Mục tiêu để mô tả thái độ cho con bú và hành vi giữa phụ nữ Việt Nam tại thành phố Hồ Chí Minh. Thiết kế một nghiên cứu định tính mô tả đã được sử dụng. Lý thuyết hành vi kế hoạch cung cấp khuôn khổ khái niệm. Thiết lập Bệnh viện Vângem bé, Khoa Sản và Phụ khoa của một bệnh viện trường đại học tại thành phố Hồ Chí Minh, Việt Nam. Tham gia 23 bà mẹ Việt Nam tự nguyện. Thu thập và phân tích dữ liệu bán cấu trúc phỏng vấn sâu với năm câu hỏi và quan sát mở được sử dụng. Các cuộc phỏng vấn ghi âm và sao chép nguyên văn. Các dữ liệu từ các cuộc phỏng vấn và quan sát được phân tích bằng cách sử dụng phân tích nội dung. Phát hiện năm loại thái độ và hành cho con bú được xác định: cho con bú tốt nhất, nhưng không độc quyền, văn hóa và truyền thống tín ngưỡng, nuôi trẻ sơ sinh là một quá trình học tập, các yếu tố ảnh hưởng đến quyết định vú thức ăn, và ý định để nuôi các con. Kết luận quan trọng và tác động đối với thực hành văn hóa tín ngưỡng và truyền thống và thực hành, và tình hình kinh tếxã hội, ảnh hưởng cho con bú các bà mẹ Việt Nam. Nhân viên y tế nên xem xét bối cảnh văn hóa và các vấn đề kinh tế xã hội khi chuẩn bị các chương trình giáo dục và can thiệp cho trẻ ăn. Kiến thức phù hợp về giá trị văn hóa cần được đưa vào giáo dục chăm sóc sức khỏe để chăm sóc đồng dạng văn hóa cho các bà mẹ Việt Nam ở Việt Nam cũng như ở các nước phương Tây.
Trang 1Breast-feeding attitudes and practices among Vietnamese mothers
in Ho Chi Minh City
,
a
Department of Public Health and Caring Sciences, Uppsala University, Box 563, SE-751 22 Uppsala, Sweden
b
Faculty of Nursing and Medical Technology, University of Medicine and Pharmacy in Ho Chi Minh City, Vietnam
a r t i c l e i n f o
Article history:
Received 19 December 2010
Received in revised form
17 February 2011
Accepted 28 February 2011
Keywords:
Breast feeding
Vietnam
Attitudes
Practices
a b s t r a c t
Objective: to describe breast-feeding attitudes and practices among Vietnamese women in Ho Chi Minh City
Design: a descriptive qualitative study was used The theory of planned behaviour provided the conceptual framework
Setting: the Well-baby Clinic, Department of Obstetrics and Gynaecology of a university hospital in Ho Chi Minh City, Vietnam
Participants: 23 voluntary Vietnamese mothers
Data collection and analysis: semi-structured in-depth interview with five open-ended questions and observation was used The interviews were tape-recorded and transcribed verbatim The data from the interviews and observations were analysed by use of content analysis
Findings: five categories of breast-feeding attitudes and practices were identified: breast-feeding best but not exclusive, cultural and traditional beliefs, infant feeding as a learning process, factors influencing decision to breast feed, and intention to feed the child
Key conclusion and implications for practice: cultural and traditional beliefs and practices, and socio-economic situation, influenced the Vietnamese mothers’ breast feeding Health-care professionals should consider cultural context and socio-economic issues when preparing infant feeding education and intervention programmes Appropriate knowledge about cultural values should be included in health-care education in order to provide culturally congruent care to Vietnamese mothers in Vietnam
as well as in Western countries
&2011 Elsevier Ltd All rights reserved
Introduction
Breast milk is the best form of nutrition for infants The World
Health Organization has recommended that infants should be
exclu-sively breastfed during the first six months Thereafter it recommends
the addition of appropriate complementary food (Kramer and
Kakuma, 2002) It is recognised that the immunological and
nutri-tional properties of breast milk are beneficial to babies (Arifeen et al.,
2001;Dewey et al., 2001) and that breast feeding is associated with
decreased childhood morbidity and mortality (Simmer, 2000)
The theory of planned behaviour
The theory of planned behaviour (TPB) is based on the construct
that most behaviours of social relevance are under volitional control
(Ajzen and Madden, 1986); specifically, the intention to perform a
behaviour, is considered the most important determinant of a behaviour According to the TPB, the behavioural intention depends
on (1) attitude toward the behaviour (an individual’s positive or negative evaluation of the behaviour), (2) subjective norm (an individual’s perception of social normative pressure or relevant others’ beliefs that he or she should or should not perform the behaviour), and (3) perceived behavioural control (an individual’s perceived ease or difficulty of performing the behaviour) The TPB provided the conceptual framework for understanding the breast-feeding attitudes and practices of Vietnamese mothers
Factors influencing breast feeding Even after a decision to breast feed, many mothers fail to reach their own breast-feeding goals because of factors discouraging them (Thomson, 1990).Forster and McLachlan (2010)found that many women had both positive and negative feelings about breast feeding, and that factors which influence breast feeding are numerous and complex Early introduction of complementary food, including solid food, is a common phenomenon and the pattern of feeding varies
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n
Corresponding author.
