Thái độ cho con bú và thực tiễn giữa các bà mẹ Việt Nam tại thành phố Hồ Chí Minh

Breast-feeding attitudes and practices among Vietnamese mothers
in Ho Chi Minh City
Pranee C. Lundberg, PhD, BSc (Nursing and Midwifery), RN (Associate Professor)
a,
n
,
Trieu Thi Ngoc Thu, MSc, BSc (Midwifery) (Head of the Department of Midwifery)
b
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
article info
Article history:
Received 19 December 2010
Received in revised form
17 February 2011
Accepted 28 February 2011
Keywords:
Breast feeding
Vietnam
Attitudes
Practices
abstract
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 bre ast-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 b e exclu-
sively breastfed d urin g the first six mo nths. Thereafter it recommends
the addition of appropriate co mplementary food (Kramer and
Kakuma, 2002). It is reco gnised th at the i mmunological a nd nutri-
tional properties of breast milk are beneficial to babies (Arifeen et al.,
2001; Dewey et a l., 2001) and that breast feeding is associat ed w ith
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 a re under volitional c ontrol
(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) s ubjective norm (an

individual’s perception of social normative pressure or relevant
others’ beliefs that he or she should o r should not p erform the
behaviour), and (3) perceived b ehavioural control (an individual’s
perceived ease or difficulty of pe rforming 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 f eeding,
and that factors which influence breast feeding are numerous and
complex. Early introduction of c omplementary food, including solid
food, is a common phenomenon and the pattern of feeding varies
Contents lists available at ScienceDirect
journal homepage: www.elsevier.com/midw
Midwifery
0266-6138/$ - see front matter & 2011 Elsevier Ltd. All rights reserved.
doi:10.1016/j.midw.2011.02.012
n
Corresponding author.
E-mail address: (P.C. Lundberg).
Midwifery 28 (2012) 252–257
(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 a nd Patel, 2008). Mother-related factors, such as employ-
ment and perceived breast milk insufficiency, infant-related f actors

(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) fo und that
the mother’s educational level and comfort with breast feeding in
public places, the father’s occupation and f eeding p reference, and
the a vailability o f sufficient food for the family significantly influ-
enced the practice of exclusive breast feeding. M eed ya et a l. (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 to UNICEF (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 b reast feeding. However,
they usually perceive colostrum negatively, and no mother was
found to feed her infant exclusively by breast f eeding. Only 9.9% of
mothers initiated breast feeding within the first hour of birth, and

