Father's Role in Breastfeeding Promotion: Lessons from a Quasi-Experimental Trial in China

Breastfeeding - a survey of fathers' support needs and preferred sources of information

BACKGROUND

Fathers can be a critical source of breastfeeding support for their partner, but little is known about what fathers would like to learn about breastfeeding. Partner's support and encouragement enhances mother's breastfeeding confidence and boost the capacity to address breastfeeding difficulties effectively. The aims of this study were to explore what fathers regard as important to learn around breastfeeding, and their current and preferred sources of information.

METHODS

A structured online survey was conducted, between September 2022 and November 2022, with fathers containing three sections: (1) sociodemographic variables; (2) perceived importance of 26 breastfeeding topics; and (3) sources of breastfeeding information. A convenience sample of expectant and current fathers aged 18 years or older, who were expecting a baby or had a child aged one year or younger, living in Australia, and able to complete survey in English was recruited. Participants were recruited on Facebook advertisement.

RESULTS

A total of 174 fathers participated in the study, majority (75%) were aged 30-39 years, current dads (74%), and university educated (69%). The breastfeeding topics that fathers perceived as the most important/ important to learn about were how to work with their partner to overcome breastfeeding challenges, how fathers can be involved with their breastfed baby, the types of support fathers can provide to breastfeeding mothers, what to expect in the first week and the benefits of breastfeeding. The most preferred health professional sources of breastfeeding information were midwives, child and family nurses and doctors. Among non-health professional sources of support, mobile app, friends and family were most popular.

CONCLUSION

Breastfeeding information to enhance fathers' knowledge and awareness of common breastfeeding challenges, and fathers' role in supporting their breastfeeding partner, appear to be (most) important for fathers. Mobile app appears to be among the most preferred non-health professional ways to provide breastfeeding information to fathers.

Effectiveness of Husbands' Support Exclusive Breastfeeding Facebook Programme During the COVID-19 Pandemic

Introduction

The exclusive breastfeeding rate for six months in the Northeast region of Thailand has recently significantly decreased, in contrast to all other regions in Thailand. Facebook is widely used worldwide to enhance knowledge, attitudes, and behaviours that support breastfeeding. This study aims to assess the effectiveness of a Facebook programme for husbands' support of exclusive breastfeeding during the COVID-19 pandemic.

Methods

We employed a quasi-experimental study design conducted from September 2020 to November 2021. Data were collected from two tertiary hospitals in Thailand, involving a total of 72 participants-36 in the experimental group and 36 in the control group. These participants were husbands of postpartum women admitted to the postpartum wards. Four research instrument were the demographic questionnaire, the Husband's EBF Knowledge, Husband's EBF Attitude, and Husband's EBF Behavior Questionnaires. Demographic data were analysed using frequency distribution, percentages, and the Chi-square test. The mean difference in husbands' exclusive breastfeeding (EBF) knowledge scores was analysed using an independent samples t-test.

Results

At baseline, there was no significant difference in husbands' exclusive breastfeeding (EBF) knowledge scores between the experimental and control groups (p = 0.82). By the 1st month, there was a significant difference in the mean scores of husbands' EBF knowledge between the two groups (p < 0.01). However, the mean score of attitude at 6-month (mean=108.03, SD=19.89) was higher than the mean score of behaviour at baseline (mean=101.81, SD=17.99), but it was not significant (p=0.40). In addition, the different score of behaviour among baseline (mean=65.86, SD=7.02) and 6-month (mean=68.58, SD=10.42) was not significant (p=0.24).

Conclusion

The findings suggest that the Facebook programme is an effective platform for conveying exclusive breastfeeding (EBF) knowledge to husbands in Northeast Thailand during the COVID-19 pandemic.

Investigating the influence of family-oriented counselling on breastfeeding continuity in mothers experiencing distractions: A randomized controlled trial

The prevalence of distraction among breastfeeding mothers is on the rise, primarily attributed to the escalating use of media technologies. This study aimed to assess the influence of family-oriented counselling on the continuity of breastfeeding in mothers experiencing distractions. This randomized controlled trial included 120 eligible lactating mothers who accessed postpartum services at comprehensive health centers in Zanjan, a city in northwest Iran from August 21, 2022 to May 10, 2023. Participants were assigned to two groups through block randomization with a block size of four. The intervention group received Family-Oriented Counselling in three sessions at weekly intervals, and the control group received standard postpartum care. The study measured outcomes using the Maternal Distraction Questionnaire and breastfeeding patterns before, monthly, and up to 4 months after counselling. Data analysis employed statistical methods, including the Chi-square test, independent t-test, repeated measures ANOVA, and the Kaplan-Meier method, with a significance level set at P < 0.05. The results showed that the continuation of exclusive breastfeeding was 33 (55 %) in the intervention group and 21 (35 %) in the control group. This difference was statistically significant (p = 0.001). The reduction in distraction scores over time was more pronounced in the intervention group compared to the control group. The between-group effect was found to be statistically significant with an eta effect size of 0.73 (p = 0.001). In conclusion, the study suggests that the implementation of a family-centered intervention was effective in promoting the continuation of breastfeeding and reducing maternal distractions both during breastfeeding and non-breastfeeding activities. This approach proves to be a valuable step in enhancing the health of both mother and child. The findings underscore the importance of considering such interventions in health policymaking.

Fathers' breastfeeding knowledge, attitudes, and involvement in the Asian context: A mixed-studies review

BACKGROUND

Despite numerous initiatives attempting to enhance BF across Asia, recent studies show that exclusive BF rates remain alarmingly low. With globalization, society has shifted from traditional family roles towards more egalitarian marriages, where Asian fathers are now more involved in parenting. As fathers' involvement in breastfeeding is highly complex and context-sensitive, evaluation of a wide range of concepts and evidence within the Asian context is necessary.

OBJECTIVE

This review aims to consolidate and appraise empirical studies exploring fathers' breastfeeding knowledge, attitude, and involvement within the Asian context.

DESIGN

A systematic mixed-studies review was conducted. Six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus, and ProQuest Dissertations and Theses Global) were searched from each database's inception date until June 2022. Studies were appraised using the Mixed Method Appraisal Tool and data was synthesised using the results-based convergent integration method.

FINDINGS

Twenty-two studies were included in this review. The synthesis of findings identified two main themes and six sub-themes.

KEY CONCLUSIONS

Asian fathers have a varied understanding of breastfeeding and their involvement in breastfeeding is influenced by personal, cultural, religious, social, and environmental factors.

IMPLICATIONS FOR PRACTICE

Perinatal care professionals play a crucial role in engaging and enhancing fathers' involvement in breastfeeding education programmes. The findings also urge policymakers to introduce more 'father-friendly' breastfeeding guidelines and educate perinatal care professionals to be more aware and sensitive to the needs of fathers. There is also a need to introduce more flexible and economically sensitive paternal leave policies to improve fathers' breastfeeding involvement.

Effectiveness of a breastfeeding promotion intervention model based on Society ecosystems Theory for maternal women: a study protocol of randomized controlled trial

BACKGROUND

Breastfeeding is recognized internationally as the most scientific and effective way to feed infants and young children. According to the World Health Organization in 2022, the exclusive breastfeeding rate within 6 months is 34.1% in China, which is still far from the goal of "more than 60% exclusive breastfeeding rate of infants within 6 months" by 2030 required by China's State Council. It is necessary to promote breastfeeding and provide maternal breastfeeding guidance to increase exclusive breastfeeding. Factors influencing breastfeeding can be explained by the society ecosystems theory, distributed in macro, mezzo and micro systems. The interventions focused on breastfeeding promotion are mainly carried out in the health systems and services, home and family environment, community environment, work environment, policy environment or a combination of these facilities. But there is sparse research on integrating resources in the macro, mezzo and micro systems of maternal breastfeeding processes to promote breastfeeding behavior. A randomized controlled trial will test the effect of a breastfeeding promotion intervention model based on the society ecosystems theory versus usual prenatal and postnatal care on maternal and infant health and the exclusive breastfeeding rate at 6 months.

