Session 1: Public health nutrition Breast-feeding practices in Ireland: Symposium on ‘The challenge of translating nutrition research into public health nutrition’

Multicomponent perinatal breastfeeding support in women with BMI >25: The Latch On multi-centre randomised trial

OBJECTIVE

To investigate the effectiveness of a multicomponent breastfeeding support intervention on breastfeeding prevalence at 3 months among women with a body mass index (BMI) >25 kg/m2.

DESIGN

Multicentre multicomponent randomised controlled trial.

SETTING

Four maternity centres in Ireland.

POPULATION

A total of 225 primiparous women and their nominated support partners. Participants were aged 18 years and over, with BMI ≥25 kg/m2, carrying a singleton pregnancy and without contraindication for breastfeeding.

METHODS

The intervention included an antenatal group breastfeeding education session for participants and their support partners, followed by a planned postnatal breastfeeding assessment and telephone support for up to 6 weeks by a lactation consultant.

MAIN OUTCOME MEASURES

Any breastfeeding at 3 months postpartum.

RESULTS

Any breastfeeding prevalence was 68.7% (n = 68) in the intervention group and 62.1% (n = 59) in the control group at 3 months postpartum (odds ratio 1.33, 95% confidence interval 0.72-2.46, p = 0.36). Any and exclusive breastfeeding rates did not significantly differ at any other time point. More women in the control group accessed support from private lactation consultants (intervention 23.5% [n = 12], control 45.3% [n = 24], p = 0.02).

CONCLUSIONS

The control group had higher than expected breastfeeding rates, and the study found no evidence of effect on the primary outcome. Providing comprehensive education and support for women intending to breastfeed remains of paramount importance.

Formula Feeding Practice and Associated Factors Among Mothers Who Visited Health Facilities for Their Infants Aged Below 6 Months in Bahir Dar City, Northwest Ethiopia, 2020

Background

Even though breastfeeding for infants and young children provides the ideal food for healthy growth and development, nowadays the use of infant formula feeding has increased worldwide. In developing countries, 1.3 million to 1.45 million childhood deaths are attributed to suboptimal breastfeeding practices.

Objective

This study aimed to assess infant formula feeding practice and associated factors among mothers who visited health facilities for their infants aged less than 6 months in Bahir Dar city in 2020.

Methods

An institution-based cross-sectional study was conducted in March-May 2020. Data were collected from 593 randomly selected mothers with infants less than 6 months of age. A multivariable logistic regression analysis was performed to identify associated factors of formula feeding practice with an a p-value of less than 0.05 and an adjusted odds ratio of 95% confidence interval.

Results

The prevalence of infant formula feeding practices was 25%. Maternal age group of 25-34 years [AOR = 2.388; 95% CI: 1.295, 4.406], mother's occupation of private employee [AOR = 6.726; 95% CI: 2.756, 16.413], government employee [AOR = 4.726; 95% CI: 1.895, 8.700] and merchant [AOR = 2.798; 95% CI: 1.066, 7.345], positive attitude to infant formula [AOR = 2.10; CI: 1.09, 4.06], delayed breast milk initiation after delivery [AOR = 3.73; 95% CI: 1.504, 9.252], mothers who had 3 antenatal care [AOR = 2.294; 95% CI: 1.317, 3.997] and source of formula milk information from supermarket/pharmacy [AOR = 6.57; 95% CI: 1.48, 29.16] and from families/friends [AOR = 2.24; 95% CI: 1.24, 4.03] were independent predictors of infant formula feeding practice.

Conclusion

This study's findings revealed that one-fourth of mothers fed infant formula before the age of 6 months. Therefore, we recommended promoting behavior change communication, focusing on attitude change in formula feeding practice and its health consequences, promoting exclusive breastfeeding practice, and strengthening ANC service provision.

Effect of baby food marketing exposure on infant and young child feeding regimes in Bangkok, Thailand

Background

Baby food marketing undermines breastfeeding by influencing women’s attitudes and decision-making favourably toward commercial baby food. This study aimed to explore the effects of various baby food marketing techniques on Thai mothers’ opinions about commercial milk formulas (CMF) and commercial complementary foods (CCF) and their infant and young child feeding behaviours.

