Breastfeeding initiation and duration among low-income women in Alabama: the importance of personal and familial experiences in making infant-feeding choices

Stress, social support, and racial differences: Dominant drivers of exclusive breastfeeding

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001-0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.

Changes in Breastfeeding and Lactation Support Experiences During COVID

Background: We surveyed parents who gave birth from 2019 to 2021 to examine changes in breastfeeding experiences and professional and lay breastfeeding support services due to the coronavirus disease 2019 (COVID-19) pandemic. We also examined racial and ethnic disparities in breastfeeding support. Materials and Methods: A cross-sectional opt-in survey of 1,617 parents was administered on Ovia's parenting app in January 2022. Respondents were 18-45 years of age and delivered in one of three birth cohorts: August-December 2019, March-May 2020, or June-August 2021. We fit linear and logistic regression models wherein the outcomes were six breastfeeding support and experience measures, adjusting for birth cohort and respondent demographics. Results: Parents who gave birth in the early pandemic versus those in the prepandemic had reduced odds of interacting with lactation consultants (odds ratio [OR]: 0.63; 95% confidence interval [CI]: 0.44-0.90), attending breastfeeding classes (OR: 0.71; 95% CI: 0.54-0.94), meeting breastfeeding goals (OR: 0.65; 95% CI: 0.46-0.92), and reporting it was easy to get breastfeeding help (estimate: -0.36; 95% CI: -0.55 to -0.17). Birth cohort was not associated with use of donor milk or receipt of in-hospital help. The later pandemic cohort differed from the prepandemic cohort for one outcome: they were less likely to meet their breastfeeding goals (OR: 0.67; 95% CI: 0.48-0.95). There were racial and ethnic disparities in the use of multiple types of breastfeeding support. Although one-third of respondents felt that the pandemic facilitated breastfeeding because of more time at home, 18% felt the pandemic posed additional challenges including disruptions to lactation support. Conclusions: Parents who gave birth in the later pandemic did not report significant disruptions to professional breastfeeding support, likely as a result of the growth of virtual services. However, disparities in receipt of support require policy attention and action.

Minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela, northeast Ethiopia: a community-based cross-sectional study

The first 2 years of life are a critical window of opportunity for ensuring optimal child growth and development. In Ethiopia, the magnitude of the minimum acceptable diet ranges from 7 to 74⋅6 %. The evidence revealed the variation and unrelated data on the prevalence of minimum acceptable diet. Therefore, the present study aimed to assess the minimum acceptable diet and its associated factors among children aged 6–23 months in Lalibela town administration, northeast Ethiopia. A community-based cross-sectional study was conducted in Lalibela town administration, northeast Ethiopia among 387 mothers/caregivers with children aged 6–23 months from May 1 to 30, 2022. The data were entered by Epidata version 3.1 and analysed by SPSS version 25.0. A multivariable binary logistic regression model was fitted to identify factors associated with minimum acceptable diet. The degrees of association were assessed using an adjusted odds ratio with a 95 % confidence interval and P-value of 0⋅05. The magnitude of minimum acceptable diet in the study area was 16⋅7 % (95 % confidence interval: 12⋅8–20⋅6 %). Sex of child, getting infant and young child feeding counselling at antenatal care, infant feeding practice-related knowledge and childhood illness are the variables that were found to be an independent predictor of minimum acceptable diet. Health facilities should strengthen infant feeding counselling starting from antenatal care visits during pregnancy for the recommended minimum acceptable diet is crucial.

Racial Differences in Breastfeeding on the Mississippi Gulf Coast: Making Sense of a Promotion-Prevalence Paradox with Cross-Sectional Data

Breastfeeding is less prevalent among African American women than their white peers. Moreover, breastfeeding rates in the South lag behind those in other regions of the U.S. Consequently, various efforts have been undertaken to promote breastfeeding among groups for which this practice is less common. This study examines African American and white racial disparities concerning (1) exposure to breastfeeding promotional information and (2) reported prevalence of breastfeeding in primary social networks. The survey combines a randomly selected sample of adults representative of the population and a non-random oversample of African Americans in a predominantly rural tri-county area on the Mississippi Gulf Coast. An initial wave of 2019 Mississippi REACH Social Climate Survey data collected under the auspices of the CDC-funded REACH program (Mississippi's Healthy Families, Mothers, and Babies Initiative; 2018-2023) is used to examine racial disparities in these two key outcomes for Mississippians in Hancock, Harrison, and Jackson counties. The results show that African American respondents are more likely to be exposed to breastfeeding promotional messages than their white counterparts. However, the reported prevalence of breastfeeding in African American respondents' primary social networks is significantly lower than that indicated by their white peers. These paradoxical results underscore the limitations of promotional efforts alone to foster breastfeeding. While breastfeeding promotion is important, the reduction of racial disparities in this practice likely requires a multi-pronged effort that involves structural breastfeeding supports (e.g., lactation spaces, peer networking groups, and pro-breastfeeding employment policies and workplaces). This study provides a promising model of innovative methodological approaches to the study of breastfeeding while underscoring the complex nature of racial disparities in lactation prevalence.

Breastfeeding in the Modern World

BACKGROUND

Social changes in the 20th century resulted in substantial reductions in the prevalence of breastfeeding in many countries but especially in those with high and increasing wealth. Concerns about this decline prompted widespread research to quantify the benefits of breastfeeding and the mechanisms by which it exerts protective effects for mothers and children. Pro-breastfeeding advocacy resulted in the WHO International Code of Marketing of Breastmilk Substitutes in 1981 and the Innocenti Declaration on Breastfeeding in 1990, which, together with numerous other initiatives, have helped to turn the tide.

SUMMARY

A tranche of recent meta-analyses of dozens of individual studies provide very strong evidence that breastfeeding has substantial benefits to babies, infants, and young children. The benefits and strengths of association vary according to the background environmental and hygiene conditions in different settings. In low-income settings, the chief measurable benefits for the child are in respect of reductions in diarrhea and respiratory infections, and in mortality. In high-income settings, breastfeeding protects against otitis media, likely protects against type 2 diabetes and overweight and obesity, and possibly protects against type 1 diabetes. It likely improves IQ by 2-3 percentage points. In mothers, breastfeeding reduces a mother's likelihood of breast and ovarian cancers. Feeding these data into the Lives Saved Tool suggests that these benefits could prevent 823,000 deaths in children and 22,000 among women.

The Influence of a Sister's Breastfeeding Experience on a Mother's Breastfeeding Behavior: Is There an Intragenerational Effect?

