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Walters D, Eberwein JD, Sullivan LM, D'Alimonte MR, Shekar M. Reaching the Global Target to Increase Exclusive Breastfeeding: How Much Will It Cost and How Can We Pay for It? Breastfeed Med 2016; 11:413-5. [PMID: 27682459 DOI: 10.1089/bfm.2016.0128] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
There is an urgent need for global action to increase the rates of exclusive breastfeeding. In 2012, the World Health Assembly (WHA) set a global target to increase the rate of exclusive breastfeeding in the first 6 months up to at least 50% by 2025. However, current investment levels are insufficient to drive the kind of progress that is needed to meet the target. Reaching the global nutrition target of increasing exclusive breastfeeding to 50% will require an average annual investment of $570 million over 10 years in addition to what is currently being spent. This investment is projected to result in an additional 105 million children being exclusively breastfed and at least 520,000 child deaths prevented over the next 10 years. This analysis was part of an investment framework developed by the World Bank, Results for Development Institute, and 1,000 Days to provide policy makers with a roadmap for how to reach four of the six WHA global nutrition targets: decreasing childhood stunting, decreasing childhood wasting, decreasing rates of anemia in women of reproductive age, and increasing exclusive breastfeeding in the first 6 months.
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202
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Aguayo VM, Gupta G, Singh G, Kumar R. Early initiation of breast feeding on the rise in India. BMJ Glob Health 2016; 1:e000043. [PMID: 28588936 PMCID: PMC5321339 DOI: 10.1136/bmjgh-2016-000043] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 07/05/2016] [Accepted: 07/06/2016] [Indexed: 11/29/2022] Open
Affiliation(s)
- Víctor M Aguayo
- United Nations Children's Fund (UNICEF) Regional Office for South Asia, Kathmandu, Nepal
| | | | | | - Rakesh Kumar
- Ministry of Health and Family Welfare, New Delhi, India
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May PA, Hasken JM, Blankenship J, Marais AS, Joubert B, Cloete M, de Vries MM, Barnard R, Botha I, Roux S, Doms C, Gossage JP, Kalberg WO, Buckley D, Robinson LK, Adnams CM, Manning MA, Parry CDH, Hoyme HE, Tabachnick B, Seedat S. Breastfeeding and maternal alcohol use: Prevalence and effects on child outcomes and fetal alcohol spectrum disorders. Reprod Toxicol 2016; 63:13-21. [PMID: 27174445 PMCID: PMC4987236 DOI: 10.1016/j.reprotox.2016.05.002] [Citation(s) in RCA: 44] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2015] [Revised: 04/29/2016] [Accepted: 05/05/2016] [Indexed: 11/28/2022]
Abstract
OBJECTIVE Determine any effects that maternal alcohol consumption during the breastfeeding period has on child outcomes. METHODS Population-based samples of children with fetal alcohol spectrum disorders (FASD), normally-developing children, and their mothers were analyzed for differences in child outcomes. RESULTS Ninety percent (90%) of mothers breastfed for an average of 19.9 months. Of mothers who drank postpartum and breastfed (MDPB), 47% breastfed for 12 months or more. In case control analyses, children of MDPB were significantly lighter, had lower verbal IQ scores, and more anomalies in comparisons controlling for prenatal alcohol exposure and final FASD diagnosis. Utilizing a stepwise logistic regression model adjusting for nine confounders of prenatal drinking and other maternal risks, MDPB were 6.4 times more likely to have a child with FASD than breastfeeding mothers who abstained from alcohol while breastfeeding. CONCLUSIONS Alcohol use during the period of breastfeeding was found to significantly compromise a child's development.
