Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community

Why do mothers mix milk feed their infants? Results from a systematic review

CONTEXT

Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially.

OBJECTIVE

An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF.

DATA SOURCES

Six databases were searched for relevant articles published in English from January 2012 to January 2022.

DATA EXTRACTION

Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF.

DATA ANALYSIS

A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger.

CONCLUSION

The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO registration no. CRD42022304253.

Social media intervention for promoting breastfeeding among WIC participants

Social media have emerged as a promising communication channel for promoting breastfeeding among a new generation of mothers. Yet, there is no published study reporting the effects of a large-scale social media intervention on key breastfeeding-related perceptions, attitudes, and behaviors. As a component of its breastfeeding promotion campaign, the Women, Infants, and Children (WIC) program implemented a 12-month intervention using Facebook and Instagram and subsequently evaluated the outcomes by surveying WIC-participating women (N = 832) twice, immediately before and after the intervention. Based on their level of exposure to the intervention messages, the women were retrospectively classified into two groups, resulting in a two-group (no-low exposure vs. medium-high exposure) quasi-experiment. Women in the medium-high exposure group, in comparison with women in the no-low exposure group, exhibited higher campaign awareness (p < .001), visits to the campaign website (p < .001), and engagement with the website content (p < .001). They also reported more positive breastfeeding attitudes (M = 17.26 vs. M = 16.51, p < .05), self-efficacy (M = 54.48 vs. M = 49.94, p < .01), and social support (M = 27.37 vs. M = 25.11, p < .001). But they did not differ from women in the no-low exposure group in breastfeeding initiation (p > .05) and duration (p > .05). In conclusion, a social media-based intervention resulted in more positive breastfeeding attitudes, higher self-efficacy, and higher perceived social support. Future studies need to investigate the optimal level of intervention message dosage that prompts significant behavioral changes.

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study

Background

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women.

Methods

Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28).

Results

The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034).

Conclusion

Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

A Qualitative Exploration of the Reasons for Expressed Human Milk Feeding Informed by the Breastfeeding Self-Efficacy Theory

BACKGROUND

There is an increasing prevalence of expressed human milk feeding. The reasons for expressed human milk feeding of healthy term infants may differ from those for preterm infants. The process of adopting expressed human milk feeding for healthy full-term infants has not been well-described in the existing literature.

RESEARCH AIM

To describe the reasons for, and antecedents to, expressed human milk feeding among Chinese women who used a high proportion of expressed human milk for feeding.

METHODS

A descriptive, prospective cross-sectional qualitative design was used. Participants (N = 25) who used a high proportion of expressed human milk feeding were recruited from a larger perspective cohort study in two public hospitals in Hong Kong. Semi-structured, in-depth, one-to-one interviews were conducted 2017-2018. Data collection and thematic analysis were guided by the Breastfeeding Self-Efficacy Theory.

RESULTS

The authors conducted thematic analysis and identified six core themes: (1) perceived maternal roles; (2) breastfeeding role models; (3) negative feedback from social networks; (4) negative direct breastfeeding experiences; (5) expressed human milk feeding as a solution to a problem; and (6) advice from health care professionals to express human milk. These themes were consistent with the four antecedents of the Breastfeeding Self-Efficacy Theory (e.g., physiological and affective state, vicarious experiences, performance accomplishments, and verbal persuasion).

CONCLUSIONS

The main reason for participants to feed expressed human milk was experiencing difficulties with direct breastfeeding. Expressed human milk feeding was used as an immediate solution for breastfeeding problems. Strengthening breastfeeding support in the early postpartum period may decrease the perceived need for human milk expression.

[Economic, social, and health determinants that influence exclusive breastfeeding in Colombia]

Exclusive breastfeeding (EBF) is an important practice that offers many benefits, such as nutritional support, prevention of infectious and chronic diseases, and assistance in psychosocial and cognitive development. This study aims to identify the determinants associated with EBF abandonment in 1,527 children under six months of age, based on information collected by the Colombian National Survey of Nutritional Status and the Colombian National Demographic and Health Survey, 2010. This is an observational cross-sectional cohort study, in which a hierarchical Poisson regression model with robust variance was applied; considering in the first level the factors associated with the mother and child and, in the second level, the information of 32 departments and Bogotá. We noticed a high rate abandonment of EBF (57.6%) and its variation between departments. The factors associated with a longer time of EBF were higher maternal schooling level, having a partner, knowledge in breastfeeding, belonging to a lower level of income, living in the eastern region, having delivery assisted by qualified team, and low birth weight. According to the variance partition coefficient (VPC), 3.2% of the probability of abandonment of EBF may be related to factors within the departmental scope. The median odds ratio (MOR) indicates that the individual risk of abandoning EBF of a child would increase by 47% if the child moved from a department with a low prevalence of abandonment to a department with high prevalence. This study allows a better understanding of the abandonment of EBF from its determinants, providing evidence to implement more effective interventions for child nutrition.

Promoting maternal self efficacy and paternal attitudes towards breastfeeding: a randomized controlled trial

BACKGROUND

Counseling is one of the ways to improve the quantity and quality of breastfeeding. The present study was conducted to investigate the effect of couple-centered counseling on fathers' attitudes and mothers' self-efficacy towards breastfeeding.

METHODS

This randomized controlled trial study was conducted on 60 primigravida pregnant women and their spouses who were randomly selected among the pregnant women referred to the two maternity hospitals of Malayer City, a city in the province Hamadan in western Iran. Data collection tools included the demographic characteristics questionnaire, Breastfeeding Self-Efficacy Questionnaire, and Iowa Infant Feeding Attitude Scale. The intervention was performed according to the principles of GATHER counseling (Greet, Ask, Tell, Help, Explain, and Return). Mothers' self-efficacy and fathers' attitudes toward breastfeeding were assessed before the intervention and 4 weeks after birth in both groups. Data were analyzed with SPSS version 23 software and using a significance level of p = 0.05.

