Controlling Infant Formula Promotion in Ho Chi Minh City, Vietnam: Barriers to Policy Implementation in the Health Sector

Abstract

Despite the irrefutable evidence of the dangers of bottle feeding and international recommendations for exclusive breastfeeding of young infants, breast milk substitutes are widely used and continue to be promoted. National and international codes to restrict marketing activities of formula companies have had little effect in many countries. Breastfeeding is nearly universally practised in Vietnam, but rarely in accordance with current guidelines for optimal infant outcomes, and infant formula is easily available, especially in large cities, where socio-economic changes linked to transition to a market economy are most visible. Although Vietnam has enacted its own legally binding code, poorly paid health staff remain potential targets for companies wishing to increase sales through inducements. This paper reports findings from a study investigating adherence to the Vietnamese Code and attitudes of a range of health staff to its objectives and provisions in a sample of health facilities. An audit and semi-structured interviews were used to gather data from 22 health facilities in Ho Chi Minh City. Results suggest gifts and inducements are commonplace, awareness of the content of the Code is low, and there is considerable resistance to its provisions, based on financial considerations as well as ambivalence about the merits of breastfeeding. Further investigation to determine prevalence of violations, stricter enforcement of the existing Code, and in-service breastfeeding education are recommended to strengthen breastfeeding promotion in Vietnam.