CELINE S.

UDANI
BSN 135

I.
Republic Act No. 7600
An act providing incentives to all government and private health
institutions with rooming in and breastfeeding practices and for other
purposes
Be it enacted by the Senate and House of Representatives of the
Philippines in Congress assembled:
SECTION 1. Title.- This Act shall be known as "The Rooming-In and
Breastfeeding Act of 1992."
SEC. 2. Declaration of Policy.- The Senate adopts rooming in as a
national policy to encourage, protect and support the practice of
breastfeeding. It shall create an environment where basic physical,
emotional, and psychological needs of mothers and infants are fulfilled
through the practice of rooming-in and breastfeeding.
Breastfeeding has district advantages which benefit the infant and the
mother, including the hospital and the country that adopts its
practice. It is the first preventive health measure that can be given
to the child at birth. It also enhances mother-infant relationship.
Furthermore, the practice of breastfeeding could save the country
valuable foreign exchange that may otherwise be used for milk
importation.
Breastmilk is the best food since it contains essential nutrients
completely suitable for the infant's needs. It is also nature's first
immunization enabling the infant to fight potential serious infection.
It contains growth factors that enhance the maturation of an infant's
organ system.
SEC. 3. Definition of Terms.- For purposes of this Act, the following
definitions are adopted:
a) Age of gestation - the length of time the fetus is inside the
mother's womb.
b) Bottlefeeding - the method of feeding an infant using a bottle with
artificial nipples, the contents of which can be any type of fluid.
c) Breastfeeding - the method of feeding an infant directly from the
human breast.
d) Breastmilk - the human milk from a mother.
e) Expressed breastmilk - the human milk which has been extracted from
the breast by hand or by breast pump. It can be fed to an infant using
a dropper, a nasogatric tube, a cup and spoon, or a bottle.
f) Formula feeding - the feeding of a new born with infant formula
usually by bottlefeeding. It is also called artificial feeding.
g) Health institutions - are hospitals, health infirmaries, health
centers, lying-in centers or puericulture centers with obstetrical and
pediatric services.
h) Health personnel - are professionals and workers who manage and/or
administer the entire operations of health institutions and/or who are
involved in providing maternal and child health services.
i) Infant - a child within zero (0) to twelve (12) months of age.
j) Infant formula - the breastmilk substitute formulated industrially
in accordance with applicable Codex Alimentarius standards, to satisfy
the normal nutritional requirements of infants up to six (6) months of
age, and adopted to their physiological characteristics.
k) Lactation management - the general care of a mother-infant nursing
couple during the other's prenatal, immediate postpartum and postnatal
periods. It deals with educating and providing knowledge and
information to pregnant and lactating mothers on the advantages of
breastfeeding, the physiology of lactation, the establishment and
maintenance of lactation, the proper care of the breast and nipples,
and such other matters that would contribute to successful
breastfeeding.
l) Low birth weight infant - a newborn weighing less than two thousand
five hundred (2,500 ) grams at birth.
m) Mother's milk - the breastmilk from the newborn's own mother.
n) Rooming-in - the practice of placing the newborn in the same room as
the mother right after delivery up to discharge to facilitate mother-
infant bonding and to initiate breastfeeding. The infant may either
share the mother's bed or be placed in a crib beside the mother.
o) Seriously ill mothers - are those who are with severe infections, in
shock, in severe cardiac or respiratory distress or dying or those with
other conditions that may be determined by the attending physicians as
serious.
p) Wet-nursing - the feeding of a newborn from another mother's breast
when his/her own mother cannot breastfeed.
Chapter 1
Rooming-In and Breastfeeding of Infants
SEC. 4. Applicability.- The provisions in this chapter shall apply to
all private and government health institutions adopting rooming-in and
breastfeeding as defined in this Act.
SEC. 5. Normal Spontaneous Deliveries.- the following newborn infants
shall be put to the breast of the mother immediately after birth and
forthwith roomed-in within thirty (30) minutes.
a) well infants regardless of age gestation; and
b) infants with low birth weights but who can suck.
SEC. 6. Deliveries by Caesarian.- Infants delivered by caesarian
section shall be roomed-in and breastfed within three (3) to four (4)
