Disaster in the Philippines: Why overzealous breastfeeding promotion has no place in relief plans

Dear FFF,

We are based in Manila which, thankfully, was spared from the brunt of typhoon Haiyan. As you may be aware, our fellow Filipinos from the other islands of Leyte and Palawan suffered from this catastrophe. Aid has been slow in coming, and the situation is now miserable and desperate. Donations from all over the world are coming in, but the logistics of getting them to the people who need them are difficult because many of the islands are isolated and cannot be easily reached. Many have not eaten since Saturday. They also do not have clean drinking water and are living in the streets amidst rubble and dead bodies.

Which brings me to my question/issue – What is the best way to feed a baby in a crisis situation like this?

 Our Department of Health has BANNED donations of formula milk – powdered or pre-mix – because of the perils of formula and because it undermines breastfeeding.  According to the Department of Health, the best solution is to breastfeed, or if the mother is no longer breastfeeding, to give support towards re-lactation. If these are not feasible, then the next alternative is wet nursing. I do understand that this is the exact reason why formula has been deemed “dangerous – because preparation of formula in unsafe, unclean conditions (including using unclean water and bottles) can lead to diarrhea and infant mortality.  However, I also believe that the options given by the Department of Health practically require a mother to choose between death of a child by starvation and death by diarrhea.  They say re-lactation as if it was like turning on a switch. Most women who have weaned young babies likely had problems lactating in the first place. How likely is it that she would be able to re-lactate in the midst of the stress, chaos, and misery of a calamity? The Department of Health says that the solution is to provide breastfeeding support, counselling, and breastfeeding-friendly setups where breastfeeding can be encouraged.  In a situation where the most basic of necessities such as water, shelter, and medical care have not even reached the victims, it does not appear that anyone is currently equipped to provide these conditions that would foster breastfeeding in a crisis situation. Wet-nursing or donated milk is the next alternative presented. On wet-nursing, I do wonder if that is really a safe option, since it is possible to also contract disease from tainted breast milk. Again, in a calamity situation, who has the time and resources to check for infectious diseases when looking for a wet nurse?  On donated milk, I concede that this is probably the most viable option, but given the sheer number of people affected, I do not think that it is a sustainable source of nutrition for all the babies affected (given that several hundred thousand homes were affected). Babies need constant nutrition, and while donated milk may augment at the start, is it really sustainable to provide for the nutritional needs of all the victims in the coming days before they are moved to a safe and clean environment? 

And so, I think, banning pre-mix formula donations is a case of letting the principle of promoting breastfeeding defeat the principle of saving as many lives as possible.  Even the American Academy of Pediatrics concedes that pre-mixed formula is the last alternative when the other options are not feasible.  Our government, however, has taken the firm stance against formula and will refuse donations of pre-mixed formula.  Incidentally, pre-mixed is not readily available in the Philippines, but I’m sure it can be procured from other countries or even by local formula manufacturers if only it were allowed.

– S. T.

 

After receiving this email, I logged on to my computer to find several sources reiterating what the author had said. According to Gulf News,

Government and private hospitals in Manila called on nursing mothers nationwide to donate milk for babies in typhoon devastated central Philippines… Explaining the aim of the campaign, (Dr. Jessica Anne Dumalag of Manila’s Philippine General Hospital’s Human Milk Bank) said, “Milk from lactating mothers is preferred over formula milk, which is basically processed cow’s milk.”

The department of health which has been promoting breast feeding has a policy to prohibit the donation of formula milk for babies in temporary shelters, during a calamity….“Children are more exposed to allergy when they consume formula milk. We are also not sure if the water used to prepare formula milk is clean (that is why it is not recommended),” said Dumalag….Government and private hospitals including private organisations were organised to accept donations of human milk. Milk donations will be pasteurised, frozen, and kept in insulated containers before they are sent to evacuation centres in central Philippines, Dumalag said.

 

Concerns over water and sterile preparation of bottle feeds during disaster situations are valid and necessary. Several years ago, we had a lengthy debate here on FFF about this very topic; I’m well aware that if relactation or wet nursing is a possibility, it is without a doubt the safest option in natural disaster settings. Bacteria-filled water, poor sanitation, and lack of resources make formula feeding a deadly proposition; when formula feeding is seen to be “encouraged” in an at-risk population, lactation may be interrupted which can have long-term consequences (i.e., the family would then need formula on an ongoing basis, which could prove difficult if money or resources were an issue). I’m not disputing this, nor am I ignoring the fact that formula marketing in the Philippines is a hot button issue at the moment, and that breastfeeding promotion is in overdrive for reasons that I can’t fully comprehend, as a privileged Western woman.

