The influence of marketing on infant and young child feeding and health is well recognized, and an International Code was adopted by the World Health Assembly (WHA) in 1981 to reduce inappropriate marketing and protect breastfeeding. Yet the marketing and influencing continue. This scoping review systematically examined the published research evidence on the nature and extent of exposure to International Code violations from 1981 to August 2021. We used several search strategies involving multi‐language databases, organization websites, citation tracking, and expert consultation, to find research items meeting our inclusion criteria. We evaluated 657 items and retained 153 studies from at least 95 countries in the review. The majority of the studies (n = 113) documenting exposure to inappropriate marketing were published since 2010. Studies reported a broad range of marketing violations targeting mothers and families, health workers, and the general public. Marketing via digital platforms and brand extension has become more frequent. The evidence shows the use of misleading and inaccurate labeling and health and nutrition claims in breach of the Code. Our review confirms that violations of the Code have not ceased and calls for renewed attention from the WHA and national governments to protect the health of children and their mothers.

The Philippines has adopted policies to protect, promote, and support breastfeeding on par with global standards, yet the impact of these policies is not well understood. This study assesses the adequacy and potential impact of breastfeeding policies, as well as the perceptions of stakeholders of their effectiveness and how to address implementation barriers. This mixed methods study entailed a desk review of policies and documents and in-depth interviews with 100 caregivers, employees, employers, health workers, and policymakers in the Greater Manila Area. Although the Philippines has a comprehensive breastfeeding policy framework, its effectiveness was limited by structural and individual barriers. Structural barriers included inconsistent breastfeeding promotion, limited access of mothers to skilled counseling, limited workplace breastfeeding support, gaps in legal provisions, weak monitoring and enforcement of the Philippine Milk Code, and the short duration and limited coverage of maternity leave. Individual barriers included knowledge and skills gaps, misconceptions, and low self-confidence among mothers due to insufficient support to address breastfeeding problems, misconceptions in the community that undermine breastfeeding, limited knowledge and skills of health workers, and insufficient support extended to mothers by household members. Breastfeeding policies in the Philippines are consistent with global standards, but actions to address structural and individual barriers are needed to enhance their effectiveness for improving breastfeeding practices.

Background: The Philippines has enacted maternity protection policies, such as the 105-Day Expanded Maternity Leave Law and the Expanded Breastfeeding Promotion Act of 2009, to protect, promote, and support breastfeeding. This study aimed to review the content and implementation of maternity protection policies in the Philippines and assess their role in enabling recommended breastfeeding practices. It also identified bottlenecks to successful implementation from the perspectives of mothers and their partners, employers, and authorities from the government and non-government organizations involved in developing, implementing, monitoring, and enforcing maternity protection policies. Methods: This study employed a desk review of policies, guidelines, and related documents on maternity protection, and in-depth interviews. Of the 87 in-depth interviews, there were 12 employed pregnant women, 29 mothers of infants, 15 partners of the mothers, 12 employers and 19 key informants from the government and non-government organizations. Respondents for the in-depth interviews were from the Greater Manila Area and were recruited using purposive snowball sampling. Data were collected from December 2020 to April 2021. Results: The study shows that maternity protection policies in the Philippines are mostly aligned with the maternity protection standards set by the International Labour Organization. However, their role in improving breastfeeding practices is limited because: (1) not all working women have access to maternity protection entitlements; (2) the duration of maternity leave entitlements is inconsistent with the World Health Organization’s recommended duration of exclusive breastfeeding; (3) there are gaps in policy implementation including: a lack of monitoring systems to measure the availability, functionality, and usage of lactation spaces; limited workplace support for breastfeeding; poor communication of maternity and paternity entitlements; and limited breastfeeding advocacy and promotion; and (4) there is limited integration between maternity protection and breastfeeding promotion interventions. Conclusions: There is a need to (1) strengthen communication about and promotion of maternity and paternity entitlements for mothers, fathers and employers, (2) improve monitoring and enforcement mechanisms to ensure utilization of entitlements among mothers, (3) develop modalities to extend the coverage of maternity entitlements to the informal sector, (4) fully cover paid leave entitlements from social insurance or public funding sources in line with International Labour Organization recommendations, and (5) revisit the limitations on the coverage of paternity entitlement.

