Philippines Senator Serves as Breastfeeding Champion

Senator Pia Cayetano is an example of a breastfeeding champion who has used her position in the national government to protect, promote, and support Philippine women’s right to breastfeed and defines herself as “a staunch breastfeeding advocate”. She has given numerous speeches, introduced legislation and motivated other politicians to support breastfeeding. Having an organic champion of breastfeeding within the government is extremely cost-effective, as champions can use many avenues to increase breastfeeding support at almost no cost. If organic champions don’t exist, catalyzing and supporting key government stakeholders to advocate breastfeeding is still a critical component of breastfeeding advocacy as is lobbying. Breastfeeding rates have increased significantly from 2003 to 2013, and while not all of these improvements can be solely attributed to Senator Cayetano, her promotion and legislative efforts supported improvements in the Philippine’s breastfeeding environment.

Description and Context

Senator Pia Cayetano is an example of a breastfeeding champion who has used her position in the national government (Senator 2004-2016, Congresswoman 2016-Present) to protect, promote, and support Philippine women’s right to breastfeed. She was the youngest woman elected Senator in the history of the Philippines and is a member of a prominent political family–both her brother and father are/were Senators, another brother is an ex-city councilor, and a third brother is a former Barangay Chairman (local government unit) and a current congressional representative (1,2). She defines herself as “a staunch breastfeeding advocate” and is well known for her pursuit of women and children's rights (3). She has over 416,500 likes on her Facebook page, 655,000 followers on Twitter, and 583,000 on Instagram (these figures continually rise), where she regularly updates about breastfeeding-related legislative issues and her charity “Pinay in Action,” which is dedicated to improving the lives of Filipino girls and women through empowering activities such as all-women sporting events, fitness clinics, and inspirational talks and seminars on women’s health, anti-violence against women, and breastfeeding promotion (4, 5, 6).

Senator Cayetano has given numerous speeches in support of protecting, promoting, and supporting Philippine women’s right to breastfeed. Most speeches center on women’s rights for breastfeeding protection during emergencies or humanitarian disasters, breastfeeding in the workplace, and paid maternity leave (7). Most recently she delivered a speech on the national Breastfeeding Month in August 2017 (8). This speech focused on strengthening the implementation of the Expanded Breastfeeding Promotion Act of 2009, a law Senator Cayetano sponsored, which mandates that breastfeeding rooms be established in public places and workplaces and that women are given paid lactation breaks (8). She ends powerfully stating, “society acknowledges and respects a woman’s unique ability to give birth to a child. But it is high time we give the same respect to breastfeeding – no jokes, no whispering behind our backs – but solid and unconditional support for this amazing gift that women have to feed and raise our babies” (8). Senator Cayetano has been instrumental in motivating other politicians to support breastfeeding; Senator Cynthia Villar and Senator ‘Bam’ Aquino supported the launch of the Philippine Senate’s breastfeeding room, and multiple other senators have been consistent co-sponsors on her proposed legislation such as Senator Grace Poe and Senator Juan ‘Sonny’ Angara (8,19,21).

In 2003, the Philippines reported that only half of all mothers initiated breastfeeding within the first hour of birth, that
only 16% of infants were exclusively breastfeeding at 4–5 months, that 57.9% were breastfeeding plus using appropriate solid and semi-solid food at 6–9 months, and that only 33.3% were still breastfeeding at 20–24 months (9). All of these rates increased significantly over the past decade: in 2013, 77% of all mothers initiated breastfeeding within the first hour of birth, 28.3% of infants were exclusively breastfeeding at 5 months, 92.6% were breastfeeding
plus using appropriate solid and semi-solid food at 6–9 months, and the median duration of breastfeeding increased (10). While clearly not all of these improvements can be solely attributed to Senator Cayetano and her entrance into
the Philippine government, her promotion and legislation efforts support the improvements in breastfeeding.

