In 2009, Alive & Thrive found that while almost all Vietnamese mothers breastfed, only about 20% practiced the ideal behavior of exclusive breastfeeding for their baby’s first 6 months of life. As a result, they sought to improve exclusive breastfeeding practices and national rates through a mass media campaign. The organization estimated they reached 2.3 million mothers of children under 2 years and a year into the campaign, the exclusive breastfeeding rates rose from 26% to 48%. In the following years, rates reached as high as 62% in certain provinces and are growing still in many areas The campaign was highly cost effective and the use of mass media is ubiquitous- virtually every country contains mass media channels - but a media audit is critical to evaluate which outlets will reach the largest target population.
Description & Context
Alive & Thrive’s (A&T) campaign used many different channels of mass media including broadcast (TV spots on national and regional TV stations), out-of-home (print ads on outside of buses, billboards, posters in health clinics, TV spots displayed on LCD screens in hospitals, health centers, and supermarkets), and online channels (a website dedicated to infant and young child feeding, an interactive online counseling & mothers’ forum, TV spots placed on Vietnamese websites popular with women, a Facebook fan page, a mobile app to connect young mothers and allow them to track baby’s milestones, share photos, access feeding recommendations). All channels of media targeted their messages to women who are pregnant or have children under 6 months of age.
In addition, A&T supported six provinces in organizing eight breastfeeding events in August 2013 as part of World Breastfeeding Week. Each event attracted 80-200 pregnant women, mothers, and caregivers with their young children and featured musical performances, contests, presentations by health professionals, and on-site counseling. Women also shared their breastfeeding experiences. Representatives from the People’s Committee and People’s Council attended and gave opening speeches at the events, which were covered in the media, including a live broadcast on Thanh Hoa’s provincial television channel. These events were an extension of A&T’s advocacy work to increase nutrition knowledge and empower provincial leaders to take positive action towards improving nutrition.
A&T also collaborated with UNICEF and the Center for Health Education (MOH) to organize a field trip to five provinces for reporters from Viet Nam Television (VTV) and several key newspapers to observe infant and young child feeding counseling services at the Mat Troi Be Tho franchises and to visit lactation rooms at business enterprises. The visits resulted in two TV reports and more than 30 published articles.
In addition to mothers, media reached families, community leaders, and health providers, and helped to shape social norms, creating an environment that supported behavior change. Just a year into the mass media campaign, the behavior of exclusive breastfeeding up to 6 months of age had risen dramatically from 26% to 48%. In the following years, rates reached as high as 62% in certain provinces are growing still in many areas.
Alive & Thrive Viet Nam’s six steps (see infograph above)
Evidence of Implementation Strategy
A&T conducted three rounds of data collection in a subset of four provinces over the next three years. Each wave of data collection was timed to follow a burst of the TV campaign (note that there were other media employed too). Data collection included surveys given to mothers of children under 6 months of age to understand attitudes and determinants of behavior.
Cost and Cost-Effectiveness
Television is the most commonly used medium in Vietnam: 81.8% of the population watched TV the previous day, while 96.9% reported watching within the past week. More than one in four Vietnamese (26.3%) say they had used the Internet in the past week, which is much higher than neighboring countries. In a population of 90 million, mass media through television is the most cost-effective measure.
Perceptions and Experiences of Interested People
Social norms regarding breastfeeding clearly shifted: when A&T Viet Nam asked mothers whether they agreed that people whose opinions they cared about thought that they should give breastmilk only—no water, no infant formula, no semisolid food—for their baby’s first 6 months: 68% of those exposed to the TV spots agreed, compared to 46% of mothers not exposed to the spots.
Results were similar when they asked mothers if they believed that other mothers were giving only breastmilk: 66% of mothers who had seen the spots agreed, and 47% of those who had not been exposed agreed. Additionally, eighteen months into the mass media campaign, 85% of mothers exposed to the campaign were confident that their breastmilk alone offered all the nutrients baby needs for 6 months, compared with 72% of mothers not exposed to the campaign.
Benefits/ Potential Damages and Risks
Exclusive breastfeeding for the first 6 months of life is the single most effective intervention for preventing child deaths. Exclusive breastfeeding—breastfeeding only with no additional foods or liquids, including water—can improve a child’s future growth, development, educational achievement, and even economic status.
Potential risks from a mass media campaign include the failure to reach the intended, large audience depending on the avenues of communication in the country. Another potential risk is the failure of the mass media campaign in promoting the uptake of the intended message and thus behavior change in the target audience, due to the campaign’s content, style, or other factors such as the belief in the credibility of the media.
Resources for a professional, commercial-style campaign could be scarce (i.e. technical professionals to develop the media ad, insufficient purchased airtime). The mass media outlet may be crowded, meaning that purchased spots may not be able to air at the appropriate times or stand out to reach the target audience.
Scaling Up Considerations
Virtually every country contains mass media channels, whether that be broadcast, out-of-home, or online. It is critical to undertake a media audit to evaluate which media/channel is appropriate to use in the country to reach the target audience.
Sufficient funds must be used to ensure a “mass” media campaign that reaches a majority of the target population. Timing, location, and other characteristics of the campaign must be designated to reach the maximum target population.
Barriers to Implement
Determining funding sources to cover costs of creating a mass media campaign. Formulating an appropriate and convincing campaign with the intended message.
Lower-income pregnant women and women with children may not have access to personal mass media outlets such as internet or television. Rural inhabitants may also face similar problems. The media audit is critical to evaluate which outlets will reach the largest target population.
- Strategic Design of Mass Media: promoting breastfeeding in Viet Nam. (2015). Alive & Thrive. Retrieved from http://aliveandthrive.org/resources/tool-strategic-design-of-mass-media-to-promote-breastfeeding/
- A&T Viet Nam Celebrates World Breastfeeding Week 2013. (2013). Alive & Thrive. Retrieved from http://aliveandthrive.org/alive-thrive-viet-nam-celebrates-world-breastfeeding-week-2013/
- SBCC Spotlight: Alive & Thrive Viet Nam: Talking Babies Media Campaign. (2014). Retrieved from http://www.thehealthcompass.org/sbcc-spotlights/alive-thrive-viet-nam-talking-babies-media-campaign
- Engaging the Media: A practical guide to meeting child nutrition advocacy goals through working with journalists. (2013). Alive & Thrive. Retrieved from http://aliveandthrive.org/wp-content/uploads/2014/11/How-to-Guide-Media_Engagement-Oct-2013.pdf
- Viet Nam Breastfeeding Campaign Normalizes Practice, Improves Rates. (2016). WHO. Retrieved from http://www.who.int/features/2016/Viet-Nam-breastfeeding-campaign/en/
- Media Use in Vietnam 2013. (2013). Broadcasting Board of Governors. Retrieved from https://www.bbg.gov/wp-content/media/2013/12/Vietnam-research-brief-final1.pdf
Authors: Sara Meyers, Katie Doucet and Gabriela Buccini