The World Health Organization Code and exclusive breastfeeding in China, India, and Vietnam

Abstract

Promoting exclusive breastfeeding (EBF) is a highly feasible and cost-effective means of improving child health. Regulating the marketing of breastmilk substitutes is critical to protecting EBF. In 1981, the World Health Assembly adopted the World Health Organization International Code of Marketing of Breastmilk Substitutes (the Code), prohibiting the unethical advertising and promotion of breastmilk substitutes. This comparative study aimed to (a) explore the relationships among Code enforcement and legislation, infant formula sales, and EBF in India, Vietnam, and China; (b) identify best practices for Code operationalization; and (c) identify pathways by which Code implementation may influence EBF. We conducted secondary descriptive analysis of available national-level data and seven high level key informant interviews. Findings indicate that the implementation of the Code is a necessary but insufficient step alone to improve breastfeeding outcomes. Other enabling factors, such as adequate maternity leave, training on breastfeeding for health professionals, health systems strengthening through the Baby Friendly Hospital Initiative, and breastfeeding counselling for mothers, are needed. Several infant formula industry strategies with strong conflict of interest were identified as harmful to EBF. Transitioning breastfeeding programmes from donor-led to government-owned is essential for long-term sustainability of Code implementation and enforcement. We conclude that the relationships among the Code, infant formula sales, and EBF in India, Vietnam, and China are dependent on countries' engagement with implementation strategies and the presence of other enabling factors.

Strengthening counseling on barriers to exclusive breastfeeding through use of job aids in Nampula, Mozambique

“…Our findings also call for addressing the excessive caseloads and limited time that health providers have through task shifting to community health workers, as well as early return to work postpartum which is a key challenge to EBF in Mozambique. Finally, as Mozambique has endorsed the WHO Code for Marketing Breastmilk Substitutes [51,52], the MOH and Ministry of Gender, Child and Social Action should join efforts to ensure the criteria for infant formula distribution to INAS are known by all relevant stakeholders and strictly followed. Short-term and long-term investments to improve breastfeeding counseling services during routine contact points and the implementation and sustainability of large-scale improvements in breastfeeding counseling in Mozambique would benefit from employing the Breastfeeding Gear Model as a framework.…”

An analysis of stakeholder networks to support the breastfeeding scale-up environment in Mexico

“…The 2030 WHO target for optimum breastfeeding practices, including at least 70 % of EBF (4) , will not be met unless a supportive policy environment is established to effectively scale up breastfeeding programmes at a national level (5)(6)(7)(8) . Key actions needed to bolster the supportive policy environment to promote breastfeeding include ensuring (1) increase funding of breastfeeding programmes, including maternity protection in the workplace, (2) compliance with the Baby-Friendly Hospital Initiative, (3) access to breastfeeding counselling and training, (4) availability of community support programmes, (5) continuous monitoring, and (6) regulation of the potential impact of formula companies and associated marketing practices on breastfeeding rates (4,5,7,9,10) .…”

Structural vulnerabilities and breastfeeding among female sex workers in Mumbai

“…These are one necessary approach to increase breastfeeding; they raise awareness, shape practices at the policy and organizational levels, and direct targeted interventions to work towards the advancement of breastfeeding goals. However, alone, they are insufficient to fully impact breastfeeding, particularly for populations such as FSWs (Robinson et al, ). To increase breastfeeding, we must be vigilant in measuring the anticipated and unanticipated effects of our policies.…”

“…In India, 54.9% of all infants under 5 months of age are exclusively breastfed (Robinson, Buccini, Curry, & Perez‐Escamilla, ). Breastfeeding is a key strategy to improve population health as it prevents infant death; infant mortality rates in India are exceptionally high (47 deaths per 1,000 births; Gupta, Dadhich, & Faridi, ).…”