Digital marketing of commercial breastmilk substitutes and baby foods: strategies, and recommendations for its regulation in Mexico.

BACKGROUND: Parents are exposed to breastmilk substitutes and baby foods marketing on the internet and social media, which hinders adequate breastfeeding and complementary feeding. This study identifies digital marketing strategies for breastmilk substitutes, specifically commercial milk formula and baby foods used by the industry to influence infant and young children's feeding practices in Mexico and proposes regulatory recommendations that can be useful for similar countries. METHODS: Qualitative study based on the CLICK monitoring framework developed by the World Health Organization, adapted for digital marketing of commercial milk formula and baby foods. Semi-structured interviews (n = 53) with key actors were conducted between November 2020 and March 2021, and used grounded theory for the analysis and interpretation with the MAXQDA 20 software. RESULTS: Commercial milk formula and baby food companies use digital media to contact and persuade parents to use their products by sending electronic newsletters with advertising. Companies hire influencers to market their products because there is no regulation prohibiting the advertisement of breastmilk substitutes on social media, and promote formula among health professionals inviting them to participate in sponsored webinars on infant nutrition, ignoring conflict of interest and the International Code of Marketing of Breastmilk Substitutes. Parents trust formula and baby food advertisements, which use emotional messages and health and nutrition claims to encourage their consumption. Health professionals consider that claims contribute to the indiscriminate use of formula, and some actors propose the use of plain packaging for these products. CONCLUSIONS: Breastmilk substitutes companies promote their products in digital media using unethical strategies that fail to comply with the International Code of Marketing of Breastmilk Substitutes. They generate strong conflicts of interest with health professionals, taking advantage of legal framework gaps and the lack of monitoring and effective sanctions for non-compliers. Updating the legal framework and monitoring compliance, including digital media, is urgently needed to protect children's right to breastfeeding, healthy nutrition and life, and the rights of women to health and informed decision-making.

Barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico.

OBJECTIVE: To study the barriers and enablers of breast-feeding protection and support after the 2017 earthquakes in Mexico. DESIGN: A qualitative study using a phenomenological approach to analyse data collected from in-depth interviews, virtual ethnography and documentary analysis of newspapers. SETTING: Data were collected after the September 2017 earthquakes in Mexico (from 8 September 2017 to 15 May 2018). PARTICIPANTS: The participants included key informants (n 13) from different sectors. Postings retrieved from forty-two Facebook and forty-seven Twitter accounts and a WhatsApp group informed the virtual ethnography analysis. Newspaper material covering the 2017 earthquakes in Mexico (seven newspapers) was retrieved for the documentary analysis. RESULTS: Interviews with key informants revealed a lack of knowledge, unclear institutional protocols during emergencies and lack of enforcement of existing international frameworks. The virtual ethnography uncovered a strong call for donations in the immediate aftermath of the earthquakes, and generalized donations of formula revealed a tense relationship between actions taken by breast-feeding experts and the negative reactions from the government and citizens. This analysis highlights the relevance of pre-existing networks of experts in protecting and supporting breast-feeding. From the newspaper documentary analysis, similar themes emerged. CONCLUSIONS: This study identified key barriers and enablers in the protection and support of breast-feeding during the 2017 earthquakes in Mexico. Relevant actors should embrace the lessons highlighted in this study because countries such as Mexico are likely to experience other emergencies in the near future.

Evaluating the effect of the initiative 'Caring for the Newborn and the Mother at Home' in Mexico.

