Friday, October 12, 2007

How was protection for infant health in the Philippines achieved?

This is a story with pictures about the ruling by the Philippines Supreme Court on the Department of Health's marketing regulations, as reported in our press release at:

In lifting the Temporary Restraining Order on the regulations the Supreme Court said in its ruling:

"The Court and all parties are in agreement that the best nourishment for infant is mother's milk. There is nothing greater than for a mother to nurture her beloved child straight from her bosom. The ideal is, of course, for each and every Filipino child to enjoy the unequaled benefits of breastmilk. But how should this end be attained?"

So let us remember what it took to face down the greed and power of the baby food transnational who wanted the regulations to die for ever and called in the power of the US Chamber of Commerce to threaten the very economy of the Philippines if the President didn't join their cause.

The International Code of Marketing of Breastmilk Substitutes was adopted by the World Health Assembly in 1981 as a minimum requirement for all countries. Article 11.3 states that independently of any other measures to enforce the Code's provisions, companies should "ensure that their conduct at every level conforms to them."

People from the Philippines were campaigning to protect their babies and mothers from aggressive marketing even before the Code was introduced. Indeed, they were instrumental in achieving the Code. Dr. Navidad Clavano, then head of pediatrics at Bagaio Hospital in Luzon, Philippines, gave evidence to Senator Edward Kennedy's Senate Hearing into the baby food industry in 1978, which gave impetus to the calls for a marketing code. Dr. Clavano, who died this month, said: "Most of the health workers are aware of the havoc that bottle feeding creates.... In the Philippines it is common knowledge that we have a very high malnutrition and high infant death, and we have a lot of economic problems. You see mothers diluting their formula, because the basic salary of a Filipino father is only around - less than two dollars, and how much would a tin of feed cost? It costs more than what he earns."

Dr. Clavano encouraged mothers to breastfeed and those that did saw marked reduction in sickness and death in their children. You can find extracts from the presentations to the Senate Hearing and much more about the history of the campaign in our response to a shamefully inaccurate article by Chris Sidgewick et al published by the pseudo-scientific journal, the British Journal of Midwifery (whose peer reviewers do not even appear to have read the primary reference used by the authors who misquoted and misrepresented its data). See:

The introduction of the Code should have been enough. There should have been no Nestlé gifts to community health workers (photo from 2006):

No Wyeth events targeting parents (photo from 2007):

No Mead Johnson formula labels claiming IQ and eye development (current label):

But the industry had opposed the Code. Nestlé's Vice President, Ernest Saunders, saying prior to its adoption it was 'irrelevant' and 'unworkable'.

So it took campaigning to achieve the Milk Code implementing some of the Code's provisions in 1986 and to expose on-going aggressive marketing, an assault on the breastfeeding culture, including in 1989 the launch of a boycott against Nestlé and the other companies in the Philippines, coinciding with the re-launch of the Nestlé boycott in other countries.

The launch took place as members of the International Baby Food Action Network (IBFAN) from around the world gathered in Manila to celebrate the 10th anniversary of IBFAN’s formation and to discus progress and plan future strategy.

In 1996 IBFAN helped Dr. Imelda Ben travel from the Philippines to the Nestlé shareholder meeting in Switzerland to raise directly with the board of directors at the shareholder meeting the aggressive marketing taking place in the Philippines. The board did not want to know and dismissed the complaints. Having attended the shareholder meeting this year I can imagine how unpleasant shareholders made it for her as they boo anyone who criticises their beloved money-making machine. See:

One of the tireless campaigners then and now is Ines Fernandez of the Philippines IBFAN group, ARUGAAN. I think I first worked with Ines soon after joining Baby Milk Action after she had appeared on television in the Philippines and spoken of the boycott. Nestlé then threatened the television with loss of advertising if it ran any more critical programmes. See:

On our March 1998, we exposed on our Campaign for Ethical Marketing action sheet Nestlé's strategy of promoting formula direct to mothers in the community with so-called 'Health Educators'. See:

Nestlé objected to our exposing this practice, which ended up causing a PR disaster for the company. It claimed in its 'Code Action Report' that our allegation was untrue, which gave us the opportunity to demand a right to reply in this publication which was distributed to policy makers around the world. Nestlé took legal advice and published my letter in its entirety - dressing it up as welcoming 'dialogue'. This is typical of Nestlé's mismanagement of the controversy - it's strategy of denials and deception results in greater attention being brought to our campaign and its malpractice.

