In my previous blog post, I described visiting remote Hmong communities in the mountains of Vietnam, where levels of undernutrition are extremely high – in some areas stunting is as high as 75 percent. For a complete contrast, the next stop on my visit was to Ho Chi Minh City. It is a huge sprawling city of at least 10 million people.
Stunting in Ho Chi Minh City is low, at 7 percent. However, exclusive breastfeeding is also very low, at only 1 percent. Many mothers – up to half – have C-sections, often by choice, and never start breastfeeding. Instead they feed their infants with formula, which does not have the same health and nutrition benefits as breast milk. Mothers who work in factories usually stop breastfeeding as soon as they return to work.
© UNICEF EAPRO/2015/Christiane Rudert
A mother practicing skin-to-skin care at a hospital in Ho Chi Minh City.
From the first hour of a baby’s life through age two or later, breastfeeding protects against illness and death—whether the child is born in a high-income or low-income country, to a rich family or a poor one. Breastfeeding is essential for early childhood development. It supports healthy brain development, increased I.Q. scores and better school performance.
In order to promote exclusive breastfeeding for the first six months of life in Vietnam, UNICEF supported the inclusion of breastfeeding into national quality criteria for hospitals. In addition, together with Alive and Thrive, UNICEF successfully advocated for six months of mandatory paid maternity leave in Vietnam. In 2013, this was passed into law.
I visited several hospitals with the national Ministry of Health inspection team to see how they were applying national hospital quality criteria, including the Ten Steps to Successful Breastfeeding. The criteria apply to all hospitals – public and private – and the inspection results are published.
UNICEF supports training centres to build skills of hospital workers in lactation management. In the huge public hospital, which delivers 60,000 babies a year, I observed the correct practices being followed. Newborn babies were placed straight on their mother’s chest to ensure breastfeeding began within the first hour after birth.
I met a mother who had delivered her baby via C-section but was successfully breastfeeding, and told me she would never consider feeding her baby with anything else. The health staff told me that it could sometimes be challenging for mothers who had C-sections to start breastfeeding within the first hour, but they were working hard to support them. I found the staff highly committed to applying the best practices for breastfeeding, in both the public and private hospitals we visited.
© UNICEF EAPRO/2015/Christiane Rudert
Mothers and pregnant women working at a clothing factory.
So it seems that the prospects of improving the initiation of breastfeeding in Ho Chi Minh City hospitals is good, but what about when the mothers return to work? To find out, I visited a large factory making clothes for the Canadian market.
The factory provides all mothers with six months paid maternity leave, as per the 2013 law. The factory also has a breastfeeding room with fridge to store breastmilk, pumps and educational materials provided by Alive and Thrive.
Women get regular breaks from work to pump their milk. I met one pregnant worker who had used the lactation room to continue breastfeeding her first child, and spoke positively about breastfeeding.
The factory directors I spoke to were clear that they needed to comply with the maternity leave law, and that women should not be discriminated against; their jobs are waiting for them when they complete the six months. The factory directors were also supportive of breastfeeding, as was the trade union.
UNICEF and Alive and Thrive are now advocating for two new laws in Vietnam: to make breastfeeding breaks and lactation rooms mandatory for all workplaces, and to establish day care centers in all work places.
As I left Ho Chi Minh City to return to my office in Bangkok, I looked back on the nutrition programmes I had seen in such different parts of Vietnam and reflected on the strong policies and laws in place, the commitment of the hospital workers to support mothers to breastfeed their newborns, the efforts of the district staff to bring nutrition programmes to the remote Hmong communities and the excellent support of UNICEF Vietnam.
Impressive indeed, and already bearing fruit: the Global Nutrition Report 2015 rates Vietnam as on course to achieve four of the five global nutrition goals assessed, including stunting and exclusive breastfeeding.
Christiane Rudert is Regional Nutrition Adviser for UNICEF East Asia and Pacific