hours after birth.
SEC. 7. Deliveries Outside Health Institutions.- Newborns delivered
outside health institutions whose mothers have been admitted to the
obstetrics department/unit and who both meet the general conditions
stated in Section 5 of this Act, shall be roomed-in and breastfed
immediately.
SEC. 8. Exemptions.- Infants whose conditions do not permit rooming-in
and breastfeeding as determined by the attending physician, and infants
whose mothers are either a) serious ill; b) taking medications
contraindicated to breastfeeding; c) violent psychotics; or d) whose
conditions do not permit breastfeeding and rooming-in as determined by
the attending physician shall be exempted from the provisions of
Section 5, 6 and 7: Provided, That these infants shall be fed expressed
breastmilk or wet-nursed as may be determined by the attending
physician.
SEC. 9. Right of the Mother to Breastfeed.- It shall be the mother's
right to breastfeed her child who equally has the right to her
breastmilk. Bottlefeeding shall be allowed only after the mother has
been informed by the attending health personnel of the advantages of
breastfeeding and the proper techniques of infant formula feeding and
the mother has opted in writing to adopt infant formula feeding for her
infant.
Chapter II
Human Milk Bank
Section 10. Provision of Facilities for Breastfeeding Collection and
Storage.- The health institution adopting rooming-in and breastfeeding
shall provide equipment, facilities, and supplies for breastmilk
collection, storage and utilization, the standards of which shall be
defined by the Department of Health.
Chapter III
Information, Education and Re-education Drive
SEC. 11. Continuing Education, Re-education and Training of Health
Personnel.- The Department of Health with the assistance of other
government agencies, professional and non-governmental organizations
shall conduct continuing information, education, re-education, and
training programs for physicians, nurses, midwives, nutritionist-
dietitians, community health workers and traditional birth attendants
(TBAs) and other health personnel on current and updated management.
Information materials shall be given to all health personnel involved
in maternal and infant care in health institutions.
SEC. 12. Information Dissemination to Pregnant Women.- During the
prenatal, perinatal and postnatal consultations and/or confinements of
the mothers or pregnant women in a health institution, it shall be the
obligation of the health institution and the health personnel to
immediately and continuously teach, train, and support the women on
current and updated lactation management and infant care, through
participatory strategies such as organization of mothers' clubs and
breastfeeding support groups and to distribute written information
materials on such matters free of charge.
Chapter IV
Miscellaneous Provisions
SEC. 13. Incentives.- The expenses incurred by a private health
institution in complying with the provisions of this Act, shall be
deductible expenses for income tax purposes up to twice the actual
amount incurred: Provided, That the deduction shall apply for the
taxable period when the expenses were incurred: Provided, further, That
the hospitals shall comply with the provisions of this Act within six
(6) months after its approval.
Government health institutions shall receive an additional
appropriation equivalent to the savings they may derive as a result of
adopting rooming-in and breastfeeding. The additional appropriation
shall be included in their budget for the fiscal year.
SEC. 14. Sanctions.- The Secretary of Health is hereby empowered to
impose sanctions for the violation of this Act and the rules issued
thereunder. Such sanctions may be in the form of reprimand or censure
and in cases of repeated wilful violations, suspension of the permit to
operate of the erring health institutions.
SEC. 15. Rules and Regulations.- The Secretary of Health, in
consultation with other government agencies, professional and non-
government organizations concerned shall promulgate the rules and
regulations necessary to carry out the provisions of this Act.
SEC. 16. Repealing Clause.- All acts, laws, decrees executive orders,
rules and regulations or parts thereof, which are contrary to or
inconsistent with this Act are hereby repealed, amended or modified
accordingly.
SEC. 17. Separability Clause.- If any clause, sentence, paragraph or
part of this Act shall be declared to be invalid, the remainder of this
Act or any provision not affected thereby shall remain in force and
effect.
SEC. 18. Effectivity.- This Act shall take effect one hundred twenty
(120) days after publication in at least two (2) newspapers of general
circulation.

