This is a prep-document for Undersecretary Maria Rosario Singh-Vergeire, who is a

panelist, representing the Philippines to the 40th Anniversary - International Code of

Marketing of Breast-milk Substitutes (WHA 34.22). In this anniversary panel, there are five
(5) countries represented:
1. United Kingdom
2. Kenya
3. The Philippines
4. Mexico
5. Turkmenistan

In this document, the countries above are listed according to the order of their time to
speak during the anniversary panel. The interview format is planted as STAGES. Each
STAGE is focused on a question, intended for each country represented.

This is the Objective of the Anniversary Panel

This thirty-minute conversation will illustrate the journey from awareness of the need for
measures to implement the Code through legislation, implementation, monitoring, and
enforcement. It will also provide a platform for Country Governments to reflect on their journey
of enacting and enforcing the Code, thus incorporating their successes into the anniversary
celebration, and using it as a call to action for other Governments to follow suit.

Proposed Agenda
The panel will be chaired by David Clark, public health and human rights lawyer, and former
UNICEF legal adviser on the Code. He will prepare the panelists and guide the conversation
through a series of stages:

NOTES

STAGE QUESTION Please regard this portion as

guidance for each topic and
question.

1. Impetus Why do you think Code This question is for MP Alison

implementation receives relatively
low priority among policy makers,
and what are some of the arguments
you found compelling in bringing
others on board?
Thewlis (UK) to speak candidly
as an opposition MP and can
offer insights into effective
government accountability
strategies.

This question focuses on the

initial push to bring the Code to
public, parliamentary, and
government attention

2. Legislation What are some of the This question is for Kenya to

challenges/hiccups that a
Government might expect to come
up against in getting national
regulations drafted and then
adopted into legislation?
bring to the discussion a
detailed account of the
processes used to bring the
Code from legislation to active
policy that equips other
Governments with a practical
step-by-step guide on how to
become Code compliant. This
will showcase the success and

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 learnings from a country with a
strong track record on
breastfeeding.

3. Implementatio What are some of the challenges
n you had to overcome in applying
your national law and holding
companies accountable for their
violations?
This question is for U/sec RSV,
representing the
PHILIPPINES, to illustrate the
struggles involved at national,
regional, and sub-national levels
in the Philippines.

NOTE FOR USEC RSV: Ma’am, for during the anniversary panel: if you could reference any
of the previous answers to form your own introduction, this would be very good. The basis of
your answer is the Assessment of Breast-milk Substitutes and Commercial Produced
Complementary Foods in the Philippines: a research by the Access to Nutrition Initiative
(ATNI) and the Nutrition Center of the Philippines (NCP) in May 13, 202, the recently
generated complaints on EO 51, s. 1986 violations from the Mother and Baby-Friendly
Philippines (MBFP) Platform, and our interactions with mother-support groups/civil society,
as well as the Philippine Center for Investigative Journalism 2020 series on the PH Milk
Code.

Your suggested response starts in page 3, which has a run-time of 6-7 minutes, at 1,050
words.

4. Monitoring and Monitoring is obviously an important This question is for the

Enforcement part in the enforcement process, yet
it is one that countries still struggle
with. What steps have you taken to
monitor regulations in your country?
What have been the challenges and
the successes?
government of Mexico to
address the question of “what
actions and steps will you be
taking to strengthen Code
compliance and enforcement, to
ensure that breastfeeding is
protected, promoted and
supported?”

5. Global Why is it important to turn global This question is for the

attention to code implementation,
influence national efforts, and
provide governments with
justification and authority to push
forward with Code implementation?
Turkmenistan government to
share their recent efforts in
prioritizing IYCF in their country.

