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Fisher E, Patel P, Wouk KG, Neupane B, Alkhalifah F, Bartholmae MM, Tang C, Zhang Q. Breastfeeding Perceptions and Decisions among Hispanic Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children: A Qualitative Study. Nutrients 2024; 16:1565. [PMID: 38892499 PMCID: PMC11173851 DOI: 10.3390/nu16111565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2024] [Revised: 05/19/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC's largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants' perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along with perceptions of WIC's breastfeeding support. These results can help the WIC program to refine its breastfeeding education to better meet the needs of Hispanic participants.
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Affiliation(s)
- Emily Fisher
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Priyanka Patel
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Kathryn G. Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC 27514, USA;
| | - Bidusha Neupane
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Futun Alkhalifah
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
| | - Marilyn M. Bartholmae
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
- Department of Psychiatry and Behavioral Health, Eastern Virginia Medical School, Norfolk, VA 23510, USA
| | - Chuanyi Tang
- Department of Marketing, Old Dominion University, Norfolk, VA 23529, USA;
| | - Qi Zhang
- School of Community and Environmental Health, Old Dominion University, Norfolk, VA 23529, USA; (E.F.); (P.P.); (B.N.); (F.A.); (M.M.B.)
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Channell Doig A. Latina Mothers' Infant Feeding Experiences During the 2022 Formula Shortage. J Perinat Neonatal Nurs 2024; 38:37-45. [PMID: 38278643 DOI: 10.1097/jpn.0000000000000799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2024]
Abstract
BACKGROUND Mothers report feeling immense pressure to breastfeed their infants, and not doing so can be associated with stigma, shame, and judgment. Many Latina mothers struggle to meet their breastfeeding goals and substitute formula earlier than planned. During 2022, an infant formula recall caused a shortage and made acquiring formula difficult or impossible in many areas of the United States. This study explores Latina mothers' experiences with infant feeding during the time of the formula shortage. METHODS In-depth interviews (N = 7) were conducted with Latina mothers who formula-fed during the shortage. Interviews were analyzed using reflexive thematic analysis. Mean maternal age was 29.7 years, and mean infant age was 10.3 months. Three mothers were born in the United States, and 4 were immigrants. RESULTS Thematic analysis generated 3 themes: (1) Fighting to breastfeed; (2) Breastfeeding is not the only way to be a "good" mother; and (3) No formula on the shelves. Participants described their determination to continue breastfeeding despite challenges before realizing that it limited their ability to care for their children. They discussed the emotional toll of the formula shortage and strategies for finding formula. CONCLUSIONS The findings emphasize the need for additional structural support for infant feeding in the United States to prevent future formula shortages and for better lactation care and mental health support for mothers who want to breastfeed.
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Affiliation(s)
- Amara Channell Doig
- Department of Behavioral and Community Health, University of Maryland, College Park
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3
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Charlesworth J, McAlpine T, Martin A, Scott J, Mullan B. Development, psychometric assessment, and predictive validity of a breastfeeding subjective norms scale among an Australian prospective cohort of first-time parents. Br J Health Psychol 2023; 28:690-704. [PMID: 36740759 DOI: 10.1111/bjhp.12648] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 01/18/2023] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Breastfeeding has a number of benefits for both mothers and their infants. Research has examined the psychosocial influences on breastfeeding, yielding important findings in relation to particular constructs that play a significant role in this vital health behaviour. One such construct is subjective norms. However, there are mixed findings in relation to the role of subjective norms in breastfeeding behaviours. This may be due to the lack of consistent measure of subjective norms across studies. Further, the influence of fathers' subjective norms on breastfeeding continuation remains unclear due to a lack of measurement. Thus, the aim of the current study was to develop and assess a reliable and valid subjective norms scale specific to breastfeeding for use among both mothers and fathers. DESIGN/METHODS Subjective norms items were developed by researchers in the domain and were tested among 949 couples. RESULTS Findings indicated that both subjective norms scales had excellent reliability, construct validity, and predictive validity. It was also found that both the mothers' and fathers' subjective norms scales tapped into two key structures: breastfeeding in general, and breastfeeding in public. Further, maternal subjective norms were predictive of breastfeeding behaviours but not paternal subjective norms. CONCLUSIONS These findings indicate that the developed subjective norms scales are reliable and valid and capture key elements of breastfeeding subjective norms among both mothers and fathers. Use of this measure in future research can help better understand the role of both mothers' and fathers' subjective norms in influencing breastfeeding behaviours.
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Affiliation(s)
- Jessica Charlesworth
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Thomas McAlpine
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Annegret Martin
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Jane Scott
- School of Population Health Curtin University, Perth, Western Australia, Australia
| | - Barbara Mullan
- Faculty of Health Sciences, enAble Institute, Curtin University, Perth, Western Australia, Australia
- School of Population Health Curtin University, Perth, Western Australia, Australia
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Gonzalez-Nahm S, Benjamin-Neelon SE. Supporting breastfeeding equity: A cross-sectional study of US birthing facility administrators. Prev Med Rep 2023; 34:102259. [PMID: 37252075 PMCID: PMC10220392 DOI: 10.1016/j.pmedr.2023.102259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 02/06/2023] [Accepted: 05/19/2023] [Indexed: 05/31/2023] Open
Abstract
Disparities in breastfeeding have continued in the United States (US) despite efforts to increase breastfeeding rates. Hospitals are in a unique position to enable breastfeeding and help reduce disparities; however, it is unclear whether hospital administration is supportive of breastfeeding equity practices or plans. This study aimed to assess birthing facility plans to support breastfeeding among women of low income and women of color across the US. We administered electronic surveys to 283 US hospital administrators between 2019 and 2020. We assessed whether facilities had a plan in place to support breastfeeding among women of low income and women of color. We assessed associations between Baby-Friendly Hospital Initiative (BFHI) status and having a plan in place. We examined reported activities provided through open-ended responses. Fifty-four percent of facilities had a plan in place to support breastfeeding among women of low income and 9% had a plan in place to support breastfeeding among women of color. Having a plan was not associated with having a BFHI designation. A lack of plan to specifically help those with the lowest rates of breastfeeding may perpetuate rather than reduce inequities. Providing anti-racism and health equity training to healthcare administrators may help birthing facilities achieve breastfeeding equity.
