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 the 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, transcribed verbatim and then translated to English by certified translators. Transcript data were analysed using an integrated conceptual framework of policy implementation. Respondents identified several positive outcomes resulting from implementation of 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 healthcare 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 breast milk and breast milk substitutes. Limited reach for women employed in the informal labour 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 in supporting 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.

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IS ANYBODY KEEPING THE CODE IN BULGARIA? A STUDY TO EXPLORE LOCAL PARENTS' AWARENESS REGARDING THE INTERNATIONAL CODE FOR THE MARKETING OF BREAST-MILK SUBSTITUTES.

Proceedings of CBU in Medicine and Pharmacy ◽

10.12955/pmp.v2.188 ◽

2021 ◽

Vol 2 ◽

pp. 144-151

Author(s):

Ivanichka Serbezova ◽

Daniela Lyutakova

Keyword(s):

Breast Milk ◽

Postnatal Care ◽

Current Knowledge ◽

Parental Attitudes ◽

Local Level ◽

Prenatal Education ◽

Cross Sectional ◽

Who Code ◽

Breast Milk Substitutes ◽

Milk Substitutes

This paper reviews Bulgarian parents’ awareness concerning the existence of the WHO Code for the marketing of breast-milk substitutes and how it can help them optimize their breastfeeding journey. Frequently occurring problems and breaches of the Code in Bulgaria are discussed, and their context explained. We focus on parental attitudes and investigate whether they acknowledge the significant necessity for a Code-compliant prenatal education and postnatal care. We also explore their viewpoints on the implementation of the Code and maximizing compliance with it on a local level. The research findings are presented graphically, and we present tendencies showcased by respondents’ opinions they have expressed in the survey. OBJECTIVES: Purposes of this research are: (1) to explore parents’ awareness about the WHO Code and their encounter with local prenatal classes in this regard (2) to assess their viewpoints on implementing the Code and if they see it as a significant step towards an optimal breastfeeding experience. METHODS: The methods we applied include an online-based cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions, aiming to explore parents’ current knowledge and viewpoints in regard to the Code and its implementation in Bulgaria. The research has been carried out via social media, and it samples parents from a local parent peer support group. Acquired data from closed-ended questions is presented, demonstrating percentages and tendencies. RESULTS: A total of 463 respondents are included CONCLUSION: It is a common practice in Bulgaria for prenatal classes not to comply with the WHO Code. Disregarding recommendations and evidence-based medicine, both some experts and companies under the scope of the Code breach its main points. Code-compliant prenatal education is practically almost non-existent with the lack of midwife-led care and classes, predominantly in the private sector, where they are almost entirely, sponsored by those companies. Nearly all parents included in this survey are more than willing and motivated to have access to Code-compliant prenatal education and postnatal care. The lack of such leaves almost no choice for Bulgarian parents actually to have access to code-compliant education and care. This inevitably influences their decision making, attitudes and behavior, potentially leading to lower breastfeeding rates and suboptimal breastfeeding satisfaction and success. Adequate measures must be reinforced to ensure implementation and proper legislation, providing monitoring and enforcement, protecting parents and their babies when they are most vulnerable.

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Legislation, policies and guidelines related to breastfeeding and the Baby Friendly Health Initiative in Australia: a document analysis

Australian Health Review ◽

10.1071/ah16067 ◽

2018 ◽

Vol 42 (1) ◽

pp. 72 ◽

Cited By ~ 3

Author(s):

Anahita Esbati ◽

Margaret Barnes ◽

Amanda Henderson ◽

Jane Taylor

Keyword(s):

Breast Milk ◽

National Level ◽

Document Analysis ◽

Economic Benefits ◽

Analysis Model ◽

National State ◽

Health Initiative ◽

Breast Milk Substitutes ◽

Milk Substitutes ◽

Breastfeeding Rates

Objectives The aim of the present study was to assess the extent to which publicly available legislation, policy and guidelines related to breastfeeding and the Baby Friendly Health Initiative (BFHI) underpin and support the uptake and implementation of the BFHI in Australia. Methods Altheide’s document analysis model (sample, data collection, data organisation, data analysis and report) was used to source and analyse publicly available legislation, policies and guidelines in Australia that were related to breastfeeding and the BFHI at national, state and professional organisational levels. Results Legislation documents contained no direct references to the BFHI or Code of Marketing of Breast-milk Substitutes, despite the documents being supportive of breastfeeding. There is little reference to the Code of Marketing of Breast-milk Substitutes or to monitoring of the Marketing in Australia of Infant Formulae (MAIF) Agreement at national and state levels. A gap exists in documents that provide up-to-date records regarding monitoring of breastfeeding rates at the national level. Conclusions National and state guidelines are supportive of breastfeeding and the BFHI. However, the BFHI and Code of Marketing of Breast-milk Substitutes are not legislated in Australia and information related to breastfeeding rates is not up to date. A legislative establishment supporting the Code and establishing plans to monitor the MAIF Agreement and breastfeeding outcomes may influence uptake and implementation of the BFHI. What is known about the topic? Extensive evidence supports the health and economic benefits of breastfeeding. Despite a high initiation rate of breastfeeding in Australia (96%) most recently reported in 2010, the rate of breastfed infants dropped considerably over time: approximately 15% of infants were breastfed for the recommended 6 months. Research supports the positive effect of the BFHI on increasing breastfeeding rates and improving breastfeeding outcomes. In 2016, there are 69 Baby-friendly-accredited maternity facilities across Australia, compared with 77 accredited facilities in 2011 (~23% of all maternity facilities). What does this paper add? This is the first document analysis of publicly available legislation, policy and guidelines related to breastfeeding and the BFHI at Australian national, state and professional organisational levels to assess the extent to which these documents support breastfeeding, as well as the uptake and implementation of the BFHI. This study identifies strengths and weaknesses at legislative, policy and guideline levels that could potentially influence the uptake and implementation of the BFHI. What are the implications for practitioners? The uptake and implementation of the BFHI is potentially influenced by legislation, policy and guidelines at national and state levels. Given the low uptake of the BFHI in Australia, this analysis outlines the extent to which these documents support breastfeeding and the BFHI, and indicates what these documents lack with regard to supporting the uptake and implementation of the BFHI.

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