METHODS/DESIGN

The study is a single-blind, parallel design, randomized controlled trial with an intervention group (n = 109) and a control group (n = 109) that compares the effect of a breastfeeding promotion intervention model based on the society ecosystems theory with usual prenatal and postnatal care. The intervention covers macro- (policy, culture), mezzo- (family-hospital-community) and micro- (biological, psychological and social) systems of the maternal breastfeeding process. Infant feeding patterns, neonatal morbidity and physical and mental health of antenatal and postpartum women will be collected at baseline (28 to 35 weeks of gestation), 1-, 4-, and 6-month postpartum.

DISCUSSION

This is a multifaceted, multifactorial, and multi-environmental breastfeeding promotion strategy to help mothers and their families learn breastfeeding knowledge and skills. The study provides a new modality for adding breastfeeding interventions to prenatal and postnatal care for healthcare providers in the hospital and the community.

TRIAL REGISTRATION

Chinese Clinical Trial Registry at www.chictr.org.cn , ChiCTR2300075795.

Breastfeeding and infant care as 'sexed' care work: reconsideration of the three Rs to enable women's rights, economic empowerment, nutrition and health

Women's lifelong health and nutrition status is intricately related to their reproductive history, including the number and spacing of their pregnancies and births, and for how long and how intensively they breastfeed their children. In turn, women's reproductive biology is closely linked to their social roles and situation, including regarding economic disadvantage and disproportionate unpaid work. Recognizing, as well as reducing and redistributing women's care and domestic work (known as the 'Three Rs'), is an established framework for addressing women's inequitable unpaid care work. However, the care work of breastfeeding presents a dilemma, and is even a divisive issue, for advocates of women's empowerment, because reducing breastfeeding and replacing it with commercial milk formula risks harming women's and children's health. It is therefore necessary for the interaction between women's reproductive biology and infant care role to be recognized in order to support women's human rights and enable governments to implement economic, employment and other policies to empower women. In this paper, we argue that breastfeeding-like childbirth-is reproductive work that should not be reduced and cannot sensibly be directly redistributed to fathers or others. Rather, we contend that the Three Rs agenda should be reconceptualized to isolate breastfeeding as 'sexed' care work that should be supported rather than reduced with action taken to avoid undermining breastfeeding. This means that initiatives toward gender equality should be assessed against their impact on women's ability to breastfeed. With this reconceptualization, adjustments are also needed to key global economic institutions and national statistical systems to appropriately recognize the value of this work. Additional structural supports such as maternity protection and childcare are needed to ensure that childbearing and breastfeeding do not disadvantage women amidst efforts to reduce gender pay gaps and gender economic inequality. Distinct policy interventions are also required to facilitate fathers' engagement in enabling and supporting breastfeeding through sharing the other unpaid care work associated with parents' time-consuming care responsibilities, for both infants and young children and related household work.

Attitudes, beliefs and social norms regarding infant and young child feeding among Nigerian mothers, fathers and grandmothers across time

Infant and young child feeding (IYCF) interventions in low-resource countries mainly target pregnant women and mothers of young children; however, fathers and grandmothers also influence IYCF practices. We conducted focus group discussions with mothers, fathers and grandmothers of young children across three time points in areas where an IYCF social and behaviour change intervention was implemented in Nigeria to explore differences by participant type and shifts over time in attitudes, beliefs and social norms related to breastfeeding and dietary diversity (DD). Overall, across time points, we found more discrepancies in attitudes, beliefs and social norms for early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) among different participant types than for DD. Although most participants agreed EIBF and EBF are good practices, mothers believed this more strongly than fathers and grandmothers; however, at endline, a shift towards acceptance of EIBF and EBF appeared among fathers and grandmothers. Across time points, all participant types acknowledged the nutritional and health benefits of green leafy vegetables and animal-source foods but described various barriers to feeding them to children. Across time points, all participant types also highlighted the importance of health workers and antenatal visits as important sources of IYCF knowledge and facilitators to following recommended practices. Insights from this study highlight the importance of including key influencers of IYCF practices in qualitative research.

Effectiveness of father-inclusive interventions on maternal, paternal, couples, and early child outcomes in low- and middle-income countries: A systematic review

Most caregiving interventions for young children are directed to female caregivers. Relatively few have included male caregivers as program participants especially in low- and middle-income countries (LMICs). The range of potential benefits that can be achieved through the engagement of fathers and male caregivers has not been adequately explored from a family systems perspective. We reviewed interventions that engaged male caregivers to support young children in LMICs and summarized impacts on maternal, paternal, couples, and child outcomes. We searched MEDLINE, Embase, PsycINFO, CINAHL, Web of Science, and Global Health Library for quantitative evaluation studies of social and behavioral interventions that included fathers or other male caregivers to improve nurturing care for young children under 5 years of age in LMICs. Three authors independently extracted data using a structured form. Forty-four articles, representing 33 intervention evaluations, were included. The most common type of intervention targeted fathers along with their female partners and primarily to address child nutrition and health. Across interventions, maternal outcomes were the most evaluated outcomes (82%), followed by paternal (58%), couple's relationship (48%) and child-level outcomes (45%). Overall, father-inclusive interventions had positive impacts on maternal, paternal and couples' relationship outcomes. Although there was greater variation in the degree of supportive evidence for child outcomes compared to maternal, paternal, and couples outcomes, findings suggested mostly positive effects across all outcomes. Limitations included relatively weak study designs and heterogeneity across interventions, outcome types, and measurement tools. Interventions that include fathers and other male caregivers have potential to improve maternal and paternal caregiving, couple's relationships dynamics, and early child outcomes in LMICs. More evaluation studies, using rigorous methods and robust measurement frameworks, is needed to bolster this evidence-base about the effect of fathers' engagement for young children, caregivers, and families in LMICs.

Investigating Maternal Perspectives of Breastfeeding Support Targeted Towards Fathers in the Milk Man Mobile App Intervention

BACKGROUND

The support of her infant's father is one of the most important factors influencing a mother's breastfeeding success, and an increasing number of interventions are targeted towards fathers. Engaging fathers as agents to influence a maternal behavior is potentially problematic, yet few studies report on maternal experiences.

OBJECTIVE

This study aims to explore mothers' perspectives of their partners' use of Milk Man, a father-focused breastfeeding smartphone app, and the acceptability of this approach.

MATERIALS AND METHODS

New mothers (N = 459) whose partners had access to the app completed a questionnaire at six weeks postpartum. These data were used to determine knowledge, use and perspectives of the app. A sentiment analysis was conducted on responses to an open-ended question seeking maternal perspectives of the app.

RESULTS

Just over a quarter of mothers (28%) had been shown something from the app, and 37% had discussed something from Milk Man with their partner. There were 162 open-ended responses related to mothers' perspectives of the app. Relevant responses (n = 129) were coded to an overall sentiment node and then to a total of 23 child nodes (sub-nodes). Most comments were positive (94), with a smaller number either negative (25) or neutral (21). Negative comments related to the usability of the app and not its intent or content.

CONCLUSION

Mothers found the father-focussed breastfeeding app to be acceptable. When designing interventions targeting one group to affect the behaviour of another, inclusion of measures to gain the perspectives of both should be seen as an imperative.