RESULTS

The participants of the control and test groups were homogeneous in terms of demographic characteristics. The change in mothers' breastfeeding self-efficacy score after intervention in the test group had a statistically significant difference compared to the control group (30.43 ± 2.53; 95%CI: 25.41,35.44), and the change in the score of fathers' attitude towards breastfeeding had a statistically significant difference after the intervention in the test group compared to the control group (19.3 ± 2.05; 95%CI: -23.36, -15.23). In the test group, the change in fathers' attitude towards breastfeeding after the intervention was significant compared to before the intervention (30.36 ± 2.38; 95%CI: 25.43, 35.25).

CONCLUSIONS

Appropriate counseling programs can change fathers' attitudes toward breastfeeding and increase mothers' breastfeeding self-efficacy, so couples' presence in breastfeeding counseling is recommended.

Determinants of breastfeeding self-efficacy among postpartum women in rural China: A cross-sectional study

Background

Breastfeeding self-efficacy is known to positively influence breastfeeding behaviors. While previous research has studied the determinants of breastfeeding self-efficacy in general, these determinants are unstudied among postpartum women in rural China. This study aims to describe the breastfeeding self-efficacy of postpartum women in rural China and identify determinants of breastfeeding self-efficacy using the Dennis breastfeeding self-efficacy framework.

Methods

Using a multi-stage random cluster sampling design, cross-sectional survey data were collected from 787 women within the 0–6 months postpartum period in 80 rural townships. Surveys collected data on breastfeeding self-efficacy, characteristics related to the Dennis breastfeeding self-efficacy framework, and demographic characteristics. Multiple linear regression analysis was used to identify determinants of breastfeeding self-efficacy.

Results

Participants reported a moderate level of breastfeeding self-efficacy, with an item mean score of 3.50. Self-efficacy was lowest for exclusive breastfeeding. Breastfeeding attitudes (β = 0.088, P< 0.001), breastfeeding family support (β = 0.168, P< 0.001), and social support from significant others (β = 0.219, P< 0.001) were positively associated with breastfeeding self-efficacy. Breastfeeding problems, including trouble with latching (β = -0.170, P< 0.001), not producing enough milk (β = -0.148, P< 0.001), and milk taking too long to secrete (β = -0.173, P< 0.001) were negatively associated with breastfeeding self-efficacy.

Conclusion

The findings indicate that positive attitudes, breastfeeding family support and social support contribute to greater breastfeeding self-efficacy in rural China, whereas difficulties with breastfeeding are associated with reduced self-efficacy. Researchers and practitioners should investigate effective strategies to improve social support and family support for breastfeeding, promote positive attitudes towards breastfeeding, and provide women with actionable solutions to breastfeeding problems.

Prevalence and multivariable predictors of breastfeeding outcomes in the United Arab Emirates: a prospective cohort study

BACKGROUND

Despite considerable policy actions at the national and hospital levels, rates of breastfeeding in the Middle East and North Africa (MENA) region remain below the global average. There is a need to explore the modifiable factors of breastfeeding such as maternal breastfeeding self-efficacy (BSE), support, and mental health among women in this region to guide interventions in the United Arab Emirates (UAE). The aim of this study was to examine the maternal predictors of any and exclusive breastfeeding in a cohort of Emirati and expatriate women residing in the UAE with a specific focus on modifiable factors.

METHODS

Using a prospective cohort design, Emirati and expatriate women were recruited in the immediate postpartum period (N = 374) and followed at three and 6 months postpartum between February 2018 and July 2019. Questionnaires with validated tools were used to collect information on sociodemographic characteristics, breastfeeding practices, BSE, postnatal depression, and anxiety. The main outcomes in the study were Any Breastfeeding and exclusivity practices, which were assessed at three and 6 months postpartum by asking the mother about her breastfeeding behaviour during the past 7 days. Multilevel, multivariate logistic regression was used to estimate the association of different variables with breastfeeding outcomes.

RESULTS

Almost all women reported initiating breastfeeding during their stay at the hospital (n = 357), while only 263 (70.3%) initiated breastfeeding within the first hour of delivery. At 6 months postpartum, 301 (81.5%) women continued to breastfeed of whom 100 (26.7%) were doing so exclusively. Older mothers who initiated breastfeeding within 1 h of birth and were satisfied with the breastfeeding support they received from family and friends had significantly greater odds of any breastfeeding at 6 months. Whereas a clinically significant Edinburgh Postnatal Depression Scale (EPDS) score, low BSE score as well as employment outside the home were associated with significantly lower odds of exclusive breastfeeding and any breastfeeding at 6 months postpartum.

CONCLUSION

This study highlights the need to develop effective education strategies and support programs targeting these modifiable variables to improve breastfeeding outcomes among women in the UAE.

Breastfeeding Outcomes, Self-Efficacy, and Satisfaction Among Low-Income Women With Late-Preterm, Early-Term, and Full-Term Infants

OBJECTIVE

To assess breastfeeding exclusivity and rate of breastfeeding, breastfeeding self-efficacy, and satisfaction with breastfeeding after hospital discharge among low-income women with late-preterm and early-term infants compared with women with full-term infants.

DESIGN

Prospective, comparative, with repeated measures.

SETTING

Four Midwestern U.S. Special Supplemental Nutrition Program for Women, Infants, and Children offices.

PARTICIPANTS

Participants included 270 mother-infant dyads.

METHODS

We assessed breastfeeding exclusivity, rate of breastfeeding, and breastfeeding self-efficacy at 2 weeks, 2 months, and 5 months and satisfaction with breastfeeding at 5 months after birth or when participants stopped breastfeeding.

RESULTS

More than 50% of women in each subgroup were non-Hispanic White. Late-preterm and early-term infants had lower breastfeeding exclusivity rates than full-term infants across the three time points (40%, 51%, and 65% at 2 weeks, p = .029; 22.5%, 34%, and 58% at 2 months, p < .001; and 7%, 15%, and 28.46% at 5 months, p < .001, respectively). The overall exclusive breastfeeding rate for all groups was 55.93% at 2 weeks, 44.07% at 2 months, and 20.37% at 5 months; 55.56% continued any breastfeeding at 5 months. Breastfeeding self-efficacy during the first 5 months after birth, satisfaction with breastfeeding, level of education, and attending breastfeeding classes were positively correlated with breastfeeding exclusivity. We found significantly less exclusive breastfeeding, lower breastfeeding self-efficacy, and lower satisfaction with breastfeeding among participants with late-preterm and early-term infants compared to those with full-term infants.

