Search

In this Series paper, we examine how mother and baby attributes at the individual level interact with breastfeeding determinants at other levels, how these interactions drive breastfeeding outcomes, and what policies and interventions are necessary to achieve optimal breastfeeding. About one in three neonates in low-income and middle-income countries receive prelacteal feeds, and only one in two neonates are put to the breast within the first hour of life. Prelacteal feeds are strongly associated with delayed initiation of breastfeeding. Self-reported insufficient milk continues to be one of the most common reasons for introducing commercial milk formula (CMF) and stopping breastfeeding. Parents and health professionals frequently misinterpret typical, unsettled baby behaviours as signs of milk insufficiency or inadequacy. In our market-driven world and in violation of the WHO International Code for Marketing of Breast-milk Substitutes, the CMF industry exploits concerns of parents about these behaviours with unfounded product claims and advertising messages. A synthesis of reviews between 2016 and 2021 and country-based case studies indicate that breastfeeding practices at a population level can be improved rapidly through multilevel and multicomponent interventions across the socioecological model and settings. Breastfeeding is not the sole responsibility of women and requires collective societal approaches that take gender inequities into consideration., Competing Interests: Declaration of interests NR received grants from the Bill & Melinda Gates Foundation during the conduct of this study. All other authors declare no competing interests., (© 2023 World Health Organization; licensee Elsevier. This is an Open Access article published under the CC BY 3.0 IGO license which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. In any use of this article, there should be no suggestion that WHO endorses any specific organisation, products or services. The use of the WHO logo is not permitted. This notice should be preserved along with the article's original URL.)

Scaling up effective interventions, policies and programmes can improve breastfeeding (BF) outcomes. Furthermore, considerable interest exists in learning from relatively recent successful efforts that can inform further scaling up, with appropriate adaptations, across countries. The purpose of this four-country case studies analysis was to examine why and how improvements in BF practices occurred across four contrasting countries; Burkina Faso, the Philippines, Mexico and the United States of America. Literature reviews and key informant interviews were conducted to document BF trends over time, in addition to why and how BF protection, promotion and support policies and programmes were implemented at a national level. A qualitative thematic analysis was conducted. The 'Breastfeeding Gear Model' and RE-AIM (Reach; Effectiveness; Adoption; Implementation; and Maintenance) frameworks were used to understand and map the factors facilitating or hindering the scale up of the national programmes and corresponding improvements in BF practices. Each of the studied countries had different processes and timing to implement and scale up programmes to promote, protect and support breastfeeding. However, in all four countries, evidence-based advocacy, multisectoral political will, financing, research and evaluation, and coordination were key to fostering an enabling environment for BF. Furthermore, in all countries, lack of adequate maternity protection and the aggressive marketing of the breast-milk substitutes industry remains a strong source of negative feedback loops that are undermining investments in BF programmes. Country-specific best practices included innovative legislative measures (Philippines), monitoring and evaluation systems (United States of America), engagement of civil society (Mexico) and behavior change communication BF promotion (Burkina Faso) initiatives. There is an urgent need to improve maternity protection and to strongly enforce the WHO Code of Marketing of Breast-Milk Substitutes., (© 2022 The Authors. Maternal & Child Nutrition published by John Wiley & Sons Ltd.)

Aim: We aimed to examine the advertising and marketing of breast milk substitutes (BMS) through the internet, social media and television in Mexico., Methods: We recorded the programming of four main TV channels at peak times to identify BMS advertisements. In addition, we identified the main BMS products and companies present on the internet, as well as related home pages and social networks (Facebook, Twitter and YouTube). After that, we examined current BMS' marketing practices using the International Code of Marketing of Breast-milk Substitutes ('the Code') as a framework for ethical marketing. Qualitative and statistical analyses are presented., Results: BMS manufacturers have a presence on television, social media and the internet. Violations of the Code, as well as promotional practices unforeseen by the Code, were identified in all the studied media. These include text and images idealising the use of BMS, as well as mechanisms for boosting sales and making contact with consumers., Conclusions: The Mexican population is exposed to BMS advertisements that breach the Code on the internet, on social networks and on television. Emerging challenges related to the use of electronic means to market BMS may call for new strategies for monitoring and enforcing the Code through local regulations., (© 2020 Paediatrics and Child Health Division (The Royal Australasian College of Physicians).)