But that’s not what this is about.

A policy that forbids powdered formula donations and encourages breastmilk donations is simply replacing one easily contaminated substance with another. Donated breastmilk – and this includes breastmilk procured by breastfeeding-related Facebook pages, speaking of privileged Western women – requires careful packaging, transport and refrigeration, not to mention screening for HIV and hepatitis B (the Philippines still has a low rate of HIV infection, but it’s rapidly increasing – TIME reports that every 3 hours a new case is now being diagnosed). There are still the same risks involved with sterilizing bottles, regardless of what’s filling them; nowhere in these news reports are people discussing the importance of cup feeding, for example – something that can significantly cut the chance of bacterial contamination.

There is, however, a substance that can be easily transported without refrigeration; that has a relatively stable and long shelf life; and which can be fed to babies in a perfectly sterile manner, at least in the short-term. That substance is ready-to-feed, pre-mixed formula, served in “nursette” bottles with pre-sterilized nipples (like these).

Granted, the cost of these supplies is rather high. But while I haven’t done the math, I’d venture to guess that the cost of procuring and safely distributing donor breastmilk would be just as prohibitive. And if people are ready and willing to donate RTF and pre-sterilized nipples, what would be the harm in allowing them to do so?

The answer is none. There would be no harm, except, perhaps, to the “cause” of breastfeeding promotion. That cause may be noble and important, but right now, it’s irrelevant. To put breastfeeding promotion ahead of feeding infants safely and in a timely manner is petty, short-sighted, and cruel. Think about it: would we discourage donations of processed, high-fat canned foods to disaster victims because of concerns over obesity, GMOs, or the environment? Or would we ensure that their immediate needs were met, and worry about preaching better health habits after the roads had been rebuilt and displaced families were settled into safe, warm homes?

The fact that Dr. Dumalog, quoted above, uses “allergies to formula” as a reason for forbidding RTF formula donations speaks to the irrationality of this policy. If a child is allergic to formula, there is also a chance s/he will react to something in a stranger’s milk. A breastfed baby may indeed react poorly to formula at first, but this is a case where the mom should receive plenty of assistance and encouragement to continue breastfeeding – not told to feed her baby via bottle with donated milk. With breastfeeding rates in the Philippines being what they are, it stands to reason that most of the babies without lactating mothers present are already formula fed – therefore they will probably do just fine with donated formula, even if it’s not the same brand. We’re talking about a little gas here, not a full-scale anaphylactic reaction.

Gulf News reports that “groups that promote breast-feeding in six hospitals and in several private clinics are part of the campaign.” A disaster situation is no place for “promotion” of anything but disaster relief. And the scariest thing about this is that the Filipino government isn’t alone in letting a hatred of formula get in the way of ration. The American Academy of Pediatrics also advocates for “screened human donor milk” before RTF (although they do, at least, acknowledge that this is an option). I have yet to see one study or agenda-free policy paper that actually looks at the viability of using donor milk as opposed to RTF formula with pre-sterilized nipples during disasters. If there is a logical reason behind these recommendations, I’d love to see it. All I can find are convoluted references to “breastfeeding being interrupted” (not an issue if we’re talking about babies who are already formula fed) and concerns about sterility and availability (absolutely valid, but just as valid in regards to donated milk, if not more so).

Governments must stop putting ideology above practicality. We are in desperate need of a neutral, informed, and rational voice to come up with better policies for infant feeding – policies that do not throw the cart before the horse, and end up running over its citizens in the process.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.


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28 thoughts on “Disaster in the Philippines: Why overzealous breastfeeding promotion has no place in relief plans

  1. The people responding to this on your Facebook page are unbelievable.
    “A few donations of free formula won’t keep coming in when moms’ milk dries up … It does a disservice as a whole to the community to undermine so many other moms.”

    HOW? How does giving continuing a baby’s supply of food undermine anyone? How does it refer in any way to breastfeeding mothers? IT DOESN’T.

    The total lack of sympathy for individual babies and families in crisis next to this breastfeeding agenda is sickening. These people are not only heartless, they apparently are completely without logical thinking skills.

