Menu ENN Search

Postscript - Progress on monitoring and enforcing the Code in Cambodia: New developments to ban digital marketing

View this article as a pdf

Lisez cet article en français ici

Grana Pu Selvi Gnanaraj is the Technical Lead for integrated nutrition for World Vision International in Cambodia

Hou Kroeun is the Country Director for Helen Keller International in Cambodia

Sedtha Chin is Programme Manager at Alive & Thrive/FHI 360 in Cambodia

Selemawit Negash is Nutrition Specialist at UNICEF Cambodia

In 2005, the Government of Cambodia adopted many provisions of the International Code of Marketing of Breastmilk Substitutes (the ‘Code’). Through a sub-decree that addresses the marketing of products for infant and young child feeding (Sub-Decree 133), the national policy now supports breastfeeding by restricting the promotion of breastmilk substitutes (henceforth referred to as ‘commercial milk formula’). In 2007, a Joint Prakas1 between four line ministries (Health, Information, Commerce and Industry) was adopted as guidance to implement this decree. An Oversight Board with two arms – a Control Committee and an Executive Working Group – was formed seven years later, in 2014, to oversee monitoring, compliance and enforcement of the legal provisions for the Code in Cambodia.

Despite regulations, there remains widespread marketing of commercial milk formula in Cambodia, with significant growth in online and social media platforms. This is outlined in the report reviewed by this article2 , in which World Vision International Cambodia highlights the increase in commercial milk formula promotion via digital platforms. The advancement in digital marketing strategies adopted by commercial milk formula companies undermines the importance of breastfeeding and exploits young mothers and parents in Cambodia. As noted in the recent Lancet Series on Breastfeeding,3 commercial milk formula companies have profited, with an annual global revenue of USD 55 billion, externalising the costs to women and young children worldwide at an estimated loss of USD 350 billion per year. The Government of Cambodia, along with members of the Scaling Up Nutrition – Civil Society Alliance (including Helen Keller International, UNICEF, WHO, Alive & Thrive and World Vision International Cambodia), are collaborating to strengthen the Code regulations and their enforcement in Cambodia to protect the rights of women and young children. The authors therefore support the proposed updates of the Joint Prakas to explicitly ban digital marketing of commercial milk formula on social media and the internet, and to call for increased investments for appropriate training, monitoring and enforcement against such violations.

A major concern is that the marketing tactics of commercial milk formula companies not only increase sales of commercial milk formula, but also erode supportive breastfeeding norms, beliefs and practices. Uncontrolled marketing of commercial milk formula on digital platforms can cause Cambodian mothers to believe that commercial milk formula is superior to breastmilk. We are alarmed at the growing trend of social media influencers working as brand ambassadors and of health professionals endorsing and promoting commercial milk formula products in Cambodia. Formula feeding in urban areas is perceived to be a sign of modernisation and an up-to-date way of feeding children. In addition, there is a perception that mothers who give birth via caesarean section cannot breastfeed. There are an increasing number of maternity clinics in urban areas that do not promote breastfeeding due to their engagement with commercial milk formula companies. The decline in exclusive breastfeeding practices, particularly among vulnerable groups like female garment factory workers, has been documented in an unpublished assessment conducted by Helen Keller International, as well as in a published experience that describes World Vision International Cambodia’s work with grandmothers4 (Bauler et al, 2022). This urges immediate action to step up efforts to ensure effective implementation, monitoring and enforcement of Sub-Decree 133, as well as of other family-friendly policies related to parental leave.

UNICEF’s report (2021) highlighted existing gaps in Cambodia’s Code in terms of reflecting minimum standards and subsequent World Health Assembly resolutions. In addition to the lack of prohibition on the digital marketing of commercial milk formula products, there are major loopholes in Sub-Decree 133, including the absence of a strict prohibition on the promotion of infant and young child feeding products; the lack of provision to prevent the distribution of sample products, equipment and materials to health facilities, as well as of the sponsorship of events and scholarships to health workers by the manufacturers and distributors of commercial milk formula products; the absence of a ban on nutrition and health claims made by the infant and young child feeding products; and a lack of warning messages on labels regarding early introduction of commercial milk formula and its risk due to the presence of potential pathogens.

In June 2022, the Ministry of Health initiated an update to the Joint Prakas, which is yet to be endorsed by the relevant ministries. Since then, we have been anticipating positive developments that could limit the marketing of commercial milk formula through social/digital media platforms. UNICEF, Helen Keller International, Alive & Thrive, WHO and World Vision International are providing technical and/or financial support for this revision process. The key amendments to the legislation include limiting commercial milk formula promotion and supply in health facilities; expanding the targeted age groups for products under the purview of this legislation from zero to 24 months to zero to 36 months – including all products marketed or presented for feeding infants and young children, and commercially produced complementary foods; preventing false and misleading health and nutrition claims made by commercial milk formula companies; preventing advertisements and promotions made through social media platforms; and enacting strict penalties on manufacturers and distributors who undermine breastfeeding while promoting their products.

