Influence of Cultural Beliefs on Infant Feeding, Postpartum and Childcare Practices among Chinese-American Mothers in New York City

The role of breastfeeding support in racial/ethnic disparities in breastfeeding practices

BACKGROUND

Persistent racial/ethnic disparities in breastfeeding practices in the United States are well documented but the underlying causes remain unclear. While racial/ethnic disparities are often intertwined with socioeconomic disparities in breastfeeding, studies suggest that lack of breastfeeding support from family, health care organizations and workplaces may contribute to racial/ethnic disparities in breastfeeding rates. No studies have investigated the extent to which racial/ethnic disparities in breastfeeding practices can be explained by breastfeeding support.

METHODS

We used survey data from participants of a federal nutrition assistance program in Los Angeles County, the most populous county in the United States, to examine causal mechanisms underlying racial/ethnic disparities in breastfeeding in five groups: Spanish-speaking Latina, English-speaking Latina, Non-Hispanic White (NHW), Non-Hispanic Black (NHB) and Non-Hispanic Asian (NHA). Applying causal mediation analysis, this study estimated the proportion of racial/ethnic differences in breastfeeding ('any' breastfeeding, i.e., partial or exclusive) rates at 6 months that could be explained by differential access to breastfeeding support from family, birth hospitals and workplaces.

RESULTS

NHB and English-speaking Latina mothers were less likely, and Spanish-speaking Latina mothers more likely to breastfeed through 6 months than NHW mothers. Lack of breastfeeding support from family, hospitals and workplaces accounted for approximately 68% of the difference in any breastfeeding rates at 6 months between NHW and NHB mothers and 36% of the difference between NHW and English-speaking Latina mothers.

CONCLUSION

These findings highlight the importance of improving support from family, hospitals and workplaces for breastfeeding mothers to reduce racial/ethnic disparities in breastfeeding.

Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.

Impacts of family care for children and the elderly on women's employment: evidence from rural China

Introduction

China's traditional culture makes rural women and men take on different family responsibilities.

Methods

Use "China Family Panel Studies" (CFPS) data and build Logit and propensity score matching models to empirically study the impact of children care and elderly care on rural married women going out to work. And explore the welfare effects of basic education public services in helping rural women take care of their families.

Results

The results show that caring for children has a significant hindering effect on rural married women's job hunting. Especially for those in low-income families, the employment inhibition is most significant among women aged 20-30 with multiple children. Contrary to previous cognition, supporting the elderly has a certain weak stimulating effect. The kindergarten public services in rural areas can help women take care of their children and relieve their work pressure. The primary school public services have not played a role in alleviating them.

Discussion

This shows that there are still a large number of female laborers in rural China who are unable to go out to work due to family care. The improvement of rural basic education public services can promote more rural women going out to work. This finding will provide a policy reference for the introduction of a formal care system and the establishment of basic education public services in China.

Infant Feeding Practices and Social Support Networks Among Immigrant Chinese American Mothers With Economic Disadvantage in New York City

BACKGROUND

Maternal social support promotes healthy infant feeding practices, which influence healthy growth and development. Less is known about how the interplay of social support networks and multicultural health beliefs may influence infant feeding practices, particularly among immigrant Chinese American mothers with economic disadvantage and low breastfeeding rates.

RESEARCH AIM

To explore the role of social support networks in the development of infant feeding practices in immigrant Chinese American mothers with infants.

METHODS

This was a prospective, cross-sectional qualitative study where we conducted semi-structured interviews in Mandarin, Cantonese, or English with Chinese American mothers of infants (N = 25) at a federally qualified health center in the Sunset Park neighborhood of Brooklyn, New York. Data were analyzed by a multicultural, multidisciplinary team using qualitative thematic analysis and the constant comparative method to identify and iteratively refine emerging codes.

RESULTS

Three themes emerged describing how broad transnational communities and close family and friends influence maternal-infant feeding practices: (1) Gathering and processing infant feeding information from broad transnational resources (i.e., from both the mother's country of residence and the mother's country of origin); (2) aligning maternal feeding attitudes with cultural health beliefs of local social networks; and (3) gaining confidence with transactional maternal-infant feeding interactions.

CONCLUSIONS

Strategies to promote healthy infant feeding should consider how family supports and culturally-relevant coaching can help align multilevel transnational social networks with healthy infant feeding practices.