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Affiliation(s)
- Philip A May
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States; The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States; Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa.
| | - Julie M Hasken
- The University of North Carolina at Chapel Hill, Nutrition Research Institute, United States
| | - Jason Blankenship
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Anna-Susan Marais
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Belinda Joubert
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marise Cloete
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Marlene M de Vries
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Ronel Barnard
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Isobel Botha
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Sumien Roux
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - Cate Doms
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
| | - J Phillip Gossage
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Wendy O Kalberg
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - David Buckley
- The University of New Mexico, Center on Alcoholism, Substance Abuse and Addictions, United States
| | - Luther K Robinson
- State University of New York, Buffalo, Department of Pediatrics, United States
| | - Colleen M Adnams
- University of Cape Town, Department of Psychiatry and Mental Health, South Africa
| | - Melanie A Manning
- Stanford University School of Medicine, Departments of Pathology and Pediatrics, United States
| | - Charles D H Parry
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa; Medical Research Council of South Africa, Alcohol, Tobacco & Other Drug Research Unit, South Africa
| | - H Eugene Hoyme
- Sanford Research, University of South Dakota Sanford School of Medicine, Department of Pediatrics, United States
| | | | - Soraya Seedat
- Stellenbosch University, Faculty of Medicine and Health Sciences, South Africa
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Bærug A, Langsrud Ø, Løland BF, Tufte E, Tylleskär T, Fretheim A. Effectiveness of Baby-friendly community health services on exclusive breastfeeding and maternal satisfaction: a pragmatic trial. MATERNAL & CHILD NUTRITION 2016; 12:428-39. [PMID: 27062084 PMCID: PMC5071711 DOI: 10.1111/mcn.12273] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/19/2015] [Revised: 11/25/2015] [Accepted: 11/26/2015] [Indexed: 11/28/2022]
Abstract
The WHO/UNICEF Baby-friendly Hospital Initiative has been shown to increase breastfeeding rates, but uncertainty remains about effective methods to improve breastfeeding in community health services. The aim of this pragmatic cluster quasi-randomised controlled trial was to assess the effectiveness of implementing the Baby-friendly Initiative (BFI) in community health services. The primary outcome was exclusive breastfeeding until 6 months in healthy babies. Secondary outcomes were other breastfeeding indicators, mothers' satisfaction with the breastfeeding experience, and perceived pressure to breastfeed. A total of 54 Norwegian municipalities were allocated by alternation to the BFI in community health service intervention or routine care. All mothers with infants of five completed months were invited to participate (n = 3948), and 1051 mothers in the intervention arm and 981 in the comparison arm returned the questionnaire. Analyses were by intention to treat. Women in the intervention group were more likely to breastfeed exclusively compared with those who received routine care: 17.9% vs. 14.1% until 6 months [cluster adjusted odds ratio (OR) = 1.33; 95% confidence interval (CI): 1.03, 1.72; P = 0.03], 41.4% vs. 35.8% until 5 months [cluster adjusted OR = 1.39; 95% CI: 1.09, 1.77; P = 0.01], and 72.1% vs. 68.2% for any breastfeeding until 6 months [cluster adjusted OR = 1.24; 95% CI: 0.99, 1.54; P = 0.06]. The intervention had no effect on breastfeeding until 12 months. Maternal breastfeeding experience in the two groups did not differ, neither did perceived breastfeeding pressure from staff in the community health services. In conclusion, the BFI in community health services increased rates of exclusive breastfeeding until 6 months. © 2015 Blackwell Publishing Ltd.
