EO 51 is the National Code of Marketing of Breastmilk Substitutes, Breastmilk Supplements, and Other Related Products. EO 51 is popularly known as the Philippine Milk Code of 1986. EO 51 regulates the marketing of infant milk formula, other milk products, foods and beverages, as well as feeding bottles and teats. The entities covered are milk companies that own and operate the product, including their manufacturers, distributors, marketing firms as well as their representatives.

The aim of the Code is to contribute to the provision of safe and adequate nutrition for infants by the protection and promotion of breastfeeding and by ensuring the proper use of breastmilk substitutes and breastmilk supplements when these are necessary, on the basis of adequate information and through appropriate marketing and distribution (Section 2, EO 51).

To regulate milk industries in aggressively marketing and advertising milk formulas in the Philippines specifically marketing efforts targeted to mothers.

It means product promotion, distribution, selling, advertising, product public relations, and information services.

EO 51 regulates the marketing, and practices related to the use of breastmilk substitutes, including infant formula; other milk products, foods and beverages, including bottle-fed complementary foods, for use as a partial or total replacement of breastmilk; and feeding bottles and teats. It also applies to their quality and availability, and to information concerning their use.

1. Specific products and other products when marketed as partial or total replacement of breastmilk:
   • Breastmilk substitutes including infant formula
   • Feeding bottles and teats
     When marketed or otherwise represented to be suitable, with or without modification for use as a partial or total replacement of breastmilk:
   • Other milk products
   • Foods and beverages
   • Bottle-fed complementary foods
2. The quality and availability, and information concerning the use of these covered products:
   
   The law mandates companies to provide the necessary information about the appropriate use of their products.
   
   However, the following vital information on the use of infant formula is rarely provided on product labelling thereof:
   • Infant formula is not a sterile product and is associated with contamination of harmful bacteria like Enterobacter sakazakii. This bacterium is associated with threatening risks of meningitis and sepsis, mostly to infants aged 28 days and below.
   • Among other precautions, the World Health Organization (WHO) and the Food and Agriculture Organization of the United Nations (FAO) emphasizes that water no cooler than 70°C should be used to prepare infant feeds from powdered formula. This temperature will kill harmful bacteria that may be present in powdered formula.

EO 51 and its Revised Implementing Rules and Regulations (RIRR) defines entities covered as:

1. Distributors (Section 4d EO 51, Section 5g RIRR);
2. Manufacturers (Section 4j EO 51, Section 5r RIRR);
3. Marketing personnel (Section 41 EO 51, Section 5 RIRR);
4. Marketing firms (Section 5s RIRR); and
5. Milk companies, which can be manufacturers or distributors (RIRR Section 5w).

The IAC is composed of representatives from the Department of Health (DOH), the Department of Trade and Industry (DTI), the Department of Justice (DOJ) and the Department of Social Welfare and Development (DSWD). Under the DOH, the Food and Drug Administration (FDA), formerly the Bureau of Food and Drugs (BFAD), is the designated secretariat of the IAC. This Committee is integral to the proper implementation of EO 51.

1. Health and nutritional claims, content of materials
2. Gifts of any sort
3. Marketing in the health care system
4. Marketing to health workers
5. Classes, seminars and other activities
6. Point-of-sale advertising
7. Donations

Products should not create belief that bottle feeding is equivalent or superior to breastfeeding. As such, labels should indicate that breastmilk is best and there is no substitute for it. Statements like "with DHA and ARA" or "fortified with lutein" are not allowed.

Statements like "improves intelligence", "for better eyesight" and "for better nutrition" are no longer allowed. Images of babies and their caregivers on the labels are also prohibited.

It means any form of financial, personal or commercial reward, inducement, incentives and other favours provided directly or indirectly, with or without company name or logo or product or brand name. (Section 5j, RIRR; Section 20, RIRR)

• Who are prohibited from giving "gifts of any sort"?
  Milk companies/manufacturers, distributors, and representatives of products covered by EO 51 are prohibited from giving any sort of gift (Section 5j and 21, RIRR). This provision in the Milk Code itself and the RIRR considerably expands the coverage of the prohibition beyond the actual formula milk product violating the Code, to the parent company manufacturing them.
  
  
• Who are prohibited from receiving "gifts of any sort"?
  Covered entities cannot give gifts of any sort to any member of the general public, hospitals, and other health facilities, including their personnel and members of their families (Section 21, RIRR). It can be seen that other violations flow logically from these premises. It must be emphasized that the Code does not prohibit the actual sale of covered products, but the marketing and misleading advertising thereof.

Milk companies or their representatives are prohibited from using the health workers and the health care system in the dissemination, distribution and promotion of covered products (Section 20, RIRR).

