"Pundits Are Saying This Is 'Anti-poor'": Competing Framing Strategies for Child Road Safety Policy in the Philippines.

Background: Child restraint systems (CRS) can lead to a 60% reduction in child deaths, yet few low- and middle-income countries (LMICs) have comprehensive policies to enforce best practice standards. In 2019, the Philippines established such a policy: the Child Safety in Motor Vehicles (CSMV) Act.

Methods: Drawing on framing theory, this study aims to understand the social dimensions of policy change to identify the Act's origins, design, and implementation. Three sources of data - 25 articles, 27 key-informant interviews, and field notes - were collected and thematically analysed.

Results: We present the findings according to two features of the framing process: storytelling and naming. The policy process can be sharply distinguished into two sections: the Act's passage into law (which was swift and successful) and its implementation (which to date has not been). The Act's implementation was stymied by three overarching frames - that it is "anti-poor," "unnecessary," and a "strategic political distraction." A media backlash at the time of implementation solidified these frames, leading President Duterte to indefinitely defer enforcement of the Act.

Conclusion: The CSMV Act emphasises that passing a law is insufficient. The trajectory of the act highlights the combined importance of (a) the framing of policy, (b) framing processes operate throughout a policy's lifecycle, and (c) the media in creating a narrative. Our findings offer valuable insights for other LMICs implementing evidence-based road safety measures, suggesting that successful implementation requires not only strong legislation but also strategic communication and frame management throughout the policy process. Understanding framing dynamics can help policy-makers anticipate and address potential resistance to life-saving public health interventions.