Objective: Intergenerational transmission of breastfeeding attitudes and behaviors from mother to daughter are well known, but there is limited research on intragenerational transmission of breastfeeding attitudes or behaviors within families. This study aimed to understand how initiation and duration of breastfeeding are influenced by past breastfeeding experiences of sisters among women in a longitudinal population-based cohort. Methods: Data were obtained on women enrolled in the 1979 National Longitudinal Survey of Youth (NLSY) who had at least one child enrolled in a substudy of cohort members' children. For each mother in the study, we determined whether any of her sisters also enrolled in the main NLSY study had previously breastfed one of their children. Results: Mothers whose sister(s) had prior breastfeeding experience were more likely to breastfeed their first-born child on unadjusted analysis (70% versus 45%, chi-square p < 0.001) and had a longer median of breastfeeding duration (median 14.5 versus 12 weeks, rank-sum p = 0.039). However, on a multivariable analysis accounting for potential confounding by maternal characteristics, infant characteristics, and differences among households, sisters' breastfeeding experience was no longer independently associated with the likelihood of breastfeeding initiation (odds ratio: 1.16; confidence interval [95% CI]: 0.73-1.85; p = 0.520) or the hazard of breastfeeding discontinuation (hazard ratio: 0.96; 95% CI: 0.82-1.12; p = 0.598). Conclusion: After adjusting for socioeconomic characteristics, intragenerational transmission of breastfeeding behavior was negligible among mothers raised in the same household. Other forms of intragenerational transmission (e.g., influence of extended family members) may be more salient influences on women's decision to breastfeed.

Breastfeeding competency scale (BCS); development and validation of an evaluation instrument on breastfeeding competency in third trimester pregnancy

Background

Breastfeeding plays an important role in the early stages of humans and throughout the development process. Breastfeeding competency is a self-assessment of pregnant women’s overall competency to breastfeeding which could predict the breastfeeding behaviours of pregnant women. However, a valid and reliable scale for assessing breastfeeding competency has not yet been developed and validated. This study was conducted to develop and validate an assessment scale designed to assess pregnant women’s breastfeeding competency in the third trimester: the Breastfeeding Competency Scale (BCS).

Methods

The BCS was developed and validated over three phases between September 2018 and September 2019, and these phases included item statistical analysis, exploratory factor analysis (EFA), content validation, internal consistency assessment, split-half reliability assessment and confirmatory factor analysis (CFA).

Results

The item statistical analysis and EFA resulted in 38 items and 4 factors that explained 66.489% of the total variance. The Cronbach’s α coefficients for the total scale and the 4 factors were 0.970, 0.960, 0.940, 0.822 and 0.931. The split-half reliability of the BCS was 0.894 and 0.890. CFA model showed that the 4-factor model fits the data well.

Conclusions

The BCS is a new valid and reliable instrument for assessing the breastfeeding competency of pregnant women in the third trimester.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12884-021-03664-1.

Intergenerational breastfeeding practices among parents and children: 1993 Pelotas (Brazil) birth cohort

The objective of this study was to investigate intergenerational breastfeeding practices according to parental sex and age at delivery in the 1993 Pelotas (Brazil) birth cohort study. This is a prospective birth cohort study, and at the 22‐year follow‐up, a substudy with all children of the cohort members who had become parents was conducted (93Cohort‐II). First generation breastfeeding data were collected at 3 months and 4‐year‐old follow‐ups. In the 93Cohort‐II, parents answered a questionnaire about their children's breastfeeding practices. Adjusted Tobit and Poisson regression models with robust variance were applied to estimate the association between predominant parental breastfeeding duration and exclusive breastfeeding duration of the children at 3 and 6 months. Out of 3,810 cohort participants, 955 (25%) had delivered at least one live‐born infant, and 1,222 children were assessed. Fifty‐four percent of parents were ≤19 years old. Direct effects of predominant parental breastfeeding duration on exclusive breastfeeding duration of their children were only observed when data were stratified by parental age: children born to parents aged ≥20 years old and who were predominantly breastfed for at least 3 months presented higher exclusive breastfeeding duration and higher prevalence of being exclusively breastfed for at least 3 months. When analyses were stratified by mothers and fathers, the result remained significant only among mothers. Longer predominant breastfeeding duration in the first generation was associated with longer exclusive breastfeeding duration in the second generation, but only among older mothers. Education and social support surrounding breastfeeding should be intensified among fathers and younger parents to create a positive environment supportive of breastfeeding.

Intenção de amamentar entre gestantes: associação com trabalho, fumo e experiência prévia de amamentação

Resumo O objetivo do presente estudo foi estimar a prevalência de intenção de amamentar (IA) por tempo insuficiente (inferior a 6 meses) ou prolongado (24 meses ou mais) e investigar sua associação com variáveis demográficas, socioeconômicas, comportamentais relacionadas à saúde, antecedentes obstétricos e experiência prévia com amamentação entre gestantes. Estudo transversal com gestantes em acompanhamento pré-natal em 17 unidades da Estratégia Saúde da Família, em Colombo (PR). Análises de regressão logística multinomial brutas e ajustadas foram empregadas para identificar associações entre IA e variáveis de exposição. Dentre as gestantes participantes da pesquisa (n = 316), 99,1% relataram IA. O tempo médio de IA foi de 13,5 meses. A IA por tempo insuficiente e prolongado foi referida por 9,8% e 22,0% das gestantes, respectivamente. Apresentaram maiores chances de IA por tempo insuficiente aquelas que não possuíam companheiro (OR 3,23, IC95% 1,31; 7,94), que exerciam trabalho remunerado (OR 5,56, IC95% 2,10; 14,71) e que eram fumantes (OR 7,79, IC95% 2,35; 25,81). A IA prolongada foi mais frequente entre as gestantes com experiência prévia em amamentação prolongada (OR 3,05, IC95% de 1,02; 9,03). Por fim, identifica-se que os fatores associados à IA subsidiam ações voltadas para os grupos vulneráveis com vistas à promoção da prática do aleitamento materno.