E-mail address: Pranee.Lundberg@pubcare.uu.se (P.C Lundberg).
Trang 2(Norris et al., 2002;Fewtrell et al., 2003;Duong et al., 2005) Factors
influencing breast feeding have been published by a number of
investigators It has been found that breast feeding is healthier for
babies than artificial milk but there are sometimes difficulties in
maintaining breast feeding due to work and family constraints
(Babington and Patel, 2008) Mother-related factors, such as
employ-ment and perceived breast milk insufficiency, infant-related factors
(Bulk-Bunschoten et al., 2001; McCarter-Spaulding and Kearney,
2001;Moffat, 2002), and husband-related factors (Earle, 2000;Kong
and Lee, 2004) have been reported.Duong et al (2005)found that
the mother’s educational level and comfort with breast feeding in
public places, the father’s occupation and feeding preference, and
the availability of sufficient food for the family significantly
influ-enced the practice of exclusive breast feeding.Meedya et al (2010)
also found breast-feeding intention, breast-feeding self-efficacy and
social support to be modifiable factors that influence women’s
breast-feeding decisions
In addition, breast feeding is influenced by health providers
(DiGirolamo et al., 2003) and the marketing of infant artificial
milk (Adair et al., 1993) Decisions regarding infant feeding are
also influenced by the social, cultural and economic environments
(Rossiter, 1992) Vietnamese mothers often believe that maternal
health is weakened by childbirth, and to restore health they
follow traditional postnatal rituals and dietary restrictions
(Lundberg and Trieu, 2010)
Breast feeding in Vietnam
In Vietnam, 19% of four-month-old infants and 12% of
six-month-old infants are breastfed exclusively (UNICEF, 2007)
Accord-ing toUNICEF (2004), causes of low rates of exclusive breast feeding
are women’s lack of support and education regarding this matter
and their long working days The early introduction of
complemen-tary food and the common use of artificial milk are also a parts of
the problem.Ergenekon-Ozelei et al (2006) showed that mothers
generally have a positive attitude towards breast feeding However,
they usually perceive colostrum negatively, and no mother was
found to feed her infant exclusively by breast feeding Only 9.9% of
mothers initiated breast feeding within the first hour of birth, and
40% started with solid food before four months
Almroth et al (2008)found that exclusive breast feeding was rare
because it was poorly understood and little appreciated, by health
professionals as well as lay persons, as the best way to feed an infant
during the first 6 months Early fluid supplementation was the rule,
and most infants received water and milk in addition to breast milk
In a study of three groups of women in Australia,McLachlan and
Forster (2006) found that women born in Vietnam used breast
feeding less (75%) than women born in Turkey (98%) and Australia
(84%) The Vietnamese-born women perceived their partners as
being negative to breast feeding and not appreciating the health
benefits of colostrum
During the last decades, after long periods of war and isolation,
Vietnam has experienced a rapid economical development Western
views have influenced the country, cities have grown, the quality of
life has increased, extended families have given way to nuclear ones,
and women’s conditions have changed (H¨agerdal, 2005) Such
changes may have affected the breast-feeding attitudes and practices
of Vietnamese mothers, especially in urban areas As little research
has been devoted to these important matters, the present study of
Vietnamese mothers in a major Vietnamese city was undertaken
Aim
The aim of the study was to describe the breast-feeding attitudes
and practices among Vietnamese mothers in Ho Chi Minh City
Method Design
A descriptive qualitative study was conducted to explore breast-feeding attitudes and practices among Vietnamese mothers
in Ho Chi Minh City
Setting Data were collected during the months of June and July 2009
at the Well-baby Clinic, Department of Obstetrics and Gynaecol-ogy, of a university hospital in Ho Chi Minh City, the largest city in Vietnam with more than 6 million inhabitants (General Statistics Office of Vietnam, 2008)
Sample Purposive convenience sampling was used to select the partici-pants The sample consisted of mothers visiting the Well-baby Clinic with their babies They should (a) have given birth to a child within the last two years, (b) be of age at least 18 years, and (c) give informed consent Twenty-three mothers participated All of them belonged to the ethnical majority group Kinh, and most of them were Buddhists Their age ranged from 25 to 40 years Their educational level varied from primary school to bachelor’s degree The most common occupations were government officer and merchant The majority lived in extended families (with husband and/or other relatives and children) in Ho Chi Minh City The number of children varied from one to three They had not experienced difficulty with childbirth
Ethical considerations The Head of the Well-baby Clinic approved the study after having conferred with a committee of the university All partici-pants had been fully informed about the purpose of the study and assured that anonymity and confidentiality would be maintained They had been told that anyone wishing to drop out could do so at any time They had also given their informed consent verbally and
