Philippines Kicks Off Global Mass Breastfeeding
MANILA, PHILIPPINES - JULY 19: Mothers pack a small room to breastfeed their newborn babies at the Dr. Jose Fabella Memorial Hospital maternity ward o
MANILA, PHILIPPINES - JULY 19: Mothers pack a small room to breastfeed their newborn babies at the Dr. Jose Fabella Memorial Hospital maternity ward o

Getty – MANILA, PHILIPPINES - JULY 19: Mothers pack a small room to breastfeed their newborn babies By MADELEINE FITZPATRICK

If you want to know if Elvira Henares-Esguerra has the guts to lead a synchronized, global moment of breastfeeding taking place on Friday across 18 countries, bear in mind that this is a woman who didn't hesitate to nurse her child in front of an audience of 700 as she shared the stage with Philippines' President Gloria Macapagal-Arroyo in 2005. "You should have seen the [officers]," says Henares-Esguerra, recalling the moment her four-year-old son ran to the stage during the President's speech to inaugurate World Breastfeeding Week in the Philippines. "They all wanted to rush and catch him. But they were too slow."

Bringing more awareness to the broad benefits of breastfeeding has been a global movement for decades. Not only is breast milk considered by Unicef and many others to be the most nutritious food for babies, containing important antibodies and changing its composition as a baby grows, but studies have shown breastfeeding also has clear economic benefits for families over using milk formula products.

Through events like Friday's Synchronized Breastfeeding Worldwide, advocates like Henares-Esguerra have helped make the Philippines, which has one of Asia's highest birthrates, one of the leaders in the international legal effort to support women's right to breastfeed. Aimed at controlling aggressive marketing of formula-milk companies, particularly in developing nations, pro-breastfeeding laws target corporate practices like sponsoring maternity-related events, giving out formula samples to new mothers, and indicating on labels and advertising that their products make babies smarter. "Breastfeeding can save the lives of both mothers and infants. It may be the single most important intervention for promoting Millennium Development Goals 4 and 5 [reducing child mortality and improving maternal health]," says Grace Agrasada, professor of pediatrics at the University of the Philippines, Manila, and the country's first International Board Certified Lactation Consultant (Henares-Esguerra is the second).

In a nation like the Philippines, where nearly half the nation lives on $2 a day, the sheer economic need for more women to move to breastfeeding is striking. With roughly 25% of formula-using families in the Philippines at or below the poverty line in 2003, families are spending a full 27% of their resources on formula. To save on costs, many families over-dilute the formula or add other kinds of milk - including condensed milk - a practice that, over time, can lead to malnutrition, illness, and death. In 2005 the World Health Organization estimated the nation's total lost wages from caring for formula-fed children with diarrhea and acute respiratory infections during the first six months of life was 1 billion pesos ($21.3 million), a figure that does not include the cost of doctor visits, medicine and hospitalization that parents have to pay. (Read "Salma Hayek, Breast-Feeding and One Very Public Service.")

The theme of this year's World Breastfeeding Week in August - "Breastfeeding - a vital emergency response" - has proved eerily prescient in the case of the Philippines. For mothers and young children caught up in the devastation of the sort wrought by Typhoon Ondoy on Sept. 26, breastfeeding advocates say the practice can provide the key to averting a whole new set of disasters. "The availability of water, cooking utensils, and fuel is very unreliable," said Nona Andaya-Castillo, co-organizer of the synchronized breastfeeding event, in Manila, three days after the nation experienced its worst flooding in nearly 50 years. She and Henares-Esguerra had just spent the previous night with President Macapagal-Arroyo, drafting a press statement advising mothers not to accept formula-milk donations during the crisis.

Macapagal-Arroyo is not the first Philippine president to come out in support of breastfeeding. In 1986 President Corazon Aquino signed into law Executive Order 51, the National Milk Code - designed to implement the objectives of the WHO's 1981 International Code of Marketing of Breast-milk Substitutes, which bans virtually all forms of advertising and marketing of infant formula, as well as forbidding milk-company representatives from contacting pregnant women and mothers, or distributing gifts to health workers. In its annual meeting in 1974, the WHO determined that breastfeeding was in decline around the world, and soon after drafted the Code as a non legally binding framework within which countries can enact their own national laws. (Read about Facebook's war on nipples.)

The International Baby Food Network (IBFAN) regularly publishes its "State of the Code by Country," classifying nations by their compliance. The Philippines gets the organization's highest rating, having "implemented most of the Code and subsequent World Health Assembly resolutions by means of a comprehensive law, decree or other legally enforceable measure." India and Sri Lanka also top the list. Developed countries Hong Kong, Japan, Singapore and Taiwan come in low, having only instituted a few voluntary provisions, and the U.S. is - in the words of IBFAN founder Annelies Allain - "at the bottom of the pile." Its position in the lowest category 9 indicates that the country has taken no action to implement laws that would protect breastfeeding or restrict the marketing practices of the formula-milk companies.

Part of the challenge of implementing pro-breastfeeding legislation, in the developing world, has been the amount of resources and the determination needed to see the process through. In August this year Vietnam's Health Ministry announced the discovery of dozens of violations of the country's formula labeling rules. In its latest Breaking the Rules, Stretching the Rules report from 2007, IBFAN documents over 3,000 Code violations, committed by 12 companies in 67 countries, and collected since 2004.

In reality, after the signing of the Philippines' own National Milk Code, "the implementation was spotty, irregular, not done consistently," says Health Undersecretary Alexander Padilla. Held up by legal complaints from milk companies who saw the code as an unlawful affront to their industry, the domestic law went through 12 drafts over 19 years. "We went through public hearings, consultations; we even tried to process the complaints of the milk companies - until when we couldn't agree on anything anymore, they brought the case to the Supreme Court," says Padilla. The milk companies' efforts finally lost the case when the Supreme Court declared on October 9, 2007: "The framers of the constitution were well aware that trade must be subjected to some form of regulation for the public good. Public interest must be upheld over business interests."

Asked how breastfeeding advocates in other nations can follow her country's example, Henares-Esguerra has this advice: "Promotion, protection, and support. You have to do all three together - you can't do one without the other." As the synchronized breastfeeding participants and nursing mothers around the world know, the right to breastfeed is something worth fighting for.