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Affiliation(s)
- Sarah Gonzalez-Nahm
- Department of Nutrition, University of Massachusetts Amherst, Amherst, MA, USA
| | - Sara E. Benjamin-Neelon
- Department of Health, Behavior and Society, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Özdil K, Çatıker A, Bulucu Büyüksoy GD. Breastfeeding within the circle of motherhood, restriction, and patriarchy: A qualitative study. Health Care Women Int 2023; 44:246-261. [PMID: 34339611 DOI: 10.1080/07399332.2021.1935958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Our purpose in the present study is to analyze the opinions of women regarding the factors that support and hinder their breastfeeding. This is a phenomenological and qualitative study. The present study included 32 breastfeeding women who live in different provinces in the Central Anatolia Region of Turkey. The data were collected using a semi-structured interview form and were evaluated using the content analysis method. Three themes and ten sub-themes about women's experience on breastfeeding their babies and factors affecting their breastfeeding were found. The themes identified were: motherhood, restriction, patriarchy.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.1935958 .
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Affiliation(s)
- Kamuran Özdil
- Aged Care Program, Nevsehir Haci Bektaş Veli University, Health Services Vocational School, Nevşehir, Turkey
| | - Aslıhan Çatıker
- Department of Nursing, Ordu University Faculty of Health Sciences, Ordu, Turkey
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Fisher E, Wouk K, Patel P, Tang C, Zhang Q. Forming the Perception of WIC Infant Feeding Recommendations: A Qualitative Study. Nutrients 2023; 15:nu15030527. [PMID: 36771234 PMCID: PMC9920282 DOI: 10.3390/nu15030527] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Revised: 12/28/2022] [Accepted: 01/16/2023] [Indexed: 01/20/2023] Open
Abstract
Nearly half of newborns in the United States are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Promoting breastfeeding is a programmatic priority, although formula vouchers are provided for those who do not exclusively breastfeed. Previous literature suggests that participant perception of WIC's breastfeeding recommendations is a significant factor predicting breastfeeding initiation, duration, and exclusivity outcomes. However, little is known about how participants' perceptions of WIC's breastfeeding recommendations are formed. To address this knowledge gap, we conducted a qualitative pilot study in Nevada, interviewing 10 postpartum WIC mothers and 12 WIC staff who had interacted with participants regarding infant feeding. Results showed participants and staff reported various perceptions of what WIC recommends, the factors that contribute to these perceptions, and how these perceptions affect breastfeeding practices. Respondents also described that WIC has a negative legacy as the "free formula program," and that environmental factors, such as the recent formula recall, have had an impact on participants' infant feeding practices. More effective public campaigns and programmatic strategies are needed to target participants' prenatal self-efficacy and to communicate the availability of skilled lactation support in the early postpartum period to improve participants' perceptions of WIC's position on breastfeeding.
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Affiliation(s)
- Emily Fisher
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Kathryn Wouk
- Pacific Institute for Research and Evaluation, Chapel Hill, NC 27514, USA
| | - Priyanka Patel
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
| | - Chuanyi Tang
- Department of Marketing, Strome College of Business, Old Dominion University, Norfolk, VA 23529, USA
| | - Qi Zhang
- School of Community and Environmental Health, College of Health Sciences, Old Dominion University, Norfolk, VA 23529, USA
- Correspondence: ; Tel.: +1-757-683-6890
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7
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Villalobos AVK, Turner MM, Lapinski MK, Hull S, Long S, Wang J, Moore EWG. Predicting Breastfeeding Intentions: A Test and Extension of the Theory of Normative Social Behavior with African American Social Identity. HEALTH COMMUNICATION 2023; 38:101-113. [PMID: 34105433 DOI: 10.1080/10410236.2021.1936750] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Breastfeeding is a health promoting social behavior but statistics suggest a persistent disparity of lower rates among African American mothers. The Theory of Normative Social Behavior (TNSB) explains when and how norms influence behaviors, but has produced inconsistent results with respect to proposed moderators group identity and injunctive norms (IN), limiting its predictive value in diverse cultural groups. Cultural norms are one of many influences on breastfeeding behaviors, yet little is known about their mechanisms of influence. The TNSB has not been tested in the breastfeeding context or within an exclusively African American cultural group. Given this knowledge gap, a survey of 528 African American mothers in the Washington, D.C. area was conducted to test the moderating effects of IN and subjective norms (SN) and social identity on the descriptive norms (DN) to intentions relationship as predicted by the TNSB. Structural equation modeling was used to show that when controlling for education and breastfeeding history, norms significantly predicted 26.4% of the variance in breastfeeding intentions. SN and DN interacted negatively to enhance breastfeeding intentions. Latent profile analysis using ethnic pride, collectivism, and religiosity scales detected four profiles of African American social identity. Social identity profile membership was a significant moderator on the DN to intentions pathway in the structural equation model. Profiles with the highest ethnic pride were significantly influenced by DN to intend to breastfeed. Implications from this study for public health intervention and communication messaging are discussed.
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Affiliation(s)
- Aubrey Van Kirk Villalobos
- Department of Prevention and Community Health, Milken Institute School of Public Health at the George Washington University
- School of Medicine and Health Sciences, The George Washington University Cancer Center
| | | | | | - Shawnika Hull
- Department of Prevention and Community Health, Milken Institute School of Public Health at the George Washington University
| | - Sahira Long
- Department of General and Community Pediatrics, Children's National Health System
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
| | - Jichuan Wang
- Department of Pediatrics, The George Washington University School of Medicine and Health Sciences
- Department of Epidemiology and Biostatistics, Milken Institute School of Public Health at the George Washington University
- Children's National Health System, Children's National Research Institute
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8
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Weston K, Anbari AB, Bullock L. The Work of Breastfeeding Among Women of Low Socioeconomic Status: A Qualitative Metasynthesis. Glob Qual Nurs Res 2023; 10:23333936231161130. [PMID: 37025117 PMCID: PMC10070751 DOI: 10.1177/23333936231161130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2022] [Revised: 02/09/2023] [Accepted: 02/15/2023] [Indexed: 04/03/2023] Open
Abstract
A theory-generating qualitative metasynthesis was used to explore the questions: (a) How do mothers of low socioeconomic status in the United States express their attitudes and beliefs on breastfeeding? (b) How do mothers of low socioeconomic status in the United States describe the types of support received related to breastfeeding? Databases were searched from January 2000 to June 2022. Eleven qualitative studies were evaluated, and six themes were identified. A model was developed illustrating how the themes impact a mother's decision to breastfeed. Positive factors included shared narratives, knowledge of breastfeeding physiology, and social network. However, more negative influences were heard such as opinions passed on from family and friends, lack of teaching and anticipatory guidance, limited support and follow up, and the perception of conflicting messages from health care professionals. This model identifies constructs that can be used as starting points for interventions, policy development and/or health promotion education.
