Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore.
International Health Policy Programme, Ministry of Public Health, Nonthaburi, Thailand.
Matern Child Nutr. 2024 Jan;20(1):e13562. doi: 10.1111/mcn.13562. Epub 2023 Sep 5.
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.
商业配方奶（CMF）的推广对母乳喂养结果产生负面影响。2019 年，新加坡更新了其 1979 年《婴儿食品销售道德规范》新加坡道德委员会（SIFECS），以增加对 0-12 个月婴儿 CMF 的营销限制。然而，对于行业策略来破坏这些限制的了解甚少。本定性研究探讨了 2019 年限制措施出台后，新加坡卫生工作者和母亲对 CMF 营销的体验。我们进行了一项定性研究，对 14 名 5 个月以下婴儿的母亲和 20 名具有产前、产科或儿科护理专业知识的卫生工作者进行了半结构化访谈。我们使用归纳编码对数据进行主题分析。确定了五个主题。母亲和卫生工作者报告了数字营销、儿童牛奶和母亲牛奶的产品线扩展，以及医疗保健环境中的 CMF 赞助。专家认可、有竞争力的价格、营养声称和品牌声誉影响了母亲对婴儿配方奶粉的选择，但母亲和卫生工作者似乎都没有意识到 CMF 营销策略对他们自身看法的影响。CMF 营销和婴儿喂养实践的限制在医院之间差异很大，私立医院和诊所对 CMF 营销的控制较少。尽管 SIFECS 更新了限制，但 CMF 公司仍继续在新加坡针对母亲和卫生工作者。SIFECS 限制应根据国际准则收紧，扩大范围包括儿童牛奶，并禁止交叉推广、数字营销以及针对卫生工作者的任何可能产生利益冲突的活动赞助。