Factors that influence women's decision on infant feeding: An integrative review

BACKGROUND

Many women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women's antenatal breastfeeding decisions, the factors that influence women's decisions during the continuum of antenatal and postnatal period are less known.

AIM

To understand and synthesise the contemporary factors that influence women's decisions on infant feeding from the antenatal period and across the breastfeeding continuum.

METHOD

Five online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes.

FINDINGS

Five main themes were identified: (a) Women's own views, (b) Family and friend's preferences and advice, (c) Health professional's preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women's intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory.

CONCLUSION

The factors that influence women's decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions.

Parental considerations during complementary feeding in higher income countries: a systematic review of qualitative evidence

OBJECTIVE

Worldwide data suggest a clash between parental complementary feeding practices and recommendations. Understanding the circumstances under which parents form their feeding practices is a crucial step to improve such practices. This paper aimed to systematically review the existing qualitative literature and synthesise the factors that parents take into consideration in relation to complementary feeding.

DESIGN

A systematic review was undertaken. Four electronic databases were searched for qualitative studies published after 2001 exploring parental experiences during complementary feeding. A framework that included authors' outcomes of interest was used to extract and synthesise study findings. The Standards for Reporting Qualitative Research were used to critically assess the included studies.

SETTING

Upper-middle- and high-income countries.

PARTICIPANTS

Parents with a child below the age of 3 years.

RESULTS

A total of forty-seven studies met the eligibility criteria and were included in this systematic review. The themes were organised into three main categories: (1) factors related to introduction of complementary foods; (2) factors related to the type of complementary foods and (3) factors related to both timing and type. The selected literature highlights: prevalent baby cues that prompt parents to introduce solid foods; parents' views on the recommended timing of complementary feeding; factors that drive the choice of complementary foods and perceived value in advice received from health professionals and grandmothers.

CONCLUSIONS

This systematic review indicates factors that can be barriers to complying with the complementary feeding guidelines, and therefore, its findings are pertinent to improving parental feeding practices through intervention studies and through infant feeding education in a primary care setting.

Breastfeeding but not Exclusively: Exploration of Chinese American Mothers' Infant Feeding Practices

BACKGROUND

Previous qualitative researchers have shown that Chinese American mothers experienced high rates of suboptimal breastfeeding, especially early introduction of other foods before the recommended 6-month period of exclusive breastfeeding.

RESEARCH AIMS

(1) To explore attitudes that Chinese American mothers have about the meaning and practice of exclusive breastfeeding; (2) to evaluate the extent of family pressure and support to maintain exclusive breastfeeding; and (3) to examine the influence of breastfeeding self-efficacy and the intention to continue exclusive breastfeeding.

METHOD

Guided by the theory of planned behavior, this descriptive cross-sectional prospective online survey was conducted with Chinese American breastfeeding mothers (N = 401). Participants' attitudes, subjective norms, and perceived behavioral control for exclusive breastfeeding behaviors were measured.

RESULTS

The M (SD) age of participants was 29.14 (SD = 6.90). Just over 50% reported receiving family support for exclusive breastfeeding. While participants had positive attitudes about exclusive breastfeeding and the value of colostrum, 64% (n = 257) had already introduced foods other than mother's own milk before their infant was 6-months old. Participants also expressed concern that their infants did not receive enough nutrition from exclusive mother's milk. Participants with more than one child had significantly greater intention to continue exclusive breastfeeding compared to participants with only one child. Perception of approval by others for exclusive breastfeeding and breastfeeding self-efficacy were significantly related to behavioral intention to continue exclusive breastfeeding.

CONCLUSION

Suboptimal infant feeding is a problem for Chinese American women and may also be a problem for mothers in other ethnic groups. We found a lack of adherence with standard recommendations for sustaining 6-months of exclusive breastfeeding.

Food Patterns among Chinese Immigrants Living in the South of Spain

This article aims to explore the food patterns of Chinese immigrants living in Spain and to understand the factors associated with these behaviors. This qualitative ethnographic study included 133 Chinese immigrants; using interviews with scripts were based on the National Health Survey of Spain. Three categories were defined: “Differences between Chinese food and Western food”; “Products and dishes consumed by Chinese immigrants” and “Modification of eating habits”. Participants found a remarkable difference between eastern (i.e., vegetables and rice) and western (i.e., dairy, high-fat, bread) foods. They also experienced a change in their eating habits, mostly related to acculturation and lack of time. Chinese immigrants have different eating patterns as compared to the native population in Spain and this information could help in future healthcare strategies. Knowing the food culture could infer aspects, such as insertion or integration, and promoting health and well-being.