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Affiliation(s)
- Karry Weston
- University of Missouri Sinclair School of Nursing, Columbia, USA
| | | | - Linda Bullock
- University of Missouri Sinclair School of Nursing, Columbia, USA
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Tran V, Reese Masterson A, Frieson T, Douglass F, Pérez‐Escamilla R, O'Connor Duffany K. Barriers and facilitators to exclusive breastfeeding among Black mothers: A qualitative study utilizing a modified Barrier Analysis approach. MATERNAL & CHILD NUTRITION 2023; 19:e13428. [PMID: 36098279 PMCID: PMC9749593 DOI: 10.1111/mcn.13428] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 08/03/2022] [Accepted: 08/19/2022] [Indexed: 12/15/2022]
Abstract
Breastfeeding has health benefits for both infants and mothers, yet Black mothers and infants are less likely to receive these benefits. Despite research showing no difference in breastfeeding intentions by race or ethnicity, inequities in breastfeeding rates persist, suggesting that Black mothers face unique barriers to meeting their breastfeeding intentions. The aim of this study is to identify barriers and facilitators that Black women perceive as important determinants of exclusively breastfeeding their children for at least 3 months after birth. Utilizing a Barrier Analysis approach, we conducted six focus group discussions, hearing from Black mothers who exclusively breastfed for 3 months and those who did not. Transcripts were coded starting with a priori parent codes based on theory-derived determinants mapped onto the Socioecological Model; themes were analysed for differences between groups. Facilitators found to be important specifically for women who exclusively breastfed for 3 months include self-efficacy, lactation support, appropriate lactation supplies, support of mothers and partners, prior knowledge of breastfeeding, strong intention before birth and perceptions of breastfeeding as money-saving. Barriers that arose more often among those who did not exclusively breastfeed for 3 months include inaccessible lactation support and supplies, difficulties with pumping, latching issues and perceptions of breastfeeding as time-consuming. Lack of access to and knowledge of breastfeeding laws and policies, as well as negative cultural norms or stigma, were important barriers across groups. This study supports the use of the Socioecological Model to design multicomponent interventions to increase exclusive breastfeeding outcomes for Black women.
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Affiliation(s)
- Victoria Tran
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Amelia Reese Masterson
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Tomeka Frieson
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | - Frankie Douglass
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
| | | | - Kathleen O'Connor Duffany
- Yale School of Public HealthNew HavenConnecticutUSA
- Community Alliance for Research and Engagement (CARE)Southern Connecticut State University and Yale School of Public HealthNew HavenConnecticutUSA
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Impact of the Infant Formula Shortage on Breastfeeding Rates. J Pediatr Health Care 2022; 37:279-286. [PMID: 36528487 DOI: 10.1016/j.pedhc.2022.11.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 11/11/2022] [Indexed: 12/16/2022]
Abstract
INTRODUCTION This study aimed to determine the impact of the infant formula shortage on breastfeeding rates. METHOD The sample included infants attending newborn through 2-month visits at a rural pediatric practice. Preshortage data was compared with postshortage data from newborn (pre: n = 302; post: n = 302), 1-month (pre: n = 273, post: n = 259), and 2-month (pre: n = 255; post: n = 234) visits. RESULTS Data analysis using Pearson's χ2 and Mann-Whitney tests found a significant increase in breastfeeding rates postshortage compared with preshortage. Breastfeeding initiation increased by 10.6% compared with preshortage. DISCUSSION Many factors contributed to the significant increase in breastfeeding initiation during the formula shortage. Reports of illnesses associated with the ingestion of infant formula made breastfeeding more appealing. Furthermore, breast milk was readily available, whereas formula was not. Positive breastfeeding experiences during the formula shortage may lead to a sustained increase in breastfeeding.
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11
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Grant A, Pell B, Copeland L, Brown A, Ellis R, Morris D, Williams D, Phillips R. Views and experience of breastfeeding in public: A qualitative systematic review. MATERNAL & CHILD NUTRITION 2022; 18:e13407. [PMID: 35914544 PMCID: PMC9480936 DOI: 10.1111/mcn.13407] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Revised: 06/23/2022] [Accepted: 06/24/2022] [Indexed: 12/02/2022]
Abstract
Breastfeeding rates in many Global North countries are low. Qualitative research highlights that breastfeeding in public is a particular challenge, despite mothers often having the legal right to do so. To identify barriers and facilitators, we systematically searched the qualitative research from Organisation for Economic Co-operation and Development countries relating to breastfeeding in public spaces from 2007 to 2021. Data were analysed using the Thematic Synthesis technique. The review was registered with PROSPERO (registration number: CRD42017081504). Database searching identified 3570 unique records. In total, 74 papers, theses, or book chapters, relating to 71 studies, were included, accounting for over 17,000 mothers. Overall, data quality was high. Our analysis identified that five core factors influenced mothers' thought processes and their breastfeeding in public behaviour: legal system; structural (in)equality; knowledge; beliefs and the social environment. Macro-level factors relating to legislation and inequality urgently require redress if breastfeeding rates are to be increased. Widespread culture change is also required to enhance knowledge, change hostile beliefs and thus the social environment in which mother/infant dyads exist. In particular, the sexualisation of breasts, disgust narratives and lack of exposure among observers to baby-led infant feeding patterns resulted in beliefs which created a stigmatising environment. In this context, many mothers felt unable to breastfeed in public; those who breastfed outside the home were usually highly self-aware, attempting to reduce their exposure to conflict. Evidence-based theoretically informed interventions to remove barriers to breastfeeding in public are urgently required.
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Affiliation(s)
- Aimee Grant
- Centre for Trials ResearchCardiff UniversityCardiffUK
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Bethan Pell
- Centre for Trials ResearchCardiff UniversityCardiffUK
- DECIPHerCardiff UniversityCardiffUK
| | - Lauren Copeland
- DECIPHerCardiff UniversityCardiffUK
- Division of Population MedicineCardiff UniversityCardiffUK
| | - Amy Brown
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Rebecca Ellis
- Centre for Lactation, Infant Feeding and Translational ResearchSwansea UniversitySwanseaUK
| | - Delyth Morris
- Subject Librarian, Dental and MedicineCardiff UniversityCardiffUK
| | | | - Rhiannon Phillips
- Division of Population MedicineCardiff UniversityCardiffUK
- Cardiff School of Sport and Health SciencesCardiff Metropolitan UniversityCardiffUK
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12
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Anaba UC, Johansson EW, Abegunde D, Adoyi G, Umar-Farouk O, Abdu-Aguye S, Hewett PC, Hutchinson PL. The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study. Int Breastfeed J 2022; 17:63. [PMID: 36050774 PMCID: PMC9438163 DOI: 10.1186/s13006-022-00500-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Accepted: 08/08/2022] [Indexed: 11/21/2022] Open
Abstract
Background Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices. Methods A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September–October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables. Results Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0–5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices. Conclusion Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women’s breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.
