Parental attitudes toward breastfeeding: their association with feeding outcome at hospital discharge

Feeding attitudes of fathers in the United States are associated with breastfeeding success: A cross-sectional study

Background/Aims: Fathers are increasingly recognized as a source of breastfeeding support. This online cross-sectional study examined the relationship between fathers' feeding attitudes and breastfeeding outcomes (initiation, duration, exclusivity) and factors influencing breastfeeding. Methods: Demographic characteristics, anthropometric measurements, and infant feeding methods were self-reported. The Iowa Infant Feeding Attitude Scale (IIFAS) assessed the feeding attitudes of 509 fathers in the USA (34.4 ± 5.2 years). Significance was determined using chi-square tests and analysis of variance (p < .05). Results: The IIFAS categorized participants into feeding attitude groups (positive to formula feeding (PFF), n = 142; neutral feeding (NF), n = 270; positive to breastfeeding (PBF), n = 97). The mean IIFAS score (55.7 ± 16.0) suggested fathers have a neutral attitude toward breastfeeding. The PBF group reported a longer duration of breastfeeding (17.1 ± 7.1 months) compared to the PFF (6.1 ± 3.0 months) or NF (12.7 ± 7.3 months) groups (p < .001). The PFF group reported that their child initiated complementary liquids earlier (18.0 ± 5.8 weeks) compared to the NF or PBF groups (NF = 21.5 ± 13.8; PBF = 24.5 ± 9.2 weeks; p < .001). Initiation of complementary solids was statistically different between the PFF group (21.3 ± 5.4 weeks) and the NF and PBF groups (NF = 26.4 ± 12.0; PBF = 26.4 ± 6.1 weeks; p < .001). Breastfeeding initiation was associated with the feeding attitude group (p < .001). Among those that reported their partner initiated breastfeeding, the feeding source (breastmilk, breastmilk + formula) was associated with the feeding attitude group (p < .001). Reasons for not breastfeeding exclusively or breastfeeding cessation were related to concerns about maternal/child health, convenience, and processes associated with breastfeeding. Conclusions: Fathers' feeding attitudes are related to breastfeeding success. Research should explore education and interventions for fathers to improve breastfeeding rates.

Breastfeeding Intention, Knowledge, and Attitude of Pregnant Women in Treatment for Opioid Use Disorder

OBJECTIVE

The objective of this study was to describe breastfeeding intention, knowledge, and attitude, and sources of infant feeding information during the prenatal period among a cohort of pregnant women in treatment for opioid use disorder (OUD).

STUDY DESIGN

Pregnant women who were receiving treatment for OUD and in the third trimester completed a questionnaire that measured demographic characteristics, infant feeding intentions, breastfeeding beliefs and attitudes, and sources of breastfeeding information. Frequency counts and percentages and means and standard deviations were used to describe data.

RESULTS

Sixty-five women completed the survey. Three-fourths reported some intention to breastfeeding. While attitudes around breastfeeding were generally positive, less than half of respondents knew the recommendations and infant health benefits of breastfeeding.

CONCLUSION

Prenatal programs for women in treatment for OUD should consider addressing patient-reported concerns and gaps in knowledge regarding the benefits of and recommendation for breastfeeding.

KEY POINTS

· Breastfeeding has unique benefits for mother-infant dyads affected by maternal OUD.. · Breastfeeding decisions are influenced by maternal psychosocial factors (e.g., knowledge and attitudes), however, such factors have not been previously assessed in women in treatment for OUD.. · Results indicate that attitudes around breastfeeding are positive but knowledge gaps exist..

A mixed methods systematic review exploring infant feeding experiences and support in women with severe mental illness

There are many benefits of breastfeeding to women and their infants but meeting the recommended 6 months of exclusive breastfeeding is likely to be more challenging for women with severe mental illness (SMI). This is the first systematic review that aims to examine evidence of (a) infant feeding outcomes in women with SMI and the factors associated with this, (b) the experiences of infant feeding and infant feeding support for women with SMI, (c) interventions for supporting infant feeding among these women and (d) health care professionals' attitudes toward supporting infant feeding in women with SMI. Mixed methods systematic review was carried out using the principles of Joanna Briggs Institute's (JBI) 'convergent integrated' methodology. CINAHL, PsycINFO, Medline and MIDIRS were used to search literature between 1994 and 2022. The quality of selected articles was assessed using JBI critical appraisal tools and thematic synthesis was undertaken to obtain findings. Eighteen papers were included in the final review. Women with SMI were less likely to initiate and continue breastfeeding than women without SMI. Several challenges with breastfeeding were highlighted, and while these were often linked to women's mental health difficulties, inconsistent advice from health care professionals and poor support with breastfeeding further compounded these challenges. This review highlights that policy and practice need to take into account the individual challenges women with SMI face when planning, initiating and maintaining breastfeeding. Education and training for health care professionals are needed to enable them to provide tailored infant feeding support to women with SMI, which reflects their individual needs.

Validation of a Turkish version of the fathers' breastfeeding attitude and participation scale

OBJECTIVE

This study aimed to determine the validity, structure, and reliability of a Turkish version of the Fathers' Breastfeeding Attitude and Participation Scale. The Fathers' Breastfeeding Attitude and Participation Scale consists of two parts, namely, Fathers' Breastfeeding Attitude and Fathers' Participation in Breastfeeding Process. Totally, the scale consists of 28 items, of which 14 items belong to Fathers' Breastfeeding Attitude and 14 items belong to Fathers' Participation in Breastfeeding Process. There is no report of a validity and reliability study in the original scale. Currently, there is no validated and reliable scale to assess Fathers' Breastfeeding Attitudes and Involvement in Turkish literature and other languages. In this context, the psychometric properties of the Fathers' Breastfeeding Attitudes and Involvement Scale were examined.

METHODS

The instruments were translated and adapted according to the WHO guidelines.

RESULTS

The Turkish version of the Fathers' Breastfeeding Attitude and Participation Scale demonstrated acceptable validity and reliability.

CONCLUSION

The use of the validated instrument to examine fathers' breastfeeding attitudes and participation in the breastfeeding process will provide data to guide as it is a determinant of breastfeeding behavior.

Development, psychometric assessment, and predictive validity of a breastfeeding subjective norms scale among an Australian prospective cohort of first-time parents

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.

A Survey of Breastfeeding Attitudes and Health Locus of Control in the Nigerian Population

OBJECTIVES

Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample.

METHODS

Men and women (N = 400) (71% female; mean age 34.2 years/ range 18-86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs).

RESULTS MEAN

IIFAS scores (mean = 57.7; sd = 7.8) became less favourable with increasing age (p = 0.02). Men had higher IIFAS scores (mean = 58.6; sd = 7.6) than women (mean = 56.6; sd = 8.0) indicating more favourable attitudes toward breastfeeding (p = 0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p = 0.003) and external powerful others HLoC (EPHLoC) (p = 0.02). Increasing age was associated with higher scores on ECHLoC (p < 0.01) and EPHLoC (p < 0.01). Multiple linear regression analysis was significant (p < 0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p < 0.01) and EPOHLoC (p < 0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p < 0.01). Neither age nor gender were associated with IIFAS scores in the final model.

CONCLUSIONS

This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.

Measuring User Engagement with a Socially Connected, Gamified Health Promotion Mobile App

Participant engagement is an important consideration in mHealth interventions and there are no standardised measurements available to guide researchers. This paper describes the engagement index customised for the Milk Man app, a mobile app designed to engage fathers with breastfeeding and parenting information. Participants were recruited from maternity hospitals in Perth, Western Australia. An engagement index with scores ranging from 0 to 100 was calculated. Kaplan Meier survival analysis was used to determine difference in duration of exclusive breastfeeding, and Pearson's chi square analysis was conducted to investigate the association of engagement level with demographic characteristics and exclusive breastfeeding at 6 weeks. While overall, partners of participants who installed Milk Man were less likely to have ceased exclusive breastfeeding at any time point from birth to six weeks postpartum, this result was modest and of borderline significance (log rank test p = 0.052; Breslow p = 0.046; Tarone-Ware p = 0.049). The mean engagement score was 29.7% (range 1-80%), median 27.6%. Engagement level had no impact on duration of exclusive breastfeeding and demographic factors were not associated with engagement level. This research demonstrates a range of metrics that can be used to quantify participant engagement. However, more research is needed to identify ways of measuring effective engagement.

