"I was told that breast-feeding is good for the baby. And I have proved it right because I raised healthy children on natural breast milk,” Susan says, adding that her children rarely get sick.

Living in a poor and remote village, Susan and her husband tills a small vegetable farm. She says that even with the available milk supplements in the market, many mothers in their village cannot afford to buy milk formulas so they rely on breast milk.

“We were told by health workers that breast milk is best for babies and we believe them. But there are also some mothers, especially working mothers, who [turn to] milk formulas after three months of breast-feeding, even if they cannot afford it,” Susan said.

An alarming threat to child survival

In Asia, there are still some women like Susan who believe that breast-feeding provides the required nutrition for babies. But UNICEF and the World Health Organization (WHO) now say that breast-feeding is on the decline in many Asian countries, thus lowering the survival rate of infants and children.

According to a joint statement issued by the two organizations, this new trend is an alarming threat to child survival; both organizations have urged governments in East Asia and the Pacific to invest more resources in the protection, promotion and support of breast-feeding.

WHO estimates up to 1.45 million children die annually in poor countries because of low breast-feeding rates.

Thailand has the lowest exclusive breast-feeding rate in Asia; only 5.4 percent of mothers nurse their babies on breastmilk alone in the first six months of their child’s life. Vietnam's rate has fallen from 29 percent in 1998 to 15 percent in 2002, while Indonesia dropped from 42 percent in 1997 to 40 percent in 2002.

In the Philippines, the rate of exclusive breast-feeding at four to five months of a child’s life fell from 20% in 1998 to 16% in 2003. It is estimated that 16,000 deaths of children under five in the Philippines are caused by inappropriate feeding practices, including the use of infant formula.

“Poor nutrition is the greatest contributing factor to under-five mortality rates,” says Dr Shigeru Omi, the Regional Director of the WHO Office for the Western Pacific. ”Breast-feeding provides a natural safeguard for a child in the first months of life and plays a critical role in growth and development.”

Dr Omi says that many mothers do not continue breast-feeding for the recommended two years or longer, replacing breastmilk with substitutes. But as the doctor points out, formula feeding is an expensive, not nutritionally equivalent, and often dangerous alternative to breastmilk, particularly in unhygienic environments.

Studies indicate that a bottle-fed child living in poverty is up to 14 times as likely to die of diarrhea and four times more likely to die of pneumonia than an exclusively breastfed infant.

Breast-feeding, according to the recent WHO review of global studies, reduces the incidence of asthma, allergies, childhood cancers, diabetes, Crohn's disease, colitis, obesity, cardiovascular disease and ear infections, while promoting cognitive development and school performance.

Other reasons for breast-feeding decline

Many health experts say there is insufficient support of breast-feeding by society in general, in particular for women who are trying to combine breast-feeding with employment outside the home.

“While it is important to maintain breast-feeding in the first six months, many working women in many countries face obstacles to breast-feeding their babies, especially when they are required to go back to work after a short maternity leave,” says Dr. Elizabeth Solang, a gynecologist. She says that these women are open targets for the formula companies who encourage them to formula-feed their children through persuasive advertising.

“In order to provide optimal childcare, we have to ensure that there is legislation to protect working women’s rights and to increase public awareness of the many great benefits of breast-feeding,” Solang says.

In May of this year, the Philippines’ Department of Health renewed its campaign to promote breast-feeding. Meant to encourage more women to opt for mother’s milk over the much-advertised infant formula, the Department of Health sponsored an event featuring the simultaneous breast-feeding of about 10,000 mothers and their children.

Milk code issue

With breast-feeding rates declining across Asia, the Philippines’ Department of Health also aims to strengthen its milk code, which was designed to ban companies from aggressively advertising products made for babies less than a year old that claim instant formula milk makes babies smarter, healthier and stronger.

According to Health Secretary Francisco Duque, “Promoting breast milk could also help abate hunger and poverty as this is cheaper, healthier, and safer and will give children a fighting chance."

As of press time, the Pharmaceutical and Healthcare Association of the Philippines is challenging a Department of Health order before the Supreme Court that would extend the ban on promoting infant formula for children up to two years old.

WHO Philippines estimates that Filipinos are spending 21.5 billion pesos ($465 million USD) a year to formula-feed their infants.

“Within the region, child survival is affected by poor water quality, hygiene and sanitation. Combine unsanitary water with the replacement of breast-feeding by infant formula and the threat becomes even deadlier,” says Anupama Rao Singh, UNICEF’s Regional Director for East Asia and the Pacific.

Millions of baby formula recalled

While an on-going debate plays out before the Supreme Court on whether to allow health officials to impose stringent measures against what they say are aggressive advertising tactics by foreign milk companies, the Philippine government announced that about 2.5 million cans of infant formula tainted by rust will be pulled from the market.

Based on the findings of the Bureau of Food and Drugs (BFAD), the milk formula cans were reportedly manufactured by Wyeth, and stored in a warehouse during a strong typhoon last year where they rusted, possibly contaminating the contents.

“Not all the formula brands are affected in the recall. We are only pulling out the milk formulas that are affected,” says BFAD Deputy Director Joshua Ramos.

In a statement issued by Wyeth, the company is adhering to the recall of millions of cans of milk formula but says that “the milk powder inside the affected cans was not compromised and the integrity of the milk powder was maintained.”

• Photograph courtesy of IRRI •

As formula companies fight to maintain their product credibility and advertising schemes, UNICEF Regional Director, Anupama Rao Singh, emphasizes the role of the Philippine government in reversing what has become a dangerous health trend. “We need to ensure that we remain committed to protecting, promoting and supporting breast-feeding by helping mothers and their families understand the benefits of breast-feeding and also the risks of artificial feeding,” Singh says. “This means governments must remain committed to enforcing the International Code of Marketing of Breast-milk Substitutes and also invest much more in the public health system.”



About the Author
Imelda Visaya-Abaño, began her journalism career in 1998 as a reporter at the Philippine Daily Inquirer, the leading daily newspaper in the Philippines. Her areas of interest are women and children's issues, science, environment, health, agriculture and education.

In 2002, Ms. Abaño was honored as the Asian Winner of the Global REUTERS-IUCN Media Awards on Environmental Reporting.

Ms. Abaño vows to continue serving her community through balanced news and fearless views. She believes in better journalism for better communities.