The Catch-22 of infant nutrition and safe childbirth in Son La, Vietnam
By Cassandra Morris, an intern with HealthBridge Vietnam
As part of its project Saving lives of mothers and children in Nepal and Vietnam, HealthBridge Vietnam is working in the northwestern province of Son La, Vietnam to improve infant health and nutrition.
Promoting optimal breastfeeding practices is a key component of HealthBridge’s strategy to improve infant health and nutrition. Given the nutritional and immunological benefits of breast milk, promoting recommended breastfeeding practices has been globally recognized as one of the most effective strategies for improving infant health and reducing child mortality.
WHO recommended guidelines for optimal breastfeeding practices include:
- Early initiation of breastfeeding, within 1 hour after birth;
- Exclusive breastfeeding for the first 6 months;
- Ongoing breastfeeding (along with appropriate complementary feeding) for upwards of 2 years, or more.
In addition to improving infant health, our project also aims to improve maternal health outcomes by increasing the number of deliveries supported by a skilled birth attendant. One strategy to accomplish this is to increase the facility delivery rate.
But, what if hospital-based deliveries are associated with lower rates of optimal breastfeeding practices?
This is the situation in Son La. Through our needs and baseline assessments we interviewed over 400 women and found that – by some measurements – delivering in a district or provincial hospital was associated with less optimal breastfeeding practices.
Specifically, our research found that women who delivered in a district or provincial hospital were far more likely to give their infants formula. While only 1 percent of infants who had been born at home had received formula in the previous 24 hours, that figure increased to over 7 percent among infants born in a district health, and jumped to 25 percent among those born in a provincial hospital.
HealthBridge researchers noted that formula was being openly displayed and sold at these health facilities, raising concern that formula is being marketed within health facilities. There were also reports that women in these facilities were encouraged to buy formula while waiting for their milk to come in. This advice conflicts with WHO guidelines, which recommend infants be breastfed within one hour of birth to ensure they receive the benefits of colostrum (first milk). Notably, birth at a commune (local) health station – where formula is neither sold nor displayed – was not associated with an increased rate of formula feeding.
While increasing the facility delivery rate leads to improvements in both maternal health and infant health, this should not come at the expense of infant nutrition and breastfeeding practices. HealthBridge will be monitoring the use of infant formula in health facilities to better understand the situation. Any inappropriate practices, such as advertising or promoting formula in health facilities, will be highlighted and discussed with staff during visits. Through ongoing monitoring and collaboration with staff, we aim to ensure that women delivering in health facilities receive accurate information on infant nutrition. This means refraining from promoting formula, and instead encouraging and supporting women to breastfeed.
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