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.

Prenatal breastfeeding knowledge, attitude and intention, and their associations with feeding practices during the first six months of life: a cohort study in Lebanon and Qatar

Background

Prenatal knowledge, attitude, and intention related to breastfeeding are postulated as important modulators of feeding practices. Using data from the Mother and Infant Nutritional Assessment (MINA) study, a three year cohort conducted in Lebanon and Qatar, this study aimed to characterize breastfeeding practices during the first six months postnatally and examine their associations with prenatal breastfeeding knowledge, attitude, exposure, and intention.

Methods

Pregnant women during their first trimester were recruited from primary healthcare centers in Beirut and Doha. Data collection was conducted in 2015 − 2018. Participants were followed-up until the child was twoyears old. Exposure, knowledge, attitude, and intentions regarding breastfeeding were assessed during the third trimester of pregnancy (n = 230), using validated questionnaires and scales. Breastfeeding practices were evaluated at four months (n = 185) and six months (n = 151) postpartum. Early initiation of breastfeeding was defined as putting the infant to the breast within one hour of birth, and exclusive breastfeeding (EBF) as feeding exclusively with breast milk.

Results

Breastfeeding practices were as follows: ever breastfeeding: 95.8%; early initiation of breastfeeding: 72.8%; breastfeeding at four and six months: 70.3% and 62.3%; EBF at four and six months: 35.7% and 18.5%. Over 95% of participants had high breastfeeding exposure, and 68.8% had strong / very strong intentions to breastfeed. Only 25% had very good knowledge, and 9.2% reported positive/strong positive attitude towards breastfeeding. After adjustment, high exposure was associated with greater odds of breastfeeding initiation (OR 10.1: 95% CI 1.25, 80.65). Both positive attitude towards breastfeeding and strong intention to breastfeed were associated with EBF at four months (OR 2.51; 95% CI 1.02, 6.16 and OR 4.0; 95% CI 1.67, 9.6), breastfeeding at four months (OR 2.92: 95% CI 1.29, 6.62 and OR 5.00: 95% CI 2.25, 11.1), and breastfeeding at six months (OR 3.74: 95% CI 1.24, 11.32 and OR 8.29: 95% CI 2.9, 23.68).

Conclusions

Findings of this study documented suboptimal knowledge and attitude towards breastfeeding and showed that prior exposure, a positive attitude, and a strong intention to breastfeed prenatally were significant predictors of breastfeeding practices postnatally. This highlights the need to develop specific interventions and policies aimed at improving breastfeeding attitudes and creating an enabling environment that supports women throughout their breastfeeding journey.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00456-x.

Determinants of Knowledge and Attitude towards Breastfeeding in Rural Pregnant Women Using Validated Instruments in Ethiopia

Understanding the underlying determinants of maternal knowledge and attitude towards breastfeeding guides the development of context-specific interventions to improve breastfeeding practices. This study aimed to assess the level and determinants of breastfeeding knowledge and attitude using validated instruments in pregnant women in rural Ethiopia. In total, 468 pregnant women were interviewed using the Afan Oromo versions of the Breastfeeding Knowledge Questionnaire (BFKQ-AO) and the Iowa Infant Feeding Attitude Scale (IIFAS-AO). We standardized the breastfeeding knowledge and attitude scores and fitted multiple linear regression models to identify the determinants of knowledge and attitude. 52.4% of the women had adequate knowledge, while 60.9% of the women had a neutral attitude towards breastfeeding. In a multiple linear regression model, maternal occupation was the only predictor of the BFKQ-AO score (0.56SD; 95%CI, 1.28, 4.59SD; p = 0.009). Age (0.57SD; 95%CI, 0.24, 0.90SD; p = 0.001), parity (-0.24SD; 95%CI, -0.47, -0.02SD; p = 0.034), antenatal care visits (0.41SD; 95%CI, 0.07, 0.74SD; p = 0.017) and the BFKQ-AO score (0.08SD; 95% CI, 0.06, 0.09SD; p < 0.000) were predictors of the IIFAS-AO score. Nearly half of the respondents had inadequate knowledge and most women had a neutral attitude towards breastfeeding. Policymakers and managers could address these factors when planning educational interventions to improve breastfeeding practices.

Psychometric properties of the original and short Hungarian version of the Iowa infant feeding attitude scale

BACKGROUND

The Iowa Infant Feeding Attitude Scale (IIFAS) is a widely used tool to assess attitudes towards infant feeding. Attitudes towards breastfeeding are one of the main influencing factors of feeding choice and breastfeeding duration. Adaptation of the IIFAS to the Hungarian context provides an opportunity for cross-cultural comparisons and helps to target breastfeeding support interventions. The growing number of shortened scales in various fields of research, demonstrates the necessity to adapt to a changing context of data collection to avoid fatigue and dropout among respondents. However, international comparisons are difficult due to the lack of a consensual shortened form of the scale. The aim of our study was to examine the psychometric properties of the Hungarian version of the IIFAS (IIFAS-H) and propose an 8-item short version that has appropriate construct validity.

METHODS

The original IIFAS was translated into Hungarian and then translated back to English. A cross-sectional study based on an internet survey in 2019 was conducted among 553 mothers whose most recent child's age was between 6 and 36 months. Psychometric properties of the Hungarian IIFAS were determined and compared with international results. In order to obtain a shorter version of the Hungarian scale, we preferably kept those items that are common with other international abbreviated IIFAS versions and deleted items with a corrected item-total correlation or factor loading of less than 0.3, where factor loadings came from a principal component analysis forcing the extraction of one principal component (factor).

RESULTS

The 17-item IIFAS-H showed good psychometric properties with a Cronbach's alpha of0.73. Further analyses proved that the examined three shortened versions of the IIFAS consisting of 11, 9, and 8 items also showed good properties (Cronbach's alpha = 0.79, 0.79, 0.76, respectively).

CONCLUSIONS

The Hungarian version of the original 17-item long IIFAS proved to be a good measurement tool with good psychometric properties. Based on our analyses, we suggest the use of the 8-item short version (IIFAS-H8) of the scale.

Breastfeeding intention and trait mindfulness during pregnancy

OBJECTIVE

Breastfeeding has been associated with many health benefits for both infant and mother. Trait mindfulness during pregnancy may have a beneficial impact on breastfeeding intention. The current study aimed to examine whether trait mindfulness during pregnancy was associated with antenatal breastfeeding intention.

DESIGN, SETTING AND PARTICIPANTS

The current study is part of a large prospective population-based cohort study among pregnant women in the south of the Netherlands.

MEASUREMENTS

A subsample of participants completed the Three Facet Mindfulness Questionnaire-Short Form at 22 weeks of pregnancy and a question on their breastfeeding intention at 32 weeks of pregnancy (N=790). Moreover, the Edinburgh Depression Scale and Tilburg Pregnancy Distress scale were completed at 32 weeks of pregnancy to assess levels of distress.

FINDINGS

Univariate analyses showed that women with breastfeeding intention during pregnancy had significantly higher scores on the mindfulness facet non-reacting (p<.001, medium effect size) and significantly lower scores on acting with awareness (p=.035, small effect size). A subsequent multiple logistic regression analysis showed that only non-reacting remained significantly associated with antenatal breastfeeding intention (OR=1.09, 95% CI [1.03, 1.15], p=.001), after controlling for confounders. Women who eventually initiated breastfeeding had significantly higher non-reacting scores (p<.001, small to medium effect size).

KEY CONCLUSIONS

The mindfulness facet non-reacting was found to be associated with antenatal breastfeeding intention. More research is needed to confirm our results, since the current study is one of the first assessing the possible relation of trait mindfulness during pregnancy and breastfeeding intention.

IMPLICATIONS FOR PRACTICE

Mindfulness-based programs during pregnancy could be helpful in improving non-reacting in pregnant women, which may enhance breastfeeding intention and ultimately the initiation of breastfeeding.

Evaluation of a Mobile-based Maternal Feeding Education Program for Overweight Prevention in Infants

PURPOSE

The purpose of this study was to evaluate a mobile-based maternal feeding education program for overweight prevention in infants based on breastfeeding attitude, breastfeeding self-efficacy, breastfeeding duration, recognition of hunger and satiety cues of infants, and knowledge regarding providing solids foods.

