Marketing Of Breast-milk Substitutes Research Articles

Legislation on marketing of breast-milk substitutes in digital and social media: a scoping review

Innovative and continuously changing methods of digital marketing are routinely used to reach young women and their families with advertisements that normalise infant artificial feeding and undermine breastfeeding. Legislation and...

Regulation of baby food marketing in Thailand: a NetCode analysis.

To report on the prevalence of different types of breast-milk substitutes (BMS) marketing and the compliance of such marketing with the 'Control of Marketing of Infant and Young Child Food Act 2017' (The Act) and the 'International Code of Marketing of Breast-milk Substitutes (WHO Code)' in Thailand. Cross-sectional quantitative study, guided by the WHO/UNICEF NetCode Periodic Assessment Protocol. Health facilities and retail outlets in Bangkok, Thai media. Mothers of 0-2-year-old children, health professionals, promotions at retail outlets and health facilities, product labels, marketing on television and the internet. Marketing to mothers was highly prevalent, mostly from electronic or digital media, while BMS companies provided items to health professionals to distribute to mothers. Promotional materials in health facilities displayed company brands or logos. At retail outlets, most promotions were price-related. Approximately two-fifths of labels contained nutrition or health claims. Television marketing was growing-up-milk (GUM) advertisements, while internet promotions were varied from price-related materials to product reviews. Most instances of non-compliant BMS marketing with the Act were advertisements to mothers, and most were infant formula. Most non-compliant BMS marketing with the WHO Code was mainly concerned GUM, which are not covered by the Act and appeared in the media. BMS marketing does not fully comply with the Act or the WHO Code. The Thai government should conduct regular monitoring and enforcement activities, educate health professionals, and strengthen the Act's provisions on the media and GUM to fully align with the WHO Code.

(Non)Marketing of Breastmilk Substitutes in South African Parenting Magazines: How Marketing Regulations May Be Working.

Although exclusive breastfeeding (EBF) for the first six months is optimal for child health, it remains low globally. Breastmilk substitutes (BMS) marketing undermines breastfeeding. In 2012, South Africa introduced Regulation 991, which prohibits marketing BMS products for infants below 6 months. Our study aimed to explore if and how BMS products were presented in South African parenting magazines post-R991. We applied a mixed-methods cross-sectional content analysis design, analyzing all 2018 issues of two popular parenting magazines. We descriptively analyzed quantitative codes, derived from an a priori framework, and conducted qualitative content analysis on a subset of texts and images. We found there was no overt marketing of BMS to parents with infants below 6 months. However, BMS advertisements were placed next to articles about young infants, and vague wording and images were ways by which BMS companies may indirectly benefit. Medical experts in both magazines promoted the introduction of solids before six months. To conclude, while BMS companies in South Africa were abiding by R991 by not overtly advertising BMS in parental print media, their influence persists. Continued monitoring of print media as well as other channels is advisable. This study may be of interest to countries considering stronger regulations of BMS advertising.

Exposure to marketing of breastmilk substitutes in Mexican women: Sources and scope

BackgroundAggressive and unregulated marketing of breastmilk substitutes (BMS) results in increased child morbidity and mortality. Unregulated BMS marketing is a major public health concern because it encourages formula consumption at the expense of breastfeeding. This study aimed to identify the sources and characterize the nature of exposure to marketing of BMS among Mexican mothers of children under 18 months of age. As a secondary objective we explored potential association between exposure to BMS marketing and infant feeding practices.MethodsCross-sectional study, comprising a pre-piloted survey, was conducted between February 2020 to February 2021 with Mexican mothers of children under 18 months of age (n = 754), in two major cities in Mexico. Mothers were selected according to their current infant feeding practices (Breastfeeding only vs. Mixed feeding). We characterized the different BMS marketing sources and scope, and related them with infant feeding practices. In addition, we used logistic regression models to estimate the odds ratio for infant feeding practices by BMS marketing exposure or recommendation.ResultsMothers reported different sources of exposure to BMS promotion, including BMS advertisements in diverse media channels (41.6%), recommendation by a healthcare professional and/or relative (76.2%), and receiving a BMS sample at a hospital (18.6%). By contrast, only 36.5% recalled hearing or seeing breastfeeding information the previous year. The odds of mixed feeding were substantially higher, compared to breastfeeding, when mothers were recommended to use a BMS by doctors/pediatricians (OR: 3.96, 95% CI: 2.00, 7.83). Having seen or heard breastfeeding information in the previous year was associated with a lower risk of mixed feeding compared to breastfeeding only (OR: 0.59, 95% CI: 0.35, 0.99).ConclusionsMexican mothers of young children in the metropolitan areas studied were highly exposed to BMS marketing and through different mass media channels and inter-personal sources. Health care professionals, particularly doctors/pediatricians, are a source of BMS promotion that are likely to have a strong influence on maternal decisions about infant feeding practices. There is an urgent need to protect mothers and their families against unregulated BMS promotion through mass media channels and directly by influential individuals, including health care providers.

