Translating the International Code of Marketing of Breast‐milk Substitutes into national measures in nine countries

Abstract

The International Code of Marketing of Breast‐milk Substitutes (the Code) adopted by the World Health Assembly (WHA) in 1981 and regularly updated through subsequent WHA resolutions, represents the international policy framework for protecting breastfeeding against inappropriate marketing practices. By March 2016, at least 135 countries had some measures covering provisions of the Code in their legislation. The translation of the International Code into national measures was investigated in the context of the advocacy efforts undertaken by the Alive & Thrive (A&T) initiative with UNICEF and partners. A real‐time evaluation was carried out over 22 months in seven Southeast Asian countries (Cambodia, Indonesia, Lao People's Democratic Republic [Lao PDR], Myanmar, Thailand, Vietnam, and Timor‐Leste) and two African countries (Burkina Faso and Ethiopia). Drivers of policy change and progress were examined. Two theory‐based approaches were used: developmental evaluation and contribution analysis. Data collection methods included participant observation, key informant meetings, in‐depth interviews, reflective practice, and desk review. Overall, countries made significant progress in translating the International Code into national measures and in moving forward throughout the policy cycle. The main driver of policy change was the creation of a strategic group, which engaged key relevant actors and supported the government in the performance of 15 critical tasks, which the analysis reveals is a second driver. Those critical tasks are described in this paper and could help public health advocates to anticipate the stages and challenges of policy change and develop more effective strategies to translate the Code into their legal framework.

Contribution of the Alive & Thrive–UNICEF advocacy efforts to improve infant and young child feeding policies in Southeast Asia

“…Therefore, this advocacy approach was very effective, and public advocates trying to inform IYCF policies can find more information for using it (Alive and Thrive, ). The contribution story also uncovered the support brought by the strategic group for the realization of a set of critical tasks, previously identified as a main driver of progress within the policy cycle (see (Michaud‐Létourneau et al, )). The use of the advocacy approach by the strategic group of actors also ensured setting the agenda for the Code and maintaining it there at all stages of the policy cycle.…”

“…Thus, the distal outcomes, represented as a unique box in Figure , involve the realization of the critical tasks. Although one paper of this supplement describes at length how those critical tasks helped translate the International Code into national measures (Michaud‐Létourneau et al, ), the present paper focuses on the contribution of A&T–UNICEF efforts to the realization of the critical tasks.…”

“…This external influence was found in all countries under study and at all time of the advocacy efforts, and represented one of the primary barriers to progress on the Code. More information can be found on those tactics in the companion article (Michaud‐Létourneau et al, ).…”

“…This is because, regardless of contexts, the detailed ToC (created based on the data collected in all countries) is seen to apply well to each country individually. The countries where the advocacy efforts were less developed also provided counter factual to reinforce the importance of some elements (the advocacy approach and the critical tasks presented in another paper of this supplement; Michaud‐Létourneau et al, ). Moreover, generally, drawing generalizations based on CA remains difficult because it relies on context‐specific interventions in which many external influences are at play (S. Lemire, ).…”

“…Both of them easily reached agreement on the main actors to interview. Additional information can be found in a companion article of this supplement (Michaud‐Létourneau, Gayard, & Pelletier, ).…”