The Associations Between Breastfeeding Duration and Body Dissatisfaction, Ethnicity, and Obesity Among Mexican Women, a Cross-Sectional Study, ENSANUT 2012

COVID-19 and the adequacy of antenatal care among Indigenous women: A retrospective crossover analysis

BACKGROUND

Often marginalized and disadvantaged by systems of oppression, Indigenous populations commonly face significant barriers to accessing adequate antenatal care (ANC). The COVID-19 pandemic had an unprecedented impact on healthcare systems worldwide, including on the provision of antenatal care; this was especially so for Indigenous communities in many regions. As such, our study aimed to estimate the association between the COVID-19 pandemic and adequate ANC received by Indigenous women in Chiapas, Mexico.

METHODS

We conducted a retrospective crossover analysis with data collected between June and December 2021 from Indigenous women who attended at least one ANC appointment at one of two health centers in San Cristóbal de las Casas, Chiapas. We used a multinomial logistic regression model considering the time frame (before and during the pandemic) as the primary independent variable. Adequate antenatal care comprised four dimensions: attendance by qualified personnel, timely first visit, sufficient frequency of visits, and adequacy of the content provided during the visits.

RESULTS

During the COVID-19 pandemic, there was a significant drop in ANC adequacy, with 12.7% (95% CI: 8.3, 18.9) of Indigenous women receiving ANC, compared with the pre-pandemic rate of 52.5% (95% CI: 44.7, 60.3), among the 158 participants. The pandemic resulted in a reduction of 75.8% in the adequacy of ANC. Considering the four dimensions of adequacy, we found that having only one dimension was associated with a relative risk ratio (RRR) of 12.45 (95% CI: 6.40, 24.23), while having two or three dimensions was associated with a RRR of 5.23 (95% CI: 2.83, 9.65) when using adequate ANC as the category of reference.

CONCLUSIONS

According to our results, Indigenous women's ANC adequacy was negatively affected by the COVID-19 pandemic. In light of these findings, we emphasize the importance of developing healthcare systems that are prepared to adapt consultation schemes by implementing virtual visits and incorporating community health workers.

Healthcare professionals and commercial milk formula recommendations in the urban Mexican context

Introduction

Breastfeeding (BF) is considered an essential component of optimal care for child health and development. In the past two decades, global data have shown improvements in some, but not all, BF indicators. Despite these positive changes sales and per capita intake of commercial milk formula (CMF) have increased globally. The CMF industry invests millions of dollars in marketing, which targets families and healthcare professionals (HCP). In Mexico, more than half of the mothers (53%) who feed their infants with CMF chose their Brand on the recommendation of HCP. Understanding the reasons behind the current recommendations for the use of CMF by HCP is important for the design of BF interventions. The primary objective of this study was to explore Mexican HCP' beliefs, attitudes, perceptions, and practices about early infant feeding practices, and reasons for recommending CMF. The secondary objective was to explore pregnant women and mother's perceptions of the infant feeding recommendations they received from HCP, and of the factors that influenced their infant feeding decisions.

Methods

The study was based on a secondary qualitative data analysis of a WHO/UNICEF multi-country study. We analyzed focus group discussions (FGDs) and in-depth interviews (IDIs) from Mexico. Data were collected through convenience sampling in Mexico City and Guadalajara. HCP (n = 34) analysis was based on IDIs, and pregnant women or mothers of children 0-18 months (n = 74) on FGDs and IDIs.

Results

Through a thematic analysis, we identified the socioecology of BF and triangulated HCP and women's accounts. HCP, pregnant women, and mothers recognized that several factors might have influenced their infant feeding decisions including healthcare facilities' policies and maternal work conditions. Although HCP believed that BF is the best way to feed newborns and young children, they routinely recommended CMF. On the other hand, pregnant women and mothers had a strong belief that BF is the best way to feed their babies. However, when women sought support from HCP, the latter often recommended switching to CMF.

Discussion

This study highlights the discordance between HCP perceptions and mothers' experiences of HCP recommendations about infant feeding. Our findings support a national call for policy actions.