CONCLUSION

Ongoing professional breastfeeding support for women is needed to improve and promote breastfeeding exclusivity and continuation among their late-preterm and early-term infants.

Factors influencing breastfeeding practices in China: A meta-aggregation of qualitative studies

The World Health Organization recommends that women exclusively breastfeed until their babies are 6 months old and continue to breastfeed while introducing complementary foods. A meta‐aggregation methodology was used to systematically review and synthesise the qualitative studies on factors influencing breastfeeding practices of healthy Chinese women in Greater China. English and Chinese databases were searched to identify peer‐reviewed qualitative studies (published 2008–2019). Relevant data were extracted, and key themes related to factors influencing breastfeeding practices were identified. Of 7587 articles identified, 22 qualitative studies met inclusion criteria for the review, 10 of which were published in Chinese. A total of 87 themes were extracted from all included studies and classified into 9 subcategories: government enactment of policies, implementation of policies in workplaces, social expectations, social support, medical and health services, services with Chinese characteristics, breastfeeding and pumping facilities, maternal perceptions of breastfeeding and self‐efficacy to breastfeed. The nine subcategories were then grouped into four categories. Potential effect associations among these influence factors of breastfeeding practices emerged from categories and subcategories. Family members' influence on breastfeeding motivation and self‐efficacy suggest a potential benefit of breastfeeding promotion interventions targeting the whole family. The role of primary care should be fully exploited in breastfeeding promotion, including both prenatal education and post‐partum visits. Standardising the training and qualifications of maternity matrons (yuesao) and folk breastfeeding specialists (cuirushi) can promote evidence‐based approaches to facilitating breastfeeding during the confinement period. Increased availability of breastfeeding and pumping facilities in the workplace would facilitate continuing breastfeeding after returning to work.

The association of breastfeeding self-efficacy with breastfeeding duration and exclusivity: longitudinal assessment of the predictive validity of the Greek version of the BSES-SF tool

INTRODUCTION

While breastfeeding self-efficacy (BSES) is an important modifiable determinant of breastfeeding, a structured assessment is not standard practice in Cyprus. We assessed the Greek version of the Breastfeeding Self-Efficacy Scale (BSES-SF), including its predictive validity in terms of Breastfeeding (BF) and Exclusive Breastfeeding (EBF) up to the sixth month.

METHODS

A methodological study with longitudinal design among 586 mother-infant dyads, as part of the "BrEaST Start in Life" project. BSES was assessed 24-48 h after birth and at the first month. Breastfeeding status was assessed at the clinic, the 1st, 4th and 6th month. The association between BSES and breastfeeding was estimated in logistic regression models and its diagnostic ability in ROC analysis.

RESULTS

With Mean = 3.55 (SD = 0.85), BSES was moderate, and lower among Cypriot women, primiparas and those who delivered by Cesarean Section (C/S). There was good internal consistency across the 14 items (Cronbach's α = 0.94) while factor analysis revealed a two-factor structure. BSES scores were higher among mothers who initiated exclusive breastfeeding (M = 3.92, SD = 0.80) compared to breastfeeding not exclusively (M = 3.29, SD = 0.84) and not breastfeeding (M = 3.04, SD = 1.09; p-value < 0.001). There was a stepwise association with exclusivity (40.5% in the highest vs 7.9% lowest quartile of self-efficacy). The association between in-hospital BSES and long-term EBF persisted in multivariable models. Women in the upper quartile of BSES at 48 h were more likely to breastfeed exclusively by adjOR = 5.3 (95% CI 1.7-17.1) at the 1st and adjOR = 13.7 (95% CI 2.7-68.6) at the 4th month. Similar associations were observed between self-efficacy at the 1st month and BF at subsequent time-points. High first month BSES (> 3.96 as per ROC) had 58.9% positive and 79.6% negative predictive value for breastfeeding at 6 months which reflects higher sensitivity but lower specificity.

CONCLUSIONS

The Greek version of BSES-SF showed good metric properties (construct, know-group, concurrent and predictive validity). In the absence of community support structures or programmes in Cyprus, prevalence of breastfeeding remains low. This suggests a need for policy, educational and community support interventions, including the systematic use of BSES scale as a screening tool to identify those at higher risk for premature BF discontinuation.

Determinants of low breastfeeding self-efficacy amongst mothers of children aged less than six months: results from the BADUTA study in East Java, Indonesia

Background

Despite the increasing rate of exclusive breastfeeding in Indonesia, there is still a need for supportive interventions. The breastfeeding self-efficacy of mothers is a key factor positively associated with optimum breastfeeding practices. Our analysis aims to assess the determinants of low breastfeeding self-efficacy amongst a sample of women with children aged under 6 months in Malang and Sidoarjo Districts, East Java, Indonesia.

Methods

We used information from 1210 mothers of children aged < 6 months recruited in the BADUTA study conducted in 2015–2016 in Malang and Sidoarjo Districts. The outcome variable in this analysis was mothers’ self-efficacy for breastfeeding using the 14 statements in the Breastfeeding Self-Efficacy-Short Form. We evaluated 17 potential predictors of breastfeeding self-efficacy, organized into six sub-groups of variables: (1) context/demographic; (2) household factors; (3) maternal characteristics; (4) child characteristics; (5) breastfeeding practices; and (6) antenatal and delivery care. Logistic regression analyses were employed to examine factors associated with mothers’ self-efficacy with breastfeeding.