The influence of breastfeeding attitudes on breastfeeding behavior of postpartum women and their spouses

Purpose

This study aimed to explore: (1) the influence of maternal sociodemographic factors on breastfeeding attitudes, (2) the relationship between breastfeeding attitudes of postpartum women and their spouses, (3) the predictors of breastfeeding behavior (mixed breastfeeding) at two months postpartum, and (4) to establish the reliability of the Chinese version of the paternal Iowa Infant Feeding Attitude Scale (IIFAS) in Taiwan.

Methods

A correlational and follow-up study design was used on a convenience sample of 215 women and 215 fathers recruited from a regional teaching hospital in central Taiwan from July 2020 to December 2020. The participants completed the IIFAS during postpartum hospitalization and a follow-up via telephone at 8 weeks postpartum for information on feeding methods and duration. The Cox proportional hazards model was used to analyze the predictors of breastfeeding duration.

Results

Maternal breastfeeding attitude scores ranged from 42 to 79, with a mean score of 59.78 (SD ± 6.68). Spouses' breastfeeding attitude scores ranged from 46 to 81, with a mean score of 59.60 (SD ± 6.93). Mother and spouse's IIFAS scores were highly correlated (r = 0.50, p < 0.001), and the scores of both parents were significantly associated with the duration of breastfeeding. With each increased point on maternal and paternal IIFAS scores, the odds of breastfeeding during the first 8 weeks increased 6% and 10%, respectively.

Conclusion

This is the first study to validate the IIFAS (Chinese version) with paternal participants in Taiwan. Identifying and understanding the infant feeding attitudes of mothers and their spouses should be an early step in designing and implementing breastfeeding interventions.

Implementation characteristics of father-inclusive interventions in low- and middle-income countries: A systematic review

Although prior reviews have documented the effectiveness of engaging male caregivers in early childhood interventions, little is known about how these interventions have been designed and implemented to reach, engage, and support male caregivers in low-resource global settings. We searched five bibliographic databases for intervention studies that engaged male caregivers to improve nurturing care for children under 5 years of age in low- and middle-income countries. Forty-four articles met the inclusion criteria, which represented 33 interventions. Fathers specifically were the most common type of male caregivers targeted in these interventions. The majority of interventions invited fathers to participate alongside their female partners. Community-based peer-groups were the most common delivery model. Most interventions used the same program structure for fathers as applied to mothers, with few considering whether implementation adaptations were needed for men. Intervention curricula were multicomponent and largely targeted child nutrition, health, and couples' relationships. A minority of programs addressed parenting, psychosocial wellbeing, violence prevention, gender attitudes, or economic support. Behavior change techniques were limited to interactive counseling and peer learning. Male caregivers remain missing from caregiving interventions for young children. A greater focus on implementation research can inform better inclusion, engagement, and support for male caregivers in nurturing care interventions.

Evidence from a Choice Experiment in Consumer Preference towards Infant Milk Formula (IMF) in the Context of Dairy Revitalization and COVID-19 Pandemic

China is the largest global consumer of infant milk formula (IMF). Chinese consumer preferences towards IMF have evolved over time but have also been rocked in recent years by COVID-19 with major implications for the IMF industry, globally and within China. This study is the first to document parents’ preferences toward IMF since the outbreak. We used novel methods to do so, through an online choice experiment of 804 participants that included risk perceptions and socio-demographic variables. Our study finds that Chinese parents continue to prioritize quality and safety attributes of IMF represented by functional ingredients, organic labelling and traceability information. Notably, it also finds greatly increased confidence in Chinese domestically produced IMF and an underlying preference away from expensive products. This implies that the era of ‘go for foreign’ and ‘go for the most expensive’ in IMF purchasing may be coming to an end. The shift in sentiment is driven by the longer-term revitalization of the Chinese dairy industry, accelerated by COVID-19. Understanding these trends will be of major benefit to both Chinese producers and non-Chinese exporters of IMF.

The Effect of a Father's Support on Breastfeeding: A Systematic Review

Aim: Including fathers in breastfeeding education programs may raise infant breastfeeding rates and durations. The aim of the study was to assess the effect on breastfeeding of breastfeeding education and/or psychosocial interventions in which fathers are included. Method: The study is based on the PRISMA method, the technique that is used in systematic reviews. A search was conducted in the literature over the period November 1, 2021-December 1, 2021 using keywords and without imposing any time restrictions. The databases "PubMed," "Web of Science," Scopus," "Medline," and "CINAHL" were scanned. Results: A total of 462 publications were reached. However, only 7 studies were considered for review on the basis of the inclusion criteria. Six of these 7 studies indicated that the support of the father increased the breastfeeding rate. Conclusions: This review shows that a father's support of breastfeeding improves breastfeeding outcomes. Including fathers in the breastfeeding process and ensuring their active participation increase breastfeeding rates.

Postnatal mental health, breastfeeding beliefs, and breastfeeding practices in rural China

Background

The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China.

Methods

Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes.

Results

The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (𝛽= − 1.11, 95% CI: − 2.07, − 0.14) and breastfeeding self-efficacy (𝛽= − 3.19, 95% CI: − 4.93, − 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (𝛽= − 1.81, 95% CI: − 3.43, − 0.18 and 𝛽 = − 2.88, 95% CI: − 4.98, − 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms.

Conclusion

Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers’ breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics.

A mixed-methods study on the association of six-month predominant breastfeeding with socioecological factors and COVID-19 among experienced breastfeeding women in Hong Kong

Background

In the past decade, various breastfeeding policies were implemented in Hong Kong, including changes in perinatal guidelines in public hospitals, adoption of the Baby-Friendly Hospital Initiative (BFHI), provision of guidelines for the marketing of formula milk, penalisation of discrimination towards breastfeeding, and extension of the statutory maternity leave. Meanwhile, the COVID-19 pandemic brought new challenges and opportunities to breastfeeding practices. Infection control measures in public hospitals included the cancellation of antenatal classes, hospital tours, and postnatal classes; suspension of perinatal visiting periods; and compulsory separation of COVID-19 positive mothers from newborns. In addition, work-from-home policies were widely implemented. This study aimed to identify the associated factors of six-month predominant breastfeeding (PBF), and to evaluate the impact of COVID-19 on breastfeeding practice.

Methods

This study was conducted from 1 March 2021 to 7 April 2021 using a mixed-methods approach. An electronic questionnaire was distributed to members of breastfeeding or parenting groups who have had breastfeeding experience in the past 10 yrs. Logistic and linear regression analyses were conducted to identify factors associated with six-month PBF both in general and during the pandemic period. A qualitative content analysis was conducted using an inductive approach.

Results

The study included 793 participants. Giving birth in a public hospital (OR 2.21; 95% CI 1.46, 3.34) and breastfeeding support from family and friends (OR 1.28; 95% CI 1.05, 1.57) were significantly associated with six-month PBF, even during COVID-19. Factors associated with the self-rated impact of COVID-19 on breastfeeding include working from home, the perceived immunological benefits of breastfeeding, and the wish to avoid breastfeeding or expressing breast milk in public premises. Furthermore, breastfeeding practice in public hospitals was more likely to be affected by the busyness of staff, while private hospitals had worse rooming-in practices and staff who had inadequate breastfeeding knowledge.

Conclusions

Giving birth in a public hospital and having breastfeeding support from family and friends were associated with six-month PBF. Furthermore, COVID-19 in Hong Kong had an overall positive impact on six-month PBF. Further studies should investigate the impact of hospital practices and the COVID-19 pandemic on breastfeeding behaviours.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00484-7.

