Infant Nutrition Protection in Bangladesh: An Assessment of the Implementation and Compliance of the Breast Milk Substitutes Act and Rules.
4 affiliations
- 1Directorate General of Health Services, Dhaka, Bangladesh.
- 2Department of Public Health, Northern University, Dhaka, Bangladesh.
- 3Department of Community Medicine, Sher-E-Bangla Medical College, Barishal, Bangladesh.
- 4Institute of Public Health Nutrition, Dhaka, Bangladesh.
Abstract
Breastfeeding is critical for infant survival, growth, and development; however, inappropriate marketing of breast-milk substitutes (BMS) continues to undermine optimal feeding practices. Bangladesh has adopted the International Code of Marketing of BMS through the BMS Act 2013 and its Rules 2017, yet evidence on implementation and compliance remains limited. This mixed-methods study assessed knowledge, implementation, and compliance with the BMS Act and its Rules across healthcare and retail settings in Bangladesh. Quantitative data were collected between September 2023 and June 2024 through interviews with 272 healthcare providers (HCPs), 136 pregnant women, 304 mothers/caregivers of children under 5 years, and observations of 150 retail shops and pharmacies. Qualitative data included in-depth interviews with HCPs and focus group discussions with mothers, caregivers, shopkeepers, and journalists. Knowledge of the BMS Act and its Rules was reported by 62.1% of HCPs but was substantially lower among pregnant women (39.4%), mothers/caregivers (38.2%-38.7%), and retail sellers (26.3%). Implementation of the legislation was constrained by limited formal training of HCPs and inconsistent counselling on BMS-related issues. Compliance was further undermined by continued promotional activities and non-prescription sales of BMS products, indicating persistent gaps between the legal framework and its implementation. Fewer than half of HCPs had received formal training, and important knowledge gaps persisted regarding promotional restrictions and penalties. Qualitative findings highlighted weak enforcement, limited counselling on BMS during maternal care, and social and clinical pressures contributing to inappropriate BMS use. Despite favourable breastfeeding practices, implementation and compliance with the BMS Act and its Rules remain suboptimal. Stronger enforcement, including consistent application of Section 18 through the Mobile Court Act, routine monitoring, mandatory HCPs' training, and institutionalized WHO NetCode monitoring are needed to improve compliance.
Related
- Dietary intake patterns and KDOQI guideline compliance among hemodialysis patients in Bangladesh: Gaps, misreporting, and clinical implications
- Critical gaps in infectious disease prevention and control: insights from IHR-2005 implementation enablers and challenges at key entry points in Bangladesh
- Nursing radiation-protection compliance and 30-day wound and pin-site adverse events after supracondylar humerus fracture fixation in children
- Understanding implementation gaps in tobacco control legislation: a mixed-methods study of COTPA compliance in urban India
- STEPwise assessment of non-communicable diseases: a pilot study among the rural elderly population of Bangladesh
BibTeX
@article{nabi2026infant,
title = {{Infant Nutrition Protection in Bangladesh: An Assessment of the Implementation and Compliance of the Breast Milk Substitutes Act and Rules.}},
author = {Shah Golam Nabi and Md Abdul Alim and Md Rifat Uddin and Md Rifat Uddin and Mohammad Rashidul Alam and Tanzir Anwar},
journal = {Maternal \& child nutrition},
year = {2026},
month = oct,
doi = {10.1111/mcn.70270},
url = {https://europepmc.org/article/MED/42905969},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Infant Nutrition Protection in Bangladesh: An Assessment of the Implementation and Compliance of the Breast Milk Substitutes Act and Rules.
AU - Shah Golam Nabi
AU - Md Abdul Alim
AU - Md Rifat Uddin
AU - Md Rifat Uddin
AU - Mohammad Rashidul Alam
AU - Tanzir Anwar
PY - 2026
DA - 2026/10/01
JO - Maternal & child nutrition
DO - 10.1111/mcn.70270
UR - https://europepmc.org/article/MED/42905969
AB - Breastfeeding is critical for infant survival, growth, and development; however, inappropriate marketing of breast-milk substitutes (BMS) continues to undermine optimal feeding practices. Bangladesh has adopted the International Code of Marketing of BMS through the BMS Act 2013 and its Rules 2017, yet evidence on implementation and compliance remains limited. This mixed-methods study assessed knowledge, implementation, and compliance with the BMS Act and its Rules across healthcare and retail settings in Bangladesh. Quantitative data were collected between September 2023 and June 2024 through interviews with 272 healthcare providers (HCPs), 136 pregnant women, 304 mothers/caregivers of children under 5 years, and observations of 150 retail shops and pharmacies. Qualitative data included in-depth interviews with HCPs and focus group discussions with mothers, caregivers, shopkeepers, and journalists. Knowledge of the BMS Act and its Rules was reported by 62.1% of HCPs but was substantially lower among pregnant women (39.4%), mothers/caregivers (38.2%-38.7%), and retail sellers (26.3%). Implementation of the legislation was constrained by limited formal training of HCPs and inconsistent counselling on BMS-related issues. Compliance was further undermined by continued promotional activities and non-prescription sales of BMS products, indicating persistent gaps between the legal framework and its implementation. Fewer than half of HCPs had received formal training, and important knowledge gaps persisted regarding promotional restrictions and penalties. Qualitative findings highlighted weak enforcement, limited counselling on BMS during maternal care, and social and clinical pressures contributing to inappropriate BMS use. Despite favourable breastfeeding practices, implementation and compliance with the BMS Act and its Rules remain suboptimal. Stronger enforcement, including consistent application of Section 18 through the Mobile Court Act, routine monitoring, mandatory HCPs' training, and institutionalized WHO NetCode monitoring are needed to improve compliance.
SN - 1740-8695
SN - 1740-8709
ER -