Breastfeeding Difficulties at Three Months are Associated with Formula Use in Vietnam

Abstract

Breastfeeding (BF) difficulties after lactation is established are not well understood, and lack of support may lead to infant feeding practices that undermine exclusive breastfeeding (EBF). We assessed the association between BF difficulties at 3mo and formula feeding (FF) between 3‐6mo in a subsample of eligible mothers (n=604) as part of a 2010 Alive & Thrive baseline household survey in Vietnam (n=4029). Almost 14% of all mothers reported BF difficulties, including perception of insufficient milk (PIM, 38%), breast pain (15%), and poor latch (15%). Only half of mothers sought support for PIM compared to three‐quarters for pain or latch. Regardless of type of difficulty or support sought, use of formula was the most common recommendation to mothers. Over half of mothers FF in the first 6mo, but use was dynamic; 27% reported first use between 3‐6mo. In multivariable analysis, BF difficulties were associated with higher odds of FF at 3‐6mo (OR, 2.32; 95% CI 1.38, 3.91), as was maternal work outside the home (OR, 2.03; 95% CI 1.30, 3.18), FF at birth (OR, 1.86; 95% CI 1.27, 2.73), and child age (OR, 1.34; 95% CI 1.06, 1.68). No association was found for education, SES, having heard about EBF, food security, BMI, BF difficulties at birth, or recent child illness. In Vietnam, later BF difficulties are associated with formula use. Targeted support for PIM, breast pain, and latch is necessary if EBF goals are to be achieved. Reduced formula use at birth and support for working mothers are also necessary to decrease formula use between 3‐6mo.Funding Source: Alive & Thrive, funded by the Bill & Melinda Gates Foundation and managed by FHI360