UN Joint Programme Supports Mothers in small villages in Viet Nam to learn the Importance of Breastfeeding

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breastfeedingHao, 24, was encouraged to breastfeed her son by a village health workerAn Giang, 26 February 2013 - Nguyen Anh Dao, 24, breastfeeds her four-month-old daughter, Minh Anh, at her home in Binh Thanh Dong commune, An Giang province. Minh Anh is strong and healthy. Although she is only four months old, she can already stand up in her mother’s lap. “I started breastfeeding in the health centre where I gave birth,” Dao says. “The doctor put the baby on my breast after delivery. Afterwards, the village health worker talked to me about breast milk. She told me that it contains good nutrients and is best for my baby’s health.”


Dao is one of many mothers who have been encouraged to exclusively breastfeed their babies by the local commune, in a programme supported by the United Nations. She is fortunate to have a supportive environment. Some new mothers face resistance from grandparents, who prefer traditional methods such as mixing water with sugar and rice powder. Other mothers have to return to work in the fields and stop breastfeeding exclusively before the recommended six months.
Dao has just returned to work herself, but is able to continue breastfeeding. She works at the People’s Committee office which is next door to the health centre and close to her home. “I breastfeed my son in the mornings before work,” she says. “Sometimes I take him to the office with me but usually I come home two or three times a day to feed him.”

Mekong Delta

Binh Thanh Dong commune is in the Mekong Delta region of southern Viet Nam. The road outside Hao’s house is lined with red flags to mark the anniversary of the founding of the Communist Party. Bright new flags and faded old ones flutter together in the wind. It’s a rural area where most people are rice farmers. Behind the houses are wide green paddy fields, with irrigation channels cutting the broad plain into neat squares like a giant table cloth. The fields are dotted with the graves of ancestors, housed in small but well-tended family graveyards, and gleaming in the bright sunshine.
While Viet Nam has achieved a significant reduction in malnutrition among under-five children during the last three decades, malnutrition remains a public health priority.Onethird of Vietnamese children less than five years old are stunted – or too short for their age - and onethird are anaemic. There is strong scientific evidence that early and exclusive breastfeeding for six months contribute to reducing neonatal mortality and stunting.
Over 2010 and 2012, the United Nations Joint Programme on Integrated Nutrition and Food Security Strategies for Children and Vulnerable Groups in Viet Nam, funded by the Spanish Millennium Development Goal (MDG) Achievement Fund, aimed to address the continuing high prevalence of malnutrition among the most vulnerable, with a focus on stunting reduction and preventing future malnutrition among children. Through the Joint Programme, the United Nations focused their work at both the national and provincial level, targeting several provinces, including Cao Bằng, Điện Biên, Đắk Lắk, Kon Tum, NinhThuận and An Giang. These provinces were selected based on their high levels of stunting as well as the presence of related activities and the capacity of agencies at the field level to implement programme activities.

 
group discussionVillage collaborator Phung leads a breastfeeding support group discussionAt a community centre near Hao’s house, a group of mothers meet for a breastfeeding support group session. It’s led by a local collaborator, 29-year-old Nguyen Thi Tuyet Phung, who starts by reviewing the learning from the last meeting. Then the mothers talk about their difficulties. One has painful nipples after breastfeeding. Another is concerned that her friend’s baby, who is fed on infant formula, is bigger than her own. Their questions are answered by a nurse from the nearby health centre. “Don’t worry if your baby is not as big as your friend’s,” she says. “The important thing is that he is healthy.”

Phung was invited to join the programme as a volunteer by staff at the health centre. “I attended training sessions on breastfeeding,” she says. “I liked it very much. I gained knowledge for myself and my family. Now, I can share my knowledge with other villagers and they believe me because they know I work with the health centre. My son is very healthy and I show him as an example. ”

Breast feeding practice

The community support group and local health centre are supported by UNICEF which, along with its sister UN agencies, the Food and Agriculture Organisation (FAO) and the World Health Organisation (WHO) together with national implementing partner – Ministry of Health and Ministry of Agriculture and Rural Development is ensuring implementation of the Joint Programme. An important and unique strength of the Joint Programme is the number and diversity of UN agencies, government stakeholders and public or private institutions involved in addressing food insecurity and malnutrition in Viet Nam.

UNICEF provides training for health workers and volunteers, materials such as posters and leaflets, and refreshments for mothers who join the meetings. The rate of exclusive breast feeding in Binh Thanh Dong commune has risen from 0.5 per cent at the start of the programme to 27.9 per cent now.
UNICEF breastfeeding expert Nguyen Dinh Quang says that it is essential for early childhood development. “In the first six months the most important thing is the baby’s brain development,” he says. “We know that breast milk is best for that.”
One aim of the programme is to change the behaviour of mothers in small villages. “It’s very challenging,” Quang continues. “Many things influence behaviour and we can’t go to every village. That’s why we work with the health centre to create the community support groups. The collaborators learn the best practice and share it with other mothers.”

UNICEF has also lobbied the government to bring in new laws to ban the advertising of infant and young child formula for children under two-years of age, and to give new mothers the right to six months maternity leave so that they can exclusively breastfeed for the recommended time. “This is a big step forward in Viet Nam,” Quang says.
 
breastfeeding thaoThao breastfeeds her three-day-old daughter at Phu Tan district hospitalDistrict hospital
Nearby, at Phu Tan District Hospital, 25-year-old rice farmer Dang Thi Thao sits on a metal bed in a white-walled recovery room that she shares with five other new mothers. She breastfeeds her second child, a three-day-old girl who is as yet unnamed. “Her grandfather is still thinking about what to call her,” she says.

Thao is assisted by Dr Huynh Thi Bich Thuy, Chief of the Obstetrical Department, who provides counselling on how to hold the baby and how to tell when she is full. “I’ve breastfed both my children,” Thao continues. “I feel happy and satisfied when I do it. The older boy Tuy is now at kindergarten and is very healthy.”

Around 90 per cent of women in the district give birth at the hospital, so it’s an important place to start. The hospital has developed a regulation with ten steps for successful breastfeeding. “For example, we have a rule that that a health worker should help every mother to breastfeed within one hour of giving birth,” Dr Thut says.

Not all parents find it so easy to breastfeed, but UNICEF’s Quang says it is possible even in the most difficult of circumstances. “I know from my own experience,” he says. “My son was two months premature and by the time he came home my wife’s breast milk had dried up. We went round the hospital collecting spare milk from lactating mothers. We spent one week doing that while he sucked on my wife’s nipples until the milk started flowing again.”
 
He adds: “If we can breastfeed successfully, anyone can.”

It is expected the Joint Programme on Integrated Nutrition and Food Security Strategies for Children and Vulnerable Groups in Viet Nam will contribute to the achievement of MDG 1 on ending poverty and hunger, MDG4 on reducing newborn and under-five mortality, and MDG5 on reducing maternal morbidity and mortality.

The author
Andy Brown is Digital Communications Consultant for UNICEF East Asia and Pacific