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Topothai C, Tan GPP, van der Eijk Y. Commercial milk formula marketing following increased restrictions in Singapore: A qualitative study. MATERNAL & CHILD NUTRITION 2024; 20:e13562. [PMID: 37667980 PMCID: PMC10750007 DOI: 10.1111/mcn.13562] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 08/17/2023] [Accepted: 08/22/2023] [Indexed: 09/06/2023]
Abstract
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.
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Affiliation(s)
- Chompoonut Topothai
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
- International Health Policy ProgrammeMinistry of Public HealthNonthaburiThailand
| | - Grace Ping Ping Tan
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
| | - Yvette van der Eijk
- Saw Swee Hock School of Public HealthNational University of SingaporeSingaporeSingapore
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Doherty T, Horwood C, Pereira-Kotze C, du Plessis L, Witten C. Stemming commercial milk formula marketing: now is the time for radical transformation to build resilience for breastfeeding. Lancet 2023; 401:415-418. [PMID: 36764312 DOI: 10.1016/s0140-6736(23)00095-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/08/2022] [Indexed: 02/10/2023]
Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7505, South Africa; School of Public Health, University of the Western Cape, Cape Town, South Africa.
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lisanne du Plessis
- Division of Human Nutrition, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Chantell Witten
- School of Public Health, University of the Western Cape, Cape Town, South Africa
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Becker GE, Ching C, Nguyen TT, Cashin J, Zambrano P, Mathisen R. Babies before business: protecting the integrity of health professionals from institutional conflict of interest. BMJ Glob Health 2022; 7:bmjgh-2022-009640. [PMID: 35926917 PMCID: PMC9358938 DOI: 10.1136/bmjgh-2022-009640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 07/12/2022] [Indexed: 11/18/2022] Open
Affiliation(s)
| | - Constance Ching
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Tuan T Nguyen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Washington, District of Columbia, USA
| | - Paul Zambrano
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Manila, Philippines
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI Solutions / FHI 360, Hanoi, Viet Nam
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Expanding Integrated Competency-Focused Health Worker Curricula for Maternal Infant and Young Child Nutrition. EDUCATION SCIENCES 2022. [DOI: 10.3390/educsci12080518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Maternal, infant, and young child nutrition (MIYCN) is important for health, survival, productivity, and development. Knowledgeable, skilled health workers are vital to provide quality care, improve health outcomes, and meet global nutrition targets. When nutrition is not adequately addressed in pre-service curricula, health workers may not be equipped with the knowledge, skills and confidence required to deliver nutrition services and accurate information free of commercial influence. Curriculum review, revision, and competency structuring provides an opportunity to benchmark course topics and content to global standards, to increase focus on learner outcomes, and to facilitate mutual recognition of qualifications across countries and regions. This paper discusses a multistage process to map an existing curriculum, analyse expected competencies, and recognize broader factors when developing a competency-focused curriculum in pre-service education that includes MIYCN. Examples of tools are provided which can be used for review and discussion of curricula and competency at local and national level and to integrate skills such as communication and counselling.
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Doherty T, Engebretsen IMS, Tylleskär T, Burgoine K, Baerug A, Mercer R, Baker P, Clark D, Pereira-Kotze CJ, Kroon M. Questioning the ethics of international research on formula milk supplementation in low-income African countries. BMJ Glob Health 2022; 7:bmjgh-2022-009181. [PMID: 35523452 PMCID: PMC9083380 DOI: 10.1136/bmjgh-2022-009181] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 04/25/2022] [Indexed: 01/04/2023] Open
Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa .,School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa.,Department of Paediatrics and Child Health, University of Cape Town, Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Ingunn Marie S Engebretsen
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
| | - Thorkild Tylleskär
- Centre for International Health, Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway.,Centre for Intervention Science in Maternal and Child Health, University of Bergen, Bergen, Norway
| | - Kathy Burgoine
- Neonatal Unit, Mbale Regional Referral Hospital, Mbale, Uganda
| | - Anne Baerug
- Unit on Breastfeeding, Division for Health Services, Norwegian Institute of Public Health, Oslo, Norway
| | - Raul Mercer
- Program of Social Sciences and Health, Latin American School of Social Sciences (FLACSO), Buenos Aires, Argentina
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Victoria, Australia
| | - David Clark
- Giovine-Clark Consultancy, Independent, New York, New York, USA
| | - Catherine Jane Pereira-Kotze
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Max Kroon
- Department of Paediatrics and Child Health, University of Cape Town, Faculty of Health Sciences, Observatory, Western Cape, South Africa.,Neonatal Service, Mowbray Maternity Hospital, Mowbray, South Africa
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