Constance Ching

Objective: The rise of commercial milk formulas (CMF) consumption by infants and young children raises concerns about their health, development, and survival. Implementing the International Code of Marketing of Breast-milk Substitutes (the Code) and maternity protection policies are two of seven critical policy actions to protect breastfeeding. This study explores the implementation of the Code, maternity protection policies, and CMF consumption in 11 countries in the East Asia Pacific (EAP) region and determines whether there are any correlations.Methods: Data on CMF consumption (from 2006 to 2019 with the projection to 2024 at the global, regional, and national levels), Code implementation scores and the age range covered by national measures, and maternity protection policies were used. Simple linear regressions were conducted to explore correlations between CMF consumption and Code implementation as well as maternity protection.Findings: In 2019, EAP contributed to 63% of global CMF consumption, toddler formula was the highest category, a product that is unnecessary and unsuitable for consumption by young children. Sales volumes and per capita consumption of most CMF types have increased in the region between 2006 and 2024. Currently, nine out of the 11 countries have adopted Code legal measures. Japan and Malaysia have none and are relying on voluntary measures. Australia, New Zealand, and Singapore now have some Code provisions as legal measures (none in 2020). CMF marketing in Australia and New Zealand remain largely voluntary. Only the Philippines and Thailand are covering CMF up to 36 months. Seven of the 11 countries provide the minimum maternity protection entitlements based on International Labour Organization (ILO) standards. As total scores on Code implementation increased, per capita CMF consumption decreased. Most countries with high overall CMF consumption had no Code legal measures. Philippines, with the highest Code implementation score, showed the lowest per capita CMF consumption. Though no correlation found between CMF consumption and paid maternity leave duration, other forms of maternity protection were not included in the regression.Recommendation: Adopt legal measures to give full effect to the Code as opposed to relying on voluntary measures. Prioritise strengthening comprehensive maternity protection, cultivate intersectoral policy environments.

Objective: To examine the bottlenecks and opportunities associated with Code monitoring and enforcement at the national level in the eight countries of South Asia region (Afghanistan, Bhutan, Bangladesh, India, Maldives, Nepal, Pakistan, and Sri Lanka).Design: Data was collected following a workshop-as-research methodology. Deductive content analysis was used to review, categorize, and analyze data. A semi-structured categorization matrix containing three main categories (background, opportunities, and bottlenecks) was developed as a guide for categorizing data on areas relevant to monitoring and enforcement.Findings: Overarching themes in bottlenecks include: (1) There is insufficient monitoring across countries, (2) Monitoring is not well-integrated into relevant enforcement mechanisms, as there is a lack of established system to efficiently ‘feed’ monitoring findings to the designated enforcement agencies, (3) Uncertainty regarding enforcement in the context of digital marketing, (4) Lack of coordination and collaboration regarding enforcement, (5) Inadequate sanctions and penalties, sometimes due to a lack of identified legal structure and adjudication system and functional administrative or enforcement mechanisms. Overarching themes in opportunities include: (1) Product registration or licensing as entry points for monitoring and enforcement, (2) authority provided in legal measures for designated agencies to carry out monitoring and enforcement actions, (3) civil society as government partners in monitoring including developing monitoring tools and strengthening systems to integrate monitoring with enforcement. Inadequately imposed.

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 use an evidence synthesis to consolidate learnings from policy support to enable breastfeeding in the Philippines and Viet Nam, to identify insights to improve future programming to improve breastfeeding practices in these two countries, and glean learnings that can potentially be adapted for similar contexts. Methods: This manuscript presents a qualitative evidence synthesis of seven purposively selected research articles 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 paid maternity leave provisions, with Viet Nam providing 6 months of paid leave, yet insufficient coverage to informal workers, and the Philippines providing 3.5 months of paid maternity leave while expanding maternity protection coverage to informal workers. From 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 potentially applicable beyond these contexts, emphasizing the need for addressing policy gaps and 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.