40% started with solid food before f our months.
Almroth et a l. (2008) foun d t hat exclusive breast f eedi ng w as r are
because it w as poorly understood and little appreciated, by health
professionals as w ell a s lay per sons , as th e best w ay t o feed a n in fant
during the first 6 months. E arly fluid su pplementation 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) fo und t hat women born in Vietnam used breast
feedingless(75%)thanwomenborninTurkey(98%)andAustralia
(84%). The Vietn amese-b orn women pe rceived th eir par tners as
being negative to breast feeding and not appreciating the h ealth
benefits of colostru m.
During the last decades, after long periods of war and i solation,
Vietnam has experienced a rapid economical development. W estern
views have influenced the country, cities have grown, the quality of
life has increased, extended families have given way to nuclear ones,
and w omen’s conditions have changed (H
¨
agerdal, 2005). Such
changes may have affected the breast-feeding attitudes and practices
of Vietnamese mot hers, e special ly in urba n areas. As l ittle res earch
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 t o describe the breast-feeding a ttitudes
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 w ithin
the last t wo ye ars, ( b) be o f ag e at le ast 1 8 y ears, a nd (c ) giv e
informed consent. Twenty-three mothers participated. All of them
belonged to the ethnical majorit y g roup Kinh,andmostofthemwere
Buddhists. The ir age ran ged from 2 5 to 40 yea rs. Their edu catio nal
level varied from primary school to bachel or’s degree. The most
common oc cupati ons we re go vernmen t of ficer a nd mer chant . The
majority lived in ext ended 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.
P.C. Lundberg, T.T. Ngoc Thu / Midwifery 28 (2012) 252–257 253
Data 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 by Lundberg
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. Disagreements
were discussed to reach a final consensus (Kvale, 1989). Pseudo-
nyms were used in the findings to maintain confidentiality.
Findings
Five themes represent ing the Vietnamese mothers’ breast-feed-
ing attitudes and practices emerged: breast-feeding best but not
exclusive, cultural and traditional beliefs (dietary precautions,
traditional practices to maintain breast m ilk, following grand-
mother, mother and mother-in-law, and use of traditional medi-
cine), infant feeding as a learn ing process, fa ctors influencing
decision t o 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 w as associated with good infant health,
so they used it. They also mentioned that they could decrease the
risk of br east disease, e .g. b reast cancer, b y b reast f eeding. 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 r eflects that the mothers followed practices for
increased production of breast milk tha t had been re commended 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 s hould eat l arge quantities o f food and drink much warm
water. They avoided eating sea food bec ause 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 p otato, cooked a s a
soup and eaten with rice. Some mothers also drank large quantities
of milk. By doing this th ey believed that t hey 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, a nd massage my brea sts. 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,
P.C. Lundberg, T.T. Ngoc Thu / Midwifery 28 (2012) 252–257254
demonstrated 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 e ncouraged 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 p lacenta i n t he woman’s ut erus, in th is w ay 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, s aid:
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 w ere encouraged by their
husband to breast feed the i nfant. 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 t o leav e the infant at home for
someone else to feed when they had to go back to work. The
mothers g enerally returned to work soon after childbirth, a majority
ofthembeforethebabywassixmonthsold.Theycombinedbreast
feeding and bottle feeding in o rder to familiarise the infant w ith
bottle feeding so that he o r she could be taken ca re 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
P.C. Lundberg, T.T. Ngoc Thu / Midwifery 28 (2012) 252–257 255
the 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 fo od after four months. They thought that after such
time breast milk would no longer be s uitable 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 sa lt powder. Some mothers

thought that the food they cooked was better than nutrient pow der,
so they gave rice soup to the infant. Mrs. Nguyet, who had a six-
month-old daughter, described how she gave supplement f ood:
After four months I gave my daughter supplementary food (thue
adam). I started with sweet powder milk (bot ngot)duringone
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 s ubjective
norm, reflecting t he 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 t hat 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 m others an intention to u se breast feeding which, however,
was not strong enough to rule out r elatively early use of b ottle
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 with Almroth 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 b onds between mothe r 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 rela ted to colostrum may partially explain why the Vietna-
mese mothers gave s upplementary arti ficial m ilk w hile 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 f amilies.
Attitudes of spouse (Scott et al., 2001), parents (Sharps et al.,
2003)andrelatives(Kendall-Tackett and Sugarman, 1995; Reid
et al., 2010) play important roles for the start and duration of breast
feeding. In developing countries, where t he 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 br east f eeding because of the support
from grandmothers, mothers and m others-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 p references of husban d and
family members, factors relating t o the health of mothers, such as
childbirth methods and locations, could influence the breast-feeding
patterns. Because of t he traditional a nd 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 c hanged
the recommended length of exclusive breast feeding from three or
four to six m onths. The recommendations might h ave been mis-
understood by some mothers so that t hey added supplementary
food earlier. It i s 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 f eeding.
P.C. Lundberg, T.T. Ngoc Thu / Midwifery 28 (2012) 252–257256
The 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. Cult ural a nd traditio nal b eliefs and practices regarding
breast feeding remained among the Vietnamese mo thers. In addi-
tion, breast feeding was influenced by socio-economic factors,
media and marketing. Health-c are professionals should consider
the cultural context and socio-economic issues when preparing
infant feeding education and intervention programmes. Appropri-
ate knowledge about cultural and tradi tional 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 c ountries.
Acknowledgements
This study was supported by the International Programme Office
for Education and Training, Sweden, thro ugh 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.
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