An Evaluation of a Perinatal Education and Support Program to Increase Breastfeeding in a Chinese American Community

INTRODUCTION

In 2015, a community health center implemented a multipronged, Chinese language, health education initiative to increase breastfeeding. Perinatal education, hospital visits after delivery, and postpartum support were implemented to provide informational and emotional support. This study evaluates the impact of the breastfeeding program for Chinese American women.

METHODS

This is a quasi-experimental study to assess the change in any and exclusive breastfeeding at 4-6 weeks postpartum. A difference-in-differences regression analysis was used to determine change in breastfeeding attributable to the program at an intervention site after adjusting for change in a control site during the same period. Change in breastfeeding was also examined by sociodemographic characteristics.

RESULTS

A total of 1475 women who received perinatal care at two community center sites in 2014 and 2016 were included in the study. Within the women who received the intervention, any breastfeeding increased by 24 percentage points to 71% and exclusive breastfeeding increased by 13 percentage points to 27%. After adjusting for the change in the control group during the same period, the increases in any and exclusive breastfeeding attributable to the program were 17 (p < 0.01) and 9 percentage points (p < 0.05), respectively. Primiparous women and those who have been in the US longer than 5 years experienced the highest increase in any breastfeeding from the program. Exclusive breastfeeding was most improved in those with non-Medicaid insurance.

CONCLUSIONS

A bilingual and bicultural breastfeeding program incorporated into routine pregnancy care at an intervention site experienced increases in both any and exclusive breastfeeding, even after adjusting for changes in breastfeeding in a control group.

SIGNIFICANCE STATEMENT

What is known on this subject? Chinese Americans are the least likely to breastfeed among all ethnicities in New York City. Cultural and language barriers plus the lack of Chinese language resources contribute to low breastfeeding rates. What this study adds? A bilingual and bicultural breastfeeding program of perinatal education and postpartum support incorporated into routine pregnancy care increased both any and exclusive breastfeeding in a Chinese American population. Increase in any breastfeeding was the greatest in primiparous women and those who had been in the US for a longer time and increase in exclusive breastfeeding was greatest in women not using Medicaid insurance.

Cultural Influences on Complementary Feeding Beliefs amongst New Chinese Immigrant Mothers in England: A Mixed Methods Study

Adequate nutrition during infancy and early childhood is essential for ensuring the growth, health, and development of children so that they can reach their full potential. There is a current void of data on infant and young child feeding practices (IYCF) in ethnic minority communities in the UK; specifically, it is difficult to find accurate Chinese IYCF data in the UK because survey data often includes Chinese in the category of ‘Chinese or other ethnic group’, further contributing to health inequalities. This mixed methods study aimed to explore the cultural influences on IYCF beliefs among new Chinese immigrant mothers. A total of 31 mothers of infants aged 6–23 months were recruited from informal community organizations. All 31 mothers were born in Mainland China, the mean length of their stay after immigrating to the UK was 10 years (range = 1–21 years), and their mean age was 29 ± 3.40 years. When using the Infant Feeding Style Questionnaire (IFSQ) to investigate IYCF beliefs, the highest score was obtained for responsive attention, with a value of 4.28 ± 0.92, indicating that parents were very attentive to child hunger and satiety cues; lower scores were obtained for indulgence soothing (1.82 ± 1.01), indulgence coaxing (2.11 ± 1.18), indulgence pampering (1.90 ± 0.95), and pressuring to soothe (1.92 ± 0.86), indicating lesser maternal indulgence and pressuring/controlling beliefs. A sub-sample (n = 14) participated in semi-structured interviews in order to understand the balancing sources of information and cultural preferences, the influence of traditional Chinese medicine, and language difficulties in accessing health services. The mothers reported barriers of IYCF beliefs and the introduction of solid foods earlier than the NHS guidelines. This study can promote optimal IYCF in Chinese immigrants and show health services the need to reconcile differences between the perceptions of British and Chinese health beliefs.

Patterns and predictors of exclusive breastfeeding in Chinese Australian mothers: a cross sectional study

BACKGROUND

While exclusive breastfeeding is recommended to 6 months of age, just 15% of mothers in Australia achieve this. The rate appears to be even lower among mothers born in China, where 90% have introduced infant formula by this time. This study aimed to examine infant feeding patterns in the first 12 months of life and the factors associated with exclusive breastfeeding at 4 months of age and infant formula introduction by 1 month of age among Chinese Australian mothers.

