This article was first printed in the Philippines by the Medical Observer. Reprinted with permission of the Medical Observer and Dr Ricardo B Gonzales. It describes how Dr Gonzales, Medical Center Chief at the Jose Fabella Memorial Hospital in Manila, views co-operation with the infant formula industry for the promotion of breastfeeding and infant health.

Working hand-in-hand for infant nutrition

When the late UNICEF Director-General James P Grant visited the Jose Fabella Memorial Medical Center in Manila several years ago, he could not restrain his tears. Mr Grant, who was the moving force behind the Mother and Baby-Friendly Hospital Initiative of UNICEF and the World Health Organization, was so touched with the sight of a premature infant being given breast-milk from a medicine glass.

Since that time, the 700-bed maternity hospital, under the direction of its Chief Ricardo B Gonzales, MD, has drawn worldwide attention for the headway it has made in applying the principles of the International Code of Marketing of Breast-milk Substitutes, as well as the Philippine counterpart of the code, and later, the Rooming-in and Breastfeeding Act of 1992. Experts and academicians would fly in from different parts of the world seeking out the antiquated hospital complex in Lope de Vega Street, and witness for themselves, the "Fabella Experience."

Defying the odds

With childbirth being the top cause for women to seek medical attention, practically all health facilities are equipped to attend to routine deliveries. As the premiere maternity hospital, Fabella is not mandated to attend to all childbirths in the Metropolis, but to serve, instead, as the training center for midwifery and OB-Gyne concerns, and as a referral center for risk or complicated pregnancies.

With more than the usual share of babies and mothers with conditions that make breastfeeding difficult, it would be expected that the hospital would experience many occasions in which infant formula would be "medically indicated." However, Fabella has maintained a 100 percent breast-milk policy for well over a decade, having been successful at employing other means of allowing premature or abnormal babies to take breast-milk, even if the milk is expressed from other mothers at the hospital. What continues to surprise the global health community is that Fabella manages to accomplish all this in over-crowded maternity wards in which mothers and babies often have to share beds with others. The hospital now averages 120 births in a single day, all of which are breastfed.

Standing out as a beacon of success in this initiative, Fabella continues to be visited by international dignitaries, academicians, observers, and various experts who wish to see things for themselves, and seek an audience with Dr Gonzales to understand his formula for success.

Need for a declaration

"The endpoint of these discussions is about the milk industry," recounts Dr Gonzales, referring to the many meetings he had with international figures visiting Fabella. "They always say, 'How does the milk industry help you? What is your relationship with the milk industry?' So I thought it was high time that I prepared an honest-to-goodness declaration of my relationship with the milk industry," he continued.

In preparing that declaration, Dr Gonzales stressed that he does not subscribe to the popular notion that breast-milk advocates should adopt an adversarial position vis-à-vis the milk companies. Advocates and activists have often pointed an accusatory finger at multinational milk companies for the decline of breastfeeding. "We shouldn't be combative. We shouldn't blame them for our negligence," he stressed, pointing out that it is only the advocates like himself who are to blame for their limited success in promoting the practice among mothers.

Turning the tables?

Dr Gonzales chooses, instead, to draw from the strengths of the milk companies. Noting that these companies are quite adept at promoting their products, while breast-milk advocates are notably inefficient in promoting the practice, the hospital chief set out to promote breastfeeding using the means employed by these international milk companies.
"We breast-milk advocates are always shouting that the problem is the milk companies. I said: 'let us turn around. Let us use the advertising strategies of the milk companies in promoting their product. Then let us promote our own products using their strategies.' That is also the reason why I had to make public my stand," Dr Gonzales told Medical Observer.

With such an outlook, Dr Gonzales explored the scientific literature used by Nestlé Philippines as basis for the company's information activities. "Let us accept the fact that their target is to approximate their product to be almost similar to breast-milk," he stressed, adding that he increased his knowledge of the characteristics of breast-milk by reading Nestlé's literature.

Dr Gonzales recounted the launch of the Baby-Friendly Initiative many years ago at which UNICEF's James Grant said: "If Fabella can do it, what more of the others?' The reason there is "We stopped blaming the milk companies. We started blaming ourselves. I think that is the greatest thing that ever happened. We now look at our own deficiencies and shortcomings," he indicated.

The official charter of The Jose Fabella Memorial Hospital encourages co-operation with the infant formula industry.