Methods

This study used a cross-sectional survey employing the World Health Organization (WHO) NetCode Toolkit Protocol for Periodic Assessment, and the United Nations International Children’s Emergency Fund (UNICEF) Multiple Indicator Cluster Survey to collect data on mothers’ experience with and their opinion on the various types of marketing of CMF and CCF, and their feeding behaviour. Data collection used structured interviews of mothers with children aged two years or below attending 33 health facilities in Bangkok. Univariable and multivariable regression analysis then investigated links between mothers’ reported exposure to baby food marketing and their infant and young child feeding behaviours, employing a semantic scale and considering key sociodemographic and other variables.

Results

Three hundred and thirty mothers were surveyed in Bangkok. Around 90% reported experiencing exposure to at least one type of baby food marketing during the previous six months, mostly from electronic media. More than half of the women had positive opinions of CMF. Virtually all children had been breastfed initially, but 74.6% were given CMF and 72.8% stopped breastfeeding before six months. Multivariable analysis showed that mothers who lived in a couple were significantly less likely to favour CMF, and mothers in middle-income households and those who had received advice about CMF from others were more likely to have a favourable opinion. Mothers in formal employment were over six times more likely to feed formula than those not in employment. Women who experienced baby food marketing at health facilities were four times more likely to feed CMF to their children than those not experiencing such marketing.

Conclusions

Specific types of baby food marketing were strongly linked to mothers’ opinions on and use of CMF in Bangkok, Thailand. It is recommended that breastfeeding policies in health facilities and employment are fully implemented and enforced.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00503-7.

Promoting the practice of exclusive breastfeeding: a philosophic scoping review

Background

The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study was to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding.

Methods

A scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo, and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2001—2022.

Results

The online search yielded 1,682 articles, however, only 44 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n = 1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 13), social cognitive theories (n = 18) and represented 16 countries. Theories of self-efficacy and planned behaviour were the most used theories.

Conclusions

This review suggests that theories and models are increasingly being used to promote exclusive breastfeeding. Orienting exclusive breastfeeding programmes within theoretical frameworks is a step in the right direction because theories can sensitize researchers and practitioners to contextually relevant factors and processes appropriate for effective exclusive breastfeeding strategies. Future research should examine the efficacy and effectiveness of theory-informed exclusive breastfeeding programmes over time. Such information is important for designing cost-effective EBF programmes.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-022-04689-w.

Historical-qualitative analysis of breastfeeding trends in three OECD countries

Background

Breastfeeding rates among high income, western countries vary considerably. This research examines three countries, Sweden, Ireland, and the United States, with respect to both public health initiatives and policy initiatives.

Methods

This article uses a historical qualitative analysis of breastfeeding rates over time. It uses the welfare state structure as a framework for understanding the variation in breastfeeding outcomes among these three countries.

Results

With its strong family policies and early adherence to international public health recommendations, Sweden was able to build high rates of breastfeeding initiation and duration. However, Sweden’s breastfeeding rates have been declining, which may be a result of increasing encouragement for fathers to take equal leave, and because Sweden is no longer prioritizing breastfeeding in its public health goals. Ireland has experienced rapid growth of both breastfeeding initiation and participation in the Baby-Friendly Hospital Initiative, though its rates still lag behind much of the Western world. The United States has seen increases in participation with the Baby-Friendly Hospital Initiative, but lacks state support in public health and labor policies.

Conclusion

This analysis suggests that in a country with a strong welfare state and early adoption of internationally recommended public policy, breastfeeding is able to flourish. It also suggests that the Baby-Friendly hospital Initiative is a predictor of breastfeeding success.