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Affiliation(s)
- Anne Bærug
- Norwegian National Advisory Unit on Breastfeeding, Women and Children's DivisionOslo University HospitalOsloNorway
| | | | - Beate F. Løland
- Norwegian National Advisory Unit on Breastfeeding, Women and Children's DivisionOslo University HospitalOsloNorway
| | - Elisabeth Tufte
- Norwegian National Advisory Unit on Breastfeeding, Women and Children's DivisionOslo University HospitalOsloNorway
| | | | - Atle Fretheim
- Global Health UnitNorwegian Knowledge Centre for the Health ServicesOsloNorway
- Institute of Health and SocietyUniversity of OsloOsloNorway
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Nguyen PH, Kim SS, Nguyen TT, Hajeebhoy N, Tran LM, Alayon S, Ruel MT, Rawat R, Frongillo EA, Menon P. Exposure to mass media and interpersonal counseling has additive effects on exclusive breastfeeding and its psychosocial determinants among Vietnamese mothers. MATERNAL AND CHILD NUTRITION 2016; 12:713-25. [PMID: 27334544 PMCID: PMC5094561 DOI: 10.1111/mcn.12330] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Revised: 03/08/2016] [Accepted: 03/31/2016] [Indexed: 11/28/2022]
Abstract
The pathways through which behavior change interventions impact breastfeeding practices have not been well studied. This study aimed to examine: (1) the effects of exposure to mass media and interpersonal counseling on exclusive breastfeeding (EBF) and hypothesized psychosocial determinants (i.e. knowledge, intention, beliefs, social norms, and self-efficacy); and (2) the pathways through which exposure to mass media and interpersonal counseling are associated with EBF. We used survey data from mothers with children < 2 year (n = 2045) from the 2013 process evaluation of Alive & Thrive's program in Viet Nam. Multiple linear regression analyses and structural equation modeling were used to estimate effects. Exposure to mass media only, interpersonal counseling only, both or neither was 51%, 5%, 19% and 25%, respectively. Exposure to both mass media and interpersonal counseling had additive effects on EBF as well as on related psychosocial factors, compared with no exposure. For example, EBF prevalence was 26.1 percentage points (pp) higher in the group that received interpersonal counseling only, 3.9 pp higher in the mass media group and 31.8 pp higher in the group that received both interventions. As hypothesized, more than 90% of the total effect of the two interventions on EBF was explained by the psychosocial factors measured. Our findings suggest that combining different behavior change interventions leads to greater changes in psychosocial factors, which in turn positively affects breastfeeding behaviors.
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Affiliation(s)
- Phuong H Nguyen
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, USA.
| | - Sunny S Kim
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, USA
| | | | | | | | | | - Marie T Ruel
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, USA
| | - Rahul Rawat
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, USA
| | - Edward A Frongillo
- Health Promotion, Education, Behavior, University of South Carolina, Columbia, South Carolina, USA
| | - Purnima Menon
- Poverty, Health and Nutrition Division, International Food Policy Research Institute, USA
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208
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Rosin SI, Zakarija-Grković I. Towards integrated care in breastfeeding support: a cross-sectional survey of practitioners' perspectives. Int Breastfeed J 2016; 11:15. [PMID: 27274761 PMCID: PMC4891910 DOI: 10.1186/s13006-016-0072-y] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2015] [Accepted: 05/09/2016] [Indexed: 11/10/2022] Open
Abstract
Background Integrated care is defined as concerted action of healthcare providers ensuring continuity of care within a patient-centered approach, thus contributing to healthcare efficiency and quality. Apart from the WHO/UNICEF Baby-Friendly Initiatives, integrated care has been poorly explored within the context of breastfeeding support. The aim of this study was to investigate the experience of breastfeeding support practitioners, identifying barriers and facilitators towards integrated care. Methods A 62-item survey was conducted among 900 participants at 3 international breastfeeding conferences. Analysis included uni-and bivariate descriptive statistics, categorizing of mutually exclusive response groups and thematic networks analysis of responses to 18 open-ended items. Results Three-hundred-and-one participants (33 % response), from 34 predominantly industrialized countries (98 %) on nearly all continents, responded to the survey. Norwegian residents alone, felt sufficiently supported in providing breastfeeding support by other healthcare providers, the work environment, society, the media and their National Breastfeeding Committee (P < 0.05). Out of 11 suggested measures for effective breastfeeding promotion, 96 % of respondents ranked integrated care as the most important. The largest response group identified in open-ended items, as a major barrier to integrated care in breastfeeding support, was “lacking or failing health promotion strategies” (n = 454), followed by “a lack of vertically integrated care” (n =268), described mainly as unsatisfactory cooperation within healthcare. This inconsistency of care also impairs “shared decision-making” on infant feeding for parents, including accessibility of information and support (n = 265). Among other measures, 29 % of respondents recommended incentivizing integrated breastfeeding support within healthcare. Two figures, based on open-ended response evaluations, illustrate participants’ ideas of the National Breastfeeding Committees’ role in coordinating policies and protagonists towards integrated breastfeeding support, and a family-centered model of integrated care to facilitate successful breastfeeding. Conclusions According to practitioners in breastfeeding support, integrated care is essential for successful breastfeeding. Quality and accessibility of breastfeeding support should be motivated by healthcare system incentives, to counter the reported lack of consistency of care within and beyond healthcare. To effectively integrate a continuum of breastfeeding support into healthcare and society, a policy consensus and strong political action are indispensable, with coordination by an empowered National Breastfeeding Committee. Electronic supplementary material The online version of this article (doi:10.1186/s13006-016-0072-y) contains supplementary material, which is available to authorized users.
