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BackgroundDespite its well-known benefits, breastfeeding practices remain suboptimal worldwide, including in Southeast Asia. Many countries in the region have thus enacted policies, such as maternity protection and the World Health Assembly International Code of Marketing of Breast-milk Substitutes (the Code), that protect, promote, and support breastfeeding. Yet the impact of such national legislation on breastfeeding practices is not well understood. ObjectiveThis study aims to review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Vietnam. MethodsThis mixed methods study includes a desk review, trend and secondary data analyses, and quantitative and qualitative data collection. Desk reviews will examine and compare the contents, implementation strategies, coverage, monitoring, and enforcement of national policies focusing on maternity protection and the Code in each country with global standards. Trend and secondary data analyses will examine the potential impact of these policies on relevant variables such as breast milk substitute (BMS) sales and women’s workforce participation. Quantitative data collection and analysis will be conducted to examine relevant stakeholders’ and beneficiaries’ perceptions about these policies. In each country, we will conduct up to 24 in-depth interviews (IDI) with stakeholders at national and provincial levels and 12 employers or 12 health workers. Per country, we will survey approximately 930 women who are pregnant or have a child aged 0-11 months, of whom approximately 36 will be invited for an IDI; 12 partners of the interviewed mothers or fathers of children from 0-11 months will also be interviewed. ResultsThis study, funded in June 2018, was approved by the Institutional Review Boards of the relevant organizations (FHI 360: April 16, 2019 and May 18, 2020; and Hanoi University of Public Health: December 6, 2019). The dates of data collection are as follows: Vietnam: November and December 2019, May and June 2020; the Philippines: projected August 2020; Myanmar and Thailand: pending based on permissions and funding. Results are expected to be published in January 2021. As of July 2020, we had enrolled 1150 participants. We will present a comparison of key contents of the policies across countries and against international standards and recommendations and a comparison of implementation strategies, coverage, monitoring, and enforcement across countries. We will also present findings from secondary data and trend data analyses to propose the potential impact of a new or amended policy. For the surveys with women, we will present associations between exposure to maternity protection or BMS promotion on infant and young child feeding practices and their determinants. Findings from IDIs will highlight relevant stakeholders’ and beneficiaries’ perceptions. ConclusionsThis study will increase the understanding of the effectiveness of policy interventions to improve breastfeeding, which will be used to advocate for stronger policy adoption and enforcement in study countries and beyond. International Registered Report Identifier (IRRID)DERR1-10.2196/21286

Policy-makers need to rethink the connections between the economy and health. The World Health Organization Council on the Economics of Health for All has called for human and planetary health and well-being to be moved to the core of decision-making to build economies for health. Doing so involves valuing and measuring what matters, more and better health financing, innovation for the common good and rebuilding public sector capacity. We build on this thinking to argue that breastfeeding should be recognized in food and well-being statistics, while investments in breastfeeding should be considered a carbon offset in global financing arrangements for sustainable food, health and economic systems. Breastfeeding women nourish half the world's infants and young children with immense quantities of a highly valuable milk. This care work is not counted in gross domestic product or national food balance sheets, and yet ever-increasing commercial milk formula sales are counted. Achieving global nutrition targets for breastfeeding would realize far greater reductions in greenhouse gas emissions than decarbonizing commercial milk formula manufacturing. New metrics and financing mechanisms are needed to achieve the health, sustainability and equity gains from more optimal infant and young child feeding. Properly valuing crucial care and environmental resources in global and national measurement systems would redirect international financial resources away from expanding carbon-emitting activities, and towards what really matters, that