Perceptions and Practices of Infant Feeding among African American Women

A large urban hospital in Florida implemented changes to achieve the Baby-Friendly Hospital Initiative (BFHI) designation in 2015 resulting in an increase of exclusive breastfeeding rates at hospital discharge; however, African American women continue to have the lowest rates overall. Qualitative interviews were conducted with 20 African American women who received prenatal care at a low-income women's clinic and gave birth at an affiliated BFHI hospital. Using a medical anthropology analytical framework to examine predisposing, enabling, and service-related factors that affect breastfeeding, this study investigated interpersonal, sociocultural, and institutional barriers to breastfeeding. Common challenges experienced by participants included lack of maternity leave from work, lack of access to electric pumps, social pressures to initiate formula supplementation, fears that breastfeeding renders infants overly dependent on their mother's care, and a lack of breastfeeding role models and/or support networks to normalize longer-term breastfeeding. We conclude that efforts to increase breastfeeding rates for African American women and promote culturally sensitive interventions must address underlying socioeconomic and structural barriers, women's perceptions of breastfeeding benefits and difficulties, and the need for improvements in postnatal lactation and doula support to foster a more inclusive culture of breastfeeding.

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

BACKGROUND

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

OBJECTIVE

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Breastfeeding in Infancy Is Associated with Body Mass Index in Adolescence: A Retrospective Cohort Study Comparing American Indians/Alaska Natives and Non-Hispanic Whites

BACKGROUND

American Indians and Alaska Natives have the highest obesity prevalence in the United States, but the influence of early childhood variables on body mass index (BMI; calculated as kg/m2) is not well understood. Previous studies have investigated the association between breastfeeding in infancy and offspring BMI, but rarely included American Indians and Alaska Natives.

OBJECTIVE

This study investigated the association between breastfeeding in infancy and BMI in American Indians and Alaska Native and non-Hispanic white adolescents and young adults.

DESIGN

Longitudinal analysis based on data from the National Longitudinal Study of Adolescent to Adult Health (1994 to 2008).

PARTICIPANTS

Adolescent respondents who self-identified as American Indians and Alaska Native or non-Hispanic white, and whose parents completed the parental questionnaire, reported their height and weight. The final sample included 655 American Indians and Alaska Native and 10,305 non-Hispanic white respondents.

STATISTICAL ANALYSES PERFORMED

Generalized estimating equations were used to measure the mean differences, 95% CIs, and P values of the association between breastfeeding in infancy and offspring BMI in adolescence, stratifying by race, and adjusting for demographic and socioeconomic variables.

RESULTS

The length of breastfeeding was inversely associated with BMI in both populations. American Indians and Alaska Natives that were breastfed for 6 to 12 months or for more than 12 months had a mean BMI of 2.69 (95% CI -3.46 to -1.92; P<0.01) and 1.54 (95% CI -2.75 to -0.33; P<0.05) units lower than those that were never breastfed. Non-Hispanic whites that were breastfed for 3 to 6 months, 6 to 12 months, or more than 12 months had a mean BMI of 0.71 (95% CI -0.93 to -0.50; P<0.01), 0.68 (95% CI -0.87 to -0.50; P<0.01), and 0.85 (95% CI -1.09 to -0.62; P<0.01) units lower than those that were never breastfed. The association between the length of breastfeeding and offspring BMI varied by race (P<0.01).

CONCLUSIONS

Breastfeeding in infancy is associated with lower mean BMI. Future research should investigate causal pathways and whether interventions promoting breastfeeding in American Indians and Alaska Natives can prevent increasing BMI.

Integrative Literature Review of Factors Related to Breastfeeding in African American Women: Evidence for a Potential Paradigm Shift

BACKGROUND

Human milk has widespread health benefits for infants, mothers, and society. However, not all populations of women, particularly African American women, engage in human milk feeding at high rates. Research aim: The purpose of this integrative literature review is twofold: (a) to examine factors that influence low rates of human milk feeding among African American women and (b) to introduce a need for a methodological paradigm shift to develop culturally relevant and effective interventions.

METHODS

The authors searched four electronic social science databases for peer-reviewed journal articles pertaining to human milk among African American women published from 1990 to 2015. Both coauthors independently assessed these articles using thematic analysis and validation. The database search yielded 47 peer-reviewed articles.

RESULTS

Three main themes emerged explaining the human milk feeding disparity: (a) the social characteristics of women likely not to feed human milk (e.g., low socioeconomic status, single); (b) women's perceptions of human milk feeding; and (c) the quality of human milk feeding information provided by health care providers (i.e., limited human milk information).

CONCLUSION

Current literature does include sociohistorical factors that have shaped current norms. Adding sociohistorical frameworks, paying particular attention to the embodied experience of historical trauma, could lead to the development of new evidence-based, culturally sensitive interventions to enhance human milk feeding in the African American community.

Infant Feeding Decision-Making and the Influences of Social Support Persons Among First-Time African American Mothers

Background While breast milk is considered the gold standard of infant feeding, a majority of African American mothers are not exclusively breastfeeding their newborn infants. Objective The overall goal of this critical ethnographic research study was to describe infant feeding perceptions and experiences of African American mothers and their support persons. Methods Twenty-two participants (14 pregnant women and eight support persons) were recruited from public health programs and community based organizations in northern California. Data were collected through field observations, demographic questionnaires, and multiple in-person interviews. Thematic analysis was used to identify key themes. Results Half of the mothers noted an intention to exclusively breastfeed during the antepartum period. However, few mothers exclusively breastfed during the postpartum period. Many participants expressed guilt and shame for not being able to accomplish their antepartum goals. Life experiences and stressors, lack of breastfeeding role models, limited experiences with breastfeeding and lactation, and changes to the family dynamic played a major role in the infant feeding decision making process and breastfeeding duration. Conclusions for Practice Our observations suggest that while exclusivity goals were not being met, a considerable proportion of African American women were breastfeeding. Future interventions geared towards this population should include social media interventions, messaging around combination feeding, and increased education for identified social support persons. Public health measures aimed at reducing the current infant feeding inequities would benefit by also incorporating more culturally inclusive messaging around breastfeeding and lactation.

Identification of Socio-demographic and Psychological Factors Affecting Women's Propensity to Breastfeed: An Italian Cohort

Background: Exclusive breastfeeding until 6 months postpartum is a World Health Organization objective and benefits have been demonstrated for both mother and infant. It is important to clarify which factors influence breastfeeding intentions. Our objective was to assess and identify socio-demographic and psychological factors associated with breastfeeding intention in a sample of pregnant Italian women. Materials and Methods: This prospective study included 160 pregnant women. The following psychological constructs were measured using standardized questionnaires: anxiety, prenatal attachment, adult attachment, personality traits, and intention to breastfeed. Socio-demographic data were also collected using a self-report questionnaire. Assessment took place after the 20th gestational week. Results: Self-employment, age and feeding received as an infant were significantly related to breastfeeding intention. Regarding psychological factors, we also found that Neuroticism was negatively associated with mother's breastfeeding intentions. Relationships between psychological constructs and breastfeeding attitude were examined and represented within a graphical modeling framework. Conclusion: It may be possible to identify women that are less inclined to breastfeed early on in pregnancy. This may aid healthcare staff to pay particular attention to women who show certain socio-demographic and psychological characteristics, so as to fulfill more focused programs.

