Happy International Women's Day

On International Women’s Day (IWD) 2023, the United Nations is calling for “DigitALL: Innovation and technology for gender equality”.

So, what does this year’s theme look like, through the lens of breastfeeding promotion, protection and support?

We asked Dr. Chantell Witten for her perspective. She is a researcher leading the Infant and Young Child Feeding (IYCF) Advocacy Project in South Africa – a project the Family Larsson-Rosenquist Foundation is supporting in collaboration with the University of the Western Cape, the University of Pretoria and the Department of Science and Technology at the National Research Centre (DSI-NRF) of Excellence in Food Security. Together they are taking a policy operationalization approach to develop an approach for planning anti-formula campaigns and to create an environment where breastfeeding is promoted, protected and supported.

Chantell has decades of experience in the field of child nutrition, particularly infant and young child feeding. She developed her expertise across several sectors including industry, academia, NGOs and at the United Nations. It is our privilege to share her expert views in the Q&A below.
 

Chantell, you are working to create an environment where women’s breastfeeding choices are not influenced by formula marketing – how does digital technology factor into this work?

As more women get connected in digital spaces, it expands our opportunities to reach them with credible information, provide training and resources and build communication groups, especially for low-income and hard to reach communities.

In my experience, social media platforms like Facebook, TikTok and Instagram have wide reach and powerful influence in areas like child health and nutrition and among mother support groups. Whatsapp groups are also effective for reaching women, and mothers in particular, who are connecting to share their breastfeeding experiences or to find information and advice. Digital access to information and peers can be empowering. It can build knowledge and camaraderie, and thus women’s confidence and autonomy. This is why it is vital to provide credible, practical information to women and mothers on health and development issues.

Similarly, digital platforms enable us to reach health and development professionals with information and learning opportunities. Digital technology can also bridge the information gap between health professionals and families, with chatbots to answer questions or offer online assistance for moms with breastfeeding challenges. This helps health professionals build relationships and trust with the families and communities they serve.

The United Nations spotlighted the need to protect the rights of women and girls in digital spaces. This goes to the heart of the 2023 Lancet Series on Breastfeeding, which reviews digital marketing tactics by formula companies. Could you share an example of a digital marketing tactic from South Africa?

Following the global launch, we co-hosted the South Africa launch of the 2023 Lancet Series on Breastfeeding as a collaborative effort of the DSI-NRF Centre of Excellence for Food Security and the DSI-NRF Centre of Excellence for Human Development. Our panel of experts included researchers, academics, civil society and the local health department. Each spoke of the need to counter the tactics formula companies use to engage with academics and health professionals – and by extension, with mothers – which steer them away from breastfeeding.

For instance, they spoke of the “echo chamber” communication strategy employed by a major formula company in South Africa. It targets a specific sector to amplify marketing and messaging to promote formula use and sales at the expense of breastfeeding and mother and child health. Academia and health professionals are central to the echo chamber, as is digital technology.

The formula industry invests heavily in strategies to engage with academia and health professionals, offering continuous professional development learning and training opportunities and sponsorship of conferences, symposia, academics and thought leaders. Most strategies rely on digital technology to expand reach and influence through online learning, webinars and access to resources. The formula industry also employs online competitions and promotions to directly entice mothers and caregivers away from breastfeeding.

What is the long-term goal of the IYCF Advocacy Project in countering these marketing tactics?

The IYCF Advocacy Project aims to develop an approach to create data-driven, strategic advocacy plans, including key messages and channels, with the potential to mitigate the effects of formula marketing and create an enabling breastfeeding environment. This is an evidence-based research process, engaging multiple sectors and stakeholders to identify key targets used by the formula industry.

The project focuses on the operationalization of how to build an effective breastfeeding advocacy strategy. It seeks to identify the who, how and through which channels to counteract activities of the formula industry, using a systematic, data-informed process to identify and prioritize key targets.

Through this research process we are identifying needs and value-adds that the formula industry targets with offers to health professionals, academia and the media. Digital technology plays an important role through hybrid teaching and learning activities, information and communication platforms, and by building a social movement with mothers and communities to reposition and re-prioritize breastfeeding as the optimal infant feeding choice.

Could you share an example of how to protect women’s and girls’ rights in digital spaces?

Empowering digital technology users to discern good, credible information. Fake news is rife, so building trusted brands and resources is a first step. Most communities have trusted resources with whom they consult; in digital spaces and communities it is no different. This is why it is important for the IYCF Advocacy Project to be aligned with credible sources like the 2022 WHO and UNICEF report: “How the marketing of formula milk influences our decisions on infant feeding” and the 2023 Lancet Series on Breastfeeding.

It is also imperative that consumers of digital information know how to fact check and verify information and sources. Primary, secondary, higher and professional education systems share a role in teaching us how to vet partnerships and resources. This capability can both protect mothers, as well as health professionals, from unscrupulous marketing tactics and also enable them to protect themselves. Mothers who are well versed about sourcing can be more confident in what they learn when seeking out facts about breastfeeding or infant and child health from digital sources.

In South Africa and globally, governments often need concrete action plans to operationalize breastfeeding policies. How does the IYCF Advocacy Program aim to bridge this operational gap between policy and implementation?

The IYCF Advocacy Project focuses on certain infant and young child feeding policies, and it will be built on the South African Regulations Relating to Foodstuff for Infants and Young Child Feeding (R991). We aim to raise visibility of prescripts in R991 as they relate to the marketing of formula, with the objective of creating an enabling environment for breastfeeding.

Fortunately, R991 has far-reaching prescripts. The regulations prohibit advertising and promotion of formula. They prohibit the formula industry from engaging with health professionals and academics working in child health and nutrition, and from marketing to parents, women and society.

The 2023 Lancet Series on Breastfeeding calls on the whole of society to reposition and reaffirm breastfeeding as the optimal choice for infant and young child feeding. The IYCF Advocacy Project aims to answer the call as its research provides insight and an action plan for how to create an enabling environment for breastfeeding, systematically and with a data-driven approach.

Gender equality is a topic of year-round importance. How can we prevent losing momentum, after the IWD spotlight moves on?

Gender sensitivity, in the South Africa context, because the burden of disease is on women and children. As is the burden to provide and care for families. There has been more recognition for women’s unpaid care work, a point raised in the 2023 Lancet Series on Breastfeeding. Breastfeeding is not only unpaid, but also comes with a cost for women and their families, while society as a whole benefits from the better health later in life of breastfed infants. Women are also often economically marginalized. Post-Covid, women primarily carried job losses and economic hardships.

Thus, there is a need for sensitivity in our programming, to be responsive to these gender disparities. We must avoid adding more demands on women’s time and energy and look towards bringing value and relief instead. For instance, in our healthcare system, we offer extended family planning hours (5:00-7:00 pm) to accommodate women working outside the home.

In integrated health and development, there is the concept of a “one-stop shop”, unlike stand-alone intervention programs which each demand the mother’s time and energy, e.g., attending family planning services on one day and then a well-baby clinic on another. With integrated programming, the value add is that maternal and child health services can be delivered at the same time and location, making it less burdensome for women to participate and access them.

The 2023 Lancet Series on Breastfeeding is a springboard for change. Momentum can only increase as we learn how to create an enabling environment for breastfeeding, and sectors and organizations beyond health start embracing breastfeeding as the optimal infant feeding choice.

The IYCF Advocacy Project envisages a multi-sector, multi-pronged approach to creating an enabling environment for mothers to breastfeed their children. It will involve educating and empowering health professionals and women but also alert society as a whole that it is needed to promote, protect and support breastfeeding.