Understanding how Infant Formula Information, Communication Channels, and Traditional Health Beliefs Affect Exclusive Breastfeeding Practices among Women in Palawan, the Philippines: A Convergent-parallel Mixed Methods Study

Exclusive breastfeeding (EBF) means that infants should only receive breast milk for the first six months of life. It is essential for both maternal and child health. In the Philippines, although various institutions have reported differing EBF rates, the overall prevalence remains low. According to the United Nations Children’s Fund (UNICEF), the country's EBF rate was only 40.9% in 2024. Existing research has shown the influence of infant formula (IF) marketing, communication channels, and traditional health beliefs on EBF, suggesting that these three factors may be possible contributors to the low EBF rate in the Philippines, including in its diverse regions. Palawan, an island province in the Mimaropa region, served as the primary study site due to its varied topographies, cultural diversity, limited EBF research, and existing collaboration with International Care Ministries (ICM). The current study aimed to understand how infant formula information, communication channels, and traditional health beliefs (THBs) affect the low EBF rate among women in Palawan, Philippines. A mixed-method convergent research design and the Diffusion of Innovation (DoI) theory were applied. Quantitative results show multiple factors were significantly associated with EBF, particularly those relevant to socioeconomic status and geographic remoteness. The qualitative results show that IF information had more influence on urban working mothers, leading them to adopt the use of IF, while people in remote areas had limited infrastructure, access, and exposure to IF. People in remote areas practiced more THBs, which were reflected in dominant societal narratives about breastfeeding, but not acknowledged by many health professionals. By comparing and triangulating both strands, the current study shows that IF information and THBs disseminated through different communication channels influenced EBF in Palawan, the Philippines, and demonstrates that both mixed methods and DoI can deepen the understanding of EBF practices. Given the significant differences in infrastructure, communication channels, and social systems between urban and remote areas, different strategies should be designed to promote EBF in these different areas. Future research should focus on the under-reported and under-studied extremely remote areas to design projects that promote EBF in a manner compatible with local practices and contexts.

Department dc:contributor.department

Dalla Lana School of Public Health

Year dc:date.issued

2025

Author dc:creator

• Wang, Zeyuan

Advisor dc:contributor.advisor

• Di Ruggiero, Erica ER

• Diffusion of Innovation
• Exclusive Breastfeeding
• Infant Formula Marketing
• Mixed Methods
• the Philippines
• Traditional Health Beliefs

Statement dc:rights

• Attribution-NoDerivatives 4.0 International

Licence dc:rights.uri

• http://creativecommons.org/licenses/by-nd/4.0/

Handle dc:identifier.uri

https://hdl.handle.net/1807/150751

OAI identifier oai:identifier

oai:utoronto.scholaris.ca:1807/150751