Oct 2019 – Exclusive – Chat with Ines Fernandez, Breastfeeding Advocate in the Philippines

As told to Nabila Hanim, BMSG Staff

At the recent Regional Breastfeeding Conference in Malaysia, the BMSG team met Ines Fernandez, a breastfeeding advocate from the Philippines. Ines has been doing extensive work, advocating for breastfeeding, and contributed to policies to make breastfeeding a right for Filipino mothers since the 1980s. Most notably, Ines has contributed significantly to protecting the feeding of infant and young children during emergencies and continues to educate mothers and their families in rural areas on breastfeeding, infant and child nutrition. Read her inspiring story as we learn more from what she has garnered from her experiences and why it is valuable for countries like Singapore to practice similar readiness in the face of disasters.

Founding Member of the Breastfeeding Movement in the Philippines

Ines (in red) with BMSG representatives during the recent 2nd Regional Breastfeeding Conference in August 2019. [Credits: Far’ain Jaafar]

I co-founded the breastfeeding movement in the Philippines in 1981. I am proud to have contributed to transforming thousands of mothers as nurturers, healers and leaders in defence of breastfeeding rights and education. In the work that I do, I have managed to facilitate the passage of three laws:

  • The Milk Code to regulate marketing of breastmilk substitutes, supplements and related products (1986)
  • The Rooming-in Act for moms and babies to be together after birth in the hospital room for breastfeeding (1992) and
  • Expanded Breastfeeding Promotion Act for working women at the workplace (2009)

I currently focus on my work in Arugaan, which is a breastfeeding support organisation that educates mothers in communities across the Philippines on initiating and sustaining breastfeeding, as well as on the importance of healthy infant and child feeding, particularly on using indigenous foods. My team and I currently conduct education efforts through classes and seminars on breastfeeding, healthy weaning foods for children as well as lactation massage workshops for relactation.

Beyond the Philippines, I am also the International Baby Food Action Network (IBFAN) representative to 11 countries in Southeast Asia. I was also previously a co-coordinator of the World Alliance for Breastfeeding Action’s (WABA) Women and Work Task Force.

Creating Support Measures for Breastfeeding Mothers

Nanay Ines conducting a peer counselling course to potential lactation counsellors in the Philippines. [Credits: Arugaan FB Page]

I co-founded Arugaan (meaning to nurture fully with lifetime commitment), a mothers’ breastfeeding support group in 1989 which provides a creche day-care for breastfeeding babies and toddlers in support of working parents.

Arugaan’s Breastfeeding Help programme provides home visits and gives breastfeeding counselling and special lactation massages to address breastfeeding challenges to nursing mothers. I call myself Nanay Ines (Nanay meaning “Mother”) as I consider myself a mother to all breastfeeding mother support groups in the Philippines under my care. To continue the good work that I do, I also conduct training for Breastfeeding Counsellors and Lactation Massage Specialists to help in relactation management and to assist babies who are bottle-fed to return to feeding from their mothers’ breasts.

The Arugaan Creche runs from 7am till 7pm and serves nutritious and indigenous foods to the children. Wet-nursing staff are also on duty in support of working breastfeeding moms. We have also developed indigenous food recipes for babies above six months old and for toddlers under the Arugaan programme called the “Eat Right Complementary Feeding”.

The Power of Relactation Massage

One of the programmes pioneered by Ines is the lactation massage class to help improve and . or induce milk supply. Partners and grandmothers are welcomed to attend the class, too.  [Credits: Ines Fernandez]

In recent years, I have also developed a relactation massage programme which has amazingly transformed women who are single, married or even grandmothers, to lactate. As I strongly believe that breastfeeding has no age barrier, a lot of women have relactated for the purpose of emergencies where breastmilk is a form of sustenance not just for children, but also the vulnerable and sick, such as the elderly and chronically-ill people.

I have also relactated! When I was 62, I became a wet nurse to a one-year old baby for two months and at 64 to a two month-old baby for a week at the Arugaan Creche Day Care. At 66, I feel that I look younger than my age because of breastfeeding and I am always ready on call in times of emergency. I am currently also coordinating a Hot Lola (Grandma) Club in support of working daughters: this means that grandma breastfeeds the baby in the day while the baby’s mother breastfeeds him or her at night. It is so meaningful that the whole family is involved in nurturing the next generation.

Ines was a wet nurse to several babies she had met in her journey as an advocate. She helps  grandmas to relactate and contribute to breastfeeding babies. [Credits: Ines Fernandez]

Relactation Programmes for Emergencies

I have led women to relactate during emergencies through the formation of the “Breastfeeding Rescue through Relactation” programme. During times of emergencies, the Breastfeeding Expert Support Team (BEST), some of whom are women ready to relactate in times of emergencies, would work very hard to produce breastmilk as a form of emergency food. Through relactation, nearly 30 women were able to relactate during two devastating typhoons in 2009 (Ondoy/Ketsana in Manila) and 2013 (Yolanda and Haiyan) that damaged and destroyed the lives of many people. In 54 days, the women were able to produce milk to help babies, young children, and even vulnerable adults who were affected by the typhoons.

Mothers and women who were committed to relactation would sit together in evacuation centres to encourage babies to return to the breast or produce breast milk to give to babies and toddlers who survived the typhoons. [Credits: Ines Fernandez]

The relactation programme transformed 3,432 mom-baby pairs into survivors. Only 20 moms were unable to relactate as they were taking hormonal contraception as early as one month after birth. They were probably given wrong information by health workers in the public health centres.

