Implementation of two policies to extend maternity leave and further restrict marketing of breast milk substitutes in Vietnam: a qualitative study

Abstract

Policy research can reveal gaps and opportunities to enhance policy impact and implementation. In this study, we use a theoretically informed qualitative approach to investigate implementation of two policies to promote breastfeeding in Vietnam. We conducted semi-structured interviews with national and local policy stakeholders (n=26) in 2017. Interviews were audio recorded and transcribed verbatim, then translated to English by certified translators. Transcript data were analyzed using an integrated conceptual framework of policy implementation. Respondents identified several positive outcomes to implementing an extended maternity leave policy (Labour Code No. 10/2012/QH13) and further restrictions on marketing of breast milk substitutes (Decree No. 100/2014/ND-CP). Decree No. 100, in particular, was said to have reduced advertising of breast milk substitutes in mass media outlets and health care settings. Key implementation actors were national-level bureaucratic actors, local organizations, and international partners. Findings reveal the importance of policy precedence and a broader set of policies to promote the rights of women and children to support implementation. Other facilitators were involvement from national level implementing agencies and healthcare personnel, and strength of government relationships and coordination with non-governmental and international organizations. Implementation challenges included insufficient funding, limited training to report violations, a cumbersome reporting process, and pervasive misinformation about breastmilk and breast milk substitutes. Limited reach for women employed in the informal labor sector and in rural communities was said to be a compatibility issue for the extended maternity leave policy in addition to the lack of impact on non-parental guardians and caretakers. Recommendations to improve policy implementation include designating a role for international organizations to support implementation, expanding maternity protections for all working women, building local-level policy knowledge to support enforcement, simplifying Decree No. 100 violation reporting processes, and continuing to invest in interventions to facilitate a supportive policy environment in Vietnam.

Lessons for strengthening policymaking for obesity and diet‐related noncommunicable disease prevention: A narrative synthesis of policy literature from the Western Pacific Region

“…A review of sodium‐reduction strategies in Pacific Island Countries identified that implementation would have been improved if strategies were better integrated into other health campaigns and surveys 85 . In Vietnam, strategies to protect breastfeeding did not extend to informal labor markets, and did not protect women working far away from home 109 . The process of adopting SSB taxes in the Solomons was hindered by lack of mandatory sugar labelling 93 .…”

“…85 In Vietnam, strategies to protect breastfeeding did not extend to informal labor markets, and did not protect women working far away from home. 109 The process of adopting SSB taxes in the Solomons was hindered by lack of mandatory sugar labelling. 93 School food policy in the Philippines did not include a food classification system to define "healthy," and the policy promoted (arguably) unhealthy packaged foods that had attracted a 'healthy' certification for being fortified with nutrients.…”

Awareness, Perceptions, Gaps, and Uptake of Maternity Protection among Formally Employed Women in Vietnam

“…With an estimated two thirds of the labor force in Vietnam ineligible for paid maternity leave [19], many families are unable to benefit from paid parental leave [27-29]. Extending maternity protection and support to female workers in the informal sector, those who have not contributed to the social insurance fund long enough to receive entitlements, or to all women regardless of employment status, could improve breastfeeding rates and related health outcomes, while making vulnerable households more resilient to financial shocks and contributing toward social and health equity [33,[39][40][41].…”

“…Since Vietnam's amended maternity leave policy took effect on 1 January 2013, data on its implementation and uptake have been lacking in peer-reviewed literature. While a recent study explored perceptions of national stakeholders on policies to protect breastfeeding, including the expanded paid maternity leave policy [33], there has been no research to explore female workers' perceptions of the policy [33]. To address this gap, we conducted this study to examine the uptake of Vietnam's maternity protection policy in terms of entitlements and awareness, perceptions, and gaps in implementation through the lens of formally employed women.…”