METHODS

Chinese Australian women with a child aged 1 to 4 years born in Australia were recruited through social media and asked to complete an online survey. Chinese ethnicity was defined as the mother or her parents having been born in mainland China, Taiwan or Hong Kong. Infant feeding practices since birth and a range of psychosocial and cultural factors were assessed. A total of 289 Chinese Australian mothers completed the survey. The relationships between exposure variables and exclusive breastfeeding at 4 months or infant formula use by 1 month were examined using multivariable logistic regression.

RESULTS

Almost all (93%) mothers initiated breastfeeding, however by 1 month of age exclusive breastfeeding rates reduced to 44%, with a further decline to 33 and 18% at 4 and 6 months respectively. Concurrently, 7% of parents reported infant formula feeding at birth increasing to 55 and 63% at 1 and 6 months of age respectively. The rates of any breastfeeding were 81% at 6 months and 50% at 12 months of age. Breastfeeding intention, self-efficacy and awareness of the infant feeding guidelines were key factors associated with sustained exclusive breastfeeding to 4 months.

CONCLUSIONS

While Chinese Australian mothers had comparable exclusive breastfeeding rates at 6 months to the general Australian population, twice as many had introduced infant formula by 1 month of age. There is an urgent need to support Chinese Australian mothers in the perinatal period to strengthen their knowledge, intention and confidence to delay early introduction of infant formula and promote exclusive breastfeeding in the early postpartum period.

"I was determined to breastfeed, and I always found a solution": successful experiences of exclusive breastfeeding among Chinese mothers in Ireland

BACKGROUND

The prevalence of exclusive breastfeeding for at least 4 months was previously found to be very low among Chinese immigrants in Ireland, at 5.8% (Zhou et al., Front Public Health 6:351, 2018). This study investigates the successful experiences of Chinese mothers living in Ireland who exclusively breastfeed for between four and 6 months.

METHODS

Participants were recruited from the sample of the Ireland Chinese Mother Survey. Qualitative in-depth interviews were conducted with fourteen participants in their homes or public places.

RESULTS

A content analysis revealed that various factors contributed to a successful experience of exclusive breastfeeding among the group of Chinese immigrant mothers, including strong self-determination; appropriate physical conditions; awareness of the benefits of exclusive breastfeeding; a lack of time constraints; and family, professional and policy support. The barriers that the mothers faced included the difficulty of balancing breastfeeding and employment, infant health issues, language barriers, an inability to consume the traditional Chinese postpartum diet and a lack of public breastfeeding facilities. Measures taken to overcome these barriers included seeking family support, resting during the lactation period, and pumping breast milk to feed from a bottle when outside the home.

CONCLUSIONS

This study highlights unique factors affecting exclusive breastfeeding among Chinese mothers in Ireland, which may be useful to health care professionals working with Chinese immigrant women internationally.

Breastfeeding and emerging motherhood identity: An interpretative phenomenological analysis of first time Chinese Australian mothers' breastfeeding experiences

BACKGROUND

Chinese Australian mothers are more likely than the general Australian mothers to introduce formula in the first month of age. A better understanding of the context of formula introduction in the early weeks of birth can provide a deeper insight into how Chinese Australian mothers can be supported to continue exclusive breastfeeding.

METHODS

An interpretative phenomenological analysis approach was used to examine the lived breastfeeding experiences of 11 first time Chinese mothers in Australia. The experiences of those who breastfed exclusively were compared to those who introduced formula in the first month after birth.

FINDINGS

An overarching theme across all participants' narratives was the meaning ascribed to breastfeeding in their emerging motherhood identity. Breastfeeding could be a pragmatic and a socially desirable method to nourish an infant but lacking personal identification to the mother. These mothers were more vulnerable to the early introduction of formula, especially when the support environment was lacking. Maternal identity conflict was common and negatively impacted exclusive breastfeeding and mothers' mental health. In contrast, mothers who identified closely with breastfeeding showed greater persistence and enjoyment in breastfeeding and were more likely to continue breastfeeding exclusively. Health professionals were perceived to have an important influence in strengthening maternal breastfeeding motivation and self-efficacy.

