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Doherty T, Kroon M, Pereira-Kotze C. Valuing Academic Freedom and Advocacy. J Empir Res Hum Res Ethics 2024:15562646241246369. [PMID: 38584389 DOI: 10.1177/15562646241246369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
This is a correspondence letter in response to an article published in the journal: Flaherman VJ, Nankabirwa V, Ginsburg AS. Promoting Transparent and Equitable Discussion of Controversial Research. Journal of Empirical Research on Human Research Ethics 2023; 18(4): 248-9.
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Affiliation(s)
- Tanya Doherty
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
- School of Public Health, University of the Western Cape, Cape Town, South Africa
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Max Kroon
- Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
- Neonatal Service, Mowbray Maternity Hospital, Mowbray, South Africa
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Gribble KD, Smith JP, Gammeltoft T, Ulep V, Van Esterik P, Craig L, Pereira-Kotze C, Chopra D, Siregar AYM, Hajizadeh M, Mathisen R. Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health. Front Public Health 2023; 11:1181229. [PMID: 37886047 PMCID: PMC10599145 DOI: 10.3389/fpubh.2023.1181229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 09/11/2023] [Indexed: 10/28/2023] Open
Abstract
Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.
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Affiliation(s)
- Karleen D. Gribble
- School of Nursing and Midwifery, Western Sydney University, Parramatta, NSW, Australia
| | - Julie P. Smith
- National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Tine Gammeltoft
- Department of Anthropology, University of Copenhagen, Copenhagen, Denmark
| | - Valerie Ulep
- Philippine Institute for Development Studies, Quezon City, Philippines
| | - Penelope Van Esterik
- Department of Anthropology, York University, Toronto, ON, Canada
- Department of Sociology and Anthropology, University of Guelph, Guelph, ON, Canada
| | - Lyn Craig
- School of Social and Political Sciences, University of Melbourne, Melbourne, VIC, Australia
| | - Catherine Pereira-Kotze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Deepta Chopra
- Institute of Development Studies, University of Sussex, Brighton, United Kingdom
| | - Adiatma Y. M. Siregar
- Center for Economics and Development Studies, Department of Economics, Faculty of Economics and Business, Universitas Padjadjaran, Bandung, Indonesia
| | - Mohammad Hajizadeh
- School of Health Administration, Dalhousie University, Halifax, NS, Canada
| | - Roger Mathisen
- Alive and Thrive East Asia Pacific, FHI Solutions, Hanoi, Vietnam
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Pereira-Kotze C, Faber M, Doherty T. Knowledge, understanding and perceptions of key stakeholders on the maternity protection available and accessible to female domestic workers in South Africa. PLOS Glob Public Health 2023; 3:e0001199. [PMID: 37315034 DOI: 10.1371/journal.pgph.0001199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 05/23/2023] [Indexed: 06/16/2023]
Abstract
Maternity protection enables women to combine reproductive and productive roles. Domestic workers are a vulnerable group due to heterogeneous non-standard employment relationships and are unlikely to have access to comprehensive maternity protection. This study aimed to explore the knowledge, understanding and perceptions of key stakeholders in government, trade unions, non-governmental organisations and other relevant organisations of the maternity protection entitlements that should be available and accessible to female domestic workers in South Africa. This qualitative cross-sectional study included in-depth interviews with fifteen stakeholders working in different sectors in South Africa and mainly at a national level involved in maternity protection availability and access. Results show that stakeholders appear to have limited understanding of comprehensive maternity protection. Many challenges related to accessing cash payments while on maternity leave were described and suggestions were provided for how this could be improved. Participants described how certain labour-related characteristics unique to the domestic work sector were barriers in accessing maternity protection. Ensuring greater awareness of all components of maternity protection and improving implementation of existing labour legislation intended to guarantee maternity protection for non-standard workers in South Africa is important to improve access to maternity protection for this vulnerable group. Improved access to maternity protection would contribute to optimal maternal and new-born health and ensure economic security for women around the time of childbirth.
