Infant Formula in the Philippines

Infant Formula in the Philippines is often fed to infants in place of breast milk or in addition to breast milk. In 2007, only 16 per cent of babies four to five months of age are still exclusively breastfed. UNICEF and the WHO recommend exclusive breastfeeding in the first six months of life. However, half of all babies in the Philippines in 2007 were exclusively breastfed for less than one month. Controversy over aggressive promotional practices of infant formula companies in the Philippines and elsewhere in the Global South began decades ago, and by 1981, there was international action to curb these practices. Additionally, in 1986, the Philippines government passed a law limiting promotion of infant formula.

Despite past attempts at regulation, infant formula companies continue successful and aggressive advertising, telling women their babies will be healthier and will have higher IQs if they are fed formula. Along with mobile phone cards and beer, infant formula is one of the top three consumer commodities in the Philippines, according to a 2007 article. In 2006, the Philippines Department of Health banned the promotion and advertising of breast milk substitutes. "This regulation was challenged by milk companies in the Supreme Court arguing that it infringed on freedom of trade and the freedom to inform the public on infant formulas. The Supreme Court sided with the petitioners and granted a temporary restraining order which prevented health authorities to enforce the ban on milk ads." A few months later, in October 2007, the Supreme Court issued a final ruling that upheld the government's right to regulate advertising and promotion of infant formula.

The popularity of infant formula is remarkable given its hefty price tag of $50 per month. As of 2006, 22.6 percent of Filipinos lived on less than $1.25 per day and 45.0 percent of the population lived on less than $2 per day.

Infant Formula Marketing 1978-1981
During the late 1970s and early 1980s, infant formula manufacturers engaged in a number of different marketing strategies to promote adoption of their products. A study conducted in the Bicol region of the Philippines found that 55 percent of health facilities that provided care to pregnant women received free samples of infant formula regularly and 84 percent distributed the samples to patients either all or some of the time. Some traditional midwives received samples as well. Companies distributing samples included Nestle, Wyeth, and Mead Johnson. All three companies "had brands available in the majority of both government and private clinics and hospitals." Free samples were most prevalent in private hospitals; 95 percent of private hospitals received free samples of infant formula. A fourth company, Abbott, also occasionally gave free samples of formula to private clinics and hospitals, but much more seldom than the other companies mentioned above.

Additionally, in the facilities surveyed, " 25 percent of the tape measures, 95 per cent of the identification bracelets, 41 percent of the growth charts, 24 percent of the prescription pads, and 21 per cent of the pens and pencils came from infant food or formula companies. Nestle and Wyeth were the most active in this regard." Other donated items included posters and pamphlets, which most commonly came from Nestle and Mead Johnson.

Some facilities also either allowed industry representatives to speak to pregnant women and new mothers, or gave out their patients names to infant formula companies. This was most common in government clinics (25 percent), government hospitals (20 percent), and private hospitals (28 percent). "For those facilities allowing this practice in 1981, Nestle had access in 68 per cent, Mead Johnson in 23 per cent, and Wyeth in 18 per cent. Carnation and Abbott had access in less than 1 per cent."

The study also asked health professionals about their contacts with infant formula companies. "Of those interviewed, 52 per cent had been contacted in the past year by a representative of an infant formula company. Approximately 23 per cent had attended an industry-sponsored conference during their ca- reers, and 5 per cent reported that an infant food or formula company had paid their expenses for a professional meeting in the past two years. Of the health professionals attending an industry-sponsored conference, 71 per cent reported Mead Johnson, and 31 per cent reported Nestle as the sponsor or cosponsor."

Of the families in the region with children under 24 months of age, 92.6 percent breast fed their children at birth, whereas only 7.4 percent fed the children breast milk substitutes. By three months of age, 88.0 percent breast fed, but 32.3 percent fed the children breast milk substitutes (some mothers did both). By six months, 84.1 percent of mothers breast fed, but now 42.8 percent fed the infants breast milk substitutes. The mothers lived in both urban and rural settings, and some did not have a store close by. The study found that: "Distance to the store. . . was an important determinant of infant-feeding behavior. The farther away was the store, the more likely the woman was to breastfeed initially and to continue it through the third month."