in writing prior to the study
Data collection The data collection involved semi-structured interviews and observation Five open-ended questions were developed for this study on the basis of unpublished results of a previous study The questions were: (1) What is your opinion on breast feeding your infant? (2) What do you believe about breast feeding your infant? (3) How do/did you breast feed your infant? (4) Do/did you give extra milk or food to your infant? (5) If yes, what kinds of extra milk or food? Please give examples
Individual interviews lasting 30–90 minutes were conducted
by the two female investigators (both midwives, one of Vietna-mese and one of Thai ethnicity) The participants were encouraged
to narrate what they thought about breast feeding and how they practiced it, and while they were doing this their facial expres-sions and gestures were observed Some participants were also observed while breast feeding their babies at the clinic The interviews were tape-recorded until no new information emerged After 23 interviews, saturation was achieved with regard to the main topics The recorded interviews were translated from Viet-namese into English and transcribed verbatim The correctness of the language of the transcripts was checked by an expert The notes from observations were made in English
Trang 3Data analysis
The data from translated interviews and observations were
analysed by using qualitative content analysis It involves a
subjective interpretation of the content of the textual data through
a systematic classification process and deals with manifest and
latent The method has been used in a previous study byLundberg
and Trieu (2010) The merging categories and themes were tested
and revised through analysis of the interviews The data were
analysed separately and the outcomes were discussed and
chan-ged to ensure reliability Peer checking, validation of emerging
codes and categories in subsequent interviews, and debriefing by
two experts with experience of the research method and the
subject were used to enhance credibility There was 85%
agree-ment between the investigators and the experts Disagreeagree-ments
were discussed to reach a final consensus (Kvale, 1989)
Pseudo-nyms were used in the findings to maintain confidentiality
Findings
Five themes representing the Vietnamese mothers’
breast-feed-ing attitudes and practices emerged: breast-feedbreast-feed-ing best but not
exclusive, cultural and traditional beliefs (dietary precautions,
traditional practices to maintain breast milk, following
grand-mother, mother and mother-in-law, and use of traditional
medi-cine), infant feeding as a learning process, factors influencing
decision to breast feed (husband support, employment, media and
advertisement, and information from health professionals), and
intention to feed the child (different time periods of breast feeding,
and infant feeding pattern)
Breast-feeding best but not exclusive
All mothers described breast milk as the best for their infant
They believed that it enhanced optimal growth and development
of their infants Breast milk, natural food made in the body of the
mother, has all nutrients that the infant needs and antibodies for
immunity It is convenient and clean, free of charge, and takes no
time to prepare Breast feeding also creates a close tie between a
mother and her infant Mrs Hanh, with two children, stated:
Breast milk (sua me) is the best food for the baby I think it helps
maternal-infant bonding My first child was not breastfed, and
he easily got sick The second child I gave breastfeeding to
prevent my baby from getting allergies, colds, diarrhoea and
colic I have breastfed up to now and I don’t need to buy any
kind of formula milk (sua bot)
Even though all mothers said that breast milk was the best, no
one was exclusively breast feeding Some mothers gave water to
their baby after breast feeding They believed that the infant
might be thirsty and they wanted to prevent tongue diseases
Mrs Long who had her first child described:
I give a little water after breastfeeding so that my baby’s tongue
does not get thick and he gets good digestion
Most of the mothers discarded the colostrum because they believed
that it was not good for the infant However, some of them had the
opinion that the colostrum was associated with good infant health,
so they used it They also mentioned that they could decrease the
risk of breast disease, e.g breast cancer, by breast feeding Mrs
Ngan, who gave colostrum to her baby, stated:
I know that colostrum has more antibodies I believe that the
baby will get good health (from it), so I breastfed directly after
birth
Some mothers started to feed their babies with artificial milk during their stay in the hospital, others after having come back from the hospital or two to four months after the birth They were afraid that their breast milk was not sufficient Therefore several mothers mixed breast milk and artificial milk when they fed their babies, e.g half of each They used different brands of artificial milk, e.g Abbot, Dielac and Ridielac Mrs Que, who had two children and mixed breast milk and artificial milk, stated:
I mix breastfeeding (nuoi con bang sua me) and bottle feeding (nuoi con bang sua bot), once breast milk and next time bottle milk, because my daughter got bottle milk in the hospital and she continues at home I want her to be familiar with bottle feeding
Cultural and traditional beliefs This theme consists of four categories related to cultural and traditional beliefs: dietary precautions, traditional practices to maintain breast milk, mother, mother-in-law and grandmother, and use of traditional medicine
Dietary precautions This category reflects that the mothers followed practices for increased production of breast milk that had been recommended to them The majority believed that they should consume ‘hot (am)’ and avoid ‘cold (duong)’ food during one month after birth to restore their balance They indicated that the nutritional value of breast milk was dependent upon the health of the lactating mother and the availability of her traditional postnatal diet If a mother was weak, suffering from any illness or taking medications, or if she had had operations, her milk was believed to be inferior The lactating mothers should eat large quantities of food and drink much warm water They avoided eating sea food because such food would give rise to allergy The most common food eaten to stimulate lactation was pig nails with green papaya or red bean and potato, cooked as a soup and eaten with rice Some mothers also drank large quantities
of milk By doing this they believed that they would produce more breast milk Mrs Phuong described her experience:
I have been told to eat soup with nails of pig or pork ragout and green papaya every week during four months and drink a lot of milk to produce more breast milk
Some mothers ate a kind of Chinese food to produce more breast milk Mrs Ngan said:
I eat everything and also several special kinds of food such as a soup with black chicken to produce more milk I don’t eat sea food because it would make me allergic
Traditional practices to maintain breast milk Some mothers used different traditional methods to produce more breast milk During the first month they mixed warm sticky rice and onion and put the mixture on their breasts They believed that this would make the breasts produce more milk with good taste Mrs Hanh said:
My grandmother told me to put warm sticky rice on my breasts, around 15 minutes per breast, and massage my breasts Then
I took it away I did this seven days after birth to produce good milk and a larger amount of milk
Several mothers used a warm cloth to clean their breasts and they massaged them with their thumbs They believed this would help them produce more milk Mrs Loan, who had one son,
Trang 4demonstrated how to massage her breast and said:
I use my thumb to do like this nine times on each breast
Sometimes I also put a warm towel on my breasts to stimulate
the production of milk I do this during one month
Following grandmother, mother and mother-in-law
Most of the mothers mentioned that they followed what
grandmother, mother and mother-in-law told them about breast
feeding These family members encouraged them to breast feed,
and told them how to maintain milk production and add
supple-mentary food The mothers also got help with cooking of special
food that would stimulate the production of breast milk and with
housework so that they could rest and concentrate on the care of
the infant Mrs Thanh, who lived in an extended family and had
her first child, stated:
My grandmother encouraged me to breastfeed my son Also,
she told me how to breastfeed I followed what she told me
Some mothers decided themselves about breast feeding because
their grandmother, mother and mother-in-law lived far away
from them They looked at people living near them, such as sisters
and friends, and then made their decisions Mrs Nhien, who lived
with her husband, described:
My mother lived far from me I talked with my sister and
decided myself how to feed my baby
Use of traditional medicines
A traditional practice related to the production of breast milk is
the use of herbal medicines Some mothers were encouraged to
drink herbal medicine in order to produce breast milk abundantly
Herbal drinks were believed to help flush out remainders of
child-birth blood and placenta in the woman’s uterus, in this way making
it clean and ready for the next baby Therefore, they drank herbal
medicine during three or four months after birth, even though they
had established their breast milk Mrs Ngan, mother of her first
child, said:
I boil some kinds of Vietnamese traditional medicine together
to drink My mother brought them from the drugstore She
told me that they would make my body healthier and give me
more breast milk
Infant feeding as a learning process
Many mothers described infant feeding as a process of
learn-ing They learnt from doctors and midwives when they attended
classes for pregnant women, from grandmothers, mothers and
mothers-in-law, from television, magazines and books, and from
their experiences of breast feeding and supplement food Their
increased knowledge gave them self-confidence Mrs Thanh, who
had her first child, stated:
I feel that I learnt little by little after childbirth how to feed my
child I think of feeding my child as a process of learning what
I should do y I learnt about the benefits of breast milk from
the doctor, the midwife and from my mother-in-law Also,
