Enacting the Code by effective national laws influence trends in exclusive breastfeeding: An analytical study from the Eastern Mediterranean Region

Abstract

Introduction: The marketing of breast milk substitutes (MBMSs) is presumed to be associated with declines in breastfeeding practices. National laws to control the MBMS are expected to improve exclusive breastfeeding (EBF) and continued breastfeeding (CBF) rates. Aim: This study aims to study the effect of national laws that control MBMS on EBF and CBF trends in the Eastern Mediterranean Region (EMR) countries. Methods: EMR infant feeding data for EBF and CBF were derived from the Global Database of the United Nations International Children’s Emergency Fund/World Health Organization (WHO). Data for the code of MBMS came from the WHO report in 2020. Percent change in EBF and CBF over the past 3 decades was correlated with scores given to the national laws according to their coverage of the provisions under the code. Results: Percent change in EBF correlated significantly with the total score given to national laws (r0.8; p<0.001) and with provisions for monitoring and enforcement, promotion to the general public, and engagement with health workers and health systems (p<0.05). CBF rates did not correlate with any of the scores for the national laws. Duration of the national law correlated with monitoring and enforcement (p<0.05). Conclusion: MBMS is the main drive for low EBF rates. National laws can directly influence early feeding practices only when all the provisions under the code are covered. National laws need to cover the code in its entirety.