{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:46:44Z","timestamp":1792612004820,"version":"4.5.0"},"reference-count":36,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T00:00:00Z","timestamp":1792540800000},"content-version":"vor","delay-in-days":20,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"},{"start":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T00:00:00Z","timestamp":1790812800000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Maternal &amp; Child Nutrition"],"published-print":{"date-parts":[[2026,10]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:p>Breastfeeding is critical for infant survival, growth, and development; however, inappropriate marketing of breast\u2010milk 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\u2010methods 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\u2010depth 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%\u201338.7%), and retail sellers (26.3%). Implementation of the legislation was constrained by limited formal training of HCPs and inconsistent counselling on BMS\u2010related issues. Compliance was further undermined by continued promotional activities and non\u2010prescription 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.<\/jats:p>","DOI":"10.1111\/mcn.70270","type":"journal-article","created":{"date-parts":[[2026,10,21]],"date-time":"2026-10-21T19:25:16Z","timestamp":1792610716000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Infant Nutrition Protection in Bangladesh: An Assessment of the Implementation and Compliance of the Breast Milk Substitutes Act and Rules"],"prefix":"10.1111","volume":"22","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0577-1667","authenticated-orcid":false,"given":"Shah Golam","family":"Nabi","sequence":"first","affiliation":[{"name":"Directorate General of Health Services Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5004-6013","authenticated-orcid":false,"given":"Md. Abdul","family":"Alim","sequence":"additional","affiliation":[{"name":"Directorate General of Health Services Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Rifat","family":"Uddin","sequence":"additional","affiliation":[{"name":"Department of Public Health Northern University Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mohammad Rashidul","family":"Alam","sequence":"additional","affiliation":[{"name":"Department of Community Medicine Sher\u2010E\u2010Bangla Medical College Barishal Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tanzir","family":"Anwar","sequence":"additional","affiliation":[{"name":"Institute of Public Health Nutrition Dhaka Bangladesh"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,10,21]]},"reference":[{"key":"e_1_2_10_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.gfs.2020.100435"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980019001269"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1177\/0890334415607815"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13335"},{"key":"e_1_2_10_6_1","article-title":"Global Nutrition Report: Action on Equity to End Malnutrition","volume":"172","author":"Behrman N.","year":"2020","journal-title":"Development Initiatives"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1080\/2159676X.2019.1704846"},{"key":"e_1_2_10_8_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2648.2012.06067.x"},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.nut.2021.111206"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980022001446"},{"key":"e_1_2_10_11_1","doi-asserted-by":"publisher","DOI":"10.1097\/MCO.0b013e328352cda2"},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1368980016001846"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12884-016-0876-1"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12889-022-14759-8"},{"key":"e_1_2_10_15_1","unstructured":"Ministry of Health and Family Welfare (MoHFW) Health Service Division Government of the People's Republic of Bangladesh. (2017).The Breast\u2010milk Substitutes Infant Foods Commercially Manufactured Complementary Foods and the Accessories Thereof (Regulation of Marketing) Rules 2017. Number 261 Dhaka.https:\/\/www.ibfan.org\/wp-content\/uploads\/2023\/05\/Bangladesh-2017-English-Code-Regulations.pdf."},{"key":"e_1_2_10_16_1","volume-title":"The Breast\u2010milk Substitutes, Infant Foods, Commercially Manufactured Complementary Foods and the Accessories Thereof (Regulation of Marketing) Act, 2013","author":"Ministry of Law (MoL), Justice and Parliamentary Affairs, Government of the People's Republic of Bangladesh","year":"2014"},{"key":"e_1_2_10_17_1","volume-title":"Bangladesh Demographic and Health Survey 2022: Key Indicators Report","author":"National Institute of Population Research and Training (NIPORT), ICF","year":"2023"},{"key":"e_1_2_10_18_1","doi-asserted-by":"publisher","DOI":"10.3390\/nu13082884"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1177\/089033440101700407"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1177\/0379572115602174"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(15)01044-2"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s41043-026-01382-y"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/mcn.13351"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1186\/s13006-024-00676-3"},{"key":"e_1_2_10_25_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.m4243"},{"key":"e_1_2_10_26_1","unstructured":"UNICEF. (2018). Breastfeeding: A Mother's Gift for Every Child. United Nations Children's Fund.https:\/\/www.unicef.org\/media\/48046\/file\/UNICEF_Breastfeeding_A_Mothers_Gift_for_Every_Child.pdf."},{"key":"e_1_2_10_27_1","volume-title":"Global Breastfeeding Scorecard, 2023: Tracking Progress for Breastfeeding Policies and Programs","author":"UNICEF","year":"2023"},{"issue":"10017","key":"e_1_2_10_28_1","doi-asserted-by":"crossref","first-page":"475","DOI":"10.1016\/S0140-6736(15)01024-7","article-title":"Breastfeeding in the 21st Century: Epidemiology, Mechanisms, and Lifelong Effect","volume":"387","author":"Victora C. G.","year":"2016","journal-title":"Lancet"},{"key":"e_1_2_10_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/heapol\/czz050"},{"key":"e_1_2_10_30_1","volume-title":"How the Marketing of Formula Milk Influences Our Decisions on Infant Feeding","author":"World Health Organization & UNICEF","year":"2022"},{"key":"e_1_2_10_31_1","volume-title":"International Code of Marketing of Breast\u2010milk Substitutes","author":"World Health Organization (WHO)","year":"1981"},{"key":"e_1_2_10_32_1","volume-title":"The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation","author":"World Health Organization (WHO)","year":"2001"},{"key":"e_1_2_10_33_1","volume-title":"Country Implementation of the International Code of Marketing of Breast\u2010milk Substitutes: Status report 2011","author":"World Health Organization (WHO)","year":"2013"},{"key":"e_1_2_10_34_1","volume-title":"The International Code of Marketing of Breast\u2010 milk Substitutes: Frequently asked questions","author":"World Health Organization (WHO)","year":"2017"},{"key":"e_1_2_10_35_1","volume-title":"Commercial Foods for Infants and Young Children in the WHO European Region: A Study of the Availability, Composition and Marketing of Baby Foods in Four European Countries","author":"World Health Organization (WHO)","year":"2019"},{"key":"e_1_2_10_36_1","volume-title":"Marketing of Breast\u2010Milk Substitutes: National Implementation of the International Code\u2014Status Report 2026","author":"World Health Organization (WHO)","year":"2026"},{"key":"e_1_2_10_37_1","volume-title":"Advocacy Brief: The Role of Midwives and Nurses in Protecting, Promoting and Supporting Breastfeeding. 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