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Affiliation(s)
- Catherine Pereira-Kotze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town, South Africa
- Department of Dietetics and Nutrition, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
| | - Tanya Doherty
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Pereira-Kotze C, Feeley A, Doherty T, Faber M. Correction: Maternity protection entitlements for non-standard workers in low-and-middle-income countries and potential implications for breastfeeding practices: a scoping review of research since 2000. Int Breastfeed J 2023; 18:12. [PMID: 36810095 PMCID: PMC9942285 DOI: 10.1186/s13006-023-00547-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/23/2023] Open
Affiliation(s)
| | - Alison Feeley
- grid.11951.3d0000 0004 1937 1135South African Medical Research Council (SAMRC) Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya Doherty
- grid.8974.20000 0001 2156 8226School of Public Health, University of the Western Cape (UWC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024Health Systems Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Mieke Faber
- grid.415021.30000 0000 9155 0024Non-communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.8974.20000 0001 2156 8226Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
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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] [What about the content of this article? (0)] [Affiliation(s)] [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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Pereira-Kotze C, Faber M, Kannemeyer L, Doherty T. Access to Maternity Protection and Potential Implications for Breastfeeding Practices of Domestic Workers in the Western Cape of South Africa. Int J Environ Res Public Health 2023; 20:2796. [PMID: 36833492 PMCID: PMC9956374 DOI: 10.3390/ijerph20042796] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Revised: 01/27/2023] [Accepted: 02/01/2023] [Indexed: 06/18/2023]
Abstract
Access to comprehensive maternity protection could contribute to improved breastfeeding practices for working women. Domestic workers are a vulnerable group. This study aimed to explore perceptions of and accessibility to maternity protection among domestic workers in the Western Cape, South Africa, and potential implications of maternity protection access for breastfeeding practices. This was a mixed-method cross-sectional study including a quantitative online survey with 4635 South African domestic workers and 13 individual in-depth interviews with domestic workers. Results from the online survey showed that domestic workers had inconsistent knowledge of maternity-protection entitlements. Data from individual in-depth interviews showed that most participants struggled to access all components of comprehensive maternity protection, with some entitlements being inconsistently and informally available. Most domestic workers were unfamiliar with the concept of breaks to breastfeed or express milk. Participants provided suggestions for improving domestic workers' access to maternity protection. We conclude that improved access to all components of maternity protection would result in improved quality of care for women during pregnancy, around the time of childbirth and on return to work, and for their newborns, especially if an enabling environment for breastfeeding were created. Universal comprehensive maternity protection could contribute to improved care for all working women and their children.
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Affiliation(s)
- Catherine Pereira-Kotze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
- Department of Dietetics and Nutrition, University of the Western Cape, Cape Town 7535, South Africa
| | | | - Tanya Doherty
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, Cape Town 7535, South Africa
- Health Systems Research Unit, South African Medical Research Council, Cape Town 7505, South Africa
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Pereira-Kotze C, Feeley A, Doherty T, Faber M. Maternity protection entitlements for non-standard workers in low-and-middle-income countries and potential implications for breastfeeding practices: a scoping review of research since 2000. Int Breastfeed J 2023; 18:9. [PMID: 36710359 PMCID: PMC9885632 DOI: 10.1186/s13006-023-00542-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 01/07/2023] [Indexed: 01/31/2023] Open
Abstract
BACKGROUND Recommended breastfeeding practices contribute to improved health of infants, young children, and mothers. Access to comprehensive maternity protection would enable working women to breastfeed for longer. Women working in positions of non-standard employment are particularly vulnerable to not accessing maternity protection entitlements. The objective of this scoping review was to determine the current research conducted on maternity protection available and accessible to non-standard workers in low-and-middle-income countries and any potential implications for breastfeeding practices. METHODS Nine databases were searched using search terms related to maternity protection, non-standard employment, and breastfeeding. Documents in English published between January 2000 and May 2021 were included. The approach recommended by the Joanna Briggs Institute was used to select sources, extract, and present data. The types of participants included in the research were female non-standard workers of child-bearing age. The core concept examined by the scoping review was the availability and access to comprehensive maternity protection entitlements of pregnant and breastfeeding women. Research from low-and-middle-income countries was included. The types of evidence sources were limited to primary research. RESULTS Seventeen articles were included for data extraction mainly from research conducted in Africa and Asia. Research on maternity protection for non-standard workers mostly focused on childcare. Components of maternity protection are inconsistently available and often inaccessible to women working in non-standard employment. Inaccessibility of maternity protection was described to disrupt breastfeeding both directly and indirectly, but certain characteristics of non-standard work were found to be supportive of breastfeeding. CONCLUSIONS Published information on maternity protection for non-standard workers is limited. However, the available information indicates that non-standard workers have inadequate and inconsistent access to maternity protection rights. The expansion of comprehensive maternity protection to all women working in positions of non-standard employment could encourage significant social and economic benefits.