I learnt about baby food from television and magazines I have
no difficulty to breastfeed my baby
Factors influencing decision to breast feed
The majority of the mothers described factors influencing the
decision to breast feed Four categories were identified: husband
support, employment, media and advertisements, and lactation
problems
Husband support Some mothers indicated that they were encouraged by their husband to breast feed the infant They felt more confident to breast feed because of such support Their husband also helped them take care of the infant Mrs Nhien, who had a three-month-old son, said:
My husband told me that breast milk will help my son have good health He encouraged me to breastfeed
Employment Most of the mothers mentioned that a difficulty with breast feeding is that of not being able to leave the infant at home for someone else to feed when they had to go back to work The mothers generally returned to work soon after childbirth, a majority
of them before the baby was six months old They combined breast feeding and bottle feeding in order to familiarise the infant with bottle feeding so that he or she could be taken care of by mother, mother-in-law, grandmother, some other relative or a maid Mrs Giang, who had a daughter of age four months, stated:
Up to now, I give my daughter breastfeeding and bottle feeding
I will go back to work this month y I prepare her for bottle feeding so that she can stay with my mother
Media and advertisements Infant feeding was influenced by media and advertisements Through these channels, most mothers were taught that artificial milk and milk powder contain vitamins, minerals and nutrients which lead to improved growth and development Advertisements for artificial milk and supplementary food, and people using such food, had important influence on the mothers’ decisions on infant feeding Mrs Hanh, mother of two children, said:
I got information about formula milk (sua bot) from advertise-ments on the TV I also read in magazines what kinds of food
I should give to my baby
Lactation problems Some mothers replaced breast feeding by artificial milk feed-ing before six months when they encountered problems such as sore or cracked nipples, engorgement of the breast, or inadequate lactation Mrs Lan, who after two months thought her breast milk was insufficient and not good for her infant, said:
I had little milk and it looked like water It was so thin and not good for my baby that I stopped breastfeeding
Mrs Han, who had problems with cracked nipples, stated:
My baby bites my nipples They become very sore and need to
be relieved by occasionally giving bottles so that I can continue
to breastfeed longer
Intention to feed the child All mothers mentioned that in the beginning they intended to breast feed but after some time they introduced different kinds of infant feeding because they believed that the infant needed more nutrients This theme consists of two categories: schemes of breast feeding, and patterns of infant feeding
Schemes of breast feeding The majority planned to breast feed during 12–24 months Some mothers mentioned that the scheme of breast feeding depended on the growth of the infant; if the infant was small they would feed more The majority breastfed during about
30 minutes every two hours Some breastfed every hour or when
Trang 5the infant cried, whereas others breastfed every three hours.
Mrs Giang, who had a two-month-old infant, said:
I breastfeed my baby every two hours, each time around 20 to
30 minutes I plan to continue until I have no milk
Some mothers gave both breast milk and artificial milk to the
infant Mrs Lan, who had a three-month-old son, stated:
I feed my son every two hours and change between breast milk
and a bottle of formula milk y I use Abbot Company formula
milk I intend to give supplementary food after my milk is
finished
Patterns of infant feeding
The mothers’ pattern of infant feeding was to give breast milk
and add artificial milk and supplement food They believed that the
combination of breast milk and other milk would help the infant
grow and become strong Most of the mothers started to add
supplement food after four months They thought that after such
time breast milk would no longer be suitable for the infant They
also wanted the infant to become familiar with the food and to be
able to eat it easily when he or she grew up The supplement food
was of different brands depending on the mother Some mothers
started with sweet powder and continued with salt powder
whereas others mixed sweet and salt powder Some mothers
thought that the food they cooked was better than nutrient powder,
so they gave rice soup to the infant Mrs Nguyet, who had a
six-month-old daughter, described how she gave supplement food:
After four months I gave my daughter supplementary food (thue
a dam) I started with sweet powder milk (bot ngot) during one
month and salty powder (bot man) during half a month because
I wanted her to be familiar with the food I also plan to give her
rice soup (chao) with some fish or beef and vegetable After one
year I will give her rice
Mrs Long, with two children, said:
I mixed sweet and salt powder milk once every day during the
fourth month I gave it twice per day in the fifth month Now
when he is six months old I give him three times a day I give
