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Nguyen TT, Huynh NL, Becker G, Tran HT, Cashin J, Mathisen R. Views on wet nursing and expressing breastmilk for sharing and human milk bank donation among mothers in two parenting social media communities in Vietnam. MATERNAL & CHILD NUTRITION 2024:e13694. [PMID: 39145992 DOI: 10.1111/mcn.13694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2024] [Revised: 06/12/2024] [Accepted: 06/12/2024] [Indexed: 08/16/2024]
Abstract
Nutrition in early life plays a key role in shaping an infant's future health. There is limited understanding of the perspectives of Vietnamese mothers with children under 24 months of age regarding breastmilk expression, donation and use. In this cross-sectional study, an online survey was administered through two parenting social media communities to assess opinions on breastmilk expression, breastmilk donation including contributions from bereaved mothers and the use of donor human milk. A 4-point Likert scale was used to evaluate respondents' opinions, and demographic and breastfeeding information was collected. Among 375 respondents, almost 30% had received breastmilk from another woman, either through direct breastfeeding (14.7%), expressed breastmilk (12.5%) or from a human milk bank (2.7%). In this survey of 375 mothers, 84.0% indicated they would store excess breastmilk, while 75.7% and 69.6% would donate to a human milk bank or another mother, respectively. When faced with insufficient breastmilk, 88.5% of mothers would seek ways to increase supply, whereas 23.8% considered using commercial milk formula. Regarding milk expression among the 375 mothers, 78.4% preferred electric pumps, compared to 48.6% for manual pumps and 45.9% for hand expression. Additionally, 80.5% of the 375 mothers would suggest donating stored milk to bereaved peers and 85.6% would suggest mothers with mild COVID-19 to continue breastfeeding with precautions. These findings indicate that this sample has positive views on breastfeeding, breastmilk donation and the use of donor human milk.
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Affiliation(s)
- Tuan T Nguyen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam
| | - Ngoc L Huynh
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam
- Keck School of Medicine, University of Southern California, Los Angeles, California, USA
- Social Marketing and Communication (SMC), FHI 360, Washington, DC, USA
| | | | - Hoang T Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang, Da Nang, Vietnam
| | - Jennifer Cashin
- Alive & Thrive, Global Nutrition, FHI 360, Washington, DC, USA
| | - Roger Mathisen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, Vietnam
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Sanghvi TG, Godha D, Frongillo EA. Inequalities in large-scale breastfeeding programmes in Bangladesh, Burkina Faso and Vietnam. MATERNAL & CHILD NUTRITION 2024:e13687. [PMID: 39020511 DOI: 10.1111/mcn.13687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/21/2024] [Accepted: 05/29/2024] [Indexed: 07/19/2024]
Abstract
Inequalities in breastfeeding programmes and practices have slowed global progress in providing the life-saving protection of breastfeeding for millions of infants despite well-known life-long impacts. As breastfeeding interventions are scaled up, inequalities in coverage and breastfeeding practices should be tracked, particularly in disadvantaged groups, who are likely to suffer the most serious health and developmental impacts of poor childhood nutrition. The literature provides evidence of inequalities in breastfeeding practices, but research is limited on socioeconomic disparities in the coverage of breastfeeding interventions. This paper (1) compares inequalities in breastfeeding practices in intervention and nonintervention areas and (2) documents inequalities in programme coverage by type of intervention. We disaggregated endline evaluation surveys in Bangladesh, Burkina Faso and Vietnam, where rigorous evaluations had documented significant overall improvements, and analysed whether inequalities in breastfeeding practices and programme coverage differed by treatment areas. We used Erreygers index to quantify inequalities and found that breastfeeding practices were largely pro-poor; intervention coverage was not consistently pro-poor. While counselling coverage often favoured women from the poorest quintile, public education/media coverage consistently favoured better-off women. Inequalities favoured more educated mothers in the coverage of combined interventions. None of the programmes had explicit equality objectives. The results indicate the need for introducing specific actions to reduce inequalities in breastfeeding policies and programmes. This is a priority unfinished agenda for nutrition programming.
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Affiliation(s)
- Tina G Sanghvi
- Alive & Thrive initiative, FHI 360, Family Health International, Washington DC and Durham, North Carolina, USA
| | - Deepali Godha
- Consultant FHI 360, 406 Ghanshyam Castle, Khajrana Square, Indore, Madhya Pradesh, India
| | - Edward A Frongillo
- Department of Health Promotion, Education, and Behaviour, University of South Carolina, Columbia, South Carolina, USA
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Hoang MV, Nguyen TT, Tran AT, Luu TQ, Vu MQ, Tran HT, Nguyen OTX, Mathisen R. Cost analysis of establishing and operating the first human milk bank at Da Nang Hospital for Women and Children in Vietnam: an activity-based costing ingredients study. Int Breastfeed J 2024; 19:47. [PMID: 38970117 PMCID: PMC11227243 DOI: 10.1186/s13006-024-00657-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2024] [Accepted: 06/30/2024] [Indexed: 07/07/2024] Open
Abstract
BACKGROUND Breastfeeding is the biological norm for feeding infants and young children. When mothers' breastmilk is unavailable, donor human milk (DHM) from a human milk bank (HMB) becomes the next option for small vulnerable newborns. A comprehensive cost analysis is essential for understanding the investments needed to establish, operate, and scale up HMBs. This study aims to estimate and analyze such costs at the first facility established in Vietnam. METHODS An activity-based costing ingredients (ABC-I) approach was employed, with the cost perspective from service provision agencies (specifically, the project conducted at Da Nang Hospital for Women and Children and Development Partners). Estimated financial costs, based on actual expenditures, were measured in 2023 local currency and then converted to 2023 US dollars (USD). We examined three scenarios: 1) direct start-up costs + indirect start-up costs + implementation costs, 2) direct start-up costs + implementation costs, and 3) capital costs + implementation costs over the 6.5 years of operation. RESULTS The total start-up cost was USD 616,263, with total expenditure on direct activities at USD 228,131 and indirect activities at USD 388,132. Investment in equipment accounted for the largest proportion (USD 84,213). The monthly costs of Da Nang HMB were USD 25,217, 14,565, and 9,326, corresponding to scenarios 1, 2, and 3, respectively. Over HMB's 6.5 years of operation, on average, the unit costs were USD 166, USD 96, and USD 62 for DHM received and USD 201, USD 116, and USD 74 for pasteurized DHM meeting specified criteria in the corresponding scenarios. Unit costs were highest in the initial six months, decreased, and reached their lowest levels after a year. Then, the unit costs experienced an increase in late 2020 and early 2021. CONCLUSION Although the unit cost of DHM in Da Nang HMB is comparable to that in certain neighboring countries, intentional measures to reduce disposal rates, improve HMB efficiency, motivate more community-based donors, and establish an HMB service network should be implemented to lower costs.
