Mother-Baby Friendly CALABARZON
Supporting the Implementation of the Mother-Baby Friendly Health Facility Initiative, the Ten Steps to Successful Breastfeeding, and Executive Order No. 51 (Philippine Milk Code) in CALABARZON Region
Preamble
We, the undersigned professional medical societies and organizations, in collaboration with the Center for Health Development CALABARZON, recognizing the vital role of breastfeeding in ensuring optimal maternal, newborn, and child health and nutrition, hereby express our unified support for the implementation and strengthening of the Mother-Baby Friendly Health Facility Initiative (MBFHFI) in the CALABARZON Region.
This Unified Position Statement affirms our collective commitment to protecting, promoting, and supporting breastfeeding through the implementation of the Ten Steps to Successful Breastfeeding, adherence to Executive Order No. 51, otherwise known as the Philippine Milk Code, and subsequent relevant policies and regulations that safeguard mothers, infants, families, and healthcare professionals from inappropriate marketing and promotion of breastmilk substitutes.
Participating Organizations
This Unified Position Statement is endorsed by:
Philippine Pediatric Society – Southern Tagalog Chapter
Philippine Obstetrical and Gynecological Society – Southern Luzon
Philippine Society of Newborn Medicine, Inc.
Philippine Society of Breastfeeding and Lactation Medicine
Philippine Society of Maternal Fetal Medicine
Perinatal Association of the Philippines
Kalusugan ng Mag-Ina, Inc.
ArugaanShared Principles
The participating organizations collectively recognize that:
Breastfeeding is the biological norm and provides unparalleled health, nutritional, developmental, economic, and environmental benefits.
Mothers and families have the right to receive accurate, evidence-based, and unbiased information regarding infant and young child feeding.
Healthcare professionals play a critical role in protecting, promoting, and supporting breastfeeding throughout pregnancy, childbirth, the postpartum period, and beyond.
Health facilities should provide an enabling environment that supports breastfeeding and complies with national and international standards.
The implementation of the Ten Steps to Successful Breastfeeding and compliance with the Philippine Milk Code are essential components of quality maternal and newborn care.
Unified Position
The participating organizations hereby express their collective support for:
A Implementation of the Ten Steps to Successful Breastfeeding
The participating organizations affirm their commitment to support the implementation, institutionalization, monitoring, and continuous improvement of the Ten Steps to Successful Breastfeeding in all applicable health facilities within the CALABARZON Region. Specifically, the organizations agree that:
On Staff Competency
Breastfeeding conferences may supplement but should not replace the standardized competency-based training required under Step 2 of the Ten Steps to Successful Breastfeeding. A DOH competency-based Lactation Management Training (e.g., a 20-hour Lactation Management Training with a minimum of 4 hours skills training or its equivalent), that comprehensively covers the Ten Steps to Successful Breastfeeding, the Philippine Milk Code, the International Code of Marketing of Breast-milk Substitutes, and subsequent World Health Assembly (WHA) resolutions is required.
On Uninterrupted Skin-to-Skin Contact
We recognize the current Department of Health (DOH) and WHO recommendation that uninterrupted skin-to-skin contact between mother and newborn should be maintained for sixty (60) to ninety (90) minutes after birth until the first life-saving breastfeed is completed. This is reinforced by the WHO Guidelines on Immediate Kangaroo Mother Care, which recommend that skin-to-skin contact be initiated immediately after birth without delay, as a critical intervention to reduce neonatal mortality and complications. The societies support the adoption of evidence-based practices that promote prolonged skin-to-skin contact as a key intervention for successful breastfeeding, maternal-newborn bonding, optimal newborn care and protection against postpartum depression. If the mother is unavailable, an alternate carer can provide the skin-to-skin contact.
On Use of Bassinet
The participating medical societies affirm that rooming-in means keeping the mother and newborn together 24 hours a day and should remain the standard of care for healthy mother-newborn dyads. If bedding-in is not doable due to environmental considerations, maternal conditions, or facility limitations; and in the absence of a carer, the use of a bassinet/crib may be allowed as a last option provided that mother-newborn proximity and breastfeeding support are maintained.
On Breastfeeding for Newborns with Special Needs
Direct breastfeeding, with appropriate positioning and attachment, is feasible for infants with cleft lip and infants with cleft palate, or both, as breast tissue can adapt to the lip defect and facilitate an effective seal. For infants with a cleft palate, a laid-back, vertical, or straddle hold can be resorted to. Direct breastfeeding may be attempted when clinically appropriate; however, when effective milk transfer cannot be achieved, expressed breast milk should be provided through appropriate alternative feeding methods, e.g. cup feeding.
On Bathing of Newborns
The participating medical societies recognize the WHO recommendation to delay newborn bathing for at least twenty-four (24) hours after birth whenever possible. Delayed bathing supports newborn thermal stability, preserves the protective benefits of vernix caseosa, and promotes successful breastfeeding. Health facilities are encouraged to align their protocols with this evidence-based practice. If a 14 hours delay is not acceptable, then bathing should be delayed for a minimum of 6 hours.