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Affiliation(s)
- Udochisom C Anaba
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria. .,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA.
| | - Emily White Johansson
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
| | - Dele Abegunde
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Formerly Population Council, Washington DC, USA
| | - Gloria Adoyi
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Save the Children, Abuja, Nigeria
| | - Olayinka Umar-Farouk
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | - Shittu Abdu-Aguye
- Breakthrough ACTION/Nigeria, Abuja, Nigeria.,Johns Hopkins Center for Communication Programs, Baltimore, MD, USA
| | | | - Paul L Hutchinson
- Breakthrough RESEARCH/Nigeria, Plot 839 Idris Ibrahim Crescent, Jabi, Abuja, Nigeria.,Department of Global Community Health and Behavioral Sciences, School of Public Health and Tropical Medicine, Tulane University, New Orleans, USA
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13
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Aderibigbe O, Lucas R. Exclusive breastfeeding in African American women: A concept analysis. J Adv Nurs 2022; 79:1699-1713. [PMID: 35621344 DOI: 10.1111/jan.15301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
AIM To report an analysis of the concept of exclusive breastfeeding (EBF) in African American women. BACKGROUND EBF is the gold standard for infant nutrition from birth until 6 months. The rate of EBF in United States is low-26%, with African American women having the lowest rates. The low rates of EBF in this population are strongly attributed to bias, racism and generational trauma. Therefore, clarifying the concept of EBF with respect to these factors is important for promoting EBF rates of this population. DESIGN Concept analysis. DATA SOURCES Search was conducted in four databases (CINAHL, PubMed, PsycINFO and Scopus) for articles published between 2001 and 2021. A total of 30 articles (20 quantitative, seven qualitative and three mixed methods) clarified the concept. Relevant literature emanated from diverse disciplines examining historical and present maternal and infant health. METHODS Concept analysis using Rodger's evolutionary method. RESULTS An operational definition of the concept of EBF in African American women was developed from the identified antecedents (modifiable and non-modifiable), defining attributes and consequences of the concept. Access to breastfeeding resources, maternal (prenatal intention to breastfeed, smoking status, attitude towards breastfeeding), infant (skin-to-skin care, successful latching and weight) and contextual factors (socioeconomic, occupational and cultural) predict EBF. The primary attributes of EBF were physiological, physical, psychological and relational. Consequences of EBF were positive health outcomes for, and increased bonding between, mother and infant. CONCLUSION This concept analysis is the first identifying modifiable and non-modifiable antecedents of EBF. The analysis provides an operational definition for EBF in African American women which is useful to promote understanding of breastfeeding. This new concept examines the historic societal trauma associated with wet nursing and reframes breastfeeding as a positive maternal and infant health behaviour.
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Affiliation(s)
| | - Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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Duncan R, Coleman J, Herring S, Kawan M, Santoro C, Atre M, Mason A, Moore S, Kumar A. Breastfeeding Awareness and Empowerment (BAE): A Black Women-Led Approach to Promoting a Multigenerational Culture of Health. SOCIETIES (BASEL, SWITZERLAND) 2022; 12:28. [PMID: 36160938 PMCID: PMC9499340 DOI: 10.3390/soc12010028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/04/2022]
Abstract
1 Background Critical gaps in the U.S. healthcare system perpetuate adverse reproductive health outcomes for Black people. Grounded in reproductive justice and trauma-informed care, Breastfeeding Awareness and Empowerment (BAE) has developed a program titled BAE Cafe to directly address these gaps by providing community-based lactation and perinatal mental health support. A literature review identified key programmatic gaps, namely, access to knowledge relevant to troubleshooting breastfeeding, peer support, community support and healthcare system support, and system-level factors that impede families and communities from accessing lactation support. 2 Methods This paper describes BAE Cafe through a group process observation and participant survey. 3 Results The observation of groups highlighted the core elements of the BAE Cafe model: knowledge, support and mental health support in a peer driven format. Participant survey feedback was overwhelmingly positive and highlighted the critical importance of lactation support for Black women by Black women and BAE's role in participants' decisions to continue breastfeeding. 4 Conclusions BAE Cafe is a replicable, scalable, peer-driven and low-barrier intervention that has the potential to improve outcomes for Black families. Additional research and investment are now needed to assess large-scale implementation to reduce disparities and address health inequity across different contexts and settings.
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Affiliation(s)
- Rebecca Duncan
- Breastfeeding Awareness and Empowerment (BAE), Philadelphia, PA 19132, USA
| | - Jabina Coleman
- Breastfeeding Awareness and Empowerment (BAE), Philadelphia, PA 19132, USA
| | - Sharon Herring
- Obstetrics and Reproductive Sciences, Temple University, Philadelphia, PA 19140, USA
| | - Meg Kawan
- Children’s Hospital of Philadelphia (CHOP) Karabots Center, Philadelphia, PA 19139, USA
| | - Christy Santoro
- Obstetrics and Reproductive Sciences, Temple University, Philadelphia, PA 19140, USA
| | - Meghana Atre
- Mailman School of Public Health, Columbia University, New York, NY 10032, USA
| | - Aleigha Mason
- School of Nursing, University of Pennsylvania, Philadelphia, PA 19104, USA
| | - Shawana Moore
- College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
| | - Aparna Kumar
- College of Nursing, Thomas Jefferson University, Philadelphia, PA 19107, USA
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Petit M, Smart DA, Sattler V, Wood NK. Examination of Factors That Contribute to Breastfeeding Disparities and Inequities for Black Women in the US. JOURNAL OF NUTRITION EDUCATION AND BEHAVIOR 2021; 53:977-986. [PMID: 34763821 DOI: 10.1016/j.jneb.2021.08.013] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 08/24/2021] [Accepted: 08/26/2021] [Indexed: 06/13/2023]
Abstract
Breastmilk is considered the optimal nutrition for newborns. US Black women continue to have the lowest breastfeeding initiation and duration rates. This Perspective examines factors associated with breastfeeding disparities and inequities among Black women through the lens of critical race theory and the social-ecological model. Recommendations to increase breastfeeding rates in this population include increased communication and educational strategies by health care professionals, education to recognize implicit bias and systemic racism in our health care system, early prenatal and ongoing postpartum breastfeeding support, increased community support, and breastfeeding groups developed by and for Black women. In addition, equity policies such as paid maternity leave and work policies that support milk expression would provide needed institutional support for women in the workplace.