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Affiliation(s)
- Minh V Hoang
- Hanoi University of Public Health, Hanoi, 11910, Vietnam
| | - Tuan T Nguyen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, 11022, Vietnam.
| | - Anh T Tran
- Hanoi University of Public Health, Hanoi, 11910, Vietnam
| | - Toan Q Luu
- Hanoi University of Public Health, Hanoi, 11910, Vietnam
| | - Mai Q Vu
- Hanoi University of Public Health, Hanoi, 11910, Vietnam
| | - Hoang T Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, 50506, Vietnam
- Department of Pediatrics, School of Medicine and Pharmacy, The University of Da Nang, Da Nang, 50206, Vietnam
| | - Oanh T X Nguyen
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang, 50506, Vietnam
| | - Roger Mathisen
- Alive & Thrive, Global Nutrition, FHI 360, Hanoi, 11022, Vietnam
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Topothai C, Tan GPP, van der Eijk Y. Commercial milk formula marketing following increased restrictions in Singapore: A qualitative study. MATERNAL & CHILD NUTRITION 2024; 20:e13562. [PMID: 37667980 PMCID: PMC10750007 DOI: 10.1111/mcn.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
The promotion of commercial milk formula (CMF) negatively impacts breastfeeding outcomes. In 2019, Singapore updated its 1979 Code of Ethics of the Sale of Infant Foods Ethics Committee Singapore (SIFECS) to increase marketing restrictions on CMF for infants 0-12 months. However, little is known about industry tactics to undermine these restrictions. This qualitative study explores health workers' and mothers' experiences with CMF marketing in Singapore following the 2019 restrictions. We conducted a qualitative study, using semistructured interviews with 14 mothers of infants aged less than 5 months and 20 health workers with expertise in antenatal, maternity, or paediatric care. We analysed data thematically using inductive coding. Five themes were identified. Mothers and health workers reported digital marketing, product line extensions with toddlers' milk and milk for mothers, and CMF sponsorships in the healthcare setting. Expert endorsement, competitive price, nutritional claims, and brand reputation influenced mothers' infant formula choices, yet both mothers and health workers appeared to be unaware of the impact of CMF marketing tactics on their own perceptions. The restriction of CMF marketing and infant feeding practices varied widely between hospitals, with private hospitals and practices having less strict controls on CMF marketing. Despite the updated SIFECS restrictions, CMF companies continue to target mothers and health workers in Singapore. SIFECS restrictions should be tightened to align with international guidelines, by increasing their scope to include toddlers' milk and prohibiting cross-promotion, digital marketing, and any sponsorships of events targeting health workers that may create a conflict of interest.
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Affiliation(s)
- Chompoonut Topothai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
- International Health Policy ProgrammeMinistry of Public HealthNonthaburiThailand
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
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Tran HT, Luu HM, Le TD, Pham NTQ, Sobel HL, Murray JCS. Factors associated with high exclusive breastfeeding rates among preterm infants under 34 weeks of gestation in Da Nang, Vietnam: A retrospective cohort study. J Glob Health 2023; 13:04121. [PMID: 37934970 PMCID: PMC10630854 DOI: 10.7189/jogh.13.04121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023] Open
Abstract
Background Preterm infants have higher mortality than full-term infants. While breastfeeding dramatically reduces preterm death, it is limited by biological and practice barriers, particularly for babies born before 34 weeks gestational age. Da Nang Hospital for Women and Children developed a quality improvement approach to improve breastfeeding of preterm infants by strengthening feeding support, non-separation, and kangaroo mother care (KMC). Methods To determine breastfeeding outcomes following discharge and explore factors associated with improved feeding, mothers of infants under 34 weeks gestational age born October 2021 to March 2022 and discharged alive were interviewed at six months and their medical records were reviewed. Results Out of 104 preterm infants included, all were exclusively breastfed at discharge and one month, 86.5% at three months, and 63.5% at six months; 47.1% received immediate skin-to-skin contact, 31.7% immediate and continuous KMC, and the remaining 68.3% continuous KMC beginning at a median of three days. Exclusive breastfeeding at six months was associated with the mother antenatally seeking breastfeeding information (odds ratio (OR) = 14.5; 95% confidence interval (CI) = 1.2-173.6), avoiding bottle-feeding at home (OR = 7.7; 95% CI = 1.7-33.7) and reduced with each day delay between birth and full breastfeeding (OR = 0.8; 95% CI = 0.6-0.9). Conclusions Hospital environments that limit mother-baby separations and feeding delays, including rooming-in of mothers and infants, KMC, and breastfeeding support from birth, enabled 100% of preterm infants born before 34 weeks gestational age to breastfeed exclusively with continued rates higher than previously reported. Addressing antenatal and post-natal factors limiting practice can further improve longer-term breastfeeding outcomes. The approach can be adapted to achieve high exclusive breastfeeding rates, regardless of gestational age.
