Team parenting support in Vietnam improves breastfeeding, the parental relationship and early childhood development

When mothers report fathers as being responsive to their needs, exclusive breastfeeding is more likely, the parental relationship is stronger, and early childhood development is better.

A team parenting support program in Vietnam has shown positive results in three areas: the parental relationship, exclusive breastfeeding and early childhood development. The programme encouraged two things: support by fathers of mothers’ breastfeeding and direct father-baby interaction.

The primary researchers, Lynn Rempel and John Rempel, looked at different ways that fathers can support breastfeeding and found that these ways were differently linked to breastfeeding, relationship quality, and early childhood development outcomes.

Using a 25-point “Partner Breastfeeding Influence Scale” developed and tested earlier by the researchers themselves, the scale identifies four types of support by the father:

• Seeking out and conveying knowledge about the value and means to achieve successful breastfeeding – termed “savvy”
• Being together and working directly with the mother in ways that support successful breastfeeding – termed “presence”
• Active physical caretaking for the mother and baby that facilitates breastfeeding – termed “helping”
• Being sensitive to what the mother needs and responding in ways that support breastfeeding – termed “responsiveness”.

“Helping” and “responsiveness” were found to be particularly linked to positive outcomes. The Rempels suggest that these two types of support describe a “teamwork” approach around breastfeeding, where fathers are not too directive and do not try to provide support when it is not needed. In a team of only two, both partners must have a generalised, flexible skillset and be sensitive to the moment and ready to adjust to changes. Much health research has found that family support can sometimes have negative effects if it is not delivered sensitively and responsively to the recipient’s needs – that is, if it undermines their sense of efficacy and personal control.

The program, which was tested in Vietnam in 2014 and involved 390 families, consisted of five elements:

• Prenatal groups for fathers on the topic of breastfeeding
• Home visits before the birth and in the three months after (at one, six and 15 weeks)
• Public messages broadcast over community loudspeakers each week
• Peer-led fathers’ clubs to enhance peer support
• A friendly public fathers’ contest between clubs to demonstrate fathers’ knowledge

(For a more detailed description of the program, based on an earlier published article by the researchers, see Supporting fathers to bond with and love their babies improves early child development and breastfeeding (Vietnam))

Through all these activities, three messages were delivered to fathers, and to the wider community, through the two public activities:

• The importance of exclusive breastfeeding
• The importance of parenting teamwork
• How and why to build an early father-infant relationship.

The program delivered improved outcomes in all three domains:

• The exclusive breastfeeding rate at one month was 35%, compared to 6% in a comparison group.
• For mothers, relationship quality from before birth to four months after the birth showed a significantly smaller decline in the program group than in the comparison group. Meanwhile, fathers reported an increase in relationship quality instead of the decline found in the comparison group. The relationship quality measure assessed intimacy, satisfaction, trust, and commitment.
• Improved child development scores at nine months in all areas – motor skills, personal-social abilities and, particularly, language skills.

All these improvements were partially explained by an increase in fathers’ breastfeeding support. All forms of father support, as reported by both fathers and mothers, were associated with longer exclusive breastfeeding, better relationship quality, and higher levels of infant language development.

In addition, two forms of support contributed over and above the others. Mothers’ assessment of fathers’ responsiveness to their needs stood out as a particularly strong predictor of positive outcomes in all three areas. And father’s own reports of their responsiveness more strongly predicted improved relationship quality and, to a lesser extent, infant language development.

Although ratings of fathers’ helpfulness did not have a standalone effect on exclusive breastfeeding, there were other important effects. Fathers’ reports of their own greater helpfulness predicted better motor and personal-social development in their infants; mothers’ positive assessment of fathers’ helpfulness was linked to better relationship quality and improved infant motor development.

Overall, fathers seemed to be more aware of the tangible help they were providing, and mothers were more influenced by the father’s sensitivity and responsive acts of caring.

In addition, the Rempels found that higher relationship quality predicted improved developmental outcomes for children. Mothers’ reporting a better relationship was linked to higher language scores; fathers’ reporting a better relationship was linked to higher scores on all early childhood development measures.

In Vietnam, as in many other low- and middle-income countries, cultural norms are in transition, and fathers are now expected to be more involved in caring for infants and young children. As this is a recent cultural change, however, fathers have limited information and experience. Vietnam has among the highest rates of child undernutrition and the lowest prevalence of exclusive breastfeeding in the world.