Main Components

Pinay in Action

“Pinay in Action,” Senator Cayetano’s charity, was created to focus on improving the well-being of all Filipina women (12). Their main activities include all-women sports events, fitness clinics, inspirational talks, and seminars that are on women’s health, anti-violence against women, and breastfeeding (12). The program is funded by the Compañero Rene Cayetano Foundation, a non-stock, non-profit organization established to promote the late Senator Rene Cayetano’s advocacies on education, health, sports and youth development, and the environment (12).

Sen Cayetano’s legislative history:

Magna Carta of Women, 2009 (13):

Modeled on international law, the Magna Carta of
Women was authored principally by Senator Cayetano as a comprehensive women's human rights law that seeks to eliminate discrimination through the recognition, protection, fulfillment and promotion of the rights of Filipino women, especially those most marginalized. Section 17 stipulates women’s rights to health, and includes access to the following services:

• Maternal care including pre- and post-natal services to address pregnancy and infant health and nutrition
• Breastfeeding promotion

Expanded Breastfeeding Promotion Act of 2009 (17):

Principally authored by Senator Cayetano, the act requires private and public establishments, including governmental establishments, to provide lactation stations. Expenses incurred by private health and non-health facilities in creating these lactation stations were stipulated to be deductible expenses (for income tax purposes) that can be up to twice the actual amount incurred. The law also stipulates “lactation periods,” at least 40 minutes every day, for breastfeeding employees. In addition, health institutions are encouraged to put up breast milk banks to store pasteurized breast milk donated by breastfeeding mothers. Finally, breastfeeding was stipulated to be included in the curriculum of schools under relevant subjects.

Philippine Disaster Risk Reduction and Management Act of 2010 (16):

This act, supported by Cayetano served to strengthen the Philippine Disaster Risk Reduction and Management System. Cayetano particularly pushed for “gender provisions” in the act that seek to implement a program where humanitarian aid workers and other sectors involved in disaster risk reduction work are educated and trained on how they can actively support breastfeeding before and during a disaster or emergency (Section 2 Part O and Section 12: 15,16).

Midwife to the Barangay Act of 2013 (14):

This law written by Senator Cayetano stipulates that at least one midwife must be appointed to each barangay, the smallest administrative unit in the Philippines. Section 4 details the midwife’s duties:

“All Midwives to the Barangay are mandated to ensure that mothers and infants, in their respective jurisdictions, are given quality and essential health care services, including, but not limited to, prenatal and postnatal care, breastfeeding support, providing information on the importance of immunization and ensuring that infants are given the proper vaccines as provided in the DOH Expanded Program on Immunization, and proper care and nutrition of both the mothers and the infants” (14).

Resolution on Breastmilk Substitutes, Breastmilk Supplements and Other Related Products 2013 (15):

Due to recently reported violations, this resolution proposed by Senator Cayetano directed the Senate Committee on Health and Demography to conduct an inquiry on the implementation of the National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements and Other Related Products as well as the Rooming-In and Breastfeeding Act of 1992 and the Expanded Breastfeeding Promotion Act of 2009.

Expanded Maternity Leave Law 2017 (26, 27):

Senator Cayetano most recently co-sponsored this law in 2017, which was approved to extend maternity leave to 120 days for female workers in the government service and the private sector with an option to extend for an additional 30 days without pay. It also provides for parental leave for adoptive parents and an additional 30 days for single mothers.

Senator Cayetano’s public speeches regarding breastfeeding:

Breastfeeding protection during emergencies or humanitarian disasters

In 2011, Senator Cayetano raised awareness for the need for maternal protections in the event of an emergency or humanitarian disaster. She cautioned against the distribution of breast milk substitutes in disaster situations and the need for local government units and relief workers to be responsive to needs of nursing mothers who take shelter in evacuation centers. “Nursing mothers must be encouraged to breastfeed while staying in relief centers and even after they return to their homes when the risk has subsided. This is to ensure that their children will continue to receive proper nutrition and protection against disease outbreaks from nutrients that could only be supplied by mother’s milk,” she said, adding “our evacuation centers and relief efforts must be gender-responsive and ready to care for the particular needs of women and children since they are among the most vulnerable whenever disaster strikes and communities at risk are forced to evacuate.” This is a critical issue for the country as roughly 20 typhoons hit the Philippines every year (18).