Community Rates of Breastfeeding Initiation

BACKGROUND

Breastfeeding initiation rates vary considerably across racial and ethnic groups, maternal age, and education level, yet there are limited data concerning the influence of geography on community rates of breastfeeding initiation.

OBJECTIVE

This study aimed to describe how community rates of breastfeeding initiation vary in geographic space, highlighting "hot spots" and "cool spots" of initiation and exploring the potential connections between race, socioeconomic status, and urbanization levels on these patterns.

METHODS

Birth certificate data from the Kentucky Department of Health for 2004-2010 were combined with county-level geographic base files, Census 2010 demographic and socioeconomic data, and Rural-Urban Continuum Codes to conduct a spatial statistical analysis of community rates of breastfeeding initiation.

RESULTS

Between 2004 and 2010, the average rate of breastfeeding initiation for Kentucky increased from 43.84% to 49.22%. Simultaneously, the number of counties identified as breastfeeding initiation hot spots also increased, displaying a systematic geographic pattern in doing so. Cool spots of breastfeeding initiation persisted in rural, Appalachian Kentucky. Spatial regression results suggested that unemployment, income, race, education, location, and the availability of International Board Certified Lactation Consultants are connected to breastfeeding initiation.

CONCLUSION

Not only do spatial analytics facilitate the identification of breastfeeding initiation hot spots and cool spots, but they can be used to better understand the landscape of breastfeeding initiation and help target breastfeeding education and/or support efforts.

Social Contexts of Infant Feeding and Infant Feeding Decisions

BACKGROUND

Infant feeding takes place within a network of social relationships. However, the social context in which infant feeding advice is received remains underresearched.

OBJECTIVE

The objective of this study was to evaluate the social contexts of infant feeding by examining individual and relationship characteristics of mothers and network members associated with advice to exclusively breastfeed, exclusively formula feed, or use a combination of breast milk and formula.

METHODS

Information about 287 network members was reported by 80 low-income mothers during a one-time survey. Characteristics of relationships associated with mothers receiving advice (exclusively breastfeed/formula feed, combination feed) from each network member were identified using 2-level logistic regression analyses.

RESULTS

Mothers had greater odds of receiving advice to exclusively breastfeed from network members who help make feeding decisions (odds ratio [OR], 2.44; 95% confidence interval [CI], 1.35-4.42), exclusively breastfed their own child or children (OR, 6.99; 95% CI, 2.96-16.51), and were health care providers (OR, 4.82; 95% CI, 1.70-13.67). Mothers had greater odds of receiving advice to breastfeed in combination with formula from network members who provided emotional support (OR, 2.45; 95% CI, 1.31-4.55), combination fed their own child or children (OR, 4.85; 95% CI, 1.80-13.05), and had an opinion that was important to the mother (OR, 2.67; 95% CI, 1.13-6.33). Mothers had greater odds of receiving advice to exclusively formula feed from network members who exclusively formula fed their own child or children (OR, 2.23; 95% CI, 1.07-4.66) than those who did not.

CONCLUSION

Social relationship characteristics and network members' infant feeding experiences may have implications for the advice new mothers receive. Future research should investigate social contexts of infant feeding longitudinally to inform interventions.

Why invest, and what it will take to improve breastfeeding practices?

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Infant Feeding in Newfoundland and Labrador, Canada: Perceptions and Experiences of Maternal Grandmothers

The purpose of this study was to examine the primary factors that influenced grandmothers’ choices of infant feeding and to explore the role that grandmothers feel they played in their daughters’ choices about infant feeding. Twenty-two maternal grandmothers who bottle fed their children and whose daughters also bottle fed their babies were recruited to participate in 4 focus groups and/or 2 interviews. Using the constant comparative method of data analysis, 3 themes emerged that described how grandmothers felt about their infant feeding experiences: “powerlessness,” “modesty,” and “ambivalence.” These themes and their implications are discussed in this article.

Breastfeeding and language outcomes: A review of the literature

Many researchers have investigated the potential impact of breastfeeding in infancy on a child's subsequent development, but only a small subset of these studies considers language development and impairment. This paper reviews that literature, discussing postnatal neurodevelopment, potential mechanisms for dietary influences on communication outcomes, studies of typically developing children, and studies of children with communication concerns. For population based studies of language development, a modest but statistically robust relationship is seen across large samples that account for breastfeeding exclusivity. A similar protective relationship is seen in studies that evaluate the relationship between breastfeeding and language disorders; effect sizes are typically larger in these papers. Implications for researchers and service providers are reviewed.

LEARNING OUTCOMES

Readers will be able to describe possible mechanisms by which early diet might influence neurodevelopment. They will be able to describe the relationships observed between diet in infancy and language outcomes in large population-based studies, as well as the trends observed in studies of the relationship between infant diet and communication impairment.

The intergenerational continuity of breastfeeding intention, initiation, and duration: a systematic review

BACKGROUND

In studies investigating predictors of breastfeeding behaviors, it is not uncommon for researchers to adjust for participants' having been breastfed as an infant. This assumes an intergenerational effect of breastfeeding continuity. Our aim was to investigate the veracity of that assumption. Specifically, we sought to summarize and evaluate evidence of associations between breastfeeding in one generation and breastfeeding intentions and behaviors in the second generation.

METHODS

A systematic search of psychological, nursing, and medical databases was conducted for studies examining "having been breastfed" as a factor in breastfeeding intention, initiation, or duration. Quality indicators were assessed and limitations reported. Effects were explored according to outcomes of intention, initiation, and duration.

RESULTS

Fifteen papers were found to be eligible for the review. Having been breastfed as an infant was consistently correlated with breastfeeding intention, initiation, and duration. Effect sizes differed depending on methodology. Men's infant-feeding status was also related to later intentions to support or encourage a partner to breastfeed.

CONCLUSIONS

Robust evidence for intergenerational breastfeeding continuity is present; however, mechanisms that explain this association were not considered in the studies reviewed and would best be explored within longitudinal cohort studies.

Breastfeeding initiation: impact of obesity in a large Canadian perinatal cohort study

OBJECTIVE

To evaluate incidence of breastfeeding initiation according to maternal pre-pregnancy body mass index (BMI) in "Grossesse en Santé", a large prospective birth cohort in Quebec City.

