National Policies on Infant and Young Child Feeding

Legal Basis, Policy Lineage, and Strategy Link

The policy framework is grounded on the 1987 Philippine Constitution, particularly Article XV, Section 3, which mandates the State to defend children’s right to proper care and nutrition and protection from conditions prejudicial to development.
The framework renews the country’s commitment to the UN Convention on the Rights of the Child and responds to Executive Order 310 dated November 3, 2000 on the National Strategic Framework for Plan Development for Children, 2000–2025 (Child 21).
The framework builds on prior national laws and initiatives, including:
- Executive Order 51 (Philippine Code of Marketing of Breast-milk Substitutes) (1986);
- Republic Act No. 7600 (Rooming-In and Breastfeeding Act of 1992);
- Republic Act No. 8172 (Salt Iodization Law);
- Republic Act No. 8976 (Food Fortification Program Act);
- Republic Act No. 8980 (ECCD Act); and
- the Philippine Plan of Action for Nutrition 1999–2004.
The framework responds to Executive Order 286 dated February 23, 2004, directing agencies to actively support and implement the “Bright Child” program through integrated delivery of services at home and in facilities.

Purpose, Overall Objective, and Goals

The policy declares an overall objective to improve the survival of infants and young children by improving nutritional status, growth, and development through optimal feeding.
The specific objectives require:
- all newborns to be initiated to breastfeeding within one hour after birth;
- all infants to be exclusively breastfed for 6 months;
- all infants to be given timely, adequate and safe complementary foods; and
- breastfeeding to be continued up to two years and beyond.
The policy serves as a guide for health workers and other concerned parties on infant and young child feeding, including appropriate practices in exceptionally difficult circumstances.

Scope and Coverage: Who Must Follow

The policy covers the whole health sector, whether government or private, including professional groups, the private sector, and LGUs, plus other stakeholders.
Coverage applies at all levels nationwide.
The target beneficiaries are:
- Infants, 0–11 months; and
- Young children, 1 year up to 3 years old.

Core Breastfeeding Requirements

Infants must be initiated to breastfeeding within one hour after birth.
Medically trained personnel—including doctors, nurses, midwives, and other birth attendants—must ensure newborns are supported to early initiation.
Health care delivery systems in all facilities must ensure newborns are initiated to breastfeeding within an hour after delivery.
Infants must be exclusively breastfed for the first six months of life.
Exclusive breastfeeding means breastmilk alone and no other foods or drinks, including no water, except vitamins and medicine drops.
Breastfeeding must be continued as frequent and on demand for up to two years of age and beyond.

Complementary Feeding Standards

At six months, infants must be given appropriate complementary foods to meet evolving nutritional requirements.
“Appropriate complementary foods” must be:
- timely: introduced when energy and nutrient needs exceed what can be provided through exclusive and frequent breastfeeding;
- adequate: providing sufficient energy, protein, and micronutrients for growing child nutritional needs;
- safe: hygienically stored and prepared, fed with clean hands using clean utensils, and not bottles and teats or artificial nipples; and
- properly fed: consistent with signals of appetite and satiety, with meal frequency and feeding method suitable for age, actively encouraging the child even during illness to consume sufficient food using fingers, spoon, or self-feeding.
Appropriate complementary feeding must encourage diversified approaches to ensure access to foods meeting energy and nutrient needs, including home- and community-based technologies to enhance nutrient density and micronutrient content.
Mothers—particularly those with infants and young children—must be provided with sound and culture-specific nutrition counselling using a wide array of indigenous foodstuffs.
The policy encourages the agriculture sector to produce, make readily available, and ensure affordability of suitable complementary feeding foods.
The policy encourages:
- low-cost complementary foods prepared with locally available ingredients using suitable small-scale community technologies; and
- industrially processed complementary foods when mothers have the means and knowledge to prepare and feed them safely.
Processed complementary foods sold or otherwise distributed must meet applicable standards recommended by the Codex Alimentarius Commission and the Codex Code of Hygienic Practice for Foods for Infants and Children.