Content analysis of breast milk substitutes marketing on Chinese e‐commerce platforms

China has the largest and fastest‐growing breast milk substitutes (BMSs) market and a disproportionately low exclusive breastfeeding rate. Many BMS manufacturers have established Chinese e‐commerce stores. This marketing is of concern as it is likely to undermine breastfeeding. This study aimed to identify: (1) the marketing themes and strategies used to promote BMSs on the Chinese BMSs e‐commerce websites; (2) if and how digital BMSs marketing may deviate from the World Health Organization Code of Marketing of Breast Milk Substitutes (the Code) recommendations. Content analysis was conducted on the flagship websites of 10 BMSs companies on the Chinese e‐commerce platform “TMall” in July 2019. The main landing page (n = 10) of the flagship TMall website and the product description page (n = 113) of all individual formulas (Stages 1–3) within each company's TMall website were examined. The content was analysed and coded using an iterative thematic analysis approach. Emphasis on Premiumization and Science & Nutrition was the most commonly used marketing approaches. A total of 27.4% of the product description pages sampled used images of infants (<12 months), 33.6% made favourable comparisons of BMSs to breast milk, and only 34.5% included probreastfeeding statements. Marketing strategies were often inconsistent with the Code, and companies used “creative” ways to target mothers, often circumventing the Code recommendations. Unsubstantiated information was commonplace and of concern, because the e‐commerce platform provided easy opportunities for bulk purchases. National regulatory actions are urgently needed to monitor online BMS marketing and the undermining of breastfeeding in China.

An exploration of pregnant women and mothers\u2019 attitudes, perceptions and experiences of formula feeding and formula marketing, and the factors that influence decision-making about infant feeding in South Africa

BackgroundDespite strong evidence showing the lifelong benefits of breastfeeding for mothers and children, global breastfeeding practices remain poor. The International Code of Marketing of Breastmilk Substitutes is an internationally agreed code of practice, adopted by the World Health Assembly in 1981, to regulate promotion of commercial formula, and is supported by legislation in many countries. However, marketing of formula remains widespread and contributes to mother’s decisions to formula feed. We present South African data from a multi-country, mixed-methods study exploring women’s decision-making about infant feeding and how this was influenced by exposure to formula marketing.MethodsUsing a consumer-based marketing approach, focus group discussions (FGDs) were conducted with pregnant women and mothers of children aged between 0 and 18 months in two urban sites in South Africa. Participants were purposively selected according to their child’s age, infant feeding practices and socioeconomic status. Ten FGDs were conducted during February 2020 with a total of 69 participants. Thematic analysis was used to analyse the data with NVivo v.12 software.ResultsDespite being encouraged by health professionals to breastfeed and intending to do so, many mothers chose to give formula in the early weeks and months of their child’s life. Mothers reported breastfeeding challenges as the most frequent reason for initiating infant formula, stating that family members and health professionals recommended formula to solve these challenges. Although participants described few advertisements for infant formula, advertisements for ‘growing-up’ formulas for older children were widespread and promoted brand recognition. Mothers experienced other marketing approaches including attractive packaging and shop displays of infant formula, and obtained information from social media and online mothers’ groups, which influenced their choice of formula brand. Mothers reported strong brand loyalty derived from previous experiences and recommendations. Health professionals frequently recommended formula, including recommending specific formula brands and specialist formulas.ConclusionGlobal formula companies use multifaceted marketing methods to promote a strong narrative portraying formula feeding as a positive lifestyle choice. Positive, coordinated efforts are required to counter pro-formula messaging and change the narrative to support breastfeeding as an aspirational choice. In particular, health professionals must stop supporting the formula industry.

