Public perceptions on breastfeeding constraints

Breastfeeding: Knowledge, Perception, And Intention to Practice Among Female Students of Tertiary Institutions in Ekiti, Southwest Nigeria

INTRODUCTION

Breastfeeding is a public health practice that is critical for the survival of infants and young children. This study aimed at determining the knowledge, attitude, and future intention to breastfeed among female undergraduates in tertiary institutions in Ekiti State, Southwest Nigeria.Methodology: A prospective cross-sectional study was conducted among 1312 female students of the tertiary institutions in Ekiti State. By convenience sampling, female students were invited to participate in the study after giving verbal consent and those studying medical, nursing, and other courses allied to medicine were excluded. Internal consistency of the data obtained from this research instrument was determined using Cronbach's coefficient Alpha with a reliability value of 0.82. Data analysis was conducted using SPSS version 25. Descriptive as well as inferential statistics were computed. Results were summarized as frequencies and percentages. The differences in knowledge, attitude, and intention to practice breastfeeding as well as other responses among the participants were compared among age groups, faculties and the sources of information using Chi-square test.

RESULT

Although 93% of the respondents agreed that breast milk is important for the development of the infant's brain thereby demonstrating good knowledge; 51.6% of the respondents demonstrated poor perception to breastfeeding believing breastfeeding makes the breast to sag while only 34% of the respondents indicated their intention to breastfeed their future babies.

CONCLUSION

The intention to breastfeed among our study participants was poor. This study revealed the need to increase awareness about breastfeeding and its benefits among this huge population of future mothers.

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.

High confidence, yet poor knowledge of infant feeding recommendations among adults in Nova Scotia, Canada

In Canada, adherence to the national 'Nutrition for Healthy Term Infants' recommendations of infant and young child feeding (IYCF; 0-24 months) is suboptimal. While maternal knowledge of IYCF is commonly assessed, that of the general public has rarely been explored. Our objective was to assess the knowledge of, and confidence in answers to, Canadian IYCF recommendations among a diverse sample of adults in Nova Scotia, Canada. Between March and May 2018, a self-administered questionnaire examining IYCF knowledge, self-rated confidence, and sociodemographic information was conducted among Nova Scotians (≥19 years) in public locations. We surveyed 229 adults; 60% (n=134) were women. Mean (95% CI) age was 44 (41,46) years, 73% self-identified as white, 77% were born in Canada, and 69% were parents. Knowledge deficits were: age to terminate breastfeeding (18.3 (16.7,19.9) months; recommendation: ≥24 months), age to introduce solids (9.2 (8.2,10.2) months; recommendation: 6 months), vitamin D supplementation (10% correct), and optimal complementary foods (only 37% indicated iron-rich foods). Correct IYCF knowledge was lower among men, non-parents, young adults (19-29 years) and low-income adults (<$50,000/year). Mean self-rated confidence (out of 10) was high (7.2 (6.9,7.5)), and not different (p>0.05) between correct and incorrect responses for: best food for a newborn, age to terminate any breastfeeding, and age to start family meal foods. We found low knowledge of IYCF guidelines, yet high confidence in responses regardless of accuracy, among adults in Nova Scotia. General public knowledge deficits may contribute to an unsupportive culture around IYCF practices and low adherence to current recommendations.

The impact of maternal socio-demographic characteristics on breastfeeding knowledge and practices: An experience from Casablanca, Morocco

Background

Breastfeeding is universally recognized by the World Health Organization as the best way of feeding infants. Therefore, several countries have initiated health promotion interventions to support successful breastfeeding based on the factors influencing breastfeeding outcomes.

Objective

To examine the association between the knowledge of breastfeeding and maternal socioeconomic and demographic characteristics, and to determine any impact on child nutritional status.

Methods

A cross-sectional study using both qualitative and quantitative methods was conducted with mothers of infants aged six- to twenty-four months. Data was collected by a semi-structured questionnaire and face-to-face, in-depth interviews with mothers to get an insight into their breastfeeding perceptions and experiences. Educational achievement and occupational class were used as indicators of socio-demographic status. Nutritional status was assessed by anthropometric measurements.

Results

A significant relationship between exclusive breastfeeding and the mother's education (P < .001) and socio-economic status (P < .001) has been highlighted. A significant link was pointed out between breastfeeding and length-for-age Z score (LAZ) (P < .001), and weight-for-age Z score (WAZ) (P = .005). Moreover, a strong association was found between maternal employment and exclusive breastfeeding (P < .001).

Conclusions

Our findings shed some light on challenges faced by mothers, as well as an association between socio-demographic characteristics and practices for facilitating exclusive breastfeeding to guide the mothers in breastfeeding management.