What are the determinants of low exclusive breastfeeding prevalence in China? A cross‐sectional study

Exclusive breastfeeding (EBF) status is far from the national target in China. To identify the modifiable factors associated with EBF of infants aged under 6 months in China. A cross‐sectional study was conducted in 12 provinces/municipalities across China in 2017–2018. We used multistage stratified cluster sampling and collected data through face‐to‐face interviews with mothers using an electronic questionnaire. Totally, 5287 pairs of mother–infant aged <6 months were investigated. The EBF prevalence was 29.2% (1544/5287). Mothers with correct knowledge of colostrum (adjusted odds ratio [AOR]:1.32, 95% confidence interval [CI]: 1.07, 1.62), EBF (AOR: 1.39, 95% CI: 1.06, 1.81) and the highest scores of perceptions for breastfeeding benefits (AOR: 1.36, 95% CI: 1.14, 1.61) were more likely to exclusively breastfeed. However, mothers with more frequent unwillingness of breastfeeding during the first month postpartum were less likely to practice EBF (AOR: 0.68, 95% CI: 0.52, 0.90). Infants having their first breast milk within 24 h of birth increased the odds of EBF (AOR: 2.41, 95% CI: 1.86, 3.13). Infants were less likely to be exclusively breastfed in the families in which the main caregiver was the grandmothers. Mothers without receiving infant formula feeding suggestions via the health facilities, media, or the Internet (AOR: 1.57, 95% CI: 1.33, 1.85) or without the experience of infant formula feeding in public (AOR: 1.45, 95% CI: 1.23, 1.72) might more likely to practice EBF. To acquire comprehensively correct knowledge and keep a positive attitude of breastfeeding for the mothers are crucial for improving the EBF prevalence. Family supports are potential interventions worth focusing on. Infant formula promotion remains a great barrier for EBF in China.

This is the first study with a large sample size that examined determinants at individual, family, community and social levels potentially affecting EBF practice in China.

In this cross‐sectional study, mothers with completely correct knowledge and positive attitude of breastfeeding, infants having their first breast milk within 24 h of birth, and without exposure to infant formula feeding suggestions or experience might more likely to practice EBF.

Dissemination of comprehensively correct knowledge and operational skills of breastfeeding, initiation of breastfeeding as soon as possible, reducing the influence of infant formula might be effective methods for improving the EBF prevalence in China.

[Knowledge of breastfeeding among mothers before maternity discharge]

OBJECTIVES

The aim of our study was to assess the knowledge of parturients about breastfeeding and to analyze the factors influencing this level of knowledge.

METHODS

It was a prospective, descriptive and analytical, cross-sectional study carried out over a period of six months including 500 parturients who gave birth at the maternity unit of the National Center for Maternity and Neonatalogy of Tunis during the period from July to December 2020. Sociodemographic, obstetrical and breastfeeding related data were collected through individual interviews carried out before leaving the postpartum service using a questionnaire written in Tunisian dialectal Arabic.

RESULTS

The average age of the mothers was 31.5 years. Housewives accounted for 73.3 % of cases. Forty-four percent of the women surveyed were first-time mothers. The main source of information was relatives (74.8 %). The prevalence of breastfeeding was 93.8 %. Knowledge about breasfeeding was insufficient in 76.4 % of cases. The level of knowledge was insufficient in particular regarding signs of effective breastfeeding, signs of awakening of the newborn, lactogenesis, and diet of breastfeeding women. Unemployment of the parturient age over 30 and primiparity negatively influenced the knowledge of parturients.

CONCLUSION

The level of knowledge of parturients was heterogeneous but generally insufficient. Health education programs on MA targeting subjects most at risk of insufficient knowledge should be put in place in order to improve the knowledge base and hopefully improve the breastfeeding rates.

Exclusive breastfeeding in rural Western China: does father's co-residence matter?

BACKGROUND

China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father's co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father's co-residence and breastfeeding family support as well as maternal decision-making power.

METHODS

A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding.

RESULTS

The exclusive breastfeeding (0-6 months) rate was 16% in rural western China. Fathers' co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227-0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (β =0.109, P = 0.105; β =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (β = - 0.196, P = 0.007).

CONCLUSIONS

Fathers' co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father's education to help them better involvement and show more respect to mothers' decisions.

Factors associated with exclusive breastfeeding practice among mothers in nine community health centres in Nanning city, China: a cross-sectional study

BACKGROUND

The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China.

METHODS

The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0-5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices.

RESULTS

In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice.

CONCLUSIONS

Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.

Effect of Baby-Led Self-Attachment Breastfeeding Technique in the Postpartum Period on Breastfeeding Rates: A Randomized Study

Objective: To evaluate the effects of a baby-led self-attachment breastfeeding support intervention on the prevalence and duration of exclusive breastfeeding and nipple pain at 3 days, 6 weeks, 3 months, and 6 months postpartum among Chinese mothers. Materials and Methods: A randomized study was conducted with 504 mother-infant dyads allocated to the baby-led self-attachment breastfeeding support intervention (n = 251) and standard postpartum care (n = 253). Data on the prevalence and duration of exclusive breastfeeding and nipple pain were collected at 3 days, 6 weeks, 3 months and 6 months postpartum. Results: Mothers in the intervention group were significantly more likely exclusively breastfeeding at 3 days (mean difference = 12.1%, 95% confidence interval [CI]: 3.9-20.2%, p = 0.004) and 6 months postpartum (mean difference = 17.8%, 95% CI: 8.3-27.4%, p < 0.001). They were less likely to stop breastfeeding over the 6-month period, compared with the control group (Hazard ratio = 0.65; 95% CI: 0.49-0.87). They were also less likely to experience nipple pain at 3 days (mean difference = -8.1%, 95% CI: -15.9 to -0.4%, p = 0.04) and 3 months postpartum (mean difference = -4.9%, 95% CI: -8.7 to -1.2%, p = 0.01). Conclusions: The baby-led self-attachment breastfeeding support is clinically effective in increasing the prevalence and duration of exclusive breastfeeding and reducing nipple pain among Chinese mothers.

Engaging family members in maternal, infant and young child nutrition activities in low- and middle-income countries: A systematic scoping review

The influence of fathers, grandmothers and other family members on maternal, infant and young child nutrition practices has been well documented for decades, yet many social and behavioural interventions continue to reach only mothers. While recent guidelines recommend involving fathers, grandmothers and other family members in maternal and child nutrition, we lack a comprehensive review of interventions that have engaged them. This scoping review aimed to address this gap by describing social and behavioural interventions to engage family members in maternal and child nutrition in low- and middle-income countries. We systematically searched PubMed, Scopus, Web of Science, Global Health and CINAHL for peer-reviewed studies meeting inclusion criteria. We screened 6,570 abstracts, evaluated 179 full-text articles, and included 87 articles from 63 studies. Studies reported a broad range of approaches to engage fathers, grandmothers and other family members to support maternal nutrition (n = 6); breastfeeding (n = 32); complementary feeding (n = 6) and multiple maternal and child nutrition practices (n = 19). Interventions were facility and community based; included individual and group-based interpersonal communication, community mobilization, mass media and mHealth; and reached mothers and family members together or separately. Most interventions were located within the health sector; rare exceptions included nutrition-sensitive agriculture, social protection, early child development and community development interventions. Few interventions addressed gender norms, decision-making, and family dynamics or described formative research or theories informing intervention design. These diverse studies can shed light on innovative programme approaches to increase family support for maternal and child nutrition.

Determinants of exclusive breastfeeding for the first six months in China: a cross-sectional study

Background

Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China.

Methods

Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding.

Results

About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding.

Conclusions

The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.