METHODS

Breastfeeding initiation in the post-partum period, pre-pregnancy BMI, sociodemographic determinants and obstetrical and neonatal factors were collected from years 2005 to 2010 in 6592 women with single pregnancies. Prenatal non-intention to breastfeed was documented in a subgroup of the cohort (years 2009-2010). Log-binomial regression analyses were performed to assess relative risk (RR) of non-initiation of breastfeeding between maternal BMI categories in models including pre- and post-natal determinants, after exclusion of variables with a mediating effect.

RESULTS

Twenty percent (20%) of obese women did not initiate breastfeeding in the post-natal period at hospital compared to 12% for normal weight women. Compared with those having a normal pre-pregnancy BMI, obese women had a higher risk of non-initiation of breastfeeding (RRunadj 1.69, 95% CI 1.44-1.98), even after adjustment for prenatal and sociodemographic factors (RRadj 1.26, 95% CI 1.08-1.46). Furthermore, the risk of non-initiation of breastfeeding in obese women still remained higher after introduction of per- and post-natal factors (RR 1.22, 95% CI 1.04-1.42). The prenatal non-intention to breastfeed was strongly associated with the non-initiation of breastfeeding for all categories of BMI.

CONCLUSION

Maternal obesity is associated with a two-fold rate of non-initiation of breastfeeding. Considering the benefits of breastfeeding and the increasing obesity rate, adapted interventions and specialized support should target both pre- and immediate post-natal periods in this population.

Enhancing breastfeeding rates among African American women: a systematic review of current psychosocial interventions

The goals of this article are to provide a review of key interventions and strategies that impact initiation and duration of breastfeeding with particular focus on low-income African American mothers' maternal psychological vulnerabilities during the early postpartum period using a social ecological perspective as a guiding framework. Although modest gains have been achieved in breastfeeding initiation rates in the United States, a projected gap remains between infant feeding practices and national Healthy People breastfeeding goals set for 2020, particularly among African Americans. These disparities raise concerns that socially disadvantaged mothers and babies may be at increased risk for poor postnatal outcomes because of poorer mental health and increased vulnerability to chronic health conditions. Breastfeeding can be a protective factor, strengthening the relationship between mother and baby and increasing infant health and resilience. Evidence suggests that no single intervention can sufficiently address the multiple breastfeeding barriers faced by mothers. Effective intervention strategies require a multilevel approach. A social ecological perspective highlights that individual knowledge, behavior, and attitudes are shaped by interactions between the individual woman, her friends and family, and her wider historical, social, political, economic, institutional, and community contexts, and therefore effective breastfeeding interventions must reflect all these aspects. Current breastfeeding interventions are disjointed and inadequately meet all African American women's social and psychological breastfeeding needs. Poor outcomes indicate a need for an integrative approach to address the complexity of interrelated breastfeeding barriers mothers' experience across layers of the social ecological system.

WIC mothers' social environment and postpartum health on breastfeeding initiation and duration

A low breastfeeding rate has been a consistent maternal and child health problem in the United States, especially for low-income families. Understanding mothers' social environment and overall well-being is important in determining how mothers will take care of themselves and their infants during the postnatal period in relation to the breastfeeding rate among low-income mothers. In this study, we examined the effects of the social environment of mothers enrolled in a Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) program in eastern Illinois and their postpartum health on breastfeeding initiation (n=103) and maintaining breastfeeding for at least 3 months (n=73). Using logistic regression models, a significant positive association (adjusted odds ratio [AOR]=3.47; 95% confidence interval [CI], 1.15-10.47; p=0.03) between marital status and breastfeeding initiation and a significant negative association (AOR=0.23; 95% CI, 0.06-0.88) between receiving food stamps and breastfeeding initiation were found. WIC mothers who were married were 4.1 times as likely to maintain any breastfeeding for at least 3 months than single mothers, and the association was significant (AOR=4.08; 95% CI, 1.36-12.27; p=0.01). The breastfeeding initiation rate was 77.7%, however, the mean±standard deviation age of the child when breastfeeding stopped was 2.2±1.4 months. There was a nonsignificant association between postpartum depression and breastfeeding initiation and maintaining any breastfeeding for 3 months. This study has shown that the familial environment of mothers plays a very important role in improving breastfeeding rates among WIC mothers. In addition, there is a negative relationship between using a food assistance program and breastfeeding among low-income women.

Factors associated with exclusive breastfeeding at hospital discharge in rural Western Australia

BACKGROUND

Breastfeeding is accepted as the best way of feeding infants, and health authorities recommend exclusive breastfeeding to around 6 months of age, but despite the evidence of its benefits, few mothers meet this goal. Infants who are exclusively breastfed in the early postpartum period are more likely to continue breastfeeding at 6 and 12 months, reinforcing the role that Baby-Friendly hospital practices play in supporting exclusive breastfeeding.

OBJECTIVES

This study aimed to determine the rate of breastfeeding initiation and identify the factors associated with exclusive breastfeeding at discharge from hospital for rural mothers.

METHODS

The prospective cohort study recruited 489 women from hospitals in regional Western Australia following the birth of their infant. Breastfeeding exclusivity at discharge was assessed based on mothers' self-reported infant feeding behavior during her hospital stay. The self-administered baseline questionnaire was completed by 427 mothers.

RESULTS

Breastfeeding was initiated by 97.7% of the mothers in this cohort, with 82.7% exclusively breastfeeding at hospital discharge. The odds of exclusive breastfeeding at discharge were more than 4 times higher for women whose infants did not require admission to the special care nursery (adjusted odds ratio [aOR] = 4.43; 95% confidence interval [CI], 1.98-9.99). Demand feeding (aOR = 3.33; 95% CI, 1.59-6.95) and 24-hour rooming-in (aOR = 2.31; 95% CI, 1.15-4.62) were also significant positive factors.

CONCLUSION

The findings suggest that hospital practices are strong predictors of exclusive breastfeeding. Greater emphasis on Baby-Friendly hospital practices in the early postpartum period may help the establishment of exclusive breastfeeding, assisting rural mothers to reach established international breastfeeding recommendations.

