Background

In January 2018, in the face of unprecedented growth in formula marketing in Myanmar’s biggest cities, three global organisations working in maternal health and child’s rights joined forces to commission Myanmar’s first integrated exclusive breastfeeding campaign. Our goal was familiar for a developing country: to level the playing field by improving exclusive breastfeeding rates and reinstalling breastmilk as the undisputed, irreplaceable product for babies in the first 6 months. But we would approach it differently. Mothers were our heroes, but not mothers alone. We understood that the days and months following childbirth were among the most disempowering of a mother’s life. Pressure to protect and do the best for baby was compounded by social expectations in Myanmar’s isolating patriarchal culture where women bear the greatest weight of parenting alone. It takes a village to raise a child—and effect behaviour change—but formative testing revealed that just 16% of women felt their husband supported their choice to exclusively breastfeed, and almost a third felt -nobody- did. To empower mothers to exclusively breastfeed, we would build a wider culture of support: from family, friends, health professionals, companies and communities all forming healthy, supportive social norms around their decision.

Describe the cultural/social/political climate in your region and the significance of your campaign within this context

In Myanmar, 1 in 20 children die before reaching five and 1 in 3 are stunted—a condition caused by undernutrition with irreversible effects on physical growth and cognitive development. Optimal breastfeeding has the greatest impact on child survival of all preventive interventions, reducing infant mortality by 14 times over formula, and providing complete and optimal nutrition before 6 months. But under 38% of children exclusively breastfeed to 6 months, while $15m+ is spent annually marketing breastmilk substitutes, drowning out government advice. Surveyed mothers recalled formula slogans more readily than the superior benefits of breastmilk. Just 3 in 5 knew the 6 months milestone, and 82% believed ‘exclusive’ could include food, water or formula. Each month economy formula costs a third of a basic formal sector wage. When families cannot afford it, they cannot go back and are forced into harmful alternatives like sweetened or condensed milk. But families don’t want the cheapest, they want the best for their children. When asked who uses formula, respondents chose images of women who looked modern, urban, rich—aspirational. Underfunded and ill-adapted to counter formula’s aggressive marketing, the health sector required a movement that re-establish exclusive breastfeeding in consumer aspirations.

Describe the creative idea

Taking on established formula brands required a brand for exclusive breastfeeding itself. Adapting the breastfeeding symbol, our brand mark formed an iconic breastfeeding mother from the Burmese characters #6la (6 moons/months), accompanied by an easier definition of ‘exclusive’. Families want health, happiness and intelligence for their child. Unsurprisingly, formula marketing evokes these aspirations in pseudo-scientific marks like IQ++ or immuno-guard. So we condensed breastfeeding’s myriad benefits into six pillars to habitulise its proven superior qualities across all media. The uniquely Burmese ‘hardiest’ joined healthiest, happiest and smartest, and pillars supporting social confirmation and justifying ‘exclusive’. The dry science unpinning these pillars was given more universal appeal in quizzes that our six celebrities took while caring for a baby—as expected of a mother. Shown making mistakes, learning, having fun and sometimes improvising movingly about their own breastfeeding experiences—all while soothing the baby—they modelled the supportive behaviour we sought.

Describe the strategy

Beyond awareness and establishing the public health platform, changing feeding behaviours would require integrated behavioural strategies. The Burmese custom of wearing latpats (bracelets) to protect newborns was adapted into commitment bracelets as wearable pledges for mothers and supporters. Activation teams with trained midwives visited mothers in participating hospitals in the days after birth (when behaviour is established) and at prenatal groups (when intentions are being formed). Accompanying latpats were monthly breastfeeding advice cards, in-person activation on our partner mHealth app for deeper, persistent, daily support aligned to the age of the child, and supporter latpat packs to give their circle. This support circle was championed across all media by five celebrities, embodying the archetypal friend, husband, sister, grandmother, and doctor who can shape a supportive norm. Singer Sung Thin Par was our hero mother and exclusively breastfed her daughter throughout the campaign, reaching 6 months on our final day.

Describe the execution

With little media budget, we relied on the power of the movement to persuade. It helped earn us coverage in 151 publications. It signed up over 27,000 to our mHealth App for gamified educational content. To the six celebrities that joined our cause in films, quizzes, posters, launch and activations, we added 35 further top-tier names, posting to 4.5m followers and appearing on TV and radio. Myanmar’s largest retailer and largest bank joined, each announcing their first breastfeeding rooms, displaying entrance and till messaging to 8.9m+ customers in 38 supermarkets where all staff wore supporter latpats, and looping films in over 500 bank branches. Myanmar Idol and the biggest morning show invited us on. Crucially, 25 major hospitals displayed #6la films and posters in waiting rooms, and gave us access to activate 1 in 4 mothers giving birth in Yangon, Mandalay and Naypyitaw over the 3-month campaign.

Describe the results/impact

Within a fraction of the budget and time, our brand achieved more saliency (19% unaided/60% aided) than all but three formula brands. Our PR value ($197k) paid for the campaign alone. Social engagement figures (1.9m+) were higher than the 15-40 female population of our target cities, while total reach (18.2m) exceeded the adult population 2.5x over. Mothers who felt supported by their husbands increased from 16% to 45% and those who felt nobody supported them dropped from 30% to 18%. Most importantly, activated mothers tested over 6 months showed a 64% increase in exclusive breastfeeding rates. The #6la brand grew beyond this, as other major international organisations commissioned extensions from Eastern Shan to the Rakhine IDP camps. This has culminated in Ministry of Health & Sports adoption as the official public health brand for exclusive breastfeeding in Myanmar, with campaigning and behaviour change through a supportive social norm planned nationwide.