METHODS

A nonequivalent control group pretest-posttest design was used for the study. Participants included 15 primiparas in the experimental group and 14 primiparas in the control group in all the follow-up tests. Using self-reported questionnaires in electronic format, data were collected four times (before the intervention, 1 month after childbirth, 3 months after childbirth, and 6 months after childbirth). Using SPSS 24 version, independent t-test and repeated-measures analysis of variance were used to test the effects of the mobile-based maternal feeding education program.

RESULTS

The experimental group showed significantly more positive breastfeeding attitude (F = 5.28, p = .008), higher breastfeeding self-efficacy (F = 3.50, p = .041), and increased breastfeeding duration (t = -2.09, p = .046) than the control group. In addition, the experimental group showed significantly improved knowledge regarding providing solid foods to the infants (F = 4.86, p = .009) in comparison with the control group. However, for education on recognizing hunger and satiety cues of infants, the mobile-based maternal feeding education program was not effective (F = 0.23, p = .878).

CONCLUSION

According to the results of this study, the mobile-based maternal feeding education program has the potential to contribute to overweight prevention in infants.

Differences in maternal characteristics and their associations with breastfeeding attitudes among primiparous mothers

BACKGROUND

The benefits of breastfeeding are well documented, yet substantially below half of all mothers globally meet the recommendation to exclusively breast-feed for 6 months.

OBJECTIVE

This study aimed to examine whether there were differences in maternal factors, including maternal characteristics and breastfeeding attitudes, between those who were eligible versus non-eligible to be included in a randomised trial, as exclusive breastfeeding was the eligibility criteria for the trial. It also aimed to investigate associations between maternal factors and breastfeeding attitudes.

METHOD

Primiparous pregnant mothers (n=88) completed questionnaires on demographic factors including maternity care and breastfeeding attitude using self-administered questionnaire and Iowa Infant Feeding Attitude Scale (IIFAS). Two weeks post-birth, mothers were screened for eligibility to be included in a randomised trial including assessing for exclusive breastfeeding (EBF). Findings were compared between inclusion (all EBF mothers) and exclusion groups (non-EBF).

RESULTS

Inclusion group mothers were significantly younger than those in the exclusion group (26.7±2.8 v 28.5±2.5, p=0.007) and the majority had their husband as the primary maternity care person after birth (X²=12.8, p=0.01). Inclusion group mothers had a more positive perception toward breastfeeding in public and at work on the IIFAS scale (p<0.05). The overall IIFAS score was positively associated with higher breastfeeding confidence (r=0.285, p=0.008), education levels (r=0.31, p=0.003), household income (r=0.32, p=0.003), and age (r=0.28, p=0.008).

CONCLUSION

EBF mothers (inclusion group) tend to be younger, had husband as primary care, and have more positive perception towards breastfeeding outside home. Overall, maternal characteristics and paternal support could influence breastfeeding practices and should be targeted for future intervention. Maternal attitude and perceptions about breastfeeding in public could be improved to encourage exclusive breastfeeding.

A cross-sectional comparison of breastfeeding knowledge, attitudes, and perceived partners' support among expectant couples in Mekelle, Ethiopia

Background

Breastfeeding is considered the biological norm and essential to reduce infant morbidity and mortality. Mothers are responsible for breastfeeding but the support of others, including their partners is an influential determinant. The aim of this study was to compare antenatal breastfeeding knowledge, attitudes, and perceived breastfeeding support of expectant couples in Mekelle, Ethiopia.

Methods

As part of a randomised controlled trial of an mHealth intervention, 128 couples in their third trimester from three selected health centres in Mekelle city were recruited to participate between September and October 2018. Couples who each had a personal mobile phone, read and spoke Tigrigna, and lived together were included. Baseline data on breastfeeding knowledge, attitudes, and perceived support (breastfeeding savvy, help, appreciation, presence and responsiveness) were collected using previously validated tools through interview by health workers.

Results

Compared to mothers, male partners were more likely to indicate their intention to provide breastfeeding appreciation (p = 0.02), breastfeeding presence (p = 0.002), and breastfeeding responsiveness (p = 0.04). The mothers’ prenatal perception of their partners’ intended breastfeeding support was lower than fathers’ perceptions to support their partners. Multiparous mothers had more positive perceptions regarding their partners’ breastfeeding savvy (p = 0.03), and breastfeeding help (p = 0.02) compared to primiparous mothers.

Conclusions

Fathers in Ethiopia are potentially strong supporters of breastfeeding practice. Future breastfeeding interventions should promote the involvement of fathers in breastfeeding and encourage mothers to increase their partners’ involvement in breastfeeding.

Breastfeeding trends, influences, and perceptions among Italian women: a qualitative study

Purpose: Breastfeeding behaviours are routinely assessed in worldwide capacities, and the World Health Organization (WHO) European Region has the lowest rates of exclusive breastfeeding. Rates in Italy are not well documented but suggest breastfeeding rates are rising since the early 2000s. Professional recommendations suggest exclusive breastfeeding should persist until the infant is at least six to twelve months of age. However, barriers to adhering to this recommendation exist, often resulting in a lack of initiation or premature cessation of breastfeeding behaviours. This study explored women's perceptions, attitudes, and experiences with breastfeeding living in Florence, Italy. Methods: Participants were 44 reproductive-aged (M = 31.7 ± 6.14; Range = 19 to 45 years) women currently utilizing the Italian healthcare system. All participants completed an in-depth, individual interview between June and August 2017 on topics related to reproductive health, including breastfeeding. Results: Resulting themes relate to breastfeeding trends and influences, the role of identity and empowered choice, as well as perspectives on public breastfeeding. Conclusions: Findings provide practical recommendations for future exploration and social marketing campaign application related to breastfeeding decision-making empowerment. Results can also be used for between-country comparison of breastfeeding behaviours and attitudes.

Maternal Infant-Feeding Attitudes, Infant Eating Behaviors, and Maternal Feeding Choice at 3 and 6 Months Postpartum: A Comparative Multicenter International Study

Objective: The aim of this study was to compare mothers' attitudes toward infant feeding and infant eating behavior in different countries, and their associations with infant feeding at 3 and 6 months. Methods: Data from 164 mothers with healthy term infants recruited for a randomized trial comparing breast pumps from the UK (n = 68), Russia (n = 51), and China (n = 45) were included in this analysis. Feeding practices were assessed using questionnaires at 3 and 6 months. Maternal attitudes toward infant feeding and infant eating behaviors were measured by Iowa Infant Feeding Attitudes Scale (IIFAS) and Baby Eating Behavior Questionnaire (BEBQ) at 5-6 weeks postpartum; scores were compared between countries and associations with infant feeding at 3 and 6 months were examined. Results: IIFAS score was significantly different between countries; mean scores in Chinese and Russian mothers (China 64.6 ± 4.88 and Russia 61.5 ± 6.15) lay in the range of "neutral breastfeeding attitudes," while British mothers had more positive attitudes (70.6 ± 6.47, post hoc p < 0.001). Russian infants had higher scores for "general appetite" (mean = 4.8 ± 0.41, p < 0.05) and "satiety responsiveness" (mean = 8.7 ± 1.08, p < 0.01) than Chinese or British infants. Longer duration of full-time education was associated with more positive attitudes toward breastfeeding in the whole sample (p < 0.001) and in the United Kingdom (p < 0.05). The majority of mothers were exclusively breastfeeding (EBF) at 3 months. Total IIFAS and BEBQ scores were not significant predictors of EBF at 3 and 6 months (p > 0.05), although greater agreement with the IIFAS statement "Formula feeding is more convenient than breastfeeding" was associated with lower EBF at 3 months (OR = 0.47, 95% CI: 0.29-0.78, p < 0.01). Conclusions: Maternal attitudes toward infant feeding and perceptions of infant eating behavior differed between countries, but were not associated with EBF at 6 months. Mothers with a greater baseline perception that formula feeding is more convenient than breastfeeding were less likely to EBF at 3 months; this could be a potential target for education.

Knowledge, attitude, motivation and planning of breastfeeding: a cross-sectional study among Jordanian women

BACKGROUND

In Jordan, the rate of exclusive breastfeeding is declining. The trend variation in breastfeeding practice is determined by different factors including antenatal women's attitude and planning which are affected by their awareness and the support they receive. This study aims to assess knowledge, attitude, support, and planning of breastfeeding among Jordanian women.

