MANILA, Philippines - The US embassy lobbied against a breastfeeding campaign in the Philippines and blocked revisions in the Philippine Milk Code's Implementing Rules and Regulations (IRRs), according to a US diplomatic cable released by anti-secrecy group WikiLeaks.
Cable 05MANILA5839, written purportedly by then US Chargé d'Affaires and later Deputy Chief of Mission Paul Jones, said the embassy's economic counselor met with Department of Health (DOH) Undersecretary Alex Padilla December 12, 2005 to convince the government to meet with pharmaceutical companies first before signing the revised Implementing Rules and Regulations (IRRs) of the Milk Code into law.
The Milk Code and its IRRs regulate the advertising of milk formula for infants. They are based on the International Labor Organization Maternity Protection Convention 183 and the International Code of Marketing of Breastmilk Substitutes, as well as the UNICEF's Global Strategy on Infant and Young Child Feeding.
"Padilla provided a copy of the latest draft IRRs, noting that several controversial provisions had already been removed," said the cable sent to Washington December 15, 2005.
Padilla told the embassy official that the DOH "really understands the industry's concerns" and discussions with various parties were ongoing. "Padilla agreed to raise Embassy concerns with the Secretary of Health," the unclassified memo added.
"Padilla provided us with an updated draft of the IRRs. He pointed out that the prohibition on using brand names and company logos has been removed for milk replacement products for use with infants over three years of age. DOH also removed an earlier requirement for prescriptions for infant formula products. However, industry still has objections to the IRR," it added.
The cable accused Padilla of making a number of observations and conclusions to support the draft IRRs "without citing any data."
It also claimed that the DOH was "under pressure" from "an influential breastfeeding lobby group" close to Malacañang.
The DOH undersecretary told the US embassy official that breastfeeding rates in the Philippines had declined significantly since 1987 while infant formula sales had increased dramatically.
Padilla also said the Philippines has a high mortality rate for children under 5 years of age and that diarrhea is a significant cause of death for this group. "He singled out infant formula, as a 'major cause of diarrhea' or a significant contributing factor. Padilla could not identify studies that support these statements but promised to provide the Embassy with additional information and data," the cable said.
The cable blamed diarrhea on dirty water and not on lactose intolerance of infants on milk formula.
According to a timeline made by the Philippine Center for Investigative Journalism, the 11th and 12th drafts of the revised IRR were being discussed in public hearings led by DOH and the Bureau of Food and Drugs around the time cable was sent. Public hearings were also being conducted by the Senate, the House of Representatives, and Malacañang.
Pharma industry concerns
The cable said the pharmaceutical industry, through the Pharmaceutical and Healthcare Association of the Philippines (PHAP), continued to press the government regarding its objections to the revised IRRs through subsequent talks with Padilla.
Padilla then reportedly told the lobby group to talk to President Gloria Macapagal-Arroyo to order the DOH not to sign the IRRs.
The embassy cited the industry's concerns, such as provisions of the IRR allegedly exceeding the original scope of the law, Executive Order 51, signed by then President Corazon Aquino on October 20, 1986.
"Certain provisions seek to prohibit rather than regulate, which is unconstitutional," said the memo written by Jones, who is now serving as US ambassador to Malaysia.
"The draft IRRs define 'infants' as three years of age or less, which exceeds international standards," it added. "The IRRs would ultimately harm the consumer by denying information. It will also damage the milk industry and negatively affect employment."
The cable said "PHAP did a quick analysis of infant formula use in the Philippines and found that the market penetration rate is only about nine percent, which reflects a low level of infant formula use."
The industry lobby group also said "it is common practice in the Philippines, especially among the poor, to feed babies sweetened condensed milk or rice water."
It did not mention figures on breastfeeding rates in the country.
The cable showed the US embassy in Manila taking the side of the pharmaceutical companies in the issue.
It said the "[milk substitute ] industry continues to advocate that it supports breastfeeding as the best choice for infants under six months of age, but that for those mothers who cannot breastfeed, it is important to have a viable, nutritional alternative and adequate information on its proper use."
The PHAP filed a suit against the DOH secretary and all the undersecretaries and assistant secretaries who signed the revised IRRs in 2006.
In 2007, the Supreme Court junked sections 4 and 11 of the Milk Code's IRRs that banned the advertising, promotion or sponsorship of infant formula, breast milk, substitutes and other related products.
It also declared null and void a section on administrative sanctions.
However, the court upheld the IRRs' 56 other provisions.
Key provisions in the revised IRRs that the Supreme Court approved include:
- exclusive breastfeeding for infants aged zero to six (6) months;
- breastfeeding still appropriate for young children up to 2 years and beyond;
- banning of artificial feeding paraphernalia in health facilities;
- banning of gifts of any sort from milk companies and manufacturers, distributors, and their representatives to the general public, hospitals, health facilities, and health workers;
- prohibition of assistance, support, logistics or, training from milk companies for health workers;
- no health care facility should be used to promote breastmilk substitutes and artificial feeding paraphernalia;
- donations of products by milk companies to health facilities is prohibited
Approved sanctions on violations of the Milk Code and its IRRs include imprisonment of up to 1 year and a fine of up to P30,000.
The Supreme Court also approved either the suspension or revocation of licenses and permits for any erring health worker, distributor, manufacturer, marketing firm or personnel who violate the code and its IRRs.