Breastfeeding and weaning practices in Bahrain: the role of mothers' education

Women's Empowerment and Determinants of Early Initiation of Breastfeeding: A Scoping Review

INTRODUCTION

Early initiation of breastfeeding (EIBF), the immediate provision of mothers' breast milk to infants within the first hour of life, has been recommended by the WHO. However, EIBF is not widely practiced, thereby increasing infant mortality risk. This review explored the available and published studies that identified interventions that empower mothers to practice EIBF.

METHOD

We conducted a scoping review to answer the aforementioned aims. Empowerment, Women, Breastfeed, and Initiation were used as initial keywords, which were further developed using Medical Subject Headings by the National Center for Biotechnology Information. Five databases, namely: Web of Science, Scopus, Cumulative Index to Nursing and Allied Health Literature via EBSCO, ProQuest, and MedLine via PubMed, were searched for potential articles. We also searched the references in addition to the main search.

FINDINGS

We included 28 articles in this review. Education was mostly used as women's empowerment indicator in EIBF intervention. Additionally, we identified barriers (C-section and postoperative pain, lactation problems and pregnancy complications, mothers' social and demographic factors, mothers' lack of professional support, babies' condition preventing EIBF) and facilitators (mothers' positive behavior in relation to educational level, completion of antenatal care, poor economic situations of mothers, babies' size at birth) of EIBF.

DISCUSSION

Education is the widely used intervention to promote mothers' participation in improving EIBF rate. Furthermore, mothers' and babies' deferring conditions and traditional practices are barriers for EIBF. This review recommends future research and empowerment efforts that sensitively address the identified barriers.

Relationship between caesarean section and breastfeeding: evidence from the 2013 Turkey demographic and health survey

Background

The mode of delivery influences breastfeeding practices. High rates of caesarean section and low breastfeeding rates are important public health concerns for all developing countries. This study aimed to determine the relationship between caesarean section and early breastfeeding practices among primiparae.

Methods

Data for primiparae with a singleton birth (N = 777) obtained from the 2013 Turkey Demographic and Health Survey were used in this retrospective cohort study. Early initiation of breastfeeding within one hour of delivery and exclusive breastfeeding during the first three days following birth were evaluated. Standardised incidence rates and standardised rate ratios of non-early initiation of breastfeeding and non-exclusive breastfeeding were calculated according to the mode of delivery.

Results

The late initiation of breastfeeding and non-exclusive breastfeeding incidence rates were 42.7 and 41.0%, respectively. The standardised incidence rate of late initiation of breastfeeding among women with vaginal delivery was 35.34%, versus 50.49% among those with caesarean delivery. The standardised rate ratios for late initiation of breastfeeding and non-exclusive breastfeeding were 1.428 (95% confidence interval (CI): 1.212–1.683) and 1.468 (95% CI: 1.236–1.762), respectively. Women who underwent caesarean section had a higher risk of late initiation of breastfeeding and non-exclusive breastfeeding during the three days following delivery, after controlling for sociodemographic and delivery-related factors.

Conclusions

This study provides useful evidence for the implementation of strategies to prevent unnecessary caesarean sections, which negatively affect not only maternal health but also neonatal health. The promotion of mother-friendly policies by healthcare institutions, implemented in a baby-friendly manner, is essential.

Determinants of in-hospital feeding practices in Shiraz, Iran: Results of a prospective cohort study

BACKGROUND

In-hospital feeding practices have been shown negatively to affect breastfeeding exclusivity and duration. The purpose of this study was to report the prevalence and determinants of delayed breastfeeding, provision of traditional prelacteal foods, and use of infant formula in hospital.

METHODS

Between June 2014 and March 2015, 700 women were recruited from three public and two private maternity hospitals in Shiraz, Iran. Data were collected at recruitment via face-to-face interviews and extracted from medical records. Multivariable logistic regression was used to explore the association of feeding practices with a variety of maternal characteristics and hospital practices.

RESULTS

Only 32.2% of infants were breastfed within 1 hour of birth, with 40.8% receiving a traditional prelacteal food, and 34.9% given formula during their hospital stay. Compared with infants delivered vaginally, those delivered by cesarean were more likely to have experienced delayed breastfeeding and received formula, but less likely to have received traditional prelacteal foods. Infants who did not experience skin-to-skin contact were more likely to have experienced delayed breastfeeding and received traditional prelacteal foods and formula in hospital.