CONCLUSION

Breastfeeding support to Chinese Australian mothers needs to consider how breastfeeding can be better integrated with their motherhood identity. Health professionals are well-positioned to facilitate this process through a better understanding of mothers' cultural and social contexts around breastfeeding.

Grandparents Raising Grandchildren: What Have We Learned Over the Past Decade?

BACKGROUND AND OBJECTIVES

In this manuscript, we update the literature over the last decade in addressing several new content areas that have emerged in the grandfamilies literature, along with issues that are still important to understanding grandparents raising their grandchildren today.

RESEARCH DESIGN AND METHODS

The social science and gerontological literature since 2004 was accessed, reviewed, organized topically, and integrated, based upon an exhaustive PsychINFO literature search.

RESULTS

Our review indicates an ongoing and/or growing emphasis on (a) the strengths of grandparent raising grandchildren, (b) diversity among grandfamilies along a number of parameters, (c) the social-interpersonal, cultural, and policy-related contexts of grandfamilies, (d) process-focused research, (e) parenting, parenting skills, and family relationships, (f) grandparent psychological distress, (g) targets for and the efficacy of interventions with grandfamilies, and (h) methodological issues relevant to the study of grandfamilies.

IMPLICATIONS

We discuss the implications of our findings in terms of more completely understanding grandfamilies along a number of parameters, as well as presenting specific recommendations for future research and practice.

National Trends in the Provision of Human Milk at Hospital Discharge Among Very Low-Birth-Weight Infants

IMPORTANCE

Human milk confers important health benefits to very low-birth-weight (VLBW) infants (≤1500 g). The extent to which the use of human milk has changed over time and the factors associated with human milk use nationally in this population are poorly understood.

OBJECTIVES

To describe US trends in the provision of human milk at hospital discharge for VLBW infants during the past decade according to census region and maternal race/ethnicity, quantify associations of census region and maternal race/ethnicity with the provision of human milk at hospital discharge, and examine regional and state variations in any provision of human milk at hospital discharge among racial/ethnic groups.

DESIGN, SETTING, AND PARTICIPANTS

A cohort study was conducted of 346 248 infants, born at 23 to 29 weeks' gestation or with a birth weight of 401 to 1500 g, who were cared for at 802 US hospitals in the Vermont Oxford Network from January 1, 2008, to December 31, 2017. The US census region was categorized as West, Midwest, Northeast, and South (reference). Maternal race/ethnicity was categorized as non-Hispanic white (reference), non-Hispanic black, Hispanic, Asian and Pacific Islanders, and Native American.

MAIN OUTCOMES AND MEASURES

Any provision of human milk at hospital discharge, defined as the use of human milk as the only enteral feeding or the use of human milk in combination with fortifier or formula.

RESULTS

Of the 346 248 infants in the study (172 538 boys and 173 710 girls), 46.2% were non-Hispanic white, 30.1% were non-Hispanic black, 18.3% were Hispanic of any race, 4.7% were Asian and Pacific Islanders, and 0.8% were Native American. Any provision of human milk at hospital discharge increased steadily among all infants, from 44% in 2008 to 52% in 2017. There were increases across all US census regions and racial/ethnic groups. Any provision of human milk at hospital discharge was higher in the West (among singleton births: adjusted prevalence ratio, 1.32; 95% CI, 1.25-1.39; among multiple births: adjusted prevalence ratio, 1.28; 95% CI, 1.21-1.35) and Northeast (among singleton births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19; among multiple births: adjusted prevalence ratio, 1.11; 95% CI, 1.04-1.19), compared with the South, and was higher among Asian mothers (among singleton births: adjusted prevalence ratio, 1.21; 95% CI, 1.18-1.25; among multiple births: adjusted prevalence ratio, 1.12; 95% CI, 1.09-1.15) and lower among Hispanic (among singleton births: adjusted prevalence ratio, 0.98; 95% CI, 0.96-1.01; among multiple births: adjusted prevalence ratio, 0.88; 95% CI, 0.86-0.91), Native American (among singleton births: adjusted prevalence ratio, 0.64; 95% CI, 0.59-0.70; among multiple births: adjusted prevalence ratio, 0.59; 95% CI, 0.50-0.69), and non-Hispanic black mothers (among singleton births: adjusted prevalence ratio, 0.67; 95% CI, 0.65-0.70; among multiple births: adjusted prevalence ratio, 0.57; 95% CI, 0.54-0.60), compared with non-Hispanic white mothers. These results were robust to adjustment for birth year and infant characteristics. Wide regional and state variations were found in any provision of human milk at hospital discharge.