The Code Action Report, which was launched as a monthly publication, became less and less frequent as Nestlé had to report other embarrassing news and run apologies. There hasn't been an issue for four years. See:

Monitoring conducted by IBFAN in the Philippines showed continued violations of the Code and subsequent, relevant Resolutions of the World Health Assembly, some of which were exposed in IBFAN's global Breaking the Rules monitoring reports.

This exposure and dedicated work by campaigners and health advocates in the Philippines led to the development of the Revised Implementing Rules and Regulations (RIRR) for the Milk Code by the Department of Health, which were introduced in July 2006 and almost immediately challenged by the pharmaceutical companies, a challenge which was almost completely rejected by the Supreme Court this week.

It would be nice to believe that the Supreme Court is independent and not subject to political pressure. We have to note, however, that the Court first rejected the industry's request for a Temporary Restraining Order on the RIRR. It was only after the President of the US Chamber of Commerce, Mr Thomas Donohue, warned President Arroyo of “the risk to the reputation of the Philippines as a stable and viable destination for investment” if she did not “re-examine this regulatory decision” that the Restraining Order was imposed - four days after Mr. Donohue's letter.

The industry has a history of not only opposing marketing regulations at the World Health Assembly, but country by country. There was a very real concern that pressure could influence the outcome of the hearing if it was not exposed.

Our IBFAN colleagues at a health conference in Sweden - the 'What next forum' - became aware of the US Chamber of Commerce letter and participants at the conference put their names to letter calling for restraint from the business community and an independent decision from the judiciary. See:

As sections of the media in the Philippines seemed reluctant to report on the case, perhaps fearing losing advertising revenues and recalling past threats from Nestlé, national and international events were organised. To remind us of some of them and other significant developments, here are some pictures and links.

Philippines groups Arugaan and Piglas ng Kababaihan called for mothers to attend a mass demonstration on 1 September 2006. Over a thousand turned out with decorated umbrellas. See the UNICEF press release and my earlier blog entry (which has more pictures).

Campaigners launched a national petition calling for the regulations to be implemented in October 2006.

My colleague Patti Rundall OBE (below, middle) and Elisabeth Sterken (left), Director of INFACT Canada, were able to visit the Philippines in November, travelling on from an international meeting on international baby food standards in Thailand. They gave many television, radio and newspaper interviews and spoke at a hearing in Congress. The story was now gaining increasing media coverage.

Back in the UK I launched our petition of solidarity with the Philippines. Hundreds of people and many organisations and networks around the world signed. We sent this to partners in the Philippines who passed it to the Secretary of State for Health and we presented it to the Embassy in London. See:

From r-l: Right Rev. Simon Barrington-Ward (former Bishop of Coventry), Minister Leo Herrera-Lim, Patti Rundall OBE, Peter Greaves (retired Senior Nutritionist, UNICEF) and Embassy official.

Rather bizarrely, Nestlé Philippines wrote to us objecting to being included in the campaign as it was not party to the legal action by the pharmaceutical companies in the Philippines, and alleged the violations we reported were years out of date. This was untrue. For example, it's labels claiming 'brain building blocks' as ingredients were still on the market and it had been told by the authorities in the Philippines too that its gifts to community health workers were not permitted.

