In the spring of 2015, the Access to Nutrition Foundation (ATNF) commissioned pilot populationbased
surveys in Hanoi, Vietnam and in Jakarta, Indonesia to systematically assess breast-milk
substitutes (BMS) manufacturers’ compliance with the International Code of Marketing of Breastmilk
Substitutes and subsequent World Health Assembly Resolutions (The Code). The purpose of
these studies was to provide analysis for the Access to Nutrition Index 2016. The definition of
covered BMS products is derived from both The Code and subsequent guidance issued by WHO in
July 2013.
1 The Code is considered applicable to any product when marketed or otherwise
represented to be suitable, with or without modification, for use as a partial or total replacement of
breast milk. Products considered to be breast-milk substitutes and included in this study include
infant formula (a BMS that can satisfy the normal nutritional requirements of infants up to 6 months
of age); follow-on formula (for infants from the six months of age); growing-up milk (milk products
generally marketed for use by infants and young children from 12 months-24 months); and
complementary foods recommended for infants less than 6 months of age. The Code also applies to
the marketing of bottles and teats.
This report presents findings from the Vietnam pilot study. This pilot study was restricted to only
12 urban boroughs of Hanoi. The results should be representative for this area, but they should not
be interpreted to apply to all of Vietnam.
The design of the survey was based, with permission from the United Nations Children’s Fund
(UNICEF) in New York, on a Protocol developed by the Interagency Group on Breastfeeding
Monitoring (IGBM) entitled Estimating the Prevalence of Violations of The Code and National
Measures. This Protocol was last updated in August 2007, and ownership of the protocol currently
rests with UNICEF.2 The IGBM Protocol calls for data collection at multiple levels to examine
different aspects of Code compliance, including interviews with pregnant women and mothers of
infants in health facilities, interviews with healthcare workers in health facilities, identification of
informational materials produced by BMS manufacturers available in health facilities and retail
stores, identification of sales promotions by BMS manufacturers in retail stores, analysis of product
labels and inserts of all available products on the local market, and monitoring of media advertising.
These channels of promotion were fully examined in the conduct of the survey.