II.
Breastfeeding Promotion Guidelines for Childcare Centers
1. Inform parents at time of enrollment that you support mothers
continuing to breastfeed and are willing to feed expressed breast
milk.
Note: Protective gloves are not necessary when handling expressed
breast milk.
2. Emphasize the value of continuing to breastfeed after returning
to work or school. Provide emotional support concerning mother's
decisions about breastfeeding and weaning.
3. Advise breastfeeding moms to begin feeding infants expressed milk
at least two weeks prior to beginning daycare to ensure that
infants are accustomed to bottle feeding.
4. Maintain a list of local lactation consultants that breastfeeding
mothers and/or staff could contact for assistance in locating an
affordable breast pump and other issues related to breastfeeding.
5. Provide written guidelines for parents and staff about
collecting, storing and feeding expressed breast milk.
Breastfeeding mothers should provide their own bottles clearly
labeled with child's full name. Any milk remaining in bottle
after a feeding should be refrigerated and either fed to the
child later or sent home with a parent at the end of the day.
6. Encourage mothers to visit and breastfeed during the day if their
schedules permit.
7. Designate a lactation corner to encourage mothers to breastfeed
if they can visit during the day. Lactation corner should be
quiet, clean, comfortable and private (if mother prefers privacy).
8. Have consistent child care provider handling infant.
 9. Feed infant expressed breast milk on demand or coordinate feeding
times according to mother's normal feeding schedule.
10.Accidental feeding of a different mother's milk should be
reported to both mothers so that proper measures can be taken to
ensure the safety and health of the infant.
11.Provide a daily record for parents tracking time and amount of
expressed milk or formula fed to infants.
12.Have a resource shelf for parents and staff, including books,
videos, pamphlets and other materials about breastfeeding
(excluding formula company literature or videos).
13.Encourage mothers to participate in breastfeeding support groups
within the community.
14.Refer parents to health education programs about breastfeeding.
15.Develop a partnership with healthcare providers and other
resources to ensure best practices for breastfeeding.
16.Model best practices for workplace breastfeeding support for own
employees.
Breastfeeding Promotion Guidelines for Ambulatory Care Settings
(Physician Offices, Health Centers, PCAP, WIC)
1. Visible support for breastfeeding, e.g. culturally appropriate
pictures or posters that shows women breastfeeding in positive
and realistic settings.
2. Positive staff attitudes toward breastfeeding at all levels of
the organization (from Housekeeping to the Medical Director and
Chief Executive Officer)
3. Comfortable chairs in waiting room for mothers to sit in while
breastfeeding.
4. Private space available for breastfeeding, when desired by
mothers.
5. Lactation specialist on staff, preferably IBCLC.
6. Breastfeeding home visit and/or telephone contact with all
breastfeeding mothers, provided by staff or peer counselor soon
after discharge from hospital.
7. Knowledgeable support for breastfeeding after returning to work.
8. Breastfeeding classes on-site.
9. Appropriate resource materials – pamphlets, books, videos from
Best Start, NYSDOH, and other reliable sources.
10.No formula company materials – pamphlets, videos, pens, mugs,
other "gifts".
11.Breastfeeding "warm line" for families to call for advice about
breastfeeding.
12.Information provided to mothers about community resources, e.g.
peer counselors, sources of pump rentals and other breastfeeding
supplies.
13.Breastfeeding assessed at each pediatric and postpartum visit.
 14.Medication choices for mother consider her breastfeeding status,
e.g. recommend contraceptives other than estrogen/progestin
methods
15.Duration of breastfeeding monitored.
Breastfeeding Promotion in Managed Care Settings
1. Visible support for breastfeeding, e.g. articles, photos in
member and provider newsletters.
2. Plan monitors breastfeeding rate among enrollees at birth, 1-2
weeks, 3 months, 6 months, and 12 months.
3. Written policy regarding breastfeeding promotion, with clear
responsibility for implementation.
4. Lactation specialist on staff, preferable IBCLC.
5. Individual(s) identified to address enrollees' breastfeeding
problems and questions.
6. Source of follow-up care identified for newborns and mothers.
7. Mother and infant seen within 7 days after postpartum discharge.
8. Source identified for urgent and after-hours advice.
9. Breastfeeding education materials given to all pregnant enrollees.
10.Community resources (e.g. peer counselors, La Leche League)
recommended to all enrollees.
11.Offer and/or encourage support staff continuing education on
breastfeeding.
Breastfeeding Promotion in the Workplace
1. Visibly promote breastfeeding, e.g. posters, articles in employee
newsletter
2. Health benefits cover:
○ Postpartum home visits
○ Lactation consultant services
○ Hospital grade electric pump rental
3. Maternity leave – 6 weeks minimum
4. Flexible hours and breaks; part-time or job-sharing schedules
offered
5. Allow infants on site, e.g. in port-a-crib by mother's work
station
6. Offer on-site child care
7. Lactation room
○ Comfortable, clean, private
○ Electric pump, sink, refrigerator
○ Resource shelf: books, pamphlets, videos
8. Breastfeeding classes on-site to address concerns about work and
breastfeeding.
9. Staff Lactation Consultant to coordinate services:
○ Classes and individual counseling
 ○ Manage lactation facilities
○ Products (pumps, pump kits, coolers, books)
10.Working parents' support group
Breastfeeding Promotion Guidelines for Hospitals
1. Visible support for breastfeeding, e.g. culturally appropriate
posters and artwork.
2. Encourage breastfeeding on demand.
3. Encourage breastfeeding both day and night.
4. Written policy allowing 24-hour rooming-in.
5. No routine orders for anti-lactation drugs.
6. No water, glucose, water, or formula given to breastfed babies
except in special circumstances.
7. No formula company materials – pamphlets, videos, pens, mugs,
other "gifts" and no formula discharge packs given to mothers of
breastfed babies.
8. No contracts with formula companies requiring the hospital to
provide mothers with formula and/or formula company "gifts".
9. No pacifiers used with breastfed babies.
10.Designated Lactation Coordinator in place, preferable IBCLC.
11.First breastfeeding in delivery or recovery room.
12.No test bottle given.
13.Breastfeeding assessment on care plan.
14.Breastfeeding assessed and documented on every shift.
15.Additional information on breastfeeding given to all
breastfeeding mothers while in hospital.
16.No timing of breastfeeding sessions.
17.All breastfeeding women taught: position and latch-on, strategies
to promote successful breastfeeding, signs nursing is going well,
common concerns, and other topics.
18.Breastmilk/breastfeeding encouraged and supported in NICU.
19.Hospital has good source of breastfeeding information for mothers
(not formula company literature or videos).
20.Breastfeeding instruction sheet provided at time of discharge.
21.Support provided to breastfeeding infants and mothers
hospitalized after initial delivery stay, e.g. infant visitation,
pump loan, lactation consultant visit.
22.Breast pumps and breaks, and breastfeeding advice/consultation
provided for breastfeeding staff.
23.Mothers supported at discharge with at least two follow-up
services (e.g. lactation clinic, peer counselors, phone
consultation, referral to La Leche group).
24.Arrange for breastfeeding home visit and/or telephone contact
with all breastfeeding mothers – provided by staff or peer
counselor soon after discharge from hospital.
III.