Breastfeeding, first-food systems and corporate power: a case study on the market and political practices of the transnational baby food industry and public health resistance in the Philippines

BackgroundThe aggressive marketing of breastmilk substitutes (BMS) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The Code), many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, commercial milk formula (CMF) markets have markedly expanded. In this paper, we adopt the Philippines as a case study to understand the battle for national Code implementation. In particular, we investigate the market and political strategies used by the baby food industry to shape the country’s ‘first-food system’, and in doing so, promote and sustain CMF consumption. We further investigate how breastfeeding coalitions and advocates have resisted these strategies, and generated political commitment for a world-leading breastfeeding policy framework and protection law (the ‘Milk Code’). We used a case study design and process tracing method, drawing from documentary and interview data.ResultsThe decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby ‘marketing around’ the Milk Code. It established front groups to implement political strategies intended to weaken the country’s breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women’s choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, from collective actions by breastfeeding coalitions, advocates and mothers.ConclusionThe Philippines illustrates the continuing battle for worldwide Code implementation, and in particular, how the baby food industry uses and adapts its market and political practices to promote and sustain CMF markets. Our results demonstrate that this industry’s political practices require much greater scrutiny. Furthermore, that mobilizing breastfeeding coalitions, advocacy groups and mothers is crucial to continually strengthen and protect national breastfeeding policy frameworks and Code implementation.

Mothers' and health workers' exposure to breastmilk substitutes promotions in Abidjan, Côte d'Ivoire.

Marketing of breastmilk substitutes (BMS) continues to undermine breastfeeding globally, and low income countries experiencing rapid economic growth are especially vulnerable as expanding BMS markets. The objective of the study was to understand the prevalence of exposure to BMS promotions among mothers of children 0–23 months, the frequency and type of contacts between BMS companies and health workers and the presence of educational/informational materials and branded equipment associated with such companies in health facilities in Abidjan using the World Health Organization's NetCode protocol. The methods included structured interviews with health workers and mothers and observations of equipment/materials in a sample of 42 facilities, 330 mothers and 129 health workers. Descriptive statistics were produced, and chi‐squared tests were used to assess differences by child age and facility type. Forty‐three per cent of mothers were advised to feed BMS products in the past 6 months, with a significantly higher percentage of mothers of older children (6–23 months) advised compared to infants 0–5 months. Two thirds (66%) of mothers had seen promotions outside of facilities. Among health workers, 63% were contacted by BMS companies, and only 8% were familiar with the International Code of Marketing of BMS. Differences were found between public/private facilities in the types of requests BMS companies made to health workers. Strong actions are needed in Côte d'Ivoire to prevent BMS promotion in the health system, including increasing health workers' knowledge of the International Code and national regulations, monitoring violations and reaching mothers and families to promote optimal breastfeeding practices.

Breastfeeding Communication Strategies, Challenges and Opportunities in the Twitter-Verse: Perspectives of Influencers and Social Network Analysis.

Using social media is one important strategy to communicate research and public health guidelines to the scientific community and general public. Empirical evidence about which communication strategies are effective around breastfeeding messaging is scarce. To fill this gap, we aimed to identify influencers in the largest available Twitter database using social network analysis (n = 10,694 users), inductively analyze tweets, and explore communication strategies, motivations, and challenges via semi-structured interviews. Influencers had diverse backgrounds within and beyond the scientific health community (SHC; 42.7%): 54.7% were from the general public and 3% were companies. SHC contributed to most of the tweets (n = 798 tweets), disseminating guidelines and research findings more frequently than others (p < 0.001). Influencers from the general community mostly tweeted opinions regarding the current state of breastfeeding research and advocacy. Interviewees provided practical strategies (e.g., preferred visuals, tone, and writing style) to achieve personal and societal goals including career opportunities, community support, and improved breastfeeding practices. Complex challenges that need to be addressed were identified. Ideological differences regarding infant feeding may be hampering constructive communication, including differences in influencers’ interpretation of the WHO International Code of Marketing of Breast-milk Substitutes and in perspectives regarding which social media interactions encompass conflict of interest.