Micronutrient Supplementation and Salt Iodization

Micronutrient supplementation targets are implemented based on DOH Administrative Order 119 s. 2003 dated December 2, 2003 (Updated Guidelines on Micronutrient supplementation).
Universal Vitamin A supplementation must continue for infants and children 6–11 months of age.
Vitamin A supplementation must also be provided to children at risk—particularly those with measles, persistent diarrhea, severe pneumonia, and malnutrition—to help re-establish body reserves and protect against severity of subsequent infections or prevent complications.
Postpartum women must be given a Vitamin A capsule within one month after delivery to increase Vitamin A concentration in breastmilk and improve Vitamin A status of breastfed children.
Children with xerophtalmia must be treated.
During emergencies, Vitamin A supplementation must be prioritized for universal supplementation schedules and for high-risk children.
Iron supplementation must be provided to:
- pregnant and lactating women; and
- low birth weight babies and children 6–11 months of age.
Iron supplements must also be provided to anemic and underweight children 1–5 years of age.
Iodine supplementation must be provided to:
- women of reproductive age group; school age children; and adult males in areas where:
  - urinary iodine excretion of less than 50ug/L affects more than 20% of the population; and/or
  - goiter prevalence among school children is greater than 5%; and/or
  - high prevalence of goiter among males exists.
Families must be encouraged and educated to use iodized salt in food preparation for older infants and young children (universal salt iodization).

Food Fortification and Safe Alternatives

Food fortification supports adequate micronutrient intake for older infants and young children.
The Department of Health must encourage manufacturers to fortify processed foods and food products based on BFAD standards.
Breastfeeding is the norm: most mothers can and should breastfeed, and most infants can and should be breastfed.
When infants cannot or should not be breastfed, the policy directs selection of the best alternative among:
- expressed breast milk from the infant’s own mother;
- breastmilk from a healthy wet-nurse; or
- human milk from a human-milk bank;
- and breast-milk substitutes fed with a cup, because cup feeding is treated as safer than feeding bottles and teats.
Only under exceptional circumstances can a mother’s milk be considered unsuitable for her infant.
Three metabolic disorders are addressed for feeding guidance:
- Galactosemia: infants cannot be fed breastmilk or other infant or milk formula because lactose must be eliminated; specially formulated lactose-free preparations or soya-based formula are required.
- Phenylketonuria: infants may be breastfed while phenylalanine blood levels are monitored; breastmilk must be supplemented with or replaced by a special low-phenylalanine formula if concentrations reach dangerous levels.
- Maple syrup urine disease: breastmilk can be combined with special synthetic formulas low in non-tolerated amino acids.
For limited cases where infants do not receive breast milk, feeding with a suitable breast-milk substitute (including infant formula or other specially prepared formula meeting applicable Codex Alimentarius standards, or home-prepared formula with micronutrient supplements) must be demonstrated by health workers or other community workers if necessary.
Instructions for any breast-milk substitute must include:
- adequate instructions for appropriate preparation; and
- health hazards of inappropriate preparation and use.
Infants who are not breastfed must receive special attention from the health and social welfare system as a risk group.

