Community‐based father education intervention on breastfeeding practice—Results of a quasi‐experimental study

Posted by Maria Codina on May 6, 2019 at 10:44 am

Although the benefits of breastfeeding are well‐documented, little is known about how best to encourage fathers to support breastfeeding. A quasi‐experimental
study of a community‐based intervention was designed to examine whether health education to promote fathers’ involvement in supporting women is associated with early initiation and exclusive breastfeeding practices. At baseline, 802 couples of fathers with pregnant wives from 12 to 27 weeks of gestational age were
recruited to either the intervention group (n = 390) or a control group (n = 412) consisting of couples seeking care through routine maternal and child health
services. Fathers in the intervention area received breastfeeding education and counselling services in health facilities and at home visits during the antenatal,
delivery, and post‐partum periods. Peer education and social exchange concerning breastfeeding were organized in fathers’ clubs. After 1 year of the intervention,
mothers in the intervention group were more likely to initiate early breastfeeding 49.2 and 35.8% in the intervention and control group respectively, P < 0.001. At
1, 4, and 6 months after birth, 34.8, 18.7, and 1.9% of the mothers in the intervention group were exclusively breastfeeding their children because of birth,
respectively, compared with 5.7, 4.0, and 0.0% of those in the control group (P < 0.001). Those practices were associated with the intervention in bivariate
and multivariate logistic and Cox regression analyses. Intervention targeting fathers at antenatal and postnatal periods may positively influence the breastfeeding
practices of mothers, and it should be an important component of breastfeeding programs.



Breastfeeding is positively associated with health, survival, and development of the infant and the health of the mother (Victora et al., 2016). The rate of early initiation of breastfeeding and exclusive breastfeeding (EBF) of infants less than 6 months of age in lowermiddle income countries was only about 32 and 37%, respectively (Victora et al., 2016). In Vietnam, most mothers (98%) breastfeed their children, but the proportion of early initiation and EBF among children between 4 and 6 months is low and varies by geographical area, socioeconomic status, and maternal education (Thrive, 2012; Tuyen & Hop, 2012). Current review indicates breastfeeding is not only a woman’s job (Rollins et al., 2016). It is affected by many individual factors including knowledge, education, workload, occupation (Dearden et al., 2002; Duong, Binns, & Lee, 2005), health of mother, method of delivery (Dearden et al., 2002; Forster, McLachlan, & Lumley, 2006; Prior et al., 2012), breastfeeding intention, and other factors (Meedya, Fahy, & Kable, 2010). Beyond individual factors, EBF is also influenced by family  gunbiade & Ogunleye, 2012; Otoo, Lartey, & Perez‐Escamilla, 2009), community‐level factors such as peer group pressures and cultural perceptions (Cohen, Brown, Rivera, & Dewey, 1999; Fjeld et al., 2008), and societal level factors (Meedya et al., 2010; Morrow, 1996).

Fathers influence breastfeeding initiation, duration, and exclusivity (Bar‐Yam & Darby, 1997). They are considered a social support for their wife’s breastfeeding (Hector, King, Webb, & Heywood, 2005; Meedya et al., 2010; Raj & Plicha, 1998) and a resource for child care and breastfeeding in the family (Clifford & McIntyre, 2008; Duong, Lee, & Binns, 2005). The role of fathers in supporting EBF has been included in the global strategy for breastfeeding promotion issued by the World Health Organization (WHO, 2003), but the role of father was not mentioned in the original Ten Steps to successful breastfeeding (WHO & UNICEF, 1989) or addressed explicitly in the revised version of the Ten Steps (WHO & UNICEF, 2018). Paternal intervention aims at strengthening breastfeeding  nowledge, positive attitudes, and involvement of fathers in providing practical, physical, and emotional support to the mother, which may improve breastfeeding practices of the mother (Brown & Davies, 2014; Sherriff, Hall, & Panton, 2014).

A review of four controlled trials carried out in western hospital settings targeting fathers during antenatal and postnatal periods, showed different effects when applying breastfeeding educational interventions (mainly in the form of class and open discussion) (Mitchell‐Box & Braun, 2013). Some studies showed positive effects on early initiation of breastfeeding (Wolfberg et al., 2004) and exclusive breastfeeding at 4 (Susin & Giugliani, 2008b) and 6 months (Pisacane, Continisio, Aldinucci, D’Amora, & Continisio, 2005) Other studies showed negative or moderate effects on exclusive breastfeeding (Abbass‐Dick, Stern, Nelson, Watson, & Dennis, 2015; Maycock et al., 2013). Based on current literature, community‐based interventions have been widely and effectively used in promoting EBF (Haroon, Das, Salam, Imdad, & Bhutta, 2013; Sinha et al., 2015). Recently, results of a unique community-based father intervention carried out in Vietnam showed that a combination of mass media approaches with group and individual education programs in commune health centres and counselling during
home visits might increase the involvement of fathers in supporting breastfeeding and the proportion of early initiation and EBF at 1, 4, and 6 months (Bich et al., 2016; Bich & Cuong, 2017; Bich, Hoa, & Malqvist, 2014). In this study, the lack of information between intervention and control sites about the equivalence of breastfeeding practices at the baseline and the failure to establish a network of fathers with participation of local health workers and stakeholders may reduce the validity and sustainability of intervention on breastfeeding practices.

The aim of the current study was to evaluate an integrated community‐based educational intervention targeting fathers at antenatal, delivery, and postnatal periods for supporting breastfeeding practices in Vietnam. We hypothesized that after the intervention, the community under intervention will have higher proportions of women practicing early breastfeeding initiation and exclusive breastfeeding at 1, 4, and 6 months than women in the control community.


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