Duration of exclusive breastfeeding may be related to eating behaviour and dietary intake in obesity prone normal weight young children

Infants who are breastfed are introduced to a variety of flavours from the maternal milk, and thus the transition from maternal milk to complementary foods may be easier for these children. The aim of this study was to investigate if duration of exclusive breastfeeding was associated with pickiness or dietary intake of vegetables, fruit, starchy foods or sugar sweetened beverages among obesity prone normal weight children aged 2–6 years. This cohort study was based on data from the Healthy Start primary intervention study, the Danish Medical Birth registry and the Danish Health Visitor’s Child Health Database. Infant feeding was registered by health nurses while home-visiting the mother and child up to four times within the first year. Information on eating behaviour and diet intake at age 2–6 years was obtained by parents. Crude and adjusted logistic and general linear regression models were used to investigate associations. A total of 236 children had complete information on all variables. Data showed lower odds of picky eating behaviour when exclusively breastfed until age 4–5 months compared to exclusively breastfed for 0–1 months (OR = 0.35, 95CI = 0.16;0.76, p = 0.008). In the crude analysis only, exclusively breastfed until age 6–10 months was associated with a higher daily intake of vegetables (p = 0.04). This study suggests that exclusive breastfeeding duration seems to influence pickiness and may contribute to facilitate the consumption of more vegetables in later childhood in obesity prone normal weight children.

A feasibility study of a multidimensional breastfeeding-support intervention in Ireland

BACKGROUND

Breastfeeding is the optimum mode of infant feeding. Despite this, most global populations do not achieve the World Health Organisation's recommendation of exclusive breast milk for the first 6 months of life. Irish breastfeeding rates are among the lowest in Europe, necessitating a well-designed breastfeeding-support intervention.

AIM

To evaluate the feasibility and acceptability of a multidimensional breastfeeding intervention in a rural and an urban maternity setting in Ireland.

DESIGN

A feasibility study of a breastfeeding-support intervention.

SETTING

Participants were recruited from The National Maternity Hospital (Dublin, urban) and Wexford General Hospital (Wexford, rural). Questionnaires were completed antenatally, at 6 weeks postpartum and at 3 months postpartum to assess acceptability of the intervention and determine breastfeeding status.

PARTICIPANTS

Pregnant women were recruited in the 3^rd trimester, alongside a support partner.

INTERVENTION

The intervention consisted of an antenatal class (including the physiology and practical approaches to breastfeeding), a one-to-one breastfeeding consultation with a lactation consultant after birth, access to a breastfeeding helpline, online resources, and a postnatal breastfeeding support group which included a one-to-one consultation with the lactation consultant.

RESULTS

One hundred women from The National Maternity Hospital, Dublin and 27 women from Wexford General Hospital were recruited. The antenatal class was attended by 77 women in Dublin and 23 in Wexford; thus, 100 women participated in the intervention. Seventy-six women had a one-to-one postnatal consultation with a lactation consultant in Dublin and 23 in Wexford. Fifty and 45 women in Dublin, and 15 and 15 in Wexford responded to the 6-week and 3-month questionnaires, respectively. At 3 months postpartum, 70% of respondents from Dublin and 60% from Wexford were breastfeeding. Mothers perceived the one-to-one consultation with the lactation consultant during postnatal hospitalization as the most helpful part of the intervention. Inclusion of a support partner was universally viewed positively as a means to support the mother's decision to initiate and continue breastfeeding.

CONCLUSION

This multidimensional intervention is well-accepted and feasible to carry out within an Irish cohort, in both urban and rural areas. Data from this feasibility study will be used to design a randomized controlled trial of a breastfeeding-support intervention.

SystEmatic review and meta-aNAlysis of infanT and young child feeding Practices (ENAT-P) in Ethiopia: protocol

INTRODUCTION

Infant and young child feeding (IYCF) is the cornerstone of infant and child survival, healthy growth and development, healthy future generations and national development. In spite of the importance of optimal nutrition in low- and middle-income countries, there has been no review conducted in Ethiopia. Thus, the aim of this systematic review and meta-analysis is to estimate the national coverage and identify the associated factors of IYCF practices in Ethiopia.

METHODS

PubMed, Scopus, EMBASE, CINHAL, EBSCO, Web of Science and WHO Global Health Library databases will be searched for all available publications from 1 January 2000 to 30 September 2017. All published studies on the timely initiation of breast feeding, exclusive breast feeding and timely initiation of complementary feeding practice in Ethiopia will be screened, selected and reviewed. Bibliographies of identified articles and grey literature will be hand-searched as well. Heterogeneity of studies will be quantified using Higgins's method where I2 statistic >80% indicates substantial heterogeneity. Funnel plots and Egger's regression test will be used to assess potential publication bias. The Newcastle-Ottawa Scale (NOS) will be used to assess the quality of evidence and risk of bias. Meta-analysis and meta-regression will be carried out to estimate the pooled national prevalence rate and an OR of each associated factor of IYCF practices. Narrative synthesis will be performed if meta-analysis is not feasible due to the substantial heterogeneity of studies.