The study concluded that, in order to increase breastfeeding rates, "improving health professionals' knowledge of breast-feeding - whether accomplished by industry, government, or both - is probably the most important area of concern." They also found that reducing formula sample distribution "would slightly increase the probability of breast-feeding at birth and at three months, and would reduce the probability of introducing breast milk substitutes after the third month. Restricting formula sample distribution would therefore have its strongest effect in reducing the incidence of mixed feeding."

1986 National Code for Marketing of Breast Milk Substitutes
On December 22, 1986, the Philippine Government passed a code of infant food marketing that banned the distribution of free and subsidized formula supplies to hospitals.


 * "While the International Code acknowledges a legitimate market for infant formula that includes mothers who cannot breast-feed or choose to bottle-feed, the National Code for Marketing of Breast Milk Substitutes of the Government of the Philippines is silent on the issue of procurement and forbids infant food manufacturers and distributors from giving free supplies to the general public, hospitals, and other health facilities and medical personnel except on request by, or with the approval of, the Department of Health (DOH). Approval by the DOH is given only for catastrophic occurrences such as floods or famine. Violators of the GOP Code face fines or imprisonment. Omission of any reference to procurement in the GOP code raises questions on how to obtain formula for infants unable to breast-feed and/or whose mothers are unwilling or unable to suckle them."

A study conducted in Cebu City between 1984 and 1988 found a drastic decrease in gifts of free formula in hospitals in the area following the passage of the 1986 law. In that area, American Home Products, Bristol-Myers, Nestle, and Abbott all marketed infant formula, and all of the companies had accepted the WHO's international regulations on marketing of infant formula. In 1984, 57.5 percent of health facilities in the area received free formula from formula manufacturers. That number declined to 52.6 percent in 1986 and to 2.8 percent in 1988. In 1988, only one formula manufacturer was still distributing free formula to two private health facilities. Likewise, in 1984 and 1986, over half of the facilities in the study distributed free formula to mothers; in 1988, only 3 percent did so. Last, in 1988, only seven of the 72 facilities in the study "still supplied clients' names to industry representatives - a marked decrease from previous years." However, in 1988, there was an 80 percent increase in distribution of free formula intended for older infants to the facilities in the survey, from 15.4 percent in 1986 to 27.8 percent in 1988.

Related Sourcewatch Articles

 * Infant Formula
 * International Code of Marketing of Breast Milk Substitutes

External Articles

 * "Ruling is a victory for Philippine children, says WHO," World Health Organization, October 12, 2007.
 * Cher S. Jimenez, "Spilled corporate milk in the Philippines," Asia Times Online, July 25, 2007.
 * Carlos H. Conde, "Breast-feeding: A Philippine battleground," New York Times, July 17, 2007.
 * Mong Palatino, "Milk wars in the Philippines: Breastmilk versus Infant Formula," Global Voices, July 11, 2007.
 * "Rally for breastfeeding: Mothers demand truth about infant formula," UNICEF, February 23, 2007.
 * Maria G. Salamat, "Breast is Always Best - DOH," Bulatlat, Vol. VI, No. 26, August 6-12, 2006.
 * Horton S, Sanghvi T, Phillips M, Fiedler J, Perez-Escamilla R, Lutter C, Rivera A, and Segall-Correa AM, "Breastfeeding promotion and priority setting in health," Health Policy and Planning, June 1996.
 * Adair LS, Popkin BM, and Guilkey DK, "The duration of breast-feeding: how is it affected by biological, sociodemographic, health sector, and food industry factors?," Demography, February 1993.
 * Williamson NE, "Breast-feeding trends and the breast-feeding promotion programme in the Philippines, Asia-Pacific Population Journal, March 1990.
 * B M Popkin, M E Fernandez, and J L Avila, "Infant formula promotion and the health sector in the Philippines," American Journal of Public Health, January 1990.
 * Griffin CC, Popkin BM, Spicer DS, "Infant formula promotion and infant-feeding practices, Bicol region, Philippines," American Journal of Public Health. September 1984.