On Non-Nutritive Sucking
Non-nutritive sucking may be done for stable preterm newborns by supervised early exposure to the breast. The use of pacifiers and gloved fingers are discouraged. This directly reflects WHO Standards for Newborn Care, which state: “Mothers of preterm infants should be supported to provide non-nutritive sucking at the breast during tube feedings to promote oro-motor skills, stimulate milk production, and prepare the infant for direct breastfeeding”.
On Maternal Milk
The participating medical societies affirm that commercial maternal milk products should not be promoted nor recommended. Evidence demonstrates a direct association between the routine consumption of energy-dense, sugar-sweetened maternal milk formulations and an increased risk of excessive gestational weight gain, pre-pregnancy overweight/obesity, and Gestational Diabetes Mellitus (GDM) among Pregnant and Lactating Women (PLW). Furthermore, in accordance with WHA Resolution 69.9 (Guidance on Ending the Inappropriate Promotion of Foods for Infants and Young Children) and Republic Act 11148 (Objective g), the promotion of maternal milk creates severe conflicts of interest, undermines optimal maternal nutrition and exclusive breastfeeding, and functions as indirect marketing for breastmilk substitutes through cross-promotion and shared series branding.
B Compliance with Executive Order No. 51 (Philippine Milk Code)
The participating organizations recognize the importance of protecting families and healthcare systems from inappropriate marketing practices related to breastmilk substitutes, feeding bottles, teats, and related products. The organizations therefore agree to:
- Protect, promote, and support breastfeeding in accordance with WHO recommendations on exclusive breastfeeding for the first six (6) months of life and continued breastfeeding with appropriate complementary feeding up to two (2) years of age or beyond.
- Executive Order No. 51 and its Revised Implementing Rules and Regulations carry the full force of law and are binding upon all health workers, health facilities, and professional organizations operating within the Philippine health care system. All physicians affiliated with our societies are therefore bound — legally and professionally — to observe the provisions of the Code in their clinical, educational, and public activities. Our societies affirm their obligation to ensure that members are adequately informed of the relevant provisions and their practical application.
- No Artificial Milk or “Breastmilk Substitute” promotion is permitted in health care settings. Our member institutions — clinics, hospitals, birthing facilities, and training centers — must not be used for the display, promotion, or advertisement of any product within the scope of the Code. No product representatives, gifts of any sort, promotional materials, sponsored signage, or related samples shall be permitted in these spaces.
- Our societies prohibit industry sponsorship that creates conflicts of interest. We shall not accept financial support, grants, speaking fees, sponsored honoraria, research funding, convention underwriting, or gifts from manufacturers or distributors of artificial milk or “Breastmilk Substitutes” that would require, expect, or result in the promotion of their products. Conflicts of interest must be fully disclosed and managed in all professional and educational activities.
- Cross-promotion is a violation of the Code and shall not be facilitated. We recognize cross-promotion — the use of shared branding, packaging design, stage numbering, mascots, and marketing identity across infant formula, follow-on formula, and toddler milk lines — as a deliberate strategy to circumvent Code restrictions. Our members shall not participate in, endorse, or provide any platform for such strategies.
- Clinical practice guidelines and educational content must be free from commercial influence. All clinical recommendations issued by our societies on infant and young child feeding shall be based solely on appraised best available scientific evidence, independent of industry involvement. Any educational activity on infant nutrition must disclose funding sources and exclude content that directly or indirectly promotes artificial milk or “Breastmilk Substitutes.”
- We support monitoring and enforcement of EO 51 and WHA 69.9. Our societies commit to collaborating with the Department of Health, the Food and Drug Administration, and civil society organizations to monitor Code violations — including digital, social media, and event-based marketing — and to report such violations to the appropriate authorities.
C Professional Practice and Continuing Education
The participating organizations acknowledge their responsibility to ensure that healthcare professionals receive evidence-based education and guidance on maternal, newborn, and infant feeding practices. The organizations agree that:
- Breastfeeding conferences may supplement but should not replace the standardized competency-based training required under Step 2 of the Ten Steps to Successful Breastfeeding. A DOH competency-based Lactation Management Training (e.g., a 20-hour Lactation Management Training with a minimum of 4 hours skills training or its equivalent), that comprehensively covers the Ten Steps to Successful Breastfeeding, the Philippine Milk Code, the International Code of Marketing of Breast-milk Substitutes, and subsequent World Health Assembly (WHA) resolutions is required.
D Medical Society Collaboration
Recognizing the importance of a coordinated multidisciplinary approach, the participating organizations commit to strengthening collaboration among pediatricians, obstetricians, neonatologists, maternal-fetal medicine specialists, lactation medicine practitioners, nurses, midwives, nutritionist-dietitians and other healthcare professionals.