ETHICS AND DISSEMINATION

Ethical clearance is not required for this study because primary data will not be collected. The results of this systematic review and meta-analysis will be published in a peer-reviewed journal and presented at an (inter)national research symposium.

SYSTEMATIC REVIEW REGISTRATION

This systematic review and meta-analysis has been registered with the International Prospective Register of Systematic Reviews (PROSPERO), registration number CRD42017056768.

Early initiation of breastfeeding among mothers of children under the age of 24 months in Southern Ethiopia

Background

The early initiation of breastfeeding (EIBF), or timely initiation of breastfeeding, is the proportion of children put to the breast within one hour of birth. It is an important strategy for reducing perinatal and infant morbidity and mortality, but it remains under practiced in Ethiopia. The aim of the study was to assess the prevalence and the predicting factors associated with EIBF.

Methods

A community based cross-sectional study was conducted in 634 mothers in Dale Woreda, South Ethiopia. Multistage cluster sampling was used to select participating mothers. EIBF was outcome variable whereas sociodemographic characteristics and knowledge and practice of maternal health service were explanatory variables. A face-to-face interview using a pretested semi-structured questionnaire was done from September 2012 to March 2013. To investigate predicting factors, bivariate and multivariate logistic regression analysis was done.

Results

A total of 634 mothers of children under 24 months were interviewed. During the time of data collection, 94.3% of the mothers had breastfed. The prevalence of EIBF was 83.7%. Ownership of the house was a significant predicting factor for EIBF. Mothers who lived in rented houses were significantly less likely (60%) to initiate breastfeeding within one hour of birth compared to mothers who owned their own house: Adjusted odds ratio 0.40 (95% Confidence Interval 0.16, 0.97).

Conclusion

More than three-fourths of mothers initiated breastfeeding within an hour. Findings from our study suggest that improving the mother's socioeconomic status as reflected by house ownership, being a significant predictor of EIBF, would have a central role in improving EIBF.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0096-3) contains supplementary material, which is available to authorized users.

Breast feeding initiation rate across Western countries: does religion matter? An ecological study

Background

Breast feeding initiation rates remain below 80% in some Western countries. Many individual-level determinants are known; however, less is known regarding cultural and societal determinants, such as religion, that could explain population-level variations. We examined the correlations of the proportions of Catholics and Protestants with the breast feeding initiation rates across and within Western countries.

Methods

Using publicly available data, we carried out an ecological study comparing the proportions of Catholics and Protestants with the rates of breast feeding initiation. We correlated data at the country level, and additionally explored within-country data in five Western countries: France (Departments), Ireland (counties), the UK (countries), Canada (provinces) and the USA (states). Our analyses accounted for human development index, gross domestic product and population density.

Results

We observed a negative correlation (r=−0.30) between the proportion of Catholics and the rate of breast feeding initiation in Western countries. This correlation was consistent when using within-country data in France (r=−0.27), Ireland (r=−0.23), the UK (r=−0.79) and Canada (r=−0.62). In the USA, the positive correlation (r=0.26) between a state's proportion of Catholics and its breast feeding initiation rate was confounded by race, education and socioeconomic status (SES). After controlling for education and SES, the state proportion of non-Hispanic white Catholics was negatively correlated (r=−0.29) with the rate of breast feeding initiation.

Conclusions

In this ecological study, we found consistent negative correlations between Catholicism and breast feeding initiation rates. Qualitative and quantitative studies at the individual level are needed to confirm and explain our findings. Our results suggest that women living in a country or region where Catholicism has historically dominated are less likely to initiate breast feeding, and that breast feeding promotion policies should be adapted to better fit populations' cultural and religious norms.