Breastfeeding protection and breastfeeding in the workplace

The Philippines celebrate World Breastfeeding Month every August. Ahead of World Breastfeeding Month, Senator Cayetano's regularly delivered speeches to the Philippine Senate to garner attention for breastfeeding issues. Her speeches have addressed World Breastfeeding Week themes and highlighted the country’s achievements as well as identified country challenges in protecting, promoting and supporting breastfeeding. She has spoken about the role of the government in guaranteeing adequate and responsive legislation that bans the advertisement, promotion, and sponsorship or marketing of infant formula. She has also called upon the Department of Health to look into illegal practices that were still occurring despite stringent breastmilk substitution legislation. She has outlined upcoming activities, highlighted other prominent breastfeeding advocates, including other senators, and launched the Senate’s first breastfeeding /lactation room (19, 20, 21, 22, 23).

Paid Maternity Leave

In 2015, Senator Cayetano proposed a bill to extend maternity leave in the Philippines to 100 days (24,25). On two occasions, while introducing her Expanded Maternity Leave Bill to the Senate, Senator Cayetano expressed public commitment to breastfeeding (23, 24). She took the opportunity during these two speeches to promote the benefits of breastfeeding, highlighting the scientific evidence to support the argument that longer maternity leave leads to increased breastfeeding rates, which in turn leads to better health outcomes for mothers and children. She used the UNICEF/Alive & Thrive policy statement on Maternity Leave as part of her evidence base for legislative action. She also invited her colleagues to visit the photo exhibition outside the Senate chamber featuring breastfeeding mothers, most of whom were government staff, including the Senator’s own Chief of Staff, Deputy Chief of Staff, personal assistant, and other members of staff. In 2017 her efforts were brought to fruition, as she co-sponsored the law that extended maternity leave to not just 100 days, but 120 days (26).

Media attention

Senator Cayetano’s efforts garnered extensive media attention. She was interviewed in the media several times about her proposed Expanded Maternity Leave Bill. One news headline highlighting the passing of the 100 Days of Maternity Leave bill in the Philippine Senate on January 2016 stated “Senator Pia Cayetano, chairperson of the Senate Committee on Women, Children, Family Relations and Gender Equality and sponsor of Senate Bill No. 2982, said the current allowable maternity leave is less than the 98-day minimum requirement of the International Labor Organization (ILO).” This article also highlighted that the bill states that private sector workers will not receive less than two thirds of their normal wage (25).

Senator Cayetano’s commitment to improving maternal and child health and nutrition in the Philippines was captured in a UNICEF Philippines press release about the legislative advocacy forum UNICEF hosted at the Philippine Senate, specifically on maternal/child health and nutrition. Senator Cayetano and other senators were present to support the agenda (28). Senator Juan Edgardo Angara stated, “we will pursue strong legislation to ensure growth and development to their full potentials. This is a very meaningful window for both houses of Congress to pass important legislation supporting this advocacy, because maternal and child nutrition and health touch on issues of social justice and inequality.” The Department of Health, National Nutrition Council, Department of Social Welfare and Development, and NGOs including World Vision, Save the Children, and International Care Ministries were all present. A similar forum at the House of Representatives took place just after the Senate’s. These forums were
organized by the Philippine Legislators’ Committee on Population and Development (PLCPD), which Cayetano and Angara chaired and vice-chaired respectively (28).