CONCLUSIONS

Although four out of the five hospitals were designated as Baby-Friendly, several of the 10 Steps to Successful Breastfeeding were not adhered to. The high rate of cesarean delivery was a barrier to the early initiation of breastfeeding and the majority of infants did not experience early skin-to-skin contact. Maternity care practices should be reviewed and include a clear breastfeeding care plan for women who undergo a cesarean delivery.

Baby-friendly hospital practices are associated with duration of full breastfeeding in primiparous but not multiparous Iranian women

There is evidence that the Baby-Friendly Hospital Initiative (BFHI) results in improved breastfeeding outcomes in Western countries, but little is known of its impact in Middle-Eastern countries. This study investigated the impact of BFHI practices on duration of full breastfeeding in a cohort of 700 Iranian mothers recruited between June 2014 and March 2015 from maternity hospitals in Shiraz and followed-up prospectively for 6 months. At baseline, mothers self-reported exposure to 7 of the BFHI Ten Steps to Successful Breastfeeding (Steps 3 to 9). Data on breastfeeding outcomes were collected at baseline, 1, 3, 4, and 6 months postpartum. Cox regression analysis was conducted to determine the impact of individual and cumulative BFHI Steps on the duration of full breastfeeding, defined as the number of weeks since discharge that an infant received only breast milk and no complementary formula or food. Mothers reported experiencing on average 3.9 (SD 1.13, range 1 to 7) Steps, and only 28% of infants were fully breastfed at 6 months. There was a protective inverse relationship for primiparous (p for trend = .022) but not multiparous mothers (p for trend = .069), between the number of Steps a woman was exposed to and the likelihood of her discontinuing full breastfeeding within 6 months postpartum. Greater exposure to BFHI practices potentially could increase primiparous mothers' chances of fully breastfeeding to 6 months. Continual monitoring of the BFHI Steps and repeated education of healthcare staff are required to ensure that Iranian mothers receive adequate breastfeeding support.

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.

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.

Complementary feeding in the MENA region: practices and challenges

Suboptimal feeding patterns during the first two years of life are key determinants of malnutrition in children and constitute an important predictor of health in later years. Early-childhood nutritional factors, stunting, and obesity have been highlighted as prominent core underlying factors of Non-Communicable Disease (NCD) development whereas the improvement of complementary feeding practices has been cited as one of the most effective preventive strategies for reducing malnutrition and adult NCDs. In the MENA region NCD prevalence shows very high rates and the limited available studies show that current practices fall behind global recommendations. Common to all countries of this region are practices of mixed breast and bottle-feeding as early as the first month, as well as the premature introduction of complementary foods. Early introduction of non-milk fluids, such as sweetened water and herbal teas, has been described as a common practice in the region and the premature introduction of complementary foods has been reported in as high as 80% of infants in several of the countries. Thus, enhancing infant/young child health can significantly reduce morbidities and mortalities, as well as adult-onset diseases, ultimately decreasing the region's overall burden of disease.

Intragroup differences in risk factors for breastfeeding outcomes in a multicultural community

A sample of 221 women who delivered at Al Qassimi Hospital, Sharjah, United Arab Emirates, were included in this prospective study to identify breastfeeding patterns at day 1, 1 month, and 6 months postpartum. The exclusive breastfeeding rate was 76.5% on day 1, 48.4% at 1 month, and 13.3% at 6 months. At 6 months, 16.1% had stopped breastfeeding. Simple and multivariable binary logistic regression analyses were used to identify factors associated with better breastfeeding outcomes. Nationality significantly affected exclusive breastfeeding at day 1 and 1 month. Pethidine use was associated with lower levels of exclusive breastfeeding at 1 month. Education was the most significant determinant of breastfeeding behavior at 6 months. Effects of the interrelationships between factors were examined and shown to influence breastfeeding outcomes in different population subgroups. The findings of this study suggest that strategies to improve breastfeeding should focus on risk factors specific to the population subgroup.