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.

Breastfeeding rates in Vietnam, and globally, remain suboptimal. A major contributor to this is the aggressive marketing of commercial milk formulas (CMF), mainly through online media. The Vietnamese Government has implemented legal measures to limit CMF marketing, but these have been difficult to enforce, because of complex online environments. We aimed to quantify the extent and nature of online violations and contradictions in various Vietnamese laws related CMF marketing over 12 months in 2022. Using a cross‐sectional study design, we used an artificial intelligence‐enabled virtual violations detector (VIVID) to monitor official websites and social media pages of 25 breastmilk substitute (BMS) merchandise and distributors, every day for 12 months in 2022. Data were summarised descriptively. We detected more than 3000 online advertisements that violated or contradicted the intent of Vietnamese laws, involving almost 7000 violations of various articles within these laws (average 9.5 violations per day). More than 700 detections were related to CMF products being registered as “supplementary foods” or similar, thereby circumventing Vietnamese CMF marketing laws, because they are not registered as “BMS products. We demonstrate the need to strengthen the design, monitoring and enforcement of existing Vietnamese laws to eliminate mothers” exposure to the exploitative digital marketing of CMF. By turning a highly resource‐intensive task into one that is, automated requiring substantially less resources, our study represents the most comprehensive in Vietnam and internationally on the extent and nature of the online marketing of BMS. VIVID can be applied worldwide to hold industry accountable for the inappropriate marketing of CMF.

This chapter proposes the concept of positive non-policy to provide an overview of homeless services in Hong Kong SAR and Malaysia. Both Malaysia and the HKSAR have no homelessness legislation and rely heavily on the voluntary sector. Positive non-policy allows the government to intervene in homelessness, often at times of crisis, without being constrained by legal obligations and by outsourcing services. We discuss its colonial background and current relationship to anti-welfarism and highlight both current punitive and caring policies. We conclude by identifying three main areas for improvement in homelessness policy while calling for further research into workable solutions within this concept.

Objectives: This study examines the status of implementation of the International Code of Marketing of Breast-milk Substitutes of eight countries in the South Asia region (Afghanistan, Bangladesh, Bhutan, India, Maldives, Nepal, Pakistan, and Sri Lanka), and describes the sales value and volume of commercial milk formula (CMF) marketed as breastmilk substitutes (BMS) and baby food in four countries (Bangladesh, India, Pakistan, and Sri Lanka).Design: A mix of descriptive methods is used to assess national status of Code implementation, including a desk review of the 2022 WHO/UNICEF/IBFAN Code Status Report, systematic content analysis of national Code measures, and insights generated from the participation of key government and UNICEF/WHO actors in a regional workshop that aimed to identify each country’s barriers, gaps, and the status of Code implementation. Data on the sales value and volume of CMF and baby food between 2007 to 2021 and with the prediction to 2026 in Bangladesh, India, Pakistan, and Sri Lanka were obtained from Global Data.Findings: There are major gaps in Code implementation in countries even with legal measures considered substantially aligned with the Code, such as the inadequate age range of CMF covered in the scope, insufficient safeguards against conflicts of interest in the health system, lack of warning of risks of intrinsic contamination of powdered milk formula, and an absence of effective monitoring and enforcement mechanisms. Data on CMF sales shows health facilities and pharmacies sustain the highest sales. Lower sales volume of infant formula (including special formula), compared to other CMF such as follow-up formula and growing-up milk, has been observed in three of the four countries (Bangladesh, India, and Sri Lanka). Overall, GUM, followed by baby cereals, accounted for a large portion of CMF and baby foods sales in the same three countries.Recommended actions include: (1) Closing the gaps between national measures and the Code, (2) Ensuring effective monitoring and enforcement mechanisms, (3) Strengthening conflicts of interest safeguards in the health system, (4) Tackling digital marketing, and (5) Galvanizing political support and support from in-country public health and women’s rights jurist networks.

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.