One more time, the MILK CODE: Its salient points

(Writer’s note: This article first appeared in this paper three years ago. This has been republished due to its timeliness but edited and updated to the current provisions and practices.)

While it is true that culture changes parallel to technological development, so is the culture of breastfeeding globally. Fortunately, it is a different story in the Philippines: breastfeeding is almost universal with 94 percent of children born have been breastfed according to the 2013 National Demographic and Health Survey (NDHS).

The same source claims that about half or 49 percent of Filipino children are breastfed within one hour of life.

Unfortunately, “more than one-third of breastfed children (36 percent) are given a prelacteal feed during the first three days of life”, it maintains.

And “More than a quarter (27 percent) of infants under age two months are fed using a bottle with a nipple”.

Depending on the medical situation of the newborn, breast milk is considered the only food that the baby should receive. In order to ensure this, a law was created.

Signed into law on October 20, 1986, the then President Corazon C. Aquino created Executive Order 51, which is more commonly called the ‘Milk Code’, setting the Philippine Code of Marketing Breast milk substitutes.

It must be noted that at the time of its enactment, the President of the Philippines held executive and legislative powers. Thus, EO 51 is commensurate to a Republic Act.

First of its kind in Asia, the Philippine Milk Code was conceived five years after the WHO International Code of Breastmilk Substitutes by the World Health Assembly to combat aggressive marketing of breastmilk substitutes that could possibly be lethal to the culture of breastfeeding.

The rationales of the Milk Code were to impose restrictions on advertising breastmilk substitute and encourage breastfeeding.

WHAT IS THE SCOPE OF THE MILK CODE?

“The milk code intends to intensify the dissemination of information on breastfeeding and proper nutrition while regulating the advertising, marketing, and promotion of breastmilk substitutes and other products, including feeding bottles and teats”, states Dr. Enrique Tayag of the National Epidemiology Center of DOH.

[Likewise], “it bans the use of the healthcare system in the use of its products”, he adds.

[Lastly], “it bans donations, samples or distribution of other promotional giveaways by milk companies to the health workers and others in the healthcare system”.

WHAT ARETHE PRODUCTS COVERED BY THE MILK CODE?

1. Breastmilk substitutes (formula milk)

2. Milk products, foods and beverages and bottle-fed substitutes as marketed for partial or full replacement of breastfeeding

3. Feeding bottles and teats

ARE THE PRODUCTS COVERED BY THE MILK CODE LIMITED FOR ANY PARTICULAR AGEGROUP?

“The products covered are not limited to a specific age bracket. The Supreme Court had its ruling on this on October of 2007”,explains Tayag.

The coverage of the Milk Code does not depend on the age of the child but on the type of product being marketed to the public.

WHO SHOULD COMPLY THE MILK CODE?

Atty. Christine P. Macaranas- de Guzman, Attorney- III of the Food and Drug Administration of the Philippines maintains that “as a Law, the Milk Code is expected to be imposed on the general public, health workers (public and private practitioners), manufacturers and distributors of covered product”.

WHAT ARE THE RESPONSIBILITIES OF THE HEALTH WORKERS IN THE MILK CODE?

1. Promote breastfeeding by complying with the Milk Code.

2. Health workers should not accept information from producers of milk products that undermine the breastfeeding practices and give credence to the equal value of bottle or formula feeding.

3. Health workers are forbidden under the Revised Implementing Rules and Regulations (RIRR) to offer or give samples of products covered in the code to pregnant women, mothers of infant including their families.

4. Health workers are prohibited in giving of utensils and paraphernalia used in the preparation of such products [artificial or formula feeding].

CAN REPRESENTATIVES OF MILK COMPANIES ENGAGE IN THE CONDUCT OF BREASTFEEDING CLASSES OR MOTHER’S CLASS?

No they cannot. Section 2 of the Implementing Rules and Regulations of the Milk Code States that manufacturers, distributors and representatives of products covered by the code are forbidden to do any of the following:

1. Conduct or involvement in any activity on breastfeeding promotion, education and production of IEC materials on breastfeeding.

2. Holding or participating as speakers in mother’s classes or seminars for women and children

3. The use of these women to market brands or company names.

In fact, “Section 18 of the RIRR of the Milk Code states that manufacturers and distributors of products within the scope of the code are prohibited from offering material or financial inducement to health workers to promote products within the scope of the code and health workers are prohibited from accepting these material and financial inducements”, Tayag explains.

Lastly, the Milk Code provides that no facility of healthcare system shall be used for the purpose of promoting products covered by the code.

WHAT IS THE POLICY ON DONATIONS?

“Section 6 (f) of the Milk code provides that “Nothing provided in the Milk Code should prevent manufacturers and distributors of products within the scope of the Code from donating covered products upon request by and with the approval of the Department of Health”, said Macaranas-de Guzman.

“But note that Section 51 of the RIRR absolutely prohibit donations of products covered within the scope of the Code, for other donations by Milk Companies, Section 52 provides that products not falling within the scope of the Code, equipment and the like whether in cash or in kind maybe given by the milk companies provided such donation is coursed through the Inter-Agency Committee.”

WHAT ARE POSSIBLE PENALTIES FOR VIOLATORS OF MILK CODE?

The law imposes criminal and administrative penalties for violators of the code.

“A regular court can impose a penalty of imprisonment ranging from 2 months to 1 year and/or fine ranging from P1,000 to P30,000”, explains Macaranas-de Guzman.

“The administrative penalties include suspension, revocation or cancellation of any license permit or authorization issued by any government agency to any manufacturer/distributor, health worker, marketing firm or their personnel.”

The month of August is also known as the National Breastfeeding Month in the Philippines.

With Additional Information from Dr. Daisy Colleen Young-Mercado.

Dr. Mercado is a registered nurse-midwife by professions. She holds a master’s degree in nursing specializing in maternal and child health and a doctor of philosophy in educational management.