    I am so done with lactivists. Done, done, done.

    • I think these activist types only ever focus on the early period where breastfeeding is established, or not. They never spend any time thinking about what happens after. (I had a seriously hard time finding information on weaning off the breast at six months, presumably because, in the bfing world, who would ever want to do that?)

      I am particularly horrified that the Philippine government thinks relactation is a viable option. Like this is something that with a few hours of effort will suddenly eliminate their need for formula, and will be achieved by every woman who attempts it because boobs work that way, right? And no one has ever had a double mastectomy, or breast hypoplasia, and no mother has ever died while her child is still too young for cow’s milk, and all women can be wet nurses at the drop of a hat and are totally willing to attach themselves to another family dealing with a crisis while they are undergoing the same crisis. I feel like babies are going to die as the result of this policy.

    • Pasteurized human breastmilk are kept frozen in small containers that when thawed can easily be given to hungry babies. And when they come from the C 130, Boy, are they hungry! I have been gong to the “Nanay Bayanihan” whenever my hospital responsibilities allow me. I have seen mothers relactate after being coached even when their child had been 7 months on formula. Why am I so passionate about this? Babies sufferred from Yolanda just like their parents did. They have been exposed to infections and breastmilk offers immunity to several diseases that no formula has ever duplicated. This should strengthen their immune system in addition to supplying nutritional needs after periods of limited oral intake. Feeding their babies during crisis gives mothers the strength to go on because their babies continue to survive because of what they have offered from their own bodies. The hormonal feedbacks from the babes sucking gives then strength to go on. Diarrhea is one of the 3 most common causes of deaths before age 5, and mainly under the first year of life. There are more babies dying from formula-fed babies than those who are breast-fed and one of contributing factors is the availability of water to mix the formula and the process of preparing the formula itself, causing abdominal distrurbances during travel in time of crisis, Breast milk fed directly from mothers offer just the right temperature of the milk, given at any time when needed and secures bonding beyond what FFF can imagine. Alienation of grown children from family is far more than those who were breastfed. If a research is done on those trigger happy adolescents who kill others, I am sure none of them were breast-fed. It is heartbreaking to realize that Pediatricians are at fault in not making new mothers realize the importance of breastfeeding their newly-born children. Formula should be restricted to follow-up milk to supplement solid complimentary feeding which should be given more weight after the age of 1-2. Chewing improves speech development. Sucking does not. If you want evidences, go to cochrane.

      • I appreciate your passion, but you are proving my point with your comments with this statement: “Secures bonding beyond what FFF can imagine. Alienation of grown children from family is far more than those who were breastfed. If a research is done on those trigger happy adolescents who kill others, I am sure none of them were breast-fed. ”

        This is a ridiculous, offensive and completely unfounded statement, which speaks to your zealotry. This type of attitude clouds judgment and does not have any place in a discussion on emergency procedures. If you read the post, you’ll see that I agree with you that relactation/wet nursing is the ideal solution. But donor breastmilk is not the answer and suggests a religious belief in the powers of breastmilk that is not backed up by sound scientific literature – including Cochrane.

        You are confusing 2 issues – 1) using RTF as a stop-gap measure for babies who were ALREADY FORMULA FED or do not have the option of a wet nurse (if there are no babies that fit this profile I will be thrilled and of course my suggestions are irrelevant) and 2) the overall use of formula in your country which indeed is a risky venture for those living in poverty and poor conditions. But this is a health issue – not one of bonding. Bottle feeding secures bonding beyond what YOU can imagine. Have you ever bottle fed your children? Because I’ve done both – breastfed and bottle fed – and due to pain, emotional distress, and other issues breastfeeding was far from a lovely experience. What is true for one personal is not a universal truth, and to imply that mothers who do not breastfeed their children are raising school-shooters is mind-boggingly cruel and idiiotic.

  2. Here’s an article I read by an aid worker who noted that donations of breast milk for disaster relief in Haiti were actually quite difficult to use. I find it hard to believe that the resources spent on keeping breast milk cold, pasteurizing it and so on are smaller than those spent transporting RTF nursettes.

    http://www.slate.com/articles/news_and_politics/foreigners/2013/11/how_to_help_typhoon_haiyan_survivors_in_the_philippines_the_only_donation.html

    Moreover, I think a difficult point but one we have to accept is that in a disaster situation no solution will be ideal. Focus on BFing and some children will die; offer formula donations and some mothers will find themselves unable to afford formula later But I think keeping children alive is more important than judging from on high about whether their parents are making sound long term decisions.