Father's Knowledge, Attitude and Support to Mother's Exclusive Breastfeeding Practices in Bangladesh: A Multi-Group Structural Equations Model Analysis

Despite worldwide initiatives, the exclusive breastfeeding (EBF) rate is low. The study aims to investigate the role of fathers’ knowledge, attitude and support in formulating mothers’ practice of breastfeeding taking Bangladeshi parental cases as a sample. The study uses a standard survey instrument following the theory of planned behavior (TPB). Responses from 332 couples are accepted following a standard criteria and used for analysis. The sample is divided into sub-groups based on delivery mode—vaginal (n = 211, 64%) and cesarean section (n = 121, 36%). Based on the sub-groups, a multi-group structural equation modelling (SEM) is applied to analyze the phenomena. The study finds that a father’s knowledge in EBF can, in one way, significantly enhance mother’s knowledge by sharing and, in another way, can enhance his own attitude to offer different support to his partner/wife which induces the chances of EBF practices by mothers. The enhanced EBF knowledge of a mother raises her attitude to practice EBF, which is also positively affected by the father’s attitude. Thus, fathers’ support, coupled with mothers’ positive attitude, the mother’s intention to practice EBF as per standard guidelines.

Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers'/healthcare staffs' knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother-infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers' knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

The effect of spousal support perceived by mothers on breastfeeding in the postpartum period

Objective

To examine the effect of mothers' perceived spousal support on breastfeeding during lactation.

Material and Methods

This is a descriptive cross-sectional study. The sample of the study consist of 80 mothers who were registered with a Pediatric Adolescent Women and Reproductive Health Center. The socio-demographic and obstetric descriptive information form and Women's Perceived Spouse Support Scale in Early Puerperium Process were used for the collection of data. Data were analyzed with number and percentage, t-test, chi-square test, ANOVA, and Tukey test.

Results

The mean age of the mothers who participated in the study was 27.05±3.50, while the mean age of the spouses was 30.58±4.12. It was determined that 41.3% of the mothers and 48.8% of the spouses were high school or higher graduates and 68.8% of the mothers didn't work and all of the spouses worked. Most of the mothers (63.7%) were primiparous and 60% had a cesarean section, 56.3% did not receive lactation education and consultation, and most of the women had exclusive breastfeeding. The mean score of the Women's Perceived Spousal Support Scale in the Early Puerperium Period of the exclusively breastfeeding mothers was 72.93 while the partial breastfeeding mothers' was 54.93 (p=0.00). Also, it was found that males with younger age group and high school and lower education level had less support for their spouses (p=0.03, p=0.02), and the rate of exclusive breastfeeding was higher in the spouses of males in higher education level (p=0.01).

Conclusion

Mothers who received more support from their spouses during the postpartum period had higher breastfeeding rates. It was determined that males with younger age and education level below high school gave less support to mothers in breastfeeding.

Conhecimento e atitudes paternas acerca da importância do aleitamento materno

Resumo Objetivo analisar o conhecimento e as atitudes paternas acerca do aleitamento materno. Método estudo descritivo transversal, de abordagem quantitativa, realizado com 220 homens-pais de lactentes com idades entre 30 dias a seis meses, vivenciando ou não o processo da amamentação e residindo no mesmo domicílio que o binômio mãe-filho. Os dados foram processados através do software IBM SPSS versão 23.0 for Windows®, sendo realizadas análises univariadas e bivariadas. Utilizou-se como instrumento um questionário, e para processamento e análise estatística a associação de variáveis. Resultados dos homens-pais estudados, 36,4% não tinham conhecimento sobre vantagens da amamentação, 48,6% não acompanharam as gestantes nas consultas de pré-natal e dos pais que exerciam atividade remunerada, 68,2% relataram auxiliar a mulher-mãe no aleitamento realizando atividades domésticas ou no cuidar de outros filhos. Conclusão e implicações para a prática evidenciou-se a ausência paterna nas consultas pré-natais e o conhecimento fragilizado quanto ao aleitamento, necessitando o desenvolvimento de estudos que evidenciem sua inserção e a criação de estratégias pelos profissionais de saúde para que esse processo seja vivenciado de maneira satisfatória pelo trinômio mãe-pai-filho.

Predictors of exclusive breastfeeding practice among migrant and non-migrant mothers in urban China: results from a cross-sectional survey

OBJECTIVE

To explore and compare the predictors for exclusive breast feeding (EBF) among migrant and non-migrant mothers in China.

DESIGN

A large-scale cross-sectional study.

SETTING

12 counties/districts were covered in China.

PARTICIPANTS

A total number of 10 408 mothers were recruited, of whom 3571 mothers of infants aged 0-5 months in urban China were used for analysis.

OUTCOME

The practice of EBF was calculated based on the foods and drinks consumed in the last 24 hours, as recommended by WHO.

RESULTS

Around 30% of Chinese mothers with infants aged 0-5 months practised EBF in urban areas, with no significant difference between migrant and non-migrant mothers (p=0.433). Among the migrant mothers, factors associated with EBF included residence in big cities (adjusted OR, AOR 1.68 (95% CI 1.20 to 2.34)), premature birth (AOR 0.27 (95% CI 0.09 to 0.81)), knowledge about EBF (AOR 2.00 (95% CI 1.51 to 2.65)), low intention of breast feeding in the first month postpartum (AOR 0.59 (95% CI 0.36 to 0.97)) and mothers working in agriculture-related fields or as casual workers (AOR 1.77 (95% CI 1.18 to 2.64)). Among non-migrant mothers, in addition to similar predictors including residence in big cities (AOR 1.40 (95% CI 1.13 to 1.73)), knowledge about EBF (AOR 1.25 (95% CI 1.02 to 1.53)) and low intention of breast feeding in the first month post partum (AOR 0.46 (95% CI 0.31 to 0.70)], early initiation of breast feeding (EIBF) (AOR 1.78 (95% CI 1.35 to 2.33)) and caesarean delivery (AOR 0.74 (95% CI 0.60 to 0.89)) were also factors associated with EBF.

CONCLUSIONS

There was no significant difference in the prevalence of EBF between migrant and non-migrant mothers in urban China. Premature birth and maternal occupation in agriculture-related fields or casual work were distinctive factors associated with EBF for migrants, while EIBF and caesarean delivery were unique predictors for non-migrants.

TRIAL REGISTRATION NUMBER

ChiCTR-ROC-17014148; Pre-results.

"When I Breastfeed, It Feels as if my Soul Leaves the Body": Maternal Capabilities for Healthy Child Growth in Rural Southeastern Tanzania

The burden of childhood stunting in Tanzania is persistently high, even in high food-producing regions. This calls for a paradigm shift in Child Growth Monitoring (CGM) to a multi-dimensional approach that also includes the contextual information of an individual child and her/his caregivers. To contribute to the further development of CGM to reflect local contexts, we engaged the Capability Framework for Child Growth (CFCG) to identify maternal capabilities for ensuring healthy child growth. Ethnographic fieldwork was conducted in Southeastern Tanzania using in-depth interviews, key informant interviews, participant observation, and focus group discussions with caregivers for under-fives. Three maternal capabilities for healthy child growth emerged: (1) being able to feed children, (2) being able to control and make decisions on farm products and income, and (3) being able to ensure access to medical care. Mothers’ capability to feed children was challenged by being overburdened by farm and domestic work, and gendered patterns in childcare. Patriarchal cultural norms restricted women’s control of farm products and decision-making on household purchases. The CFCG could give direction to the paradigm shift needed for child growth monitoring, as it goes beyond biometric measures, and considers mothers’ real opportunities for achieving healthy child growth.