Breastfeeding and breastmilk substitute use and feeding motivations among mothers in Bandung City, Indonesia

Suboptimal breastfeeding is common in Indonesia, with only half of infants 0–5 months of age exclusively breastfed and feeding of breastmilk substitutes (BMS) highly prevalent among infants and toddlers. Various factors influence these feeding practices, including social norms, limited health system support and BMS manufacturer marketing practices. This cross‐sectional survey aimed to identify the prevalence of breastfeeding and BMS feeding among children aged 0–35 months, explore socio‐demographic characteristics and motivating factors associated with these feeding behaviours and identify the prevalence of mothers' exposure to BMS promotions. Indonesian mothers of children <3 years of age (n = 595) were interviewed in Bandung City health facilities using structured questionnaires. Although all children were ever breastfed, half of children across all age groups received BMS in the previous day. Maternal employment outside the home and insufficient breastmilk production were associated with BMS use. The most important motivational factors for feeding BMS were perceived benefits for growth, intelligence and immunity. Despite Indonesian legislation restricting some BMS marketing, 93% of mothers reported observing a BMS promotion outside the health system, with television, social media and newspapers as the most common sources. Half of mothers (43%) reported observing a BMS promotion within the health system, and half (46%) reported receiving recommendations from health workers to use BMS. Such high prevalence of BMS marketing may be influencing caregivers' feeding choices; stronger national legislation and implementation of laws are needed to ensure mothers' ability to make feeding choices free from manufacturer influence.

Compliance With the “Baby-Friendly Hospital Initiative for Neonatal Wards” in Russian Hospitals

The expansion of the Baby-Friendly Hospital Initiative to neonatal wards, known as the Neo-BFHI, provides recommendations to support breastfeeding, as outlined in the Three Guiding Principles, the expanded Ten Steps, and the International Code for Marketing of Breast-Milk Substitutes. In 2017, Russia participated in an international survey about compliance with the Neo-BFHI. To assess breastfeeding support policies and practices in Russian neonatal wards at the country and federal district level in accordance with the Neo-BFHI recommendations. This study was a prospective cross-sectional survey. We used the Neo-BFHI Self-Assessment questionnaire to collect data from neonatal wards that had all levels of care. A total of N = 60 Russian neonatal wards in hospitals that have ever been designated Baby-Friendly or planned to do so participated in the survey. Compliance scores at the federal district and country level ranging from 0-100 were used to summarize results. The median country overall score was 90 (IQR = 83 - 93). Respect for mothers, continuity of care, having a breastfeeding policy, and rooming-in had the highest median scores. Family-centered care, antenatal informing, skin-to-skin contact, and human milk use had the lowest median scores. Neonatal wards in the hospitals that were ever designated as Baby-Friendly had significantly higher scores than those that were never designated. Most respondents (n = 48, 80%) expressed a desire to obtain Neo-BFHI designation in their neonatal wards. Neo-BFHI recommendations can be successfully implemented in Russian neonatal wards at hospitals designated Baby-Friendly or planning to be designated.

Enacting the Code by effective national laws influence trends in exclusive breastfeeding: An analytical study from the Eastern Mediterranean Region

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&lt;0.001) and with provisions for monitoring and enforcement, promotion to the general public, and engagement with health workers and health systems (p&lt;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&lt;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.

The Relationship Between Place of Birth and Early Breastfeeding Initiation in Indonesia.