This means there can be no display of marketing materials (e.g. placards, posters, toys, record books) or actual display of products covered by the Code in any healthcare facility. "Professional service" representatives, "mothercraft nurses" or similar personnel, provided or paid for by manufacturers or distributors is prohibited (Section 7d, EO 51).

"No financial or material inducements or gifts of any sort to promote products within the scope of this code shall be offered or given by milk companies nor accepted by health workers and/ or members of their families" (Section 18, RIRR). "No assistance, support, logistics or training from milk companies may be permitted" (Section 32, RIRR).

To avoid the use of these venues to market their brands or company names and to protect women and pregnant mothers, companies of covered products are prohibited from conducting or being involved in any breastfeeding promotion or education, production of information materials on breastfeeding, or holding/ participating in classes or seminars for women and children and other similar activities whether with the intention to promote covered products or not (Section 22, 34, RIRR).

This prohibition covers activities related to other products used as partial breastmilk substitutes (such as follow-up milk formula and complementary foods). The Code also covers feeding bottles and teats. Thus, manufacturers and distributors of feeding bottles and teats also cannot hold classes for women and children, whether related to infant feeding or not.

There shall be no point of sale advertising, giving of samples or any promotion devices to induce sales directly to the consumers at the retail level, such as special displays, discount coupons, premiums, rebates, special sales, bonus and tie-in sales, loss-leaders, prices or gifts for the products within the scope of this Code (Section 23, RIRR).

Donations of products, materials, defined and covered under EO 51 and its IRR are strictly prohibited (Section 51, RIRR).

Donations of products and equipment not falling within the scope ofEO 51 given by regulated entities, whether in kind or in cash, may only be coursed through the IAC which shall determine if the donation will be accepted or not (Section 52, RIRR).

RA 10028 mandates workplace compliance with EO 51, prohibiting companies with products under the scope of the law from making any donations for lactation stations and activities related to breastfeeding promotion in the workplace.

Donations are also prohibited in times of disasters and calamities.13 Indiscriminate distribution of these products put infants at greater risk of illness and death.14.15 Provision for the needs of bottle-feeding infants in disaster areas will be met in accordance with guidelines set by the DOH, UNICEF and WHO.

A Milk Code monitor:

• Monitors compliance and problems encountered in the implementation of theMilk Code.
• Submits reports on the status of the Milk Code implementation to the FDA
• Verifies reports of Milk Code violations.
• Monitors the labels and marketing practices of products within the scope of the Code at various distribution centres.
• Carries out monitoring activities at any time, or based on specific reports/suggestions from the FDA in their respective jurisdictions.
• Anyone who is committed to protecting and promoting breastfeeding can report a Milk Code violation.

To report violations, the following information must be collected using the monitoring form:

1. Date and place where violation was found/seen.
2. Specific location (health facility, store, TV ad, radio/TV channel).
3. For printed matters, get sample or a picture of the violation.
4. For radio/TV ad or programmes, clearly specify airing time, TV channel or radio frequency.
5. For website based violations, provide web link or screenshoots.
6. For violative products, e.g. mislabeled or misbranded product, a sample shall be purchased and receipt should be obtained and submitted as part of the evidence.

Submissions should be made to:

• The Director
• Food and Drug Administration
• Civic Drive, Fi/invest Corporate City
• Alabang, Muntinlupa City
• Philippines 17 81
• Trunkline: (+63) 2 857-1900
• Fax: (+63) 2 807-0751 I
• (+63) 2 807-8511
• E-mail: report@fda.gov.ph

Violations can also be reported online through SMS, this website: (to follow), and mobile application (to follow).

The liability provided by law for those individuals or entities who engage in the prohibited acts displays how important breastmilk promotion and awareness is to the representatives of the Philippine people. The following sanctions will be imposed upon conviction for any violation of the Code:

Penalties per Entity:

1. Individual
   • Imprisonment of two months to one year and/or
   • Fine of Php 1,000 to Php 30,000
2. Corporation/Partnership
   • Impose the penalty for individuals on the chairman of the board of directors, president, general manager or partners and/or persons directly responsible
   • Suspension/ revocation of license, permit or authority for pursuit of business
3. Health Worker
   • Revocation of license, permit or authority for the practice of profession/occupation

Section 46 of the RIRR provides for administrative sanctions not imposed by EO 51 which can include:

1. Fine of Php 1,000,000.00, recall of the offending product, cancellation of the Certificate of Product Registration, revocation of the License to Operate of concerned company, blacklisting of the company to be furnished the Department of Budget and Management and the Department of Trade and Industry for repeated violations; and
2. Penalty of Php 2,500 per day for each day of violation the violation continues after being notified by the appropriate body.