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Affiliation(s)
- Melissa Petit
- College of Nursing, Washington State University, Spokane, WA
| | - Denise A Smart
- College of Nursing, Washington State University, Spokane, WA.
| | | | - Natsuko K Wood
- College of Nursing, Washington State University, Spokane, WA
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Matriano MG, Ivers R, Meedya S. Factors that influence women's decision on infant feeding: An integrative review. Women Birth 2021; 35:430-439. [PMID: 34674954 DOI: 10.1016/j.wombi.2021.10.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 10/07/2021] [Accepted: 10/07/2021] [Indexed: 11/25/2022]
Abstract
BACKGROUND Many women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women's antenatal breastfeeding decisions, the factors that influence women's decisions during the continuum of antenatal and postnatal period are less known. AIM To understand and synthesise the contemporary factors that influence women's decisions on infant feeding from the antenatal period and across the breastfeeding continuum. METHOD Five online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes. FINDINGS Five main themes were identified: (a) Women's own views, (b) Family and friend's preferences and advice, (c) Health professional's preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women's intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory. CONCLUSION The factors that influence women's decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions.
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Affiliation(s)
| | | | - Shahla Meedya
- School of Nursing, University of Wollongong, Australia.
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Carlin RF, Cornwell B, Mathews A, Wang J, Cheng YI, Yan X, Fu LY, Moon RY. Impact of Personal Social Network Types on Breastfeeding Practices in United States-Born Black and White Women. Breastfeed Med 2021; 16:807-813. [PMID: 34009013 PMCID: PMC8665818 DOI: 10.1089/bfm.2021.0037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: An individual's personal social network influences behavior; one is more likely to adopt behaviors consistent with norms within the network to avoid social stigma. Personal social network types, which are associated with individual behaviors, have been identified for new mothers: exclusive (kin centric) and expansive (not kin centric). Objective: To analyze the impact of personal social network type on breastfeeding practices in U.S.-born Black and White mothers. Methods: Mothers of infants <6 months old completed surveys about their personal social networks and feeding practices. Multinomial logit models examined how social network types moderated effects of sociodemographic factors on feeding practices. Results: Of 402 mothers, 67% self-identified as Black and 33% as White. Forty-six percent were exclusively breastfeeding; 26% were mixed breast and formula feeding. The likelihood of exclusively breastfeeding was positively associated with percentage of network members who had breastfed; this association was stronger for mothers with exclusive networks than those with expansive networks (β = 2.74, p < 0.001 versus β = 1.78, p = 0.03). Black race was positively correlated with exclusive breastfeeding or mixed feeding for mothers with exclusive networks (β = 1.50, p = 0.046; β = 1.86, p = 0.02, respectively). Lower educational level was negatively correlated with exclusive breastfeeding; this correlation was stronger for mothers with exclusive networks (β = -1.91, p = 0.002 versus β = -1.70, p = 0.04). Lower educational level was also negatively correlated with mixed feeding for mothers with exclusive networks (β = -1.61, p = 0.02). Conclusions: Mothers' personal social network type likely moderates the relationship between sociodemographic variables and feeding practices. While the influence of having network members with breastfeeding experience is important, the magnitude of influence is stronger in exclusive networks.
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Affiliation(s)
- Rebecca F. Carlin
- Department of Pediatrics, Columbia University, New York, New York, USA
| | | | - Anita Mathews
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Jichuan Wang
- Center for Translational Science, Children's National Health System, Washington, District of Columbia, USA
- Department of Epidemiology and Biostatistics, George Washington University, Washington, District of Columbia, USA
| | - Yao I. Cheng
- Center for Translational Science, Children's National Health System, Washington, District of Columbia, USA
| | - Xuewen Yan
- Department of Sociology, Cornell University, Ithaca, New York, USA
| | - Linda Y. Fu
- Department of Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Rachel Y. Moon
- Department of Pediatrics, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Stelson EA, Kulkacek L, Frasso R, Hall M, Guevara JP. Perspectives on Breastfeeding from Mothers with Postpartum Depression Symptoms: A Qualitative Assessment of Antecedents, Barriers, Facilitators, and Intervention Suggestions. Breastfeed Med 2021; 16:790-798. [PMID: 34010030 PMCID: PMC8817733 DOI: 10.1089/bfm.2020.0251] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Background: Postpartum depression (PPD) is one of the most common birthing complications, and studies negatively associate PPD with breastfeeding initiation and continuation. However, little is known about either the breastfeeding experience of mothers with PPD or what resources mothers need for sustained breastfeeding from their perspectives. This study aimed to identify the antecedents, barriers, and facilitators to breastfeeding for mothers with PPD, understand the relationship between self-efficacy and emergent themes, and generate suggestions to inform supportive interventions. Materials and Methods: Birth mothers who screened positive for PPD and reported breastfeeding were recruited to participate in semistructured interviews. Interviews were transcribed verbatim, and inter-coder discrepancies from double coding were resolved through consensus. Thematic analysis was facilitated using immersion-crystallization methods. Results: Participants identified five antecedent themes that encourage initiation (professional support, infant health, mother's health, cost-effectiveness, and faith), four facilitator themes for sustained breastfeeding (infant connection, decreased stress, personal attributes, and logistical strategies), and seven barrier themes (physical pain, infant nutrition, negative feelings, latching difficulties, medical conditions, public breastfeeding, and sleep). Participants' suggestions fell into three primary themes: supportive services, managing expectations, and respecting self-determination. Conclusion: Antecedent and facilitator themes did not overlap, indicating that factors encouraging breastfeeding initiation differ from sustaining factors. Participant suggestions, barriers, and facilitators did not largely differ from mothers without PPD in other qualitative studies. Therefore, interventions should tailor support to specific breastfeeding phase and may not need to be markedly different for mothers with PPD, in addition to depression management.