A qualitative study investigating the barriers to returning to work for breastfeeding mothers in Ireland

Background

The World Health Organization (WHO) recommends that mothers exclusively breastfeed for the first 6 months of an infant’s life. In Ireland, currently paid maternity leave is 26 weeks and the expectant mother is required by law to finish work 2 weeks before her expected delivery date. Mothers wishing to exclusively breastfeed for 6 months or longer find themselves having to take holiday leave or unpaid leave from work in order to meet the WHO’s guidelines. The aim of this study is to explore women’s experiences of breastfeeding after their return to work in Ireland.

Methods

This study was carried out utilizing a qualitative design. Initially 25 women who returned to the workforce while continuing to breastfeed were contacted, 16 women returned consent forms and were subsequently contacted to take part in an interview. Interviews were recorded and transcribed verbatim and thematic analysis was employed to establish recurring patterns and themes throughout the interviews.

Results

Women noted that cultural attitudes in Ireland coupled with inadequate or inconsistent advice from health professionals posed the biggest challenge they had to overcome in order to achieve to 6 months exclusive breastfeeding. The findings of this study illustrate that mothers with the desire to continue to breastfeed after their return to work did so with some difficulty. Many did not disclose to their employers that they were breastfeeding and did not make enquiries about being facilitated to continue to breastfeed after their return to the workplace. The perceived lack of support from their employers as well as embarrassment about their breastfeeding status meant many women concealed that they were breastfeeding after their return to the workplace.

Conclusion

While it has been suggested that WHO guidelines for exclusive breastfeeding for 6 months may be unattainable for many women due to work commitments, a different problem exists in Ireland. Mothers struggle to overcome cultural and societal obstacles coupled with inadequate support from health professionals. Encouraging and facilitating women to continue to breastfeed after they return to work will help to normalise breastfeeding within Irish culture and promote continued breastfeeding as a viable option for working mothers.

Electronic supplementary material

The online version of this article (doi:10.1186/s13006-016-0075-8) contains supplementary material, which is available to authorized users.

The Association Between Infant Temperament and Breastfeeding Duration: A Cross-Sectional Study

BACKGROUND

Little is known about the relationship between infant temperament and breastfeeding. The few studies investigating this report mixed results. Some suggest that difficult infants are breastfed for shorter duration, others report opposing results or no association between the two.

AIM

This study investigated associations between infant difficult temperament and breastfeeding duration in a nationally representative cohort of Irish 9-month-old infants.

METHODS

Breastfed, normal birth-weight singletons from The Infant Cohort of the Growing Up in Ireland Study (n = 5,955) were considered in this research. The Infant Characteristics Questionnaire (ICQ), completed by the mother, was used to assess four different dimensions of difficult temperament: fussy, unpredictable, unadaptable, and dull. Our main interest was the fussy dimension as this is captured best by the ICQ. Initially, a logistic regression (LR) model having the binary version, short (<90 days) or long breastfeeding (≥90 days) as outcome variable, was constructed. Next, a proportional odds logistic regression (POLR) model examining the five-level categorical version (≤1 week, 2 weeks-<1 month, 1-<3 months, 3-<6 months, and ≥6 months) of breastfeeding duration was developed. All regression models were adjusted for relevant sociodemographic data.

RESULTS

A total of 3,119 infants were breastfed for less than 90 days, while 2,836 were breastfed for 90 days or longer. The LR and POLR models showed a mild inverse association between infant fussiness/difficultness and breastfeeding duration (LR: OR = 0.98, 95% CI: 0.97-0.99, POLR: OR = 0.98, 95% CI: 0.97-0.99). Higher infant unpredictability is associated with longer breastfeeding duration (LR: OR = 1.04, 95% CI: 1.02-1.07, POLR: OR = 1.04, 95% CI: 1.02-1.06).

CONCLUSIONS

In this cross-sectional study, we found that breastfeeding duration was inversely associated with infant fussiness and positively associated with infant unpredictability.

