Saturday, August 25, 2012

Tale of two nipples

IF informed choice is good for reproductive health, why not for breastfeeding and breast milk substitutes?

The logic seems clear enough. According to an unattributed article published in The Philippine Star’s Aug. 23, 2012 issue, the nongovernment organization (NGO) Women Involved in Nation-Building (WIN) supports the congressional proposal to amend the Milk Code of the Philippines.

A WIN spokesperson said that while the NGO considers mother’s milk as the “platinum standard for infant nutrition,” it asserts that “The Breastfeeding and Milk Regulation Act” will “safeguard and promote women’s rights to proper knowledge and information that will help lead mothers to numerous options”.

What is lacking in the range of options currently available to mothers? Information and access to breast milk substitutes is banned or constrained by the Milk Code. For instance, WIN cites the donations of milk formula and other infant food products that were turned away from evacuation centers at the height of the recent monsoon rains and flash floods that hit Metro Manila and surrounding cities.

If passed into law, House Bill 3537, or the proposed Act to Promote Comprehensive Program on Breastfeeding Practices in the Philippines, will allow milk donations during disasters and emergencies. The proposal to amend the Milk Code is authored by Rufus Rodriguez (Cagayan de Oro), Josephine Lacson-Noel (Malabon), Magtanggol Gunigundo (Valenzuela), Anna Bondoc (Pampanga), Lani Mercado (Cavite), and Lucy Torres (Leyte).

I, too, agree that women’s right to informed choice must be upheld. Yet, if circumstances, such as evacuation conditions, poor health and others, decrease the attractiveness or convenience of breast milk, I don’t believe the solution is to shift focus on other options.

I believe in working harder at nursing one’s child.

The Milk Code is that rarity in the Philippines: a law that’s being implemented. Because it is followed, the policy creates a structure and an environment that supports the delivery of the benefits provided for by law.

In September 1993, I gave birth to our first born in a government hospital. My older son was a lusty 10-pounder who developed an instant dislike for my breasts. Despite swallowing an ocean’s worth of clam soup and imbibing other folk recipes for copious milk during my nine months of waiting, I could not squirt anything but a few drops of colorless liquid into my son’s tiny but endlessly rooting mouth.

It did not help at all that I did not slide gracefully into motherhood the first time. A last-minute C-Section gave me a seven-inch incision. Trial labor left me with hemorrhoids. And after nine months of anticipation, I was wrestling with this small ill-tempered tyrant who slapped away my aching breasts, kicked at my fresh sutures, and howled blue murder for the world’s earliest case of enforced fasting.

In 1993, there was no rooming-in policy. I went to the nursery for my son’s feeding. While my son protested and I struggled to muster son, breasts, sutured belly and post-partum depression, a gallery of baby visitors witnessed my breastfeeding misadventures. After a month, I gave in to mixed feeding.

The bottle, with its superior silicone liquid rubber nipple and gushing supply of infant formula milk, handily won the battle of teats. After I got replaced in my son’s affections by a 1.8-kilo can of infant formula milk, my own milk trickled and dried up.

In 1998, my second son made his appearance. I was the same flat-chested me, except five years older and more stressed by teaching, writing and tutoring my first-born. Yet, with age came experience. I no longer panicked when eight pounds of appetite made their imperious demands. The weak-looking initial trickle of breast milk I now knew as colostrum, an important source of immunity-enhancing antigens.

What made a difference, too, was the change of government policy. Rooming-in gave my son and I more privacy for nursing. No breast milk substitutes were allowed. No cute baby books from milk company sponsors. No milk handouts and cartoon character-decorated feeding bottles to give overwrought mothers a break.

Nature gave me two breasts; my son and I found a use for these for more than two years. Practice, not formula, makes perfect.

( 09173226131)

*First published in Sun.Star Cebus August 26, 2012 issues of the “Matamata” Sunday column

Saturday, August 18, 2012

Biting the breast

LET’S not forget what the monsoon rain brought out: disaster and human spirit.

One who inspires is Rina Nato. This 33-year-old Filipina nurses babies who get hungry while their mothers are out looking for money or food.

Days after the flash floods that hit Metro Manila, many of the families evacuating at the temporary shelter set up at the St. Francis Chapel in Cainta, Rizal still could not return to their homes but needed more than the donations that came their way.
Women left their babies with grandmothers, who had to “fake breastfeeding” to quiet their hungry cries.

This dilemma did not escape Rina, a social worker, reported Tara Quismundo in the Philippine Daily Inquirer’s (PDI) Aug. 17, 2012 issue.

In Rina, I caught more than a glimpse of the Filipino’s sense of “pakikipagkapwa-tao”.

