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

Background The 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. Results The 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. Conclusion The 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.

Breastfeeding practice, breastfeeding policy and hospitalisations for infectious diseases in early and later childhood: a register-based study in Uppsala County, Sweden

ObjectiveTo examine the association between breastfeeding practice and hospitalisations for infectious diseases in early and later childhood, in particular, to compare exclusive breast feeding 4–5 months with exclusive breastfeeding 6 months or more. Thereby, provide evidence to inform breastfeeding policy.DesignA register-based cohort study.SettingA cohort was created by combining the Swedish Medical Birth Register, the National Inpatient Register, the Cause of Death Register, the Total Population Register, the Longitudinal integration database for health insurance and labour market studies, with the Uppsala Preventive Child Health Care database.Patients37 825 term and post-term singletons born to women who resided in Uppsala County (Sweden) between 1998 and 2010.Main outcome measuresNumber of hospitalisations for infectious diseases in early (<2 years) and later childhood (2–4 years).ResultsThe risk of hospitalisations for infectious diseases decreased with duration of exclusive breastfeeding until 4 months of age. In early childhood, breast feeding was associated with a decreased risk of enteric and respiratory infections. In comparison with exclusive breast feeding 6 months or more, the strongest association was found between no breastfeeding and enteric infections (adjusted incidence rate ratios, aIRR 3.32 (95% CI 2.14 to 5.14)). In later childhood, breast feeding was associated with a lower risk of respiratory infections. In comparison with children exclusively breastfed 6 months or more, the highest risk was found in children who were not breastfed (aIRR 2.53 (95% CI 1.51 to 4.24)). The risk of hospitalisations for infectious diseases was comparable in children exclusively breastfed 4–5 months and children exclusively breastfed 6 months or more.ConclusionsOur results support breastfeeding guidelines that recommend exclusive breastfeeding for at least 4 months.

Systematic Review: The Impact Analysis and Implementation Policies of Exclusive Breastfeeding Programs

Background: Health promotion is an effort to improve the society's ability in order to make people empower themselves. Exclusive breastfeeding/ASI eksklusif is the practice of giving breast milk to infants for the first six months of life (without any additional food or water) a preventive intervention that addresses the single greatest potential impact on child mortality. Objective: To analyze the impact of the availability and unavailability of program policy that support exclusive breastfeeding in improving the implementation of exclusive breastfeeding policy. Method: The method used in this research was a systematic review technique. The process of searching for articles through Sagepub, Google, and Google Scholar. The keywords used were breastfeeding policy, breastfeeding policy and health promotion, breastfeeding health promotion, workplace breastfeeding policy, and maternity leaves starting from February 20, 2020, to April 15, 2020, and found 153 articles which were then sorted into 35 articles. The articles discussed the implementation of the exclusive breastfeeding program (10), the exclusive breastfeeding policy (12), and the impacts arising from the exclusive breastfeeding policy (13) with articles in Indonesian (10) and English (25). Results: The found policy that have not been implemented by the Indonesian government are policies that adopt the latest version of The International Code of Marketing of Breas Milk Substitutes. Weak implementation of follow-up on sanctions and fines if it violates applicable policy. Conclusion: The exclusive breastfeeding program carried out by Indonesia is still in the scope of classes for pregnant women, companion groups, exclusive breastfeeding socialization, and breastfeeding motivator training. Social, economic, and cultural factors are other supporting factors related to exclusive breastfeeding success.

STAKEHOLDER FRAMING AND POLICY LEGITIMACY: BREASTFEEDING POLICY IN ACEH PROVINCE

World Health Organization merupakan Badan Kesehatan Dunia yang mempunyai target pencapaian ASI Eksklusif pada tahun 2025 yakni 50%. Pencapaian ASI Di Indonesia masih terkategori rendah dan berfluktuatif. Tahun 2018 pola pemberian ASI di Indonesia sebanyak 37,3%. Sedangkan Tahun 2018 terjadi peningkatan capaian ASI eksklusif Provinsi Aceh sebesar 66,5%. Menariknya Provinsi Aceh tentang bagaimana mengumpulkan komitmen politik untuk memperkuat kebijakan dan menargetkan program menyusui berskala besar. Tujuan dari penelitian ini adalah untuk meneliti interaksi antara elit pemerintah dan pemangku kepentingan masyarakat di Provinsi Aceh dengan fokus pada kebijakan menyusui di Peraturan Gubernur (No.49 Tahun 2016). Analisis kualitatif media dan dokumen parlementer menggunakan metode hermeneutic,dengan menganalisis konteks dimana Kebijakan menyusui disebutkan oleh pemangku kepentingan di media dan parlemen. Dasar teoritis penelitian ini menggunakan pendekatan yang orientasinya pada pemangku kepentingan terhadap legitimasi,serta menggabungkan analisis kerangka kebijakan dengan konsep struktur kebijakan tiga tingkatan. Temuan empiris menekankan pentingnya komunikasi dua arah antara pemerintah dan pemangku kepentingan masyarakat, pembuktiannya melalui analisis kerangka kebijakan. Pada akhirnya, hasil menunjukkan bahwa legitimasi kebijakan lebih mungkin dijamin jika tidak ada maksud yang tersembunyi dari sebuah kebijakan atau sebelumnya dapat dideteksi melalui analisis kerangka pemangku kepentingan.