The Philippine Milk Code was enacted in 1986 to protect breastfeeding and reduce inappropriate marketing of breastmilk substitutes (BMS). The Philippine Milk Code is categorized as “substantially aligned” with the International Code of Marketing of Breast-milk Substitutes (“the Code”), but its provisions are assessed as relatively weak in prohibiting promotion to the general public. The extent to which violations of the Philippine Milk Code persist in traditional media platforms and in the digital space has not been systematically explored. This study employed a cross-sectional multimedia audit to examine the marketing and promotion of products under the scope of the Code, as well as those regulated by the Philippine Milk Code. Through a media monitoring conducted from March to September 2018, a total of 430 unique television (n = 32), printed (n = 87) and online (n = 311) promotional materials were identified. A coding tool was used to analyze the content, including the marketing elements used in the materials. Our findings show that commercial milk formula (CMF) for children ≥36 months old was the most promoted type of product (n = 251); and staging of events (n = 211), provision of special discounts or financial inducements (n = 115) and the use of taglines (n = 112) were the most used marketing elements. Promotion of CMF for children <36 months old was uncommon, which supports the conclusion that there is broad compliance with the Philippine Milk Code in terms of the types of products promoted. However, analysis of marketing elements reveals that the CMF industry circumvents the Philippine Milk Code through the use of false and misleading health and nutrition claims, emotionally manipulative language in promotional materials, and cross-promotion. The findings indicate gaps in enforcement and regulatory measures that require urgent attention.

Background/Objectives: There is extensive evidence that breastfeeding saves lives, improves health, and provides value to the economy and societies worldwide. The Philippines and Viet Nam have progressive policies to enable breastfeeding, and breastfeeding rates in these countries have substantively improved. In the Philippines, exclusive breastfeeding under six months (EBF) increased from 35.9% (2008) to 60.1% (2021) and, in Viet Nam, in just over a decade, EBF has more than doubled, from 17.0% (2010) to 45.4% (2021). We aimed to use an evidence synthesis to consolidate learnings from policy support to enable breastfeeding in the Philippines and Viet Nam, to identify insights to improve future programming to improve breastfeeding practices in these two countries, and glean learnings that can potentially be adapted for similar contexts. Methods: This manuscript presents a qualitative evidence synthesis of seven purposively selected research articles from the Philippines and Viet Nam. Results: Since the 1960s, the Philippines and Viet Nam have notably improved policies protecting breastfeeding. Both countries have implemented legislation that is substantially aligned with the International Code of Marketing of Breast-milk Substitutes and subsequent World Health Assembly resolutions. Both countries have improved paid maternity leave provisions, with Viet Nam providing 6 months of paid leave, yet insufficient coverage to informal workers, and the Philippines providing 3.5 months of paid maternity leave while expanding maternity protection coverage to informal workers. From 2006–2021, breastfeeding rates increased in both countries alongside policy improvements yet barriers to implementation remain. Conclusions: Implementation research has documented policy progress and improved breastfeeding rates in the Philippines and Viet Nam. Our analysis offers valuable lessons potentially applicable beyond these contexts, emphasizing the need for addressing policy gaps and targeted cross-sectoral policy actions to enhance breastfeeding practices. Learnings from implementing national marketing restrictions of commercial milk formula and associated products and maternity protection policies in these countries could inform the implementation of newly developed regional standards together with supportive policies, facilitating the harmonization of regional regulatory environments.

To determine the content, implementation, and effectiveness of policies aimed at improving breastfeeding practices in the Philippines. This study used mixed methods, including a desk review of relevant policies and documents and in-depth interviews with 100 caregivers, workers, employers, health workers, and policymakers. Although the Philippines has a strong regulatory framework to protect breastfeeding, the implementation and effectiveness of breastfeeding policies are limited by structural and individual barriers. Structural barriers include: a lack of consistent breastfeeding promotion, limited access to skilled counselling support from health system to community level, and limited breastfeeding support in workplaces for working mothers. Inappropriate marketing of commercial milk formula, including cross-promotion and engagement of industry representatives with health professionals, persists due to gaps in legal provisions and weak monitoring and enforcement of the Philippine Milk Code. Individual barriers include failure to address early breastfeeding problems, misconceptions that undermine breastfeeding, limited knowledge and skills of health workers and caregivers, and lack of support from family members. Breastfeeding promotion, protection, and support policies in the Philippines are consistent with global standards, but their effectiveness for improving breastfeeding practices can be improved by addressing persistent barriers at the structural and individual levels. Bill & Melinda Gates Foundation (Grant Number OPP50838) and Irish Aid.