METHODS

A face-to-face cross-sectional semi-structured questionnaire survey was conducted among healthy women in the antenatal clinic and postpartum ward at three hospitals in Northern Jordan during the period August 2019 to December 2019. Data were collected about demographic characteristics, women's knowledge and attitude towards breastfeeding, antenatal and postnatal support and counseling, and feeding planning. Customized scales were utilized to assess knowledge and attitude. Factors associated with planning to breastfeed were reported.

RESULTS

660 women completed the survey questionnaire. The majority were 20 to 35 years of age, 10% were primiparous, and 30% were employed. 78% were knowledgeable about breastfeeding benefits and aware of WHO recommendations. 72% had a positive attitude towards breastfeeding. More than half received support from their husbands to breastfeed their infants, while less than 20% received any counseling from their obstetric providers. 97% reported their intention to breastfeed, and more than half indicated their willingness to breastfeed exclusively. With multivariable logistic regression modelling, predictors of EBF planning include: primiparity (AOR 1.79; 95% CI 1.1, 3.25), positive attitude (AOR 1.80; 95% CI 1.05, 3.1) and positive husband's support (AOR 1.92; 95% CI 1.18, 3.15). Barriers include women's employment (AOR 0.43; 95% CI 0.26, 0.70) and low birthweight (AOR 0.46; 95% CI 0.25, 0.84).

CONCLUSION

Jordanian women are highly knowledgeable about breastfeeding benefits, and they exhibit a positive attitude towards breastfeeding resulting in a very high percentage intending to breastfeed their infants. Limited counseling about breastfeeding is a major gap in antenatal care. As intentions might not reflect the actual practice after delivery, gaps and barriers affecting the determinants of successful breastfeeding should be identified, and corrective tools should be implemented accordingly. Allocating a specific time for antenatal or postnatal counseling and support is expected to promote breastfeeding practice in our population.

First-Time Mothers' Enjoyment of Breastfeeding Correlates with Duration of Breastfeeding, Sense of Coherence, and Parental Couple and Child Relation: A Longitudinal Swedish Cohort Study

Objectives

Many women do not reach their own breastfeeding goals regarding duration of breastfeeding. Different factors influence breastfeeding, and to learn more about breastfeeding within a multidimensional and longitudinal perspective, further research is needed. Therefore, the aim of the present study was to investigate diverse factors correlated with first-time mothers' enjoyment of breastfeeding and breastfeeding duration, between childbirth and two years after birth.

Methods

In a prospective longitudinal cohort study, 324 newly become mothers were followed. The Spearman correlation test was used to investigate factors correlated with the degree to which mothers enjoy breastfeeding and the duration of breastfeeding. The Mann–Whitney test was conducted for comparisons of demographic characteristics between mothers who did or did not breastfeed.

Results

Among the mothers, 99.2% initiated breastfeeding after birth. Frequencies of breastfeeding were 54.8% at six months, 9.1% at one year, and 1.0% at two years. The degree to which the mother enjoyed breastfeeding was correlated positively with (1) the duration of breastfeeding, (2) more positive feelings for and relation to the child, (3) the partner's perceived relation to the child, (4) a higher sense of coherence, and (5) stronger perceived parental couple's relationship. Longer breastfeeding duration was correlated positively with (1) a higher degree of enjoyment of breastfeeding, (2) more positive relation to the child, and (3) stronger perceived parental couple's relationship. Additionally, breastfeeding during the first two hours after birth, more positive feelings for and relation to the child, and a higher degree of enjoyment of breastfeeding were more frequently reported among breastfeeding mothers, in comparison with not breastfeeding mothers.

Conclusion

Mothers' subjective experience from breastfeeding, sense of coherence, and couple relationship with partner and relationship with the child are valuable factors in regard to breastfeeding.

Breastfeeding practices 2008-2009 among Chinese mothers living in Ireland: a mixed methods study

Background

Migration to another country has a potential influence on breastfeeding practices. A significant difference in breastfeeding rates between Irish nationals and non-nationals has been reported. This study was conducted to explore breastfeeding practices of the Chinese in Ireland, one of the largest Irish ethnic groups, and to explore the influence of living in Ireland on breastfeeding practices. This is the first and the only migration study so far on breastfeeding practices among the Chinese in Ireland.

Methods

A sequential explanatory mixed methods approach was adopted. The first phase was a cross-sectional self-administered retrospective mailed survey, to explore breastfeeding practices and determinants of breastfeeding among a convenience sample of Chinese mothers living in Ireland (n = 322). Recruitment was conducted in the Dublin metropolitan area, with the application of the snowball technique to increase sample size. The second phase consisted of seven semi-structured focus groups (n = 33) conducted in Dublin, to explore the influence of living in Ireland on breastfeeding among Chinese mothers who had given birth in Ireland. Quantitative data were analyzed by univariate and multivariate logistic regression analyses, and informed the qualitative data collection. Qualitative data were analyzed by thematic content analyses, to explain and enrich the qualitative results.

Results

The breastfeeding initiation rate among Chinese immigrants to Ireland who gave birth in Ireland (CMI) (75.6%) was high and close to that of Chinese immigrant mothers who gave birth in China (CMC) (87.2%). However, giving birth in Ireland was independently associated with a shorter duration of breastfeeding (< 4 months) among Chinese immigrants. Qualitative results explained that a shorter breastfeeding duration among CMI than that of CMC was mainly due to cultural conflicts, a lack of family support, language barriers, immigrants’ low socioeconomic status, and mothers’ preference for infant formula on the Irish market. Both quantitative and qualitative data revealed a strong cultural belief in the efficacy of the traditional Chinese postpartum diet for breast milk production for both CMC and CMI. Antenatal feeding intention was a strong determinant for breastfeeding initiation and duration among CMI.

Conclusion

Migration to Ireland was found to be associated with a shorter duration of breastfeeding of the Chinese. Culturally sensitive and language-specific education and support of breastfeeding is needed for the Chinese mothers living in Ireland. The mixed methods design presented here might serve as a template for future migration research on breastfeeding.

Infant feeding beliefs and practices of Arabic mothers in Australia

BACKGROUND

Culturally sensitive care in the health care system is imperative for optimal outcomes of all patients, especially women and their infants. For Arabic mothers in Australia, there is minimal research exploring their beliefs that could impact on their infant feeding decisions and practices.

AIM

The aim of this study was to explore the experiences, knowledge and influences around infant feeding in Arabic women in Australia.

METHOD

A qualitative descriptive approach was used. Focus groups were conducted with Arabic women in community organisations (Catholic & Islamic) in Sydney. A thematic analysis was undertaken. The Iowa Infant Feeding Attitude Scale (IIFAS) was also used to measure maternal attitudes towards infant feeding.

FINDINGS

A total of 17 women participated in three focus groups. Themes relating to infant feeding were identified, including (1) sources of knowledge and education, particularly, where mothers obtained their infant feeding knowledge, and how this was influenced; (2) cultural beliefs related to the support and direction of family members.; (3) religious beliefs surrounding the continuation of infant feeding practices; (4) social and personal themes as an influence on infant feeding decisions and practices, and (5) factors associated with cessation of exclusive breastfeeding, including the lack of support from health care professionals.

CONCLUSION

The Arabic women in this study have expressed their need for further culturally sensitive care surrounding infant feeding knowledge and practices, and for that care to be situated in their community. Further intervention-based studies in the community focusing on culturally competent and sensitive care are recommended.

Mother-infant bonding is not associated with feeding type: a community study sample

Background

Bonding refers to emotions and cognitions towards one’s infant. Breastfeeding is believed to facilitate bonding, yet only a handful of studies have empirically tested this assertion. This study aimed to confirm whether a positive association between breastfeeding and bonding exists and whether breastfeeding may be protective against the negative consequences of mood and sleep disturbances on bonding.

Method

A cross-sectional survey was administered to a convenience sample of Israeli mothers of infants ages 1–9 months. The main outcome measures were breastfeeding history, bonding (Postpartum Bonding Questionnaire, PBQ), mood (Edinburgh Postnatal Depression Scale, EPDS) and sleep (Pittsburgh Sleep Quality Index, PSQI).

