JMIR Publications

ABSTRACT

Background:

Despite all that is known about the benefits of breastfeeding, these practices remain sub-optimal worldwide and in Southeast Asia. Yet, there has been little exploration of how national Maternity Protection and International Code of Marketing of Breastmilk Substitutes (the Code)-related policies have impacted breastfeeding.

Objective:

To review the content, implementation, and potential impact of policies relating to maternity protection and the Code in Myanmar, the Philippines, Thailand, and Vietnam.

Methods:

The study will be be conducted in four countries: Myanmar, Philippines, Thailand, and Vietnam using mixed methods, including desk review, trend data analysis, and quantitative and qualitative data collection. Desk reviews will examine the contents, implementation strategies, coverage, monitoring, and enforcement of national policies focusing on maternity protection and the Codes in each country and compare with global standards. Trend data analysis will examine the potential impact of these policies on relevant variables such as infant formula sales and women workforce participation following maternity leave. 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 policymakers or authorities at national and provincial levels and stakeholders from the United Nations, non-governmental organizations, research organizations, and media; and 12 employers or 12 health workers depending on the policy focus in each country. Per country, we will survey approximately 930 women who are pregnant or with a child aged 0-11 months, of whom approximately 36 will be invited for an IDI as will 12 partners of the interviewed mothers or fathers of children from 0-11 months.

Results:

We will present a comparison of key contents of the policies across countries and against international standards / recommendations. Similarly, we will present the comparison of implementation strategies, coverage, monitoring and enforcement across countries. We will also present data from interrupted time-series approach to quantify the change in the slope or level of selected outcomes before and after the effective of a new or an amendment of a policy. Findings from IDI contents will include themes, sub-themes, and quotes from the coded phrases. For the surveys with women, we will present associations between exposure to maternity protections (e.g., taking leave, duration of leave, paid leave, lactation support at work, social norm) and on infant and young child feeding practices. We will also present associations between exposure to infant formula promotion (e.g., advertisement, advice, gift …) and on infant and young child feeding practices as well as women’s intentions, knowledge, beliefs, social norms and self-efficacy.

Conclusions:

This study will increase understanding of the effectiveness of policy interventions to address the structural determinants of breastfeeding, namely national policies on maternity protection and the Code. By assessing the potential impact of these policies and bottlenecks for successful implementation through the perspective of various stakeholders, including policymakers, implementors, and beneficiaries, this study will build an evidence base that can be used to prevent backsliding and to advocate for stronger policies and improved enforcement.