An essential part of our coordinated efforts has been the monitoring and enforcement of the Code legislation, which relies on promoting and supporting breastfeeding, as well as training monitors and healthcare staff on the contents of Sub-Decree 133. Alive & Thrive Cambodia’s team has supported the Ministry of Health and trained healthcare providers on breastfeeding and lactation counselling, especially midwives who work in maternity wards. The team has also incorporated the legal provisions within the Early Essential Newborn Care Quality Improvement Guideline 2022 and the Maternal and Child Health Nutrition Score card tool used in the national Cambodia nutrition project, which is used to assess health facility quality. Helen Keller International has oriented healthcare staff to Sub-Decree 133, including nurses and midwives, and pioneered some early work to improve the monitoring and enforcement mechanisms in the country (Hou et al, 2019). Helen Keller International, along with WHO, Alive & Thrive and UNICEF, supports the Ministry of Commerce to identify and report Code violations submitted through the Cambodian court system.

To address the alarming trend of digital marketing of commercial milk formula, in February 2021, World Vision International Cambodia’s technical team piloted an online reporting tool to capture any violations of Code legislation (including in retail stores and health facilities, as well as on social media). This tool has the option to share screenshots and links to online platforms that violate the legal provisions. This tool has been found to be effective in reducing paperwork according to the members of the Technical Working Group that provides recommendations to the Executive Working Group. Discussions are underway with the Ministry of Health to use this tool as an official government reporting system, as well as to allow the Executive Working Group to collate and analyse data and act on violations. This system has already been approved in principle by government representatives from the National Maternal and Child Health Centre, and the team is now checking for opportunities to build it into the ministry’s website, which could allow development partners and the public to file complaints directly.

We believe that civil society partners need to continue their advocacy efforts, especially to ensure appropriate financing. There is a need for intensive efforts and political will from different line ministries, including to mobilise funds and to firmly commit to improve national breastfeeding rates. Further, effective enforcement will require continuing improvements to specific budget allocation by the Ministry of Health to support the monitoring of the Code; increasing political will and coordinating the enforcement of the Code regulations; and addressing the major bottlenecks of institutional human resources and capacity to support Code monitoring (UNICEF, 2021).

It is the collective hope of the authors of this postscript that the additional legislation, along with the updated Joint Prakas and the collaboration of government and civil society to monitor and enforce the related Code legislations, will support progress on breastfeeding and deter unethical marketing of commercial milk formula, including on digital platforms. We do not want to lose the momentum of the successes so far, and we encourage the commitment of a greater range of organisations and government ministries to protect breastfeeding and promote the responsible marketing of commercial milk formula in Cambodia.

For more information, please contact Grana Pu Selvi Gnanaraj at Grana_Selvi@wvi.org

References

Bauler S, Reinsma K, Gnanaraj GPS et al (2022) Addressing child wellbeing among ‘skip-generation’ households in Cambodia. Field Exchange, 67. www.ennonline.net/fex/67/cambodiagarmentsandiycf

Hou K, Green M, Chum S et al (2019) Pilot implementation of a monitoring and enforcement system for the International Code of Marketing of Breast-milk Substitutes in Cambodia. Maternal & Child Nutrition, 15, 4, e12795. https://doi.org/10.1111/mcn.12795

UNICEF (2021) Strengthening Implementation of the Breast-milk Substitutes Code in Southeast Asia: Putting Child Nutrition First. UNICEF East Asia and Pacific Region.

www.unicef.org/eap/reports/strengthening-breast-milk-substitutes-code-southeast-asia

Read more...

 

1 Prakas is a Cambodian term that means ‘official proclamation’. It is a ministerial or interministerial decision signed by the relevant minister(s). A proclamation must conform to the Constitution and to the law or sub-decree to which it refers.

2 https://www.ennonline.net/fex/69/the-threat-of-social-media-towards-exclusive-breastfeeding-the-cambodia-perspective

3 https://www.ennonline.net/fex/69/the-lancet-2023-series-on-breastfeeding

4 https://www.ennonline.net/fex/67/cambodiagarmentsandiycf.

More like this

FEX: The threat posed by social media to exclusive breastfeeding in Cambodia

This is a summary of two items that were included in issue 69 of Field Exchange: a report summary and a views piece. The original report summary was authored by Grana Pu Selvi...

FEX: The threat of social media towards exclusive breastfeeding: The Cambodia perspective

View this article as a pdf Lisez cet article en français ici This is a summary of the following report: World Vision International - Cambodia (2022) Under Social Media...

