MANILA, Philippines -- The World Health Organization said a study has found that Filipino mothers who have been influenced by advertisements or their doctors to use infant formula are two to four times more likely to feed their babies with those products.
The study appears to support the Philippines' decision to limit advertising for infant formula, which can discourage mothers from breast-feeding that provides health benefits for newborns.
Published by the Social Science and Medicine Journal in September and released this week, the study said those mothers were 6.4 times more likely to stop breast-feeding babies within one year of age – a step that raises risks of illness and death for the infant.
Breast milk significantly reduces infant mortality, according to international health experts, who recommend that mothers exclusively breast-feed for the first six months and continue breast-feeding, supplemented by solid foods, until their babies are 2 years old.
The International Code of Marketing of Breast-Milk Substitutes, sponsored by the World Health Organization and UNICEF, is not legally binding. It is up to individual countries to implement the code by enacting their own laws.
The Philippine study wanted to examine if marketing for breast milk substitutes was to blame for a drop in breast-feeding in the Southeast Asian country, one of several where multinational companies fought a legal battle for the right to aggressively sell baby formulas.
When the Philippine government tried to tighten its advertising laws for milk products, the companies took it to court.
The Supreme Court ruling in October 2007 upheld the Department of Health's mandate to regulate advertising of breast milk substitutes. It prohibited all health and nutrition claims but failed to support a full advertising ban, citing freedom of speech.
WHO data show exclusive breast-feeding rates for Filipino babies up to four months old dropped from 47.3 percent in 1998 to 40.1 percent in 2008.
Four of the six authors of the study are from the WHO, led by the organization's medical officer Howard Sobel. They conducted a household survey between April and December 2006 and focus groups in April-May 2007.
According to their findings, 59.1 percent of the mothers recalled an infant formula advertisement message and one-sixth reported a doctor recommended using formula. Those who recalled an ad message were twice as likely to feed their babies infant formula, while whose advised by a doctor where four times as likely to do so.
"Despite poverty and extra strain on household income associated with formula use, 41.1 percent of the infants and young children were fed formula," the authors said.
The WHO says addition of formula leads to decreased stimulation from suckling and its reflex for breast milk production. Not breast-feeding also was associated with a 5.8 times increased risk of all-cause deaths in the first two months of life, with risks elevated up to the second year, it says.
The authors said that despite the WHO's adoption in 1981 of the International Code of Marketing Breast Milk Substitutes to curtail unethical marketing promotions, few countries have fully implemented the code's ban on advertising or other forms of promotion.
Alex V. Castro III, executive director of the Infant Pediatric Nutrition Association of the Philippines that groups infant formula makers, said the association fully supports breast-feeding.
He said their members have been diligently complying with the Philippines' adaptation of the WHO's milk code, including prohibitions in advertising. He said no advertisement has been allowed without approval of an interagency headed by the Department of Health.