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Affiliation(s)
- Elisabeth A. Stelson
- Department of Social and Behavioral Sciences, T.H. Chan School of Public Health, Harvard University, Boston, Massachusetts, USA
| | - Laura Kulkacek
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rosemary Frasso
- College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Moriah Hall
- Center for Public Health Initiatives, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - James P. Guevara
- Department of Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
- Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
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Nguyen TT, Tran HTT, Cashin J, Nguyen VDC, Weissman A, Nguyen TT, Kelly B, Mathisen R. Implementation of the Code of Marketing of Breast-Milk Substitutes in Vietnam: Marketing Practices by the Industry and Perceptions of Caregivers and Health Workers. Nutrients 2021; 13:2884. [PMID: 34445044 PMCID: PMC8399411 DOI: 10.3390/nu13082884] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 08/06/2021] [Accepted: 08/19/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND The promotion of breastmilk substitutes (BMS) is an important barrier to successful breastfeeding. OBJECTIVE To examine the enactment and implementation of the Code of Marketing of Breast-Milk Substitutes (the Code) in Vietnam with a focus on marketing practices by the baby food industry and perceptions of caregivers, health workers, and policy makers. METHODS From May to July 2020, we conducted a mixed-method, cross-sectional study including a survey of 268 pregnant women and 726 mothers of infants aged 0-11 months and in-depth interviews with a subset of interviewed women (n = 39), policy makers, media executives, and health workers (n = 31). RESULTS In the previous 30 days, two mothers (out of 726) participating in the quantitative survey reported that health workers had recommended BMS, at private hospitals in both cases. In-depth interviews with health workers showed that hospitals have internal procedures to prevent the promotion of BMS by health workers. However, companies employed representatives to promote products not covered under the Code (e.g., commercial milk formula for pregnant women) at antenatal care visits and by gaining contact information from women and using this information to promote BMS outside the hospital, often on social media. In the 30 days preceding the survey, one-fifth of pregnant women were exposed to promotions of commercial milk formula for pregnant women and 7.1% to promotions of BMS. Among mothers of infants, 7.3% and 10.7% of respondents with infants aged 0-5 and 6-11 months, respectively, were exposed to some form of BMS promotion in the past 30 days. Around the time of birth, parents commonly brought BMS to maternity facilities (52.5%) or purchased it nearby (35.4%). CONCLUSIONS Although Vietnam has a strong regulatory environment for the protection, promotion, and support of breastfeeding, there are implementation, monitoring, and enforcement gaps. Stronger enforcement of national policies to regulate the presence of BMS industry representatives in health facilities-both public and private-and the promotion of BMS products on digital platforms are needed.
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Affiliation(s)
- Tuan T. Nguyen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (A.W.); (R.M.)
| | - Ha T. T. Tran
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (V.D.C.N.); (T.T.N.)
| | - Jennifer Cashin
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (A.W.); (R.M.)
| | - Van D. C. Nguyen
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (V.D.C.N.); (T.T.N.)
| | - Amy Weissman
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (A.W.); (R.M.)
- Asia Pacific Regional Office, FHI 360, Bangkok 10330, Thailand
| | - Trang T. Nguyen
- Research and Training Center for Community Development, Hanoi 11616, Vietnam; (H.T.T.T.); (V.D.C.N.); (T.T.N.)
| | - Bridget Kelly
- School of Health and Society, University of Wollongong, Wollongong, NSW 2522, Australia;
| | - Roger Mathisen
- Alive & Thrive Southeast Asia, FHI 360, Hanoi 11022, Vietnam; (J.C.); (A.W.); (R.M.)
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20
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Edelblute HB, Altman CE. The Interaction and Impact of Social Support and Father Absence on Breastfeeding. Breastfeed Med 2021; 16:629-634. [PMID: 33913762 DOI: 10.1089/bfm.2020.0202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Behaviors related to early childhood nutrition are influenced by a mother's social environment. In many low- and middle-income countries, breastfeeding rates have steadily declined. At the same time, many communities have a history of domestic or international migration that affects the family support systems for women and children remaining in these communities. While social support has been shown to be important to health behaviors conducive to maternal and child health, scant research examines whether social support moderates the impact of an absent father on breastfeeding. Objective: We aim to assess the relationship between father absence and breastfeeding duration and test whether social support moderates the impact of father absence on breastfeeding duration. Methods: We use data from the Social Networks and Health Information Survey (n = 292), a random household survey conducted in a municipality in Guanajuato, Mexico, to estimate Poisson regression models of breastfeeding duration. Results: In multivariate models, an absent father is negatively associated with breastfeeding, whereas social support is positively associated. A significant and positive interaction between father absence and social support suggests that at high levels of support, breastfeeding duration for women with absent fathers does not appear to be meaningfully different from women with present fathers. This suggests that receiving high levels of social support during pregnancy may mitigate the absence of the child's father. Conclusions: Social support interventions for mothers of infants should target mothers and children in households without a father. More research should also be directed at understanding how social support processes during pregnancy can affect breastfeeding in other low- and middle-income countries with high rates of emigration.
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Affiliation(s)
- Heather B Edelblute
- Department of Health, West Chester University, West Chester, Pennsylvania, USA.,Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
| | - Claire E Altman
- Department of Health, West Chester University, West Chester, Pennsylvania, USA.,Department of Health Sciences, University of Missouri, Columbia, Missouri, USA
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Olaniyan A, Isiguzo C, Hawk M. The Socioecological Model as a framework for exploring factors influencing childhood immunization uptake in Lagos state, Nigeria. BMC Public Health 2021; 21:867. [PMID: 33952252 PMCID: PMC8098781 DOI: 10.1186/s12889-021-10922-6] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Accepted: 04/26/2021] [Indexed: 11/30/2022] Open
Abstract
Background Nigeria is one of the ten countries globally that account for 62% of under- and unvaccinated children worldwide. Despite several governmental and non-governmental agencies’ interventions, Nigeria has yet to achieve significant gains in childhood immunization coverage. This study identifies intrapersonal, interpersonal, organizational, community, and policy-level factors that influence childhood immunization uptake from various stakeholders’ perspectives using the Socioecological Model (SEM). Methods Using the Socioecological Model as a guiding framework, we conducted ten focus group sessions with mothers/caregivers and community leaders residing in Lagos state and nine semi-structured interviews with healthcare workers who provide routine immunization services in Lagos state primary healthcare facilities. We performed a qualitative analysis of focus groups and semi-structured interviews using deductive coding methods. Results The study sample included 44 mothers/caregivers and 24 community leaders residing in Lagos State, Nigeria, and 19 healthcare workers (routine immunization focal persons) working in the primary healthcare setting in Lagos state. Study participants discussed factors at each level of the SEM that influence childhood immunization uptake, including intrapersonal (caregivers’ immunization knowledge, caregivers’ welfare and love of child/ren), interpersonal (role of individual relationships and social networks), organizational (geographical and financial access to health facilities, health facilities attributes, staff coverage, and healthcare worker attributes), community (community outreaches and community resources), and policy-level (free immunization services and provision of child immunization cards). Several factors were intertwined, such as healthcare workers’ education of caregivers on immunization and caregivers’ knowledge of vaccination. Conclusions The reciprocity of the findings across the Socioecological Model levels emphasizes the importance of developing multi-pronged interventions that operate at multiple levels of the SEM. Our results can inform the design of culturally appropriate and effective interventions to address Nigeria’s suboptimal immunization coverage.