Results

More than half of the women in this study had a low level of self-efficacy. One of the factors associated with low breastfeeding self-efficacy found in this study was mothers’ problems related to breastfeeding. Mothers who had problems with breastfeeding not related to illness (adjusted odds ratio [aOR] 3.27; 95% CI 2.45, 4.36) or problems related to both illness and non-illness conditions (aOR 3.57; 95% CI 1.37, 9.33) had higher odds of low breastfeeding self-efficacy than those who did not have any problems. Compared to mothers who completed university education, there was a significantly higher odds of low breastfeeding self-efficacy in mothers who completed primary school or lower (aOR 1.88; 95% CI 1.16, 3.05); completed junior high school (aOR 2.27; 95% CI 1.42, 3.63); and completed senior high school (aOR 1.94; 95% CI 1.29, 2.91). Other significant predictors of low breastfeeding self-efficacy were mothers not exposed to any breastfeeding interventions (aOR 1.87; 95% CI 1.09, 3.22); working outside the house (aOR 1.69; 95% CI 1.23, 2.32); not obtaining any advice on breastfeeding (aOR 1.40; 95% CI 1.08, 1.82); with low knowledge of breastfeeding (aOR 1.38; 95% CI 1.03, 1.84); and delivered by Caesarean section (aOR 1.34; 95% CI 1.05, 1.70).

Conclusions

Multipronged breastfeeding education programs and support are required to improve women’s self-efficacy with breastfeeding. Improved access to breastfeeding counselors, active support for mothers following cesarean delivery, and increased supporting facilities at workplaces are essential to improve self-efficacy with breastfeeding.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-021-00357-5.

The effects of mother's education on achieving exclusive breastfeeding in Indonesia

BACKGROUND

Even though the Indonesian government have set regulations for maintaining exclusive breastfeeding practices, the coverage remains low. The study aims to analyze the effects of mother's education level on the coverage of exclusive breastfeeding in Indonesia.

METHODS

This study used data from the 2017 Nutrition Status Monitoring Survey. It covered data of 53,528 children under 5 years old (7-59 months) as the samples. Variables included exclusive breastfeeding status, mother's education level, mother's age, marital status, employment status, gender, residence, under five's age and gender. A binary logistics regression was performed in the final test.

RESULTS

Mothers who graduated from elementary school were 1.167 times more likely to perform exclusive breastfeeding compared to mothers who never attended schools. Additionally, those who graduated from junior high school had 1.203 times possibilities to give exclusive breastfeeding compared to mothers without educational records. While, mothers who graduated from high school were 1.177 times more likely to perform exclusive breastfeeding compared to those without educational records. Mothers who graduated from tertiary education had 1.203 times more possibilities to perform exclusive breastfeeding compared to mothers who were never enrolled to schools. Other variables also became affecting predictors on exclusive breastfeeding, such as mother's age, mother's employment status, child's age, and residence.

CONCLUSIONS

The mother's education level positively affects exclusive breastfeeding practice in Indonesia.

Newborn Clinic: A Novel Model to Provide Timely, Comprehensive Care to Newborns Following Nursery Discharge

Ensuring safe and timely follow-up after well baby nursery (WBN) discharge is an ongoing challenge. This study demonstrates the efficacy of a novel model for follow-up, the Newborn Clinic (NBC), in reducing time to outpatient follow-up after WBN discharge. Our retrospective chart review of 17 952 newborns found that time to follow-up visit decreased significantly following NBC establishment. Emergency department visits, a marker of infant morbidity, were slightly increased in the post-establishment cohort. There was no difference, however, in hospital readmissions. Analysis within the post-establishment cohort showed that newborns with jaundice, a high-risk group, were much more likely to have early follow-up if their visit was scheduled with NBC. Our study demonstrates that NBC is an effective model for decreasing time from WBN discharge to follow-up visit. It should be considered as an initiative to run concurrently with expedited newborn discharge initiatives so that safe follow-up need not be sacrificed.

Prospective Monitoring of Breastfeeding Behaviors in Primiparous Mothers with Risky and Non-risky Age Groups

AIM

This study aimed at monitoring breastfeeding behaviors in primiparous mothers with risky and non-risky age groups prospectively.

METHOD

This is a kind of comparative and prospective study that was carried out in 306 mothers who were registered at seven family health centers. The study sample comprised 68 primiparous mothers who were in the risky age group and 238 primiparous mothers who were not in the risky age group. It was interviewed with the mothers twice when their babies were one and six months old. Personal Information Form, Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF), and LATCH Breastfeeding Assessment Tool were used for data collection.

RESULTS

The mothers in the risky age group had a lower breastfeeding rate when their babies were one month old and a higher formula feeding rate when their babies were six months old than the rates observed in case of the mothers in the non-risky age group. Mothers in the non-risky age group breastfed 14.8 times more in the first month and 5.4 times more in the sixth month than those in the risky age group. The mean scores of LATCH and BSES-SF in the first month and the mean scores of BSES-SF in the sixth month of mothers in the non-risky age group were higher than those of the mothers in the risky age group.

CONCLUSION

It was determined that primiparous mothers in the non-risky age group exhibited more positive behaviors in terms of breastfeeding. Close monitoring of breastfeeding behaviors of mothers in the risky age group could be recommended.

Investigating Predictors of Prenatal Breastfeeding Self-Efficacy

Background

While breastfeeding is considered the optimal method of infant feeding, Canadian breastfeeding rates remain below the World Health Organization recommendations. Breastfeeding self-efficacy is known to positively influence breastfeeding outcomes. While previous research has identified predictors of breastfeeding self-efficacy in the immediate postpartum, this study identified predictors of breastfeeding self-efficacy in the prenatal period. Research aim: The aim of this study was to identify predictors of breastfeeding self-efficacy in the prenatal period among both primiparous and multiparous women.

Methods

A sample of 401 Canadian pregnant women in their third trimester completed an online survey. Stepwise multiple linear regression identified predictors of breastfeeding self-efficacy.