  3. Pingback: FFF Friday: "From formula to breast and back again..." - Fearless Formula Feeder

  4. There is no reason that both safe formula cannot be utilized as well as have lactation consultants be present to help the lactating mothers keep up their supply and help donate to other mothers. Why does it have to be either/or? The competition is completely unnecessary. We need to do whatever is necessary to keep these babies alive, whatever that looks like.

    • Every country has its own approach to problems. I would rather that ours spend more in the beginning and enjoy the advantages of what breastmilk can offer, mentally (Higher DHA), emotionally (closer bonding) and physically (nutrient content) more freedom from illness (such as pneumonia, diarrhea, asthma/allergy, other forms of infection).

      I would rather that we bring up children who will be moral leaders and wiser to choose our leaders and willing to prosecute when crimes are well evidenced.

  5. I know absolutely nothing about how disaster relief works, but this is very short-sighted for the Filipino government. Some of these women are going to have older babies that may have only been breastfed for a very short time. I can’t imagine being able to relactate with any degree of speed or efficiency when everything is fine. Trying to do that in a disaster situation and expecting it to work is just damn stupid.

    • I stand corrected based on the response below. If women were combo feeding rather than exclusively formula feeding, it does make more sense to try to build up that supply to exclusively breastfeed.

    • You just have to see for yourself how hungry babies suck almost breathlessly for the milk. you are invited to come to our tent “Nanay Bayanihan” and watch. It also gave the wet- nursing mothers joy difficult to put in words..

  6. Hello… I decided to answer here because your blog posts will be more easily accessible/searchable than your FB post

    First of all, thanks for the concern for our welfare… especially those of the mothers of young babies and the babies themselves. Hopefully though, you will allow us the same concern.

    The fact is, despite being breastfeeding advocates, we also care for the welfare of the mixed fed and the formula fed. Our government may be vetoing the donation of formula but that never meant we will allow formula-fed babies to suffer, get sick, die just because they are formula fed. There is a system in place where formula for formula fed babies can be had during disasters, at evacuation centers. There is budget to buy milk for them as well as that fact that they can freely ask milk companies to donate the milk required in these evacuation centers (if they have money to just dole them out for free at conferences, please trust me, that they have funds enough to give them for free after natural calamities).

    Another fact is that most Filipino moms, as well as other nationalities I presume, start out breastfeeding. Only around 35% are still exclusively breastfeeding after 6 months in our country but a lot are still mix-feeding. Based on experiences in relief missions, most mothers are really breastfeeding to some degree… so there is no NEED for indiscriminate formula distribution. And if the child is older than 1 year old, formula becomes even more unnecessary as the goal becomes more about getting good solids into that baby.

    Of the 9 infants brought to our tent today at the Air Base where survivors are being brought… only one was formula fed. All were breastfed. And we sure had formula and feeding bottles for that baby. We had clothes for him as well. And well-meaning people who bought formula were thanked as graciously as those who only brought clothes or diapers.

    Now, is it wrong for our government to turn away formula donations? I say not, because the need for such is not high on the list. And yes, please trust me, that once we get a lot of them out there… they will be used, even by those who don’t need them. Unfortunately, safe water and sterility IS always an issue in our evacuation centers (as well as stricken areas).

    Is it wrong for our government to wish instead to get cash, or clothes, or maybe other baby needs? I say not. Because those ARE high on the list that we need post-calamity.

    Is it wrong for us advocates to remind our friends not to give formula donations? I say not… because for the same amount of money, they could already have bought a family 1-3 days worth of food (and Filipino families tend to be bigger than most Western families, so much more mouths to feed). Can you blame us for wanting more water instead? More fruits? More rice? More cooked food? More clothes?

    Isn’t it sadder for an evacuation center to be flooded with formula and powdered milk donations… where everyone gets handed a can (this has happened many times before, we have since become stricter, and thanks to social media, it has been more easily prevented)… while most of the evacuees/survivors go by without clean drinking water? Without food? Without can openers or stoves to open and cook the canned goods and rice they are given?