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Affiliation(s)
- Abisola Olaniyan
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA.
| | - Chinwoke Isiguzo
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
| | - Mary Hawk
- Department of Behavioral and Community Health Sciences, University of Pittsburgh Graduate School of Public Health, 130 De Soto Street, 6120 Public Health, Pittsburgh, PA, 15261, USA
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Feasibility and Acceptability of a Tailored Infant Safe Sleep Coaching Intervention for African American Families. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18084133. [PMID: 33919783 PMCID: PMC8070675 DOI: 10.3390/ijerph18084133] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/22/2021] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/23/2022]
Abstract
Background: Approximately 3600 infants die suddenly and unexpectedly annually in the United States. Research suggests limitations of current behavioral interventions to reduce the risk for sleep-related deaths among African American families living in under-resourced neighborhoods. Guided by the theory of planned behavior and the socio-ecological model, the My Baby’s Sleep (MBS) intervention intends to reduce the risk for sleep-related infant deaths while addressing complex needs of African American families living in under-resourced neighborhoods. Objective: To assess feasibility and acceptability of MBS, a 7-month intervention that includes four home visits and multiple check-ins via phone and text message. Methods: This was a single-arm feasibility and acceptability study with quantitative and qualitive measures. African American families were recruited from community agencies that served an under-resourced metropolitan area. Results: Eight families (eight mothers, nine co-caregivers) completed the intervention. Families reported high acceptability of MBS content, process, and format, as evidenced by qualitative data and mean evaluation scores. Conclusion: MBS is feasible and acceptable among African American families living in under-resourced neighborhoods. These results suggest further investigation of MBS intervention efficacy in a large-scale randomized controlled trial.
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Segura-Pérez S, Hromi-Fiedler A, Adnew M, Nyhan K, Pérez-Escamilla R. Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. Int J Equity Health 2021; 20:72. [PMID: 33676506 PMCID: PMC7936442 DOI: 10.1186/s12939-021-01388-4] [Citation(s) in RCA: 66] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? METHODS The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. RESULTS We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). CONCLUSIONS Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.
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Affiliation(s)
| | | | - Misikir Adnew
- Yale School of Public Health, 135 College Street, New Haven, CT 06510 USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, New Haven, USA
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24
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Improving breastfeeding duration through creation of a breastfeeding-friendly pediatric practice. J Am Assoc Nurse Pract 2021; 33:1273-1281. [PMID: 33534287 DOI: 10.1097/jxx.0000000000000521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 08/18/2020] [Indexed: 11/27/2022]
Abstract
BACKGROUND Breastfeeding is the gold standard for infant feeding. In the United States, 83.2% of women initiate breastfeeding on their infant's birth. When the infant reaches 6 months of age, however, only 57.6% of mothers are still breastfeeding, and a mere 24.9% are breastfeeding exclusively. LOCAL PROBLEM Breastfeeding rates in rural areas are below the national averages. The greatest disparities exist in minorities and individuals with lower educational and socioeconomic status. METHODS A preintervention/postintervention design was used for this quality improvement project. The Model for Improvement's Plan, Do, Study, Act cycle guided the project processes. Breastfeeding rates were obtained at each well-child visit from newborn through 4 months of age. On completion, mean preimplementation and postimplementation breastfeeding rates were compared to determine effectiveness. INTERVENTIONS A breastfeeding support initiative was implemented at a multisite rural Illinois pediatric practice. An evidence-based breastfeeding policy was developed, staff education sessions were conducted, private lactation rooms were created, and breastfeeding photographs/posters were displayed throughout the offices. Lactation support services were publicized via signs and social media postings. RESULTS Overall breastfeeding rates were higher at each time point after implementation. Statistically significant increases occurred at the newborn and 1-month visits, with a modest improvement at 2 and 4 months. CONCLUSIONS This project demonstrated an improvement in breastfeeding duration rates. It is anticipated that this practice-wide standard of care change will promote breastfeeding throughout the first 12 months of life.
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Maviso MK, Ferguson B, Kaforau LM, Capper T. A qualitative descriptive inquiry into factors influencing early weaning and breastfeeding duration among first-time mothers in Papua New Guinea's rural eastern highlands. Women Birth 2021; 35:e68-e74. [PMID: 33485816 DOI: 10.1016/j.wombi.2021.01.006] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 01/03/2021] [Accepted: 01/04/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Exclusive breastfeeding confers multiple maternal and child health benefits. Although breastfeeding initiation following birth is common in Papua New Guinea, many first-time mothers may not achieve optimal breastfeeding duration. AIM This study aims to explore and describe factors influencing early weaning and breastfeeding duration among first-time mothers in Papua New Guinea's rural eastern highlands. METHODS A qualitative descriptive approach was adopted in this study. Data were collected through semi-structured in-depth interviews with 20 first-time mothers. The interviews transcripts were then thematically analysed. RESULTS Three key themes identified were: source of breastfeeding information and support; social networks and breastfeeding communication; and balancing perceived gender and maternal roles. The study further identified a lack of fathers' involvement in supporting breastfeeding. CONCLUSION Social and relational networks, and maternal factors need to be considered to better understand breastfeeding practices. Efforts to achieve optimal breastfeeding outcomes entail targeted and culturally appropriate programs, including fathers' involvement as they play important roles in breastfeeding and infant feeding practices.