the sweet powder milk in the morning, and the salt one
around 12 o’clock and six o’clock in the afternoon I plan to
give him rice porridge (chao dac) or rice-floured porridge (bot)
after six months
Discussion
As all mothers believed that breast milk was beneficial for the
infant, they had a positive attitude to breast feeding The subjective
norm, reflecting the beliefs of relevant others, such as grandmothers,
mothers, mothers-in-law and husbands, also favoured breast
feed-ing However, the perceived behavioural control was influenced by
the belief that colostrum was not good for the infant, by lactation
problems, by media and advertisements, and by the necessity to go
back to work soon after childbirth In the context of TPB (Ajzen and
Madden, 1986), these mixed but predominantly positive influences
gave the mothers an intention to use breast feeding which, however,
was not strong enough to rule out relatively early use of bottle
feeding
Traditionally, Vietnamese women do not start with breast
feeding within the first few hours after birth (Morrow, 1996)
The early introduction of artificial milk and supplementary food is
in accord withAlmroth et al (2008)who described that exclusive
breast feeding was rare and that most infants received water and
milk in addition to breast milk The majority stated that they
followed traditional cultural beliefs about breast feeding, and were influenced by grandmothers, mothers and mothers-in-law It is important that health-care professionals consider such beliefs and practices in culturally sensitive ways in infant feeding education and in interventions to pregnant women and new mothers The mothers seemed to have good knowledge about the psychological benefits of breast feeding, and they commonly stated that breast feeding increases the bonds between mother and infant Yet, many of them discarded colostrums which they believed to be unhealthy for the infant (Rossiter, 1992;Bui et al., 2008) Cultural beliefs related to colostrum may partially explain why the Vietna-mese mothers gave supplementary artificial milk while they were
in hospital However, some of them gave colostrum to the infant, which may indicate a change in the beliefs about colostrum The mothers’ habit of following traditional dietary restrictions seems to be explained by the conviction that a well-balanced maternal diet enhances maternal and infant health and encourages lactation (Rossiter, 1992) For example, the postnatal traditional meal of pork ragout and green papaya is meant to produce fresh, nourishing milk, where ‘fresh’ connotes ‘balanced’ and should be understood in the context of Vietnamese theory of health (Groleau
et al., 2006; Lundberg and Trieu, 2010) As maternal health was weakened by childbirth, the mothers got support from grand-mothers, mothers and mothers-in-law This allowed them to rest and restore their ‘vital energy (chi’i)’ In this way, they prevented excessive ‘cooling’ of their bodies and assured fresh, nourishing and abundant maternal milk for their babies
Because of the Vietnamese culture, the women were dependent
on their husbands and the senior members of their families Attitudes of spouse (Scott et al., 2001), parents (Sharps et al.,
2003) and relatives (Kendall-Tackett and Sugarman, 1995; Reid
et al., 2010) play important roles for the start and duration of breast feeding In developing countries, where the position of women in the society is relatively low, the role of spouse and relatives in encouraging breast feeding is crucial (Kendall-Tackett and Sugarman, 1995;Arora et al., 2000;Meedya et al., 2010) Many of the mothers had confidence in breast feeding because of the support from grandmothers, mothers and mothers-in-law Ekstr ¨om et al (2003) showed that social support, for e.g from grandmothers, improved the confidence of the mothers Together with socio-cultural determinants such as feeding preferences of husband and family members, factors relating to the health of mothers, such as childbirth methods and locations, could influence the breast-feeding patterns Because of the traditional and socio-cultural features of Vietnam, it is important that health promotion on breast feeding should target not only pregnant women but also family members, especially husbands and grandmothers
The early introduction of supplementary food is a major problem of infant feeding among Vietnamese women (Duong
et al., 2005;Babington and Patel, 2008) Work has been found to have important influence on the method of infant feeding (McCarter-Spaulding and Kearney, 2001;Moffat, 2002;Babington and Patel, 2008) Mothers seem to think that artificial milk feeding
is a good choice when they plan to return to work The opinions of family members have also been found to affect the choice of infant feeding method (Sj ¨ogren, 2005; Mistry et al., 2008) Therefore, health-care professionals should have the influence of work and family in mind when informing new mothers about the direct and long-term benefits of breast feeding
Kramer and Kakuma (2002) described that WHO has changed the recommended length of exclusive breast feeding from three or four to six months The recommendations might have been mis-understood by some mothers so that they added supplementary food earlier It is important that health-care professionals who give advice to pregnant women and new mothers regularly update their knowledge and counselling skills as regards exclusive breast feeding