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Affiliation(s)
- Hoang Thi Tran
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Hanh My Luu
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Thao Dieu Le
- Neonatal Unit, Da Nang Hospital for Women and Children, Da Nang, Vietnam
- Department of Paediatrics, School of Medicine and Pharmacy, Da Nang University, Vietnam
| | - Nga Thi Quynh Pham
- World Health Organization Representative Office in Viet Nam, Ha Noi, Vietnam
| | - Howard L Sobel
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
| | - JCS Murray
- World Health Organization Western Pacific Regional Office, United Nations Avenue, Manila, Philippines
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Michaud-Létourneau I, Gayard M, Wassef J, Likhite N, Tharaney M, Cissé AS, Le Dain AS, Laillou A, Zafimanjaka MG, Kiburente M, Bambara E, Kim SS, Menon P. "Stronger with Breastmilk Only" Initiative in 5 African Countries: Case Study on the Implementation Process and Contribution to the Enabling Environment for Breastfeeding. Curr Dev Nutr 2023; 7:101988. [PMID: 37736401 PMCID: PMC10509664 DOI: 10.1016/j.cdnut.2023.101988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2023] [Revised: 08/04/2023] [Accepted: 08/09/2023] [Indexed: 09/23/2023] Open
Abstract
Background The practice of giving water before 6 mo of age is the biggest barrier to exclusive breastfeeding in West and Central Africa. To address this challenge, a regional initiative, "Stronger with Breastmilk Only" (SWBO), was rolled out at country level in several countries of the region. Objective We examined the implementation process of the SWBO initiative and the contribution of its advocacy component to a more supportive environment for breastfeeding policies and programs. Methods This study was based on 2 assessments at the national level carried out in 5 countries (Burkina Faso, Chad, Democratic Republic of the Congo, Senegal, and Sierra Leone) using qualitative methods. We combined 2 evaluative approaches (contribution analysis and outcome harvesting) and applied 2 theoretical lenses (Breastfeeding Gear Model and Consolidated Framework for Implementation Research) to examine the implementation process and the enabling environment for breastfeeding. Data sources included ∼300 documents related to the initiative and 43 key informant interviews collected between early 2021 and mid-2022. Results First, we show how a broad initiative composed of a set of combined interventions targeting multiple levels of determinants of breastfeeding was set up and implemented. All countries went through a similar pattern of activities for the implementation process. Second, we illustrate that the initiative was able to foster an enabling environment for breastfeeding. Progress was achieved notably on legislation and policies, coordination, funding, training and program delivery, and research and evaluation. Third, through a detailed contribution story of the case of Burkina Faso, we illustrate more precisely how the initiative, specifically its advocacy component, contributed to this progress. Conclusion This study shed light on how an initiative combining a set of interventions to address determinants of breastfeeding at multiple levels can be implemented regionally and contributes to fostering an enabling environment for breastfeeding at scale.
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Affiliation(s)
- Isabelle Michaud-Létourneau
- Society for Implementation Science in Nutrition, Washington DC, USA
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | - Marion Gayard
- Society for Implementation Science in Nutrition, Washington DC, USA
| | - Jacqueline Wassef
- Society for Implementation Science in Nutrition, Washington DC, USA
- Département de médecine sociale et préventive, École de santé publique, Université de Montréal, Montréal, Québec, Canada
| | | | | | | | | | | | | | | | - Estelle Bambara
- Direction de la Nutrition, Ministère de la santé, Ouagadougou, Burkina Faso
| | - Sunny S. Kim
- International Food Policy Research Institute, Washington DC, USA
| | - Purnima Menon
- International Food Policy Research Institute, Washington DC, USA
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Salem M, Ertz M. "Better start": promoting breastfeeding through demarketing. BMC Public Health 2023; 23:1681. [PMID: 37653479 PMCID: PMC10472652 DOI: 10.1186/s12889-023-16561-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Accepted: 08/18/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND This paper explores how demarketing strategies impact women's breastfeeding attitudes, intentions, and behaviors under the moderation of time pressure and breastfeeding knowledge. METHODS A cross-sectional questionnaire-based survey among 369 respondents is used to test the proposed hypotheses. The study's population includes all breastfeeding women in Palestine. Snowball and convenience sampling were used to choose study participants through personal connections and social media. Every respondent was encouraged to share the survey with their social media contacts. RESULTS The data results confirm the positive effects of promotion, place, price, and product demarketing, respectively, on women's attitudes, intentions, and behavior toward breastfeeding. These effects were reinforced by reduction in time pressure and breastfeeding knowledge. Furthermore, demarketing effects are stronger for younger, more educated, unemployed, and lower-income women. CONCLUSION The study is a primer on promoting breastfeeding instead of formula by means of demarketing strategies.
