Social and Behavioral Sciences, Yale School of Public Health, New Haven, Connecticut.
Health Policy & Management, Yale School of Public Health, New Haven, Connecticut.
Matern Child Nutr. 2019 Jan;15(1):e12685. doi: 10.1111/mcn.12685. Epub 2018 Sep 30.
Promoting exclusive breastfeeding (EBF) is a highly feasible and cost-effective means of improving child health. Regulating the marketing of breastmilk substitutes is critical to protecting EBF. In 1981, the World Health Assembly adopted the World Health Organization International Code of Marketing of Breastmilk Substitutes (the Code), prohibiting the unethical advertising and promotion of breastmilk substitutes. This comparative study aimed to (a) explore the relationships among Code enforcement and legislation, infant formula sales, and EBF in India, Vietnam, and China; (b) identify best practices for Code operationalization; and (c) identify pathways by which Code implementation may influence EBF. We conducted secondary descriptive analysis of available national-level data and seven high level key informant interviews. Findings indicate that the implementation of the Code is a necessary but insufficient step alone to improve breastfeeding outcomes. Other enabling factors, such as adequate maternity leave, training on breastfeeding for health professionals, health systems strengthening through the Baby Friendly Hospital Initiative, and breastfeeding counselling for mothers, are needed. Several infant formula industry strategies with strong conflict of interest were identified as harmful to EBF. Transitioning breastfeeding programmes from donor-led to government-owned is essential for long-term sustainability of Code implementation and enforcement. We conclude that the relationships among the Code, infant formula sales, and EBF in India, Vietnam, and China are dependent on countries' engagement with implementation strategies and the presence of other enabling factors.
促进纯母乳喂养（EBF）是改善儿童健康的一种高度可行且具有成本效益的方法。规范母乳代用品的营销对于保护 EBF 至关重要。1981 年，世界卫生大会通过了世界卫生组织《国际母乳代用品销售守则》（《守则》），禁止不道德地宣传和推销母乳代用品。本比较研究旨在：(a) 探讨《守则》的执行情况与立法、婴儿配方奶粉销售和印度、越南和中国的 EBF 之间的关系；(b) 确定《守则》运作的最佳做法；(c) 确定《守则》执行可能影响 EBF 的途径。我们对现有的国家级数据进行了二次描述性分析，并对 7 名高级别关键知情者进行了访谈。研究结果表明，执行《守则》是改善母乳喂养结果的必要但不充分的步骤。还需要其他有利因素，如充足的产假、为卫生专业人员提供母乳喂养培训、通过“爱婴医院倡议”加强卫生系统，以及为母亲提供母乳喂养咨询。还确定了一些具有强烈利益冲突的婴儿配方奶粉行业策略，这些策略对 EBF 有害。将母乳喂养方案从由捐助方主导转变为由政府主导，对于《守则》的长期可持续执行和实施至关重要。我们的结论是，《守则》、婴儿配方奶粉销售和印度、越南和中国的 EBF 之间的关系取决于各国对执行策略的参与程度以及其他有利因素的存在。