Mixed-Methods Systematic Review of Behavioral Interventions in Low- and Middle-Income Countries to Increase Family Support for Maternal, Infant, and Young Child Nutrition during the First 1000 Days

Fathers, grandmothers, and other family members' influence on maternal, infant, and young child nutrition (MIYCN) is widely recognized, yet synthesis of the effectiveness of engaging them to improve nutrition practices during the first 1000 d is lacking. We examined the impact of behavioral interventions to engage family members in MIYCN in low- and middle-income countries through a mixed-methods systematic review. We screened 5733 abstracts and included 35 peer-reviewed articles on 25 studies (16 with quantitative and 13 with qualitative data). Most quantitative studies focused on early breastfeeding, primarily engaging fathers or, less often, grandmothers. Most found positive impacts on exclusive breastfeeding rates and family members' knowledge and support. The few quantitative studies on complementary feeding, maternal nutrition, and multiple outcomes also suggested benefits. Qualitative themes included improved nutrition behaviors, enhanced relationships, and challenges due to social norms. Interventions engaging family members can increase awareness and build support for MIYCN, but more rigorous study designs are needed. This systematic review is registered at PROSPERO as CRD42018090273, https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=90273.

Exploring the challenges and opportunities towards optimal breastfeeding in Ethiopia: a formative qualitative study

Background

Breastfeeding, particularly exclusive breastfeeding, is essential to ensure the short- and long-term health of infants and mothers. Sub-optimal breastfeeding practices currently take place in low income countries contributing to morbidity and mortality. This research explored the challenges and opportunities around exclusive breastfeeding in a large city in Ethiopia to inform a larger breastfeeding intervention.

Methods

Fathers and mothers who had children less than 2 years of age, and who could speak, and understand Tigrigna were recruited from two health centres located in Mekelle, Ethiopia. Two focus group discussions (FGDs) with fathers and two FGDs with mothers (n = 42) were conducted using a semi-structured interview guide to explore the challenges and opportunities related to breastfeeding. Discussions were audio-recorded and transcribed in Tigrigna and translated to English. The data were manually analysed using thematic analysis, generating open codes which were grouped to form themes.

Results

Four themes with 11 sub-themes emerged. The themes identifies were: conflicted emotions on the birth of baby (feeling happy and feeling worried); perspectives on intergenerational approaches (old-fashioned beliefs of grandparents and the power of science, breastfeeding in public, breastfeeding knowledge); gender roles as barriers and enablers (the burden on women, changes in men’s roles and the financial status of the household); the role of healthcare (delivery of health information to parents, the role of health care providers and perceptions of inadequate milk supply).

Conclusion

Parents reported a range of opportunities with respect to breastfeeding, including the power of a scientific approach, the positive role of healthcare, and shifts within gender roles that maximized the potential support from fathers. However, there remains a tension between the beliefs of older generations and current best-practice. Parents continue to need ongoing support in order to practice optimal breastfeeding.

Challenges and responses to infant and young child feeding in rural Rwanda: a qualitative study

BACKGROUND

Despite different interventions to improve child nutrition conditions, chronic malnutrition is still a public health concern in Rwanda, with a high stunting prevalence of 38% among under 5-year-olds children. In Rwanda, only 18% of children aged 6-23 months are fed in accordance with the recommendations for infant and young child feeding practices. The aim of this study was to explore challenges to infant and young child feeding practices and the responses applied to overcome these challenges in Muhanga District, Southern province of Rwanda.

METHODS

Sixteen (16) focus group discussions were held with mothers, fathers, grandmothers, and community health workers from 4 rural sectors of Muhanga District. The discussions were recorded, transcribed verbatim, and thematically analyzed using qualitative data analysis software, Atlas.ti.

RESULTS

Two main themes emerged from the data. Firstly, there was a discourse on optimal infant and young child feeding (IYCF) practices that reflects the knowledge and efforts to align with early initiation of breastfeeding, exclusive breastfeeding for the first 6 months, as well as initiation of complementary foods at 6 months recommendations. Secondly, challenging situations against optimal practices and coping responses applied were presented in a discourse on struggling with everyday reality. The challenging situations that emerged as impeding appropriate IYCF practices included perceived lack of breast milk, infant cues, women's heavy workload, partner relations and living in poverty. Family and social support from community health workers and health facility staff, financial support through casual labor, and mothers saving and lending groups, as well as kitchen gardens, were used to cope with challenges.

CONCLUSION

Factors influencing IYCF practices are multifaceted. Hence, intervention strategies to improve child nutrition should acknowledge the socially embedded nature of IYCF and address economic and social environmental constraints and opportunities, in addition and above knowledge only.

Integrative Review of Fathers' Perspectives on Breastfeeding Support

OBJECTIVE

To critically review and summarize the results of published articles on fathers' perspectives regarding breastfeeding support for their partners.

DATA SOURCES

We searched the following databases for articles published between January 2010 and May 2019: CINAHL, MEDLINE, PubMed, Scopus, Web of Science, ThaiJo, and ThaiLis. We included articles published in English and Thai.

STUDY SELECTION

After duplicates were removed, our initial search yielded 3,927 articles. We excluded articles in accordance with pre-established criteria. We performed a quality appraisal of the selected full-text articles and ultimately included 27 in this review.

DATA EXTRACTION

We analyzed studies that met inclusion criteria and extracted and organized data related to fathers' perspectives on breastfeeding support into a structured table.

DATA SYNTHESIS

The data were synthesized into three themes: Attitude Toward Breastfeeding, Knowledge of Breastfeeding, and Fathers' Perceptions of the BreastfeedingSupportThey Provided.

CONCLUSION

Our results showed that fathers' perspectives on breastfeeding support were shaped by their knowledge of breastfeeding and participation in the breastfeeding process. To promote breastfeeding, further research is required to design and implement appropriate interventions to help fathers effectively support their breastfeeding partners.

Community-based father education intervention on breastfeeding practice-Results of a quasi-experimental study

Although the benefits of breastfeeding are well-documented, little is known about how best to encourage fathers to support breastfeeding. A quasi-experimental study of a community-based intervention was designed to examine whether health education to promote fathers' involvement in supporting women is associated with early initiation and exclusive breastfeeding practices. At baseline, 802 couples of fathers with pregnant wives from 12 to 27 weeks of gestational age were recruited to either the intervention group (n = 390) or a control group (n = 412) consisting of couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education and counselling services in health facilities and at home visits during the antenatal, delivery, and post-partum periods. Peer education and social exchange concerning breastfeeding were organized in fathers' clubs. After 1 year of the intervention, mothers in the intervention group were more likely to initiate early breastfeeding 49.2 and 35.8% in the intervention and control group respectively, P < 0.001. At 1, 4, and 6 months after birth, 34.8, 18.7, and 1.9% of the mothers in the intervention group were exclusively breastfeeding their children because of birth, respectively, compared with 5.7, 4.0, and 0.0% of those in the control group (P < 0.001). Those practices were associated with the intervention in bivariate and multivariate logistic and Cox regression analyses. Intervention targeting fathers at antenatal and postnatal periods may positively influence the breastfeeding practices of mothers, and it should be an important component of breastfeeding programs.

Studying perceived needs for information on maternal and infant health care in the puerperium period among fathers of newborns in China

OBJECTIVE

The objective of this study is to understand the perceived needs for information on maternal and infant healthcare during the puerperium among the fathers of newborns in China, and to examine factors that are associated with the patterns of perceived needs.

DESIGN

A cross-sectional study was conducted.

METHODS

A survey was conducted in the obstetrics department of the First Affiliated Hospital of Soochow University in Suzhou, China. A total of 206 fathers of newborns were interviewed with a response rate of 98.1%. Latent class analysis (LCA) was used to identify a priori unknown patterns of perceived needs for information (knowledge/skills) on maternal and infant healthcare during the puerperium period. Chi-square tests were applied to examine factors associated with such patterns of needs.