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Affiliation(s)
- Mohammed Salem
- Business Department, University College of Applied Sciences, Remal, P.O. Box 1415, Gaza, Gaza Strip, Palestine.
| | - Myriam Ertz
- Department of Economics and Administrative Sciences, Université du Québec à Chicoutimi, Saguenay, Canada.
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Bidashimwa D, Hoke T, Huynh TB, Narkpitaks N, Priyonugroho K, Ha TT, Burns A, Weissman A. Plastic pollution: how can the global health community fight the growing problem? BMJ Glob Health 2023; 8:e012140. [PMID: 37295791 PMCID: PMC10277055 DOI: 10.1136/bmjgh-2023-012140] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/06/2023] [Indexed: 06/12/2023] Open
Affiliation(s)
| | - Theresa Hoke
- Health Service Research, FHI 360, Durham, North Carolina, USA
| | - Thu Ba Huynh
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
| | | | | | - Trinh Thai Ha
- Asia Pacific Regional Office, FHI 360, Hanoi, Vietnam
| | - Allison Burns
- Knowledge Exchange, FHI 360, Durham, North Carolina, USA
| | - Amy Weissman
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
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Fisher J, Tran T, Tran H, Luchters S, Hipgrave DB, Nguyen H, Tran T, Hanieh S, Simpson JA, Biggs BA, Tran T. Structured, multicomponent, community-based programme for women's health and infant health and development in rural Vietnam: a parallel-group cluster randomised controlled trial. THE LANCET. CHILD & ADOLESCENT HEALTH 2023; 7:311-325. [PMID: 37011652 DOI: 10.1016/s2352-4642(23)00032-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/10/2022] [Revised: 01/26/2023] [Accepted: 02/03/2023] [Indexed: 04/03/2023]
Abstract
BACKGROUND Interventions to improve early childhood development have previously addressed only one or a few risk factors. Learning Clubs is a structured, facilitated, multicomponent programme designed to address eight potentially modifiable risk factors, and offered from mid-pregnancy to 12 months post partum; we aimed to establish whether this programme could improve the cognitive development of children at 2 years of age. METHODS For this parallel-group cluster-randomised controlled trial, 84 of 116 communes (the clustering unit) in HaNam Province in rural Vietnam were randomly selected and randomly assigned to receive the Learning Clubs intervention (n=42) or usual care (n=42). Women aged at least 18 years who were pregnant (gestational age <20 weeks) were eligible for inclusion. Data sources were standardised, and study-specific questionnaires assessing risks and outcomes were completed in interviews in mid-pregnancy (baseline), late pregnancy (after 32 weeks of gestation), at 6-12 months post partum, and at the end of the study period when children were 2 years of age. Mixed-effects models were used to estimate trial effects, adjusting for clustering. The primary outcome was the cognitive development of children at 2 years of age, assessed by the Bayley Scales of Infant and Toddler Development Third Edition (Bayley-III) cognitive score. This trial is registered with the Australian New Zealand Clinical Trials Registry (ACTRN12617000442303). FINDINGS Between April 28, 2018, and May 30, 2018, 1380 women were screened and 1245 were randomly assigned (669 to the intervention group and 576 to the control group). Data collection was completed on Jan 17, 2021. Data at the end of the study period were contributed by 616 (92%) of 669 women and their children in the intervention group, and by 544 (94%) of 576 women and their children in the control group. Children aged 2 years in the intervention group had significantly higher mean Bayley-III cognitive scores than those in the control group (99·6 [SD 9·7] vs 95·6 [9·4]; mean difference 4·00 [95% CI 2·56-5·43]; p<0·0001). At 2 years of age, 19 (3%) children in the intervention group had Bayley-III scores less than 1 SD, compared with 32 (6%) children in the control group, but this difference was not significant (odds ratio 0·55 [95% CI 0·26-1·17]; p=0·12). There were no significant differences between groups in maternal, fetal, newborn, or child deaths. INTERPRETATION A facilitated, structured, community-based, multicomponent group programme improved early childhood development to the standardised mean in rural Vietnam and could be implemented in other similarly resource-constrained settings. FUNDING Australian National Health and Medical Research Council and Grand Challenges Canada Saving Brains Initiative. TRANSLATION For the Vietnamese translation of the abstract see Supplementary Materials section.
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Affiliation(s)
- Jane Fisher
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia.