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Affiliation(s)
| | - Alison Feeley
- grid.11951.3d0000 0004 1937 1135South African Medical Research Council (SAMRC) Developmental Pathways for Health Research Unit (DPHRU), School of Clinical Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Tanya Doherty
- grid.8974.20000 0001 2156 8226School of Public Health, University of the Western Cape (UWC), Cape Town, South Africa ,grid.415021.30000 0000 9155 0024 Health Systems Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Mieke Faber
- grid.415021.30000 0000 9155 0024 Non-communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa ,grid.8974.20000 0001 2156 8226 Department of Dietetics and Nutrition, University of the Western Cape, Cape Town, South Africa
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Pereira-Kotze C, Horwood C, Haskins L, Kingston G, Luthuli S, Doherty T. Exploring women's exposure to marketing of commercial formula products: a qualitative marketing study from two sites in South Africa. Glob Health Action 2022; 15:2074663. [PMID: 35946213 PMCID: PMC9377257 DOI: 10.1080/16549716.2022.2074663] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Background Regulating the marketing of commercial formula products is a long-term commitment required to protect breastfeeding. Marketing strategies of formula manufacturers, retailers and distributors evolve at a rapid rate. Objective The aim of this research was to describe exposure of pregnant women and mothers of young children in South Africa to marketing of commercial formula products, compared to international recommendations and national legislation. Methods Using mobile phone marketing diaries twenty participants in Cape Town and Johannesburg documented the formula marketing they were exposed to for one week. Ten mothers were interviewed to explore their perceptions towards marketing exposure in more depth. Results Women reported limited infant formula advertising, but an abundance of strategies used to market growing-up formula and powdered drinks for children over 36 months. Strategies included product packaging, in-store displays, online distribution channels and educational material about product ranges. Online strategies were reported, namely social media marketing (sponsored adverts and support groups), websites and mobile phone applications providing infant and young child feeding information and price discounts, print and TV advertisements, and competitions. Products for children over 36 months are cross-promoted with products prohibited to be advertised by national legislation. Conclusions South African women are being exposed to covert marketing of infant, follow-up, and growing-up formula. Explicit marketing of products for children over 36 months of age allows formula companies to provide messages about branding and use of commercial formula products to mothers. National legislation should be updated and effectively implemented to address changing marketing strategies.
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Affiliation(s)
| | - Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Tanya Doherty
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Abstract
BACKGROUND Maternity protection rights incorporate comprehensive benefits that should be available to pregnant or breastfeeding working women. RESEARCH AIM To describe South Africa's maternity protection legal and policy landscape and compare it to global recommendations. METHOD A prospective cross-sectional comparative policy analysis was used to review and describe national policy documents published from 1994-2021. Entitlements were mapped and compared to International Labour Organization standards. The document analysis was supplemented by interviews conducted with key national government department informants. Thematic analysis was used to evaluate policy and interview content. RESULTS Elements of maternity protection policy are incorporated into South Africa's constitutional dispensation, and some measures are consistent with international labor and social security standards. However, the policy framework is fragmented and difficult to interpret. The fragmented policy environment makes it challenging for employees to know their maternity rights' entitlements and for employers to understand their responsibilities. Confusion regarding maternity protection rights is amplified by the complexity of ensuring access to different forms of maternal protection in pre- and postnatal stages, oversight by multiple government departments, and heterogenous working environments. CONCLUSIONS Maternity protection in South Africa is fragmented and difficult to access. Overcoming these challenges requires legislative and implementation measures to ensure greater policy coherence and comprehensive guidance on maternity protection rights. Addressing gaps in maternity protection in South Africa may provide insights for other countries with shortcomings in maternity protection provisions and could contribute to improved breastfeeding practices.