European Code against Cancer 4th Edition: Breastfeeding and cancer

Breast cancer is the most frequent cancer in women, and incidence rates have been rising in European Union (EU) countries over recent decades due in part to a sharp decline in breastfeeding practices. Evidence for a protective association between breastfeeding and the risk of breast cancer at all ages is convincing, and modest protective relationships between breastfeeding and the risk of endometrial and ovarian cancers have been suggested. The reduction in breast cancer risk is estimated at 2% for an increase of 5 months of lifetime breastfeeding. The longer women breastfeed, the more they are protected against breast cancer. In addition, breastfeeding is associated with several health benefits for both the mother and the breastfed child. Taking all this evidence into account, the 4th edition of the European Code against Cancer recommends: "Breastfeeding reduces the mother's cancer risk. If you can, breastfeed your baby".

A comparison of maternal attitudes to breastfeeding in public and the association with breastfeeding duration in four European countries: results of a cohort study

BACKGROUND

There is wide variation in the duration of breastfeeding across Europe which may in part be due to the between-country differences in mothers' and societal attitudes towards breastfeeding in public. The objective of this study was to quantify and compare the maternal attitudes to, and practice of, breastfeeding in public in four European centers and investigate the association with duration of breastfeeding.

METHODS

Participants (n = 389) were mothers recruited from maternity wards of hospitals in Glasgow (Scotland), Stockholm (Sweden), Granada (Spain), and Reggio-Emilia (Italy).

RESULTS

Among those who had breastfed, Scottish (adjOR 0.25 [95% CI 0.12-0.50]) and Italian mothers (adjOR 0.30 [95% CI 0.14-0.63]) were significantly less likely than Swedish mothers to have ever breastfed in public. Mothers who had a negative attitude toward breastfeeding in public were less likely to have ever breastfed in public (adjOR 0.05 [95% CI 0.02-0.17]), and those who had never breastfed in public were in turn more likely to discontinue breastfeeding earlier.

CONCLUSIONS

Perceived social norms may exert a stronger influence on breastfeeding outcomes than a woman's breastfeeding attitudes and knowledge. Differences between European countries in the duration of breastfeeding may be explained in part by differences in societal attitudes to breastfeeding in public.

Social and demographic determinants for breastfeeding in a rural, suburban and city area of South East China

Breastfeeding is a traditional practice in China, yet few studies have explored its current trend after socioeconomic reform. This study aims to characterize breastfeeding rates and possible associations with sociodemographic factors using a breastfeeding questionnaire administered to 1,385 mothers of 6-year-old children. Rates were lowest among city residents and negatively associated with parental and grandmother education levels as well as mothers' professional occupational status. These findings highlight the impact of urbanization on maternal and child health and the effect of marketing tactics for breast milk substitutes (BMS). Public health education promoting breastfeeding should target urban families, particularly those educated.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design

OBJECTIVE

The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed.

DESIGN

A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools.

METHODS

The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data.

RESULTS

Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools.

CONCLUSION

The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Affect, corporeality and the limits of belonging: breastfeeding in public in the contemporary UK

The UK has some of the lowest breastfeeding duration rates in the industrialised world. This paper considers women's experiences breastfeeding in public as a factor in breastfeeding duration. Research is based on an analysis of: 11 interviews and a 46-person survey of new mothers in Southampton, Hampshire; 180 postings about breastfeeding in public on UK parenting website mumsnet; and a patent application for a 'portable lactation module'. I analyse these data through an engagement with the work of cultural theorist Sara Ahmed to argue that the 'limits of sociability' in public space in the UK can be marked through affective practice. This paper makes three unique contributions to scholarship. First, it increases understanding regarding an issue of direct importance to health policy by filling a gap in knowledge about women's experiences breastfeeding outside the home in the UK. Second, it contributes to the field of health geography by showing how affective environments can constrain health-promoting behaviours. Third, it extends conceptual work in human geography more broadly through an analysis of the relationships between affect, embodiment and urban subjectivity.

Factors associated with duration of breastfeeding in ireland: potential areas for improvement

There is a need to comprehensively examine why mothers in Ireland discontinue breastfeeding early and to explore the factors influencing duration of breastfeeding during the first 6 months postpartum. Findings from this study provide valuable direction for future strategies and interventions aimed at increasing breastfeeding duration rates in Ireland.