Breast Milk

• Antibodies – Helps your baby’s immune system gain strength,

fighting off bacteria and viruses. When you or your baby is
exposed to a virus or bacteria, your breast milk "fights back" by
producing antibodies specific to that virus or bacteria. Formula
is exactly the same, time after time, regardless of what your
baby is exposed to.

• Water – Your breast milk contains the perfect amount of water to

satisfy your baby’s thirst and adjusts to your baby’s needs.

• Fat – Breast milk contains more fat than cow’s milk and is more
easily absorbed by your baby. This is one of the reasons that
breast fed babies have different stools than bottle (formula) fed
babies. Since the baby is not excreting any wasted fats the stool
will be a yellow mustard color with a mildly sweet smell.

• Protein – Protein that is used to help your baby’s body grow and
develop is in just the right amount and in a form most readily
absorbed.

• Carbohydrates – Breast milk contains more carbohydrates than

cow’s milk. These carbohydrates provide a very important source
of energy.

• Vitamins and minerals – As long as you, the mother, eat a

reasonably well balanced diet, your breast milk will contain all
of your baby’s vitamin and mineral requirements, until about age
6 months.

• Taste - Breast milk changes in taste, depending on the different

foods the mother eats. Breastfed babies are more likely to accept
new and different foods once they start on solids (not
recommended until age 6 months) than their formula-fed peers,
because formula tastes the same every single time, while
breastmilk takes on a taste similar to the different foods a
mother eats.
• Breastfed babies eat more often than bottle-fed babies because
the fats and proteins in breast milk are more easily broken down
than the fats and proteins in formula, so they are absorbed and
used more quickly. This means that breastfed babies often have
fewer digestive troubles than bottle-fed babies.
• One of the amazing things about breast milk is that your milk is
specially formulated to have the right composition for your baby,
and to contain exactly the right amounts of nutrients. It
continually changes in composition so that your baby gets what he
or she needs at any age.
• Breastfeeding is free.
Cow's Milk

• No antibodies – Antibodies that are in breast milk are not in

cow’s milk / formula and cannot be artificially produced.

• Water – The amount of water in cow’s milk / formula can’t change

to suit your baby’s need the way breast milk can.

• Fat – The fat in cow’s milk / formula is very different than the
fat in breast milk and your baby can’t absorb it as easily.

• Protein – The amount of protein in cow’s milk / formula is at

least double the amount in breast milk and is also a different
and less digestible type.

• Carbohydrates – Cow’s milk / formula has smaller amounts of

carbohydrates than breast milk.

• Vitamins and minerals – Cow’s milk / formula has more of some

vitamins and minerals and less of others than breast milk; it’s
not the right amount for your baby.

• There are over 100 ingredients in breast milk which ARE NOT in
formula, even the new "DHA added" formulas. Formula is intended
as a replacement for breastmilk when breastmilk is not available,
but sadly, it does not even come close to it!
• Fats in formula aren't as well absorbed, which is one reason why
bottle-fed babies have more troubles in digestion and more
unpleasant smelling bowel movements than breastfed babies.
• Bottle-fed babies receive the exact same nutrients every time
they eat. But breast milk, on the other hand, continually changes
in composition so that your baby gets what he or she needs at any
age.
• Bottle feeding costs you more.