Legislation and Policies

Establishing and enacting national breastfeeding legislation and policies demonstrates country-level commitment to scaling up, promoting and supporting breastfeeding programs and initiatives. The adoption of national breastfeeding legislation and policies is one key step countries can take towards improving maternal and child health. Proper integration and support of legislation and policies requires adequate funding and resources.

To be effective, policies supporting breastfeeding must be:

• Officially adopted;
• Integrated into existing health programs, and
• Supported through vigorous coordination and monitoring efforts and enforced when violated.

The themes for the Legislation & Policies Gear assess the adoption, coverage and quality of key breastfeeding legislation and policies:

1. National Breastfeeding Policy (Benchmarks LPG1, LPG2)
   
2. Baby Friendly Hospital Initiative (BFHI) (Benchmark LPG3)
   
3. International Code of Marketing of Breast Milk Substitutes (Benchmark LPG4, LPG5)
   
4. National Maternity Protection Legislation. (Benchmarks LPG6, LPG7, LPG8, LPG9, LPG10)

All benchmarks are referenced to “the past year” unless otherwise noted.

Description: The existence of a national policy on breastfeeding is a key step to scaling up breastfeeding nationally. This national policy needs to reflect country level support and commitment towards breastfeeding mothers. This benchmark assesses whether a national policy on breastfeeding has been officially adopted/approved by the government.

Possible data sources: Government legislation and policies as well as policy briefs, and interviews with national level government officials, especially within the health sector or infant/young child feeding area, may reveal the existence of this policy, it’s stage of development, and whether it has or is expected to be adopted/approved.

How to score: The scoring for this benchmark reflects the existence and level of development and adoption of a national policy on breastfeeding in the past year.
• No progress: There is no national policy on breastfeeding.
• Minimal progress: A national policy on breastfeeding is under discussion.
• Partial progress: A national policy on breastfeeding has been written but it has not been officially adopted/approved by the government.
• Major progress: A national policy on breastfeeding has been written and has been officially adopted/approved by the government.

Description: The national breastfeeding plan of action should reflect the way a country will be implementing their national policy on breastfeeding. If there is no national breastfeeding policy, then it is probable that there is no national breastfeeding plan of action. This benchmark assesses if a country has a national breastfeeding plan of action.

Possible data sources: Interviews with national level government officials, especially within the health sector or infant/young child feeding area, may reveal the existence of the national breastfeeding plan of action, the stage of development, and the content of this plan of action. Government legislation and policies as well as policy briefs should be closely reviewed to examine the national breastfeeding plan of action, assess its content, and score it accordingly.

How to score: The scoring for this benchmark reflects the existence and quality of the objectives (i.e. measurable and time bound) of the national breastfeeding plan of action in the past year.

Measurable objectives/targets refers to objectives that are followed and can be easily assessed to evaluate progress with the national breastfeeding plan.

Time bound objectives/targets refers to objectives that have a time frame within which they have to be achieved/accomplished.

• No progress: There is no national breastfeeding plan of action.
• Minimal progress: Some strategies in the national breastfeeding plan of action are implemented but the plan does not have measurable nor time bound objectives/targets.
• Partialprogress: Some strategies in the national breastfeeding plan of action are implemented and the plan has measurable and time bound objectives/targets.
• Majorprogress: All the strategies in the national breastfeeding plan of action are implemented and the plan has measurable and time bound objectives/targets.

Description: The healthcare system has strategies/policies designed to deliver high quality health care. The BFHI/Ten Steps criteria is the “gold standard” for promoting breastfeeding within facilities. To deliver high quality maternity care, the healthcare system should include the BHFI/Ten Steps criteria as a standard that facilities need to meet. This benchmark assesses the questions of how well the BFHI/Ten Steps criteria are included into the health care system strategies at a national level and their reflection of the BFHI WHO/UNICEF global criteria.

Possible data sources: Interviews with national level government officials, especially within the health sector or infant/young child feeding area, may reveal the existence of national BFHI/Ten Steps criteria. Government legislation and policies as well as policy briefs should be closely reviewed to examine the national BFHI/Ten Steps criteria (if it exists) and assess its content and level of incorporation in the national health care system strategies/policies.