Results

Two hundred seventy-one mothers (21–46 years) completed the survey. 65.7% reported current breastfeeding, 22.1% past breastfeeding, 12.2% never nursed. The PBQ correlated with both the EPDS and PSQI. Breastfeeding was associated with greater daytime fatigue, but not with any other sleep problem, and was not associated with bonding. This negative result was confirmed with Bayesian analysis demonstrating that the probability for the null hypothesis was 4.5 times greater than the hypothesized effect. Further, hierarchical regression revealed a positive relationship between bonding, daytime fatigue and depression symptoms only among women who were currently breastfeeding.

Conclusions

These findings suggest that among healthy mothers, breastfeeding may not be a central factor in mother-infant bonding, nor is it protective against the negative impact of mood symptoms and bonding difficulties. Theoretical and methodological bases of these findings are discussed.

Electronic supplementary material

The online version of this article (10.1186/s12884-019-2264-0) contains supplementary material, which is available to authorized users.

Knowledge and attitudes towards breastfeeding practices: A cross-sectional survey of postnatal mothers in China

OBJECTIVE

To examine the mothers' knowledge and attitudes toward breastfeeding and highlight barriers to exclusive breastfeeding in Chinese postpartum mothers.

DESIGN

Cross sectional survey SETTING: Maternity wards of two large, multi-service teaching hospitals, Wuhan, China.

PARTICIPANTS

324 postnatal mothers completed a structured questionnaire during their stay at hospital from October 2016 to January 2017.

MEASUREMENTS AND FINDINGS

Descriptive and inferential statistics revealed that most mothers showed neutral attitude on breastfeeding and neutral knowledge level as well. The average score for the total Iowa Infant Feeding Attitude Scale (IIFAS) was 56.55±4.77 M±SD, and 10.83±2.77, M±SD for the knowledge section. The mothers who had poor knowledge were less likely to initiate breastfeeding within an hour after birth.

CONCLUSIONS

The results of this study are applicable to nurses and nurse midwives to assist in identification of women who may be at-risk to not initiate breastfeeding. Maternal positive attitude and good knowledge play key roles in the process of breastfeeding. Thus, it is important to provide antenatal and early postpartum education and periodical breastfeeding counselling, especially for new mothers, to improve maternal attitudes and knowledge toward breastfeeding practices.

Comparison of attitudes to breastfeeding among Spanish-born and Chinese-born postpartum women in Madrid

Background

Maternal breastfeeding is a practice that is associated with multiple health benefits for mothers and children. One of the lowest rates of breastfeeding has been observed among Chinese women who immigrate to high income countries. At present, there is a lack of comparative information between this group and that of Spanish-born women. Considering the relationship between the attitude of women towards breastfeeding and the initiation of breastfeeding, the aim of the study was to determine whether the attitude towards breastfeeding among Chinese postpartum women who have immigrated to Spain differs from that of Spanish-born postpartum women.

Methods

Cross-sectional study, with between-group comparison, of 73 postpartum Spanish-born and Chinese immigrant women admitted to the maternity units of “12 de Octubre” Hospital (Spain) between April and November 2016. Attitudes toward breastfeeding were analyzed using the Spanish or Chinese version of the Iowa Infant Feeding Attitude Scale (IIFAS). A wide set of socioeconomic, biological, working and attitudinal conditions were considered as covariates. The association between IIFAS and country of origin was assessed by three multiple linear regression models (B, SE, and 95% confidence interval were calculated).

Results

All Chinese women were first generation immigrants. Chinese-born women were four years younger than Spanish-born mothers, had a lower educational level, more frequently had a paid job (mainly self-employed), and planned to return to work almost two months earlier than Spanish-born mothers did. Most Chinese women did not breastfeed exclusively.

Chinese immigrant women obtained scores of approximately 9 points less in the Iowa Infant Feeding Attitude Scale (IIFAS) when compared to Spanish-born women [95% CI -15.59, -2.48], after adjusting for the different socioeconomic, educational and work-related factors.

Conclusions

Chinese-born women resident in Spain present a lower score on the IIFAS, when compared to Spanish-born women, which implies a more negative attitude towards breastfeeding. The between-groups difference is consistent, even when adjusting for known confounders and other factors which could affect the attitude of the mothers. It is therefore striking that, despite being in Spain, Chinese-born women maintain these preferences/attitudes regarding breastfeeding, compared with Spanish-born women, who obtain overall high scores.

Is being resolute better than being pragmatic when it comes to breastfeeding? Longitudinal qualitative study investigating experiences of women intending to breastfeed using the Theoretical Domains Framework

Background

In the UK, initiating then discontinuing breastfeeding before two weeks post-partum is common. The aim of this longitudinal qualitative study was to explore which psychosocial factors may influence discontinuation.

Methods

A sample of 10 pregnant women intending to breastfeed were recruited. A longitudinal qualitative design was used to capture views prior to and two weeks following birth. Semi-structured interviews were conducted underpinned by the Theoretical Domains Framework to explore a comprehensive list of psychosocial factors.

Results

Four women discontinued breastfeeding at the time of the second interview. Pre-partum differences were identified between maintainers and discontinuers; discontinuers appeared to have stronger intentions to breastfeed based on their self-determination, self-confidence and perception of fewer barriers to breastfeeding. Post-partum, discontinuers highlighted how they felt physically unable to carry on; their feeding experiences elicited negative emotions and pain. Negative emotions appeared to be exacerbated by original breastfeeding beliefs and advice given by healthcare professionals.

Conclusions

The women in this study who discontinued breastfeeding showed less cognitive flexibility, which appeared to exacerbate post-partum emotional distress, when they encountered difficulties. Women with strong intentions and self-determination might benefit from support in anticipating potential barriers and identifying ways of overcoming them.

Infant Feeding Attitudes and Practices of Spanish Low-Risk Expectant Women Using the IIFAS (Iowa Infant Feeding Attitude Scale)

The Iowa Infant Feeding Attitude Scale (IIFAS) has been shown to have good psychometric properties for English-speaking populations, but it has not been validated among low-risk pregnant women in Spain. The aim of this study was to assess the reliability and validity of the translated version of the IIFAS in order to examine infant feeding attitudes in Spanish women with an uncomplicated pregnancy. Low-risk expectant women (n = 297) were recruited from eight primary public health care centres in Galicia (Spain). Questionnaires including both socio-demographic and breastfeeding characteristics and items about infant feeding were administered during the third trimester. Participants were contacted by telephone during the postpartum period to obtain information regarding their infant feeding status. Prediction validity and internal consistency were assessed. The translated IIFAS (69.76 ± 7.75), which had good psychometric properties (Cronbach's alpha = 0.785; area under the curve (AUC) of the receiver operating characteristic (ROC) curve = 0.841, CI95% = 0.735⁻0.948), showed more positive attitudes towards breastfeeding than towards formula feeding, especially among mothers who intended to exclusively breastfeed. This scale was also useful for inferring the intent to breastfeed and duration of breastfeeding. This study provides evidence that the IIFAS is a reliable and valid tool for assessing infant feeding attitudes in Spanish women with an uncomplicated pregnancy.

Trends and disparities in receipt of pharmacotherapy among pregnant women in publically funded treatment programs for opioid use disorder in the United States

OBJECTIVE

To describe differences in geographic, demographic, treatment, and substance use characteristics by pharmacotherapy receipt among pregnant women entering publically funded treatment for opioid use disorder (OUD) in the United States.

METHODS

1996 to 2014 Treatment Episode Data Set-Admissions data from pregnant admissions with OUD, defined as reporting opioids as the primary substance of use leading to the treatment episode, were analyzed for this cross-sectional study. The proportion of all pregnant admissions with OUD who received pharmacotherapy was calculated by year and U.S. census region. Trends across time were assessed using the Cochrane-Armitage Trend test. Associations between demographic, substance use, and treatment characteristics and pharmacotherapy receipt were assessed using Chi-square tests and multivariable logistic regression.

RESULTS

The proportion of pregnant admissions where opioids were the primary substance of use increased from 16.9% to 41.6% during the study period, while the proportion of pregnant admissions with OUD who received pharmacotherapy remained relatively unchanged at around 50%. Overall, pharmacotherapy recipients were generally older and white, more likely to receive treatment in an outpatient setting, be self-referred, and report heroin as the primary substance, daily substance use, and intravenous drug use, and less likely to have a co-occurring psychiatric problem compared to those who did not receive pharmacotherapy. Regional differences in pharmacotherapy utilization exist; the South consistently had the fewest pregnant admissions with OUD receiving pharmacotherapy.