Evidence of Implementation Strategy

As evidenced in the “Main Components” section, Senator Cayetano has proposed and implemented an abundance of legislation, as well as made many public speeches promoting the support of breastfeeding. Her popularity on Facebook and Twitter, where she regularly updates about breastfeeding-related legislative issues, display the large audience she is reaching. In addition, her charity “Pinay in Action,” is clear evidence of her support of breastfeeding, as it puts on seminars on women’s health and breastfeeding promotion. Many national Philippine news stations cover Senator Cayetano’s efforts. For instance, in August 2014, the Philippine Star covered the opening of the Senate lactation room, part of the Expanded Breastfeeding Promotion Act that stipulated breastfeeding rooms in private and public places, including government establishments (11).

There have been large improvements in breastfeeding in the Philippines since 2003, when Senator Cayetano entered the national government; in 2003, the Philippines reported:

• Half of all mothers initiated breastfeeding within the first hour of birth
• 16% of infants were exclusively breastfeeding at 4–5 months
• 57.9% were breastfeeding plus using appropriate solid and semi-solid food at 6–9 months

All of these rates increased significantly by 2013:

• 77% of all mothers initiated breastfeeding within the first hour of birth
• 28.3% of infants were exclusively breastfeeding at 5 months
• 92.6% were breastfeeding plus using appropriate solid and semi-solid food at 6–9 months (10).

While these improvements cannot be solely attributed to Senator Cayetano, her high profile and strong promotion and legislation efforts would have contributed to these the improvements in breastfeeding rates.

Cost and Cost-Effectiveness

Having an organic champion of breastfeeding within the government is extremely cost-effective as they can use many avenues to increase breastfeeding support at almost no cost: they can introduce and promote legislation, raise awareness on a large-scale, influence other policy decision-makers, and sponsor activities related to breastfeeding. If their support of breastfeeding is truly organic, then it comes at no cost as all of these actions will be internally-motivated and without the need of a monetary incentive. However, costs may be associated to help the government official carry out their supportive actions. For instance, Senator Cayetano’s “Pinay in Action” charity requires sponsors to be able to hold all its activities, which includes hosting seminars on breastfeeding. In addition, staff that aid Senator Cayetano–perhaps managing the Facebook and Twitter pages–also necessitate a salary. Finally, news coverage on Senator Cayetano’s promotion efforts may have associated costs as well.

If there is no organic champion of breastfeeding, catalyzing and supporting key government stakeholders to advocate breastfeeding is still a critical component of breastfeeding advocacy (30). To this end, breastfeeding organizations can reach out personally to government officials, a method that could be particularly effective if they have a specific project the official could promote. Lobbying is also an effective method at creating change, however, breastfeeding organizations might not have the money to hire a lobbyist, which can be expensive.

Ultimately, if a country can find a well-known government official with a stake in breastfeeding and motivate them to promote breastfeeding, they can achieve cost-effective national coverage through many different political and social avenues.

Perceptions and Experiences of Interested People

There is strong evidence of Senator Cayetano’s popularity from press releases and her Twitter and Facebook feeds. The number of likes and shares she obtains from her posts show a large, supportive audience (4,5). In addition, many national news stations cover Senator Cayetano’s efforts in a positive light. For instance, in August 2014, the Philippine Star called the opening of the Senate lactation room a “landmark act,” that was part of the Expanded Breastfeeding Promotion Act that stipulated breastfeeding rooms in private and public places, including government establishments (11). Another press release from the online website Smart Parenting praised her Expanded Breastfeeding Promotion Act (29).