How to score: The scoring for this benchmark reflects the existence, adoption, and level of incorporation (i.e. coverage) of the BFHI/Ten Steps criteria in healthcare system strategies/policy in the past year. It also addresses the quality of the criteria (i.e. if it is consistent or not with the BFHI WHO/UNICEF global criteria).

• No progress: There are no national BFHI/Ten Steps criteria in country.
• Minimal progress:National BFHI/Ten Steps criteria exists and it is consistent with BFHI WHO/UNICEF global criteria, or it has been adopted but it has not been incorporated into the healthcare system strategies/policies nationally.
• Partial progress: National BFHI/Ten Steps criteria exists and it is consistent with BFHI WHO/UNICEF global criteria, it has been adopted and it has been partially incorporated into the healthcare system strategies/policies nationally.
• Major progress: National BFHI/Ten Steps criteria exists, it is consistent with BFHI WHO/UNICEF global criteria, and it has been adopted and incorporated into the healthcare system strategies/policies nationally.

Description: The International Code of Marketing of Breast Milk Substitutes (the Code) is an international policy developed by the WHO that protects breastfeeding by setting standards, requirements, and enforcement penalties in response to the unethical promotion of manufactured breastmilk substitutes. The specific content of the adopted Code is essential to the scoring of this benchmark since the Code must include provisions for a monitoring system, penalties for violations, and reporting of violations.

Possible data sources: Interviews with national level government officials, especially within the health sector or infant/young child feeding area, may reveal whether the Code has been adopted or if there is an equivalent decree supporting and enforcing the Code. Organizations, such as IBFAN, may have websites that provide updates on country progress with adopting and enforcing the Code. Government legislation and policies as well as policy briefs should be closely reviewed to examine the adopted Code and assess its content to determine if it provides for a monitoring system, penalties for violations, and reporting of violations.

How to score: The scoring of this benchmark reflects the level of adoption of the Code into legislation as well as the existence and level of provisions for a monitoring system, penalties for violations, and reporting of violators.

Where the provisions in the National Code are modified to a lower standard than that of the International Code, a country cannot receive a score of major progress. There can be situations where countries may have decrees rather than legislation and these decrees have the same power as law, are enforceable and have to be carried out. If the Code is issued as a decree, countries will have to assess whether it conforms to the requirements of legislation (i.e. does this have power of law? Is it enforceable and has to be carried out?) and not a voluntary agreement. If so, that decree can be considered equivalent to legislation and countries would follow the scoring algorithm accordingly. If it is a voluntary agreement lacking enforceability, countries should consider that the Code has not been adopted.

• No progress: International Code of Marketing of Breast Milk Substitutes has not been adopted in legislation.
• Minimal progress: International Code of Marketing of Breast Milk Substitutes has been adopted in legislation but does not include all provisions of the Code nor provisions for a monitoring system, penalties for violations, and reporting of violators.
• Partial progress: International Code of Marketing of Breast Milk Substitutes has been adopted in legislation and includes all provisions of the Code but not provisions for a monitoring system, penalties for violations, and reporting of violators.
• Major progress: International Code of Marketing of Breast Milk Substitutes has been adopted in legislation and includes all provisions of the Code and provisions for a monitoring system, penalties for violations, and reporting of violators.

Description: This benchmark assesses whether the Code of Marketing of Breast Milk Substitutes adopted by the country has been enforced during the last 3 years. This assumes that the International Code of Marketing of Breast Milk Substitutes has been adopted as a National Code. Enforcement of the Code is considered an important component to protecting, promoting and supporting breastfeeding. The level of enforcement of the National Code (local, subnational, national) is one component determining the level of breastfeeding protection within the country.

Possible data sources: Interviews with national level enforcement officials may reveal whether the Code has been enforced. If the Code is reported to have been enforced, then it is key to identify the regulatory agency in charge and review their documents spelling out the provision of the Code.

How to score: The scoring reflects the degree and coverage of enforcement of the provisions of the National Code the country has adopted. Penalties and sanctions must be considered only if they are proportional to the violation.
Enforced means that there is evidence that penalties and sanctions have been enforced for violations of the Codeduring the last 3 years.