The effect of breastfeeding on children's educational test scores at nine years of age: results of an Irish cohort study

This retrospective cross-sectional paper examines the relationship between early breastfeeding exposure and children's academic test scores at nine years of age independent of a wide range of possible confounders. The final sample comprised 8226 nine-year-old school children participating in the first wave of the Growing Up in Ireland study. The children were selected through the Irish national school system using a 2-stage sampling method and were representative of the nine-year population. Information relating to breastfeeding initiation and exposure duration was obtained retrospectively at nine years of age via parental recall and children's academic performance was assessed using standardised reading and mathematics tests. Hierarchical linear regression analysis with robust standard errors to control for clustering at the school level was used to quantify the effect of breastfeeding on children's test scores. Propensity score matching was used to compare treatment effects across groups defined by their propensity to breastfeed. In unadjusted analysis, children who were breastfed scored 8.67 percentage points higher on reading and 7.42 percentage points higher on mathematics compared to those who were never breastfed. While the breastfeeding advantage attenuated appreciably when adjusted for a range of child, maternal, socio-economic and socio-environmental characteristics, children who were breastfed continued to enjoy a significant test score advantage of 3.24 (p<0.001) and 2.23 (p<0.001) percentage points on reading and mathematics respectively compared to those who were never breastfed. Any amount of breastfeeding was associated with significantly higher test scores than no exposure, but evidence of a dose-response relationship was weak. The results of the propensity score matching analysis indicated that the test score advantage of breastfed children is robust and that the magnitude of the effect varies across groups defined by their propensity to breastfeed, being largest amongst the most socially disadvantaged and falling to near zero among the most advantaged group.

UK-born ethnic minority women and their experiences of feeding their newborn infant

OBJECTIVE

to explore the factors that impact on UK-born ethnic minority women's experiences of and decisions around feeding their infant.

DESIGN

in-depth semi-structured interviews.

PARTICIPANTS

34 UK-born women of Black African, Black Caribbean, Pakistani, Bangladeshi, Indian and Irish parentage and 30 health-care professionals.

SETTING

women and health-care professionals were recruited primarily from hospitals serving large numbers of ethnic minority women in London and Birmingham.

FINDINGS AND CONCLUSIONS

despite being aware of the benefits of exclusive breast feeding, many women chose to feed their infant with formula. The main barriers to breast feeding were the perceived difficulties of breast feeding, a family preference for formula feed, and embarrassment about breast feeding in front of others. Reports from women of South Asian parentage, particularly those who lived with an extended family, suggested that their intentions to breast feed were compromised by the context of their family life. The lack of privacy in these households and grandparental pressure appeared to be key issues. Unlike other participants, Irish women reported an intention to feed their infant with formula before giving birth. The key facilitators to breast feeding were the self-confidence and determination of women and the supportive role of health-care professionals.

IMPLICATIONS FOR PRACTICE

these findings point to common but also culturally specific mechanisms that may hinder both the initiation and maintenance of breast feeding in UK-born ethnic minority women. They signal potential benefits from the inclusion of family members in breast-feeding support programmes.

"The way to break the taboo is to do the taboo thing" breastfeeding in public and citizen-activism in the UK

Like other forms of infant feeding, breastfeeding is a fundamental act of care. Yet despite being the recommended way of feeding babies, breastfeeding is not always easy to do. In addition to lack of support, bio-physical problems and the need to return to work; discomfort with breastfeeding in public is a factor shaping infant feeding choice (and the decision to stop breastfeeding specifically). With increased awareness of breast milk's health benefits in recent years, there has been a rise in efforts to make breastfeeding in public more commonplace and socially acceptable (including through lactation advocacy or "lactivism"). This paper considers breastfeeding in public and lactation advocacy in the UK through interviews with lactation activists, non-activist breastfeeding mothers, and participant-observation at two breastfeeding picnics held in 2009. Building on existing scholarship in Geography, I suggest that lactivism can be understood as an effort to expand the boundaries of where care-work is allowed to take place: thus constituting a form of "care-work activism".

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

OBJECTIVE

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers.

DESIGN

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

SETTING

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

SUBJECTS

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

RESULTS

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

CONCLUSIONS

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.