In many countries, hospital-based births are associated with the early initiation of breastfeeding, within the first hour postpartum, especially where the Baby Friendly Hospital Initiative guidelines have been adopted. While Indonesia has adopted the guidelines, there is a relatively low rate of early breastfeeding initiation in the country. To determine the relationship between place of birth and early breastfeeding initiation in Indonesia. This study was a retrospective cross-sectional survey using national data from the 2017 Indonesia Demographic and Health Survey (N = 14,279). The association between place of birth and early breastfeeding initiation was examined using logistic regression models, adjusting for potential confounders. The overall prevalence of early breastfeeding initiation in Indonesia was 60.9% with a greater proportion of mothers giving birth in health facilities. In the multivariate model, there was a significant interaction between wealth index, insurance status, and place of birth on the timing of breastfeeding initiation. In the subgroup of mothers residing in middle wealth index households, women who gave birth in clinics and hospitals had lower odds of early breastfeeding initiation compared to those who gave birth at home (0.56; 0.34, 0.90; p = .018) and (0.58; 0.40, 0.85; p = .005), respectively. Place of birth was significantly associated with early breastfeeding initiation. There is a need to consider health disparities and to strengthen the implementation of the WHO guidelines, Baby Friendly Hospital Initiative, and International Code of Marketing of Breastmilk Substitutes, to increase early breastfeeding initiation in Indonesia.

Marketing of breast milk substitutes on the internet and television in Mexico.

We aimed to examine the advertising and marketing of breast milk substitutes (BMS) through the internet, social media and television in Mexico. We recorded the programming of four main TV channels at peak times to identify BMS advertisements. In addition, we identified the main BMS products and companies present on the internet, as well as related home pages and social networks (Facebook, Twitter and YouTube). After that, we examined current BMS' marketing practices using the International Code of Marketing of Breast-milk Substitutes ('the Code') as a framework for ethical marketing. Qualitative and statistical analyses are presented. BMS manufacturers have a presence on television, social media and the internet. Violations of the Code, as well as promotional practices unforeseen by the Code, were identified in all the studied media. These include text and images idealising the use of BMS, as well as mechanisms for boosting sales and making contact with consumers. The Mexican population is exposed to BMS advertisements that breach the Code on the internet, on social networks and on television. Emerging challenges related to the use of electronic means to market BMS may call for new strategies for monitoring and enforcing the Code through local regulations.

Promotion of Human Milk Substitutes in the Opinion of Mothers of Young Children

Background. The International Code of Marketing of Breast-milk Substitutes was established to reduce the detrimental effect of promotional activities of companies producing BMS on attitudes towards breastfeeding. Objective. The study was carried out to assess maternal opinions on promotional activities related to BMS in medical facilities, participation of medical staff in advising mothers to feed children with BMS, and other promotional activities related to those products. Design. This study was part of the Netcode survey. Data was collected via structured interviews and the results were analyzed with the use of descriptive statistics and Chi-Square Post-Hoc analysis using the program SPPS. Settings. Poland. Participants. Women caring for children age 0-36 months (N =380). Results. More than one third of the interviewed women (35%) declared that they were informed to give milk products other than human milk to children below 6 months of age (n=132). Among people recommending these types of products, women mostly indicated health care professionals. In health centers mothers were mainly exposed to brochures and have received free samples of BMS. Conclusions. The investigation has shown a substantial exposition of women to marketing of BMS, with significant involvement of medical professionals. Promoting BMS to mothers who can feed naturally, without providing them enough support to continue natural feeding is unethical. Measures should be implemented to better adhere to the Code.

Being There: The Development of the International Code of Marketing of Breast-milk Substitutes, the Innocenti Declaration and the Baby-Friendly Hospital Initiative.

Margaret Isabirye Kyenkya (photo) grew up in Uganda with five bothers and six sisters. Her Bachelor of Arts was in Social Work and Social Administration (Makerere University, Uganda), and was followed by a Masters in Sociology, (Nairobi University), and a Certificate in Mother and Child Health (International Child Health Institute, London). Her PhD focused on Hospital Administration inspired by the WHO/UNICEF Baby Friendly Hospital Initiative. She has worked as a researcher, the founder of Non-Governmental Organizations, a Senior United Nations Officer (New York Headquarters and several regions), a Manager in the United States Agency for International Development-funded National Health and Nutrition Projects, and a governmental Health and Nutrition Adviser. A certified trainer in a number of health and nutrition areas, a breastfeeding counselor, and a retired La Leche League Leader, Dr. Kyenkya has significantly influenced the course of lactation support and promotion globally. She stated, "My most precious and valued occupation is that of a mother [of five] and grandmother [of eight]." Dr. Kyenkya currently lives in Atlanta, Georgia, in the United States. (This interview was conducted in-person and transcribed verbatim. It has been edited for ease of readability. MK refers to Margaret Kyenkya; KM refers to Kathleen Marinelli.).