The introduction for the Supplement in Maternal & Child Nutrition: What will it take to increase breastfeeding? describes the contribution of each of the articles included in this Supplement to the current evidence about the major structural challenges in place to overcome to improve breastfeeding practices, as well as the evidence‐based policies and interventions that can be effective at advancing breastfeeding on a large scale to promote, protect and support breastfeeding. Key messages: Breastfeeding saves lives, improves the short‐ and long‐term health and cognitive development of infants, and the health of their mothers across the globe.In most countries, the vast majority of women are choosing to breastfeed but very often cannot do it for as long as they wish because of major structural barriers across layers of the social‐ecological model.Caregivers need to learn the skills to manage normal baby behaviours such as crying and fussiness without placing breastfeeding at risk.Implementation of well‐coordinated evidence‐based programmes at the facility and community levels through a highly qualified and motivated workforce, as well as with adequate resources, is needed to improve breastfeeding.Improving maternity benefits for women working in the formal and informal sectors and enforcing the World Health Organization Code of Marketing of Breastmilk Substitutes are key to improving breastfeeding.Implementation science research is needed to translate into large‐scale policy and practice the vast knowledge that we have on what is needed to improve breastfeeding globally. [ABSTRACT FROM AUTHOR]

Milk formula sales have grown globally, particularly through follow‐up formulas (FUF) and growing‐up milks (GUM). Marketing strategies and weak regulatory and institutional arrangements are important contributors to caregivers' decisions about child feeding choices. This study describes maternal awareness, beliefs, and normative referents of FUFs and GUMs among Mexican pregnant women and mothers of children 0–18 months (n = 1044) through the lens of the theory of reasoned action (TRA). A cross‐sectional survey was undertaken in two large metropolitan areas of Mexico. Descriptive analyses were conducted following the constructs of the TRA. One‐third of the participants had heard about FUFs, mainly through health professionals (51.1%) and family (22.2%). Once they had heard about FUFs, the majority (80%) believed older infants needed this product due to its benefits (hunger satisfaction, brain development, and allergy management). One quarter of the participants were already using or intended to use FUFs; the majority had received this recommendation from doctors (74.6%) and mothers/mothers‐in‐law (25%). Similarly, 19% of the women had heard about GUMs. The pattern for the rest of TRA constructs for GUMs was similar to FUFs. Mexican women are exposed to FUFs and GUMs, once women know about them, the majority believe older infant and young children need these products, stating perceived benefits that match the poorly substantiated marketing claims of breast‐milk substitutes. Health professionals, particularly doctors, act as marketing channels for FUFs and GUMs. Marketing of FUFs and GUMs represents a threat to breastfeeding in Mexico and a more protective regulatory and institutional environment is needed. Key messages: Mexican pregnant women and mothers are highly exposed to FUFs and GUMs.Most women who know FUFs and GUMs believe older infants and young children need these products.The perceived benefits of FUFs and GUMs match those displayed in BMS marketing.Health providers are being used as marketing channels for FUFs and GUMs.Stronger regulatory and institutional frameworks for BMS are urgently needed in Mexico. [ABSTRACT FROM AUTHOR]

Background: Aggressive and unregulated marketing of breastmilk substitutes (BMS) results in increased child morbidity and mortality. Unregulated BMS marketing is a major public health concern because it encourages formula consumption at the expense of breastfeeding. This study aimed to identify the sources and characterize the nature of exposure to marketing of BMS among Mexican mothers of children under 18 months of age. As a secondary objective we explored potential association between exposure to BMS marketing and infant feeding practices. Methods: Cross-sectional study, comprising a pre-piloted survey, was conducted between February 2020 to February 2021 with Mexican mothers of children under 18 months of age (n = 754), in two major cities in Mexico. Mothers were selected according to their current infant feeding practices (Breastfeeding only vs. Mixed feeding). We characterized the different BMS marketing sources and scope, and related them with infant feeding practices. In addition, we used logistic regression models to estimate the odds ratio for infant feeding practices by BMS marketing exposure or recommendation. Results: Mothers reported different sources of exposure to BMS promotion, including BMS advertisements in diverse media channels (41.6%), recommendation by a healthcare professional and/or relative (76.2%), and receiving a BMS sample at a hospital (18.6%). By contrast, only 36.5% recalled hearing or seeing breastfeeding information the previous year. The odds of mixed feeding were substantially higher, compared to breastfeeding, when mothers were recommended to use a BMS by doctors/pediatricians (OR: 3.96, 95% CI: 2.00, 7.83). Having seen or heard breastfeeding information in the previous year was associated with a lower risk of mixed feeding compared to breastfeeding only (OR: 0.59, 95% CI: 0.35, 0.99). Conclusions: Mexican mothers of young children in the metropolitan areas studied were highly exposed to BMS marketing and through different mass media channels and inter-personal sources. Health care professionals, particularly doctors/pediatricians, are a source of BMS promotion that are likely to have a strong influence on maternal decisions about infant feeding practices. There is an urgent need to protect mothers and their families against unregulated BMS promotion through mass media channels and directly by influential individuals, including health care providers. [ABSTRACT FROM AUTHOR]