Trang 6The influence of marketing of commercial infant artificial milk
on the breast-feeding behaviour of mothers in this study is in
accord with several studies (Rossiter, 1992;Bentley et al., 2003)
Mothers may misperceive infant artificial milk as the norm for
western infants and get the impression that artificial milk has the
same nutritional value as breast milk Another threat to breast
feeding is posed by the rapid social and economic changes taking
place in Vietnam New opportunities to get incomes present
obstacles to exclusive breast feeding and make mothers
vulner-able to the vigorous advertising of infant artificial milk Therefore,
Vietnamese authorities should closely monitor artificial milk
promotion activities in mass media and health-care settings and
take actions aimed at limiting their harmful effects
This study was limited by the small number of participants
It may not be possible to generalise the findings because of the use
of convenience samples However, as the participants had
differ-ent ages, educational background, occupations, type of family and
number of children, the findings provide a relatively broad
over-view of breast-feeding attitudes and practices among Vietnamese
mothers in Ho Chi Minh City Further research should be carried
out regarding midwives’ perspectives on exclusive breast feeding
Conclusion and implications
Although the mothers had intention to breast feed during a long
period they relatively early introduced bottle milk and
supplemen-tary food Cultural and traditional beliefs and practices regarding
breast feeding remained among the Vietnamese mothers In
addi-tion, breast feeding was influenced by socio-economic factors,
media and marketing Health-care professionals should consider
the cultural context and socio-economic issues when preparing
infant feeding education and intervention programmes
Appropri-ate knowledge about cultural and traditional values should be
included in the health-care education in order to achieve culturally
congruent care to pregnant women and new mothers in Vietnam,
as well as in Western countries
Acknowledgements
This study was supported by the International Programme Office
for Education and Training, Sweden, through its exchange
pro-gramme Linnaeus-Palme between Uppsala University and
Univer-sity of Medicine and Pharmacy in Ho Chi Minh City We are
thankful to the Vietnamese mothers for their participation in
the study
References
Adair, L.S., Popkin, B.M., Guilkey, D.K., 1993 The duration of breast-feeding: how is
it affected by biological, sociodemographic, health sector, and food industry
factors? Demography 30, 63–80.
Ajzen, I., Madden, T.J., 1986 Prediction of goal-directed behaviour: attitudes,
intentions and perceived behavioural control Journal of Experimental Social
Psychology 22, 453–474.
Almroth, M.R., Arts, M., Dinh Quang, N., Thi Thuy Hoa, P., Williams, C., 2008.
Exclusive breastfeeding in Vietnam: an attainable goal Acta Paediatrica 97,
1066–1069.
Arifeen, S., Black, R.E., Antelman, G., Baqui, A., Caulfield, L., Becker, S., 2001.
Exclusive breastfeeding reduces acute respiratory infection and diarrhea
deaths among infants in Dhaka slums Pediatrics 106, URL: /http://www.
pediatrics.org/cgi/content/full/106/5/e67S.
Arora, S., McJunkin, C., Wehrer, J., Kuhn, P., 2000 Major factors influencing
breastfeeding rates: mothers’ perception of father’s attitude and milk supply.
Pediatrics 106, URL: /http://www.pediatrics.org/cgi/content/full/106/5/e67S.
Babington, L., Patel, B., 2008 Understanding child feeding practices of Vietnamese
mothers The American Journal of Maternal Child Nursing 33, 376–381.
Bentley, M.E., Dee, D.L., Jensen, J.L., 2003 Breastfeeding among low income,
African-American women: power, beliefs and decision making Journal of
Bui, Q.T., Le Linh, C., Rahman, Z., 2008 Child health status and maternal and child care in Quangtri Province, Vietnam Asia Pacific Journal of Public Health 20, 228–235.
Bulk-Bunschoten, A.M.W., van Bodegom, S., Reerink, J.D., Pasker-de Jong, P.C.M.,
de Groot, C.J., 2001 Reluctance to continue breastfeeding in the Netherlands Acta Paediatrica 90, 1047–1053.
Dewey, K.G., Cohen, R.J., Brown, K.H., Rivera, L.L., 2001 Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras Journal of Nutrition 131, 262–267.
DiGirolamo, A., Grummer-Strawn, L.M., Fein., S.B., 2003 Do perceived attitudes of physicians and hospital staff affect breastfeeding decisions? Birth 30, 94–100 Duong, D.V., Binns, C.W., Lee, A.H., 2005 Introduction of complementary food to infants within the first six months postpartum in rural Vietnam Acta Paediatrica 94, 1714–1720.
Earle, S., 2000 Why some women do not breast feed: bottle feeding and fathers’ role Midwifery 16, 323–330.
Ekstr ¨om, A., Widstr ¨om, A.M., Nisssen, E., 2003 Breastfeeding support from partners and grandmothers: perceptions of Swedish women Birth 30, 261–266.
Ergenekon-Ozelei, P., Elmaci, N., Ertem, M., Saka, G., 2006 Breastfeeding beliefs and practices among migrant mothers in slums of Diyarbakir, Turkey, 2001 European Journal of Public Health 16, 143–148.
Fewtrell, M.S., Lucas, A., Morgan, J.B., 2003 Factors associated with weaning in full term and preterm infants Archives of Disease in Childhood Fetal and Neonatal
88, F296–301.