• No progress: National Code of Marketing of Breast Milk Substitutes has not been enforced.
• Minimal progress: National Code of Marketing of Breast Milk Substitutes has been minimally enforced, which means enforcement happens only in a few localities or situations.
• Partial progress: National Code of Marketing of Breast Milk Substitutes has been partially enforced, which means enforcement happens in most of the localities or situations.
• Major progress: National Code of Marketing of Breast Milk Substitutes has been enforced in the whole country.

Description: This benchmark assesses whether the Maternity Protection Convention 2000 (No. 183), put forth by the International Labour Organization (ILO), has been ratified or existing maternity protection legislation meets some or all of their provisions. This benchmark allows for the existence of other maternity laws but uses the standards expressed in the Maternity Protection Convention 2000 as the benchmark countries should strive to meet.

Possible data sources: The ILO website provides data on countries that have ratified any of the Maternity Protection Conventions, although it is important to acknowledge that these data are not always up to date. This can be searched on the website through the country or by the Maternity Protection Convention. To assess if maternity protection laws exist, interviews with national level government officials, especially within the infant/young child feeding area, may reveal whether maternity protection laws have been adopted. Government legislation and policies as well as policy briefs should be closely reviewed to examine the maternity protection laws and assess the content of these laws.

How to score: The scoring for this benchmark reflects whether countries have adopted maternity protection laws but not ratified the Maternity Protection Convention, or if countries have ratified older versions of the Maternity Protection Convention but not the most current version (see Annex 1 for further explanation).

• No progress: There are no maternity protection laws in the country and the Maternity Protection Convention, 2000 (No. 183) is not ratified.
• Minimal progress: There are a few maternity protection laws that meet the provisions of the Maternity Protection Convention 2000, (No. 183) but the Maternity Protection Convention 2000, (No. 183) is not ratified.
• Partial progress: There are some maternity protection laws and most meet the provisions of the Maternity Protection Convention, 2000 (No.183) but the Maternity Protection Convention, 2000, (No. 183) is not ratified.
• Major progress: The maternity protection laws all meet or exceed the provisions of the Maternity Protection Convention, 2000 (No. 183) or Maternity Protection Convention 2000, (No. 183) is ratified.

Description: This benchmark assesses if there is paid maternity leave legislation for women. Paid maternity leave is an essential standard to the Maternity Protection Convention 2000. Countries that have maternity leave legislation need to have legislation equal to or better than that provided in the Maternity Protection Convention 2000 to be able to score major progress with this benchmark.

Possible data sources: Interviews with national level government officials, especially within the infant/young child feeding area, should reveal whether maternity protection laws have been adopted. To assess if maternity leave legislation is included in any maternity protection legislation, this legislation should be read and reviewed closely to assess the content and coverage of these laws.

How to score: The scoring of this benchmark reflects the existence and quality of paid maternity leave with the specifications described in the Maternity Protection Convention 2000 serving as the standard for countries to meet or surpass for an optimal score on this benchmark.
The Maternity Protection Convention 2000 stipulates at least 14 weeks maternity leave with women receiving at least 2/3rd of their previous earnings during this time.

• No progress: There is no paid maternity leave legislation for women.
• Minimal progress: There is paid maternity leave legislation for women but it stipulates less than 14 weeks leave and receiving less than 2/3rd of their previous earnings.
• Partial progress: There is paid maternity leave legislation for women and it stipulates at least 14 weeks leave but receiving less than 2/3rd of their previous earnings OR it stipulates less than 14 weeks but receiving at least 2/3rd of the previous earnings.
• Major progress: There is paid maternity leave legislation for women AND it stipulates at least 14 weeks leave and receiving at least 2/3rd of their previous earnings.

Description: Provision of breastfeeding or expressing breaks for lactating women is essential to protecting, promoting, and supporting breastfeeding. A policy providing maternal protection for breastfeeding/expressing breaks is required to encourage employers to adhere to protecting these rights. This benchmark assesses whether there is legislation that protects and supports breastfeeding/expressing breaks for lactating women at work. If a country committee feels that this legislation is not effectively exercised or enforced, it can be put forward as a recommendation for action.