    Is it so wrong to have toddlers (babies past age 1) start weaning off formula feeding bottles and get started on more solid intake instead? I will admit that improperly cooked food WILL still cause illnesses but again, for the same price, a family could feed the entire family and not just the child. It would logistically be more draining for a struggling family in the long term to support formula feeding by one member of the family (when it is no longer necessary).

    I have to emphasize the above because the trend in the country now is that toddlers and preschoolers NEED milk, when what they need is calcium, (as well as other vitamins, minerals)… all of which can be had from a balanced diet and eating indigenous food (we even have a folk song of sorts listing high-calcium food that is more readily available, even for poor families.)

    And dare I add the sad fact that those who will be left behind in evacuation centers will be the truly marginalized ones… the ones without good education, or a network of supportive family to support them. I cannot even begin to imagine just how many those will be post-Yolanda. And these truly marginalized ones will NEVER be able to sustain formula feeding, so it is really in the best interests of the government to get them to relactate (if they were only mix feeding, as most cases are) not only to reduce costs for formula purchase for them, but also to reduce risks of badly prepared formula (we have met evacuees who dilute milk, or prepare them with rainwater gathered in pails, or even portalet water).

    And yes, I understand how our government must be failing our marginalized post-calamity (or the Filipino as a people, but I digress)… but allowing for indiscriminate donation and distribution of formula and powdered milk will not make our local government units act faster on relocation, sanitation and health issues. But again, the babies will have been put at risk.

    Which is why we (breastfeeding advocates) are proud and happy that our government at least has the gumption to say NO to formula donations. I hope though that it is not taken out of context and that people from other parts of the world do not necessarily assume that we are awful creatures so scared of milk company propaganda. (well, we are scared of how they can be underhanded at times, but we are not awful creatures).

    We are mothers like most of you are, who see the face of our own precious little ones in the faces of other children.

    We are professionals like some of you are… and educated as most of you are… we have thought this through, are aware of the facts, consider both the short and long term.

    Unfortunately though, some of our people have been brainwashed into thinking that what is bought is better than what they already have or can give… and some of them have failed to compute the cost to their family of formula feeding when they could have otherwise continued breastfeeding (going back to how most start out breastfeeding anyway, and with the right information and support could have really been successful at it, barring physiological and medical impediments). We speak for them.

    Again, thank you for thinking about Filipino babies and young children and their moms… now, kindly trust that we think of them too. 🙂

    • Hi Mec-

      Thanks for your informative, sensitive and astute comment. I sincerely appreciate it.

      Honestly, everything you’ve said here has put my mind at rest. I have a feeling that the confusion was born of rhetoric rather than reality – and that is a huge relief. I think there’s a larger issue at hand here – one that has nothing to do with the Philippines, specifically, but rather the goals/attitudes of international aid organizations and govt emergency plans, overall. And I do think that Western breastfeeding advocates tend to turn these situations into fodder for their cause, which is wrong. The last thing I’d want to do is unintentionally do the same, just in the reverse – and I know on our Facebook page, the conversation devolved a bit into the old breast/bottle debate that has no place in an important and timely discussion of current relief efforts. I apologize if that is what has resulted from my original post, which was a reaction to what was being distributed in the media and Western breastfeeding advocacy pages.

      OF COURSE I don’t fault you (or your government) for wanting clean water, food, clothing, etc. over formula samples that could harm babies. My gosh. Nothing could be farther from the truth (at least my personal truth – can’t speak for anyone else, but I assume they’d say the same). But the emphasis on the evils of formula rather than anyone offering a rational explanation like you so eloquently just did (thanks again for that) put all of us into a bit of a panic. That is why I say that breastfeeding advocacy can’t control relief efforts – my hope is that we can put these issues aside and think of the immediate concerns, the immediate needs of those affected. Granted, there’s an overlap – encouraging breastfeeding in parts of the world where disasters are frequent (as they are in your neck of the woods) does make sense on a level that it doesn’t in areas of relative security. But it always worries me when I see the first response to a disaster focus so much attention on screaming about the evils of formula when I do think there’s a place for RTF or even child/adult versions of RTF that are sterile, easy sources of transportable nutrition. As I said on the Facebook thread, I think we should all be open to new solutions to old problems – we can always do better. That doesn’t mean that wet nursing/relactation isn’t the best course of action when possible – of course it is! But we should also have solutions for those who don’t have that option. Blanket statements like “formula donations are forbidden” rather than giving suggestions to those who want to help (i.e., “donations of money to the following reputable aid organizations, which will ensure that all babies are adequately and safely fed, would be a better course of action”) just get people confused and angry. Maybe this is a problem of semantics – but it could so easily be solved by a bit of thought and moderation. Zealotry is what we fight against in this community – not sensible solutions to real problems, which is what this policy sounds like when someone as smart as you takes a minute to clarify it.