Beliefs and Norms Influencing Initiation and Sustenance of Exclusive Breastfeeding: Experiences of Mothers in Primary Health Care Facilities in Ermelo, South Africa

Exclusive breastfeeding (EBF) is not a norm in many communities in South Africa despite the World Health Organizations' recommendations for EBF in the first six months of infant's life. Thus, South Africa continues to observe suboptimal and poor practices of EBF. The purpose of the study was to explore the experiences of mothers who are HIV-positive and negative on EBF and examine the extent to which initiation and sustenance of EBF is influenced by cultural beliefs, societal norms, and family norms and practices in Mpumalanga Province. Three focus group discussions and twelve in-depth interviews were conducted among thirty mothers who were purposively selected during their visits to the facilities for childcare services. Interviews were audiotaped, transcribed verbatim, and transcripts were analysed through thematic analysis using NVivo version 10. Mothers were aged between 18 and 42 years, most were unemployed and were living in poor sociodemographic backgrounds in extended family households. We found evidence of factors that influence the decision to EBF and mix feed infants among mothers. Traditional and cultural beliefs and norms that exist within their communities informed decisions mothers took to EBF. These beliefs existed alongside mothers' opinions on breastfeeding (BF) and HIV infection, as well as the fears of harming the baby through HIV infection, leading to early cessation of BF. Mothers were also advised by family members, friends, and even some healthcare workers to use traditional medicines while BF. The association of EBF with sagging breasts and weight loss as well as discomfort with public BF are personal beliefs that influenced initiation and early cessation of EBF. Breastfeeding messages ought to be context specific to improve the knowledge, understanding, acceptance and practice of EBF among HIV-positive and negative mothers. Culturally appropriate counselling messages that address the known cultural practices of the populations affected are essential to changing the beliefs and norms of the communities including extended families of EBF mothers.

Self-compassion and body image in pregnancy and postpartum: A randomized pilot trial of a brief self-compassion meditation intervention

The current study evaluated the efficacy of a three-week self-compassion (SC) meditation intervention in improving body image and SC during pregnancy and postpartum. Participants (n = 71; age = 31.92 ± 3.98 years; white = 61, 85.9%; intervention = 35, 49.3%; pregnant = 33, 46.5%; postpartum = 38, 53.5%) were recruited from a health coaching program and 35 were randomly assigned into a three-week SC meditation intervention while 36 were randomly assigned to a waitlist control condition. Linear regressions using full-information maximum likelihood estimation examined the effect of intervention group on body image and SC outcomes controlling for baseline level of outcome, pregnancy or postpartum status, previous meditation experience, and physical activity. Results indicated women in the intervention group reported significantly reduced body shame and body dissatisfaction and improved body appreciation and self-compassion compared to women in the control group. Implementation of a brief SC meditation intervention during pregnancy and postpartum has potential to improve mental health outcomes related to body image. Future work should replicate this study with a larger, more diverse sample of women.

Nurses' and midwives' perspectives on how the pursuit for the 'perfect' body image affects their own breastfeeding practices: a qualitative study in Ghana

Background

Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices.

Methods

A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis.

Results

Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children.

Conclusions

The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed.

'[The pediatrician] said that maybe my milk, instead of doing good, no longer helped': the ecology of infant formula in rural communities in Central Mexico

OBJECTIVE

As Mexico continues to develop, an epidemiological and nutritional transition has led to an increase in infant formula use in its rural and indigenous communities. Our objective was to determine the social and cultural factors that influence the use of formula in such populations in Central Mexico.

DESIGN

Qualitative study using a data collection instrument based on the socio-ecological framework.

SETTING

Two rural and indigenous communities in Central Mexico.

PARTICIPANTS

Mothers, fathers, grandparents and healthcare providers.

RESULTS

Breast-feeding was favoured in both communities; however, several cultural traditions hindered exclusive breast-feeding. As these communities became more developed, emerging ideas of modernity led to negative connotations about breast-feeding and many mothers began to view formula as a complement for breast-feeding. Formula was seen as a convenient solution for breast pain, insufficient milk and body image. Healthcare providers promoted the use of formula through their own beliefs, information, communication and conflicts of interest with formula industry representatives. The recent social and economic changes in these communities combined with the increased advertising and availability of breast milk substitutes have facilitated the preference for formula.

CONCLUSIONS

Women in rural, indigenous communities in Central Mexico are increasingly using formula. Efforts at the policy and institutional levels are needed to protect mothers and their children from the detrimental consequences of unregulated formula promotion and the formula culture that it brings with it.