(Photo: EZEQUIEL BECERRA/AFP/Getty Images)

Egypt Requires Breast Exam for Subsidized Formula

Measures required for economic reform plan evoke anger

CAIRO, Egypt – Heated debate has broken out in Egypt over a new regulation requiring mothers to undergo a breast examination in order to qualify for subsidized infant formula.
Imported infant formula costs this nation $51 million annually from its meager foreign currency reserves and is part of a system of government underwritten subsidies that total around $340 million each year.

The subsidy reduction comes as child nutritionists and doctors worry that too many Egyptian mothers have replaced the breast with bottle feeding.

Early this month parents held a rare public demonstration outside the headquarters of the Egyptian Pharmaceutical Trading Company, a state-owned firm, to protest the first of a series of austerity measures linked to an economic reform program that in turn coincides with a $12 billion loan from the International Monetary Fund. “We are poor. The children have the right to have milk,” said Abu Samir, an unemployed construction worker and father of five-month old twins. “Some mothers are now using water and sugar to feed their children because of the price hikes.”

The demonstrators said that the government was erecting obstacles to their children’s survival by restricting the distribution of subsidized formula to just over a thousand Health Ministry run pharmacies in this county of more than 90 million people. For a short time, they blocked the road outside the pharmaceutical company on the eastern fringe of the capital, but riot police showed restraint, seemingly mindful of the economic pressures causing the unrest.

Austerity measures and protests

A sharp thirteen percent devaluation of the Egyptian pound has been underway for a year, and the country’s trade deficit has skyrocketed from $9.5 billion before the 2011 revolution to $45 billion today. The new cash infusion from the IMF will require a massive reduction of this trade deficit and a further devaluation of Egypt’s currency. A resulting rise in the cost of imports is hitting the pocketbook of all but the wealthiest of consumers.

Just down the road from the infant formula protest, a billboard urges Egyptians to “Rationalize our consumption, reduce our imports” as part of an information campaign aimed at selling the public on the government’s IMF loan-tied market reforms.“They told us that the life will be more expensive but not in this insulting and exhausting way,” said a protesting mother who declined to give her name out of security concerns. “I go from pharmacy to pharmacy and told there is no milk.”

At the Health Ministry’s headquarters near Tahrir Square, spokesperson Khaled Megahed said the breast examinations were part of a series of new rules to prevent “leakages” in the supply of subsidized formula almost echoing the language of the austerity promotion billboards.

Government inspectors claim synthetic milk has ended up at bakeries and caterers to hold down costs of their products and maximize profits but nursing mothers say they are paying the price for the corruption of others.

On Saturday the Al-Haqaneya Association for Rights and Freedoms filed an urgent appeal to the State Council’s administrative court claiming the new rules violate child welfare and protection clauses in Egypt’s constitution.“There is definitely a tightening of the rules with eligibility for the formula subsidy limited to women who have twins, have a breast defects or suffer from a chronic disease, “said Dalia Abd Alhamed, a gender researcher at the Egyptian Initiative for Personal Rights.

“Our ‘right to health’ team is monitoring the breast exams issue but as of now we cannot confirm that part of the policy has been implemented,” Alhamed told The Media Line.

A response from the Muslim Brothers and Egypt’s Army

Figures from Egypt’s outlawed Muslim Brotherhood organization seized upon false reports of “public” exams as a symbol of the what they characterized as a depraved regime that disrespects women. “Let me now remind you of [President Abdel Fatteh Al-]Sisi’s words when he said Egyptian women will not be molested,” said Hamza Zawba, a former spokesman for the Brotherhood’s Freedom and Justice Party.

“Sisi said he would not let them end up in boats in the sea like Syrian women,” Zawba said in a commentary aired on a Brotherhood TV station beamed into Egypt from Turkey. “But he will let them expose their breasts to a soldier or a doctor to see if they have milk or not!”

The Health Ministry denounced claims women would undergo public examinations saying the formula eligibility checks will take place privately in mobile health clinics and pledged to roll out a “smart card” system for synthetic milk similar to the device given to indigent families receiving government food assistance.

Egypt’s army — eager to prevent unrest and maintain its place at the center of society — stepped into the infant formula business as well.

“Citizens must realize that the armed forces exert all efforts to ease the burden on ordinary people,” said military spokesman Mohamed Samir who announced that Egypt’s army had signed a contract with a French firm to import baby formula. The military said it would sell the at a price of around $3 a unit instead of $6 – the market price at private pharmacies outside the state run distribution system.

The breast vs. bottle feeding argument reaches Egypt

Research from the United Nation’s Children’s UNICEF and child nutritionists say that the ongoing formula subsidy and market interventions — like the price support announced by Egypt’s military — may have inadvertently caused a surge in bottle feeding here even as the developed world has re-embraced breast feeding. “While in Europe and America women are going back to breastfeeding, latest trends show a progressive reduction in mothers’ breastfeeding in Egypt,” said Habiba Hassan Wassef, a Cairo based nutrition consultant to international aid agencies.
“Only 29 percent of children in Egypt aged four to five months are exclusively breastfed, according to statistics from UNICEF and exclusive breastfeeding in the first four to six months of a child’s life is known to boost early childhood health,” Wassef said.

The UNICEF report says infant and young child feeding practices in Egypt remain sub-optimal and the organization in partnering with the Ministry of Health to encourage mothers to breastfeed before leaving the maternity ward with their new baby. “We are working together to renew the dialogue and commitment with Egypt’s health facilities becoming baby friendly as well as strengthening the code of marketing of breast milk substitutes,” said Bruno Maes, UNICEF’s Egypt Representative.

“There is a need to better inform mothers and communities on the importance of breastfeeding for their child’s survival and mental and physical development,” Maes told The Media Line.

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