Barriers to breastfeeding in the African American population of Shelby County, Tennessee

Breastfeeding is recommended exclusively for the first 6 months of life, with continuation after the addition of complementary foods for at least 1 year of life. Breastfeeding rates are low in the Southeastern United States, especially among African Americans. Disparities in breastfeeding rates between African Americans and whites are especially pronounced in Memphis (Shelby County), TN. Our research objectives were to explore this disparity using focus groups, specifically to identify perceived barriers, and also to seek possible solutions from the target population. Focus groups were conducted in nine community settings within the county. Groups primarily consisted of women of childbearing years, but groups with men, grandmothers, and teens were also conducted. Common barriers for breastfeeding that were identified included pain, embarrassment with public nursing, going back to work, concern about "partying" and breastfeeding, and "just not wanting to" breastfeed. A notable finding was a substantial concern about sexuality and breastfeeding. As a possible solution, participants recommended putting breastfeeding educational materials widely across the county in many venues. Barriers to breastfeeding in Memphis are similar to those in other areas, with key concerns about sexuality and partying. Involving the target population yielded specific recommendations to improve breastfeeding promotion efforts.

Information needs, seeking behaviors, and support among low-income expectant women

Previous studies have consistently found associations between low income and infant health outcomes. Moreover, although health information-seeking is a maternal behavior related to improved health outcomes, little is known about the health information-seeking behaviors and information needs of low-income pregnant women. The purpose of the current investigation was to examine the information needs, information-seeking behaviors, and perceived informational support of low-income pregnant women. Accordingly, the study recruited 63 expectant women enrolled in a subsidized prenatal care program in Milwaukee, Wisconsin, during two time periods: March-May 2011 and October-December 2011. Results indicated that participants relied heavily upon interpersonal sources of information, especially family and the father of the baby; rarely used the Internet for health-related information; and desired information beyond infant and maternal health, such as finding jobs and accessing community/government resources. Participants who used family members as primary sources of information also had significantly increased levels of perceived informational support and reduced uncertainty about pregnancy. Our findings have implications for the dissemination of pregnancy-related health information among low-income expectant women.

Maternal sociodemographic characteristics and the use of the Iowa Infant Attitude Feeding Scale to describe breastfeeding initiation and duration in a population of urban, Latina mothers: a prospective cohort study

BACKGROUND

The World Health Organization recommends exclusive breastfeeding until 6 months of age. Maternal attitudes toward infant feeding are correlated with chosen feeding method and breastfeeding duration. The Iowa Infant Feeding Attitude Scale (IIFAS) has been used to assess attitudes towards breastfeeding prenatally and is predictive of breastfeeding decisions in certain population groups.

METHODS

In a cohort of pregnant Latina women recruited from two hospitals in the San Francisco Bay Area (n=185), we administered the IIFAS prior to delivery. Information regarding feeding choice, maternal sociodemographic information, and anthropometrics were collected at 6 months and 1 year postpartum. Analysis of predictors for breastfeeding initiation, breastfeeding at 6 and 12 months and exclusive breastfeeding at 6 months were evaluated using multivariate logistic regression adjusting for potential confounders.

RESULTS

In our cohort of Latina mothers, breastfeeding a previous infant was associated with breastfeeding initiation (OR 8.29 [95% CI 1.00, 68.40] p = 0.05) and breastfeeding at 6 months (OR 18.34 [95% CI 2.01, 167.24] p = 0.01). College education was associated with increased exclusive breastfeeding at 6 months (OR 58.67 [95% CI 4.97, 692.08] p = 0.001) and having other children was associated with reduced breastfeeding at six months (OR 0.08 [95% CI 0.01, 0.70] p = 0.02). A higher IIFAS score was not associated with breastfeeding initiation, breastfeeding at 6 or 12 months or exclusive breastfeeding at 6 months of age.

CONCLUSIONS

Initial choices about breastfeeding will likely influence future breastfeeding decisions, so breastfeeding interventions should specifically target new mothers. Mothers with other children also need additional encouragement to maintain breastfeeding until 6 months of age. The IIFAS, while predictive of breastfeeding decisions in other population groups, was not associated with feeding decisions in our population of Latina mothers.

Knowledge, attitude, and practices regarding early start of breastfeeding among pregnant, lactating women and healthcare workers in El-Minia University Hospital

BACKGROUND

Breastfeeding within the first hour of life is a potential mechanism for health promotion and is considered to be an indicator of excellence of breastfeeding. This study was conducted to evaluate the knowledge, attitude, and practice regarding early breastfeeding initiation within the first hour of life in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, Minia, Egypt.

SUBJECTS AND METHODS

A study was conducted on four groups of participants from both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital, each of them consisting of 30 individuals, using a questionnaire to assess the knowledge, attitude, and practice regarding early breastfeeding initiation for each group.

RESULTS

Sixty percent of women delivered by spontaneous vaginal delivery and 16.7% of those delivered by cesarean section initiated breastfeeding within 30 minutes to 1 hour after birth. Forty percent of lactating women delivered by spontaneous vaginal delivery, 83.3% of lactating women delivered by cesarean section, and 36.7% of healthcare workers used prelacteal feed instead of early breastfeeding initiation. The most important factors affecting the breastfeeding initiation were maternal illness followed by immediate skin-to-skin contact.

CONCLUSIONS

Although the majority of women participating in this study exhibited knowledge about early breastfeeding initiation, actual application of this practice was clearly deficient. In order to improve the rates of breastfeeding initiation within the first hour of life we should enhance vaginal delivery and prenatal classes and implement Baby-Friendly Hospital Initiative policies in both the Pediatrics and Gynecology and Obstetrics Departments of Minia University Hospital.

Early conditions in the breastfeeding of premature newborn infants

PURPOSE

To describe the breastfeeding initial conditions for premature infants.

METHODS

The sample consisted on 26 mother/baby dyads. The babies had an average of 36.1 weeks corrected gestational age and were hospitalized in a Neonatal Intensive Care Unit in Southern Brazil. Data was collected from medical records, and the observation of the dyads was conducted during feeding, using the Observation and Evaluation of the Breastfeeding Protocol. Favorable and unfavorable behaviors were registered regarding position, responses, suction, affection and anatomy of the breast. After the observation, a questionnaire was applied to the mothers.

RESULTS

The best results refer to the position of mother/child and affection and the poorer ones to the infant responses. Statistically significant correlations by the Spearman Correlations Coefficient were observed between some items of the protocol and other study variables.

CONCLUSION

Most premature infants from this sample presented a satisfactory initiation on analyzed aspects referring to breastfeeding. Still, we emphasize the need of practices for breastfeeding effectiveness and its encouragement in this population.