CONCLUSIONS AND RELEVANCE

Overall prevalence of any provision of human milk at hospital discharge among VLBW infants has steadily increased during the past decade. Disparities by US region and race/ethnicity in the provision of human milk exist and have not diminished over time.

Maternal Perception of Adequacy of Mother's Milk Among Mothers Giving Birth at a Teaching Hospital in Sri Lanka

BACKGROUND:

Sri Lanka boasts high rates of early and exclusive breastfeeding. Perceived inadequacy of milk, a global problem, is the main cause for early cessation of breastfeeding.

RESEARCH AIMS:

The aims of this study are to (a) determine the prevalence, (b) identify the risk factors, and (c) ascertain the association that maternal psychological distress has with perceived inadequacy of milk (PIM), among mothers during the early postpartum period. Identifying and addressing modifiable risk factors for PIM may improve mothers' satisfaction with breastfeeding.

METHODS:

A cross-sectional descriptive study of mothers ( n = 249) during the first week after birth was conducted at Colombo North Teaching Hospital (Ragama, Sri Lanka) from May 1, 2016, to June 10, 2016. Participants were recruited when the infant was more than 24 hours but less than 7 days old. A self-administered questionnaire, including the six-item Kessler Psychological Distress Scale, was used.

RESULTS:

The majority of mothers (78%) perceived their milk quantity to be adequate. A family member telling mothers that their milk supply was low had the most significant associations with perceived inadequacy. Other associations were antenatal maternal complications and birth by cesarean section. Kessler scores indicating psychological distress occurred in 26% of all participating mothers, with a higher mean score in those with PIM.

CONCLUSIONS:

Sri Lankan family members should be educated further about normal patterns of milk production during the postpartum period. The authors recommend that PIM be included in screening tools for postpartum depression in Sri Lanka.

Adherence to initial exclusive breastfeeding among Chinese born and native Spanish mothers

Background

Benefits of breastfeeding on the health of children, mothers and society are well known. However, breastfeeding rates vary according to the population examined. Chinese-born women migrated to high-income countries have shown low breastfeeding rates. Nevertheless, studies comparing breastfeeding rates of Chinese-born immigrants and natives are scarce.

The aims of this study were therefore: 1) to compare the rate of exclusive breastfeeding at hospital discharge after giving birth between Chinese-born women resident in Spain and native Spanish women, 2) to assess the influence of the biological, socioeconomic, work-related and cultural factors on exclusive breastfeeding in women of Chinese origin.

Methods

A cross-sectional descriptive study with between group comparisons. This study included 73 postpartum women (33 Chinese-born and 40 native Spanish women). The association between exclusive breastfeeding and the country of origin was assessed by binary logistic regression.

Results

Native Spanish women showed a greater prevalence of exclusive breastfeeding (80%) compared to Chinese born immigrant women (36.4%) (adjusted for socioeconomic status, parental level of education, age, cesareans and birth weight) (OR = 0.21; 95% CI 0.05–0.91; p = 0.037). However, in other models that considered both work and cultural influences, no differences were observed.

Discussion

The classic biological and socioeconomic variables (educational and socioeconomic levels) do not seem to explain the lower rates of exclusive breastfeeding among Chinese immigrant women. This paradigm of inequity appears to be based on both the work conditions as well as cultural characteristics of Chinese born women in Spain, such as their overall attitude towards breastfeeding.

Comparison of attitudes to breastfeeding among Spanish-born and Chinese-born postpartum women in Madrid

Background

Maternal breastfeeding is a practice that is associated with multiple health benefits for mothers and children. One of the lowest rates of breastfeeding has been observed among Chinese women who immigrate to high income countries. At present, there is a lack of comparative information between this group and that of Spanish-born women. Considering the relationship between the attitude of women towards breastfeeding and the initiation of breastfeeding, the aim of the study was to determine whether the attitude towards breastfeeding among Chinese postpartum women who have immigrated to Spain differs from that of Spanish-born postpartum women.