Implementing the Baby Friendly Hospital Initiative in a Tertiary Health Facility: Lessons from the University of Port Harcourt Teaching Hospital, Nigeria

Background: As part of Nigeria’s effort to attain the targets of the 1990 Innocenti Declaration, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. The 2005 Innocenti Declaration reiterated the need for the Initiative by asking governments to “revitalize” it and maintain “the Global Criteria as the minimum requirement for all facilities”. The Nigerian government adopted the Initiative and in response to the national directive for tertiary health facilities to become Baby Friendly, the University of Port Harcourt Teaching Hospital (UPTH) established its BFHI Committee in 1992, with a multi-departmental and multi-disciplinary membership. Although the Baby Friendly Hospitals designated following this directive have largely not been reassessed, the BFHI Committee of the UPTH has remained active, implementing relevant activities at the facility and within and outside Rivers State.&#x0D; Aims: To share experiences with sustaining BFHI activities without adequate support in a tertiary health facility with a goal to stimulating commitment to the establishment and sustenance of similar committees in similar health facilities.&#x0D; Place and Duration of Study: University of Port Harcourt Teaching Hospital, Nigeria; 27 years.&#x0D; Methodology: From the inception of the Committee, an administrative structure comprising of the Steering Committee and its Chairman, the Coordinator and Secretary was set up. Information on the activities of the Committee was extracted from the reports of activities, Minutes of Meetings and other publications of the Committee. These were analysed for presentation. &#x0D; Results: Established in 1992 to drive the hospital’s mandate to become Baby Friendly, the Committee has sustained the efforts to promote, protect and support breastfeeding through capacity development, provision of technical support to Departments and facilities, promotion of research and support of the implementation of the Ten Steps to Successful Breastfeeding, the International Code of Marketing of Breast milk Substitutes, HIV and Infant Feeding Counselling, Facility Based Management of Severe Acute Malnutrition and others.&#x0D; Some of the achievements of the Committee during the period 1992-2019 are:&#x0D; &#x0D; Sustained implementation of activities in support of the Ten Steps to Successful Breastfeeding (operating the Crèche, Mother’s Room, Nutrition Clinic and Breastfeeding Room in the Special Care Baby Unit, Nutrition education and the distribution of Information, Education and Communication materials on breastfeeding and the Code).&#x0D; Celebration of the World Breastfeeding Week and mobilization of stakeholders to celebrate the Week since 1997.&#x0D; Awareness creation on the Code for improved compliance within and outside Rivers State&#x0D; Integration of breastfeeding education into the curricula of health workers&#x0D; The Conduct of the 2015 World Breastfeeding Trends Initiative Assessment in Nigeria&#x0D; &#x0D; Challenges: include changes in leadership with some leaders not showing commitment to the mandate of the Committee; Lack of funds, lack of dedicated staff for breastfeeding promotion in the hospital and pressure from infant food industries.&#x0D; Conclusion: Successful and continued implementation of the Baby Friendly Hospital Initiative with its expansion to the BFH Community Initiative will contribute to improved breastfeeding practices and therefore the attainment of the global nutrition targets. While mitigating the challenges to effective implementation of the Committee’s activities, tertiary health facilities should reposition themselves to promote, protect and support the initiative for the realization of relevant global nutrition targets.

Perspectives about the baby friendly hospital/health initiative in Australia: an online survey

