Health authorities in the Philippines were vigilant in keeping out infant formula donations when Typhoon Bopha hit last December, but activists are concerned the infant formula industry will succeed in pushing through legislative changes that will allow formula donations in future emergencies, making it harder to convince women in those crises to continue exclusive breastfeeding.
Breastfeeding - especially during emergencies - has been medically linked to improved child survival due to the incomparable nutrients and antibodies human breast milk offers. But emergencies are also the hardest time to convince women that breast milk can keep their children alive, due to myths about stressed or malnourished women not being able to breastfeed.
When Typhoon Washi (locally known as Sendong) hit the southern Philippines’s Mindanao Island in December 2011, breast-milk substitutes, including formula, turned up in evacuation centres even though they are banned under the country’s “Milk Code”. The Department of Health singled out infant formula maker Nestlé Philippines, issuing a cease-and-desist order requesting it to stop donating milk products to typhoon survivors. The problem was not the company, insisted Nestlé spokeswoman Meike Scmidt, but rather “kind-hearted private individuals and organizations” who donated products of their own will.
“We have the industry’s toughest system in place to enforce our policies governing the marketing of breast-milk substitutes,” she told IRIN. “Our monitoring procedures include control measures that prevent donations of breast-milk substitutes during emergencies, and those control measures are routinely audited.”
Yet the company is now part of a formula interest group called the Paediatric Nutrition Association of the Philippines (IPNAP) which is trying to change the country’s Milk Code. One of the proposals is to allow unrestricted donations of breast-milk substitutes during crises. Activists have rallied to fight what they characterize as the “diluting” and weakening of the current Milk Code, allegations that Nestlé dismisses.
Milk of life
Medical studies have linked formula donations to increased diarrhoea during crises, as was the case during Indonesia’s 2006 earthquake in Central Java.
A 2012 UN Children’s Fund (UNICEF) study found one-week diarrhoea incidence among those who received milk substitutes after the earthquake was more than twice as high as those who did not (24.5 percent versus 11.5 percent); overall, the rate of diarrhoea among infants aged 12-23 months was five times higher than before the earthquake, which researchers linked to breast-milk substitute donations.
Some 80 percent of the 832 surveyed surviving households had received donated infant formula, 76 percent commercial porridge and 49 percent powdered milk. Pre-earthquake only 32 percent of the infants had ever had breast-milk substitutes, a rate that rose to 43 percent at the time of the survey,
“Uncontrolled distribution of infant formula exacerbates the risk of diarrhoea among infants and young children in emergencies,” concluded the study, a message aid agencies are still struggling to publicize.
Doing things differently
Almost one year after Typhoon Washi hit, Typhoon Bopha (local name Pablo) hit Mindanao Island again, this time taking out entire villages in Compostela Valley and Davao Orientale along the island’s northern and eastern coasts. Some 2,000 are dead or missing.
Five days after the Category 5 (winds up to 250km) typhoon made landfall on 4 December, the regional health director for Davao Region (heart of affected zone) circulated a memo to all governmental and aid agencies working on health, water and sanitation urging them to enforce and uphold Health Department regulations prohibiting the distribution of milk products to women and children. The memo stated such donations by “well-meaning, but misinformed donors” were unnecessary.
The challenge, said UNICEF nutrition officer for emergencies in the Philippines Paul Zambrano, is reaching aid groups that bypass any donation coordination structure such as local NGOs and faith-based groups. “They go directly into communities. Monitoring at the local level is difficult,” he said.
Even with health officials’ vigilance to keep out milk products, the disaster took a heavy toll on nutrition in affected areas: Aid groups estimate 95,600 persons will be at risk of malnutrition in 2013 including nearly 67,000 children under the age of five and 29,000 pregnant and lactating women.
The youngest are the most vulnerable. One month after the typhoon hit, of the nearly 500 children under age five surveyed, 66 percent had some illness (most often accompanied by a fever, cough and diarrhoea). Breast-milk substitutes increase the risk of these illnesses due to unsafe water used to mix formula and lack of fuel to sterilize products.
The proposed Milk Code changes are pending review as parliament is on recess until 1 July, and the country prepares to elect new parliamentarians in 13 May elections.