Methods

Cross-sectional study, with between-group comparison, of 73 postpartum Spanish-born and Chinese immigrant women admitted to the maternity units of “12 de Octubre” Hospital (Spain) between April and November 2016. Attitudes toward breastfeeding were analyzed using the Spanish or Chinese version of the Iowa Infant Feeding Attitude Scale (IIFAS). A wide set of socioeconomic, biological, working and attitudinal conditions were considered as covariates. The association between IIFAS and country of origin was assessed by three multiple linear regression models (B, SE, and 95% confidence interval were calculated).

Results

All Chinese women were first generation immigrants. Chinese-born women were four years younger than Spanish-born mothers, had a lower educational level, more frequently had a paid job (mainly self-employed), and planned to return to work almost two months earlier than Spanish-born mothers did. Most Chinese women did not breastfeed exclusively.

Chinese immigrant women obtained scores of approximately 9 points less in the Iowa Infant Feeding Attitude Scale (IIFAS) when compared to Spanish-born women [95% CI -15.59, -2.48], after adjusting for the different socioeconomic, educational and work-related factors.

Conclusions

Chinese-born women resident in Spain present a lower score on the IIFAS, when compared to Spanish-born women, which implies a more negative attitude towards breastfeeding. The between-groups difference is consistent, even when adjusting for known confounders and other factors which could affect the attitude of the mothers. It is therefore striking that, despite being in Spain, Chinese-born women maintain these preferences/attitudes regarding breastfeeding, compared with Spanish-born women, who obtain overall high scores.

Infant Feeding Beliefs, Attitudes, Knowledge and Practices of Chinese Immigrant Mothers: An Integrative Review of the Literature

Chinese are a fast-growing immigrant population group in several parts of the world (e.g., Australia, Canada, Europe, Southeast Asia, United States). Research evidence suggests that compared to non-Hispanic whites, individuals of Asian-origin including Chinese are at higher risk of developing cardiovascular disease and type 2 diabetes at a lower body mass index (BMI). These risks may be possibly due to genetic differences in body composition and metabolic responses. Despite the increasing numbers of Chinese children growing up in immigrant families and the increasing prevalence of obesity among Chinese, little research has been focused on children of Chinese immigrant families. This integrative review synthesizes the evidence on infant feeding beliefs, attitudes, knowledge and practices of Chinese immigrant mothers; highlights limitations of available research; and offers suggestions for future research. Using the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) guidelines, we searched four electronic academic/research databases (CINAHL, Medline, PsycINFO, and PubMed) to identify peer-reviewed, full-text papers published in English between January 2000 and September 2017. Only studies with mothers 18+ years old of normally developing infants were included. Of the 797 citations identified, 15 full-text papers were retrieved and 11 studies (8 cross-sectional studies, 3 qualitative studies) met the inclusion criteria and were included in this review. Reviewed studies revealed high initiation rates of breastfeeding, but sharp declines in breastfeeding rates by six months of age. In addition, reviewed studies revealed that the concomitantly use of breast milk and formula, and the early introduction of solid foods were common. Finally, reviewed studies identified several familial and socio-cultural influences on infant feeding beliefs and practices that may increase risk of overweight and obesity during infancy and early childhood among Chinese children of immigrant families. Nonetheless, as only 11 studies were identified and because the majority of studies (n = 8) were conducted in Australia, additional research including longitudinal studies, and studies conducted in countries with large Chinese immigrant population are needed to further identify and understand influences on Chinese immigrant mothers' beliefs, attitudes, and practices related to infant feeding that may increase risk of child overweight and obesity. This information is needed to develop interventions tailored to the beliefs and needs of this fast-growing immigrant group and aimed at promoting healthy infant feeding practices to prevent childhood overweight and obesity.

Exploring Barriers to Breastfeeding Among Chinese Mothers Living in Madrid, Spain

In Spain, immigrant women have high rates for initiating breastfeeding. In contrast, the case of immigrant Chinese mothers stands out, due to the low rate. In China, breastfeeding has historically been the cultural norm. An ethnographic study was conducted to explore aspects related to the low rate of breastfeeding. Field observations and informal interviews were conducted in two hospitals and a primary care center. Semi-structured interviews were performed with Chinese mothers and health workers. Among Spanish health workers, there is a belief that Chinese women do not breastfeed due to cultural reasons. The rapid return to work and the popular phenomenon of sending babies back to China for grandparents to raise constitute barriers for breastfeeding. Although in China breastfeeding is common practice, in Madrid the prioritization of productivity over reproduction and the existence of the so-called "satellite babies" and transnational maternity make the establishment and maintenance of breastfeeding difficult.