| | - Thach Tran
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Ha Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
| | - Stanley Luchters
- Centre for Sexual Health and HIV AIDS Research (CeSHHAR), Harare, Zimbabwe; Liverpool School of Tropical Medicine, Liverpool, UK; Department of Public Health and Primary Care, Ghent University, Ghent, Belgium
| | - David B Hipgrave
- UNICEF, New York, NY, USA; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Hau Nguyen
- Women and Global Health Unit, School of Public Health and Preventive Medicine, Monash University, Melbourne, VIC, Australia
| | - Thuy Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
| | - Sarah Hanieh
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Julie Anne Simpson
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
| | - Beverley-Ann Biggs
- Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia; Department of Medicine and Victorian Infectious Diseases Service at the Doherty Institute, University of Melbourne, Melbourne, VIC, Australia
| | - Tuan Tran
- Research and Training Centre for Community Development (RTCCD), Hanoi, Vietnam
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Rollins N, Piwoz E, Baker P, Kingston G, Mabaso KM, McCoy D, Ribeiro Neves PA, Pérez-Escamilla R, Richter L, Russ K, Sen G, Tomori C, Victora CG, Zambrano P, Hastings G. Marketing of commercial milk formula: a system to capture parents, communities, science, and policy. Lancet 2023; 401:486-502. [PMID: 36764314 DOI: 10.1016/s0140-6736(22)01931-6] [Citation(s) in RCA: 74] [Impact Index Per Article: 74.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 08/21/2022] [Accepted: 09/26/2022] [Indexed: 02/10/2023]
Abstract
Despite proven benefits, less than half of infants and young children globally are breastfed in accordance with the recommendations of WHO. In comparison, commercial milk formula (CMF) sales have increased to about US$55 billion annually, with more infants and young children receiving formula products than ever. This Series paper describes the CMF marketing playbook and its influence on families, health professionals, science, and policy processes, drawing on national survey data, company reports, case studies, methodical scoping reviews, and two multicountry research studies. We report how CMF sales are driven by multifaceted, well resourced marketing strategies that portray CMF products, with little or no supporting evidence, as solutions to common infant health and developmental challenges in ways that systematically undermine breastfeeding. Digital platforms substantially extend the reach and influence of marketing while circumventing the International Code of Marketing of Breast-milk Substitutes. Creating an enabling policy environment for breastfeeding that is free from commercial influence requires greater political commitment, financial investment, CMF industry transparency, and sustained advocacy. A framework convention on the commercial marketing of food products for infants and children is needed to end CMF marketing.
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Affiliation(s)
- Nigel Rollins
- Department of Maternal, Newborn, Child and Adolescent Health and Ageing, WHO, Geneva, Switzerland.
| | | | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC, Australia
| | | | | | - David McCoy
- International Institute for Global Health, United Nations University, Kuala Lumpur, Malaysia
| | | | | | - Linda Richter
- University of the Witwatersrand, DSI-NRF Centre of Excellence in Human Development, Johannesburg, South Africa
| | - Katheryn Russ
- Department of Economics, University of California, Davis, CA, USA
| | - Gita Sen
- Public Health Foundation of India, Bangalore, India
| | - Cecília Tomori
- Johns Hopkins School of Nursing, Johns Hopkins University, Baltimore, MD, USA
| | - Cesar G Victora
- International Center for Equity in Health, Federal University of Pelotas, Pelotas, Brazil
| | | | - Gerard Hastings
- Institute for Social Marketing, University of Stirling, Stirling, UK
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11
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Nguyen TT, Cashin J, Tran HT, Hoang TA, Mathisen R, Weissman A, Murray JCS. Birth and newborn care policies and practices limit breastfeeding at maternity facilities in Vietnam. Front Nutr 2022; 9:1041065. [PMID: 36407547 PMCID: PMC9668009 DOI: 10.3389/fnut.2022.1041065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 10/10/2022] [Indexed: 09/29/2023] Open
Abstract
The prevalence of early and exclusive breastfeeding in Vietnam remains sub-optimal. The objective of this study was to determine factors associated with early initiation of breastfeeding (EIBF) and exclusive breastfeeding for the first 3 days after birth (EBF3D). We conducted a population-based, cross-sectional survey of 726 mothers with children aged 0-11 months in two provinces and one municipality from May to July 2020. Multinomial logistic regression was used to examine factors associated with EIBF and EBF3D. The prevalence of EIBF was 39.7% and EBF3D 18.0%. The EIBF prevalence is positively associated with immediate and uninterrupted skin-to-skin contact (SSC) for 10-29 min (aOR: 2.55; 95% CI: 1.49, 4.37), 30-59 min (aOR: 4.15; 95% CI: 2.08, 8.27), 60-80 min (aOR: 4.35; 95% CI: 1.50, 12.6), or ≥90 min (aOR: 5.87; 95% CI: 3.14, 10.98). EIBF was negatively associated with cesarean birth (aOR: 0.24; 95% CI: 0.11, 0.51), bringing infant formula to the birth facility (aOR: 0.49; 95% CI: 0.30, 0.78), purchased it after arrival (aOR: 0.37; 95% CI: 0.24, 0.60), or did both (aOR: 0.43; 95% CI: 0.21, 0.89). EBF3D was negatively associated with cesarean section birth (aOR: 0.15; 95% CI: 0.06, 0.39), vaginal birth with episiotomy (aOR: 0.40; 95% CI: 0.18, 0.88), bringing formula to the maternity facility (aOR: 0.03; 95% CI: 0.01, 0.07), purchased it after arrival (aOR: 0.02; 95% CI: 0.01, 0.06) or did both (aOR: 0.04; 95% CI: 0.02, 0.10). Receiving counseling from any source was not significantly associated with early breastfeeding practices. Policy and health service delivery interventions should be directed at eliminating infant formula from birthing environments, reducing unnecessary cesarean sections and episiotomies, providing immediate and uninterrupted SSC for all births, and improving breastfeeding counseling and support.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Jennifer Cashin
