Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, Australia.
Alive & Thrive Southeast Asia, FHI 360, Manila, Philippines.
Global Health. 2021 Oct 26;17(1):125. doi: 10.1186/s12992-021-00774-5.
The aggressive marketing of breastmilk substitutes (BMS) reduces breastfeeding, and harms child and maternal health globally. Yet forty years after the World Health Assembly adopted the International Code of Marketing of Breast-milk Substitutes (The Code), many countries are still to fully implement its provisions into national law. Furthermore, despite The Code, commercial milk formula (CMF) markets have markedly expanded. In this paper, we adopt the Philippines as a case study to understand the battle for national Code implementation. In particular, we investigate the market and political strategies used by the baby food industry to shape the country's 'first-food system', and in doing so, promote and sustain CMF consumption. We further investigate how breastfeeding coalitions and advocates have resisted these strategies, and generated political commitment for a world-leading breastfeeding policy framework and protection law (the 'Milk Code'). We used a case study design and process tracing method, drawing from documentary and interview data.
The decline in breastfeeding in the Philippines in the mid-twentieth Century associated with intensive BMS marketing via health systems and consumer advertising. As regulations tightened, the industry more aggressively promoted CMFs for older infants and young children, thereby 'marketing around' the Milk Code. It established front groups to implement political strategies intended to weaken the country's breastfeeding policy framework while also fostering a favourable image. This included lobbying government officials and international organizations, emphasising its economic importance and threats to foreign investment and trade, direct litigation against the government, messaging that framed marketing in terms of women's choice and empowerment, and forging partnerships. A resurgence in breastfeeding from the mid-1980s onwards reflected strengthening political commitment for a national breastfeeding policy framework and Milk Code, resulting in-turn, from collective actions by breastfeeding coalitions, advocates and mothers.
The Philippines illustrates the continuing battle for worldwide Code implementation, and in particular, how the baby food industry uses and adapts its market and political practices to promote and sustain CMF markets. Our results demonstrate that this industry's political practices require much greater scrutiny. Furthermore, that mobilizing breastfeeding coalitions, advocacy groups and mothers is crucial to continually strengthen and protect national breastfeeding policy frameworks and Code implementation.
母乳代用品的大力推销（BMS）减少了母乳喂养，在全球范围内危害儿童和产妇健康。然而，在世界卫生大会通过《国际母乳代用品销售守则》（《守则》）四十年后，许多国家仍未将其规定全面纳入国家法律。此外，尽管有《守则》，商业配方奶粉（CMF）市场仍显著扩大。在本文中，我们以菲律宾为例，研究实施国家《守则》的斗争。特别是，我们调查了婴儿食品行业用来塑造国家“第一食品系统”的市场和政治策略，从而促进和维持 CMF 的消费。我们进一步调查了母乳喂养联盟和倡导者如何抵制这些策略，并为具有世界领先地位的母乳喂养政策框架和保护法（《牛奶法》）争取政治承诺。我们使用案例研究设计和过程追踪方法，利用文献和访谈数据。
二十世纪中叶，菲律宾母乳喂养率下降与通过卫生系统和消费者广告进行的密集 BMS 营销有关。随着监管的收紧，该行业更积极地为较大婴儿和幼儿推广 CMF，从而“绕过”《牛奶法》进行营销。它成立了前沿组织来实施政治策略，旨在削弱该国的母乳喂养政策框架，同时也树立了有利的形象。这包括游说政府官员和国际组织，强调其经济重要性以及对外国投资和贸易的威胁，对政府直接提起诉讼，将营销信息框定为妇女的选择和赋权，以及建立伙伴关系。二十世纪八十年代中期以来母乳喂养的复苏反映了对国家母乳喂养政策框架和《牛奶法》的政治承诺的加强，这反过来又来自母乳喂养联盟、倡导者和母亲的集体行动。
菲律宾说明了全球范围内实施《守则》的持续斗争，特别是婴儿食品行业如何利用和调整其市场和政治实践来促进和维持 CMF 市场。我们的研究结果表明，该行业的政治实践需要更严格的审查。此外，动员母乳喂养联盟、倡导团体和母亲对于不断加强和保护国家母乳喂养政策框架和《守则》的实施至关重要。
