Factors associated with intention to breastfeed in Vietnamese mothers: A cross-sectional study

PLOS ONE RESEARCH ARTICLE Factors associated with intention to breastfeed in Vietnamese mothers: A crosssectional study Duong Thi Thuy Doan ID1,2, Colin Binns2, Andy Lee2, Yun Zhao2, Minh Ngoc Pham2,3, Hoa Thi Phuong Dinh ID1*, Chuong Canh Nguyen4, Ha Thi Thu Bui1 a1111111111 a1111111111 a1111111111 a1111111111 a1111111111 1 Hanoi University of Public Health, Hanoi, Vietnam, 2 School of Public Health, Curtin University, Western Australia, Australia, 3 Thai Nguyen University of Medicine and Pharmacy, Thai Nguyen, Vietnam, 4 Hanoi Gynecology and Obstetrics Hospital, Hanoi, Vietnam * Abstract Introduction OPEN ACCESS Citation: Doan DTT, Binns C, Lee A, Zhao Y, Pham MN, Dinh HTP, et al. (2023) Factors associated with intention to breastfeed in Vietnamese mothers: A cross-sectional study. PLoS ONE 18(12): e0279691. https://doi.org/10.1371/journal. pone.0279691 Editor: Tanya Doherty, Medical Research Council, SOUTH AFRICA Breastfeeding has many benefits for mothers, children, and the environment over both the short and longr-term. Prenatal intention to breastfeed is a powerful predictor of short-term breastfeeding outcomes. Objective This study aims to analyze breastfeeding intentions, including the intention to feed infants with breastmilk only and to continue exclusive breastfeeding to 6 months among pregnant mothers in Hanoi, Vietnam. Received: February 1, 2021 Accepted: December 13, 2022 Published: December 12, 2023 Copyright: © 2023 Doan et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Data Availability Statement: All relevant data are within the manuscript and its Supporting Information files. Funding: This research was funded by a grant from the Vietnam National Foundation for Science and Technology Development (NAFOSTED) and the National Health and Medical Research Council of Australia under grant number NHMRC.108.032018.09. DTTD was supported by an Australian Government Research Training Program (RTP) Scholarship. The funders had no role in study Methods The analysis included 1230 singleton mothers, between 24- and 36-weeks’ gestation, who attended antenatal clinics in two hospitals in Hanoi in 2020. Results The proportion of mothers with an “breastfeeding intention” (i.e., intention to feed an infant with breastmilk only) and “exclusive breastfeeding intention” to 6 months was 59.9% and 41.7%, respectively. Mothers who were 25 years or older (aOR = 1.35, 95%CI:1.00–1.81), had an undergraduate educational degree or higher (aOR = 1.38, 95%CI: 1.08–1.76), had observed another woman breastfeeding (aOR = 1.43, 95%CI: 1.03–2.00), were not living with parents-in-law (aOR = 1.34, CI: 1.05–1.70), and were multiparous (aOR = 1.60, 95%CI: 1.16–2.19) had higher odds of “exclusive breastfeeding intention” to 6 months. Among primiparous women, those who thought their husbands support breastfeeding were more likely to intend to feed an infant with breastmilk only. Among multiparous women, feeding the previous child with breastmilk exclusively before the introduction of complementary foods and not giving solid foods together with water until 6 months, were significant predictors for both breastfeeding intentions. PLOS ONE | https://doi.org/10.1371/journal.pone.0279691 December 12, 2023 1 / 15 PLOS ONE design, data collection, and analysis, decision to publish, or preparation of the manuscript. Competing interests: The authors have declared that no competing interests exist. Breastfeeding intentions among Vietnamese mothers Conclusion Mothers without exclusive breastfeeding experience should be provided with greater support to promote exclusive breastfeeding intention and outcomes. Introduction The benefits of breastfeeding for both infants and mothers are numerous and substantial, across the short- and long- term. Breastfeeding protects infants against many infections, including diarrheal disease and respiratory tract infections [1,2], and creates a healthy microbiome that is associated with lower rates of chronic illness later in life [3–6]. Increasing the exclusive breastfeeding rate among children under 6 months and continued breastfeeding for those aged 6-23 months could potentially save 823,000 children’s lives annually [4]. Benefits for mothers include the reduction of complications and depression during post-partum periods [7–9], and are also associated with lower rates of breast and ovarian cancer, hypertension, and diabetes later years in life [10–12]. Prenatal intention to breastfeed is a powerful predictor of short-term breastfeeding outcomes including initiated breastfeeding, exclusive breastfeeding, or any breastfeeding for both the first and second child [13–17]. Having the intention to breastfeed for six months or more was associated with feeding any breastmilk [14]. For those who initiated breastfeeding, one of the strongest predictors of discontinuing breastfeeding was low intention to breastfeed [16]. Mothers who intended to breastfeed had more knowledge about potential food contaminants and consulted more sources of information about nutrition and diet than mothers who did not intend to breastfeed [18]. Recent studies have shown that many factors can affect breastfeeding intentions. These factors include parity, previous breastfeeding experience [15,19–21], seeing other women breastfeed [22,23], having a supportive partner [19,20,22,24,25], not living with any family-in-law [20], breastfeeding knowledge [26–28], and having a positive attitude and beliefs regarding the benefits of breastfeeding [20,22]. Each of these are modifiable factors that health practitioners can target to improve breastfeeding rates. In addition, demographic variables including the place of residence [27], occupation [26], household economic status [20,26], maternal age [20,27], and maternal education [19,20,27] are also associated with breastfeeding intention. Vietnam is a middle-income country in Southeast Asia with a population of 99 million. While an increase in the breastfeeding rate has been observed in some other developing countries [29], it continues to decline in Vietnam, particularly in urban areas [30,31]. In Vietnam, the breastfeeding rate within one hour of birth was only 45.2%, while the exclusive breastfeeding rate within the three first days after birth was even lower at 25.8% in 2012. The rate of exclusive breastfeeding through the first 6 months (24-hour recall) was 12.6%, lower than the national level (24%) [32]. These rates indicate a very low coverage and at present cannot be achieving the Vietnam’s 2030 targets [33]. Further, recent years have shown more intensive advertising of infant formula, and breastmilk substitutes [34]. The recent COVID-19 pandemic and the increased promotion of breastmilk substitutes on social media are influencing mothers’ infant f (...truncated)