Breastfeeding as a Saviour in Difficult Times

Breastfeeding management experts are very few and far in between globally. In the Philippines, Arugaan BESTeam walk their talk, share resources and support mothers who are in need.

When the medical group of the Philippines General Hospital led by neonatologist Dr. Mianne Silvestre called for volunteers in their medical mission for typhoon survivors, some of the Arugaan BESTeam who were lactating moms volunteered to become wet nurses to babies who had survived the typhoons.

A community effort: When breastmilk is seen as a vital form of sustenance in times of crises, everyone chips in to help. In the case of this malnourished baby, a wet nurse had helped to feed the baby while his mother attempted to relactate. Baby was also given expressed breastmilk during the period of time that mum was relactating. [Credits: Ines Fernandez]

These mothers managed to cross nurse by exchanging babies so that all the mom survivors will instantly learn by hands-on demonstration about breastfeeding positions, proper latching and hand expressing breastmilk. We advocate hand expression because we had observed that many breast pumps destroy and damage the breasts and ultimately reduce breastmilk supply and flow in a matter of a few months.

Lactation Massage to Increase Milk Supply 

We promote the Arugaan lactation massage techniques to enhance the breasts’ potential for lactation. We have empowered by teaching mothers how to express breastmilk using  their very own hands to regain their power to nurture naturally with God’s gift of love: breastfeeding.

During our relactation journey after the disastrous typhoons Yolanda and Haiyan, we had managed to help 3,000 moms in one month and followed up with 6,000 moms in a successive periods of three months after. We encountered many orphans left with either their grandmas or with their dads, or small children who had to care for their younger sibling. The most heartbreaking moment was when we met a 10 year-old girl who was solely taking care of her 10 month-old breastfed sibling; they had lost their mother and their other siblings who were washed away by the tidal waves.

Required Infrastructure for Breastfeeding Mothers During Emergencies

The Arugaan BESTeam’s food security program assisted 500 moms with babies and young children daily at the evacuation centres, some of which were located on seashores.

We found that it was very helpful to cook hot meals on the spot by using indigenous food found locally. We brought root crops, vegetables, crockery, stoves as well as donated baby slings, cloth diapers, natural soap, towels and clothing from Manila.

We had portable breastfeeding tents painted with big colorful photos of our visual aids so that people walking past could read the breastfeeding messages translated into the local language.

Help knows no boundaries. The members of the BESTeam not only helped in breastfeeding but also distributed important supplies for mothers and babies who were in need.  [Credits: Ines Fernandez]

The Irony of Donated Food and Formula Milk in Times of Disasters

Many aid agencies give bags of canned goods and artificial milk. We encountered many moms crying for help as they thought that their breastmilk supply was diminishing and their babies had become totally dependent on donated formula milk. However, we found that many of these mothers were actually fully engorged!

We helped some of these mothers by providing counselling and lactation massage and were happy to discover that they had a good supply of breastmilk. To pay forward, they in turn donated their excess milk to hungry toddlers and orphans. We also encouraged them to share their breast milk with severely acute malnourished children.

In times of a forthcoming emergency, we can now rely on transformed breastfeeding mothers and counsellors whom we have trained in the evacuation centres. We taught them how to counsel other mothers and demonstrate hands-on proper breastfeeding positions to boost the confidence and capability of mothers for breastfeeding success.

Trauma a Huge Challenge

Sacrifice – Some Arugaan members had to leave behind very young children and travel far distances, sometimes by boat, to reach affected rural areas after the typhoons to help mothers and babies. [Credits: Ines Fernandez]

Daily, we encountered the stench of dead bodies washed up on shore in the aftermath of typhoons. Many of my team members who were able to stay to assist experienced grief and trauma, but the team spirit worked well coupled with the powerful breastfeeding hormones! Oxytocin that kept us calm and soothed amidst chaos and crisis. It kept us alive and enthusiastic to serve the sisterhood. In reflection, we hope to extend a “Care for the Carers” programme as psychosocial therapy for breastfeeding mothers and volunteers.

Readiness in Times of Disasters and Emergencies for Breastfeeding Mothers & Children

The best time for breastfeeding preparedness is NOW, in times of peace. A continuing emergency drill of successive breastfeeding counselling and lactation massage is the best intervention. Education for policymakers and aid agencies and government should be part of the programme for disaster risks and preparedness.

The infrastructure is needed to work on the basics and tap existing resources. Practice your emergency drill by creating a scenario of limited resources within, such as water scarcity. Be food literate and plant indigenous trees and plants, especially those that can provide indigenous food that heals and nourishes in difficult times. I have observed that during the typhoons, fallen trees, especially coconuts, saved the lives of the typhoon survivors as food relief came three weeks after. Sadly, canned goods are palatable only for the first two transitional weeks of daily meals. Survivors found that they were unable to bear the taste after a month of eating these. Many of the survivors said that they longed for the taste of natural, tropical foods.

Some of our BMSG counsellors had the rare opportunity to learn lactation massage from Nanay Ines herself earlier in 2019 when she visited Singapore then. [Credits: Far’ain Jaafar]

It is also good to gain knowledge of how to make the best of situations where water and electricity are scarce. Most of all, we need to understand fully well how breast milk can be the food and medicine depot during emergencies and crises, a life-saving food for the vulnerable from babies to adults, while waiting for rescue and relief. Exchange experiences, ideas and expertise on emergency responses between mother-support groups in Southeast Asia and uncover similarities and differences of resources and culture. Indeed, breastfeeding is a responsibility and not a choice, especially in times of disaster.

Indeed, breastfeeding is a responsibility and not a choice, especially in times of disaster.  – Ines Fernandez