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Affiliation(s)
- McKenzie Ken Maviso
- Division of Public Health, School of Medicine and Health Sciences, University of Papua New Guinea, Port Moresby, Papua New Guinea.
| | - Bridget Ferguson
- School of Nursing, Midwifery and Social Sciences, Higher Education Division, Central Queensland University, Brisbane, Queensland, Australia
| | - Lillian Maye Kaforau
- Pacific Technical and Further Education (TAFE) Science, Technology & Environment, College of Foundation Studies, University of South Pacific, Honiara Campus, Solomon Islands
| | - Tanya Capper
- School of Nursing, Midwifery and Social Sciences, Higher Education Division, Central Queensland University, Brisbane, Queensland, Australia
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Dieterich R, Chang J, Danford C, Scott PW, Wend C, Demirci J. She "didn't see my weight; she saw me, a mom who needed help breastfeeding": Perceptions of perinatal weight stigma and its relationship with breastfeeding experiences. J Health Psychol 2021; 27:1027-1038. [PMID: 33445978 DOI: 10.1177/1359105320988325] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Weight stigmatization is related to emotional and psychological distress including low self-esteem, body image dissatisfaction, depression, and anxiety; all linked with suboptimal breastfeeding outcomes. This qualitative descriptive study explored postpartum individuals' recalled experiences of weight stigma during interactions with perinatal healthcare professionals and its perceived influence on their breastfeeding experiences. Semi-structured phone interviews were conducted with (n= 18) participants. Three themes emerged: (1) "Size Doesn't Matter: They Looked Beyond the Scale," (2) "My Self-Confidence and Desire to Breastfeed is More Important than Weight," and (3) "I Was on My Own"-Limited Social Support not Weight Stigma Influenced Breastfeeding.
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Affiliation(s)
| | - Judy Chang
- University of Pittsburgh School of Nursing, USA
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Moon RY, LoCasale-Crouch J, Turnbull KLP, Colson E, Kellams A, Heeren T, Kerr S, Hauck FR, Corwin MJ. Investigating Mechanisms for Maternal Education Disparities in Enacting Health-Promoting Infant Care Practices. Acad Pediatr 2020; 20:926-933. [PMID: 32201345 PMCID: PMC7483851 DOI: 10.1016/j.acap.2020.03.008] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/10/2020] [Accepted: 03/14/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Although higher education and healthier practices are positively associated, the explanatory mechanisms for this association remain unclear. The purpose of this study was to better understand mechanisms underlying this association by examining maternal adherence to 2 health-promoting infant care practices: supine placement and breastfeeding. METHODS We analyzed nationally representative data from the Study of Attitudes and Factors Effecting Infant Care, which surveyed US mothers after infant birth and 2 months thereafter. Using the Theory of Planned Behavior as a framework, we used structural equation models to elucidate mediational pathways from maternal education to supine infant placement or any breastfeeding. RESULTS Data from 3297 mothers demonstrated 77.0% of infants usually were placed supine, and 57.8% received any breastfeeding. The overall direct effect of maternal educational level on supine placement and any breastfeeding was odds ratio (OR) 1.31 (95% confidence interval [CI] 1.11-1.54) and OR 2.82 (95% CI 2.35-3.37), respectively. In pathway analyses, the strongest associations with both supine position and breastfeeding were seen with positive attitudes (supine: aOR 18.96, 95% CI 9.00-39.92; breastfeeding: aOR 3.86, 95% CI 2.19-6.82) and positive social norms (supine: aOR 6.69, 95% CI 4.52-9.89; breastfeeding: aOR 5.17, 95% CI 4.28-6.23). Mothers with more education had higher odds of both positive attitudes and positive norms for the 2 practices. CONCLUSIONS The associations linking educational attainment with health practices are intricate, with multiple mediating pathways. Attitudes and social norms are powerful forces that mediate the association between maternal educational attainment and both infant supine positioning and breastfeeding, and may be important mediators for other health behaviors.
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Affiliation(s)
- Rachel Y Moon
- Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va.
| | - Jennifer LoCasale-Crouch
- Curry School of Education and Human Development, University of Virginia (J LoCasale-Crouch and KLP Turnbull), Charlottesville, Va
| | - Khara L P Turnbull
- Curry School of Education and Human Development, University of Virginia (J LoCasale-Crouch and KLP Turnbull), Charlottesville, Va
| | - Eve Colson
- Department of Pediatrics, Washington University School of Medicine (E Colson), St. Louis, Mo
| | - Ann Kellams
- Department of Pediatrics, University of Virginia School of Medicine (RY Moon and A Kellams), Charlottesville, Va
| | - Timothy Heeren
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass; Department of Biostatistics, Boston University School of Public Health (T Heeren), Boston, Mass
| | - Stephen Kerr
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass
| | - Fern R Hauck
- Department of Family Medicine, University of Virginia School of Medicine (FR Hauck), Charlottesville, Va
| | - Michael J Corwin
- Slone Epidemiology Center, Boston University (T Heeren, S Kerr, and MJ Corwin), Boston, Mass
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Wen J, Yu G, Kong Y, Liu F, Wei H. An exploration of the breastfeeding behaviors of women after cesarean section: A qualitative study. Int J Nurs Sci 2020; 7:419-426. [PMID: 33195754 PMCID: PMC7644566 DOI: 10.1016/j.ijnss.2020.07.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 06/21/2020] [Accepted: 07/17/2020] [Indexed: 02/06/2023] Open
Abstract
Objectives To explore the factors affecting breastfeeding behaviors in women after cesarean section. Methods This is a qualitative study that used a phenomenological approach. This study used individual face-to-face interviews with 19 women who underwent a cesarean section in a Women and Children’s Hospital in China between July to September 2019. Information saturation was used to determine sample size. Data were analyzed using a thematic content analysis method. Themes were developed based on the theory of planned behavior. Results Thirteen (68.42%) had a planned cesarean section, and six (31.58%) cesarean sections were unplanned or emergent. Three major themes emerged: ambivalent attitude about breastfeeding, motivation to comply with the traditional cultural norms, and barriers and challenges. The motivating factors for breastfeeding after cesarean sections included perceived benefits of human milk, support from healthcare professionals, and responsibility for breastfeeding. The challenges for breastfeeding after cesarean sections included physical discomfort, knowledge and skills deficit of breastfeeding, lactation deficiency, and lack of knowledge and coping skills in managing their depressive mood after cesarean sections. There were a couple of neutral factors, such as the influences of family and peers. These factors could influence women either positively as facilitators or negatively as barriers. Conclusions The findings can offer valuable information for healthcare professionals to help women breastfeed after cesarean sections. To promote women’s breastfeeding behaviors after cesarean sections, it is necessary to change women’s attitudes, belief systems, and the external environments and help them become more confident.
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Affiliation(s)
- Juan Wen
- School of Nursing of Qingdao University, Qingdao, Shandong, China
| | - Guiling Yu
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Yan Kong
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Furong Liu
- Qingdao Women and Children's Hospital, Qingdao, Shandong, China
| | - Holly Wei
- College of Nursing at East Carolina University, Greenville, NC, USA
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