Feeding in Exceptional Circumstances

The policy establishes feeding options during certain circumstances and times of crisis:
- breastfeeding is the first and best option;
- expressed breastmilk fed by cup;
- breastfeeding from a healthy wet nurse;
- human milk from a milk bank fed by cup;
- infant formula (preferably generically labelled) fed by cup.
Families in difficult situations—including natural or human-induced calamities—must receive special attention and practical support to feed children adequately, and mothers and babies must remain together wherever possible.
Health workers must ensure protection, promotion, and support of breastfeeding and timely, safe, and appropriate complementary feeding.
In exceptional cases where small numbers of infants must be fed on breastmilk substitutes and milk supplements, substitutes/supplements must be safe, suitable, and prepared in accordance with applicable Codex Alimentarius standards, or home-prepared formula with micronutrient supplements.
Artificial feeding is treated as difficult in crises due to scarcity of clean water, fuel, and utensils, and the policy requires risk-minimizing measures to avoid commercial exploitation, including:
- donations of breastmilk substitutes, feeding bottles, teats, and commercial baby foods should be limited, if not refused;
- breastmilk substitutes must never be part of general distribution; distribution must be only to infants with a clear need, and only for as long as the infant needs them (until a maximum of 1 year or until breastfeeding is re-established);
- bottles and teats must never be distributed, and their use must be discouraged; cup feeding must be encouraged;
- information on adequate preparation and hazards of inappropriate preparation must be provided;
- uncontrolled distribution of infant formula or milk supplements is treated as leading to early and unnecessary cessation of breastfeeding, and more detailed guidelines must be developed with the national disaster coordinating body and health teams for local government units and others concerned.
Malnourished infants and young children must receive extra attention during early rehabilitation and over the longer term, including nutritional supplementation and continued frequent breastfeeding and, when necessary, relactation.
The policy provides guidance that most low birth weight infants can be breastfed within the first hour after birth, and that breastmilk is particularly important for preterm infants and very low birth weight infants due to higher risk of infection, long-term ill health, and death.

HIV-Related Feeding Guidance and Special Circumstances

HIV-infected mothers must receive counselling including:
- general information on meeting their own nutritional requirements; and
- the risks and benefits of various feeding options;
- specific guidance selecting the option most likely to be suitable for their situation.
Feeding options for HIV-positive mothers include:
- exclusive breastfeeding;
- wet-nursing;
- expressing and heat-treating breastmilk;
- breastmilk from banks;
- commercial infant formula; and
- home modified animal milk.
HIV-positive mothers must be supported in their feeding options.
The policy requires extra attention for children living in special circumstances, including:
- orphans and children in foster care;
- children born to adolescent mothers;
- mothers suffering from physical or mental disabilities;
- mothers with drug- or alcohol-dependence;
- mothers who are imprisoned; and
- children in disadvantaged or otherwise marginalized populations.

Support Systems and Facility Obligations

Mothers, fathers, and other caregivers must have access to objective, consistent, complete information about appropriate feeding practices free from commercial influence, including timing and types of foods, quantity, frequency, and safe feeding.
Skilled support must be available to help mothers initiate and sustain appropriate feeding practices, prevent difficulties, and overcome them; such support must be a routine part of prenatal, delivery and postnatal care, and services for well baby and sick child.
“Infant and Young Child Feeding Specialist” support must be accessible to respond to common problems initiating and sustaining exclusive and continued breastfeeding and other feeding difficulties.
Specialist assistance may come from a doctor, nurse, midwife, or trained community health volunteer.
Community-based networks offering mother-to-mother support and trained breastfeeding counsellors must be used within or closely with the health system.
A communication and marketing plan must be developed to generate political support at all levels, including communities and families.
Mother Baby Friendly Hospital Initiatives (MBFHI) must be reviewed, accelerated, and sustained, with focus on sustaining certified MBF hospitals to comply with the 10 steps to Successful Breastfeeding, and expanding to other hospitals, health centers, and clinics.
The Rooming-In and Breastfeeding Act (R.A. 7600) must be strictly enforced in all hospitals to ensure mothers’ rights to breastfeed and children’s rights to be breastfed.
All health facilities—public or private—must provide a supportive environment through compliance with the Philippine Code of Marketing of Breast-milk Substitutes (E.O. 51), including:
- facilities must not display breastmilk substitutes; and
- facilities must not display posters or conduct sampling of such products;
- facilities must instead provide an enabling environment to improve and promote breastfeeding and appropriate complementary feeding practices and mother health and nutrition.
Hospitals must support and provide an enabling environment so mothers can ensure continued breastfeeding and adequate complementary feeding to hospitalised sick children, and mothers must be allowed to keep their breastfed children with them whenever feasible.
Continuing training programs for promoting, protecting, supporting, and improving infant and young child feeding must be institutionalized for pre-service and in-service health providers.
Workplaces must provide an enabling environment for breastfeeding mothers returning to work, including breastfeeding rooms, refrigerators for breastmilk storage, creches, and breaks for breastfeeding or expressing milk.
Maternity protection measures must be implemented consistent with the ILO Maternity Protection Convention, 2000 No. 183 and Maternity Protection Recommendation, 2000 No. 191, including maternity leave, day-care facilities, and paid breastfeeding breaks for women employed outside the home.
The Department of Health must ensure fulfillment of children’s rights to the highest attainable standard of health care and nutrition and must enjoin government and non-government partners and private sector and international organizations to form a strong alliance for the IYCF Strategy’s aims and objectives.
The Department must avoid conflict of interest by not forging partnerships with manufacturers and distributors of infant formula, milk supplements, complementary foods, feeding bottles and teats, and related products.