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Affiliation(s)
- Catherine Pereira-Kotze
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, , Bellville, Western Cape, South Africa
| | - Kitty Malherbe
- Department of Mercantile and Labour Law, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa.,Department of Dietetics and Nutrition, University of the Western Cape, Bellville, Western Cape, South Africa
| | - Tanya Doherty
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, , Bellville, Western Cape, South Africa.,Health Systems Research Unit, South African Medical Research Council, Tygerberg, Western Cape, South Africa
| | - Diane Cooper
- School of Public Health, Faculty of Community and Health Sciences, University of the Western Cape, , Bellville, Western Cape, South Africa
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Pereira-Kotze C, Doherty T, Faber M. Maternity protection for female non-standard workers in South Africa: the case of domestic workers. BMC Pregnancy Childbirth 2022; 22:657. [PMID: 35996086 PMCID: PMC9394052 DOI: 10.1186/s12884-022-04944-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Accepted: 07/27/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Many women work in positions of non-standard employment, with limited legal and social protection. Access to comprehensive maternity protection for all working women could ensure that all women and children can access health and social protection. This study aimed to describe the maternity protection benefits available to women in positions of non-standard employment in South Africa, using domestic workers as a case study. METHODS A qualitative descriptive study design was used. National policy documents containing provisions on maternity protection were identified and analysed. Interviews were conducted with purposively selected key informants. Data extracted from published policy documents and information obtained from interviews were triangulated. A thematic analysis approach was used for evaluation of policy content and analysis of the interviews. RESULTS Twenty-nine policy and legislative documents were identified that contain provisions on maternity protection relevant to non-standard workers. These documents together with three key informant interviews and two media releases are used to describe availability and accessibility of maternity protection benefits for non-standard workers in South Africa, using domestic workers as a case study. Maternity protection is available in South Africa for some non-standard workers. However, the components of maternity protection are dispersed through many policy documents and there is weak alignment within government on maternity protection. Implementation, monitoring, and enforcement of existing maternity protection policy is inadequate. It is difficult for non-standard workers to access maternity protection benefits, particularly cash payments. Some non-standard workers have unique challenges in accessing maternity protection, for example domestic workers whose place of work is a private household and therefore difficult to monitor. CONCLUSION The heterogeneity of non-standard employment makes it challenging for many women to access maternity protection. There are policy amendments that could be made and improvements to policy implementation that would enhance non-standard workers' access to maternity protection. Potential long-term benefits to women and children's health and development could come from making comprehensive maternity protection available and accessible to all women.
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Affiliation(s)
| | - Tanya Doherty
- School of Public Health, University of the Western Cape (UWC), Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa
| | - Mieke Faber
- Non-Communicable Diseases Research Unit, South African Medical Research Council (SAMRC), Cape Town, South Africa.,Department of Dietetics and Nutrition, University of the Western Cape (UWC), Cape Town, South Africa
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Doherty T, Coutsoudis A, McCoy D, Lake L, Pereira-Kotze C, Goldhagen J, Kroon M. Is the US infant formula shortage an avoidable crisis? Lancet 2022; 400:83-84. [PMID: 35654081 DOI: 10.1016/s0140-6736(22)00984-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 05/20/2022] [Accepted: 05/20/2022] [Indexed: 11/24/2022]
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.
