Implementation of the Code of Marketing of Breast-Milk Substitutes in Vietnam: Marketing Practices by the Industry and Perceptions of Caregivers and Health Workers

Abstract

Background: The promotion of breastmilk substitutes (BMS) is an important barrier to successful breastfeeding. Objective: To examine the enactment and implementation of the Code of Marketing of Breast-Milk Substitutes (the Code) in Vietnam with a focus on marketing practices by the baby food industry and perceptions of caregivers, health workers, and policy makers. Methods: From May to July 2020, we conducted a mixed-method, cross-sectional study including a survey of 268 pregnant women and 726 mothers of infants aged 0–11 months and in-depth interviews with a subset of interviewed women (n = 39), policy makers, media executives, and health workers (n = 31). Results: In the previous 30 days, two mothers (out of 726) participating in the quantitative survey reported that health workers had recommended BMS, at private hospitals in both cases. In-depth interviews with health workers showed that hospitals have internal procedures to prevent the promotion of BMS by health workers. However, companies employed representatives to promote products not covered under the Code (e.g., commercial milk formula for pregnant women) at antenatal care visits and by gaining contact information from women and using this information to promote BMS outside the hospital, often on social media. In the 30 days preceding the survey, one-fifth of pregnant women were exposed to promotions of commercial milk formula for pregnant women and 7.1% to promotions of BMS. Among mothers of infants, 7.3% and 10.7% of respondents with infants aged 0–5 and 6–11 months, respectively, were exposed to some form of BMS promotion in the past 30 days. Around the time of birth, parents commonly brought BMS to maternity facilities (52.5%) or purchased it nearby (35.4%). Conclusions: Although Vietnam has a strong regulatory environment for the protection, promotion, and support of breastfeeding, there are implementation, monitoring, and enforcement gaps. Stronger enforcement of national policies to regulate the presence of BMS industry representatives in health facilities—both public and private—and the promotion of BMS products on digital platforms are needed.

Beliefs and Norms Associated with the Use of Ultra-Processed Commercial Milk Formulas for Pregnant Women in Vietnam

“…We employed a stratified multiple-stage cluster sampling design [12,13]. Three provinces were selected purposively to represent diverse types of communities in Vietnam.…”

“…The nonresponse rate of this stage was 14.6%. Those who agreed to participate were contacted by the research coordinators who arranged for the interview [12,13]. The sample included both permanent and temporary residents (i.e., migrant workers) of the selected subdistricts.…”

“…The sample included both permanent and temporary residents (i.e., migrant workers) of the selected subdistricts. Data were collected electronically using tablets and uploaded daily to a secure cloudbased server and then reviewed by the data manager [13]. The data collection teams (including two supervisors and 18 enumerators) received training and were supervised by investigators at the Research and Training Centre for Community Development (RTCCD) and Alive & Thrive (A&T) [13].…”

“…Data were collected electronically using tablets and uploaded daily to a secure cloudbased server and then reviewed by the data manager [13]. The data collection teams (including two supervisors and 18 enumerators) received training and were supervised by investigators at the Research and Training Centre for Community Development (RTCCD) and Alive & Thrive (A&T) [13]. Data were collected in accordance with the approved research protocol [12,13].…”

“…On average, enumerators took 45 min to complete an interview. To compensate participants for their time, we provided VND 100,000, equivalent to $4.50 (US Dollars), to at the end of each interview [13]. Interviewees had the option to select a gift such as a raincoat or a parenting book in lieu of the cash gift.…”