OBJECTIVE: The WHO and UNICEF recommend home visits to improve health outcomes for mothers and newborns. We evaluated the effect of home visits by community volunteers during pregnancy and postpartum on breast-feeding practices, women's knowledge about benefits, beliefs and myths of breast-feeding, obstetric and neonatal warning signs, preparation for childbirth and initial care for newborns, and diarrhoea and respiratory diseases in children. DESIGN: Community quasi-experimental design. We estimated difference-in-difference models with fixed effects at the community level weighted by propensity score and investigated implementation barriers through focus groups and semi-structured interviews. SETTING: Poor rural communities in Mexico; 48 intervention and 29 control. PARTICIPANTS: Baseline and follow-up information were reported from two independent cross-sectional samples of women with babies aged between 6 and 18 months (baseline: 292 control, 320 intervention; follow-up: 292 control, 294 intervention). RESULTS: The intervention increased reports of exclusive breast-feeding in the first 6 months by 24·4 percentage points (pp) (95 % CI: 13·4, 35·4), mothers' knowledge of obstetric warning signs by 23·4 pp (95 % CI: 9·2, 37·5) and neonatal warning signs by 26·2 pp (95 % CI: 15·2, 37·2) compared to the control group. A non-linear dose-response relation with the number of home visits was found. Diarrhoea and respiratory diseases among children decreased in the intervention v. control group but were not statistically significant. CONCLUSIONS: Home visits should be implemented as a complementary strategy to the provision of prenatal and postnatal care in rural communities due to their potential positive effects on the health of mothers and their children.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México.

Objetivo. Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos. Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones. Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

Corrigendum: Barriers to promoting breastfeeding in primary health care in Mexico: a qualitative perspective.

[This corrects the article DOI: 10.3389/fnut.2023.1278280.].

Barriers to promoting breastfeeding in primary health care in Mexico: a qualitative perspective.

Objective: This article aimed to identify the main barriers related to promoting and counseling breastfeeding (BF) at the Primary Health Care (PHC) in Mexico. Methodology: A qualitative study with a phenomenological approach was carried out in 88 health centers of the Ministry of Health in the states of Chihuahua, Oaxaca, Chiapas, Veracruz, Mexico, and Yucatan. From September to November 2021, we interviewed 88 key health professionals (HPs) (physicians, nurses, nutritionists, and others) from the PHC of the Ministry of Health in Mexico and 80 parents of children under 5 years old. In addition, nine focus groups were conducted with parents and caregivers. The data obtained were triangulated with information from focus groups and semi-structured interviews. Results: Of the total interviews, 43.2% (n = 38) were nurses, 29.5% (n = 26) were physicians, 19.3% (n = 17) were nutritionists, and the rest were other health professionals. In the group of users, 97.6% (n = 121) were women. We identified contextual barriers, such as the lack of well-trained health professionals and the scarcest nutrition professionals, as material resources in the health units, without mentioning the low user attendance at their control consultations. Furthermore, we identified barriers related to the orientation and promotion of breastfeeding in health units, including a lack of specific strategies, ineffective communication, and the recommendations of commercial milk formulas. Conclusion: The results presented reflect the reality of Mexico in relation to BF, making it urgent to take immediate action to improve the quality of nutritional care related to the promotion and orientation of BF at the PHC.

Implementation of Breastfeeding Policies at Workplace in Mexico: Analysis of Context Using a Realist Approach.

Return to work is one of the most significant barriers to breastfeeding (BF). Family-friendly policies are critical to ensure that BF and maternal work are not mutually exclusive. This study aims to determine contextual factors and underlying mechanisms influencing the implementation of workplace policies in Mexico. Following a qualitative approach, the study was conducted in the following four cities in Mexico: Mérida, Chihuahua, Guadalajara, and Monterrey. Interviews were conducted in 14 workplaces, and included 49 (potential) beneficiaries, 41 male employees, and 21 managers and human resources personnel. The information collected was analyzed through a deductive thematic analysis and mapped against the Context-Mechanism-Outcome framework of Breastfeeding Interventions at the Workplace. Contextual factors influencing a BF-friendly environment in the workplace were as follows: work-schedule flexibility, provision of lactation services (i.e., BF counseling) other than a lactation room, women's previous experience with BF and family-friendly environments in the workplace. The underlying mechanisms enabling/impeding a BF-friendly environment at the workplace were as follows: awareness of Mexican maternity protection legislation, usage of BF interventions in the workplace, culture, supervisor/co-worker support and BF-friendly physical space. To achieve a BF-friendly environment in the workplace, actions at the level of public policy and workplaces must accompany adherence to Mexican legislation.

