Healthcare professionals and commercial milk formula recommendations in the urban Mexican context

Commercial milk formula marketing entry points: setting the course of infant and young child feeding trajectories

BACKGROUND

There is a limited understanding of the dynamic influences that shape infant and young child feeding (IYCF) decisions over time. We conducted an innovative qualitative study to reconstruct IYCF trajectories across early life course phases, in the context of the socioecological model (SEM) and the commercial determinants of IYCF.

METHODS

Women of different socioeconomic status were interviewed in two large metropolitan areas in Mexico. Our specific goal was to allow us to better understand if and how the commercial milk formula (CMF) marketing influenced breastfeeding decisions in a complex dynamic way involving the individual, relational, community and societal levels.

RESULTS

Hospitals, health professionals, and interactions with social media were key category entry points throughout the prenatal, perinatal, early infancy period and beyond. The CMF industry interfered by engaging a wide array of actors across the different layers of the SEM, most prominently the health care system and the workplace. Through its marketing strategies the CMF operates subconsciously and its messages are most effective when health institutions, health care providers, workplace spaces and social norms are weak in their support for breastfeeding.

CONCLUSIONS

The cases in our study highlight how, together with a weak breastfeeding counseling system, and health professionals who lack training in breastfeeding and normal infant behavior, lead to the opportunity for CMF marketing to shape infant feeding, and ultimately to the decision to feed formulas that some mothers were not planning to use and cannot afford.

Factors Influencing Health Professionals' Decisions Regarding the Indication of Infant Formula: A Qualitative Exploration in Uruguay

BACKGROUND

Health systems are fundamental to the promotion and protection of breastfeeding. Health professionals have a pivotal influence on families' infant feeding decisions and may act as facilitators or barriers to adequate breastfeeding practices.

RESEARCH AIM

To explore factors influencing health professionals' decisions regarding the indication of infant formula in Montevideo, the capital of Uruguay, an emerging Latin American country.

METHOD

This was a qualitative study based on semi-structured interviews with 30 health professionals (neonatologists, pediatricians, family doctors, and nurses) working in primary and secondary care in both private and public health institutions. The interviews were audio-recorded, transcribed, and analyzed using content analysis based on deductive-inductive coding.

RESULTS

The narratives of the participants identified maternity wards as the healthcare sites where the indication of infant formula occurs most frequently. Motives underlying the indication of infant formula by health professionals were diverse. The type of birth and the conditions of the child and the mother were the most relevant in secondary care, whereas maternal work was the main determining factor in primary care. A wide range of factors encouraging and discouraging the indication of infant formula were identified by health professionals in primary and secondary healthcare locations, which were related to all the levels of influence of the socioecological model.

CONCLUSIONS

Strategies to reduce the use of infant formula in Uruguay should include improving the support and guidance provided to families in the maternity ward, strengthening the implementation and monitoring of the Baby-Friendly Hospital Initiative, and improving the current maternity leave regulations.

Breastfeeding among women employed in Mexico's informal sector: strategies to overcome key barriers

BACKGROUND

Rates of exclusive breastfeeding fall below recommended levels, particularly among women in paid employment. In Mexico, more than half of women are in informal employment, meaning they lack many of the protections that may support breastfeeding.

METHODS

In-depth interviews with 15 key informants representing government agencies (n = 6 organizations), NGOs (n = 4), international organizations (n = 2), and academia (n = 2) in Mexico. Interviews were conducted between March and June 2023. To understand and describe barriers to breastfeeding among informally employed women in Mexico according to key informants and the current and potential policies to address these barriers, we conducted a qualitative thematic analysis.

RESULTS

Current policies to promote, protect, and support breastfeeding predominantly apply to all employed women, but respondents expressed concern that they did not provide adequate protection for women in informal employment. Additional themes concerned the need for relevant programs to be institutionalized and coordinated, discussions of breastfeeding as a right, and the legal equivalence (whether true in practice or not) of formal and informal workers.

CONCLUSIONS

Women employed in Mexico's informal sector face a dearth of maternity protections. According to key informants, few policies exist to promote, protect, and support breastfeeding among employed women, in general, but the economic vulnerability and challenging working conditions of women in informal employment exacerbates their situation. The lack of access to formal labor protections, such as paid maternity leave, creates a significant barrier to breastfeeding for women in the informal sector. Recommendations include short-term policies to fill gaps in social protection for informally employed women, as well as longer-term solutions such as the development of universal social protection programs and supporting formalization.

Implementation of the Baby-Friendly Hospital Initiative in Mexico: a systematic literature review using the RE-AIM framework

The Baby-Friendly Hospital Initiative (BFHI) is a global strategy to encourage health facilities to promote, support, and protect breastfeeding by implementing a package of policies and practices known as the Ten Steps to Successful Breastfeeding. Prior studies have found that implementing the Ten Steps has a positive impact on breastfeeding outcomes. Yet, little is known about the implementation of the Ten Steps in Mexico. The objective of this study was to conduct a systematic review to evaluate the reach, efficacy/effectiveness, adoption, implementation, and maintenance of the Ten Steps in Mexico, using the RE-AIM framework. The systematic literature review included studies published in English or Spanish without date restrictions. Two of the authors coded each of the articles through a harmonized data extraction tool, and group meetings were used to discuss any discrepancies. The reviewed data were managed in the Rayyan platform. The risk of study bias was assessed through the Johanna Briggs Institute critical appraisal checklists. Of the 1,123 articles initially identified, 6 met the review inclusion criteria. None of the articles evaluated the reach and maintenance of the Ten Steps. The articles identified major gaps in the implementation of the Ten Steps. Most of the articles had important limitations in terms of their quality. In Mexico, it is necessary to rethink the BFHI and employ multiple strategies to improve implementation of the Ten Steps, including developing transparent BFHI monitoring mechanisms that produce data on implementation and that are publicly available, as well as investing in implementation research and evaluation to generate strong evidence to support the adoption and efficient maintenance of the Ten Steps in health facilities in Mexico. When properly implemented, BFHI becomes central to promote, protect, and support breastfeeding. Therefore, it is essential for Mexico to position BFHI as a top priority of the country's public policy agenda.

Systematic Review Registration

identifier: CRD42021248118.