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209
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Pérez-Escamilla R, Hall Moran V. Scaling up breastfeeding programmes in a complex adaptive world. MATERNAL AND CHILD NUTRITION 2016; 12:375-80. [PMID: 27161881 DOI: 10.1111/mcn.12335] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
The 2016 Breastfeeding Lancet Series continues to provide unequivocal evidence regarding the numerous benefits that optimal breastfeeding practices offer to children and women worldwide and the major savings that improving these practices can have as a result of their major public health benefits. Unfortunately, this knowledge remains underutilized as there has been little progress scaling up effective breastfeeding programmes globally. Improving the uptake and scaling up of effective national breastfeeding programmes that are potent enough to improve exclusive breastfeeding duration should be a top priority for all countries. Complex analysis systems longitudinal research is needed to understand how best to empower decision makers to achieve this goal through well-validated participatory decision-making tools to help their countries assess baseline needs, including costs, as well as progress with their scaling-up efforts. Sound systems thinking frameworks and scaling-up models are now available to guide and research prospectively future scaling-up efforts that can be replicated, with proper adaptations, across countries.
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Affiliation(s)
- Rafael Pérez-Escamilla
- Department of Chronic Disease Epidemiology, Yale School of Public Health, New Haven, Connecticut, USA
| | - Victoria Hall Moran
- Maternal and Infant Nutrition and Nurture Unit, Brook Building, University of Central Lancashire, Preston, UK
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Rollins NC, Bhandari N, Hajeebhoy N, Horton S, Lutter CK, Martines JC, Piwoz EG, Richter LM, Victora CG. Why invest, and what it will take to improve breastfeeding practices? Lancet 2016; 387:491-504. [PMID: 26869576 DOI: 10.1016/s0140-6736(15)01044-2] [Citation(s) in RCA: 1206] [Impact Index Per Article: 150.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.
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Affiliation(s)
- Nigel C Rollins
- Department of Maternal, Newborn, Child and Adolescent Health (MCA), WHO, Geneva, Switzerland.
| | - Nita Bhandari
- Centre for Health Research and Development, Society for Applied Studies, New Delhi, India
| | | | - Susan Horton
- Department of Economics, University of Waterloo, ON, Canada
| | - Chessa K Lutter
- Department of Noncommunicable Diseases and Mental Health, WHO, Geneva, Switzerland
| | - Jose C Martines
- Centre for Intervention Science in Maternal and Child Health (CISMAC), Centre for International Health, University of Bergen, Norway
| | - Ellen G Piwoz
- Global Development Program, Bill & Melinda Gates Foundation, Washington, DC, USA
| | - Linda M Richter
- DST-NRF Centre of Excellence in Human Development, University of the Witwatersrand, Johannesburg, South Africa
| | - Cesar G Victora
- International Center for Equity in Health, Post-Graduate Programme in Epidemiology, Federal University of Pelotas, Pelotas, Brazil
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