Liberia: ‘House Bill Did Not Pass Law Making Breastfeeding Mandatory’

.... Says the Ministry of Health, while attempting to discredit the Daily Observer, but evidence proves that the House-approved bill indeed makes breastfeeding mandatory. 

The Ministry of Health says the nutrition bill passed by the House of Representatives at no point in time called for making breastfeeding mandatory, rather the bill is about the implementation of the WHO code of marketing of breastmilk substitutes.

The Ministry, in a response to a Daily Observer publication titled, House Votes to Make Breastfeeding Mandatory, claimed that the report was “erroneous and led to misinformation in the public domain that exclusive breastfeeding is mandatory in Liberia.”

In the publication, the Daily Observer wrote that the House of Representatives has unanimously passed a bill requiring mothers to breastfeed their children until they are six months old, saying the bill aimed to make breastfeeding ‘a duty and not an option for able mothers’.

The publication says the House while passing the bill, argued that it is the right of every child to be breastfed for six months and that the bill is designed to help “nurture a strong relationship between a mother and child.”

But for Minister Wilhelmina Jallah, the Ministry of Health performs its statutory responsibility of promoting programs for Health and nutrition by closely monitoring all the processes leading to the passage of the bill titled, “An Act to Amend the National Public Health Bill, Part XI, Chapter 51: Regulation for Making Goods and Other Products for Infants and Young Children, adding thereto Subsection 51.4(B).”

“Considering the misinformation, we wish to make the following clarifications: the purpose of the bill is to regulate the marketing of foods and other products that threaten the welfare and health of infants and young children in Liberia,” said Dr. Jallah in a press statement. “It does not make exclusive breastfeeding mandatory for women.  The 34th Session of the World Health Assembly (WHA) adopted the International Code of Marketing of Breastmilk Substitutes in 1981 as a minimum requirement to protect and promote appropriate infant and young child feeding.”

But while the Ministry of Health is denying breastfeeding has been made mandatory in Liberia and that the Daily Observer publication is erroneous, evidence from the House proves otherwise – indicating that breastfeeding is being made mandatory for 0-6 months.

The House-approved bill as reported by Daily Observer provides for regulating breast milk substitutes but says the age of using breastmilk substitutes cannot be less than 6 months – meaning mothers cannot give a child any other food or water until after 6 months.

According to Section 51.4, (b) of the approved bill: “The age after which the product (foods and other products) is recommended in numeric figures which, in the case of a complementary food or drinks including water, shall not be less than six (6) months.”

The law also says that the replacement of breastmilk is imperative WHEN there is a medical or life-threatening reason to the child.

Below is the full text of the House-approved bill:

“An Act To 51: Amend Regulation The National Of Marketing Public Health Of Foods Law, Part Xi, Chapter 51:  Regulation Of Marketing Of Foods And Other Products For Infants And Young Children, Adding Thereto Subsection 51.4(B).

WHEREAS, breastfeeding is an integral part of human (infants and young children) existence on earth;

WHEREAS, breastmilk supplies amongst other things nutrients in the proper proportion which, if must be replaced, should be done with a substance that serves the same purpose as breastmilk;

CONSIDERING THAT it is imperative for the replacement of breastmilk when there exist medical or other situations that threaten the survival of an infant's or young child's life;

WHEREAS, Section 51.18 of the Public Health Law mandates for the establishment of the Nutrient Division, which is to ensure the enforcement of laws that contravene the best for the survival of an infant or child which includes putting into place proper mechanisms for said effect;

NOW, THEREFORE, it is enacted by the Senate and House of Representatives of the Republic of Liberia in Legislature Assembled:

Section 1:

The Public Health of Law, Part XI: Foods and Other Products for Infants and Young Children; Chapter 51: Regulation of Marketing of Foods and Other Products for Infants and Young Children is hereby amended adding thereto Section 51.4(b) to read thus: The age after which the product (foods and other products) is recommended in numeric figures which in the case of a complementary food or drinks including water shall not be less than six (6) months.

Section 2:

The Ministry through its Nutrient Division shall ensure/to make a code of marketing of breast milk substitutes. 

Section 3: This Act shall take effect immediately upon publication into handbills.  Any law to the contrary notwithstanding.”

However, the Ministry of Health despite the glaring fact the House passed the bill making breastfeeding mandatory from 0-6 months old, says the bill passed by the House encourages the provision of safe and adequate nutrition for infants, by protecting, promoting, and supporting breastfeeding, and guides the proper use of breastmilk substitutes - if they must be used.  

“It is medically proven that breast milk is the best food for infants in their first 1000 days.  Among several other benefits, exclusive breastfeeding, 0-6months of birth, makes a child healthy, intelligent, strong, and creates stronger bonds between a child and the mother, and reduces families' spending on medication and breast milk substitutes,” the Minister of Health argued.  “Liberia, as a member of the comity of nations, is taking steps to domesticate the World Health Assembly's recommendations. Over 84 countries have domesticated the Code.”

The Cost of Not Breastfeeding in Liberia

In Liberia, only 5 out of every 10 babies under six months are exclusively breastfed in Liberia, says UNICEF in a 2020 report. During the launch of the ‘Stronger With Breastmilk Only’ campaign, the organization says most babies in Liberia receive plain water, other liquids, and foods in addition to breastmilk during their first six months of life, contributing to child malnutrition, illnesses, and even death.

The costs of not breastfeeding are enormous, and it costs Liberia US$200,000 annually to treat children with diarrhea and pneumonia and type II diabetes in mothers that visit health facilities due to inadequate breastfeeding, according to the UNICEF report.

It says Liberia stands to lose more than US$14 million a year due to future cognitive losses associated with not breastfeeding. WHO and UNICEF recommend that babies are fed nothing but breast milk for their first 6 months, after which they should continue breastfeeding – as well as eating other safe and nutritionally adequate foods – until 2 years of age or beyond.

In that context, the WHO Member States including Liberia have made a commitment to increasing the rate of exclusive breastfeeding in the first 6 months of life to at least 50% by 2025 as one of a set of global nutrition targets.  A 2019 poll conducted by UNICEF in 10 countries in West and Central Africa revealed that in Liberia 56% of youth incorrectly believe that babies need water in the first six months of life.

UNICEF Stronger With breastmilk report disclosed that one-third of the children in Liberia suffer from chronic malnutrition (2019-2020, LDHS) — resulting in too many children suffering from stunted growth or unsuspected hunger which is a lack of essential vitamins and minerals.

Stunting is irreversible and negatively affects a child's brain function, organ development, and immune system, which can then result in poor achievement at school, decreased productivity and earnings in adult life, greater risk of developing obesity and diabetes later in life, and ultimately, diminished chances of escaping the cycle of poverty.

Meanwhile, the Ministry of Health has therefore commended the House of Representatives for passing the Code of Marketing of Breastmilk Substitute Bill into Law and, however, encouraged the August Body to review recommendations put forward by the plenary and incorporate inputs that will broaden the benefits of the law.

“There are still opportunities to listen to more opinions before the Senate concurs,” said Dr. Jallah, the Minister of Health.