To this end, the signatory societies pledge the following commitments:
Philippine Pediatric Society – Southern Tagalog Chapter (PPSSTC)
- Digital Health Promotion: Utilize the newly formed Community Health Advocacy and Multimedia Promotion (CHAMP) committee to create content promoting breastfeeding across digital platforms (e.g., Facebook, YouTube) for pediatricians and the public.
- Inter-Committee Alignment: Mobilize the Continuing Professional Education (CPD), NOURISH (undernutrition/overnutrition), and CARE-ND (Care for At-Risk Newborn and Breastfeeding) committees to collaborate on community outreach and breastfeeding advocacy.
- Research Mentorship: Promote and mentor trainees and consultants in conducting clinical and operational research on breastfeeding.
- Conflict of Interest Elimination: Phase out commercial milk company sponsorships for future postgraduate courses, workshops, and society activities.
Philippine Pediatric Society – Rizal and Marikina Cluster (Cluster 5)
- Hospital Accreditation: Audit/inventory non-accredited hospitals in the Rizal area and coordinate with local healthcare leaders to help at least 80% achieve Mother-Baby Friendly Hospital Initiative (MBFHI) accreditation via targeted webinars.
- Public Education: Expand social media outreach and invite multidisciplinary expert speakers to participate in cluster podcasts focused on mother-baby health.
- Specialist Collaboration: Partner closely with neonatologists in Rizal to streamline regional newborn and lactation support.
Philippine Society of Newborn Medicine (PSNbM)
- Nationwide Dissemination: Distribute key workshop takeaways across all nine (9) nationwide PSNbM regional clusters.
- Guidelines Revision: Integrate newly raised evidence-based practices into the ongoing revision of the Standards of Newborn Care Manual.
- Data & Statistics Enhancement: Incorporate 3-month and 6-month exclusive breastfeeding tracking rates into monthly hospital audit statistics alongside birth and mortality metrics.
- Multi-Center Research: Conduct multi-center research across clusters to generate baseline data on clinical practices and neonatal outcomes.
- Regional Program Focus: Prioritize Region 4A (CALABARZON) as a focal target area for projects aimed at improving neonatal survival rates.
Philippine Society of Maternal Fetal Medicine (PSMFM) with Philippine Obstetrical and Gynecological Society (POGS)
- Technical Guidance: Serve as technical partners providing expert guidance to support MBFHI policy recommendations and professional education.
- Clinical Practice Guidelines (CPG) Update: Revise the CPG on Maternal Nutrition to incorporate evidence-based statements regarding the consumption risks of commercial maternal milk.
- Milk Bank Expansion: Encourage and advocate for the establishment of human milk banks across hospitals in Region 4A.
- Ethical Review: Revisit organizational partnership policies to ensure alignment with ethical marketing practices and address industry conflicts of interest.
Perinatal Association of the Philippines (PAP)
- Code Compliance: Maintain strict adherence to Executive Order 51 (The Philippine Milk Code) across all chartered and affiliated multidisciplinary member societies.
- Policy Implementation: Operationalize and disseminate all upcoming Mother-Baby Friendly Health Facility policy statements generated by member specialty groups.
- Multidisciplinary Training: Serve as an umbrella education and training arm for Essential Intrapartum and Newborn Care (EINC) and early lactation management protocols.
Philippine Society of Breastfeeding and Lactation Medicine (PSBLM)
- Sponsorship-Free Advocacy: Maintain independence from formula and infant food industry funding for all society educational congresses and advocacy programs.
- Policy Enforcement & Leadership: Provide technical leadership and oversight to ensure complete compliance with EO 51, national regulations, and relevant breastfeeding laws.
- Curriculum Rollout: Develop and roll out structured training programs (e.g., Mother-Baby-Friendly training, DOTs, 95-hour courses, and refresher modules) for multidisciplinary professionals.
- Monitoring & Registry: Establish a regional registry of trained healthcare personnel (20-hour/40-hour course completers) and conduct regular reporting on regional breastfeeding outcomes.
- Focal Coordination: Assign a dedicated CALABARZON/Region 4A focal person to streamline multidisciplinary projects and activities across the region.
Call to Action
The participating organizations call upon healthcare institutions, healthcare professionals, local government units, academic institutions, policymakers, development partners, and other stakeholders to strengthen efforts toward creating an environment that protects, promotes, and supports breastfeeding and mother-baby friendly practices.
Together, we reaffirm our commitment to ensuring that every mother receives appropriate support and every newborn is given the best possible start in life through evidence-based, ethical, and family-centered care.
Effectivity
This Unified Position Statement was adopted during the Unified Action for Mother-Baby Friendly CALABARZON Through Medical Society Collaboration conducted at the Richmonde Hotel – Eastwood, Quezon City on
This Statement shall serve as a guiding framework for collaborative actions and initiatives to support the implementation of the Mother-Baby Friendly Health Facility Initiative, the Ten Steps to Successful Breastfeeding, and Executive Order No. 51 (Philippine Milk Code) within the CALABARZON Region.