Relactation success at National Children’s Hospital, Philippines

Joanne Datangel-Gallardo, MD, DPPS is a breastfeeding mother and pediatrician serving mostly poor patients at National Children’s Hospital, Philippines. She will present “Relactation Success Among Mothers of Formula-Fed Infants Who Received Lactation Education and Management at National Children’s Hospital, Philippines” at the upcoming International Breastfeeding and MAINN Conference.

In her presentation, Dr. Datangel-Gallardo will detail how proper lactation education, frequent follow-up, and management of individualized breastfeeding challenges have helped mothers to relactate despite months of exclusive bottle-feeding, without the need for any galactagogues. Dr. Datangel-Gallardo says that what once seemed like relactation anecdotes by  community breastfeeding support groups, has now been replicated and studied in her institution showing “promising results.”

Particularly, she recalls one mother-infant dyad under her study: The  baby was five months old and had been exclusively formula fed for three months. This baby was admitted for ileal stenosis and underwent surgery. After the surgery, Dr. Datangel-Gallardo remembers the mother begging to be included in the relactation study despite advice from their nutrition consultant to feed the baby commercially prepared milk. The mother refused. After two weeks of exclusively breastfeeding, the baby regained her original weight and  physical well-being, and this dyad continues to breastfeed at more than two years old.

Infant feeding challenges abound

Dr. Datangel-Gallardo reports that “the permeation of the propaganda of milk companies, even to the poorest of the poor, have led many mothers to believe that breastfeeding only works with the fortunate few.”

Others believe that breastfeeding is only meant for those who cannot afford artificial baby milk.  

And because Filipinos live in an extended family setting and “filial respect predominates”, ill-informed family members often influence mothers’ infant feeding plans when they’re told “that their milk is not enough for their babies.”

“This problem is compounded with cultural beliefs such as transferring ‘sickness’, ‘tiredness’ or ‘bad emotions’ to the infant through breast milk during emotional situations, or breastmilk in the left breast being rice and breastmilk in the right breast being water,” Dr. Datangel-Gallardo goes on.  

Artificial feeding is not often sustainable due to its financial burden on families. Some families resort to diluting milk or using coffee creamers, Dr. Datangel-Gallardo says. Severe malnutrition results. Save the Children Foundation reports that 1 in 3 children under 5 years old is malnourished in the Philippines.

Dr. Datangel-Gallardo describes birth culture in the Philippines: In the general population especially in the rural poor, many still opt for home birth attended by a traditional birth attendant or midwife. However, due to erroneous practices and increased…deaths in the past, the government policy insisted on lying-in, health centers and hospital settings for birthing. Quezon City passed an Ordinance banning home birth. What may work in an urbanized community may not in isolated islands such as Busuanga, Palawan with 6,000 inhabitants and only one municipal doctor. Add to this dismal situation, the rising rate of teenage pregnancy and their inability to get sufficient prenatal support in local hospitals. In Metro Manila, some groups that support traditional home birth or water birth supported by a qualified doula and a well trained midwife have been gaining respect. These few progressive groups have formed Gentle Birth Philippines and Pinay Doulas Collective to support mothers who desire unmedicated birth.

Gradually improving health outcomes

The World Breastfeeding Trends Initiative (WBTi) Philippines report shows a significant improvement from 2009 to 2015 in its assessment. Dr. Datangel-Gallardo sheds light on the government’s efforts which have influenced these outcomes. For instance, The Department of Health led by the Family Health Division convened the Infant and Young Child Feeding (IYCF) Management Committee, as well as its Technical Working Group composed of individuals from government agencies, the Philippine Pediatric Society, some NGOs like UNICEF and KMI and some breastfeeding groups. This collaborative’s five year plan is making progress, says Dr. Datangel-Gallardo.

Moreover, a Presidential executive order has made August Breastfeeding Awareness Month which is celebrated nationally with “media mileage.”

“Providing lactation rooms and paid lactation breaks among working breastfeeding mothers and extending the coverage of the Milk Code from infancy to young children (approximately 36 months)… may have made an improvement on the Philippines breastfeeding rates,” suggests Dr. Datangel-Gallardo.

Of course the adoption of the International Code of Marketing of Breastmilk Substitutes in the Philippines has played a role in improving maternal infant health outcomes.

Dr. Datangel-Gallardo, with the help of Ines Avellana-Fernandez Director of Arugaan and IBFAN SEA Coordinator, explain: Executive order 51 was signed by the late Philippine President Cory Aquino in 1986 under her government after ousting the late Dictator President Ferdinand Marcos. The law–Philippine Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Related Products (popularly known as the Milk Code)– took effect in 1987 with persistent action by NGO breastfeeding coalitions, people’s organizations, religious groups, medical and legal professionals. In 2007, The Pharmaceutical and Healthcare Association of the Philippines sued the health department over proposed regulations to strengthen the Milk Code. 

“Compared to most countries we could say that the Philippines have taken big steps in controlling the promotional activities of these big milk companies who try to reach out to mothers and health professionals,” Dr. Datangel-Gallardo and Avellana-Fernandez go on. But, the Food and Drug Administration (FDA)– the organization assigned to process complaints, monitor the Milk Code and facilitate the review of milk companies’ promotional activities– has done little to enforce the Code, they say.  

“Sanctions for violations are also deemed very minimal compared to the enormous profit from sales of a bottle company,” they continue. “If such challenges persist, the slowly growing breastfeeding culture may eventually backslide.”

Dr. Datangel-Gallardo tributes the bulk of infant feeding improvements in the Philippines to volunteers.

“I could staunchly say that it was the efforts and spirit of volunteerism of the breastfeeding advocates and support groups outside the government health system who made a huge difference,” she begins. “Through the years, many breastfeeding support groups have been born in response to the needs of the society such as Arugaan, Breastfeeding Pinays (slang for Filipinas) and LATCH… Mothers from these support groups are volunteers and usually will give support without asking for anything in return.”

Connect with Dr. Datangel-Gallardo at the conference! Register here.

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