Predicting weight status in Chinese pre-school children: independent and interactive effects of caregiver types and feeding styles

Objective

To investigate caregiver type as a potential moderating effect in the relationship between feeding style and weight status among Chinese pre-school children.

Design

Cross-sectional data collected with the Caregiver’s Feeding Style Questionnaire (CFSQ), anthropometric data, childcare and sociodemographic information.

Setting

Shenyang, China.

Subjects

Caregiver–child dyads (n 857).

Results

After controlling for confounders, authoritarian feeding style was associated with a 0·30 lower BMI Z-score. Fathers as primary caregivers were related to lower BMI Z-score (β=−0·66), while grandparents as main caregivers were associated with higher BMI Z-score (β=0·66) after adjusting for covariates. Mothers buffered the relationship between authoritarian (β=0·50, 95 % CI 0·04, 0·95) or indulgent (β=−0·60, 95 % CI −1·06, −0·14) feeding styles and BMI Z-score. Grandparents strengthened the trend that indulgent feeding style was related to higher BMI Z-score (β=0·54, 95 % CI 0·01, 1·08).

Conclusions

The results of independent and interactive effects of specific feeding styles and caregiver types had different influences on child BMI Z-scores. Longitudinal investigations are needed to evaluate the effect of fathers’ and grandparents’ feeding on their children’s nutrition and weight status.

Refugees, asylum-seekers and undocumented migrants and the experience of parenthood: a synthesis of the qualitative literature

OBJECTIVE

To synthesize the recent qualitative literature and identify the integrative themes describing the parenthood experiences of refugees, asylum-seekers and undocumented migrants.

METHODS

We searched seven online databases for the period January 2006 to February 2017. We included English and French published peer-reviewed articles and graduate-level dissertations, which qualitatively examined the parenthood experiences of refugees, asylum-seekers and undocumented migrants. We summarized study characteristics and performed a thematic analysis across the studies.

RESULTS

One hundred thirty eight studies met inclusion criteria. All but three were conducted in high-income countries, mainly in the US. Migrants studied were mostly undocumented from Latin America and refugees from Sub-Saharan Africa. Almost all studies (93%) included mothers; about half (47%) included fathers; very few (5%) included extended family members. We identified three integrative themes: 1) experiencing hardship and/or loss in the context of precarious migration and past traumas; 2) building resilience and strength by bridging language, norms and expectations; and 3) living transnationally: obligations, challenges and resources. Each theme contributed to shaping the parenthood experience; the transnationalism theme intersected with the themes on hardship and loss and resilience and strength.

CONCLUSION

More research is needed with fathers, extended family members, asylum-seekers and in the LMIC context. A transnational lens needs to be applied to programs, policies and future research for refugee, asylum-seeker and undocumented migrant parents. Addressing transnational concerns (family separation and reunification), acknowledging transnational resources, fostering a transnational family identity and conducting transnational and longitudinal studies are potentially pivotal approaches for this sub-population of parents.

An Exploration of How Mexican American WIC Mothers Obtain Information About Behaviors Associated With Childhood Obesity Risk

OBJECTIVE

To explore how a sample of Mexican American mothers with preschool-aged children recruited from a Midwestern Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinic obtained information about 4 behaviors associated with childhood obesity risk: eating, physical activity, screen time, and sleep.

DESIGN

One-on-one structured interviews in which participants were asked how they communicated with family, learned to take care of their first infant, and obtained information about the 4 targeted behaviors for their preschool-aged child.

SETTING

An urban WIC clinic in the Midwest.

PARTICIPANTS

Forty Mexican-descent mothers enrolled in WIC with children aged 3-4 years.

PHENOMENON OF INTEREST

Exposure to information about the 4 targeted behaviors among Mexican-descent mothers participating in WIC.

ANALYSIS

Quantitative and qualitative data were used to characterize and compare across participants.

RESULTS

Participants primarily obtained information from their child's maternal grandmother during their first child's infancy and from health professionals for their preschool-aged child. Participants typically obtained information through interpersonal communication, television, and magazines. Participants were most interested in healthy eating information and least interested in screen time information. Some participants did not seek information.

CONCLUSIONS AND IMPLICATIONS

Participants engaged in different patterns of information seeking across their child's development and the 4 behaviors, which suggests that future research should be behaviorally specific. Findings from this study suggest several hypotheses to test in future research.