Assessment of baby food marketing and implementation of the Control of Marketing Promotion of Infant and Young Child Food Act B.E. 2560 in Thailand

Abstract

Breastfeeding (BF) is essential for optimal child growth and development, and women's reproductive health. However, in Thailand in 2019, breastfeeding rates were low, 14% for exclusive BF for the first 6 months of age and 15% for continued BF for two years. Inappropriate breastmilk substitutes (BMS) marketing is an important factor because it can change mothers' attitudes towards BMS and feeding behavior. The International Code of Marketing of Breastmilk Substitutes (the Code) and related World Health Assembly resolutions calls on governments to restrict BMS marketing, by adopting its provisions into national law. In Thailand since 2017, the Control of Marketing Promotion of Infant and Young Child Food Act B.E. 2560 (the Act) has been implemented. However, the implementation of the Act has never been evaluated in Thailand. This thesis aimed to report on BMS marketing and its effects on infant and young child feeding in Thailand and assess the impact of legislative change addressing inappropriate breast-milk substitutes marketing to provide empirical evidence of gaps in the Act implementation and BMS marketing situations, and policy implications for improving and strengthening the Act and strengthening its implementation. I adapted standard tools for data collection and data analysis such as the framework of corporate political activity (CPA) in the food industry, to examine CPA during the Act legislation, the NetCode Periodic Assessment Protocol, and the Thailand Multiple Indicator Cluster Survey, for a cross-sectional survey to investigate the compliance of BMS marketing with the Code and the Act and its effects on mothers' attitudes and feeding behavior. Also, I used semi-structured interviews to identify CPA and gaps in the monitoring and enforcement of the Act. The thesis comprises seven chapters. Four of these are published papers. The first study found BMS companies used CPA during the Act legislation such as lobbying. CPA caused weakened the Act and negative concerns of stakeholders over the Act. To cope with the CPA, Department of Health (DOH) provided information to stakeholders and avoided informal contact from BMS companies. The second study revealed most violation of the Code was marketing growing-up milk products in the media, while the violation of the Act was marketing infant formula to mothers. Moreover, labels of complementary food for 6-36-month children commonly violated regulations. The third study found mothers who received advice on formula from others were more likely to have positive attitudes to milk formula. Mothers who reported experiencing BMS marketing at health facilities had a higher likelihood of formula feeding. Also, health professionals who had not been trained on the Act were more likely to think that providing items to health professionals for distribution to mothers was appropriate. The last study showed there were six key gaps in the monitoring system and enforcement, namely the direction and process of the monitoring system and enforcement, key provisions of the Act, communications, human resources, budget allocations, and external challenges. To over-come these gaps, DOH might strengthen the monitoring system and enforcement such as reducing loopholes, increasing the skills of human resources, allocating a sufficient budget for monitoring, and communicating to stakeholders and the public. The thesis provides important policy implications. First, BMS marketing, and CPA of BMS companies could be assessed regularly to detect their current situation. Second, Thailand's monitoring system and enforcement of the Act might be improved by solving key gaps in the law. Third, DOH might have communication strategies to increase understanding of the Act's objectives and purpose among the public and relevant target groups. Last, DOH could strengthen BF policies in health facilities, and set specific obligations for health workers in relevant national guidelines. Show more