Breastfeeding mothers' experiences: the ghost in the machine

We critically review qualitative research studies conducted from 2000 to 2012 exploring Western mothers' breastfeeding experiences. We used the search criteria "breastfeeding," "qualitative," and "experiences" to retrieve 74 qualitative research studies, which were reduced to 28 when the terms "existential'' and "research'' were applied. We found that the impact of technology and the pervasive worldwide marketing of infant formula devalued breastfeeding mothers' narratives in a number of ways. Women's bodies were viewed as machine-like objects and the breast was seen as a disembodied object. Dominated by technological narrative, women's bodies were considered unpredictable and hormonal, needing to be managed by health care professionals. This means the disseminating breastfeeding discourse needs to be reinterpreted for practical use. We found that some of the researchers utilized narrative informed by phenomenological philosophy that appears to edge closer to understanding mothers' experiences in a more profound way than nonphenomenological research. However, we need to be mindful of the transparency of terms in replacing one form of technological narrative with another.

A grandmothers' tea: evaluation of a breastfeeding support intervention

This study's purpose was to evaluate an intervention to facilitate grandmothers' knowledge and support of breastfeeding. A pilot study with a quasi-experimental two-group posttest design was used to evaluate whether the intervention made a difference in grandmothers' knowledge, attitudes, and intent to recommend breastfeeding. The 26 grandmothers in the intervention group attended A Grandmothers' Tea program; the 23 grandmothers in the control group received written information. The intervention group had greater posttest knowledge scores than the control group but had no significant differences in attitudes or intent. However, a significant difference was evident between the attitude scores of grandmothers who breastfed their infants and of grandmothers who did not breastfeed their infants regardless of receiving the intervention.

African American women and breastfeeding: an integrative literature review

The purpose of this article is to present a review of literature regarding factors that influence breastfeeding intentions, initiation, and duration in the African American population. Research related to health disparities experienced by African Americans in the United States, as well as research regarding the protective benefits of breastfeeding for those specific health disparities, are also presented. Community and institutional interventions and promotional campaigns aimed at increasing initiation and duration of breastfeeding in the African American population are discussed. Future research regarding African American women's breastfeeding experiences using Black feminist thought as a theoretical foundation is recommended.

Predicting breastfeeding duration related to maternal attitudes in a taiwanese sample

The purpose of this study was to examine maternal attitudes and sociodemographic variables associated with Taiwanese mothers' continuation of breastfeeding at 6 weeks postpartum. A sample of 140 in-hospital breastfeeding mothers was recruited in Taiwan. Participants completed the Iowa Infant Feeding Attitude Scale (IIFAS) in the hospital prior to discharge. Postdischarge participants were contacted by telephone at 3 and 6 weeks postpartum to obtain information regarding their feeding method and duration. Findings revealed that in-hospital maternal breastfeeding attitudes are predictive of breastfeeding duration. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Women's husband/partner was found to be the main source of breastfeeding support. We recommend health-care professionals add the IIFAS to their assessment to identify mothers at high risk for discontinuing breastfeeding and to develop and better evaluate breastfeeding promotion programs.

Assessing infant breastfeeding beliefs among low-income mexican americans

Focus groups were conducted with low-income, pregnant women and new mothers receiving services from the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC program) along with their male partners and their mothers. All participants were Hispanics of Mexican American origin. The topics for the focus-group discussions were breastfeeding beliefs and perceptions. All participants were aware of the benefits of breastfeeding. Participants identified time, embarrassment, and pain as barriers to breastfeeding; discussed decision-making efforts regarding breastfeeding; identified cultural beliefs related to breastfeeding; and discussed the lack of care-provider support for breastfeeding.

Modified breastfeeding attrition prediction tool: prenatal and postpartum tests

In earlier studies, the Breastfeeding Attrition Prediction Tool (BAPT) demonstrated predictive validity in the postpartum period. The purpose of this study was to compare the effectiveness of a modified version of the BAPT when given in the last trimester (BAPT1) and following delivery (BAPT2) in predicting breastfeeding attrition among 117 women who planned to breastfeed for at least 8 weeks. Subjects completed the BAPT during a prenatal breastfeeding class and again at delivery, and they received a phone call at 8 weeks to determine breastfeeding status. In this study, neither of the two administrations of the BAPT was predictive of breastfeeding status at 8 weeks. Findings here may differ because subjects in the current study were all committed enough to attend breastfeeding class and, thus, varied less on commitment than women in earlier studies. Significant associations were found with level of education and having a close relative who breastfed. To assist the perinatal educator in identifying women most at risk for early cessation of breastfeeding, the use of three questions regarding level of education, family support, and breastfeeding preparation is suggested.

The value of listening to grandmothers' infant-feeding stories

The purpose of this study was to examine the usefulness of storytelling as a foundation for communicating with grandmothers about breastfeeding. The benefits of storytelling are applied to an analysis of infant-feeding stories that grandmothers told during a focus group study conducted by the authors. Thirty-five grandmothers participated in the study. A qualitative content analysis of the interview transcripts revealed that grandmothers' infant-feeding stories provided insights into the people (characters) and circumstances (setting) that affected their early experiences of infant feeding. By asking grandmothers to tell their stories, health-care professionals may understand the personal and cultural context grandmothers bring to their support of new mothers and facilitate a place for grandmothers' voices to be heard.

Aleitamento materno exclusivo e fatores associados a sua interrupção precoce: estudo comparativo entre 1999 e 2008

OBJETIVO: Analisar os indicadores do aleitamento materno exclusivo (AME) do Hospital Universitário de Brasília (HUB) nos anos de 1999 e 2008 e identificar fatores associados a sua interrupção precoce MÉTODOS: Estudo retrospectivo transversal com análise de prontuários de crianças atendidas nos anos 1999 e 2008 no Ambulatório de Pediatria, Crescimento e Desenvolvimento do HUB. A duração do AME foi dicotomizada em até quatro meses e quatro meses ou mais, estimando as razões de prevalência para o desmame precoce (AME<4 meses), utilizando-se um modelo de regressão de Poisson com variância robusta e o teste não paramétrico de Mann-Whitney para comparação do tempo de AME nos anos estudados. RESULTADOS: Foi analisado um total de 2.173 pacientes, 1.443 referentes ao ano de 1999 e 730 referentes ao ano de 2008. Observou-se um incremento de 110,7 para 123,6 dias na duração do AME de 2008 em relação a 1999 (p<0,0001). O desmame precoce foi 12,6% maior em mães com até sete anos de estudo do que em mães com 11 ou mais anos de estudo (p<0,05). Os demais fatores analisados não mostraram relação estatística com o desmame precoce. CONCLUSÕES: Assim como o encontrado nas capitais brasileiras e Distrito Federal, verificou-se incremento no que diz respeito à duração do AME, associado positivamente ao nível educacional materno mais elevado. Convém ressaltar, porém, que a duração observada no estudo ainda se encontra abaixo dos 180 dias recomendados pela Organização Mundial de Saúde.

