Scope of Good Practice
Alive & Thrive's multicomponent mass media campaign used formative research, behavior change theory, and top-notch creative to help mothers adopt a life-saving practice. Exclusive breastfeeding means that an infant receives only breastmilk with no additional foods or liquids, not even water. The benefits of exclusive breastfeeding on child survival, growth and development are well-documented. Exclusive breastfeeding is the single most effective intervention for preventing child deaths. With emotionally appealing visuals, charming voices of children and carefully crafted messages, this campaign broke through the clutter of Vietnam's sophisticated media environment to change social norms and increase breastfeeding.
The Problem Addressed by the Campaign
Child malnutrition persists in Vietnam. While most mothers (98 percent) breastfeed for a period of time, practices are suboptimal. Many mothers give their children water, use infant formula and/or introduce soft and semisolid foods too early (i.e., before 6 months of age). Only 62 percent put the baby to breast within the first hour of life. Even fewer, 20 percent of infants under 6 months of age, are exclusively breastfed, as recommended by the World Health Organization and the United Nations Children's Fund (UNICEF).
A&T reviewed behavioral and health survey data and conducted its own formative research to arrive at the decision that the best use of mass media would be to promote the practice of exclusive breastfeeding for 6 months. The campaign team's analysis showed that the "component" behavior of giving water (mothers mistakenly believe that without water, their babies will be thirsty or hot) is the biggest threat to exclusive breastfeeding, so one of the spots targets that behavior. Through a series of concept testing and pretesting, the team identified the most likely determinants of the behavior - knowledge, beliefs about outcomes, social norms and perceived behavioral control (mothers' confidence that their milk is adequate). The research led them to emphasize that global experts stand behind exclusive breastfeeding and that exclusive breastfeeding supports cognitive development.
Alive & Thrive Vietnam knew that to improve rates of exclusive breastfeeding at a scale large enough to have a population-level impact, we needed to support our face-to-face counseling with mass media. Mothers could already say that “breast is best,” but In Vietnam, the biggest threat to exclusive breastfeeding is that mothers give water and still think they are “exclusively” breastfeeding. Behavioral theory led the team to focus on social norms and on building mothers’ confidence (“Breastmilk has enough water and all the nutrition you need.”).
What better way to get the public’s attention than with adorable talking babies who dole out advice to their mothers? The creative was developed and produced by Ogilvy & Mather Vietnam. In this spot, "No Water," the baby directly addresses the misguided behavior of giving water to a baby under 6 months: “Mom, I don’t need to drink additional water!” The TV spot stresses not just “healthy” as an outcome of breastfeeding, but “smart” too – a powerful persuader among families we interviewed. Since the team learned that Vietnamese mothers are heavily swayed by science, the spot assures them that breastmilk is “proven globally.”
Alive & Thrive purchased placement of the TV spots on national and provincial TV stations. To further the reach of the spots, they are also played on screens in supermarkets and are posted on widely used websites. Additionally, the media campaign includes Internet, posters, bus wrap advertising, loudspeaker announcements and stories placed through earned media efforts.
A report on the first round of post-campaign evaluation will be available in June 2013. Preliminary data suggest that over 70 percent of mothers in the provinces surveyed reported seeing the campaign spots, and that exposure to the campaign may be associated with increases in exclusive breastfeeding for 6 months – even in areas of the country where the team did not deliver the other components of the program. Further, data seem to confirm the behavior change theory: exposure to the campaign is associated with changes in the selected behavioral determinants; and the behavioral determinants are associated with the behaviors being promoted.
Conclusions and Recommendations
Alive & Thrive, including this spot from the Vietnam mass media campaign, is funded by the Bill & Melinda Gates Foundation and managed by FHI 360. The Foundation has ensured that the campaign will be rigorously evaluated, making this the first breastfeeding mass media campaign to be studied in more than twenty years. Preliminary data already indicate that increases in Vietnamese breastfeeding practices are associated with exposure to this campaign. The evaluation is eagerly awaited by large donor organizations, like the World Bank, who seek evidence to support their investments in nutrition communication efforts in many additional countries. The team recommends that future health campaigns apply behavioral theory for strategic design.