BEIRUT: At a time when the world is seeing a boom in breast-feeding rates, Lebanon remains stubbornly stuck on formula, and although the Health Ministry has sought to counter this, activists want the government to crack down on companies skirting the law.
The law in question, entitled “Organizing the Marketing of Baby and Young Child Feeding Products and Tools,” was passed in 2008 and forbade all formula-producing companies from marketing their products to children less than 3 years of age. But critics say firms are ignoring the new rules amid poor implementation of the legislation.
At a morning “nurse-in” on the steps of the Public Health Ministry, mothers, children and a few fathers bearing colorful signs gathered to demand that the law be more strictly enforced in an effort to curb the promotion of formula for young children in hospitals and doctors’ offices.
Organized by local pro-breast-feeding activist group, LACTICA, those assembled complained that the distribution of formula samples in hospitals was hindering efforts to encourage mothers to breast-feed, with such marketing practices making it more difficult for women to make informed choices.
On the side of the sunny, morning demonstration, activist Dareen Fares recalled the trials she experienced when hospital staff tried to persuade her to give her son formula during his first few days of life.
“They told me, ‘You are starving your baby,’” Fares said. “Moms don’t need this. They need medical staff to be more supportive.”
It was a story that was echoed by many of the mothers at the protest, and one repeatedly heard by Iman al-Zein of the Lebanese Association for Early Childhood Development. A lactation consultant and breast-feeding advocate since the early ’90s, Zein says hospitals and pediatricians are incentivized by formula companies and give in for want of more funding.
Public health research and clinical evidence overwhelmingly conclude that breast-feeding is the best option for both mother and baby’s health. Compared to formula, it is cost-effective and superior in promoting cognitive and physical development and boosting immunity in the first crucial period of a child’s life.
In Lebanon, however, many new mothers opt to forego breast-feeding due to exhaustion and fears of insufficient milk supply as well as the possible change in their appearance.
AUB pediatrician Haya Hamade’s 2013 study of mothers in the Lebanese capital found that the rate of those that exclusively breast-feed was only 27 percent. National statistics fall even lower. The most recent UNICEF data showed that 15 percent of children under 6 months were only breast-fed. This drops to 1.5 percent at the end of 6 months.
A 2014 study by Mona Nablusi, head of pediatrics at the American University of Beirut Medical Center, identified three crucial components to breast-feeding success: education, encouragement from medical professionals and support from peers.
Speaking to The Daily Star, Dr. Walid Ammar, director-general of the Public Health Ministry, stressed the health benefits of breast-feeding for both mothers and children and emphasized the need for it to become a priority for the government.
He said the main obstacle to ensuring proper legislation implementation was one of human resources: “We are overwhelmed and understaffed.”
He regularly receives photos of advertisements from breast-feeding activists, which he reviews for violations of law 47.
“This is a very important issue for us. We are behind this law,” he said.
The ministry established a committee to review the advertisements, prohibiting those that promote formula for children under 3 years old. But in response to the law’s passage, Ammar and his colleague, pediatrician Antoine Romanos, said formula companies had found ways around it, abiding by the letter of the law, but not the spirit.
One roadblock to proper implementation of law 47 is its vagueness regarding ways to punish companies who violate it.
“This is often left to the discretion of the judge. The law is very tough, but I think this represents a weakness,” Ammar said.
LACTICA organizer Sara Luis-Hannan said that greater implementation of the law required more effort and monitoring from the ministry.
She also cited the asymmetry of funding as a major reason for the pressure mothers feel to choose formula over real milk: “There is no budget to advertise breast-feeding, but formula companies have millions of dollars to spend on advertising each year.”
Her husband, Raffi Ohanian, who was front and center among the demonstrators, said families were bombarded with formula advertisements, making it tempting for mothers to switch.
“It is important for the father to be on the side of the mother and to support her in breast-feeding,” Ohanian said.
While breast milk is best for both mother and child, some doctors are right to recommend formula under circumstances that may jeopardize the baby’s health.
President of the Lebanese Society of Pediatrics, Dr. Imad Chokr, said breast-feeding was most important in the first six months to one year, but agreed milk could be supplemented with formula if there were problems with the child’s development.
“There are situations when breast milk is insufficient, and the baby isn’t gaining enough weight, especially during the first month of life,” echoed Antelias-based pediatrician, Dr. Raffi Kaloustian. “When you feed via bottle, you know the quantity you are getting, but the baby might suckle at the breast for two minutes and you don’t know how much he took.”
Bledina, one of the largest formula companies in Lebanon, declined to be interviewed, but parent company Danone released the following statement: “We believe that ‘Breast milk is the best’ and the importance of protecting and promoting exclusive breast-feeding for the first six months and continued breast-feeding for as long as possible.
“Bledina supports the aims and principles of the WHO [World Health Organization] code of marketing breast milk substitute and implementation of Lebanon Law 47/2008. We have strict internal policies that aim to ensure all our businesses operate in a responsible manner,” it added.