BackgroundEvidence supports the health and economic benefits of breastfeeding, and the positive impact of the Baby Friendly Health Initiative (BFHI) on increasing breastfeeding rates and improving breastfeeding outcomes. The BFHI is a World Health Organization and United Nations International Children’s Emergency Fund initiative to promote, support and maintain breastfeeding. The BFHI was updated in 2018 and includes the Ten Steps to Successful Breastfeeding (the Ten Steps 2018) and the International Code of Marketing of Breast-milk Substitutes (the WHO Code). Despite policy and guideline support for breastfeeding and the BFHI, there are currently only 70 accredited hospitals, healthcare centres and regional clusters in Australia, accounting for 23% of maternity facilities. This research aimed to explore health professionals and other stakeholders’ perspectives on the uptake and implementation of the BFHI in Australia from an organisational change perspective.MethodsAn online survey administered via relevant Australian-based professional associations was fully or partially completed by 332 participants who support mothers and newborns in their roles. Descriptive statistics and content analysis were used to analyse quantitative and qualitative data.ResultsThe majority of participants supported legislating the WHO Code, closely monitoring BFHI compliance, ensuring sufficient knowledge about breastfeeding and the BFHI among staff, improving care within maternity facilities, continuous support of mothers’ post-discharge, and improving social media support of breastfeeding. It was also perceived that an interdisciplinary team approach and multidisciplinary involvement were important requirements for successfully implementing the BFHI. There was no consensus among participants that Australian health policies support breastfeeding and the implementation of the BFHI.ConclusionsThis study emphasised the significance of legislation around the Code, executive and leadership support and culture, and providing adequate resources concerning uptake and implementation of the BFHI. Considering that uptake of the BFHI has been limited and no formal government support has been provided to further develop the BFHI and support the Code in Australia, findings of this research may help with potential future actions to facilitate the BFHI uptake and Code implementation.

David Clark: Defender of Human Rights and Breastfeeding.

On September 10, I had the pleasure of interviewing my friend and colleague David Lawson Clark, the legal advisor for infant and young child nutrition and expert on the International Code of Marketing of Breast-milk Substitutes at UNICEF. A native of Scotland, David began his career as an attorney with the Scottish Development Agency and subsequently worked for the United Nations Interregional Crime and Justice Research Institute in Rome, Italy. Since 1995, David has assisted more than 60 countries in drafting legislation to implement the International Code of Marketing of Breastmilk Substitutes and has been instrumental in bringing a human rights-based approach to the protection, promotion, and support of breastfeeding. He has contributed to the development of international policy guidelines in the area of HIV and infant feeding and infant feeding in emergencies, and has provided guidance on issues around international trade agreements and intellectual property rights. David has written and contributed to many articles and publications on health and nutrition policy, developed courses and training materials on the implementation of the International Code and maternity protection, and has facilitated numerous workshops on the issue. (LGS refers to Dr. Laurence Grummer-Strawn and DC are the verbatim responses of David Clark).

ASSOCIAÇÃO ENTRE OFERTA DE FÓRMULAS INFANTIS E CHUPETAS NA MATERNIDADE E AMAMENTAÇÃO NOS PRIMEIROS SEIS MESES DE VIDA

Introdução: Amamentação (AM) é base para a segurança alimentar e saúde. Deve ser promovida na maternidade por práticas como os passos 6 (não oferecer suplementos) e 9 (não oferecer bicos) da Iniciativa Hospital Amigo da Criança (IHAC). Objetivo: Avaliar o cumprimento dos passos 6 e 9 da IHAC e sua associação com a AM nos primeiros seis meses de idade. Metodologia: Coorte prospectiva em seis hospitais do município de São Paulo, sendo três Hospitais Amigos da Criança (HAC) e três não HAC. Mães foram entrevistadas na maternidade e por telefone aos 30 e 180 dias. Investigaram-se o cumprimento dos passos 6 e 9 e as práticas de AM. As associações foram analisadas por regressão logística ajustada para as variáveis de confusão determinadas pelo gráfico acíclico direcionado (DAG). Resultados: Amostra de 969 mães na primeira entrevista, 902 na segunda e 814 na terceira. Os passos 6 e 9 foram cumpridos nos dois grupos de hospitais. O não cumprimento do passo 6 reduziu o AME aos 30 dias (aOR=1,82; IC=1,19-2,77) e a AM aos 180 dias (aOR=1,79; IC=1,15-2,78). O descumprimento do passo 9 reduziu o AME aos 30 dias (aOR=2,33; IC=1,30-4,19). Conclusão: A chance do AME no primeiro mês foi reduzida pela oferta de fórmula infantil e chupeta na maternidade. Aos seis meses, a amamentação foi reduzida pela introdução de fórmula na maternidade. Os resultados reforçam a importância do cumprimento das disposições do Código Internacional de Comercialização de Substitutos do Leite Materno, propiciando um ambiente seguro que incentive a mulher a escolher amamentar.DOI: 10.12957/demetra.2019.43555