It later emerged that Nestlé also tried to have the UNICEF and WHO representatives in the Philippines removed from their posts for criticising aggressive marketing. See:

Nestlé head office became involved in the correspondence, in the course of which the Global Public Affairs Manager admitted that Nestlé is 'widely boycotted', something the Chief Executive had tried to play down previously. See:

In December there was the shocking news of the assassination of Assistant Solicitor General Nestor J. Ballocillo who had been defending the Department of Health in the Supreme Court. He had worked on other high profile cases and no-one jumped to conclusions, but it understandably made our colleagues fearful. The Solicitor General said publicly the murder may have had something to do with the case. See:

And so the campaigning went on. With demonstrations outside the Supreme Court. See:

Record-breaking mass breastfeeding events. See:

I took some of Nestlé's promotional materials along to our annual demonstration at Nestlé (UK) HQ in May 2007 to show how Nestlé targets health workers. See:

The case gained coverage in the UK media. See:
Even on Chinese television. See:

UNICEF Philippines produced its film Formula for Disaster, which can be ordered or viewed on line via:

The crack down in the UK on health claims may have had an impact. The Supreme Court upheld the ban on these in the Philippines. This was a report of the UK action in the Manila Times:

And, of course, the bare breasts demonstration outside the Supreme Court on the final day of hearings caught the interest of the tabloids in the Philippines. See:

And now we have our victory. All points won bar an outright ban on advertising - advertisements have to go before a committee, which has the power to ban them - and the schedule of proposed fines.

Let's remember what was won. The Court found for the Department of Health on virtually all points:

* Coverage of products – scope including products for older children upheld

* Department of Health's right to issue regulations - upheld

* Labelling provisions - right to specify warnings and ban claims upheld

* Powers with regard to regulating advertising - upheld

* Company information for women distributed through the health care system – ban upheld

* Independence of research – requirement for ethical clearance upheld

* Independence in policy making – ban on company involvement upheld

* Donations from companies – prohibition upheld

For more details see:

In its statement welcoming the ruling, WHO Philippines said:

"We congratulate the DOH for its commitment to the revised Implementing Rules and Regulations of the Milk Code. We are delighted that amidst the many challenges in the past two years to find resolve on this matter, the DOH, along with local and international breastfeeding advocates, like UNICEF Philippines, Save the Babies Coalition led by Arugaan, the World Breastfeeding Action Group (WABA), IBFAN Network, Baby Milk Action UK, La Leche League, and many others remained faithful in their role to protect Philippine children’s health and welfare."

The actions set out above were just a part of efforts of many people around the world.

There are two messages to take away from this.

If you have come to this campaign new and think that lives can be protected simply by sitting down with the companies and asking them nicely to change, then you are mistaken. Enforceable legislation is necessary. The malpractice should have stopped with the introduction of the International Code 26 years ago. As the experience of the Philippines shows, it takes concerted action by campaigners over years to hold these corporations to account. At any time they could have agreed to meet their obligations under Article 11.3 of the Code, but instead they continued to push their products, contributing to the unnecessary deaths and suffering in the Philippines. Remeber 16,000 infants die every year there because of inappropriate feeding. Efforts to promote breastfeeding are undermined by the companies.

They are still being undermined as I type this, because the companies do not stop just because the regulations are now in force. The regulations will need to be monitored and enforced. And the Philippines is just one of many countries where the same story is playing out.

The more positive message is that if you have supported this campaign in any way, in the Philippines, internationally or supporting our actions, then you share in this victory.

While there is still work to be done to enforce the regulations and achieve the outright ban on promotion, the situation in the Philippines is perhaps now more hopeful than at any point in the past 26 years or longer. We hope to see aggressive marketing stopped and breastfeeding rates to increase. Lives that would have ended with pitiful deaths from diarrhoea, dehydration and malnutrition will not be lost.

The Supreme Court said: "The ideal is, of course, for each and every Filipino child to enjoy the unequaled benefits of breastmilk. But how should this end be attained?"

In the pictures on this page you see part of the answer to that question.


Anonymous said...

Thanks for this wonderful summary of the events leading up to the present Supreme Court decision. And thank you, Mike, for your support to all our efforts here in the Philippines. This victory is yours too!

Denise Arcoverde said...

Hi, Mike! I don't know if you know today is Blog Action Day and the theme for this year is "environment". I took the opportunity to talk about the relation between water and Nestle, specially in Brazil. I thought I should tell you, maybe you have ideas to write about it also, and it is a nice way to "publicize" your blog with other audiences.

Send my greetings to Sonia!