    • “indiscriminate donation and distribution of formula and powdered milk will not make our local government units act faster on relocation, sanitation and health issues” – I can understand that you don’t want random people handing out powder formula or milk. But I would have thought that foreign donations would be chalnneled through local government relief networks, like the centre you described where a formula fed baby was given formula. I don’t see the harm in accepting donations of formula so you can focus your resources on things that are better bought locally. I guess I’m confused because on the one hand you say you provide formula where needed and on the other hand you say that the government would rather have clothes and so on. Why does the one have to exclude the other? Why should RTF formula donations be rejected when clothes are accepted?

      • The main thing is that at any given second, only the people there in the shelters know exactly what they need RIGHT THEN. I agree with Suzanne that rhetoric is the problem here. It’s not that formula donations aren’t wanted. It’s that donations of goods aren’t wanted – money is wanted so that the EXACT needed things can be purchased. Otherwise, you can have a situation where an area ends up with an overload of baby formula but no clean bottled water for adults. Or somewhere else gets a ton of water, but what they need is medicine. So unless donations of goods are specifically called for, it’s better to give money to a trusted NPO (or government) who has people on the ground to assess the need in each area and them buy exactly what is needed.

        • What about the fact that RTF formula is not locally available and may be a lifesaver in these situations? Should it not be donated? Strikes me as a case of cutting of one’s nose to spite one’s face.

          • Aid organizations don’t have to buy locally – it’s still a matter of managing resources most effectively. Asking for donations of X on a global scale means you can get absolutely flooded with X, far more than you need and have a place to store. Or you get XY, which is almost X, but not quite X and not as useful as the people donating intended. In other cases, the money individuals spend to buy X could have bought a lot more X through the channels charities use, because they can get bulk discounts, charitable works discounts, etc. Money can be stored and transferred to where it’s needed faster than pallets of RTF – so six months later when people have lost interest in the disaster of the day you don’t have to worry about the cost of moving an oversupply from one area to another where it’s in demand.

            In some cases there will be calls to donate specific items and not just money, and it’s fine to do so, but this is why in *most* cases, monetary donations are preferred.

            (I don’t work for a rescue charity, but have a good friend who does. I also lived through Hurricane Sandy which is a much more minor disaster, but we had buses of people showing up to be volunteers who had no place to stay, no experience volunteering, and in spite of their best intentions they were a burden rather than an asset. It seems like direct donation of RTF could only be a benefit, but it’s more important to provide aid workers with the means to get what they need, when they need it.

  7. Could I also say, Suzanne, that I do think general breast-bottle debates have a place here – because the arguments I’m reading from disaster management/infant feeding pros are strongly informed by a belief that “mothers don’t know their own bodies,” are misinformed about relactation, and are inclined to make irresponsible long-term decisions when formula is presented to them. Which are very similar to the arguments we hear in much more stable, secure contexts, and while the environmental and social/economic variables are very different in a disaster-struck, poorer country, it seems the response of lactivists is the same. It’s not about addressing the needs of individual mothers and babies so much as about seeing a formula company shill behind every effort to supply formula.

  8. Pingback: Philippines prohibits donations of formula to typhoon survivors | My Family Blog

  9. Thanks for explaining that Pris, it does make a lot of sense. What still confuses me is that they aren’t saying “please send just money and nothing else” but are saying “send clothes, send xyz but don’t you dare send formula.”