is, health for all. Doing so should start with considering breastfeeding as the highest quality, local, sustainable first-food system for generations to come. [phrase omitted] Les responsables politiques doivent repenser les liens entre economie et sante. Le Conseil de Organisation mondiale de la Sante sur l'economie de la sante pour tous a demande que le bien-etre et la sante, aussi bien de l'humain que de la planete, soient desormais au creur du processus de prise de decisions afin de creer des economies au service de la sante. Il est donc imperatif d'identifier et de valoriser ce qui compte, d'accroitre et d'optimiser le financement de la sante, d'innover pour le bien commun et de renforcer les capacites du secteur public. En partant de cette reflexion, nous plaidons pour une reconnaissance de l'allaitement dans les statistiques relatives a l'alimentation et au bienetre, et estimons que tout investissement realise dans ce domaine devrait etre considere comme un credit-carbone dans le cadre des modalites financieres mondiales liees aux systemes economiques et sanitaires ainsi qu'a une alimentation durable. Les femmes allaitantes nourrissent la moitie des enfants en bas age dans le monde avec d'immenses quantites de lait extremement precieux. Ces activites de soins ne sont pas comptabilisees dans le produit interieur brut ou les bilans alimentaires nationaux, contrairement aux ventes de lait maternise en constante progression. Atteindre les cibles mondiales de nutrition pour l'allaitement contribuerait davantage a reduire les emissions de gaz a effet de serre que decarboner la production de lait maternise. De nouveaux parametres et mecanismes de financement sont necessaires pour beneficier des avantages en matiere de sante, de durabilite et d'equite qui decoulent d'une meilleure alimentation des nourrissons et jeunes enfants. Valoriser correctement les principales ressources consacrees a l'environnement et aux soins dans les systemes de mesure nationaux et mondiaux permettrait de detourner les moyens financiers internationaux du developpement d'activites a fort taux d'emissions pour les rediriger vers ce qui compte vraiment, c'est-a-dire la sante pour tous. Et pour y parvenir, la premiere etape consisterait a reconnaitre l'allaitement comme l'aliment de base, local, durable et de qualite pour les generations futures. [phrase omitted] Los responsables de formular las politicas deben volver a plantearse las conexiones entre la economia y la salud. El Consejo sobre la Economia de la Salud para Todos de la Organizacion Mundial de la Salud ha pedido que la salud y el bienestar humanos y del planeta se situen en el centro de la toma de decisiones a fin de desarrollar economias para la salud. Esto requiere valorar y medir lo que importa, mas y mejor financiacion sanitaria, innovacion para el bien comun y reconstruccion de la capacidad del sector publico. Nos basamos en este pensamiento para argumentar que la lactancia materna deberia reconocerse en las estadisticas de alimentacion y bienestar, mientras que las inversiones en lactancia materna deberian considerarse como una compensacion de emisiones de carbono en los acuerdos globales de financiacion para sistemas alimentarios, sanitarios y economicos sostenibles. Las mujeres lactantes alimentan a la mitad de los bebes y ninos pequenos del mundo con inmensas cantidades de una leche muy valiosa. Este trabajo de cuidados no se contabiliza en el producto interior bruto ni en los balances alimentarios nacionales y, sin embargo, si se contabilizan las ventas cada vez mayores de leche de formula comercial. Alcanzar los objetivos mundiales de nutricion para la lactancia materna supondria una reduccion mucho mayor de las emisiones de gases de efecto invernadero que descarbonizar la fabricacion de leche de formula comercial. Se necesitan nuevas metricas y mecanismos de financiacion para lograr los beneficios en materia de salud, sostenibilidad y equidad de una alimentacion mas optima de los bebes y los ninos pequenos. Una valoracion adecuada de los cuidados esenciales y de los recursos medioambientales en los sistemas de medicion globales y nacionales redirigiria los recursos financieros internacionales lejos de la expansion de las actividades que emiten carbono, y hacia lo que realmente importa, es decir, la salud para todos. En este contexto, habria que empezar por considerar la lactancia materna como el sistema de primera alimentacion de mayor calidad, local y sostenible para las generaciones futuras., Introduction Amid widespread health system weaknesses and inequities exposed by the coronavirus disease 2019 (COVID-19) pandemic, the World Health Organization (WHO) Director-General tasked the WHO Council on the Economics of [...]