Results

The following variables explained 41.2% of the variance in breastfeeding self-efficacy among the entire sample: feeling prepared for labor and birth, number of children, breastfeeding knowledge, anxiety, length of plan to exclusively breastfeed, income, plan to exclusively breastfeed, and type of health-care provider. Among primiparous women, the following variables explained 31.6% of the variance in breastfeeding self-efficacy: feeling prepared for labor and birth, income, anxiety, length of plan to exclusively breastfeed, education, and marital status. Among the multiparous women, the following variables explained 33.6% of the variance in breastfeeding self-efficacy: anxiety, length of prior exclusive breastfeeding experience, breastfeeding knowledge, and plan to exclusively breastfeed.

Conclusion

Through the identification of predictors of breastfeeding self-efficacy in the prenatal period, health-care providers can strategically target women at risk of low breastfeeding self-efficacy and intervene early to promote breastfeeding.

Induced Lactation for Adoptive Breastfeeding Dyads

Introduction

Breastfeeding has many benefits for both mother and baby, but not all mothers can have their own babies. Here we used an induced lactation protocol to breastfeed adopted babies.

Materials and Method

We implement and describe an induced lactation protocol for adoptive breastfeeding dyads at Kemang Medical Care (KMC) Women and Children Hospital and Permata Depok Hospital, Greater Jakarta, Indonesia. Participants included 32 of 48 breastfeeding dyads or subjects undergoing induced lactation protocols and fulfilling the inclusion criteria. The induced lactation protocol included the Praborini Method (hospitalization for nipple confusion) to promote latching, pharmacologically induced lactation, and at-breast supplementation.

Results

Nineteen babies (59.4%) were aged <1 month and nine (28.1%) were aged 1–3 months at protocol initiation. Almost all (31 babies, 96.8%) were adopted after birth. At first examination, 20 babies (62.5%) could not latch, but all dyads could breastfeed after hospitalization for <1–2 days. Breast milk was induced after one cycle of Yasmin in 24 cases (75%). All mothers took domperidone and no side-effects were reported. Average breastfeeding duration was 8.5 months, with weaning at 2–25 months of age, with working mothers weaning at ≤4 months. At-breast supplementation was used until weaning.

Conclusions

Adopted babies can achieve long-term breastfeeding through this multimodal protocol. Further prospective studies are warranted.

Self-efficacy, infant feeding practices, and infant weight gain: An integrative review

It has been suggested that self-efficacy specific to parenting or feeding may influence the decisions parents make regarding infant feeding; however, a review of this topic has not been conducted. The purpose of this integrative review is to synthesize the literature regarding the potential role of self-efficacy in infant feeding practices or infant weight gain. A total of 40 articles were used to guide this review, which were classified into three categories examining an association with self-efficacy (1) breastfeeding; (2) infant feeding practices such as parental feeding style and dietary quality; and (3) infant weight gain. Evidence regarding breastfeeding self-efficacy (BFSE) and breastfeeding is extensive; mothers with a higher sense of BFSE more often initiate breastfeeding and breastfeed for longer durations. The evidence regarding self-efficacy and the association with infant feeding practices other than breastfeeding is sparse. However, several studies report that mothers who have a higher sense of self-efficacy are more likely to follow infant feeding practices which align with recommendations. The authors have speculated an association between self-efficacy and infant weight gain; yet, to date, no study has found a significant association. More research is needed on the topic, particularly in diverse populations and with fathers and mothers.

Breastfeeding Duration and the Theory of Planned Behavior and Breastfeeding Self-Efficacy Framework: A Systematic Review of Observational Studies

Introduction Numerous studies have shown that the constructs of the Theory of Reasoned Action (TRA), Theory of Planned Behavior (TPB) and Breastfeeding Self-Efficacy (BSE) Framework can effectively identify relationships between maternal psychosocial factors and breastfeeding initiation. However, the ability of these theories to predict breastfeeding duration has not been adequately analyzed. The aim of the review was to examine the utility of the constructs of TRA/TPB and BSE to predict breastfeeding duration. Methods We conducted a literature search using Pubmed (1980-May 2015), Medline (1966-May 2015), CINAHL (1980-May 2015), EMBASE (1980-May 2015) and PsycINFO (1980-May 2015). We selected studies that were observational studies without randomization or blinding, using TRA, TPB or BSE as the framework for analysis. Only studies reporting on breastfeeding duration were included. Results Thirty studies were selected, which include four using TRA, 10 using TPB, 15 using BSE and one using a combination of TPB and BSE. Maternal intention and breastfeeding self-efficacy were found to be important predictors of breastfeeding duration. Inconsistent findings were found in assessing the relationship between maternal attitudes, subjective norms, perceived behavior control and breastfeeding duration. Discussion The inadequacy of these constructs in explaining breastfeeding duration indicates a need to further explore the role of maternal self-determination in breastfeeding behavior.

Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6 months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6 months; preferably according to Hispanic subgroups.

Online social support group use by breastfeeding mothers: A content analysis

Background

Breastfeeding is a public health priority and lack of breastfeeding support a contributing factor to the low initiation and continuation rates in the UK. Online social support groups are being increasingly utilised by breastfeeding mothers and research into this phenomenon is only now emerging.

Aim

To document and describe the posts made within an online breastfeeding support group.

Method

The posts made to an online breastfeeding social support group between 1^st and 7^th November 2016 were recorded using an unobtrusive non-participant design, and subject to systematic message content analysis. Themes relating to topics of discussion were deduced from the data and concepts of social support used to analyse the data.

Results

The group received 501 posts over the week (m = 72, range 20–93 a day) and was accessed 24 hours a day. Eighty-two percent of posts received comments (m = 12, range 0–415, SD = 24) and 93% received likes (m = 11, range = 0–641, SD 42). The group was used from pregnancy and until the child was over two years old. The majority of infants discussed were aged 6 weeks to 6 months. Informational support was the greatest reason for use (65%), followed by esteem support (18%) and emotional support (10%). Thirteen topics of conversations were identified.

Conclusion

Mothers are using online social support groups in their thousands to seek information from people in similar situations. Not only do they pose questions but they discuss a range of parenting and breastfeeding topics in an environment that aims to support and facilitate responses. The impact of this support avenue within the wider context of professional, family and offline support warrants further investigation through a qualitative approach.