Possible data sources: Interviews with national level government officials, especially within the infant/young child feeding area, should reveal whether maternity protection laws have been adopted. To assess if legislation that protects and supports breastfeeding/expressing breaks is included in any maternity protection legislation, this legislation should be read and reviewed closely to assess the content and coverage of these laws.

How to score: The ILO standards were used for the scoring of this benchmark. The scoring for this benchmark reflects the existence and coverage of legislation that protects and supports breastfeeding/expressing breaks.

• No progress: There is no legislation that protects and supports breastfeeding/expressing breaks at work.
• Minimal progress: Labor policies encourage employers to protect and support breastfeeding/expressing breaks for their workers, but there is no legislation stipulating this.
• Partial progress: There is local legislation that protects and supports breastfeeding/expressing breaks at work.
• Major progress: There is national legislation that protects and supports breastfeeding/expressing breaks at work.

Description: If a particular job places a breastfeeding mother at risk of harm or negative consequences, maternity protection legislation needs to provide worksite accommodations for that mother. This includes: (1) not forcing a woman to perform work that is risky to her or her infant/young child and (2) providing alternative work at the same wage until she is no longer breastfeeding. This benchmark assesses the existence of legislation for supporting worksite accommodations for breastfeeding women. If a country committee feels that this legislation is not effectively exercised or enforced, it can be put forth as a recommendation for action.

Possible data sources: Interviews with national level government officials, especially within the infant/young child feeding area, should reveal whether maternity protection laws have been adopted or not. To assess if legislation supporting worksite accommodations for breastfeeding women is included in any maternity protection legislation, this legislation should be read and reviewed closely to assess the content and coverage of these laws.

How to score: The scoring for this benchmark reflects existence and coverage of legislation that supports worksite accommodations (including the provision of alternate worksite accommodations) for breastfeeding.

• No progress: There is no legislation for supporting worksite accommodations for breastfeeding.
• Minimal progress: There are labor policies that encourage employers to support worksite accommodations for their workers for breastfeeding, including providing alternate work at the same wage until the mother is no longer breastfeeding, but there is no legislation stipulating this.
• Partial progress: There is local legislation that supports worksite accommodations, including providing alternate work at the same wage until the mother is no longer breastfeeding.
• Major progress: There is national legislation that supports worksite accommodations, including providing alternate work at the same wage until the mother is no longer breastfeeding.

Description: Employment protection affords women protection again termination and is a guarantee of the same position or equivalent pay until the end of maternity leave. It also prohibits employers from requiring women to take a pregnancy test upon hiring unless under certain special circumstances. Protection against employment discrimination includes stipulations that prohibit discrimination during employment for pregnant or breastfeeding women. If a country committee feels that this legislation is not effectively exercised or enforced, it can be put forth as a recommendation for action.

Possible data sources: Interviews with national level government officials, especially within the infant/young child feeding area, should reveal whether maternity protection laws have been adopted. To assess if legislation providing employment protection and prohibiting employment discrimination against pregnant and breastfeeding women is included in any maternity protection legislation, this legislation should be read and reviewed closely to assess the content and coverage of these laws.

How to score: The scoring for this benchmark reflects the existence and quality of legislation providing employment protection and prohibiting employment discrimination against pregnant and breastfeeding women.

• No progress: There is no legislation providing employment protection and prohibiting employment discrimination against pregnant and breastfeeding women.
• Minimal progress: There is legislation prohibiting employment discrimination against pregnant and breastfeeding women but does not include any employment protections (i.e. against termination, same position and payment upon return from maternity leave, no pregnancy test upon hiring).
• Partial progress: There is legislation prohibiting employment discrimination against pregnant and breastfeeding women and it includes some but not all employment protections (i.e. against termination, same position and payment upon return from maternity leave, no pregnancy test upon hiring).
• Major progress: There is legislation prohibiting employment discrimination against pregnant and breastfeeding women which includes all employment protections (i.e. against termination, same position and payment upon return from maternity leave, no pregnancy test upon hiring).

• Legislation and Policies Gear
• Legislation and Policies Gear Scoring Table