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Introduction: The marketing of breast milk substitutes (MBMSs) is presumed to be associated with declines in breastfeeding practices. National laws to control the MBMS are expected to improve exclusive breastfeeding (EBF) and continued breastfeeding (CBF) rates. Aim: This study aims to study the effect of national laws that control MBMS on EBF and CBF trends in the Eastern Mediterranean Region (EMR) countries. Methods: EMR infant feeding data for EBF and CBF were derived from the Global Database of the United Nations International Children’s Emergency Fund/World Health Organization (WHO). Data for the code of MBMS came from the WHO report in 2020. Percent change in EBF and CBF over the past 3 decades was correlated with scores given to the national laws according to their coverage of the provisions under the code. Results: Percent change in EBF correlated significantly with the total score given to national laws (r0.8; p<0.001) and with provisions for monitoring and enforcement, promotion to the general public, and engagement with health workers and health systems (p<0.05). CBF rates did not correlate with any of the scores for the national laws. Duration of the national law correlated with monitoring and enforcement (p<0.05). Conclusion: MBMS is the main drive for low EBF rates. National laws can directly influence early feeding practices only when all the provisions under the code are covered. National laws need to cover the code in its entirety.

Background: The revised ten steps of the baby-friendly hospital initiative (BFHI) in 2018 require breastfeeding protection through the implementation of the International Code of Marketing of breast-milk substitutes (The Code). Aim: The aim of the study was to assess the satisfaction of staff with the implementation of the global criteria of the revised "Ten steps" of BFHI in 15 Eastern Mediterranean region (EMR) countries. Methodology: Professionals representing Member States who registered to an EMR-WHO webinar meeting on monitoring BFHI were involved in giving feedback about the extent to which their workplace abides by the global criteria, Ten Steps including the Code. Feedback was also obtained about the status of adherence to the global criteria of steps 2, 3, 4, 5 6, and 9 using a rating scale (1-10). Countries were grouped into two groups: High income (HIC) and middle and low income (MIC and LIC). The results were statistically analyzed by country groups and by workplaces. Findings: 109 participants representing 15 countries responded. The respondents from HIC gave significantly higher satisfaction scores than MIC and LIC in relation to global criteria for the Code and steps 2, 3, 4, 5, 6, and 9 of the BFHI p<0.05. There were significant correlations between all of the BFHI global criteria of the Code with staff training and competency skills, and some of the clinical practices included within the revised Ten Steps p<0.05 from hospitals but not in the community. There were also significant differences between public and private hospitals in code, 1 st h skin-toskin contact (step 4), and counseling on risks of bottles and pacifiers (step 9). Conclusions: In the EMR implementation of the revised Ten Steps of BFHI particularly the Code, Step 4 and Step 9 need strengthening through monitoring, using the updated indicators, and competency training modules devised by the WHO and UNICEF in 2020.

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