BREASTFEEDING PROMOTION BY VIETNAMESE PHYSICIANS
Cooperative Extension
University of California, Berkeley
Project was funded by the Department of Health Services, WIC program, Sacramento, CA  
Contract # 98-15195

Kim-Phuc Nguyen, MS,  CLE, Joanne Pakel Ikeda, MA, RD, Giao Pham, MD, MS

BACKGROUND: The Vietnamese population in California is large and growing.  After the fall of Saigon in 1975, about 600,000 Vietnamese came to United States as war refugees.  The 1990 Census reported that in California alone, there are more than 280,000 Vietnamese.  Continuing arrivals from Southeast Asia, secondary migration from other states, and high fertility rate, have made the Vietnamese population the fastest growing Asian Pacific minority in the state.  Vietnamese mean per capita income is only $9032 and 27.5% of Vietnamese live below the poverty level, which is twice the rate of the entire nation (Census, 1990).         

Traditionally, most Vietnamese women  breastfeed their children for a  prolonged period in their native country (WHO, 1991).  However, statistics show a significant reduction in breastfeeding among Vietnamese women after immigration to Western countries (Rossiter, 1992).  Dr. Eunice Romero-Gwynn, Cooperative Extension Nutrition Specialist at the University of California, Davis, was the first to document the abandonment of breastfeeding by Indochina immigrants.  The WIC staff in California is concerned about the declining rate of breastfeeding.  According to the CALIFORNIA Breastfeeding Promotion Committee Report in 1996, the rate of breastfeeding among Southeast Asians is the lowest of any ethnic group in California. Surveys conducted by  the Vietnamese Community Health Promotion Project at University of California, San Francisco, show that most Vietnamese visit Vietnamese physicians (Jenkins, 1990).       
                                                                                              
OBJECTIVES: This project aimed to increase the incidence of breastfeeding among Vietnamese women and to motivate Vietnamese-American physicians and their office staff to promote breastfeeding among their pregnant Vietnamese patients through informational pamphlets, advice, and support.

METHODS: To promote rate and duration of breastfeeding among Vietnamese women, we conducted a 29-month intervention program targeting Vietnamese physicians in private practices in Santa Clara County, a district with a significant Vietnamese population.  Access to this population was achieved indirectly through Vietnamese physicians and their office staff who distributed breastfeeding information to their Vietnamese patients.
Eleven Vietnamese physicians specializing in obstetrics, gynecology, and pediatrics in the Santa Clara county were recruited to collaborate with this project. After the recruitment of physicians, the subjects, pregnant Vietnamese women in the Santa Clara county, were recruited through the patient lists of the physicians.
The intervention included the development of breastfeeding educational materials which play a key role in the promotion of breastfeeding, informal training for physician office staff, Continuing Medical Education (CME)  session for physicians,  and monthly visits to physician’s offices to reinforce breastfeeding promotion 

RESULTS: A CME on breastfeeding was held in the Fall of 1999.  Eighty nine people participated, among them 54 Vietnamese-Americans physicians (including 11 participating physicians) and 23 physician’s office staff. A series of 6 Vietnamese language breastfeeding educational brochure were developed and distributed regularly to the private practice physicians.  The materials include a series of six tear-off sheet: Breastfeeding! Best for You, Your Baby & Family; The Qualities of Breast milk; How to Breastfeed; Breast milk: Expression and Storage; Taking Care of Sore Nipples and Breast Engorgement; and What to Eat When You Are Breastfeeding . Evaluation includes collecting data on breastfeeding from 92 mothers, who are patients of the targeted offices, at 4 weeks and again at 6 months after childbirth. Of the 92 subjects, data was obtained from 78 mothers, an overall response rate of 85%. The rest had telephone numbers that were wrong or disconnected. 56% of the mothers were younger than 30 years of age. 34% of the mothers were participated in WIC program, and 32% did not graduate from high school. The mothers were asked what feeding method was used in the hospital immediately after birth: 91% said that they breastfed their babies in the hospital. The breastfeeding rate decreased dramatically at 4 weeks after delivery; only 56% of the mothers continued to breastfeed theirs babies. At 6 months after delivery, 15% of the mothers still breastfed their babies. Twenty five mothers were asked for the reason they stopped breastfeeding at 4 weeks: almost 80% said that they did not have enough milk or that bottle feeding was easier, 25% had to return to work or school or had problems with breastfeeding such as sore nipples or breast engorgement,  20% stopped breastfeeding for fear that it would change the way they look, and 4% had medical problems

IMPLICATIONS: This project was successful in getting Vietnamese-Americans mothers to initiate breastfeeding. Since there was no support for these women to continue to breastfeed after release from the hospital, it is not surprising that the rate of breastfeeding dropped. Future efforts to encourage breastfeeding in this population should include outreach to physicians and breastfeeding support for patients after giving birth. The educational materials developed for this study can be used by physicians, WIC and health organizations serving the Vietnamese.