title: Pervasive promotion of breastmilk substitutes in Phnom Penh, Cambodia, and high usage by mothers for infant and young child feeding.
abstract: In 2005, Cambodia passed the Sub-Decree on Marketing of Products for Infant and Young Child Feeding (no. 133) to regulate promotion of commercial infant and young child food products, including breastmilk substitutes. Helen Keller International assessed mothers' exposure to commercial promotions for breastmilk substitutes and use of these products through a cross-sectional survey among 294 mothers of children less than 24 months of age. Eighty-six per cent of mothers reported observing commercial promotions for breastmilk substitutes, 19.0% reported observing infant and young child food product brands/logos on health facility equipment and 18.4% reported receiving a recommendation from a health professional to use a breastmilk substitute. Consumption of breastmilk substitutes was high, occurring among 43.1% of children 0-5 months and 29.3% of children 6-23 months of age. Findings also indicated a need to improve breastfeeding practices among Phnom Penh mothers. Only 36.1% of infants 0-5 months of age were exclusively breastfed, and 12.5% of children 20-23 months of age were still breastfed. Children that received a breastmilk substitute as a prelacteal feed were 3.9 times more likely to be currently consuming a breastmilk substitute than those who did not. Despite restriction of commercial promotions for breastmilk substitutes without government approval, occurrence of promotions is high and use is common among Phnom Penh mothers. In a country with high rates of child malnutrition and pervasive promotions in spite of restrictive national law, full implementation of Cambodia's Sub-Decree 133 is necessary, as are policies and interventions to support exclusive and continued breastfeeding.
  
  
  CONCLUSIONS
  Despite prohibition without specific approval by the national government, companies are pervasively promoting breast-milk substitutes in Phnom Penh, particularly on television and at points of sale. Strengthened implementation and enforcement of Cambodia's subdecree 133 are needed to better regulate promotion in order to protect breastfeeding for the nutrition and health of infants and young children in Cambodia. Mothers who used a breast-milk substitute as a prelacteal feed were 3.9 times more likely to currently feed this same child a breast-milk substitute, as compared with mothers who did not provide breast-milk substitute as a prelacteal feed. Supporting breastfeeding among mothers after delivery is critical to establish and sustain optimal breastfeeding practices. Use of breast-milk substitutes is also very common among mothers of children under 2 years of age in Phnom Penh. We recommend promoting exclusive and continued breastfeeding as beneficial to children's health and development, and supporting policy and workplace environments that enable breastfeeding up to and beyond 24 months of age.
authors.affiliation: Helen Keller International, Asia Pacific Regional Office, Phnom Penh, Cambodia.
authors.forename: Alissa M
authors.initials: AM
authors.lastname: Pries
authors.affiliation: Consultant to Helen Keller International.
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Huffman
authors.affiliation: Helen Keller International, Phnom Penh, Cambodia.
authors.forename: Khin
authors.initials: K
authors.lastname: Mengkheang
authors.affiliation: Helen Keller International, Phnom Penh, Cambodia.
authors.forename: Hou
authors.initials: H
authors.lastname: Kroeun
authors.affiliation: Helen Keller International, Washington D.C., USA.
authors.forename: Mary
authors.initials: M
authors.lastname: Champeny
authors.affiliation: Consultant to Helen Keller International.
authors.forename: Margarette
authors.initials: M
authors.lastname: Roberts
authors.affiliation: Helen Keller International, Washington D.C., USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Zehner
mesh_terms: D001942:Breast Feeding / Q000208:ethnology; D002160:Cambodia; D002657:Child Development; D003430:Cross-Sectional Studies; D003906:Developing Countries; D004032:Diet / Q000009:adverse effects* / Q000191:economics / Q000208:ethnology; D005260:Female; D006801:Humans; D007223:Infant; D007225:Infant Food / Q000191:economics; D041943:Infant Formula / Q000191:economics / Q000331:legislation & jurisprudence; D007231:Infant, Newborn; D008297:Male; D009035:Mothers / Q000193:education; D018673:Nutrition Policy; D009749:Nutrition Surveys; D010349:Patient Compliance / Q000208:ethnology; D010353:Patient Education as Topic; D014504:Urban Health / Q000208:ethnology
keywords: Cambodia; breastfeeding; breastmilk substitutes; infant feeding; prelacteal feedinginfant feeding; promotion