UP TO 24 MONTHS
Viet Nam has experienced impressive economic growth and rapid reductions in poverty over the last decade, but the prevalence of malnutrition remains uncharacteristically high. Nearly a quarter of children under five years of age in Viet Nam are stunted. Malnutrition is present in all economic strata, and in all geographic regions of Viet Nam. At the same time, obesity in children and adults is on the rise. Viet Nam’s poor nutrition outcomes are due in large part to suboptimal infant and young child feeding practices. Most women (97%) breastfeed, but only a quarter initiate breastfeeding in the first hour of birth; and the same proportion of women practice exclusive breastfeeding in the first six months.351 Only 22% of children are breastfed up to
two years of age. According to Alive and Thrive’s Formative Research and Opinion Leader Research in 2010, inadequate maternity leave was one of the barriers to ensuring six months of exclusive breastfeeding. In an effort to protect and promote exclusive breastfeeding during the first six months and continuation of breastfeeding to 24 months, the Ministry of Health and the Ministry of Labour, Invalids and Social Affairs, together with a coalition of advocacy partners in Viet Nam, joined forces to strengthen two national policies that impact IYCF: the Labour Code, which governs paid maternity leave; and the Advertisement Law, which governs aspects of the marketing of BMS in Viet Nam. Both policies are key to providing mothers and families the support they need to make the best feeding choices for their children. They also fulfil the Government of Viet Nam’s obligations under the Convention on the Rights of the Child to create an enabling environment for breastfeeding.
The main challenges came from the commercial sector, which sought to convince policy-makers that the new legislation was unnecessary while attempting to undermine the factual and evidence-based advocacy messages that were being used to promote the measures. Members of Parliament and other stakeholders were hesitant to ban the advertisement of BMS for children up to 24 months because it would be against World Trade Organization agreements. In addition, there was an assumption that employers and even female workers did not want the extension of maternity leave up to six months. The survey conducted by the General Confederation of Labour, however, showed positive results where 90% of both employers and female workers preferred six months of paid maternity leave. This was crucial for the law to be passed. The partners demonstrated that Viet Nam could better implement its obligations under the Committee on the Rights of the Child by adopting the proposed measures. There was also the potential obstacle of funding the extended maternity leave. However, the Department of Social Health Policies Enforcement, which is the guiding body of Viet Nam’s social health insurance, confirmed that there were sufficient funds to cover the cost of extension.
In 2012, after two years of focused engagement with decision-makers and key stakeholders, both policies were successfully strengthened. First, on June 18, Viet Nam’s National Assembly made a landmark decision to extend paid maternity leave from four to six months, giving mothers the support to breastfeed exclusively for six months. Three days later, on June 21, the National Assembly voted to expand its ban on the advertising of BMS for infants from six to 24 months – including feeding bottles and teats – as well as other nutrition products for infants under six months of age. Viet Nam’s law now more closely aligns with international recommendations, helping ensure that more mothers and families receive the best information about child feeding.
Below is a summary of lessons learnt:
Establishing and sustaining partnerships
• Conducting a stakeholder analysis at an early stage will help identify the right government and nongovernment partners.
• Leverage the experience, expertise, and comparative advantages within partnerships; trusted
partnerships help to think bigger, share responsibility, mitigate cost, and leverage the unique strengths of specific organizations.
• Strengthened collaboration with development partners will provide strong evidence at the scientific, economic and socio-cultural levels, as well as benchmarks and supportive evidence from other countries. It will also support building local capacity.
• The advocacy process requires financial resources and technical support, and therefore advance planning is needed to engage and obtain this support from development partners and stakeholders. UNICEF gave support through the sharing of experience from other countries in the world. It also provided financial support for organizing a high-level advocacy meeting with the National Assembly.
Building evidence
• Conduct research early to inform strategies. Research is not only useful to provide information to develop and implement strategies, it is also a tool for getting allies and partners aligned around a common set of goals and strategies. Moreover, collect local, regional, and international data to inform communications, taking into account that each country context will be different. It was very important that UNICEF supported the Department of Social Health Policies Enforcement of Viet Nam Security Funds to carry out a budget analysis, which confirmed that there were sufficient funds to cover the cost of extending maternity leave to six months.
• Build economic evidence to win policy-maker support.
Developing messages and materials
• Identify and use strategic message-frames, since every country context requires different message-frames to achieve maximum impact. Identify those frames, use them consistently, and ensure that message- frames are speaking with one voice.
• Create compelling collateral materials. Policy-maker and opinion-leader audiences are often pressed for time and materials should therefore be brief and should clearly highlight key points.
• Deploy effective champions to deliver the message and consider who is most authoritative and motivational for specific audiences.
Building consensus
1 Ensure an input and feedback mechanism for various stakeholders. Prospective policy changes will have widespread and sometimes varied impacts on different groups and constituencies. It is important to provide space for each group and constituency to share their opinions throughout the process.
2 Anticipate and plan for strong resistance. Throughout the process, interest groups will raise their objections to policy change. In Viet Nam, even after the Advertisement Law had passed, the Viet Nam Chamber of Commerce and Industry sent a formal letter to the President of the National Assembly opposing the policy and urging the National Assembly to change their decision.
Monitoring and enforcement
It is important that laws/policies are adopted but it is more important to make sure they are monitored and enforced. This process still needs further effort in Viet Nam, and the Government seeks technical and financial support from UNICEF, Alive and Thrive and other development partners to train health inspectors and relevant stakeholders on compliance with policies, conducting supportive monitoring/inspections, organizing review meetings with policy-makers and stakeholders to disseminate the results from monitoring/ inspections and gradually integrate these activities into the Government’s routine activities.
Indonesia.