  10. I am also in the Philippines (lest I be accused of commenting from my high American horse) and have some comments/questions:

    (1) I laud the efforts of Mec Arevalo and the other mothers who are working in the evacuation center to care for the moms and children who were victims of the typhoon. What they are doing is truly amazing work. I think it is necessary to point out, for objectivity’s sake, that evacuation to these centers only started happening about a week after the typhoon struck. Before that, very few people could get in and out of the affected areas. Because of the chaos and logistical difficulties on the ground, aid only started coming in towards the end of that first week. There were no organized evacuation centers and few health workers. In the meantime, people were sleeping on the streets, and if at all, relief goods had to be flown in by military planes and distributed to the victims in the places where they were converging. During those critical first few days, when there were no organized evacuation centers, everyone should recognize and accept that there was no viable option for feeding a baby who for any reason had no access to a lactating breast. (and by viable, I mean, an option other than the pipedream of relactation) (2) The Airbase evacuation center is just one of the many places where survivors have been brought. That air base is located in Manila which was not even hit by the typhoon, has working facilities and is the main hub of relief operations. This is as good as it gets as far as evacuation centers are concerned. I believe nine babies were there at the time when the comment was posted. But what about the several hundred thousand other babies who are not as lucky to be in that evacuation center or in any evacuation center for that matter? (Note that not all of the victims are already in evacuation centers. Many of them are still living inside churches, gymnasiums, and other makeshift shelters.) In case a baby actually needs formula in this situation (assuming no wet nurse, mom cannot relactate), how would she be fed properly? Again, Dept. of Health and Philippine Milk Code have no answer to this question. The World Health Organization does – Ready Use Formula. (3) Amidst all the name calling and rhetoric exchanged in Suzanne’s FB page, not one lactivist has been able to satisfactorily answer the burning question – Why allow donated breastmilk and not RUF? As Suzanne has already pointed out, donated breastmilk is also unwieldy and unsuitable for a non-sterile environment: bottles need to be washed; shelf life is an issue; and as with RUF, once you thaw it, you have to use it all up within a short period of time. So why allow it? The answer might be that the use of donated BM will only be done in evacuation centers under controlled circumstances. Which is exactly the same as with formula. So why allow donations of one and not the other? (4) What is so wrong with ready to use formula, especially as a stop gap? Especially as a means to feed a baby who was not anymore breastfeeding in the first place or worse has lost a mother? Yes, RUF is not commercially available in the Philippines, but it is likely that local formula companies would be willing to help bring them in (but no one would want to work with those evil people). But really, the only contrary argument that I have read against RUF in the articles is that it may cause allergies. But as discussed by Suzanne, so can donor milk and so can wet nursing. So, is there any logical or policy consideration against RUF donations (in sterile single serve packs)?

    • I believe introducing RUF in the Philippines was tried once by Abbott but due to the climate in the Philippines the shelf-life was limited and a lot wasted.. If pushed against the wall by a crying hungry baby, I dont see why RUF can not be used in extreme situations and after other means exhausted.

      • We are not talking about using these in a commercial manner on a long-term basis, but for short-term emergency efforts, in single-serve packs that do not require refrigeration or water. I guarantee you their shelf life is far longer than that of donated breastmilk.

      • It sounds like a company tried to introduce it to sell. A reduced shelf life isn’t necessarily a concern when talking about relief efforts. It depends on HOW reduced- if the formula goes bad after a month in those temperatures, that’s plenty of time for emergency efforts. I don’t think anyone is suggesting they start regularly selling RUF- they’re suggesting taking donations of a safe, sterile foodsource for babies in immediate need.

        Why is it better to leave a baby hungry while “other means [are] exhausted” instead of having RUF on hand and using it to keep the baby healthy while exhausting those other means?

        I understand Pris’s point about money being more helpful- but, as people have said, why are they accepting breastmilk and other food instead of money, but are rejecting formula?

  11. Donated breastmilk is not equal to RTF formula.
    Donated breastmilk supports health and is protective for babies who are being exposed to abnormally unsafe conditions in ways that formula can not. Since there is apparently no shortage of available formula for those who need it, I am unclear why this is being debated? But I do know one thing. During the critical days BEFORE the services and aid arrived and was organized, the babies who were breastfed were damn lucky, and the ones who were not, were at great risk.

    • Where have you seen that there is “no shortage of available formula for those who need it”?

      You are right that the babies who were breastfed were “damn lucky”. I’m not worried about them. I’m worried about the babies who were not. Would you tell a pediatric cancer victim that healthy kids were damn lucky so no one should look for a cure?

      Lastly, what evidence do you have that unscreened donor breastmilk, stored in fragile, awful, unsanitary conditions, offers health and protection that formula does not? I’ve not seen evidence to back this up; would love to see it if you have it.

  12. “But I do know one thing. During the critical days BEFORE the services and aid arrived and was organized, the babies who were breastfed were damn lucky, and the ones who were not, were at great risk.” – It is really smug comments like this that are not helping the discussion.

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