Evidence-Based Lessons from Policy Implementation Research in Two Countries Achieving Progress on Global Breastfeeding Targets: Recommendations from the Philippines and Viet Nam

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Abstract
Background/Objectives: There is extensive evidence that breastfeeding saves lives, improves health and provides value to the economy and societies worldwide. The Philippines and Viet Nam have progressive policies to enable breastfeeding, and breastfeeding rates in these countries have substantively improved. In the Philippines, exclusive breastfeeding under six months (EBF) increased from 35.9% (2008) to 60.1% (2021) and in Viet Nam, in just over a decade, EBF has more than doubled, from 17.0% (2010) to 45.4% (2021). We aimed to consolidate learnings from policy support to enable breastfeeding in the Philippines and Viet Nam, and synthesized insights highlighting successful implementation strategies and areas for improvement to guide future programming. Methods: This paper presents an evidence synthesis of seven research articles using mixed methods research from the Philippines and Viet Nam. Results: Since the 1960s, the Philippines and Viet Nam have notably improved policies protecting breastfeeding. Both countries have implemented legislation that is substantially aligned with the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions. Both countries have improved maternity leave provisions, with Viet Nam providing six months of paid leave, yet insufficient coverage to informal workers, and the Philippines providing 3.5 months paid maternity leave while expanding maternity protection coverage to informal workers. Between 2006-2021, breastfeeding rates increased in both countries alongside policy improvements yet barriers to implementation remain. Conclusions: Implementation research has documented policy progress and improved breastfeeding rates in the Philippines and Viet Nam. Our analysis offers valuable lessons applicable beyond these contexts, emphasizing the need for targeted cross-sectoral policy actions to enhance breastfeeding practices. Learnings from implementing national marketing restrictions of commercial milk formula and associated products, and maternity protection policies in these countries could inform the implementation of newly developed regional standards together with supportive policies, facilitating the harmonization of regional regulatory environments.
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