The Efficacy of Using Peer Mentors to Improve Maternal and Infant Health Outcomes in Hispanic Families: Findings from a Randomized Clinical Trial

Introduction The Maternal Infant Health Outreach Worker (MIHOW) program is a home visiting program, utilizing peer mentors to improve maternal/child health outcomes in underserved communities. Findings are presented from a randomized clinical trial (RCT) testing the efficacy of the MIHOW model in a sample of Hispanic women in Tennessee. We hypothesized maternal and infant outcomes would be better in women assigned to MIHOW than women assigned to the minimal education intervention (MEI) group (receipt of educational materials). Methods Women entered the study during pregnancy (< 26 weeks gestation) and were followed through 6 months postpartum. A total of 188 women were enrolled and randomly assigned (MEI = 94; MIHOW = 94), with 178 women completing the study (MEI = 87; MIHOW = 91). Results Positive and statistically significant (p < 0.01) effects of MIHOW were observed on breastfeeding self-efficacy and exclusivity, levels of depressive symptoms and parenting stress, safe sleep practices, and infant stimulation in the home. No statistically significant differences were noted in number of prenatal visits. Discussion Results expand limited empiric evidence and provide strong support of the effectiveness of MIHOW on improving health outcomes in this sample of Hispanic mothers and their infants. MIHOW is a viable option for providing culturally sensitive services to immigrant and underserved families.

Pragmatic Trial to Evaluate the Effect of a Promotora Telephone Intervention on the Duration of Breastfeeding

OBJECTIVE

To evaluate the effectiveness of a telephone intervention delivered by promotoras (lay health care workers) to increase the duration of exclusive breastfeeding (EBF) in Hispanic women at 12 weeks postpartum. Secondary objectives were to assess breastfeeding duration (BFD) and to evaluate background variables that may be associated with EBF and BFD.

DESIGN

Pragmatic trial.

SETTING

Two obstetric clinics affiliated with a community medical center in Southern California.

PARTICIPANTS

We recruited 61 participants from the two clinics. Participants were 18 to 45 years old and planned to breastfeed their infants. Women who showed interest in the study were sequentially divided into an intervention (n = 31) or a control group (n = 30).

METHODS

The intervention consisted of telephone support for breastfeeding provided by certified and trained promotoras.

RESULTS

Fourteen out of 31 (45%) participants in the intervention group continued to practice EBF compared with 4 out of 30 (13%) in the control group (odds ratio = 3.39, p = .04). Breastfeeding duration in days was significantly longer for the participants in the intervention group (F =1/59 = 29.88, p < .01). The positive predictors of EBF at 12 weeks after birth were prior breastfeeding experience, perceived breastfeeding support, promotora telephone support, and higher scores on the acculturation scale. Positive predictors of BFD were breastfeeding support, promotora telephone support, and higher scores on breastfeeding self-efficacy. A negative predictor was lower household income.

CONCLUSION

Our results indicate that a telephone support intervention delivered by promotoras may increase the rates of EBF by threefold at 12 weeks after birth.

Efeitos de uma tecnologia educativa na autoeficácia para amamentar e na prática do aleitamento materno exclusivo

RESUMO Objetivo Avaliar os efeitos do uso de um álbum seriado sobre a autoeficácia materna na amamentação e suas repercussões no aleitamento materno exclusivo (AME) nos primeiros 2 meses de vida da criança. Método Ensaio clínico realizado em Recife, Região Nordeste do Brasil, com 112 mulheres no terceiro trimestre de gestação, distribuídas de forma aleatória em grupo-intervenção (GI) e grupo-controle (GC). A intervenção caracterizou-se pelo uso do álbum seriado no GI. A coleta de dados foi realizada por meio de entrevistas no pré-natal e contato telefônico na segunda, quarta e oitava semanas pós-parto. Foi utilizada a BSES-SF para mensurar os escores de autoeficácia. Na análise, utilizou-se de estatística descritiva, bivariada por meio de testes de comparação de proporções e médias e avaliação do risco relativo. Resultados Houve diferença estatisticamente significante nas médias dos escores de autoeficácia entre as mulheres do GI e GC (p<0,001) e nas taxas de AME (p<0,001), a probabilidade de amamentar exclusivamente no GI foi duas vezes maior do que no GC (RR 2,2 IC 1,51-3,21). Conclusão O uso do álbum seriado como ferramenta educacional repercutiu positivamente nos escores de autoeficácia para amamentar e na manutenção do AME no GI. Registro Brasileiro de Ensaios Clínicos: RBR-5N7K99

The Voices That Influence HIV-Positive Mothers' Breastfeeding Practices in an Urban, Ghanaian Society

BACKGROUND

The World Health Organization recommends that HIV-positive mothers should breastfeed for at least 1 year. There are people in the lives of these mothers who influence their decisions. Research aim: The aim was to explore the role of social persuasion in the decision-making processes of HIV-positive breastfeeding mothers.

METHODS

A qualitative, exploratory research design was employed ( N = 13). Participants were recruited from a public hospital in the Greater Accra Region of Ghana. One-on-one interviews were recorded and transcribed verbatim, and the contents of the transcripts were analyzed for emerging themes.

RESULTS

The perspectives of spouses, health workers, counselors, and siblings about breastfeeding affect the breastfeeding practices of mothers living with HIV in Ghana. Most of the women had negative experiences with their midwives. Because of complex social and cultural influences, the opinions of spouses, health professionals, siblings, and members of the communities in which breastfeeding mothers with HIV live influence breastfeeding practices.

CONCLUSION

This study described HIV-positive, breastfeeding mothers' perceptions of the role played by spouses, health professionals, siblings, and the community in breastfeeding decisions and practices. Influential people in the lives of breastfeeding mothers with HIV should be involved during interventions by HIV counselors to promote breastfeeding practices.