Fellowship, or sharing the lot of others, is a value one expects of but sees rarely in public servants. Even then, I do not know of any civil service code that requires a government employee to share something as intimate as one’s milk in the line of duty.

Yet Rina, a mother of a three-month-old infant, knew instinctively what the hungry babies and their equally desperate grandmothers needed: milk that’s nutritious, safe and free.

In the rudimentary conditions of an evacuation center, it must be impossible to hygienically store expressed milk. The PDI article also pointed out that Rina knew formula milk could not be distributed as aid, in keeping with the provisions of the Philippine Milk Code.

The article does not explain Rina’s decision to respond to duty unconventionally. Perhaps her training and immersion as a social worker makes her more sensitive to others. Or nature might have endowed her with an abundance of breast milk, more than what her own child needs. There’s a natural synchronicity that makes breast milk flow in answer to the hunger of one’s own, as experienced by mothers who are still at work while their babies are left at home.

Often, when hunger is sated and the infant sleeps or plays, the milk does not shut off automatically. Mothers are encouraged to safely store this milk for later feedings. Others let the milk flow until it stops, stimulated anew when the infant grows hungry.

As the convention goes, the more a mother nurses, the more milk she produces. This inexhaustible supply of free, quality sustenance for the first 36 months of a child makes breast milk a virtual fountain of life.

By offering to be a wet nurse, Rina is reversing an oppressive patriarchal tradition. The ancient practice of poor women acting as wet nurses for the infants of rich families goes back to agrarian or medieval societies where such “privilege” was considered as socially necessary: rich women had to keep their figures after giving birth and poor women had to survive, even if it meant their own infants grew sickly or died, subsisting on inferior substitutes because the social order denied them their own mother’s milk.

No victim of patriarchy, Rina’s sacrifice is not without cost. Even if nature graces you with an abundance of milk, it can be an actual physical pain to nurse. Hungry infants will attack nipples with the same gusto whether these are made by nature or technology. All too soon, an infant’s gums will sprout teeth, which can be used with surprising efficiency to grip and pull and gnaw.

Yet, more daunting than a queue of hungry babies waiting for their turn to nurse is the consolidated House Bill on Breastfeeding, which may yet amend the present Milk Code and the Expanded Breastfeeding Promotion Act of 2009.

If passed into law, the amended Milk Code will narrow the application of breast feeding from infants falling within the first 36 months to the first six months only, allow donations of artificial breast milk substitutes during emergencies, make lactation breaks at the work place unpaid, and generally bring back mothers and infants within the orbit of well-funded and aggressive marketing campaigns of milk formula companies.

How many Rina Natos will we need then to offset the damage of another disaster of our own making?

( 0917-3226131)

* First published in Sun.Star Cebus Aug. 19, 2012 issue of the “Matamata” Sunday column

Saturday, August 11, 2012

Best and worst

LAST Tuesday, while Metro Manilans were waking up to another round of heavy rains and flooding replacing unwelcome memories of Ondoy, two persons flew in from Singapore. For the German and the Chinese, it was their first trip to the country.

They returned back to their base country on the same day, as many parts of the metro and other cities in Luzon went under water. What impressions of the country, a Filipino colleague mused, did they bring back with them?

Below are my answers if the question had been meant for me:

WORST place for systems. If you expect systems to be in place, be ready for disappointments. Some long-time residents say that authorities in flood-prone Manila still don’t get it: how can they not prepare for disasters that strike regularly? Others also say that some of the areas that didn’t go underwater during Ondoy now did. So what went wrong?

BEST place for improvisations. News footages captured the heroism of rescuers. It wasn’t just saving the lives of strangers, even people who did not want to leave their homes, but doing so with very little resources and a lot of obstacles. Lacking motorized inflatable boats and life vests and other safety gear, rescuers showed what one could do with a piece of rope, the interior of a wheel and determination. Although there were no reports of casualties among rescuers or the people they were helping, a system should include the purchase of modern equipment to facilitate rescue missions and ensure the safety of rescuers, many of whom are volunteers.

BEST humans. Coming after our poor showing at the Olympics and the divisive squabbling over the Reproductive Health Bill, the selflessness of volunteering and cooperation to help those made homeless, hungry and ailing by the flash floods reminded us why the Filipino is great. Students, government employees, housewives, and others who could have just stayed home volunteered to repack food and give aid. The days of no work, no class released many to aid the rescue and relief operations. Cheers also to the news media, particularly radio and TV, for keeping the public informed and vigilant. Journalists sought out communities that were inaccessible and badly in need of help.