Digital marketing of formula and baby food negatively influences breast feeding and complementary feeding: a cross-sectional study and video recording of parental exposure in Mexico.

BACKGROUND: There is little evidence of the association between digital marketing of formula and baby food and infant and young child feeding (IYCF) practices. OBJECTIVE: Assess parents' exposure to digital marketing of formula and baby food for children <2 years and its association with the purchase and IYCF practices in Mexico. METHODS: Parents ≥18 years recruited from a market research panel completed an online survey (n=1074) and capture-on-screen (n=95) between December 2020 and January 2021. Logistic regressions were used to estimate the association between exposure to digital marketing of formula and baby foods with its purchase, motivation, consumption and IYCF practices. RESULTS: Digital marketing of formula and baby food was self-reported by 93.9% of parents in the online survey and observed by 93.7% in the capture-on-screen. Recorded ads did not comply with the International Code of Marketing of Breast-milk Substitutes. Parents who self-reported seeing a higher versus lower number of ads were less likely to exclusive breast feed (OR=0.38; 95% CI: 0.19 to 0.78), and more likely to give mixed feeding (OR=2.59; 95% CI: 1.28 to 5.21), formula (OR=1.84; 95% CI: 1.34 to 2.53), processed foods (OR=2.31; 95% CI: 1.59 to 3.32) and sugary drinks (OR=1.66; 95% CI: 1.09 to 2.54). Higher exposure to ads was associated with a higher chance of purchasing products motivated by nutritional (OR=2.1; 95% CI: 1.32 to 3.28) and organic claims (OR=2.1; 95% CI: 1.21 to 3.72). CONCLUSIONS: Digital marketing of formula and baby food may negatively influence IYCF and should be regulated to ensure children's nutrition and health.

Consumo de agua, bebidas azucaradas y uso de bebederos en secundarias del Programa Nacional de Bebederos Escolares de la Ciudad de México / Plain water and sugar sweetened beverages intake and use of school drinking fountains in secondary schools of the National School Drinking Fountains Program in Mexico City

Resumen: Objetivo: Describir prácticas de consumo de bebidas y uso de bebederos escolares en estudiantes de secundarias del Programa Nacional de Bebederos Escolares (PNBE). Material y métodos: Estudio transversal descriptivo, con enfoque mixto en secundarias públicas (turnos matutino y vespertino). Se indagó el consumo de agua y bebidas azucaradas, utilización de bebederos escolares y barreras-facilitadores para el consumo de agua. Resultados. Se entrevistaron 617 estudiantes (11 a 16 años); 51.5% fueron hombres. El consumo promedio de agua (568.9 ml; IC95%: 470.7-667.1) y bebidas azucaradas (143.4 ml; IC95%:124.0-162.7) fue similar entre hombres y mujeres. En el turno matutino las mujeres presentaron una menor probabilidad de hacer uso de los bebederos en comparación con los hombres (p=0.032). Hombres y mujeres desconfían del agua de los bebederos. Conclusiones: Se requieren acciones integrales para favorecer el consumo de agua y el uso de los bebederos en las secundarias del PNBE.

Abstract: Objective: To describe beverages consumption practices, and school drinking fountains utilization among secondary school's students from National School Drinking Fountains Program (PNBE, Spanish acronym). Materials and methods: Descriptive cross-sectional study with mixed methods in public secondary schools (morning and afternoon shifts). We estimated plain water and sugar sweetened beverages consumption, school drinking fountains utilization, and barriers-facilitators for plain water consumption. Results: We interviewed 617 students (11 to 16 y); 51.5% were men. The mean of plain water intake (568.9 ml; CI95%: 470.7-667.1), and sugar sweetened beverages (143.4 ml; CI95%:124.0-162.7) was similar among women and men. In the morning shift women had a lower probability of utilizing the school drinking fountains in comparison with men (p=0.032). Men and women have mistrust water that comes from school drinking fountains. Conclusions: Integral actions are necessary to favor plain water consumption, and utilization of school drinking fountains at PNBE secondary schools.