FIRST OF TWO PARTS
BREAST WARS: LIFE SAVING WITH BREASTFEEDING
project initiated by the DOH and the World Health Organization (WHO).
EBF means giving only breast milk to an infant within the first hour of life up to its sixth month. Babies need nothing else, not even water.
Castro said EBF has been medically proven to be “optimal feeding” that can prevent 16,000 infant deaths in the country annually.
The WHO recommends exclusively breastfeeding babies for the first six months, then giving them nutritious complementary food with continued breastfeeding up to two years old or beyond.
Peer counselors
Since the DOH’s previous general information dissemination on EBF failed to popularize the adoption of the practice, BF TSEK uses peer counselors to do more personal campaigning on it.
For the training of peer counselors to promote EBF, the NCP assisted the DOH and local governments in nine highly urbanized cities: Antipolo, Dasmariñas, Bacoor and Imus in Region 4A; Iloilo in Region 6; Cebu, Lapu-Lapu and Mandaue in Region 7; and Tacloban in Region 8.
Champion
Recognized as a Breastfeeding Champion by the DOH in its national IYCF program last Oct. 18, 2012, Cebu City recorded a “high 64 percent” of mothers who initiated breastfeeding during the first 30 minutes after birth.
This is in keeping with the DOH’s “Unang Yakap” campaign to establish immediate “skin-to-skin” contact between the newborn and its mother even before the umbilical cord is cut, said Dr. Maria Theresa L. Tipgos, Cebu City IYCF Coordinator.
She added that compared to the 34 percent national average for EBF, Cebu recorded 50 percent of the mothers giving only breast milk to their infants up to the sixth month.
In Cebu City, EBF is practiced by 77 percent, or 332 out of 449, of lactating mothers enrolled in 13 health centers in lowland and mountain barangays, said BF TSEK Region 7 coordinator Clarinda Paquibot.
Sowing confusion
In noting the breastfeeding milestones achieved by Cebu, the DOH singled out the functioning of community support groups, particularly barangay health workers (BHWs) trained as breastfeeding peer counselors (PCs) to educate and motivate pregnant mothers and assist lactating mothers to breastfeed.
However, Tipgos observed that the grassroots network that promotes IYCF good practices is also used by formula milk companies to sow “confusing messages” that have a negative impact on breastfeeding.
“Manufacturers and distributors shall not be permitted to give, directly, or indirectly, samples and supplies of products within the
Underage mothers avoid prenatal checks, missing out on crucial education, including on breastfeeding
scope of this Code or gifts of any sort to any member of the general public, including members of their families, to hospitals and other health institutions, as well as to personnel within the health care system” to promote the use of breast milk substitutes or bottle feeding, or induce sales, mandates the “National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Other Related Products” or Executive Order 51, more popularly known as the Milk Code of 1986.
All-expense-paid
From openly plying barangay midwives with allexpense-paid seminars and freebies, milk formula companies have become more subtle in reaching health center workers and, indirectly through them, mothers, observed Tipgos.
She said some medical representatives visit health centers during lunch or hand out free cereals, which encourage mothers to introduce food before the sixth month or rely on commodities that are less nutritious yet expensive to sustain.
Punishing violators
Tipgos believes in not just educating mothers about EBF but also enforcing sanctions against community health workers who violate the Milk Code.
Paquibot said the Aug. 24, 2012 “Breastfeeding Summit for Health Workers” held at the Cebu City Health Department (CCHD) was conceptualized to answer Tipgos’s concern that some “health center staff… are still entertaining milk company representatives despite past orientations and trainings on the promotion of exclusive breastfeeding.”
Tipgos’s aggressiveness against milk substitute endorsers is matched by her reputation for strictness in going after health workers violating the Milk Code, confirmed Jovelyn S. Ponce, public health midwife at the Labangon health center.
For a first offense, a public health worker submits a letter explaining why he or she was promoting breast milk substitutes. A warning is given after the second offense. A third offense means termination and revocation of license, said Ponce.
Ignorance of the law did not excuse a public health midwife, who had to explain in writing why a mother in her barangay was seen feeding her infant small bits of cereal. The mother told Tipgos she got the cereal sample from the health center, narrated Ponce.
When Tipgos became IYCF coordinator of Cebu City, one of her first steps was to direct health center staff to remove all posters promoting milk formula brands and other products.
Scouring barangays
During the last quarter of 2012, the CCHD and BF TSEK trained and mentored 302 barangay health workers (BHWs) and city nutrition scholars to become breastfeeding PCs.
Paquibot reported that public health midwives preferred BHWs to volunteers because they could call on the BHWs when needed as they receive a monthly honorarium of P5,000 in Cebu City. Tipgos said BHWs are also first in line at the grassroots due to their assignment to specific sitios.
The BHWs improve the immersion of Cebu City’s 86 health centers into the community. Tipgos said a public health midwife caters to an average of 15,000 persons in Cebu City. There are only six public health doctors, including herself, serving the city’s health centers.
By roaming around their assigned sitios and visiting homes, like public health versions of the “personal sellers” tapped by networking firms, BHW-PCs spot those who want to hide their pregnancy: teens as young as 15.
Pregnant teens
High school students and out-of-school youths constitute the majority of pregnant mothers frequenting six health centers in Cebu City.
Basak-Pardo,
Laban- gon and Basak, San Nicolas Brotherhood (SNB) cater to lowland communities. Busay and Babag serve upland sitios. Tisa residents are in lowland and upland sitios. Forty-six percent, or 12 out of 26 pregnant mothers interviewed for this report, were in their teens when first pregnant.
Teen pregnancies challenge because unless parents know about the pregnancy and accompany their daughters to the health center, underage mothers avoid prenatal checks, missing out on crucial education, including on breastfeeding.
Fears
Esterlita Panal, a BHWPC in Basak, SNB, observed that some young mothers are ashamed to breastfeed in public. Others fear their breasts will sag and make them unattractive.
Because she breastfeeds and is a celebrity to boot, actress Regine Velasquez is often cited as a breastfeeding role model.
Mothers Shara Gayle To-ong, 17, and Antonette Monares, 17, of Tisa argued that breastfeeding even gives fuller breasts to the flat-chested.
This “show and tell” strategy of asking young mothers to speak up and show that BF has not ruined their figures may be convincing, said medical anthropologist Michael Tan, dean of the University of the Philippines Diliman College of Social Sciences and Philosophy.
More important than correcting myths among young mothers is giving them options to avoid unplanned and unwanted pregnancy.
Cebu City Health Officer Dr. Stella Ygoña said, “Adolescent classes (are held) in some barangays, such as Labangon, Ermita, San Jose, Barrio Luz and Mambaling, with high incidence of teenage pregnancy.”
EBF is also one of the topics in pre-marriage counseling, she added.
“We conduct lectures on reproductive health in schools,” said Tipgos.
CCHD personnel act as resource persons when breastfeeding is discussed in class. DOH 7 handles the integration of breastfeeding in the school curriculum.
Sex counseling and seminars on responsible parenthood are jointly undertaken by the Babag Committee on Health and the Health Center, said Councilor Gina Cabantug, as a response to the number of teen mothers and women and men cohabiting in the mountain barangay.