CONCLUSION

Although the proportion of pregnant admissions to substance use treatment centers with OUD has increased since the mid-1990s, the proportion receiving pharmacotherapy has not changed. Significant variations in pharmacotherapy utilization exist by geography and demographic, substance use and treatment characteristics. Utilization of pharmacotherapy at publically funded treatment centers providing care for pregnant women with OUD should be expanded.

Psychometric Assessment and Precision Remodeling of the Iowa Infant Feeding Attitude Scale to Improve Clinical Use and Efficacy Among Prenatal Women in Canada

BACKGROUND

The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been widely used to assess maternal attitudes toward infant feeding and to predict breastfeeding intention. The IIFAS has been validated among prenatal women located in Newfoundland and Labrador in Canada, although its length may prove challenging to complete in a clinical setting. Research aim: The authors aimed to reduce the number of items from the original 17-item IIFAS scale while maintaining reliability and validity.

METHODS

A nonexperimental cross-sectional design was used among 1,283 women in their third trimester residing in Newfoundland and Labrador. Data were collected from August 2011 to June 2016. An exploratory factor analysis using principal component analysis was performed to explore the underlying structure of the IIFAS. The internal consistency of both the 17-item and reduced version was assessed using Cronbach's alpha and item-total correlation. The area under the curve and linear regression model were used to assess predictive validity of intention to breastfeed.

RESULTS

Our findings revealed that a 13-item IIFAS (Cronbach's α = .870) had relatively similar internal consistency to the original IIFAS (Cronbach's α = .868). Three themes were extracted from the factor analysis, resulting in the removal of four items. The reduced scale demonstrated an excellent ability to predict breastfeeding intention (area under the curve = 0.914).

CONCLUSION

The reduced 13-item version of the IIFAS is a psychometrically sound instrument that maintains its accuracy and validity when measuring maternal feeding attitudes during pregnancy and can be more time efficient in clinical settings compared with the 17-item IIFAS.

Baby-Friendly Hospital designation has a sustained impact on continued breastfeeding

The Baby‐Friendly Hospital (BFH) Initiative has led to an increase in breastfeeding rates and duration worldwide. But little is known about whether the beneficial effects persist beyond a facility's designation as a BFH. To investigate the association of BFH designation (current, former, and never) and compliance with Baby‐Friendly (BF) practices on breastfeeding in Switzerland, this study combined nationwide survey data on breastfeeding with BFH monitoring data. In this cross‐sectional study, 1,326 children were born in 34 current (N = 508), 28 former (N = 425), and 34 never designated BFHs (N = 393). We compared exclusive and any breastfeeding according to BFH designation over the first year of life, using Kaplan‐Meyer Survival curves. Logistic regression models were applied to analyse breastfeeding prevalence, and Cox‐regression models were used for exclusive (0–6 months) and continued (6–12 months) breastfeeding duration. Average duration of exclusive breastfeeding (13.1 weeks, 95% confidence interval [12.0, 17.4]) and any breastfeeding (32.7 weeks, 95% confidence interval [30.5, 39.2]) were the longest for babies born in currently accredited BFHs. Exclusive breastfeeding was associated with high compliance with monitored BF practices in current BFHs and with the number of BF practices experienced in all hospitals. Continued breastfeeding was significantly longer when babies were born in current BFHs (cessation hazard ratio 0.60, 95% confidence interval [0.42, 0.84]) or in former BFHs (cessation hazard ratio 0.68, 95% confidence interval [0.48, 0.97]). Overall, the results support continued investment into BFHs, because babies born in current BFHs are breastfed the most and the longest, whereas a former BFH designation shows a sustained effect on continued breastfeeding.

Antenatal psychological and socioeconomic predictors of breastfeeding in a large community sample

BACKGROUND

Despite much work to publicise the benefits of breastfeeding most women do not persist for the first 6months, as recommended by the WHO. Successful breastfeeding for 6months may depend on several factors, including perinatal mental health. We aimed to investigate the impact of antenatal depressive symptoms, attitudes towards breastfeeding and socio-demographic factors in predicting breastfeeding for 6months in a large community sample.

METHODS

The sample was based on the Avon Longitudinal Study of Parents and Children (n=9479), a large-scale birth cohort. Breastfeeding was assessed at multiple time-points, from postnatal day 1 until 6months postnatal. Self-reported symptoms of maternal depression were assessed at 18 and 32weeks gestation and at 8weeks postnatal. Antenatal attitudes towards breastfeeding were assessed at 32weeks gestation. Antenatal, obstetric, psychosocial and socio-demographic variables were also assessed.

RESULTS

Antenatal depressive symptoms at both 18 and 32weeks gestation were associated with decreased breastfeeding initiation and duration. However, the prediction of breastfeeding by these symptoms was confounded by socio-demographic and psychosocial covariates. A positive antenatal attitude towards breastfeeding was the strongest predictor and was associated with a 20-30% increase in breastfeeding initiation and maintenance at all time points.

CONCLUSION

This study highlights the wide range of factors that independently predict breastfeeding, and suggests that an intervention program to improve antenatal attitudes especially warrants investigation.

Family-based obesity prevention for infants: Design of the "Mothers & Others" randomized trial

OBJECTIVE

Our goal is to test the efficacy of a family-based, multi-component intervention focused on infants of African-American (AA) mothers and families, a minority population at elevated risk for pediatric obesity, versus a child safety attention-control group to promote healthy weight gain patterns during the first two years of life.

DESIGN, PARTICIPANTS, AND METHODS

The design is a two-group randomized controlled trial among 468 AA pregnant women in central North Carolina. Mothers and study partners in the intervention group receive anticipatory guidance on breastfeeding, responsive feeding, use of non-food soothing techniques for infant crying, appropriate timing and quality of complementary feeding, age-appropriate infant sleep, and minimization of TV/media. The primary delivery channel is 6 home visits by a peer educator, 4 interim newsletters and twice-weekly text messaging. Intervention families also receive 2 home visits from an International Board Certified Lactation Consultant. Assessments occur at 28 and 37weeks gestation and when infants are 1, 3, 6, 9, 12, and 15months of age.

RESULTS

The primary outcome is infant/toddler growth and likelihood of overweight at 15months. Differences between groups are expected to be achieved through uptake of the targeted infant feeding and care behaviors (secondary outcomes) and change in caregivers' modifiable risk factors (mediators) underpinning the intervention.

CONCLUSIONS

If successful in promoting healthy infant growth and enhancing caregiver behaviors, "Mothers and Others" will have high public health relevance for future obesity-prevention efforts aimed at children younger than 2years, including interventional research and federal, state, and community health programs.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT01938118, August 9, 2013.

Reliability and Validity of the Reduced Spanish Version of the Iowa Infant Feeding Attitude Scale

OBJECTIVE

To translate the Iowa Infant Feeding Scale (IIFAS) into Spanish, to test its psychometric properties, and to explore item reduction for the Spanish version.

DESIGN

Instrumental study.

SETTING

Six hospitals in eastern Spain.

PARTICIPANTS

A convenience sample of 1,354 pregnant women was recruited.

METHODS

The IIFAS was translated using forward and back translation. Dimensional structure, internal consistency, and construct validity of the Spanish IIFAS version were assessed. Criteria to improve the reliability of the scale and the predictive power of the items were used to reduce the scale.

RESULTS

Statistics on the psychometric properties suggested the need for item reduction. Cronbach's alpha coefficient of the nine-item final version of the Spanish IIFAS (IIFAS-S) was 0.792. The confirmatory factor analysis showed a unidimensional structure. Demographic response patterns and correlations with the IIFAS-S scale provided further evidence of construct validity. Pregnancy IIFAS-S scores significantly predicted breastfeeding rates and exclusivity.

CONCLUSION

The results of this study indicated that the Spanish translation of the IIFAS is a valid and reliable measure of women's attitudes toward breastfeeding.

Assessing Infant Feeding Attitudes of Expectant Women in a Provincial Population in Canada: Validation of the Iowa Infant Feeding Attitude Scale

BACKGROUND

Maternal attitudes to infant feeding are predictive of intent and initiation of breastfeeding.