Forster, D.A., McLachlan, H.L., 2010 Women’s views and experiences of breast feeding: positive, negavtive or just good for the baby? Midwifery 26, 116–125 General Statistics Office of Vietnam, 2008 /http://www.gso.gov.vn/default_ en.aspx?tabid=467&idmid=3&ItemID=6173S (last accessed 14/05/2008) Groleau, D., Souliere, M., Kirmayer, L.J., 2006 Breastfeeding and the cultural configuration of social space among Vietnamese immigrant women Health
& Place 12, 516–526.
H ¨agerdal, H., 2005 Vietnams Historia Historiska Media, Lund, Sweden Kendall-Tackett, K.A., Sugarman, M., 1995 The social consequences of long-term breastfeeding Journal of Human Lactation 11, 179–183.
Kong, S.K.F., Lee, D.T.F., 2004 Factors influencing decision to breastfeed Journal of Advanced Nursing 46, 369–379.
Kramer, M.S., Kakuma, R., 2002 Optimal duration of exclusive breastfeeding Cochrane Database of Systematic Reviews 1 Art no CD003517.
Kvale, S., 1989 To validate is the question In: Kvale, S (Ed.), Issues of Validity in Qualitative Research Studentlitteratur, Lund, pp 73–92.
Lundberg, P.C., Trieu, T.N.T., 2010 Vietnamese women’s cultural beliefs and practices related to the postpartum period Midwifery, doi: 10.1016/ j.midw.2010.02.006.
McCarter-Spaulding, D.E., Kearney, M.H., 2001 Parenting self-efficacy and percep-tion of insufficient breast milk Journal of Obstetric, Gynecologic and Neonatal Nursing 30, 515–522.
McLachlan, H.L., Forster, D.A., 2006 Initial breastfeeding attitudes and practices of women born in Turkey, Vietnam and Australia after giving birth in Australia International Breastfeeding Journal 1 doi:10.1186/1746-4358-1-7 /http:// www.internationalbreastfeedingjournal.com/content/1/1/7S.
Meedya, S., Fahy, K., Kable, A., 2010 Factors that positively influence breastfeeding duration to 6 months: a literature review Women and Birth 23, 135–145 Mistry, Y., Freedman, M., Sweeney, K., Hollenbeck, C., 2008 Infant-feeding practices of low-income Vietnamese American women Journal of Human Lactation 24, 406.
Moffat, T., 2002 Breastfeeding, wage labour, and insufficient milk in peri-urban Kathmandu, Nepal Medical Anthropology 21, 207–230.
Morrow, M., 1996 Breastfeeding in Vietnam: poverty, tradition and economic Journal of Human Lactation 12, 97–103.
Norris, F.J., Larkin, M.S., Williams, C.M., Hampton, S.M., Morgan, J.B., 2002 Factors affecting the introduction of complementary foods in the preterm infant European Journal of Clinical Nutrition 56, 448–454.
Reid, J., Schmied, V., Beale, B., 2010 ‘I only give advice if I am asked’: examining the grandmother’s potential to influence infant feeding decisions and parent-ing practices of new mothers Women and Health 23, 74–80.
Rossiter, J.C., 1992 Maternal–infant health beliefs and infant feeding practices: the perceptions and experiences of the immigrant Vietnamese women in Sydney Contemporary Nurse 1, 75–82.
Scott, J.A., Landers, M.C., Hughes, R.M., Binns, C.W., 2001 Factors associated with breastfeeding at discharge and duration of breastfeeding Journal of Paedia-trics and Child Health 37, 254–261.
Sharps, P.W., El-Mohandes, A.A., Nabil El-Khorazaty, M., Kiely, M., Walker, T., 2003 Health beliefs and parenting attitudes influence breastfeeding patterns among low-income African-American women Journal of Perinatology 23, 414–419 Simmer, K., 2000 Human milk banks and evidence-based medicine Journal of Paediatrics and Child Health 36, 182–183.
Sj ¨ogren, B., 2005 Psykosocial obstetrik Studentlitteratur, Lund.
Thomson, A.M., 1990 Why don’t women breastfeed? In: Robinson, S., Thomson, A (Eds.), Midwives, Research and Childbirth, vol 1 Chapman and Hall, Suffolk UNICEF, 2004 Exclusive breastfeeding—safe, sound and sustainable, says UNICEF UNICEF /http://www.unicef.org/vietnam/media_522.htmlS.
UNICEF, 2007 Breastfeeding within one hour of birth can significantly reduce infant mortality in Viet Nam UNICEF /http://www.unicef.org/vietnam/