Breastfeeding attitudes among couples planning exclusive breastfeeding or mixed feeding

OBJECTIVES

The goals of the study were to describe maternal and paternal attitudes toward breastfeeding among couples planning exclusive breastfeeding and those planning mixed feeding and to compare maternal predictions of paternal attitudes with actual paternal attitudes.

METHODS

Expectant parents with the intention to breastfeed were recruited from outpatient clinics. During the third trimester of pregnancy, mothers and fathers independently completed a demographic questionnaire and a breastfeeding attitude survey. In addition, mothers were asked to predict fathers' attitudes.

RESULTS

Seventy-one subjects completed all study requirements: 56 planned to exclusively breastfeed, and 15 planned to mix feed. The majority of subjects were white, educated beyond high school, and married. Expectant parents planning to exclusively breastfeed were significantly more likely to report higher paternal age (p=0.019), higher maternal age (p=0.006), and higher maternal education (p=0.023) than those planning to mix feed. Among fathers, those planning exclusive breastfeeding expressed more favorable attitudes related to naturalness (p=0.009) and closeness (p=0.036) than their mixed-feeding peers. Compared with mothers planning mixed feeding, those planning exclusive breastfeeding indicated more favorable attitudes related to naturalness (p=0.006) and respect for breastfeeding women (p=0.005). Overall, mothers reported more favorable attitudes toward breastfeeding than fathers in several areas, including disease protection (p=0.004), respect for breastfeeding women (p=0.043), and naturalness (p=0.011). The mother's predictions were less favorable than the father's actual attitudes in the areas of purpose of breasts (p=0.007), respect (p=0.049), and closeness (p=0.024).

CONCLUSIONS

Results suggest expectant parents who plan to mix feed may be fundamentally different from those planning to exclusively breastfeed. There is a continued need to identify factors that influence the prenatal decision to mix feed and to develop strategies that promote exclusive breastfeeding in this population.

African American women's infant feeding choices: prenatal breast-feeding self-efficacy and narratives from a black feminist perspective

PURPOSE

Examining prenatal breast-feeding self-efficacy and infant feeding decisions among African American women using a mixed-method approach. A black feminist philosophy was used to keep women's experiences as the central research focus.

METHOD

The Prenatal Breast-feeding Self-efficacy Scale was used to determine differences between intended breast-feeders and formula users among 59 women. Seventeen narrative interviews were conducted to analyze postpartum accounts of actual feeding practices.

RESULTS

Both groups (intended breast- or formula-feeders) demonstrated confidence in their ability to breast-feed. Women planning to breast-feed (M = 82.59, SD = 12.53) scored significantly higher than anticipated formula users (M = 70, SD = 15.45), P = .001 (2-tailed). Four of the six themes emerging from narrative analysis were similar to categories of self-efficacy: performance accomplishments, vicarious experiences, verbal persuasions, and physiological reactions. In addition, themes of social embarrassment and feelings of regret were identified.

CONCLUSION

Although African American women in this study rated themselves overall as confident with breast-feeding, several narratives about actual feeding choices indicated ambivalence. Women planning to breast-feed need continued support from their healthcare providers throughout the childbearing year. Furthermore, prenatal and immediate postpartum opportunities may exist for nurses to encourage breast-feeding among individuals who initially plan formula use.

Community based participatory research of breastfeeding disparities in African American women

OBJECTIVE: Lack of support for breastfeeding mothers has been consistently identified in the literature as a barrier for breastfeeding across racial and ethnic groups. Using a community-based participatory approach, academic and community-based partners conducted an iterative process to assess barriers, facilitators and potential mediating interventions for breastfeeding in the African-American community in Durham, North Carolina. METHODS: Eight focus groups were conducted with African-American mothers, fathers and grandmothers. Researchers transcribed and coded each focus group and analyzed using Atlas ti. 5.2. Patterns and themes that emerged informed the development of community stakeholder interviews; 41 interviews were conducted with community representatives. These findings informed the development of a support group pilot intervention. The pilot support groups were evaluated for increase in knowledge of attendees. RESULTS: Focus group and community interviews indicate that African Americans may disproportionately experience inadequate support for breastfeeding. This lack of support was reported in the home, the workplace, among peers, and from healthcare providers. The pilot support groups resulted in increased knowledge of breastfeeding among group participants OR=3.6 (95% CI: 2.5, 5.2). CONCLUSIONS: The findings from this research underscore the importance of a multi-level approach to breastfeeding support for African American women to address breastfeeding disparities.

Exploring the Role of Touch in the First Year of Life: Mothers' Perspectives of Tactile Interactions with Their Infants

Introduction:

Touch is a basic instinctual interaction between a parent and his or her infant and has a vital role in the infant's early development. Parents provide a variety of tactile stimulation while addressing their infant's daily care routines. This paper reports on research findings, exploring the nature of this tactile interaction and how it is influenced by personal and contextual factors.

Method:

A qualitative study, employing a phenomenological approach, was conducted to explore the experiential nature of tactile interaction. Data were collected from six mothers of typically developing infants through single semi-structured interviews, and analysed thematically. Credibility and trustworthiness were addressed throughout the research process through peer checking, an audit trail and the completion of a reflexive diary.

Findings:

The mothers described the importance of tactile interaction as a medium through which to bond with their infant and also discussed the influence that the infant's development has on this dyadic relationship. Personal and contextual factors were identified as affecting engagement in tactile interaction.

Conclusion:

Based on these findings, recommendations are made for occupational therapists who work with infants. The consideration of personal and contextual factors that influence mother-infant tactile interaction will contribute to a family-centred approach to therapy and support the achievement of best practice in this area.

Predictors of breastfeeding exclusivity in a WIC sample

OBJECTIVE

To examine predictors of breastfeeding exclusivity in low-income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC).

DESIGN

A secondary data analysis of existing clinical and administrative data.

SETTING

An urban community health center serving low-income families.

PARTICIPANTS

Two hundred and thirty-five (235) low-income women who initiated breastfeeding and received WIC services.

METHODS

Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period.

RESULTS

Only 23% of the sample breastfed exclusively. Women who received first-trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR = 2.02, p ≤ 0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR = 3.85, p ≤ 0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR = 0.50, p ≤ 0.05).

CONCLUSION

Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low-income WIC recipients.