WORST humans. P-Noy chided people who resisted efforts to relocate them to evacuation centers, where food and medical assistance were easier to channel. He wondered if material possessions were worth more than the lives of loved ones and rescuers, who had to contend with heavy obstacles and risks to return to rescue them. Yet, it’s not difficult to empathize with homeowners protecting their homes and livestock from looters. Despite the deep floods, threat of electrocution and drowning and other hazards, submerged homes were still ransacked. “Jumper” boys ran off with the cargo of vehicles that floundered in flooded intersections. One TV personality attested that the food donated for network volunteers “tasted good, in fairness.”

WORST timing for trial-and-error. By changing “green” to “orange” at the height of the calamity, the Pag-asa confused the public and incensed P-Noy in the piloting of their rainfall warning system. Officials said that they changed colors as a concession to criticisms that the original color coding—yellow for monitoring, green for alert, and red for evacuation—confused people more used to the “red-yellow-green traffic light system”. However, changing colors at the height of a crisis and without sufficient explanation made the agency seem as unpredictable as the weather it still has to accurately read.

BEST time to think about others. We may never get any kind of system going. We may never buy all the modern equipment and facilities we need when disaster strikes. We can do something, though, about the trash we are disposing, the plastic bags we can reuse, the packaging we dispose without a thought. If “we” sounds too ambitious, “I” is shorter, simpler, easier: “I can”.

( 09173226131)

*First published in Sun.Star Cebu’s Aug. 12, 2012 issue of the “Matamata” Sunday column

Sunday, August 05, 2012


IT’S not just rain that’s making this overcast Saturday pregnant with possibilities.

I’m staying home, purposely avoiding the Epifanio delos Santos Avenue (Edsa) today.
This weekend, thousands of high school seniors take the University of the Philippines College Admission Test (Upcat). A jeepney ride away from Edsa is UP Diliman, one of the largest campuses in the UP system that may take the lion’s share of the estimated 60,000 that take the Upcat every year.

This afternoon till early evening, the Catholic Bishops’ Conference of the Philippines (CBCP) will also hold its “Prayer Power Rally Against the RH Bill” at the Edsa shrine. Red shirts will be worn to symbolize the blood of the innocent, infants and women the CBCP says will be sacrificed in the abortions “encouraged” or “condoned” by the RH Bill.

Weeks in advance, high school students roamed the Diliman campus to find their testing venues and improve their chance of being on time for Upcat. Yesterday, despite gusty winds and drenching rain, the visitors still did their tour of duty, standing out among the Diliman regulars. It may have been the school uniforms and the campus maps. Trailing after a group of boys that was checking out the colleges of Mass Communication and Music, I think it’s the excitement that yips in the surface cool of teen murmur.

That was a bittersweet moment. More than three decades ago, I also sat down for the Upcat, all choked up with the fear of possibly leaving my high school alma mater and the excitement of expecting a more liberal life in college. When my older son took and passed the Upcat more than three years ago, I felt the same anticipation and pride when he passed—as well as the pang when my son finally decided on another course and a private university.

An alumnus of a private high school, my son felt that the state university could not guarantee state-of-the-art facilities and training that the private sector provides. An alumna and a teacher of UP, I kept my peace and respected his choice.

It felt odd and still feels odd now: stepping back and making room for a person who’s coming into his own. I used to buy his Read-Aloud books and later, the references and rare novel; now he’s making choices that would never have occurred to me when I was 18 turning 35.

But if I learned something from the Upcat my son and I took, it’s that education frees a person to make choices. The Upcat is just an exam; UP, one of many destinations. But to be able to weigh possibilities, to use reason in narrowing the field and singling out superior options, to chart a path that takes you from this point of your existence to that point of your aspiration—this is choice. This is power.

With wage-earner parents, that’s probably all our sons will get from us.

It’s more than what some get. Crossing an Edsa underpass one evening after class, I ran into a young man. The dark and the plastic bag half-covering his face made it hard to guess his age. The bag, smeared with rugby on the inside, inflated and deflated with his frenzied breathing.

In the underbellies of the MRT stretching along Edsa are many other children and youths whose future ends in a bag stuffed into their face. In Quezon Avenue is a little girl who skips up and down the skywalk, singing “pangitpangitpangit”. I’ve never seen her with her parents or a pair of slippers.

Last year, more than 70,000 took the Upcat. Only about 1/8 passed. Those who didn’t make it still have a choice. Parents of the Upcat takers—as well as those wearing red shirts for the Edsa shrine rally this afternoon, I dare say—know how much it takes to give one’s children a choice.

In deciding whether our children face a lifetime or a wasteland of choices, we must choose.

(, 09173226131)

*First published in Sun.Star Cebu’s Aug. 5, 2012 issue of the “Matamata” Sunday