- Alive & Thrive East Asia Pacific, FHI 360, Washington, DC, United States
| | - Hoang T. Tran
- Neonatal Unit and Human Milk Bank, Department of Pediatrics, School of Medicine and Pharmacy, Da Nang Hospital for Women and Children, The University of Da Nang, Da Nang, Vietnam
| | - Tuan A. Hoang
- Department of Maternal and Child Health, Vietnam Ministry of Health, Hanoi, Vietnam
| | - Roger Mathisen
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
| | - Amy Weissman
- Alive & Thrive East Asia Pacific, FHI 360, Hanoi, Vietnam
- Asia Pacific Regional Office, FHI 360, Bangkok, Thailand
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Cetthakrikul N, Kelly M, Baker P, Banwell C, Smith J. Effect of baby food marketing exposure on infant and young child feeding regimes in Bangkok, Thailand. Int Breastfeed J 2022; 17:64. [PMID: 36050746 PMCID: PMC9435428 DOI: 10.1186/s13006-022-00503-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 08/08/2022] [Indexed: 11/17/2022] Open
Abstract
Background Baby food marketing undermines breastfeeding by influencing women’s attitudes and decision-making favourably toward commercial baby food. This study aimed to explore the effects of various baby food marketing techniques on Thai mothers’ opinions about commercial milk formulas (CMF) and commercial complementary foods (CCF) and their infant and young child feeding behaviours. Methods This study used a cross-sectional survey employing the World Health Organization (WHO) NetCode Toolkit Protocol for Periodic Assessment, and the United Nations International Children’s Emergency Fund (UNICEF) Multiple Indicator Cluster Survey to collect data on mothers’ experience with and their opinion on the various types of marketing of CMF and CCF, and their feeding behaviour. Data collection used structured interviews of mothers with children aged two years or below attending 33 health facilities in Bangkok. Univariable and multivariable regression analysis then investigated links between mothers’ reported exposure to baby food marketing and their infant and young child feeding behaviours, employing a semantic scale and considering key sociodemographic and other variables. Results Three hundred and thirty mothers were surveyed in Bangkok. Around 90% reported experiencing exposure to at least one type of baby food marketing during the previous six months, mostly from electronic media. More than half of the women had positive opinions of CMF. Virtually all children had been breastfed initially, but 74.6% were given CMF and 72.8% stopped breastfeeding before six months. Multivariable analysis showed that mothers who lived in a couple were significantly less likely to favour CMF, and mothers in middle-income households and those who had received advice about CMF from others were more likely to have a favourable opinion. Mothers in formal employment were over six times more likely to feed formula than those not in employment. Women who experienced baby food marketing at health facilities were four times more likely to feed CMF to their children than those not experiencing such marketing. Conclusions Specific types of baby food marketing were strongly linked to mothers’ opinions on and use of CMF in Bangkok, Thailand. It is recommended that breastfeeding policies in health facilities and employment are fully implemented and enforced. Supplementary Information The online version contains supplementary material available at 10.1186/s13006-022-00503-7.
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Affiliation(s)
- Nisachol Cetthakrikul
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia. .,International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand.
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Julie Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
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Samaniego JAR, Maramag CC, Castro MC, Zambrano P, Nguyen TT, Datu-Sanguyo J, Cashin J, Mathisen R, Weissman A. Implementation and Effectiveness of Policies Adopted to Enable Breastfeeding in the Philippines Are Limited by Structural and Individual Barriers. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10938. [PMID: 36078649 PMCID: PMC9517919 DOI: 10.3390/ijerph191710938] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Revised: 08/23/2022] [Accepted: 08/24/2022] [Indexed: 06/15/2023]
Abstract
The Philippines has adopted policies to protect, promote, and support breastfeeding on par with global standards, yet the impact of these policies is not well understood. This study assesses the adequacy and potential impact of breastfeeding policies, as well as the perceptions of stakeholders of their effectiveness and how to address implementation barriers. This mixed methods study entailed a desk review of policies and documents and in-depth interviews with 100 caregivers, employees, employers, health workers, and policymakers in the Greater Manila Area. Although the Philippines has a comprehensive breastfeeding policy framework, its effectiveness was limited by structural and individual barriers. Structural barriers included inconsistent breastfeeding promotion, limited access of mothers to skilled counseling, limited workplace breastfeeding support, gaps in legal provisions, weak monitoring and enforcement of the Philippine Milk Code, and the short duration and limited coverage of maternity leave. Individual barriers included knowledge and skills gaps, misconceptions, and low self-confidence among mothers due to insufficient support to address breastfeeding problems, misconceptions in the community that undermine breastfeeding, limited knowledge and skills of health workers, and insufficient support extended to mothers by household members. Breastfeeding policies in the Philippines are consistent with global standards, but actions to address structural and individual barriers are needed to enhance their effectiveness for improving breastfeeding practices.
