IS ANYBODY KEEPING THE CODE IN BULGARIA? A STUDY TO EXPLORE LOCAL PARENTS' AWARENESS REGARDING THE INTERNATIONAL CODE FOR THE MARKETING OF BREAST-MILK SUBSTITUTES.
Keywords:breastfeeding, lactation, formula, healthcare, midwife, breast-milk
This paper reviews Bulgarian parents’ awareness concerning the existence of the WHO Code for the marketing of breast-milk substitutes and how it can help them optimize their breastfeeding journey. Frequently occurring problems and breaches of the Code in Bulgaria are discussed, and their context explained. We focus on parental attitudes and investigate whether they acknowledge the significant necessity for a Code-compliant prenatal education and postnatal care. We also explore their viewpoints on the implementation of the Code and maximizing compliance with it on a local level. The research findings are presented graphically, and we present tendencies showcased by respondents’ opinions they have expressed in the survey.
OBJECTIVES: Purposes of this research are: (1) to explore parents’ awareness about the WHO Code and their encounter with local prenatal classes in this regard (2) to assess their viewpoints on implementing the Code and if they see it as a significant step towards an optimal breastfeeding experience.
METHODS: The methods we applied include an online-based cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions, aiming to explore parents’ current knowledge and viewpoints in regard to the Code and its implementation in Bulgaria. The research has been carried out via social media, and it samples parents from a local parent peer support group. Acquired data from closed-ended questions is presented, demonstrating percentages and tendencies.
RESULTS: A total of 463 respondents are included
CONCLUSION: It is a common practice in Bulgaria for prenatal classes not to comply with the WHO Code. Disregarding recommendations and evidence-based medicine, both some experts and companies under the scope of the Code breach its main points. Code-compliant prenatal education is practically almost non-existent with the lack of midwife-led care and classes, predominantly in the private sector, where they are almost entirely, sponsored by those companies. Nearly all parents included in this survey are more than willing and motivated to have access to Code-compliant prenatal education and postnatal care. The lack of such leaves almost no choice for Bulgarian parents actually to have access to code-compliant education and care. This inevitably influences their decision making, attitudes and behavior, potentially leading to lower breastfeeding rates and suboptimal breastfeeding satisfaction and success. Adequate measures must be reinforced to ensure implementation and proper legislation, providing monitoring and enforcement, protecting parents and their babies when they are most vulnerable.
Bagci Bosi, A. T., Eriksen, K. G., Sobko, T., Wijnhoven, T. M., & Breda, J. (2016). Breastfeeding practices and policies in WHO European Region Member States. Public health nutrition, 19(4), 753–764. https://doi.org/10.1017/S1368980015001767
Black, R. E., Allen, L., Bhutta, Z., et al. (2008). Maternal and child undernutrition: global and regional exposures and health consequences, PlumX Metrics, doi: https://doi.org/10.1016/S0140-6736(07)61690-0
Brown, A., Shenker, N., (2020). Experiences of breastfeeding during COVID‐19: Lessons for future practical and emotional support, doi: https://doi.org/10.1111/mcn.13088
Bulgarian group of WABA (2012). Rezultati ot monitoring na tema: "Proverka na vǎzmožnostite za socialen kontrol na politikite za detsko hranene i zdrave v uslovijata na kriza." [Monitoring survey titled “Inspection on Possibilities for Social Control over the Policies for Infant Feeding and Health in Times of Crisis”]. Results retrieved March 12, 2021 from - https://news.bg/bulgaria/karmeneto-u-nas-ne-e-zashtiteno-alarmirat-eksperti.html
Bulgarian group of WABA. (2006). Zaključenie ot godišnata srešta na Globalen alians za zaštita na detskoto hranene i zdrave po slučaj SSK, [Conclusion of their annual meeting on the occasion of WBW], Retrieved March 11, 2021 from - http://www.bebe.bg/Svetovna_sedmitsa/zakliuchenie.htm
de Preneuf F, (2020), Food security and COVID-19. Retrieved March 10, 2021 from - https://www.worldbank.org/en/topic/agriculture/brief/food-security-and-covid-19
Eurostat, (2021), Infant mortality rates. Retrieved March 10, 2021 from – https://tinyurl.com/3hv4pmvf
Petrova S, Rangelova L, Duleva V et al. (2010) Current children’s breastfeeding practice in Bulgaria and determinants. Bulg J Public Health 4, 11–26. Retrieved March 11, 2021 from - http://ncpha.government.bg/files/Jurnal_NCPHP_4_2010.pdf
Tulleken, C., Wright, C., Brown, A., et al. (2020). Marketing of breastmilk substitutes during the COVID-19 pandemic, doi: https://doi.org/10.1016/S0140-6736(20)32119-X
World Food Programme, (2020). Risk of hunger pandemic as coronavirus set to almost double acute hunger by the end of 2020. Retrieved March 10, 2021 from - https://insight.wfp.org/covid-19-will-almost-double-people-in-acute-hunger-by-end-of-2020-59df0c4a8072
World Health Organization International Code of Marketing of Breast-Milk Substitutes and Subsequent Resolutions. [(accessed on 10 March 2021)]; Retrieved March 10, 2021 from: https://www.who.int/nutrition/netcode/resolutions/en/
World Health Organization (2020). Marketing of Breast-milk Substitutes: National Implementation of the International Code | Status Report 2020. Retrieved March 10, 2021 from - https://resourcecentre.savethechildren.net/node/17628/pdf/9789240006010-eng.pdf
World Health Organization (2017). The International Code of Marketing of Breast-milk Substitutes. Frequently Asked Questions. 2017 Update. Retrieved March 10, 2021 from - https://resourcecentre.savethechildren.net/node/18972/pdf/the_international_code_of_marketing_of_breast-milk_substitutes_-_frequently_asked_questions.pdf
How to Cite
Copyright (c) 2021 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.
The author is the copyright holder. Distribution license: CC Attribution 4.0.