OBJECTIVES

The Iowa Infant Feeding Attitude Scale (IIFAS) has not been validated in the Canadian population. This study was conducted in Newfoundland and Labrador, a Canadian province with low breastfeeding rates. Objectives were to assess the reliability and validity of the IIFAS in expectant mothers; to compare attitudes to infant feeding in urban and rural areas; and to examine whether attitudes are associated with intent to breastfeed.

METHODS

The IIFAS assessment tool was administered to 793 pregnant women. Differences in the total IIFAS scores were compared between urban and rural areas. Reliability and validity analysis was conducted on the IIFAS. The receiver operating characteristic (ROC) of the IIFAS was assessed against mother's intent to breastfeed.

RESULTS

The mean ± SD of the total IIFAS score of the overall sample was 64.0 ± 10.4. There were no significant differences in attitudes between urban (63.9 ± 10.5) and rural (64.4 ± 9.9) populations. There were significant differences in total IIFAS scores between women who intend to breastfeed (67.3 ± 8.3) and those who do not (51.6 ± 7.7), regardless of population region. The high value of the area under the curve (AUC) of the ROC (AUC = 0.92) demonstrates excellent ability of the IIFAS to predict intent to breastfeed. The internal consistency of the IIFAS was strong, with a Cronbach's alpha greater than .80 in the overall sample.

CONCLUSION

The IIFAS examined in this provincial population provides a valid and reliable assessment of maternal attitudes toward infant feeding. This tool could be used to identify mothers less likely to breastfeed and to inform health promotion programs.

Predicting Behaviors to Reduce Toxic Chemical Exposures Among New and Expectant Mothers: The Role of Distal Variables Within the Integrative Model of Behavioral Prediction

There is a growing body of evidence linking childhood exposure to environmental toxins and a range of adverse health outcomes, including preterm birth, cognitive deficits, and cancer. Little is known, however, about what drives mothers to engage in health behaviors to reduce such risks. Guided by the integrative model of behavioral prediction, this study surveyed women who were pregnant and/or had children younger than 7 years (N = 819) to identify the factors that determine engagement in behaviors to reduce childhood exposure to toxic chemicals in the environment. Structural equation modeling pertaining to three different environmental toxins-bisphenol A, arsenic, and pesticides-demonstrated that perceived normative pressure was the primary determinant of behavior across all three models. Additionally, we identified two key distal variables-perceived risk and information seeking-that not only increased the model's predictive power but also consistently and positively predicted perceived social norms regarding exposure reduction behaviors. Findings also suggest important differences across these behaviors. Implications for health communication researchers and practitioners developing interventions, communication campaigns, and persuasive messages to promote prenatal and pediatric environmental health are discussed.

Expectant parents' views of factors influencing infant feeding decisions in the antenatal period: A systematic review

OBJECTIVE

To explore the factors that influence expectant parents' infant feeding decisions in the antenatal period.

DESIGN

Mixed method systematic review focussing on participant views data.

DATA SOURCES

CINAHL, Medline, Embase and PsychInfo databases were interrogated using initial keywords and then refined terms to elicit relevant studies. Reference lists were checked and hand-searching was undertaken for 2 journals ('Midwifery' and 'Social Science and Medicine') covering a 3 year time period (January 2011-March 2014). Key inclusion criteria: studies reflecting expectant parents' views of the factors influencing their infant feeding decisions in the antenatal period; Studies in the English language published after 1990, from developed countries and of qualitative, quantitative or mixed method design.

REVIEW METHODS

A narrative interpretive synthesis of the views data from studies of qualitative, quantitative and mixed method design. Data were extracted on study characteristics and parents' views, using the Social Ecological Model to support data extraction and thematic synthesis. Synthesis was influenced by the Evidence for Policy and Practice Information and Co-Ordinating Centre approach to mixed method reviews.

RESULTS

Of the 409 studies identified through search methods, 17 studies met the inclusion criteria for the review. Thematic synthesis identified 9 themes: Bonding/Attachment; Body Image; Self Esteem/Confidence; Female Role Models; Family and Support Network; Lifestyle; Formal Information Sources; Knowledge; and Feeding in front of others/Public. The review identified a significant bias in the data towards negative factors relating to the breastfeeding decision, suggesting that infant feeding was not a choice between two feeding options, but rather a process of weighing reasons for and against breastfeeding. Findings reflected the perception of the maternal role as intrinsic to the expectant mothers' infant feeding decisions. Cultural perceptions permeated personal, familial and social influences on the decision-making process. Expectant mothers were sensitive to the way professionals attempted to support and inform them about infant feeding choices.

CONCLUSIONS

By taking a Social Ecological perspective, we were able to explore and demonstrate the multiple influences impacting on expectant parents in the decision-making process. A better understanding of expectant parents' views and experiences in making infant feeding decisions in the prenatal and antenatal periods will inform public health policy and the coordination of service provision to support infant feeding activities.

Exclusive breastfeeding practices in the Coast region, Tanzania

BACKGROUND

Although breastfeeding in general is common and culturally accepted in many sub-Saharan countries, recommended exclusive breastfeeding infants to 6 months is rare. In rural Tanzania, data on infant feeding practices is rare.

OBJECTIVE

To examine and describe exclusive breastfeeding practices in rural settings (Coast Region) of Tanzania.

METHODS

A cross-sectional study was conducted in Coast Region of Tanzania involving 342 mothers. Only mothers with children aged between 6 and 23 months were interviewed in their residences. Data analyses included descriptive and logistic regression analyses.

RESULTS

The majority, 66%, of mothers reported to have breastfed their new born within the first hour of life. About 30% reported to have breastfed exclusively for up to at least six months. Those who did not practice complete exclusive breastfeeding mentioned insufficient milk as the main reason. Correlates of exclusive breastfeeding included maternal education and attitudes towards exclusive breastfeeding.

CONCLUSION

The rate of exclusive breastfeeding in rural areas like the Coast Region of Tanzania is still very low. Programs aimed to promote exclusive breastfeeding must take multi-factorial considerations.

Genealogy of breastfeeding

Decline and resurgence of breastfeeding (BF) characterized last century. Several factors influencing BF outcome were identified. Despite the huge literature on BF, no data on its matrilineal transmission are available. BF practice was prospectively followed in 2546 Italian mothers. Lactation and BF outcome were related, besides to known factors interfering with BF, to the occurrence of previous maternal and paternal BF. Recalls of grandmaternal and grand-grandmaternal BF behaviours allowed the construction of familiar pedigrees of BF across three generations. Having been breastfed was the strongest factor addressing successful BF establishment (odds ratio (OR) 9.33; 95% confidence interval (CI) 7.40-11.84; p < 0.0001) and BF duration (at 6 months: OR 3.79; 95% CI 3.11-4.64; p < 0.0001). The hazard ratio for breastfed vs non-breastfed mothers was 0.46 (95% CI 0.41-0.50; log-rank p < 0.0001). The rate of BF failures was fivefold higher in non-breastfed mothers, mostly occurring during lactogenesis when the let-down reflex becomes essential.

CONCLUSION

At any generation, mothers are likely to have daughters repeating their BF experience. Differently from the intergenerational effects of environmental factors responsible for the BF secular trend, this trait is transgenerationally transmitted and reversible, with temporal and clinical features of lactation failure. Accordingly, we speculate that epigenetic mechanisms might alter offspring's oxytocinergic receptor signalling.

WHAT IS KNOWN

Several cultural and socio-demographic factors are known to influence breastfeeding outcome. The generational effects of breastfeeding itself have not been investigated so far.

WHAT IS NEW

Maternal breastfeeding is the most important factor addressing daughters' breastfeeding outcome. This behavior is transmitted transgenerationally, with features suggesting epigenetic mechanisms.

Is maternal anxiety a barrier to exclusive breastfeeding?

OBJECTIVE

To assess the association of maternal anxiety with nonadherence to exclusive breastfeeding.

METHODS

This questionnaire-based study was conducted at a tertiary care teaching hospital in South India mothers with infants less than 6 months of age and not exclusively breastfeeding were interviewed and their demographic and clinical details were noted. The Iowa Infant Feeding Attitude Scale (IIFAS) and Hospital Anxiety and Depression Scale (HADS) were administered to these mothers.

