Esta ley prohíbe la administración de suplementos de leche materna, suero glucosado, agua u otros alimentos a recién nacidos en centros de servicios de maternidad y cuidado infantil, a menos que sea médicamente prescrito o con el consentimiento expreso de los padres o tutor. Establece sanciones por incumplimiento y requiere que el Departamento de Salud prepare y distribuya material informativo sobre la ley.
(Approved March 13, 2004)
To prohibit the feeding of mother's milk supplements to newborn babies in maternity service centers, unless medically prescribed, or with the consent of the mother, father or tutor; impose sanctions for noncompliance; and for other purposes.
It is standard procedure in maternity service centers to feed milk supplements, glucose serum, or water to the newborn babies before breast feeding them for the first time. The feeding of supplements or food before nursing increases the risk of infection in children. If they are bottle-fed, it could interfere with the infant's sucking reflex and as a result, with the stimulation of the nipple and the ingestion of milk.
There is scientific evidence that the introduction of supplements of mother's milk in the early stages of the newborn's life has a detrimental effect in the breastfeeding behavior of the infant which could erode the confidence of the mother for natural breastfeeding. Studies also have established that the use of supplements that are not medically prescribed, brings about the premature abandonment of breastfeeding.
It in thus concluded that mothers need a health system to support their desire to breastfeed. They also require the provision of competent help in the natural breastfeeding process to prevent or overcome difficulties so that other
foods and supplements are not administered to their children without prior express consent of the mother, or a specific medical indication. There is no medical justification to give free samples of mother's milk supplements to mothers either before or after childbirth who are able to breastfeed.
The Legislature of the Commonwealth of Puerto Rico, being aware of the unparalleled benefits of breastfeeding and the difficulty of increasing the percent of women who breastfeed, has approved this legislative bill with the intention of eliminating some of the barriers.
Section 1.- This Act shall be known as "An Act on the Feeding of Breast-Milk Supplements to Newborns."
Section 2.- Definitions For purposes of this Act, the following words and phrases shall have the meaning stated below:
(a) "Maternity Service Centers:" includes delivery rooms, obstetric preparation or recovery rooms, or any place where women are given treatment during the gestation, childbirth or post-partum process, and have the pertinent permits of the competent Commonwealth of Puerto Rico agencies.
(b) "Care Centers:" every center for the care of infants between one (1) day and one (1) year of their birth.
(c) "Gynecologists:" any doctor of medicine authorized by pertinent legislation and regulations to practice gynecology or obstetrics in the Commonwealth of Puerto Rico.
(d) "Mother's milk substitutes:" any food commercialized or otherwise introduced as a pertinent or complete substitute of breast milk, whether or not it is adequate for this purpose.
Section 3.- Regulations
(a) It is prohibited in the jurisdiction of the Commonwealth of Puerto Rico, for maternity centers, care centers, or gynecologic, pediatric or obstetric offices that treat women who are six (6) months pregnant or over, or children less than one (1) year of age, to administer maternal milk substitutes, glucose serum, water, or any other food or drink other than maternal milk to newborn babies and infants, without prior written medical authorization, or the express written consent of the mother, father or tutor. A mothers who wants maternal milk substitutes to be fed to the newborn may also state her consent in writing at any time after childbirth. In the event of a medical emergency in which there has been no express written consent authorization by the mother, the prior medical authorization may be replaced by a subsequent authorization that refers to the possibility of an emergency.
(b) Doctors shall not authorize the use of said foods or beverages unless it is recommended by the best medical practices and to benefit the health of the infant.
(c) The Department of Health shall prepare brochures that clearly describe the provisions of this Act within ninety (90) days of its approval, and shall make them available in maternity wards, care centers and offices of gynecologists and obstetricians; the materials shall be placed in visible areas in maternity service centers to be seen by all visitors and patients who are waiting or resting. Maternity wards, care centers and offices of gynecologists and obstetricians shall place said informative
materials within one hundred twenty (120) days after the effective date of this Act.
Section 4.- Penalties The Department of Health, through the Assistant Secretary of Health Facilities Certification and Regulation may impose fines of up to two thousand $(2,000)$ dollars for each act of noncompliance with this Act, following the applicable procedures set forth in the Uniform Administrative Procedures Act. Said fine shall never be less than five hundred (500) dollars.
Section 5.- Effectiveness This Act shall take effect immediately after its approval.
I hereby certify to the Secretary of State that the following Act No. 79 (H.B. 4018) of the $7^{ ext {th }}$ Session of the $14^{ ext {th }}$ Legislature of Puerto Rico:
AN ACT to prohibit the feeding of mother's milk supplements to newborn babies in maternity service centers, unless medically prescribed, or with the consent of the mother, father or tutor; impose sanctions for noncompliance; and for other purposes, has been translated from Spanish to English and that the English version is correct.
In San Juan, Puerto Rico, today $24^{ ext {th }}$ of June of 2005.
Luis E. Fusté-Lacourt Director