Loida, 37, lives with her husband Richard and four-year-old son David in Santa Rosa, a small town on the shores of Laguna Lake, south of Manila. In the streets, brightly decorated ‘jeepney’ buses and tricycles drive through a large yellow arch, which used to serve as a watchtower for marauding pirates. Small stores sell mobile phone top-ups, and along the highway street stalls sell hot coconut and cassava pies to passers-by.
Loida works in a government office in Pasig City, Metro Manila. When David was born in 2012, she received 78 days paid maternity leave (around 2.5 months) from her employer. It was longer than usual because she had a caesarean delivery. For natural birth, the leave entitlement was just 60 days. On returning to work, Loida wanted to continue breastfeeding, but faced many challenges.
“I continued to express milk at work, usually once or twice during a ten hour day,” Loida recalls. “But it was not convenient at all, because there was no designated lactation room. I was allowed to use the pantry in my boss’s office to express milk, but it made me anxious as she might need to use the place anytime. I was also worried that the sound of my electric breast pump might distract people meeting in her office.”
As the pantry was not a proper lactation room, Loida had to express standing up and could not guarantee the cleanliness of the area. “I could, however, store my expressed breast milk in the office refrigerator during the day and take it home after work,” she says.
Loida continued breastfeeding until David was five months old, but she couldn’t pump enough milk to last the whole day, so she had to switch to mixed feeding. UNICEF and WHO recommend exclusive breastfeeding for six months, but without adequate maternity leave or well-designed workplaces, for mums like Loida this isn’t always possible.
Nutrition in ASEAN
According to a new report from UNICEF, WHO and ASEAN, children in the Philippines suffer from high levels of stunting and wasting. There are more than 11 million children aged under five in the Philippines. Around 30 percent of them are stunted, and 8 percent are acutely malnourished. If children are stunted, this impacts their brain development, affecting their chances for education and employment later in life. Stunted girls also have higher risk of complications in delivery when they have their own children.
Disasters also have an impact, the report finds. The Philippines is the most disaster-struck country in ASEAN, with regular typhoons and floods and a long-running conflict in the south. Disasters disrupt families’ livelihoods and children’s access to food and water, which can in turn can lead to diseases such as diarrhea and cholera.
Breastfeeding is one of the best ways to prevent malnutrition, but unfortunately only 34 percent of infants in the Philippines are exclusively breastfed for the first six months of life. UNICEF is working to promote good maternity practices in the Philippines, including longer mandatory paid maternity leave, breastfeeding support in the workplace, and nutrition counselling for breastfeeding mothers and families with young children.
In January, following sustained advocacy by UNICEF and partners, the Philippines Senate passed an Expanded Maternity Leave Bill. This provides for 100 days paid maternity leave and applies to all female workers in the government and private sector, regardless of the method of delivery. It also allows for an additional 30 days leave without pay. A counterpart bill now needs to be passed by Congress, which will reconvene in July following elections. Once passed by both houses, it will be submitted to the President for signing into law.
“The Expanded Maternity Leave Bill is an improvement on the current provision of 60 days, and would be a big step towards our eventual goal of 180 days maternity leave,” says UNICEF Philippines Health and Nutrition Chief Willibald Zeck. “Maternity leave is an essential part of supporting exclusive breastfeeding, which is the best thing that a mother can do for their baby’s health in the first six months of life.”
However, Willibald warns that these gains have to be protected against efforts by the infant formula industry to undermine breastfeeding. “After natural disasters, for example, formula companies often hand out milk powder to mothers in evacuation centres,” he says. “Mothers mix this with dirty water, leading to diarrhoea and sometimes death. Afterwards, the mothers’ own breastmilk has dried up, so they have to continue buying formula.”
UNICEF and the EU recently completed a five-year partnership to tackle nutrition issues in five Asian countries, including Indonesia, Lao PDR and the Philippines. “The objective of the partnership was to help governments develop a holistic approach to nutrition, looking beyond just the health sector,” Christiane Rudert, Regional Nutrition Adviser for UNICEF East Asia and Pacific, says.
UNICEF also works with local governments to promote good maternity and breastfeeding practices. In Naga City, for example, in the Philippines’ central Bicol Region, the Mayor and city government have taken a strong interest in maternity protection, including the establishment of lactation stations.
Sitting beneath the imposing Mount Isarog volcano, Naga City is home to a famous wooden statue of the Virgin Mary. The city is surrounded by farmland and fishing areas, and is famous for spicy food. It’s also recognised as a centre of good governance in the Philippines, having won around 150 awards on effective urban management.
Working with UNICEF, ILO and ALLWIES (an organization supporting informal workers), the city government helped set up a lactation station in Naga City market. This is space where market vendors and customers can go to breastfeed or express breast milk and store it in a refrigerator until they go home. There are regular information and counselling sessions. Market stall owners share the cost, which comes to 50 pesos ($1 USD) each per year.
“As well as the market, we now have breastfeeding corners in all public schools, local barangays, many shopping malls, the main bus terminal, and at City Hall,” says Raquel Buere from Naga City’s Nutrition Office. “The peer counsellors are volunteers, but we provide them with training and uniforms. We’ve had really positive feedback from the market vendors and other mothers. And we can already see the results – the rate of exclusive breastfeeding in Naga City has increased from 54 percent in 2010, to 86 percent now.”
For Loida, the Expanded Maternity Leave Bill is a welcome development, although it comes too late to help her with David. “I hope a law providing for longer maternity leave will be passed,” she says. “I strongly believe that longer paid maternity leave would have allowed me to breastfeed for longer, and more exclusively.”
She also highlights the importance of breastfeeding-friendly workplaces. “It’s not enough that people at work are supportive of breastfeeding,” Loida adds. “The workplace itself should also be made conducive in terms of facilities.”
There is clearly more that needs to be done to promote breastfeeding and good infant nutrition in the Philippines. But the Senate and Naga City government have shown that, where political will exists, progress is possible.
Andy Brown is Regional Communication Specialist for UNICEF East Asia and Pacific