international organization balked. Apparently, they had already given a huge amount to another international children's organization who had no clue about breastfeeding. This international children's organization, in turn, turned to various breastfeeding counselor groups, asking them to work almost gratis. And this international children's organization even had the nerve to suggest formula donations - when the numbers show that the exclusively breastfed children greatly outnumbered the formula-fed or mixed-fed babies! For the initial Sta. Rosa mission, the group agreed to go in exchange for transportation to be arranged by the international organization. They had also promised to prepare the goody bags but since we had been able to solicit and make 500 bags, we told them that for this mission, they just needed to prepare the transportation. Meeting time was 730am on a Saturday to allow the group to get to the site before 10am and be back in the city in the afternoon. 10am - and the group was still waiting for the non-existent transportation promised by the international organization!! Needless to say, the mission for that weekend was cancelled. The mission eventually pushed through about a week later but this time, the blinders were off and we knew and emphasized that this mission is by our group and not in partnership with any other organization.

3. Don’t go without bringing anything

Finally, we learned that when doing the missions, we needed to bring goody or loot bags to the mothers. These moms lost almost everything and although they were not doing anything, by participating during the talks, they feel that they contributed something and needed to be "paid." During the first mission, it was quite chaotic since we brought whatever we could find - mix of clothes, bedsheets, toys, soaps and toiletries. The moms wanted to exchange what they received and kept comparing what their neighbors got. For the next missions, we knew better and prepared standard loot bags for the moms.

Most of the evacuation centers have been cleared out as the government has implemented a "Balik Probinsya" (return to the province) program. As a result, there were a couple of missions cancelled because the evacuees were no longer there or were too busy packing. With more typhoons predicted to come to the Philippines, I expect that we might be called to volunteer again in the future. Our experience with Ondoy has opened up our eyes to several realizations and prepared to us better for future missions. But for now, our organization has decided to move on and focus on our primary mission/purpose which is to counsel and support breastfeeding moms.

Mission Accomplished!

*This is an edited version of Velvet’s account.

Six nursing moms went on a breastfeeding mission to ULTRA (a sports arena) in Pasig City yesterday. Pasig City was one of the hardest hit in the typhoon Ondoy flood. Earlier that day, I went to UP-PGH-NICU's milk bank to drop off some of Naima's extra milk and pick-up the pasteurized milk that we were going to use for cup-feeding.

Dr. Zeka had informed me that ABS-CBN was going to be there to cover the pasteurization process. Since I was donating milk, they decided to do an ambush interview! (note the bad hair day!) I agreed to the interview hoping that more moms would donate milk to the existing milk banks. The need for breast milk exists not only during calamities such as Ondoy but also during regular days, to serve the requirements of premature and sickly babies whose mothers cannot fully provide breast milk. If you’re a nursing mom, click here to find out where you can donate your milk.

At the ULTRA Pasig, there were 2 areas (big gym and the covered court that housed the evacuees. We first went to the biggest gym, where there were about 120++ moms and babies including 1 mom who gave birth in the a public school (where they were formerly housed) with her 3 day old baby. Velvet tried to shower her with more gifts compared to the other moms because she was so touched by the baby and mom tandem. The new mom was still experiencing birthing pains and was crying from the pains. However, she was nursing her baby which was a happy sight.

We were very happy to observe that the moms there were mostly breastfeeding. One mom, who was mixed feeding, used to give her baby 5 bottles of formula per day. However, with the lack of clean water, she is trying her best to relactate and is now down to 2 bottles of formula per day.

We brought about 15 liters of pasteurized breast milk from the PGH milk bank but only 1.3L were thawed and used. Velvet was only able to cup feed a few kids. Initially, we were supposed to leave the extra milk for the public health workers to distribute. Since there was a blackout, we had to return the unused frozen milk to avoid wastage and allow other babies to benefit from it.

Since there was no electricity, it was a good thing that it was showering a bit outside to temper the heat. We could only imagine how hot it gets inside the arena at high noon! There was also no megaphone available so we had to shout out our message to the participants.

It was a team effort and as Velvet noted, there was great teamwork! There were 6 moms with an audience of more than 120. Happily, we survived. Judy had the bright idea of conducting a game of "Truths and Myths". With the assistance of Mec, they were able to encourage the audience to participate and ask their questions about breastfeeding. The moms were so happy to receive clothes and toys for their kids.

After the breastfeeding talk, we gave some goodies to the moms. To have more order and prevent the moms with their babies from getting too tired from lining up, Velvet requested that the team distribute soap, napkins, clothes to each and every mom who sat down patiently.

There was a group who wanted to give Bonamil and Nestogen to the evacuees. Eagle-eyed Atty. Booey alerted the group to this activity and she pointed it out to the Department of Health representatives. Dr. Del Rosario of DOH Pasig and Ms. Myrna of DOH-National immediately approached them and asked them NOT to distribute formula as what they were doing is against the law. It was very sad since the donors were doctors! However, they started distributing their goods when we left so I’m unsure if they still proceeded to distribute formula milk.

Two LATCHers, Jenny Medina and Mec Arevalo previously participated in the UP-PGH Breastfeeding Mission but for all the others (except for Velvet), it was our first time to be involved in such an activity. The Pasig BF Mission was a little difficult with its glitches but I believe that we survived it and completed the activity with flying colors!

Breastfeeding Mission

Tomorrow, LATCHers will be going on a breastfeeding mission at Ultra, where 500 familes (about 2,000 individuals) are housed. These families are evacuees who were formerly housed in public schools. But they have been transferred to Ultra to allow the students to resume classes.