Fatores relacionados ao Aleitamento Materno Exclusivo em bebês nascidos em hospital amigo da criança em uma capital do Norte brasileiro

RESUMO Objetivou-se determinar os fatores relacionados com o Aleitamento Materno Exclusivo em bebês nascidos em hospital amigo da criança na cidade de Belém, capital do Pará, e verificar se os escores da Escala de Autoeficácia na Amamentação encontram-se dentre esses fatores. Estudaram-se 414 binômios mãe-bebê, cujos bebês nasceram em 2016. Utilizaram-se questionários socioeconômicos e obstétricos, aplicando a Escala de Autoeficácia na Amamentação no momento da alta hospitalar. A média do escore de amamentação foi 61 pontos; 32,45% das mães tinham entre 19 e 23 anos; 36,56% delas possuíam 2º grau completo; 43,34% percebiam até um salário mínimo; 62,95% eram amasiadas; e 17,92% trabalhavam fora do lar. Os fatores relacionados ao Aleitamento Materno Exclusivo foram: faixa etária e escolaridade materna, mãe com trabalho fora do lar, estado civil materno, incentivo do companheiro quanto ao Aleitamento Materno e o escore da escala de autoeficácia.

Brazilian Immigrant Mothers' Beliefs and Practices Related to Infant Feeding: A Qualitative Study

BACKGROUND

Exclusive breastfeeding for the first 6 months of life and timely introduction of appropriate solid foods are important determinants of weight status in infancy and later life stages. Disparities in obesity rates among young children suggest that maternal feeding practices during the first 2 years of life may contribute to these disparities. Brazilians are a growing immigrant group in the United States, yet little research has focused on parental beliefs and behaviors affecting the health of Brazilian immigrant children in the United States. Research aim: This study aimed to explore beliefs and infant-feeding practices of Brazilian immigrant mothers in the United States.

METHODS

Focus group discussions were conducted with Brazilian immigrant mothers. Transcripts were analyzed using thematic analysis and themes categorized using the socioecological model.

RESULTS

Twenty-nine immigrant Brazilian mothers participated in the study. Analyses revealed that all participants breastfed their infants. The majority initiated breastfeeding soon after childbirth. However, most mothers did not exclusively breastfeed. They used formula and human milk concomitantly. Family and culture influenced mothers' infant-feeding beliefs and practices in early introduction of solid foods.

CONCLUSION

As the number of children in the United States growing up in families of immigrant parents increases, understanding influences on Brazilian immigrant mothers' infant-feeding practices will be important to the development of effective interventions to promote healthy infant feeding and weight status among Brazilian children. Interventions designed for Brazilian immigrant families should incorporate an understanding of social context, family, and cultural factors to develop health promotion messages tailored to the needs of this ethnic group.

Comparing maternal breastfeeding self-efficacy during first week and sixth week postpartum

Introduction

The ideal nourishment for the first 12 months of a child’s life comes from breastfeeding its mother’s milk, and maternal self-efficacy is one factor which affects breastfeeding duration. Therefore, the present study aimed to compare the maternal breastfeeding self-efficacy during the first week and sixth-week postpartum.

Methods

This descriptive, analytical study was conducted on 767 women referring to the Family Health Research Center of Rasht in 2014. Mothers were selected through continuous sampling. For data collection, we used demographic questionnaires, and Dennis breastfeeding self-efficacy scale. For data analysis, Chi-square, Mann-Whitney U, Pearson’s correlation coefficient and multiple regression were performed using SPSS version 19.

Results

In this study, most mothers had scores compatible with moderate self-efficacy in the first week, and in the sixth week had high self-efficacy for breastfeeding. There was a significant relationship between breastfeeding self-efficacy (BSE) score and employment status (p<0.0001). Also, we found significant BSE score differences between primiparous and multiparous women (p<0.001).

Conclusion

Results of the study indicate that breastfeeding duration increases the breastfeeding self-efficacy levels. So, Developing and implementing appropriate approaches are needed to improve breastfeeding duration in mothers.

Social-Cognitive Predictors of Exclusive Breastfeeding among Primiparous Mothers in Addis Ababa, Ethiopia

BACKGROUND

Despite the presence of high impact interventions to improve infant and young child feeding, only about 52% of mothers in Ethiopia exclusively breastfeed their child for the first six months after delivery. Although the decision to breastfeed a child is ultimately that of the mother, this decision could be influenced by a variety of factors including social-cognitive ones.

OBJECTIVES

The objectives of the study were to describe the breastfeeding behaviour of primiparous mothers during their prenatal period in terms of intentions/goals, outcome expectancies, self-efficacy, and socio-structural factors and assess their exclusive breastfeeding (EBF) practices as well as identify the social-cognitive predictors of EBF practices among these mothers in Addis Ababa, Ethiopia.

METHODS

A prospective follow up health facility-based study with quantitative methods was used with a sample of 233 primiparous women. Both structured and semi-structured questions were used for collection of data. The Statistical Package for Social Sciences (SPSS) version 21 was used for data analysis. Findings at the 95% confidence interval and P-value of 5% were reported as statistically significant.

RESULTS

39.1% (n = 59) of the respondents were found to have high breastfeeding self-efficacy, 51.4% (n = 71) have good breastfeeding outcome expectancies, and 6.5% (n = 9) respondents had supportive breastfeeding socio-structural factors. Bivariate correlation analysis showed positive and statistically significant correlation between each of breastfeeding self-efficacy, outcome expectancy, and socio-structural factors, with EBF practice. However, only breastfeeding self-efficacy and outcome expectancies were statistically significant predictors of EBF among the primiparous women when controlling for confounding variables.

CONCLUSIONS AND RECOMMENDATIONS

Health programmes aimed at improving EBF among primiparous mothers should look beyond providing health information alone. Rather improving primiparous women's breastfeeding self-efficacy and outcome expectancy is strongly recommended. Further community based large scale research is also recommended among similar groups of women.