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1. In October 2021, Executive Order No. 51, or the Philippine Milk Code, will be
turning 35 years old. It has been a celebrated piece of health and social policy,
hailed for how it is one of the early adoptions of the International Code of
Marketing of Breastmilk Substitutes. It has taught us one thing via our Supreme
Court: that the Department of Health holds the reins in ensuring that policies,
standards, and regulations have the best interest of the Filipino people’s health
in mind. We are working toward a unified approach towards the implementation
of the Philippine Milk Code.
2. This legislation underpins RA 11148, or the Republic Act on the Health and
Nutrition of Mothers and Children, which was passed in 2018. RA 11148
ensures that the regulation of information on breastfeeding, as well as proper
nutrition for our young ones is supported by education and services for mothers,
children, and adolescents within the Nurturing Care Framework.
3. The DOH is the primary implementer of these laws, but the decentralized
structure of our health care system makes implementation a challenge in itself.
It is subject to the priorities of local government units, which serve in limited
terms and where a small number of health and community development workers
are tenured.
4. The second challenge involves raising awareness among the public and private
sector on the Philippine Milk Code. It is crucial that families, health and
community workers, legislators, institutions, and the general public are aware of
these laws. Awareness is the key to strengthening public and private sector
response to the protection, promotion, and support of the Code and IYCF
practices—yet this is still a challenge after almost 35 years.
Multiple setbacks, including natural disasters, the loss of key family members to
unstable political climate, and the COVID-19 pandemic, have displaced multiple
families, caused income loss, and further launched them into poor health and
hunger. These have heightened the need for IYCF and Milk Code information
and education campaigns and strategies to equip the public and private sector
in their role as active implementers.
Calls for infant formula donations and unsupervised community distribution of
milk formula peaked during the beginning of the lockdown, and so did
corresponding social media interaction around this discussion. This was a test,
not only for the implementation of the Milk Code and the Health and Nutrition

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 Republic Act by the government, but also the effectiveness of the country’s
IYCF service delivery.
5. The third challenge is the growing market for baby food in our country.
Between 2016 to 2020, it grew 6 percent, and milk formula accounted for 95%
of that growth. The market in 1986 is different from today’s market, and while
our regulatory strategy has since evolved, implementation continued to be a
challenge.
The 2021 Access to Nutrition Initiative, or ATNI, report showed non-compliance
among major industry players in the Philippines. Marketing restrictions on
breastmilk substitutes — as detailed by the International Code, World Health
Assembly resolutions, and the Philippine Milk Code — were and are still being
flouted.
6. Lastly, as with many of our regulatory policies, enforcement and maximizing the
policing power of the health sector remains a challenge. Again and again, we
encounter the same reasons for Milk Code violations: non-awareness of Milk
Code regulations on the use of the health infrastructure and the general public
as channels for marketing, and misinformation among players and
representatives, who believe that their interactions do not constitute conflicts of
interest.

7. INTERVENTIONS
a. The response of the health sector must meet the evolving landscape of
industry and governance. We recognize the importance of collaboration
between the public and private sectors — but the partnership must focus on
the goal of protecting public health and welfare.
b. As an intervention, we are strengthening coordination with our regional
offices; partner government agencies, who are also members of the National
Nutrition Council; local government units; and community support groups led
by mothers. Our interactions have highlighted the need for restructuring of
our Code enforcement and monitoring system.
In 2019, we began a series of training that spearheaded increased
awareness on the Philippine Milk Code, and spearheaded the discussion of
the Code and RA 11148 as the backbone of protecting, promoting, and
supporting proper infant and young child feeding practices.

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 c. We also have a crowd-sourced violation reporting platform, which was
launched in 2017. The Department of Health is now more aware and alert of
marketing violations that use the health system, our health workers, and
outlets accessed by the public. We need an elevation system in the
resolution of the violations, as most violators cease and cooperate after
verbal and written reprimands from the DOH. Our legal response needs to be
more efficient and even more transparent to protect mothers, children, and
the general public from misinformation that may come from mass media or,
unfortunately, from our very own health system.
d. We are now moving toward more inclusive regulations that engage the public
and private sectors, including the industry, to ensure that our regulatory
processes are not a mystery, and that marketing regulations also apply to
CSR activities that are prone to becoming extensions of product advertising.
These marketing regulations exist to protect the health and survival of
newborns and children, as well as breastfeeding mothers who are vulnerable
whether they are in and out of crisis situations.

While we have opened an avenue for reporting violations on the Milk Code
and the rights of mothers to receive maternal and child health services, we
shall be developing a separate interface with the industry to coordinate Code
compliance in the market and in times of disasters and emergencies.

8. CONCLUSION
a. The current restructuring of the national health system provides a more
conducive and collaborative structure for the enforcement of the Milk Code,
the expansion of key health system actors, and the delivery of primary health
services for mothers, infants, and their families.
b. I have to reiterate that the Code can only do so much as a strategy to ensure
that Filipinos know about safe, sustainable, and proper infant and young
child feeding practices. Our current paradigm is this: marketing regulations
act as supportive interventions that ensure access to health and nutrition
information, so that public health efforts on communicating adequate and
sustainable feeding practices are neither diminished nor undermined.

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