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Affiliation(s)
| | | | | | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI 360, Quezon City 1101, Philippines
| | - Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam
| | | | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Washington, DC 20009, USA
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam
| | - Amy Weissman
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
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Becker GE, Ching C, Nguyen TT, Cashin J, Zambrano P, Mathisen R. Babies before business: protecting the integrity of health professionals from institutional conflict of interest. BMJ Glob Health 2022; 7:bmjgh-2022-009640. [PMID: 35926917 PMCID: PMC9358938 DOI: 10.1136/bmjgh-2022-009640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Manila, Philippines
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
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Cetthakrikul N, Kelly M, Banwell C, Baker P, Smith J. Regulation of baby food marketing in Thailand: a NetCode analysis. Public Health Nutr 2022; 25:1-13. [PMID: 35733357 PMCID: PMC9991832 DOI: 10.1017/s1368980022001446] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Revised: 05/21/2022] [Accepted: 05/26/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE 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. DESIGN Cross-sectional quantitative study, guided by the WHO/UNICEF NetCode Periodic Assessment Protocol. SETTING Health facilities and retail outlets in Bangkok, Thai media. PARTICIPANTS Mothers of 0-2-year-old children, health professionals, promotions at retail outlets and health facilities, product labels, marketing on television and the internet. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- Nisachol Cetthakrikul
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT2601, Australia
- International Health Policy Program, Ministry of Public Health, Nonthaburi, Thailand
| | - Matthew Kelly
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT2601, Australia
| | - Cathy Banwell
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT2601, Australia
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Australia
| | - Julie Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT2601, Australia
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Becker GE, Zambrano P, Ching C, Cashin J, Burns A, Policarpo E, Datu-Sanguyo J, Mathisen R. Global evidence of persistent violations of the International Code of Marketing of Breast-milk Substitutes: A systematic scoping review. MATERNAL & CHILD NUTRITION 2022; 18 Suppl 3:e13335. [PMID: 35313063 PMCID: PMC9113471 DOI: 10.1111/mcn.13335] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Revised: 01/28/2022] [Accepted: 02/04/2022] [Indexed: 01/03/2023]
Abstract
The influence of marketing on infant and young child feeding and health is well recognized, and an International Code was adopted by the World Health Assembly (WHA) in 1981 to reduce inappropriate marketing and protect breastfeeding. Yet the marketing and influencing continue. This scoping review systematically examined the published research evidence on the nature and extent of exposure to International Code violations from 1981 to August 2021. We used several search strategies involving multi‐language databases, organization websites, citation tracking, and expert consultation, to find research items meeting our inclusion criteria. We evaluated 657 items and retained 153 studies from at least 95 countries in the review. The majority of the studies (n = 113) documenting exposure to inappropriate marketing were published since 2010. Studies reported a broad range of marketing violations targeting mothers and families, health workers, and the general public. Marketing via digital platforms and brand extension has become more frequent. The evidence shows the use of misleading and inaccurate labeling and health and nutrition claims in breach of the Code. Our review confirms that violations of the Code have not ceased and calls for renewed attention from the WHA and national governments to protect the health of children and their mothers. Exposure to inappropriate marketing continues across the world in health systems, public spaces, points of sale, media, emergency programs, and direct to mothers. Studies have documented the emergence of products and marketing practices designed to circumvent the Code. Labeling and health and nutrition claims were found that were misleading, inaccurate, and in breach of the Code. Evidence of marketing through social media and other digital platforms has increased over time. Future research, guidance, and policies would benefit from an accessible central repository of comprehensive and comparable measurement tools and evidence.
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Affiliation(s)
| | - Paul Zambrano
- Alive & Thrive Southeast Asia/FHI 360, Manila, Philippines
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI 360, Washington, District of Columbia, USA
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Washington, District of Columbia, USA
| | | | | | | | - Roger Mathisen
- Alive & Thrive Southeast Asia/FHI 360, Manila, Philippines
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Vitalis D, Witten C, Pérez-Escamilla R. Gearing up to improve exclusive breastfeeding practices in South Africa. PLoS One 2022; 17:e0265012. [PMID: 35271643 PMCID: PMC8912204 DOI: 10.1371/journal.pone.0265012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Accepted: 02/14/2022] [Indexed: 11/19/2022] Open
Abstract
South Africa has one of the lowest breastfeeding rates on the African continent. Globally, just 44% of infants are breastfed soon after birth, and 40% of those less than six months old are exclusively breastfed. To improve infant nutrition by 2025, the United Nations established targets to eliminate malnutrition and increase exclusive breastfeeding (EBF) rates to at least 50%. Despite the WHO Code regulations endorsed by the World Health Assembly since 1981, breaches continue to be prevalent due to a combination of weak implementation, monitoring and enforcement in low-to-middle income countries. Over the years, infant formula sales in LMICs (including South Africa) have skyrocketed contributing to excess infant morbidity and mortality. To that end, the specific aims of this study was to gain an understanding of priority actions and strategies necessary to improve breastfeeding outcomes in South Africa in the context of the HIV pandemic. The team used a qualitative study design based on a semi-structured interview guide. The guide consisted of eight open-ended questions addressing the WHO HIV-related infant feeding guidelines, the WHO International Code of Marketing of Breastmilk Substitutes, political will, and advocacy. Of the 24 individuals contacted, 19 responded and 15 agreed to participate. The Breastfeeding Gear Model guided the thematic analysis. The three main themes identified were 1) WHO guidelines on HIV and infant feeding, 2) Improving exclusive breastfeeding, and 3) Advocacy. Key informants identified issues that need to be addressed to improve breastfeeding outcomes in South Africa. Strong political will is a key ingredient to harness the resources (human, financial) needed to implement, monitor, and act against Code violators. South Africa and other countries with similar challenges should consider using the WHOs Network for Global Monitoring and Support for Implementation of the International Code of Marketing of Breast-milk Substitutes and Subsequent relevant World Health Assembly Resolutions (NetCode) methodology.