RESULTS

A total of 85 mother-infant dyads were included. The mean age of the mothers was 26 years and 57% were from urban areas. Among the additional feeds given, cow's milk was the commonest (57.6%), followed by gripe water (28.2%) and formula feeds (16.5%). The mean HADS anxiety subscale score was 12.2 (±5.3) and HADS depression subscale score was 9.5 (±3.8). The mean score on IIFAS was 58.4 (±3.6) suggesting a relatively favorable attitude toward breastfeeding. On linear regression analysis, higher HADS depression score, lower birth weight and lower per capita income were independent predictors of poorer attitudes toward breastfeeding.

CONCLUSION

Maternal anxiety may be an independent risk factor for nonadherence to exclusive breastfeeding for the initial six months.

The influence of infant feeding attitudes on breastfeeding duration: evidence from a cohort study in rural Western Australia

Background

Breast milk is the optimal source of nutrition for infants in the first six months of life. Promoting and protecting breastfeeding is reflected in public health policy across the globe, but breastfeeding rates in both developing and industrialised countries continue to demonstrate that few mothers meet these recommendations. In addition to sociodemographic factors such as age, education and income, modifiable factors such as maternal infant feeding attitudes have been shown to influence breastfeeding duration. The objective of this paper was to describe the influence of infant feeding attitudes on breastfeeding duration in rural Western Australia.

Methods

A cohort of 427 women and their infants were recruited from hospitals in rural Western Australia and followed for a period of 12 months. Information about feeding methods was gathered in hospital and at a further seven follow-up contacts. Infant feeding attitude was measured using the Iowa Infant Feeding Attitude Scale (IIFAS), and a score of > 65 was considered positive towards breastfeeding.

Results

Mothers with an IIFAS score of > 65 were approximately twice as likely to be exclusively breastfeeding at six months, and breastfeeding at any intensity to 12 months. The median duration of exclusive breastfeeding for mothers with an IIFAS score of > 65 was 16 weeks (95 % CI 13.5, 18.5) compared with 5 weeks for those with a score < 65 (95 % CI 3.2, 6.8) (p < 0.0001). The median duration of any breastfeeding to 12 months was more than twice as long for mothers with an IIFAS score > 65 (48 vs. 22 weeks, p < 0.001).

Conclusions

Women in this rural cohort who had a more positive attitude towards breastfeeding had a longer duration of both exclusive breastfeeding to six months and any breastfeeding to 12 months. Further research examining the breastfeeding attitudes of specific subgroups such as men, grandparents and adolescents in rural areas will contribute to the evidence base and help to ensure that breastfeeding is seen as the normal method of infant feeding.

Why do mothers of young infants choose to formula feed in China? Perceptions of mothers and hospital staff

In China the exclusive breastfeeding rate remains low and infant formula is widely used. This study aimed to elicit and compare mothers' and hospital staff perceptions of the reasons that shaped mothers' decision to formula feed. In-depth interviews with 50 mothers, and four focus group discussions with 33 hospital staff, were conducted in Hangzhou and Shenzhen in November 2014. Responses given by the mothers and hospital staff showed a number of commonalities. The perception of "insufficient breast milk" was cited by the majority of women (n = 37, 74%) as the reason for formula feeding. Mothers' confidence in breastfeeding appears to be further reduced by maternal mothers or mothers-in-law's and "confinement ladies" misconceptions about infant feeding. Inadequate breastfeeding facilities and limited flexibility at their workplace was another common reason given for switching to formula feeding. A substantial proportion of mothers (n = 27, 54%) lacked an understanding of the health benefits of breastfeeding. Antenatal education on breastfeeding benefits for expectant mothers and their families is recommended. Moreover, mothers should be provided with breastfeeding support while in hospital and be encouraged to seek professional assistance to deal with breastfeeding problems after discharge. Employers should also make work environments more breastfeeding-friendly.

Improvement in long-term breastfeeding for very preterm infants

INTRODUCTION

The extensive health benefits of breastfeeding preterm infants for both mother and infant have been widely reported. However, establishing and maintaining breastfeeding for very preterm (VP) infants remain challenging. The aim of this study was to examine changes in breastfeeding of VP infants over time.

SUBJECTS AND METHODS

Breastfeeding questionnaires were administered to two cohorts of parents of VP infants (<32 weeks) cared for at the tertiary perinatal or surgical neonatal unit in Western Australia. Of these, 488 infants were included in cohort 1 (C1) (births from January 1, 1990 to June 30, 1992) and 253 in cohort 2 (C2) (from January 1, 2011 to September 14, 2012).

RESULTS

More mothers (96.8%) initiated breastfeeding in C2 compared with those in C1 (65.6%) (p<0.001). Additionally, 41.4% of mothers in C2 breastfed for more than 6 months, relative to 25.8% in C1 (p<0.001). The benefits of breastfeeding were endorsed by more women in C2 (45.8%) compared with C1 (11.4%) (p<0.01). Reasons for stopping feeding remained largely consistent.

CONCLUSIONS

Significant improvements were evident in the initiation and duration of breastfeeding of the VP infant over time. This improvement was associated with attitudinal shifts in mothers about the benefits of breastfeeding.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Reliability and Validity of the Japanese Version of the Iowa Infant Feeding Attitude Scale: A Longitudinal Study

BACKGROUND

The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has shown good reliability and validity to measure attitudes toward infant feeding in various countries. It is also known to be associated with breastfeeding intention and exclusivity. However, the IIFAS has not been psychometrically tested among Japanese women.

OBJECTIVE

This study aimed to develop the Japanese version of the IIFAS (IIFAS-J) and assess its reliability and validity.

METHODS

This longitudinal study was conducted with 781 women at 4 hospitals in Japan. The translated IIFAS was administered to participants during their third trimester. Infant feeding status was self-reported at 4 and 12 weeks postpartum using follow-up questionnaires. The predictive validity was determined by examining the association between the IIFAS-J score during pregnancy and infant feeding status at 4 and 12 weeks postpartum.

RESULTS

One item was removed after a principal components analysis. Therefore, the IIFAS-J consisted of 16 items. Cronbach's alpha of the IIFAS-J was 0.66. A higher IIFAS-J score during the third trimester was associated with a higher postdischarge exclusive breastfeeding rate at 4 weeks postpartum (B = 0.05; adjusted odds ratio = 1.05; 95% confidence interval, 1.01-1.10).

CONCLUSION

The 16-item Japanese version of the IIFAS is a reliable and valid scale for measuring maternal infant-feeding attitudes during pregnancy.

Knowledge and beliefs about breastfeeding are not determinants for successful breastfeeding

A cross-sectional prospective study was performed to assess knowledge and attitude toward breastfeeding among mothers in a tertiary hospital in Malaysia and its influence on their breastfeeding practices. Two hundred thirteen women who had delivered healthy babies at term were enrolled. A structured questionnaire containing demographic data and the Iowa Infant Feeding Attitude Score were used, followed by a telephone interview after 8 weeks to determine the feeding outcome. Women of Malay ethnicity with higher education level who had received breastfeeding counseling had a significantly more favorable attitude toward breastfeeding. Ethnicity was found to be a significant determinant in the success of breastfeeding, whereas returning to work was a major reason for discontinuing breastfeeding. In ensuring a successful breastfeeding practice, apart from knowledge and attitude, issues surrounding culture and traditions as well as improving deliverance of readily available support should be addressed.

Predictors of breastfeeding duration among women in Kuwait: results of a prospective cohort study

The purposes of this paper are to report the prevalence of breastfeeding to six months among women in Kuwait and to determine the factors that are associated with the duration of breastfeeding. A cohort of 373 women recruited from maternity wards in four hospitals in Kuwait city were followed from birth to 26 weeks postpartum. The association of any and full breastfeeding duration and predictor variables were explored using multivariate Cox's proportional hazards models. At six months, 39% of all infants were receiving some breast milk and only 2% of infants had been fully breastfed to 26 weeks. Women born in other Arab countries were less likely to discontinue breastfeeding than women born in Kuwait. Other factors positively associated with breastfeeding duration were level of maternal education, higher parity, infant being demand fed in hospital and a preference for breastfeeding on the part of the infant's father and maternal grandmother. The introduction of a pacifier before four weeks of age and the mother intending to return to work by six months were negatively associated with duration. These findings present a number of opportunities for prolonging breastfeeding duration in Kuwait.