RESULTS

The majority of the participants perceived strong needs for information on maternal and infant healthcare during the puerperium. LCA identified three latent classes on perceived needs for information on maternal healthcare among Chinese fathers of newborns: Class 1 - Low: Some Infant Health Related Needs; Class 2 - Moderate: Lower Physical Recovery Needs; and Class 3 - High: Enthusiastic Needs. Similarly, three latent classes were identified for perceived needs for information on infant health care: Class 1 - Low: Some Medical Needs; Class 2 - Moderate: Lower Breastfeeding Needs; and Class 3 - High: Enthusiastic Needs. Fathers aged 30 to 35, urban residents, and those with higher education were more likely to be in the Enthusiastic Needs groups for information needs for both maternal and infant healthcare.

CONCLUSIONS

Perceived needs for information on maternal and infant healthcare are widespread among fathers of newborns in China. Three distinct latent classes for perceived needs for information (knowledge/skills) on maternal and infant health were identified in this population. Socio-demographics, such as age, residence, and education, were significantly associated with such patterns of needs. The findings have implications for the development of interventions to improve maternal and infant healthcare in China.

Breastfeeding in the 21st century: How we can make it work

There is abundant knowledge on the major health and social benefits of breastfeeding, and on how to protect, promote, and support breastfeeding. Hence, it is surprising that recommended breastfeeding behaviors continue to be suboptimal in the 21st Century among large segments of the population, globally. Moving forward, it is crucial to enable the breastfeeding environments for women through family friendly employment policies and to enforce the WHO Code for Marketing of Breastmilk Substitutes. It is also key to invest more in training the workforce for successful large-scale implementation and sustainability of the Baby Friendly Hospital Initiative, community-based breastfeeding counseling, and to prevent conflicts of interests with infant formula companies. Behavior change social marketing interventions that include social media need to be designed following social network science and behavioral economics principles. Evidence-informed policy tools are now available to help policy makers invest in and guide the scaling-up of cost-effective breastfeeding programs.

Women's experiences of ceasing to breastfeed: Australian qualitative study

OBJECTIVE

To investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding.

DESIGN

Multimethod, qualitative study; questionnaire, focus groups and interviews.

SETTING

Northern and Southern Tasmania, Australia.

PARTICIPANTS

127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013.

RESULTS

Mothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure).

CONCLUSIONS AND IMPLICATIONS

For many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.

Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature

OBJECTIVE

Support from fathers is consistently associated with improved breastfeeding duration and exclusivity rates. Additionally, there is growing evidence that fathers want to be included in breastfeeding interventions provided by health care professionals. The objective of this review was to determine the effect of partner-inclusive educational and psychosocial interventions on breastfeeding initiation, duration, and exclusivity.

DESIGN

A systematic review was conducted using a search strategy developed with an expert health sciences librarian. Electronic databases MEDLINE, EMBASE, CINAHL, and PsycINFO were systematically searched for randomized controlled trials and quasi-experimental studies from inception to August 4, 2018. Independent data extraction and quality assessments were conducted by authors using Cochrane Collaboration tools. Due to significant heterogeneity in intervention content, outcome measures, and follow-up time points, data were synthesized qualitatively.

FINDINGS

3982 articles were identified, of which 12 studies in 15 publications met the inclusion criteria and were included. All of the studies improved at least one breastfeeding outcome, including duration (n = 5/9) and exclusivity (n = 8/10) up to 24 weeks postpartum. Six studies examined increasing paternal breastfeeding support and all found beneficial effects. Biases were identified in the studies with the most common bias relating to the randomization process and the blinding of outcome assessors.

IMPLICATIONS FOR PRACTICE

The inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms.

Effectiveness of targeting fathers for breastfeeding promotion: systematic review and meta-analysis

BACKGROUND

Further research gaps exist in relation to the promotion of breastfeeding. Robust scientific evidence obtained by a meta-analysis would provide objectively summarized data while enabling the assessment of consistency of findings. This review includes the first documented meta-analysis done on the effectiveness of targeting fathers for promoting breastfeeding (BF). Assessments have been done for a primary outcome and for six more secondary outcomes.

METHODS

PubMed, EMBASE, Google Scholar, CENTRAL databases and unpublished researches were searched. Selections of randomized-controlled trials and quasi-experimental studies were done in three rounds. Heterogeneity and potential publication bias were assessed. Eight studies were included in meta-analysis and others in narrative synthesis of the outcomes. Pooling was done with the Mental- Haenszel method using risk ratio (RR). Summary-of-Findings table was composed by Review-Manager (version 5.3) and GRADEproGDT applications. Subsequent sensitivity analysis was done.

RESULTS

Selected eight interventional studies included 1852 families. Exclusive BF at six months was significantly higher (RR = 2.04, CI = 1.58-2.65) in the intervention groups. The RR at 4 months was 1.52 (CI = 1.14 to 2.03). Risk of full-formula-feeding (RR = 0.69, CI = 0.52-0.93) and the occurrence of lactation-related problems were lower in the intervention groups (RR = 0.24, CI = 0.10-0.57). More likelihood of rendering support in BF-related issues was seen in intervention groups (RR = 1.43, CI = 1.22-1.68). Increase of maternal knowledge and favorable attitudes on BF were higher in the intervention groups (P ≤; 0.001). The quality of evidence according to GRADE was "low" (for one outcome), "moderate" (for four outcomes), and "high" (for two outcomes).

CONCLUSIONS

Targeting fathers in promotion of BF has provided favorable results for all seven outcomes with satisfactory quality of evidence. This review was registered in the PROSPERO-registry (ID: 2017-CRD42017076163) prior to its commencement.

Informational interventions on paternal outcomes during the perinatal period: A systematic review

PROBLEM

The perinatal period is a stressful transition for new parents.

BACKGROUND

Various forms of educational interventions are available and are found to be efficacious in improving maternal and child outcomes. Such interventions for fathers were scarce and western-centric. Fathers should be educated as they have an impact on maternal and child outcomes.

AIM

This review aims to evaluate the efficacy of quantitatively-studied informational support-focused interventions for fathers using paternal outcomes only.

METHODS

The search was carried out in six databases: Cumulative Index to Nursing and Allied Health Literature, PubMed, Scopus, Embase, Psychological Information Database, and MedNar. Cochrane Collaboration's tools were used to assess the eligibility of the studies.

FINDINGS

A total of 17 studies with 18 interventions were identified and included in the narrative synthesis. Most interventions were delivered to the Western population during the antenatal or postpartum period. The method of delivery for these interventions was mainly face-to-face, with inconclusive findings on various paternal psychosocial outcomes.

DISCUSSION

Limited father-inclusive interventions were available. Technology-based longitudinal studies with interventions carried out across the perinatal period with longer follow-up periods were recommended for interventions providing informational support for fathers. Future studies can also examine paternal physical health and behavioural outcomes. Interventions in culturally-diverse populations should be designed and tested for their efficacies as fathers have different informational needs, especially in Asia.

CONCLUSION

Informational interventions for fathers were found to be lacking and recommendations for future studies on educational interventions for fathers were discussed.