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Affiliation(s)
- Debbie Vitalis
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
- * E-mail:
| | - Chantell Witten
- Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Rafael Pérez-Escamilla
- School of Public Health, Yale University, New Haven, Connecticut, United States of America
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Nguyen TT, Cashin J, Tran HTT, Vu DH, Nandi A, Phan MT, Van NDC, Weissman A, Pham TN, Nguyen BV, Mathisen R. Awareness, Perceptions, Gaps, and Uptake of Maternity Protection among Formally Employed Women in Vietnam. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:4772. [PMID: 35457636 PMCID: PMC9031189 DOI: 10.3390/ijerph19084772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/20/2022] [Revised: 03/30/2022] [Accepted: 04/12/2022] [Indexed: 02/01/2023]
Abstract
Maternity protection is a normative fundamental human right that enables women to combine their productive and reproductive roles, including breastfeeding. The aim of this study is to examine the uptake of Vietnam's maternity protection policy in terms of entitlements and awareness, perceptions, and gaps in implementation through the lens of formally employed women. In this mixed methods study, we interviewed 494 formally employed female workers, among whom 107 were pregnant and 387 were mothers of infants and conducted in-depth interviews with a subset of these women (n = 39). Of the 494 women interviewed, 268 (54.3%) were working in blue-collar jobs and more than 90% were contributing to the public social insurance fund. Among the 387 mothers on paid maternity leave, 51 (13.2%) did not receive cash entitlements during their leave. Among the 182 mothers with infants aged 6-11 months, 30 (16.5%) returned to work before accruing 180 days of maternity leave. Of 121 women who had returned to work, 26 (21.5%) did not receive a one-hour paid break every day to express breastmilk, relax, or breastfeed, and 46 (38.0%) worked the same or more hours per day than before maternity leave. Although most women perceived maternity leave as beneficial for the child's health (92.5%), mother's health (91.5%), family (86.2%), and society (90.7%), fewer women perceived it as beneficial for their income (59.5%), career (46.4%), and employers (30.4%). Not all formally employed women were aware of their maternity protection rights: women were more likely to mention the six-month paid maternity leave (78.7%) and one-hour nursing break (62.3%) than the other nine entitlements (2.0-35.0%). In-depth interviews with pregnant women and mothers of infants supported findings from the quantitative survey. In conclusion, although Vietnam's maternity protection policy helps protect the rights of women and children, our study identified implementation gaps that limit its effectiveness. To ensure that all women and their families can fully benefit from maternity protection, there is a need to increase awareness of the full set of maternity entitlements, strengthen enforcement of existing policies, and expand entitlements to the informal sector.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Ha T. T. Tran
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (N.D.C.V.)
| | - Duong H. Vu
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
| | - Arijit Nandi
- Department of Epidemiology, Biostatistics and Occupational Health and Institute for Health and Social Policy, McGill University, Montreal, QC H3A 1A3, Canada;
| | - Minh T. Phan
- Department of Legal Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam; (M.T.P.); (B.V.N.)
| | - Nguyen D. C. Van
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (N.D.C.V.)
| | - Amy Weissman
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
| | - Toan N. Pham
- Institute of labor Science & Social Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam;
| | - Binh V. Nguyen
- Department of Legal Affairs, Ministry of Labor, Invalids and Social Affairs (MOLISA), Hanoi 11022, Vietnam; (M.T.P.); (B.V.N.)
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (D.H.V.); (A.W.); (R.M.)
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Nguyen TT, Cashin J, Ching C, Baker P, Tran HT, Weissman A, Nguyen TT, Mathisen R. Beliefs and Norms Associated with the Use of Ultra-Processed Commercial Milk Formulas for Pregnant Women in Vietnam. Nutrients 2021; 13:4143. [PMID: 34836398 PMCID: PMC8621914 DOI: 10.3390/nu13114143] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/12/2021] [Accepted: 11/17/2021] [Indexed: 01/08/2023] Open
Abstract
Commercial milk formula for pregnant women (CMF-PW) is an expensive, ultra-processed food with a high concentration of sugar, the consumption of which may be linked to negative health outcomes. However, CMF-PWs are promoted as beneficial for pregnant women and lactating mothers as well as their children. To date, little is known about the factors associated with the use of CMF-PW among pregnant women. We performed this analysis to examine the association between the use of CMF-PW and related beliefs and norms among pregnant women in Vietnam. We interviewed 268 pregnant women in their second and third trimesters from two provinces and one municipality representing diverse communities in Vietnam. Multinomial (polytomous) logistic regression, structural equation modeling (SEM), and propensity score matching (PSM) analysis were used to examine associations between beliefs and social norms related to CMF-PW and reported consumption, characterized as occasional, recent, and never during the current pregnancy. Overall, 64.6% of pregnant women reported using CMF-PW during the current pregnancy and 34.7% consumed CMF-PW on the day prior to the interview. Strong beliefs that CMF-PW will make a child smart and healthy (53.7%) and the perception that use of CMF-PW is common (70.9%) were associated with increased use on the previous day (beliefs: aOR: 3.56; 95% Confidence Interval (95% CI): 1.65, 7.71; p < 0.01 and social norms aOR: 2.29; 95% CI: 1.13, 4.66; p < 0.05). SEM and PSM analyses confirmed these findings for both occasional and regular CMF-PW use. Results are consistent with observations of CMF-PW product labels and marketing tactics in Vietnam. The prevalent use of CMF-PW in Vietnam is associated with the belief that these products make children smart and healthy and the perceived social norm that most mothers use these products, which mirrors marketing messages and approaches employed by the CMF industry.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (C.C.); (A.W.); (R.M.)
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (C.C.); (A.W.); (R.M.)
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (C.C.); (A.W.); (R.M.)
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, VIC 3220, Australia;
| | - Hoang T. Tran
- Neonatal Unit and Human Milk Bank, Da Nang Hospital for Women and Children, Da Nang 50506, Vietnam;
| | - Amy Weissman
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (C.C.); (A.W.); (R.M.)
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
| | - Thao T. Nguyen
- School of Biotechnology and Food Technology, Hanoi University of Science and Technology, Hanoi 11615, Vietnam;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (C.C.); (A.W.); (R.M.)
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