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.

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

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

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

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

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:

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.

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

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 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.

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: / />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
Nutrition 133, 305S–309S.
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

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.