Effectiveness of breastfeeding interventions delivered to fathers in low- and middle-income countries: A systematic review

Adequate support for lactating mothers is crucial to improve the rates of early initiation, exclusive, and continued breastfeeding. Maternal breastfeeding intention and ongoing breastfeeding duration are strongly predicted by their partners' breastfeeding beliefs. Partner support has a significant effect on improving rates of any and exclusive breastfeeding, when compared with professional support, particularly in low-income populations. This systematic review investigates the effectiveness of breastfeeding interventions targeting fathers in low- and middle-income countries (LMIC). A systematic literature search was undertaken on Medline (EBSCOhost), PsycInfo, CINAHL, and Scopus databases and via manual searching. Inclusion criteria were experimental or quasiexperimental designs targeting fathers from LMIC, which measured either breastfeeding initiation, breastfeeding exclusivity, or duration of breastfeeding as the main outcomes. No time restriction was put in place, and all articles were published in English. The quality of selected papers was assessed using the Joanna Briggs Institute tool. A total of 8 articles were included from 6 interventions: 2 quasiexperimental and 4 randomized control trials. All interventions involved breastfeeding education targeting fathers; 2 were given only to fathers, and 4 delivered to both fathers and mothers. Among these interventions, 2 measured both early initiation and exclusive breastfeeding; one exclusive breastfeeding only; one exclusive breastfeeding, knowledge, and attitudes; one exclusive breastfeeding and knowledge; and one breastfeeding, continued breastfeeding, and awareness. Across all interventions, breastfeeding education showed significant improvement in breastfeeding outcomes in the intervention compared with the control groups. In summary, breastfeeding education interventions targeting fathers in LMIC are effective in improving early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. Thus, breastfeeding promotion should consider the education and involvement of fathers in the intervention.

Family-Centered Breastfeeding Education to Promote Primiparas' Exclusive Breastfeeding in China

BACKGROUND

Few breastfeeding education programs focus on primiparas and the importance of family members on exclusive breastfeeding in China. Research aim: This study aimed to explore the influence of a family-centered breastfeeding education program in promoting exclusive breastfeeding up to 6 months postpartum and to improve women's attitude and knowledge, family members' knowledge, and family support.

METHODS

This was a two-group quasi-experimental design with multiple comparisons. Participants ( N = 59) were randomized to either the intervention ( n = 29) or the control ( n = 30) group. The intervention group received two prenatal breastfeeding education lectures that included important family members, three home visits, eight telephone calls, text or video/audio support, and quality online resources during lactation. The control group received in-hospital care and follow-up by community nurses after discharge.

RESULTS

Compared with the control group, the intervention group was more likely to exclusively breastfeed in the first 6 months, odds ratio = 0.44, 95% confidence interval [0.20, 0.98]. The mean knowledge level of the intervention group improved more across time ( p < .05) and was higher than the control group ( p < .05). Perceived family support within the intervention group was significantly higher than the control group from 1 to 6 months ( p < .05).

CONCLUSION

The breastfeeding education program is an effective strategy to promote exclusive breastfeeding in China.

Chinese women's experiences, emotions and expectations of breast-feeding in public: a qualitative study

OBJECTIVE

To explore Chinese mothers' experiences, emotions and expectations of breast-feeding in public places.

DESIGN

Exploratory qualitative study. Purposive sampling was used to recruit participants and face-to-face interviews were conducted. Themes were identified by content analysis.

SETTING

Two different geographical communities in Wuhan, Hubei Province, central China, March-May 2016.

SUBJECTS

A total of twenty-seven mothers aged 23-33 years, who had one child under 3 years of age and had experience of breast-feeding in public places.

RESULTS

Seven themes emerged from the interviews: struggling to balance infant's needs and personal feelings; embarrassed or natural emotion regarding breast-feeding in public places; effect of cultural and social norms; internalized concerns going beyond actual social reaction; measures to make breast-feeding in public places easier; desire for more public facilities; and expecting emotional support from society members.

CONCLUSIONS

More positive social support, favourable policies and necessary facilities were desired to enable mothers to breast-feed in an appropriate public location. Women expected increased public acceptance of breast-feeding practices and support from government health officials to ensure women's success in breast-feeding in public settings.

Maternal intention to exclusively breast feed among mainland Chinese mothers: A cross-sectional study

OBJECTIVE

to examine postpartum maternal recall of their intentions to exclusively breast feed among breastfeeding women and identify its predictors.

DESIGN AND SETTING

a cross-sectional descriptive study was conducted in a regional teaching hospital at Guangzhou, China between April 1 and July 14, 2014.

PARTICIPANTS

571 mothers who were within four days after delivery were recruited to the study.

MEASUREMENTS

data were collected by four research assistants with maternal intention to breast feed data sheet, the Network Support for Breastfeeding Scale (NSBS), and a socio-demographic data sheet.

FINDINGS

greater than half of the mothers (69.5%) intended to exclusively breast feed. The logistic regression analysis revealed six variables which predicted postpartum maternal recall of their intentions to exclusively breast feed. They were support from husband, being breast-fed as an infant, previous breast feeding experience, attending antenatal breast feeding class, time of decision to breast feed, and the rating of the importance of my baby's health.

CONCLUSION AND IMPLICATIONS FOR PRACTICE

health care professionals could develop strategies to enhance mothers' intention to exclusively breast feed, such as providing antenatal breast feeding class on internet, a strong focus on the benefits of exclusive breast feeding on the baby's health in the education programme, and more efforts directed toward educating school-aged children and adolescents to modify societal perceptions of what are considered normal infant feeding. Mothers' husband could be encouraged in supporting exclusive breast feeding.

Family members' infant feeding preferences, maternal breastfeeding exposures and exclusive breastfeeding intentions

BACKGROUND

Maternal breastfeeding intentions are strongly associated with breastfeeding exclusivity and duration. Factors that affect new mothers' exclusive breastfeeding intentions have not been adequately examined.

OBJECTIVE

The purpose of this study was to examine the association between family member's infant feeding preferences, breastfeeding exposures, and womens' exclusive breastfeeding intentions.

METHODS

1277 breastfeeding mother-infant pairs were recruited from four public hospitals in Hong Kong. We used multiple logistic and linear regression models to explore the impact of the family members' infant feeding preferences and breastfeeding exposures on exclusive breastfeeding intentions.

RESULTS

78.1% mothers reported an intention to exclusively breastfeed, and the median intended duration of exclusive breastfeeding was 26 weeks. The husband's preference for breastfeeding (aOR = 1.67; 95% CI 1.20-2.31), previous breastfeeding experience (aOR = 1.56; 95% CI 1.10-2.23) and attendance at an antenatal breastfeeding class (aOR = 2.09; 95% CI 1.45-3.02) were all strongly associated with higher maternal intention to exclusively breastfeed. For every additional family member who preferred breastfeeding, the odds of intending to exclusively breastfeed increased by 32% (aOR1.32; 95% CI, 1.13-1.55). Similarly, the proportion of participants intending to exclusively breastfeed increased progressively with more breastfeeding exposures.

CONCLUSIONS

Including fathers and other significant family members in antenatal breastfeeding education can help to maximize breastfeeding support for the new mother and encourage new mothers to exclusively breastfeed.

Amamentação: validação de tecnologia assistiva em áudio para pessoa com deficiência visual

Resumo Objetivo Validar tecnologia assistiva sobre amamentação para cegos pessoas com deficiência visual na modalidade literatura de cordel em áudio através do acesso online. Métodos Pesquisa de desenvolvimento metodológico. Realizada de agosto de 2012 a março de 2013, com 124 pessoas cegas, as quais apreciaram tecnologia (literatura de cordel) sobre amamentação. Realizaram-se testes para variáveis quantitativas. Resultados A maioria dos sujeitos tinha idade de 30-49 anos (61,3%), sexo feminino (51,6%), cursaram o ensino médio (48,4%), não casados (55,6%), e com deficiência visual de nascença (51,6%). Em relação à avaliação da tecnologia assistiva, pelas médias encontradas, os tópicos foram favoráveis e bem avaliados, objetivo (93,6 ± 10,7), organização (87,0 ± 14,5), estilo de áudio (86,7 ± 15,6) e motivação (88,9 ± 15,3). Conclusão Após avaliações, a tecnologia atingiu os objetivos propostos, com boa organização geral, estrutura, estratégia de apresentação e coerência, além de apropriada compreensão, bom estilo de áudio, motivadora e interessante.