Formula Use In A Breastfeeding Culture: Changing Perceptions And Patterns Of Young Infant Feeding In Vietnam

Previous research identified an increase in formula use as a barrier to exclusive breastfeeding (EBF) in Vietnam. In the context of a process evaluation (PE) of the Alive & Thrive program to promote EBF, 121 in‐depth interviews with rural mothers, fathers, and grandmothers of infants 0‐12 mo formed the basis of a case study analysis (n=48 families). While 79% of mothers had heard about EBF and breastfeeding was universal, EBF prevalence was only 2%. Two‐thirds of infants were formula fed (FF) before 6 months (40% at birth, 12% at 1‐3 mo, and 15% at 4‐6 mo). Stopping and restarting FF was common. Among early starters, families reported a desire to support the mother, “what I could do for her was feed our baby with formula,” often sua non (bovine colostrum formula) sold in the hospital. All 6 cesarean sections FF at birth. Mothers were reluctant to FF but felt they had “no choice” when infants were “crying because of hunger”. For families introducing FF at 1‐3 mo, perception of insufficient milk (PIM) drove use. For the category of 4‐6 mo, introduction of complementary food (CF) was also early due to pressure from grandmothers, or returning to work, or under the perception that infants need to be prepared to accept CF. High awareness of formula advertisements, conflicting advice from health professionals, and a universal perception that insufficient maternal diet led to poor breastmilk supply also influenced FF despite the high cost. Families valued and practiced BF, but require targeted support for BF initiation and PIM, as well as appropriate and timely CF. Grant Funding Source : Alive & Thrive, funded by the Bill & Melinda Gates Foundation and managed by FHI360