The power of policies to protect, support and promote infant and young child nutrition: From Viet Nam to Southeast Asia

3rd July 2015
Viet Nam breastfeeding

(Originally posted in November 2014)

Ms. Phan Thi Hong Linh and Ms. Manini Sheker at Alive & Thrive Viet Nam write for Eldis on the strategies used to influence policy around infant and young child nutrition in Viet Nam.

In the summer of 2012, new mothers in Viet Nam had a reason to rejoice. On June 18, the Vietnamese National Assembly in Hanoi made a historic decision, with over 90% of its members voting to extend paid maternity leave from four to six months. This was a bold departure from other policies of its kind in the Southeast Asian region. Three days later, Viet Nam’s leadership made another unprecedented decision – to expand the ban on advertising breast milk substitutes for infants and young children, from birth to 24 months of age. The decision helped align Viet Nam’s law more closely with the International Code of Marketing of Breast milk Substitutes and subsequent World Health Assembly resolutions. In subsequent years, another important policy gain followed – the institutionalization of baby-friendly hospital principles in provinces across the country.

These policy changes did not happen overnight, but were the result of the concerted advocacy efforts of a coalition of civil society, government, and business actors who were committed to ensuring that policies were in place that nurture every Vietnamese child’s capacity to grow.

In Viet Nam, malnutrition, which is largely due to inadequate infant and young child feeding practices, persists across all regions and economic strata with one of four children under five stunted . Merely 54% of women initiate breastfeeding in the first hour of birth and less than a quarter of children are exclusively breastfed in the first six months.

Process for policy change diagram

Efforts to improve feeding practices have focused mainly on strengthening community-based interventions and health systems. Yet research conducted by Alive & Thrive, a multi-year initiative aimed at improving the nutrition status of infants and young children in Viet Nam, showed that maternal workloads, the maternity leave policy and breast milk substitute advertisements were key barriers to the adoption of recommended breastfeeding practices.

Strengthening the policy environment by extending paid maternity leave and consolidating regulations on the marketing of breast milk substitutes was crucial for encouraging optimal infant and young child feeding practices among mothers and families. But policy change requires both a significant shift in thinking and a major act of decision-making.

To achieve this a comprehensive strategy was used involving:
  • Establishing key partnerships from government and non-government sectors. While Alive & Thrive could provide support in building the evidence base for policy change, UNICEF brought its experience as a child rights focused organization, and the Viet Nam National Assembly’s Institute of Legislative Studies, took the lead in addressing questions and concerns relating to the two policies.
  • Developing an evidence-base. Opinion leader research was critical for understanding attitudes among leaders on infant and young child feeding, and what policy asks would be most viable. Research with mothers also showed that returning to work was one of the main barriers to exclusive breastfeeding in the first six months. Extending paid maternity leave was important for ensuring that mothers did not have to choose between their careers and the best nutrition for their children.
  • Creating compelling messages to target key policy audiences. The messages were framed to win the minds of decision makers, appealing to the rights of a child and the important role policies supporting infant and young child feeding practices can play in the continued economic success of Viet Nam and the health of the future workforce.
  • Building consensus for the policies and cultivating champions. The success of this process is evident in the overwhelming support for both policies, garnering over 90% of the vote in the National Assembly.
These policy successes have made Viet Nam a model to follow in Southeast Asia where as many as 28 million children under the age of five do not currently meet their full height potential . Viet Nam’s process of policy change has sparked interest throughout the region. Alive & Thrive and UNICEF have hosted regional advocacy workshops to share lessons learned, and will work over the next two years along with Save the Children in seven countries across the region – Cambodia, Indonesia, Laos, Myanmar, Thailand, Timor Leste and Viet Nam – to develop and implement tailored road maps and strategies for creating policies that support, promote and and protect infant and young child nutrition throughout the region.