FEX: Postface – Progrès accomplis en matière de suivi et d’application du Code au Cambodge : des avancées vers l’interdiction du marketing digital

Read an English version of this article here Grana Pu Selvi Gnanaraj est responsable technique pour la nutrition intégrée chez World Vision International au...

FEX: Ending the marketing of breastmilk substitutes

This is a summary of a Field Exchange views article that was included in issue 67. The original article was authored by Gwénola Desplats Gwénola Desplats is a...

FEX: Ending the marketing of breastmilk substitutes: An amazing push to increase breastfeeding rates.

View this article as a pdf Lisez cet article en français ici This article describes recent initiatives that were taken to better regulate the marketing of breastmilk...

FEX: Editorial

View this article as a pdf Dear readers, a warm welcome to the 69th edition of Field Exchange in which we feature a varied selection of content from around the globe. After...

FEX: The Lancet 2023 series on breastfeeding: Unveiling the predatory tactics of the formula milk industry

View this article as a pdf Lisez cet article en français ici This is a summary of the 2023 Lancet Series on breastfeeding:...

en-net: I am planning to do a research on the impact of mass media on exclusive breastfeeding rates in Nigeria. What should be the duration of the Intervention before we can expect any change in EBF?

Here's some work that A&T has done that can shed light on your query...and a few extra articles. http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.2016.303561 Snyder,...

FEX: Violations of the International Code of Marketing of Breast-milk Substitutes: Indonesia context

Research snapshot1 Information and promotional materials produced by breast-milk substitute (BMS) companies and the distribution of free samples of BMS have a well understood...

FEX: Philippine Nutrition Cluster’s battle for the best: the breast

By Ms. Florinda Panlilio, Department of Health, Philippines Ms. Florinda Panlilio is a Nutritionist-Dietitian IV in the Department of Health -Health Emergency Management...

FEX: La menace des médias sociaux envers l’allaitement maternel exclusif : la perspective du Cambodge

Read an English version of this article here Il s'agit d'une synthèse du rapport en anglais suivant : World Vision International, Under Social Media Influence: Digital...

FEX: Human milk: A win-win-win for health, sustainability, and economics?

Julie Smith Honorary Associate Professor and ARC Future Fellow at The Australian National University Alessandro Iellamo Independent Consultant Tuan Nguyen Technical Advisor...

FEX: Infant formula advertising in medical journals: a cross-sectional study (and struggle to publish)

By Sarah Morgan, Tony Waterston and Marko Kerac View this article as a pdf Sarah Morgan is a Public Health Registrar currently working with National Health Service (NHS)...

FEX: Livelihood assessment approaches in emergencies

A paper and recently summarised editorial1,2 Violations of the International Code of Marketing of Breastmilk Substitutes have been previously reported in Field Exchange3. A...

IYCF-E Resources

NEW: Visit the IYCF-E HUB established in May 2021 for a global, comprehensive and interactive repository of essential IYCF-E resources! For a list of key IYCF-E resources and...

FEX: Infant Feeding in Emergencies: Experiences from Indonesia and Lebanon

By Ali Maclaine and Mary Corbett Ali Maclaine has a MSc in Human Nutrition from the London School of Hygiene and Tropical Medicine. She has been involved in infant feeding and...

FEX: Draft Guidelines for the Marketing of Ready to Use Supplemental Foods for Children

In the absence of guidelines to govern the marketing of ready to use supplemental foods (RUSFs), members of the UNSCN NGO/CSO constituency drafted a guidance to specifically...

Video: SUN Civil Society Alliance - Cambodia

Hou Kroeun is the Deputy Country Director at Helen Keller International in Cambodia. He is also the coordinator of the SUN Civil Society Alliance in Cambodia. In this...

FEX: Increased diarrhoea following infant formula distribution in 2006 earthquake response in Indonesia: evidence and actions

By Fitsum Assefa, Sri Sukotjo (Ninik), Anna Winoto and David Hipgrave Fitsum Assefa is a nutritionist with over 15 years experience working on public nutrition in various...

en-net: Nestle Boycott - is it working?

The boycott is one of the largest boycotts in the commercial history. I am aware of the historical background and the various efforts. To me, the various efforts to sustain the...

Close

Reference this page

Grana Pu Selvi Gnanaraj, Hou Kroeun, Sedtha Chin, Selemawit Negash (). Postscript - Progress on monitoring and enforcing the Code in Cambodia: New developments to ban digital marketing. Field Exchange 69, May 2023. p46. www.ennonline.net/fex/69/progress-on-monitoring-and-enforcing-the-code-in-cambodia-new-developments-to-ban-digital-marketing

(ENN_7624)

Close

Download to a citation manager

The below files can be imported into your preferred reference management tool, most tools will allow you to manually import the RIS file. Endnote may required a specific filter file to be used.