| | - Anna Coutsoudis
- Paediatrics and Child Health, University of KwaZulu-Natal, Durban, South Africa
| | - David McCoy
- United Nations University, International Institute for Global Health, Kuala Lumpur, Malaysia
| | - Lori Lake
- Children's Institute, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | | | - Jeffrey Goldhagen
- International Society for Social Pediatrics and Child Health, Jacksonville, FL, USA; Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, FL, USA
| | - Max Kroon
- Neonatology, University of Cape Town Faculty of Health Sciences, Cape Town, South Africa
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Horwood C, Luthuli S, Pereira-Kotze C, Haskins L, Kingston G, Dlamini-Nqeketo S, Tshitaudzi G, Doherty T. An exploration of pregnant women and mothers' attitudes, perceptions and experiences of formula feeding and formula marketing, and the factors that influence decision-making about infant feeding in South Africa. BMC Public Health 2022; 22:393. [PMID: 35209893 PMCID: PMC8872897 DOI: 10.1186/s12889-022-12784-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2021] [Accepted: 02/09/2022] [Indexed: 11/18/2022] Open
Abstract
Background Despite strong evidence showing the lifelong benefits of breastfeeding for mothers and children, global breastfeeding practices remain poor. The International Code of Marketing of Breastmilk Substitutes is an internationally agreed code of practice, adopted by the World Health Assembly in 1981, to regulate promotion of commercial formula, and is supported by legislation in many countries. However, marketing of formula remains widespread and contributes to mother’s decisions to formula feed. We present South African data from a multi-country, mixed-methods study exploring women’s decision-making about infant feeding and how this was influenced by exposure to formula marketing. Methods Using a consumer-based marketing approach, focus group discussions (FGDs) were conducted with pregnant women and mothers of children aged between 0 and 18 months in two urban sites in South Africa. Participants were purposively selected according to their child’s age, infant feeding practices and socioeconomic status. Ten FGDs were conducted during February 2020 with a total of 69 participants. Thematic analysis was used to analyse the data with NVivo v.12 software. Results Despite being encouraged by health professionals to breastfeed and intending to do so, many mothers chose to give formula in the early weeks and months of their child’s life. Mothers reported breastfeeding challenges as the most frequent reason for initiating infant formula, stating that family members and health professionals recommended formula to solve these challenges. Although participants described few advertisements for infant formula, advertisements for ‘growing-up’ formulas for older children were widespread and promoted brand recognition. Mothers experienced other marketing approaches including attractive packaging and shop displays of infant formula, and obtained information from social media and online mothers’ groups, which influenced their choice of formula brand. Mothers reported strong brand loyalty derived from previous experiences and recommendations. Health professionals frequently recommended formula, including recommending specific formula brands and specialist formulas. Conclusion Global formula companies use multifaceted marketing methods to promote a strong narrative portraying formula feeding as a positive lifestyle choice. Positive, coordinated efforts are required to counter pro-formula messaging and change the narrative to support breastfeeding as an aspirational choice. In particular, health professionals must stop supporting the formula industry. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-12784-y.
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Affiliation(s)
- Christiane Horwood
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa.