Benefits and Potential Damages and Risks

• A significant risk in having a highly visible government official supporting breastfeeding is that, outside of legislation, the message is in their own words and media outlets. This could lead to messages without factual support regarding breastfeeding. In addition, the official may only be respected by part of the population, leading a significant majority to reject the message.
• A risk with focusing efforts on an official that supports breastfeeding is that they may not have adequate time and capacity to strongly promote breastfeeding as they have many other national issues they must consider. Breastfeeding promotion and protection could fall by the wayside.
• There is a risk that the government official will be voted out of office. If possible, the best practice is to have two or more government officials support breastfeeding.
• Benefits include bringing more attention and legislation to support breastfeeding through an influential government official that publicly support its purpose. Ultimately, this could lead to a larger acceptance and normalization of the act of breastfeeding both in law and in the country’s culture.
• Having a breastfeeding advocacy group that supports the government champion can be very beneficial; this can ensure that the government official is updated on current progress on-the-ground and can bring new ideas for legislation to their attention.

Scaling Up Considerations

• It may be beneficial for the government official that supports breastfeeding to include this in any statement regarding their areas of interest in legislation and advocacy. Formalizing their support in this way ensures that they will be expected to pursue legislation and promotional efforts for breastfeeding.
• The government official needs a way to reach breastfeeding mothers for educational and support purposes. Senator Cayetano has done this through her charity “Pinay in Action” that hosts seminars on breastfeeding, and through her Facebook and Twitter pages that disseminate information.
• Press releases are published for any speech, presentation, or action that the government official does pertaining to the support of breastfeeding in order to disseminate the message on a large-scale.
• If there is no organic champion of breastfeeding, catalyzing and supporting key government stakeholders to advocate breastfeeding is still a critical component of breastfeeding advocacy (30). To this end, breastfeeding organizations can reach out personally to government officials, a method that could be particularly effective if they have a specific project the official could promote. Lobbying is also an effective method at creating change.

The largest barrier is a lack of a government official with an organic support for breastfeeding; if there is no such official, breastfeeding stakeholders must advocate effectively and motivate a government official to promote
breastfeeding. This requires much more time, effort, and possibly money; lobbying is also a possibility but often a cost-prohibitive one.

Equity Considerations

Rural or poor mothers may not have access to social media via Internet, and so would not be privy to Cayetano’s online promotion and support efforts. Nonetheless, legislation is nation-wide and should impact their lives.

References:

1. Senate of the Philippines: 17^th Congress. Biography of Senator Pia S. Cayetano. Retrieved from https://www.senate.gov.ph/senators/sen_bio/pcayetano_bio.asp
2. Senate of the Philippines: 17^th Congress. Biography of Senator Alan Peter S. Cayetano. Retrieved from https://senate.gov.ph/senators/sen_bio/cayetano_alanpeter_bio.asp
3. Official Website of Philippine Senator Pia S. Cayetano. (2014). Give ‘Morong 43’ Mom a Chance to Breastfeed Baby. Retrieved from http://senatorpiacayetano.com/?p=83
4. Facebook. Official Pia Cayento. Retrieved from https://www.facebook.com/officialpiacayetano/
5. Twitter. Official Twitter of Pia Cayento. Retrieved from https://twitter.com/piacayetano?lang=en
6. Pinay in Action: Empowering Women One Step at a Time. Retrieved from http://www.pinayinaction.com/
7. Official Website of Philippine Senator Pia S. Cayetano. (2014). Speeches. Retrieved from http://senatorpiacayetano.com/?page_id=8
8. Official Website of Philippine Senator Pia S. Cayetano. (2014). Speech on Breastfeeding Month. Retrieved from http://senatorpiacayetano.com/?p=3082
9. World Health Organization. (2013). Breastfeeding in the Philippines: A Critical Review. Retrieved from http://iris.wpro.who.int/bitstream/handle/10665.1/12402/9789290617273_eng.pdf?ua=1
10. World Breastfeeding Trends Initiative. (2015). Report: Philippines. Retrieved from http://www.worldbreastfeedingtrends.org/GenerateReports/report/WBTi-Philippine-2015.pdf
11. Mendez, C. “Senate Launches Breastfeeding Room Today” (2014). The Philippine Star. Retrieved from https://beta.philstar.com/headlines/2014/08/11/1356239/senate-launches-breastfeeding-room-today
12. Pinay in Action: Empowering Women One Step at a Time. About Us. Retrieved from http://www.pinayinaction.com/?page_id=579#piaAdvoc
13. Congress of the Philippines. RA 9710: The Magna Carta of Women (2009). Retrieved from http://www.lawphil.net/statutes/repacts/ra2009/ra_9710_2009.html
14. Senate of the Philippines. S. No. 28: Midwife to the Barangay Act of 2013 (2013). Retrieved from http://senate.gov.ph/lisdata/1583613074!.pdf
15. Senate of the Philippines. Res. No. 218: Resolution on Breastmilk Substitutes, Breastmilk Supplements and Other Related Products (2013). Retrieved from http://senate.gov.ph/lisdata/1738014612!.pdf
16. Congress of the Philippines. RA 1021: Philippine Disaster Risk Reduction and Management Act of 2010. (2010). Retrieved from http://www.lawphil.net/statutes/repacts/ra2010/ra_10121_2010.html
17. Congress of the Philippines. RA 10028: Expanded Breastfeeding Promotion Act of 2009. Retrieved from http://www.lawphil.net/statutes/repacts/ra2010/ra_10028_2010.html
18. Facebook: Official Pia Cayetano. (2011). New Release: Encourage Breastfeeding in Evacuation Centers. Retrieved from https://www.facebook.com/notes/pia-cayetano/encourage-breastfeeding-in-evacuation-centers/188012007929265
19. Official Website of Philippine Senator Pia S. Cayetano. (2014). Give Breastfeeding Moms a (Lactation) Break! Retrieved from http://senatorpiacayetano.com/?p=59
20. Official Website of Philippine Senator Pia S. Cayetano. (2014). Let’s Embrace a Breastfeeding Culture. Retrieved from http://senatorpiacayetano.com/?p=1853
21. Official Website of Philippine Senator Pia S. Cayetano. (2014). Breastfeeding- A Winning Goal for Life. Retrieved from http://senatorpiacayetano.com/?p=2352
22. Official Website of Philippine Senator Pia S. Cayetano. (2014). Breastfeeding A Security Issue. Retrieved from http://senatorpiacayetano.com/?p=2379
23. Official Website of Philippine Senator Pia S. Cayetano. (2015). Breastfeeding and Work, Let's Make It Work! Retrieved from http://senatorpiacayetano.com/?p=2855
24. Official Website of Philippine Senator Pia S. Cayetano. (2015). Extend Maternity Leave to 100 days. Retrieved from http://senatorpiacayetano.com/?p=2884
25. Official Website of Philippine Senator Pia S. Cayetano. (2016). Senate OKs 100 Days Maternity Leave Bill. Retrieved February 17, 2016, from http://senatorpiacayetano.com/?p=2965
26. Senate of the Philippines. S. No. 1305: Expanded Maternity Leave Law of 2017. (2017). Retrieved from https://www.senate.gov.ph/lisdata/2530221794!.pdf
27. ABS-CBN News. (2017). Senate OKs 120-day Maternity Leave Bill. Retrieved from http://news.abs-cbn.com/focus/01/24/17/100-day-maternity-leave-bill-now-in-house-plenary
28. UNICEF. (2015). UNICEF launches child nutrition advocacy with Senate, House [Press release]. Retrieved from http://www.unicef.org/philippines/media_24461.html#.VuMQJY-cHIU
29. Smart Parenting. (2010). The Expanded Breastfeeding Promotion Act (RA 10028): Support for Breastfeeding Mothers in the Workplace. Retrieved from https://www.smartparenting.com.ph/life/news/the-expanded-breastfeeding-promotion-act-ra-10028-support-for-breastfeeding-mothers-in-the-workplace
30. WHO. (2015). Breastfeeding Advocacy Initiative. Retrieved from http://apps.who.int/iris/bitstream/10665/152891/1/WHO_NMH_NHD_15.1_eng.pdf?ua=1