The Effect of a Perinatal Breastfeeding Support Program on Breastfeeding Outcomes in Primiparous Mothers

The purpose of this study was to examine the effect of a self-efficacy intervention on primiparous mothers' breastfeeding behaviors. Participants were recruited from an antenatal clinic at a university-affiliated hospital. Seventy-five primiparous mothers were recruited from November 2013 to February 2014 for the control group, and 75 primiparous mothers were recruited from March to June 2014 for the intervention group. The intervention group participated in a 1-hr prenatal breastfeeding workshop and a 1-hr breastfeeding counseling session within 24 hr after delivery. The Breastfeeding Self-Efficacy Scale-Short Form and the infant feeding method were assessed at hospital discharge, as well as 4 and 8 weeks postpartum. The breastfeeding support program was found to be effective and beneficial to mothers. Nurses should incorporate breastfeeding self-efficacy interventions into their routine care to support new mothers and to increase their breastfeeding self-efficacy and the duration of their breastfeeding exclusivity.

The effect of mother's educational status on early initiation of breastfeeding: further analysis of three consecutive Nepal Demographic and Health Surveys

Background

The World Health Organization recommends initiating breastfeeding within the first hour of birth. This study is aimed at assessing the effect of the mother’s education on early initiation of breastfeeding.

Methods

Data from the Nepal Demographic and Health Surveys (NDHS) 2001, 2006 and 2011 were used which included 12,845 last born children born within 5 years before the surveys. Early initiation of breastfeeding was defined as the initiation of breastfeeding within the first hour after birth. Hierarchical modelling was used to ascertain the association of maternal education and early initiation of breastfeeding, after controlling for other covariates in a multiple logistic regression.

Results

Maternal education was associated with a higher likelihood of early initiation of breastfeeding in each survey. Pooled data analysis revealed higher odds of early initiation of breastfeeding among the mothers with primary education (adjusted odds ratio (OR) 1.24, 95 % confidence interval (CI): 1.09, 1.42) and secondary or higher education (OR: 1.63 95 % CI: 1.42, 1.88). In the most recent NDHS 2011 survey, odds of early initiation of breastfeeding was higher among mothers with primary education (OR: 1.52; 95 % CI: 1.21, 1.91) and mothers with secondary or higher education (OR: 2.20; 95 % CI: 1.76, 2.76) compared to mothers with no education. Similarly, the odds of early initiation of breastfeeding was higher among mothers with secondary and higher education in the 2006 data (OR: 1.66; 95 % CI: 1.30, 2.12) and in 2001 (OR = 1.30; 95 % CI: 1.00, 1.67).

Conclusions

As the association between a mother’s educational status and her likelihood of early initiation of breastfeeding increases, long-term approaches to prioritising education for women and girls should be explored. In the short term, uneducated mothers should be targeted with breastfeeding promotion strategies such as counselling and peer education.

Electronic supplementary material

The online version of this article (doi:10.1186/s12889-015-2405-y) contains supplementary material, which is available to authorized users.

Maternal and Hospital Factors Associated with First-Time Mothers' Breastfeeding Practice: A Prospective Study

Continuity of breastfeeding is infrequent and indeterminate. Evidence is lacking regarding factors associated with breastfeeding at different postpartum time points. This prospective study investigated the change in, and correlates of, breastfeeding practices after delivery at a hospital and at 1, 3, and 6 months postpartum among first-time mothers. We followed a cohort of 300 primiparous mothers of Taiwan who gave birth at two hospitals during 2010-2011. Logistic and Cox regression analyses were performed to determine factors that were correlated with breastfeeding practices. In the study sample, the rate of exclusive breastfeeding during the hospital stay was 66%; it declined to 37.5% at 1 month and 30.2% at 3 months postpartum. Only 17.1% of women reported continuing breastfeeding at 6 months. Early initiation of breastfeeding, rooming-in practice, and self-efficacy were significantly related to exclusive breastfeeding during the hospital stay. After discharge, health literacy, knowledge, intention, and self-efficacy were positively and significantly associated with breastfeeding exclusivity. Later initiation (hazard ratio=1.53; 95% confidence interval, 1.05, 1.97), shorter intention (hazard ratio=1.42; 95% confidence interval, 1.13, 1.68), and self-efficacy (hazard ratio=0.98; 95% confidence interval, 0.96, 0.99) were important predictors of breastfeeding cessation within 6 months of delivery. Continuous breastfeeding practice for 6 months is challenging and difficult for new mothers. Results showed that factors related to breastfeeding varied over time after delivery. Interventions seeking to sustain breastfeeding should consider new mothers' needs and barriers at different times.

Breast-feeding patterns of ethnic groups in rural western China

Objective

To determine the breast-feeding pattern of four main ethnic groups (the Han, Uygur, Tibetan and Zhuang) living in rural western China.

Design

The study utilized a cross-sectional design.

Setting

Forty-five counties in ten provinces in western China in 2005.

Subjects

A sample of 11 783 children younger than 36 months old (8960 Han, 1281 Uygur, 792 Tibetan and 750 Zhuang) and their mothers were recruited using a stratified, multistage, cluster random sampling method.

Results

The rates of exclusive breast-feeding of children at 6 months of age in the Han, Uygur, Tibetan and Zhuang ethnic groups were 11·6 %, 0·8 %, 4·4 % and 13·8 %, respectively. The rates of any breast-feeding for children at 24 months of age were 8·5 %, 25·7 %, 3·0 % and 4·3 % in the four ethnic groups, respectively. After adjusting for related factors, Zhuang children had a higher odds ratio of exclusive breast-feeding to 6 months compared with Han children, whereas Uygur and Tibetan children had lower odds ratio (Zhuang: OR=1·291; 95 % CI 1·006, 1·657; Uugur: OR=0·062; 95 % CI 0·032, 0·121; Tibetan: OR=0·323; 95 % CI 0·220, 0·475). Uygur children had a lower hazard ratio of discontinued breast-feeding compared with Han children, whereas Tibetan children had a higher hazard ratio (Uygur: HR=0·368; 95 % CI 0·333, 0·408; Tibetan: HR=1·366; 95 % CI 1·244, 1·500).

Conclusions

The breast-feeding pattern differed among the Han, Uygur, Tibetan and Zhuang ethnic groups. The results suggest that health education regarding the benefits of breast-feeding is needed in rural western China.