| | - Silondile Luthuli
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | | | - Lyn Haskins
- Centre for Rural Health, University of KwaZulu-Natal, Durban, South Africa
| | - Gillian Kingston
- M&C Saatchi World Services, London, UK.,King's Business School, Kings' College London, London, UK
| | | | | | - Tanya Doherty
- School of Public Health, University of the Western Cape, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
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Pereira-Kotze C, Jeffery B, Badham J, Swart EC, du Plessis L, Goga A, Lake L, Kroon M, Saloojee H, Scott C, Mercer R, Waterston T, Goldhagen J, Clark D, Baker P, Doherty T. Conflicts of interest are harming maternal and child health: time for scientific journals to end relationships with manufacturers of breast-milk substitutes. BMJ Glob Health 2022; 7:bmjgh-2021-008002. [PMID: 35149553 PMCID: PMC8845199 DOI: 10.1136/bmjgh-2021-008002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Accepted: 11/24/2021] [Indexed: 12/30/2022] Open
Affiliation(s)
- Catherine Pereira-Kotze
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Bill Jeffery
- Centre for Health Science and Law, Ottawa, Ontario, Canada
| | - Jane Badham
- JB Consultancy, Johannesburg, Gauteng, South Africa
| | - Elizabeth C Swart
- Dietetics & Nutrition, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Lisanne du Plessis
- Division of Human Nutrition, Stellenbosch University-Tygerberg Campus, Cape Town, South Africa
| | - Ameena Goga
- HIV Prevention Research Unit, Medical Research Council of South Africa, Tygerberg, South Africa.,Department of Paediatrics, University of Pretoria Faculty of Health Sciences, Pretoria, South Africa
| | - Lori Lake
- Children's Institute, Department of Paediatrics and Child Health, University of Cape Town, Cape Town, South Africa
| | - Max Kroon
- Neonatology, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa
| | - Haroon Saloojee
- Paediatrics and Child Health, University of the Witwatersrand Faculty of Health Sciences, Johannesburg, Gauteng, South Africa
| | - Christiaan Scott
- Paediatrics and Child Health, University of Cape Town Faculty of Health Sciences, Observatory, Western Cape, South Africa.,Red Cross War Memorial Children's Hospital, Rondebosch, Western Cape, South Africa
| | - Raul Mercer
- Program of Social Sciences and Health, FLACSO Argentina, Buenos Aires, Argentina
| | - Tony Waterston
- International Society for Social Pediatrics and Child Health, Newcastle-upon-Tyne, UK
| | - Jeffrey Goldhagen
- International Society for Social Pediatrics and Child Health, Jacksonville, Florida, USA.,Department of Pediatrics, University of Florida College of Medicine-Jacksonville, Jacksonville, Florida, USA
| | - David Clark
- Giovine-Clark Consultancy, Coxsackie, New York, USA
| | - Phillip Baker
- Institute for Physical Activity and Nutrition, Deakin University, Geelong, Melbourne, Australia
| | - Tanya Doherty
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
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Pereira-Kotze C, Doherty T, Swart EC. Use of social media platforms by manufacturers to market breast-milk substitutes in South Africa. BMJ Glob Health 2021; 5:bmjgh-2020-003574. [PMID: 33272942 PMCID: PMC7716659 DOI: 10.1136/bmjgh-2020-003574] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 11/03/2020] [Accepted: 11/11/2020] [Indexed: 01/04/2023] Open
Abstract
In South Africa (SA), exclusive breast feeding remains rare, with breast-milk substitutes (BMS) commonly being used in ways that are detrimental to infant and young child nutrition, health and survival. The use of internet, digital and mobile platforms has increased, including in low-income and middle-income countries, like SA and these platforms are avenues for BMS marketing. SA has national legislation (Regulation R991) to enforce the International Code of Marketing of BMS. This paper aims to provide pertinent examples of how BMS manufacturers in SA use social media to market their products thus violating national regulations. A digital (and social media) ethnography approach was used to study BMS organisations' activity on Facebook and Instagram. Purposively selected examples of social media posts observed (from 2015 to 2019) were included, and content analysed in terms of national legislation. Several examples of BMS social media marketing are presented and interpreted according to provisions of national regulations that they violate. BMS manufacturers have found ways on social media to market their products in a media space that is complex to regulate, and where it is difficult to enforce national regulations. It is necessary to engage with stakeholders, notably social media companies, to alert them to relevant regulations applicable to their platforms. Monitoring the marketing of products for infants and young children by national governments needs to include online and digital platforms especially social media.
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Affiliation(s)
- Catherine Pereira-Kotze
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa
| | - Tanya Doherty
- School of Public Health, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa.,Health Systems Research Unit, South African Medical Research Council, Tygerberg, South Africa
| | - Elizabeth C Swart
- Dietetics & Nutrition, University of the Western Cape Faculty of Community and Health Sciences, Cape Town, South Africa.,DSI/NRF CoE in Food Security, University of the Western Cape, Bellville, South Africa
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