Enablers and barriers to workplace breastfeeding in the Armed Forces: a systematic review

IntroductionThe UK has no legislation protecting employees’ access to breastfeeding facilities. Without specific breastfeeding policy, provisions to access workplace facilities can be inconsistent and negatively impact employees’ breastfeeding duration, retention and morale, particularly servicewomen who work in varied and demanding military environments. This is an important policy area for the British Army to retain talented and trained soldiers.MethodsUsing Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement principles, PubMed, Embase, CINAHL and Pro-Quest Databases were searched for studies relevant to accessing appropriate breastfeeding facilities in UK workplaces and high-income countries’ Armed Forces. Factors acting as barriers and enablers to accessing facilities were identified. UK government and Armed Forces’ websites were searched for grey literature on existing policies and guidance for accessing facilities.ResultsBarriers and enablers to access from 16 studies were described by three thematic areas: attitudes to breastfeeding, facility provisions and use of facilities. Factors which employers could influence included specific breastfeeding policy, universal workplace education, existence of suitable facilities and individualised breastfeeding plans. The key areas for policy development identified were clearly defined responsibilities; individualised risk assessments and breastfeeding plans; appropriate, but flexible, facility provision and access; signposting of relevant workplace accommodations; and physical fitness provisions.ConclusionsFive recommendations are presented: development, implementation and evaluation of breastfeeding policy; universal workplace breastfeeding education; the need for breastfeeding risk assessments and plans based on individual breastfeeding practice; written minimal and ideal standards for breastfeeding facilities and access, which considers workplace locations; and exceptions from deployment and physical fitness testing.

Model Kontrol Manajemen Laktasi di UPT Puskesmas Pahandut Kota Palangkaraya

In breastfeeding, it is necessary to carry out lactation management efforts by the mother to support the success of exclusive breastfeeding, because in essence lactation management starts during pregnancy, after childbirth, and during the breastfeeding period of the baby. Lactation management regulates the entire breastfeeding process to run smoothly and successfully, from the production of breast milk to the process of the baby sucking and swallowing breast milk. Therefore, it is necessary to support the fulfillment of breastfeeding for infants, namely the control model of lactation management which aims to ensure that lactation management can be carried out properly so that exclusive breastfeeding can be carried out. The design of this study used a Quasy Experiment research design with a Pre-Post-test Control Group Design, using a sample of 30 post-partum mothers in Pahandut Health Center, Palangka Raya City. This group was divided into 15 respondents as the intervention group and 15 respondents as the control group. In this study using the Paired T-Test statistical test. The results of statistical tests were also obtained from each control variable, the value of P value for counseling (0.000), family support (0.000), exclusive breastfeeding policy (0.000), breast care (0.017) and hypno breastfeeding (0.048). P value <of a (0.05) means that the variable of counseling, family support, exclusive breastfeeding policy, breast care and hypno breastfeeding are very effective in helping increase milk production.

Creating Intersectional Subjects: A Critical Discourse Analysis of Health Science Breastfeeding Research

Reducing race disparities in breastfeeding has become a health objective in the United States, spurring research aimed to identify causes and consequences of disparate rates. This study uses critical discourse analysis to assess how Black women are constructed in 80 quantitative health science research articles on breastfeeding disparities in the United States. Our analysis is grounded in critical race and intersectionality scholarship, which argues that researchers often incorrectly treat race and its intersections as causal mechanisms. Our findings reveal two distinct representations. Most commonly, race, gender, and their intersection are portrayed as essential characteristics of individuals. Black women are portrayed as a fixed category, possessing characteristics that inhibit breastfeeding; policy implications focus on modifying Black women’s characteristics to increase breastfeeding. Less commonly, Black women are portrayed as a diverse group who occupy a social position in society resulting from similar social and material conditions, seeking to identify factors that facilitate or inhibit breastfeeding. Policy implications emphasize mitigating structural barriers that disproportionately impact some Black women. We contribute to existing knowledge by demonstrating how dominant health science approaches provide evidence for health promotion campaigns that are unlikely to reduce health disparities and may do more harm than good to Black women. We also demonstrate the existence of a problematic knowledge set about Black women’s reproductive and infant feeding practices that is both ahistorical and decontextualized.