According to Dr. Zeka (who coordinated with UNICEF/WHO/DOH on behalf of LATCH), what is being sought is several visits to the evacuation center to give support to the local government units (who previously had established breastfeeding support systems) whose services were disrupted by Ondoy. Despite the Milk Code, donations of formula milk are still being requested and continue to pour in. In fact, last Saturday, when I was at the Ateneo covered courts volunteering for the repacking, I saw a mountain of repackaged formula milk - various brands.

LATCH will be bringing some pasteurized breastmilk from PGH-NICU milk bank to provide temporary relief to mothers/infants where the mother is too ill to breastfeed, or the baby is fully dependent on formula. However, the ultimate goal is the return to exclusive breastfeeding of as many mothers as possible, and to protect those who are already breastfeeding so that they continue to breastfeed exclusively for the first 6 months and then continue to breastfeed with the addition of complementary food.

LATCH also hopes to be able to keep track of data (illness and death in formula-fed vs breastfed babies) which can be submitted to other organizations/institutions/countries as evidence that breastfeeding in a disaster situation is possible and much more beneficial than formula feeding.

We hope to be able to provide a mother's class in Filipino to expectant mothers. I've prepared some materials on the benefits of breastfeeding in Filipino as well as pictures of positioning. I was hoping to be able to translate some of the myths and barriers to breastfeeding but there's not enough time to be ready for tomorrow's activity. We also seek to assess breastfeeding moms (positioning, latch), support moms who are mix-feeding and encourage them to get back to exclusive breastfeeding. Meanwhile, milk from PGH-NICU will be cup-fed to babies.

Velvet of Arugaan was hoping to conduct a cooking demo to encourage moms to use indigenous foods in complementary feeding. However, given the limited preparation time, this may be postponed for the next visit.

More updates after the activity...

What I Learned From The Milk Code Forum

Last Saturday, I was happy to have attended the Milk Code Forum organized by Arugaan, in cooperation with UP WinLaw and UP Volunteers for Children. It was a packed day, with several speakers. The coordinator/facilitator was Nanay Ines of Arugaan and she had the entire room decorated with various breastfeeding posters.

The forum started with a brief welcome by Unicef's Elham Monsef. She focused on the theme of this year's World Breastfeeding Week and discussed how the promotion of formula during emergencies displaced the breastfeeding moms. She also emphasized that in times of calamities, formula donations should not be given directly to breastfeeding moms, but rather be coursed through the Department of Health who will then determine whether a certain mom really needs it or whether giving her this formula will just curtail her breastfeeding relationship. Elham stressed the need to strengthen the 3 pillars of breastfeeding - protect, support and promote; and rued the loss of the culture of breastfeeding in the Philippines.

The forum participants were also lucky to hear Dr. Anthony Calibo's discussion. Dr. Anthony Calibo is the Philippine Medical Tourism Manager of the Office of the Undersecretary for Special Concerns, Department of Health. Dr. Calibo is also a practicing pediatrician and is connected with St. Luke's Medical Center. He discussed his experience as a medical student (on how breastfeeding is superficially discussed) and as young resident, who was bombarded by marketing strategies of big milk companies, in hopes that he will be swayed to support them. Dr. Cabilo emphasized that breastfeeding information should be given even by the ob-gynes and believed that pediatricians have a role in prenatal care (e.g. if only to advise the mothers about breastfeeding and rooming-in). He wrote a research paper on the top things that ob-gynes discuss with their patients and sadly, breastfeeding is not included in the list. It is really a sickness of the medical practice - to rely on milk companies/big pharmaceutical companies to support medical conventions - and thus be susceptible to marketing gimmicks or strategies thrown back to the doctors.

Part 2

Unicef on WBW 2009 - Breastfeeding a crucial priority for child survival in emergencies

UNICEF joined the World Alliance for Breastfeeding Action in commemorating World Breastfeeding Week, 1-7 August 2009, through the release of this video which underscores the vital importance of breastfeeding during emergencies.

You can read UNICEF's press release here. Two things struck me most in that press release.

"Globally, only 38 percent of infants under the age of six months are exclusively breastfed".
The Philippines' 2008 National Demographic and Health Survey (NDHS) has just been recently publicly released and I am sad to read that the Philippine statistics are even lower than the global rates. Although the headline states that 50% of Filipina moms breastfeed, this number refers to babies at 1-2 months. According to our Secretary of Health Francisco Duque III, "the 50 percent breastfeeding rate in 2008 was down from 53 percent in 2003; the same study showed 34 percent of infants below six months are being exclusively breastfed." Actually, the 34% rate refers to babies at 2-3 months. I was able to obtain a copy of of the 2008 NDHS survey and the results are more dismal. At 4-5 months, only 22.6% are exclusively breastfeeding, despite the UNICEF's (and other experts') position that breastfeeding provides the best food for a baby’s first six months of life.

"More damaging is the common donor impulse to send infant formula or breast milk substitutes to disaster zones"
When I was single and not breastfeeding Naima, I was guilty of this same practice. Actually, even during the early months of breastfeeding Naima, I was likewise guilty of propagating the formula culture. I had cans and cans of formula leftover since I was already making enough milk for Naima. My mom's secretary had a baby two months older than Naima and was think of weaning at 6 months. I did encourage her to continue breastfeeding, but I guess my encouragement was not enough and what was even more damaging was that as I eventually sent her all my cans and bottles of formula.
In hindsight, I should have thrown out all those formula instead of giving them away. This is also the reason why I don't advice new moms to buy even just a small can of formula "for reserve" or for "just in case". With the Filipino trait of being frugal/thrifty, you will certainly be tempted to use the formula or give it away.