Case Study and Policy Analysis in Enhancing Midwifery Students' Understanding of the International Code of Marketing of Breastmilk Substitutes
DOI:
https://doi.org/10.59525/gej.v3i1.956Keywords:
Breastfeeding, Code, Education, Midwifery, ProtectionAbstract
Background: The International Code of Marketing of Breastmilk Substitutes (the Code), adopted by the World Health Assembly in 1981, remains a cornerstone in protecting breastfeeding from inappropriate commercial influence. Purpos of study: This study aims to evaluate the combined use of case study and policy analysis methods in enhancing midwifery students’ understanding of the Code. Methods: This qualitative study applied a dual-method approach case study and policy analysis to enhance student understanding of the Code within the context of Indonesia. Case reports of Code violations were documented by midwifery students through field assignments, while a policy analysis component utilized lecture materials, government regulations (PP 33/2012; Ministry of Health regulation 39/2013), and WHO/UNICEF guidance. Results: Findings demonstrate that combining case-based learning with structured policy analysis significantly improved students’ ability to identify Code breaches, link them to specific articles, and recommend appropriate reporting and advocacy measures. This approach not only strengthened academic learning but also fostered professional advocacy skills. Conclusion: The study concludes that integrating case study and policy analysis into midwifery curricula can be an effective pedagogical model to prepare health professionals as protectors of breastfeeding rights in line with international and national commitments.
References
Baker, P. et al. (2016) “Global trends and patterns of commercial milk-based formula sales: is an unprecedented infant and young child feeding transition underway?,” Public health nutrition, 19(14), pp. 2540–2550. Available at: https://doi.org/10.1017/S1368980016001117.
Baker, P. et al. (2021) “First-food systems transformations and the ultra-processing of infant and young child diets: The determinants, dynamics and consequences of the global rise in commercial milk formula consumption,” Maternal & Child Nutrition, 17(2), p. e13097. Available at: https://doi.org/https://doi.org/10.1111/mcn.13097.
Baker, P. et al. (2023) “The political economy of infant and young child feeding: confronting corporate power, overcoming structural barriers, and accelerating progress,” The Lancet, 401(10375), pp. 503–524. Available at: https://doi.org/10.1016/S0140-6736(22)01933-X.
Coovadia, H.M. et al. (2007) “Mother-to-child transmission of HIV-1 infection during exclusive breastfeeding in the first 6 months of life: an intervention cohort study,” The Lancet, 369(9567), pp. 1107–1116. Available at: https://doi.org/https://doi.org/10.1016/S0140-6736(07)60283-9.
Henjum, S. et al. (2017) “Media audit reveals inappropriate promotion of products under the scope of the International Code of Marketing of Breast-milk Substitutes in South-East Asia,” Public Health Nutrition. 2017/03/15, 20(8), pp. 1333–1342. Available at: https://doi.org/DOI: 10.1017/S1368980016003591.
Hernández-Cordero, S. et al. (2019) “Violations of the International Code of Marketing of Breast-milk Substitutes in Mexico.,” Maternal & child nutrition, 15(1), p. e12682. Available at: https://doi.org/10.1111/mcn.12682.
JW, C. and JD, C. (2018) Research Design: Qualitative, Quantitative, and Mixed Methods Approaches. Los Angeles.: Sage.
Lau, Y. et al. (2016) “Efficacy of e-technologies in improving breastfeeding outcomes among perinatal women: a meta-analysis.,” Maternal & child nutrition, 12(3), pp. 381–401. Available at: https://doi.org/10.1111/mcn.12202.
Michaud-Létourneau, I., Gayard, M. and Pelletier, D.L. (2019) “Translating the International Code of Marketing of Breast-milk Substitutes into national measures in nine countries.,” Maternal & child nutrition, 15 Suppl 2(Suppl 2), p. e12730. Available at: https://doi.org/10.1111/mcn.12730.
Pérez-Escamilla, R. et al. (2023) “Breastfeeding: crucially important, but increasingly challenged in a market-driven world,” The Lancet. Elsevier B.V., pp. 472–485. Available at: https://doi.org/10.1016/S0140-6736(22)01932-8.
Piwoz, E.G. and Huffman, S.L. (2015) “The Impact of Marketing of Breast-Milk Substitutes on WHO-Recommended Breastfeeding Practices.,” Food and nutrition bulletin, 36(4), pp. 373–386. Available at: https://doi.org/10.1177/0379572115602174.
Pries, A.M. et al. (2016) “Pervasive promotion of breastmilk substitutes in Phnom Penh, Cambodia, and high usage by mothers for infant and young child feeding.,” Maternal & child nutrition, 12 Suppl 2(Suppl 2), pp. 38–51. Available at: https://doi.org/10.1111/mcn.12271.
Rollins, N.C. et al. (2016) “Why invest, and what it will take to improve breastfeeding practices?,” The Lancet, 387(10017), pp. 491–504. Available at: https://doi.org/10.1016/S0140-6736(15)01044-2.
Shapu, R.C. et al. (2022) “Effectiveness of Triple Benefit Health Education Intervention on Knowledge, Attitude and Food Security towards Malnutrition among Adolescent Girls in Borno State, Nigeria.,” Foods (Basel, Switzerland), 11(1). Available at: https://doi.org/10.3390/foods11010130.
Siregar, A.Y.M., Pitriyan, P. and Walters, D. (2018) “The annual cost of not breastfeeding in Indonesia: the economic burden of treating diarrhea and respiratory disease among children (< 24mo) due to not breastfeeding according to recommendation,” International Breastfeeding Journal, 13(1), p. 10. Available at: https://doi.org/10.1186/s13006-018-0152-2.
Victora, C.G. et al. (2016) “Breastfeeding in the 21st century: epidemiology, mechanisms, and lifelong effect,” The Lancet, 387(10017), pp. 475–490. Available at: https://doi.org/10.1016/S0140-6736(15)01024-7.
Walt, G. et al. (2008) “‘Doing’ health policy analysis: methodological and conceptual reflections and challenges,” Health Policy and Planning, 23(5), pp. 308–317. Available at: https://doi.org/10.1093/heapol/czn024.
WHO (1981) International Code of Marketing of Breastmilk Substitutes. Geneva: WHO.
WHO (2020) Marketing of breast-milk substitutes: national implementation of the international code, status report 2020. Genewa. Available at: https://apps.who.int/iris/bitstream/handle/10665/332183/9789240006010-eng.pdf?sequence=1&isAllowed=y.
WHO (2023) Infant and young child feeding, WHO.
WHO (2025) Breastfeeding in Indonesia on the rise, but mothers need more support On World Breastfeeding Week, UNICEF and WHO underscore importance of sustained investment, WHO.
WHO; UNICEF (2019) Global Breastfeeding Scorecard, 2018. Enabling Women To Breastfeed Through Better Policies And Programmes. Geneva.
WHO and UNICEF (2020) Protecting, promoting and supporting breastfeeding in facilities providing maternity and newborn services: the revised Baby-friendly Hospital initiative: 2018 implementation guidance: frequently asked questions, WHO. Switzerland: https://www.who.int/publications/i/item/9789240001459.
WHO and UNICEF (2021) Indicators for assessing infant and young child feeding practices Definitions and measurement methods. Geneva: CC BY- NC-SA 3.0 IGO.
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