Implementing Mechanism and Governance

Overall management of the IYCF must be the responsibility of a Management Committee of the Department of Health.
The Management Committee’s chair must be the Undersecretary for Health Operations, and it must be co-chaired by the Undersecretary for External Affairs.
The Management Committee members must include Directors (or their alternates) from:
- National Center for Disease Prevention and Control (NCDPC);
- National Center for Health Facility Development (NCHFD);
- Bureau of Food and Drugs (BFAD);
- Bureau of Health Facility Services (BHFS);
- National Center for Health Promotion (NCHP);
- Bureau of Local Health Development (BLHD); and
- Dr. Jose Fabella Memorial Medical Center (designated as the IYCF National Training Institution).
NCDPC staff must act as the Secretariat and convenor of the Management Committee.
National IYCF coordinators or focal persons must be designated for major program components:
- Mother and Baby Friendly Hospital Initiatives must be coordinated by NCHFD;
- Enforcement of EO 51 (Milk Code) and RA 7600 must be coordinated by BFAD; and
- Public Health Initiatives must be coordinated by NCDPC.
An IYCF Interagency Group must be created to provide technical assistance to DOH for planning, coordination, monitoring, evaluation, and research, and it must recommend policies, guidelines, and standards on IYCF.
The Interagency Group must include representatives from government and non-government organizations, international organizations, health professionals, and the private sector.
Coordinators at regional/provincial/city levels must be designated to accelerate IYCF and sustain MBFHI gains in the 1990s.
Existing multi-sectoral functional committees at regional/provincial/city/municipal levels must be mobilized to perform similar functions.

Supervision, Monitoring, Awards, and Research

Periodic monitoring and evaluation of IYCF implementation progress must be established, institutionalized, and integrated with other MCH reviews.
Indicators for monitoring must be defined and agreed upon by major stakeholders.
Monitoring of indicators must be integrated into the DOH Monitoring Coaching Team and the regular hospital assessment system.
National and regional monitoring teams must be strengthened to ensure strict compliance with laws supporting IYCF.
An incentive and award system must be planned to sustain efforts promoting, protecting, and improving infant and young child feeding.
The National Nutrition Council must give regular awards for local government units, and IYCF indicators must be integrated into that award system.
Models of good practice must be documented and disseminated to stakeholders, including local government units.
Continuing clinical and population-based research and behavioral investigation must be conducted to improve feeding practices, including:
- access to breastfeeding support;
- programmatic and community-based interventions;
- maternal nutritional status and pregnancy outcomes; and
- preventing mother-to-child transmission of HIV in relation to infant feeding.

Repealing Clause

Any existing provisions of DC 76-A s. 1992 (Guidelines on Rooming-in, BF and Breastmilk Feeding) must be repealed.
Any issuances found inconsistent with DOH Administrative Order No. 2005-0014 must be repealed.