title: Gaps between breastfeeding awareness and practices in Vietnamese mothers result from inadequate support in health facilities and social norms.
abstract: BACKGROUND
  Although gaps between breastfeeding awareness and practices have been described, determinants of the gaps have not been well investigated.
  
  
  OBJECTIVE
  The aim of this study was to examine determinants of the gap between breastfeeding awareness and practices in Vietnam.
  
  
  METHODS
  We interviewed 10,834 mothers with children aged 0-23 mo in 11 of 63 Vietnam provinces about breastfeeding practices, awareness, barriers, and support. A gap between awareness and practice was defined when a mother was aware of the benefit but did not perform the corresponding practice. Logistic regression models were used to examine determinants associated with the gaps.
  
  
  RESULTS
  The percentages of mothers with an awareness-practice gap for early initiation of breastfeeding, exclusive breastfeeding (EBF), continued breastfeeding at 1 y, and continued breastfeeding at 2 y were 34%, 66%, 19%, and 49%, respectively. Mothers had a lower awareness-practice gap in early initiation of breastfeeding if they received breastfeeding support from a health worker during pregnancy (OR: 0.79; 95% CI: 0.69, 0.92) or at birth (OR: 0.73; 95% CI: 0.60, 0.88). This gap was more likely to occur among those with a natural birth in the hospital (OR: 1.92; 95% CI: 1.50, 2.45), cesarean delivery (OR: 28.95; 95% CI: 20.1, 44.7), and breastfeeding difficulties (OR: 1.52; 95% CI: 1.21, 1.90). For EBF, the gap was lower among mothers with a higher social norm (OR: 0.20; 95% CI: 0.15, 0.27) or when they received breastfeeding support at birth by a health worker (OR: 0.82; 95% CI: 0.70, 0.95). In addition, intention of feeding infant formula at birth and having breastfeeding difficulties were associated with an increased gap in EBF [ORs (95% CIs): 1.28 (1.08, 1.51) and 1.29 (1.06, 1.57), respectively]. For continued breastfeeding at 1 y, social norms were associated with a lower gap (OR: 0.61; 95% CI: 0.41, 0.91), whereas breastfeeding difficulties were associated with an increased gap (OR: 1.70; 95% CI: 1.12, 2.57).
  
  
  CONCLUSIONS
  Reducing breastfeeding awareness-practice gaps requires strengthening breastfeeding support in health facilities and the sociocultural environment to make desired practices normative.
authors.affiliation: Alive & Thrive Project, Family Health International 360, Hanoi, Vietnam; tuan_72@yahoo.com tnguyen@fhi360.org.
authors.forename: Nguyen T
authors.initials: NT
authors.lastname: Tuan
authors.affiliation: International Food Policy Research Institute, Hanoi, Vietnam; and.
authors.forename: Phuong H
authors.initials: PH
authors.lastname: Nguyen
authors.affiliation: Alive & Thrive Project, Family Health International 360, Hanoi, Vietnam;
authors.forename: Nemat
authors.initials: N
authors.lastname: Hajeebhoy
authors.affiliation: Arnold School of Public Health, University of South Carolina, Columbia, SC.
authors.forename: Edward A
authors.initials: EA
authors.lastname: Frongillo
mesh_terms: D001942:Breast Feeding; D005260:Female; D006266:Health Education; D006268:Health Facilities; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D007223:Infant; D007227:Infant Nutritional Physiological Phenomena; D007231:Infant, Newborn; D016015:Logistic Models; D016017:Odds Ratio; D012944:Social Support; D014744:Vietnam