First Food Justice: Infant Feeding Disparities and the First Food System

Breastfeeding and first foods--including human milk and infant formula--affect us all as individuals and a society of eaters and feeders. They also shape us in part through having significant effects on community health and well-being, workplace strength, and environmental integrity. In addition, we all affect breastfeeding and first foods. Society, the economy, and the environment constrain and enable breastfeeding success, for example, and they often do so differently by race, class, and other social categories. It is important we recognize and address these realities for our own individual interests as well as those we as a citizenry hold in common.

Attitudes of Chinese Adults to Breastfeeding in Public: A Web-Based Survey

OBJECTIVE

To explore Chinese adults' perceptions and attitudes toward breastfeeding in public places.

MATERIALS AND METHODS

This was a web-based survey including 10 items on breastfeeding participants (N = 2,021) who were recruited by convenience sampling.

RESULTS

Almost 95% believed that public places should have lactation rooms, 86% thought it was acceptable for mothers to breastfeed in this location, and 65% of respondents agreed that it was acceptable for mothers to breastfeed in public. Though 47% believed that viewing women breastfeeding in public was embarrassing, more than 80% felt that breastfeeding in public was appropriate and decent and did not violate social morality. More than 90% of respondents approved of policies supporting breastfeeding in public. Women, married people, those who had children, had some knowledge about breastfeeding, or had the experience of viewing women breastfeeding in public were more likely to hold positive perceptions and attitudes toward breastfeeding in public places.

CONCLUSIONS

Prior experience and knowledge about breastfeeding have a great influence on people's perceptions and attitudes toward breastfeeding in public, so education about breastfeeding is very important. Breastfeeding education should not only include the techniques of breastfeeding practices but also include information policies that support breastfeeding in public, including the importance of lactation rooms.

Breastfeeding Supports and Services in Rural Hawaii: Perspectives of Community Healthcare Workers

Background. In the state of Hawaii, breastfeeding initiation rates are higher than the national average but fall below target rates for duration. Accessing breastfeeding support services is challenging for mothers living in rural areas of the state. Healthcare workers (HCWs) working with mothers and infants are in a key position to encourage and support breastfeeding efforts. The purpose of this study is to gain a better understanding of a Hawaiian community's (specifically Hilo, Hawai‘i) breastfeeding service and support issues. Method. The qualitative study design utilized was a focused ethnography. This approach was used to gather data from participant HCWs (N = 23) about their individual or shared experience(s) about the breastfeeding supports and services available in their community. An iterative process of coding and categorizing the data followed by conceptual abstraction into patterns was completed. Results. Three patterns emerged from the qualitative interviews: Operating within Constraints of the Particular Environment, Coexisting Messages, and Process Interrupted. Participants identified a number of gaps in breastfeeding services available to their clients including the lack of available lactation consultants and the inconsistent communication between hospital and community providers. A number of implications for practice and further research were suggested within the results and are discussed.

Campus Climate

A return to work and school presents mothers with barriers to breastfeeding. Concerns include negative attitudes toward breastfeeding, scheduling and break-time, and appropriate, private space. Current federal laws require worksite support and provision of adequate accommodations for lactation purposes, as do some state laws. An evaluation of faculty, staff, and students (N = 510) at a large public university, assessed breastfeeding knowledge, attitudes, and support following the implementation of new mother-friendly policies and lactation rooms. Additionally, awareness of the lactation rooms and university policies were assessed. Overall, the university climate reflected high breastfeeding knowledge and positive attitudes. Employees had higher awareness of the new lactation facilities and university policies than did students. Implementation limitations were a need for education and awareness efforts targeted to students. Future directions for worksites and schools are addressed.

Barriers to Human Milk Feeding at Discharge of Very-Low-Birth-Weight Infants: Maternal Goal Setting as a Key Social Factor

BACKGROUND

While black mothers initiate human milk (HM) provision at lower rates than non-black mothers in the United States, some neonatal intensive care units (NICUs) report similar initiation rates regardless of race/ethnicity for mothers of very-low-birth-weight (VLBW) infants. However, racial disparity frequently becomes evident in the proportion of black infants who continue to receive HM feedings at NICU discharge. Since social factors have been associated with differences in HM provision for term infants, we sought to identify differences in social factors associated with HM feeding at discharge based on race/ethnicity.

MATERIALS AND METHODS

A prospective cohort study of racially diverse mothers of VLBW infants measured social factors including maternal education, breastfeeding support, return to work/school, HM feeding goal, previous breastfeeding, or formula experience. Multivariate logistic regression modeling was applied to social factors to predict HM feeding at discharge. Additional regression models were created for racial/ethnic subgroups to identify differences.

RESULTS

For all 362 mothers, WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) eligibility and maternal goal near time of discharge of providing any HM negatively and positively predicted HM feeding at discharge, respectively. Perceived breastfeeding support from the infant's maternal grandmother negatively predicted HM feeding at discharge for black mothers.

CONCLUSIONS

Future interventions to increase duration of HM provision in VLBW infants should focus on the establishment and maintenance of maternal HM feeding goals. Further studies of the familial support system of black mothers are warranted to determine multigenerational impact and potential interventions.

Using breastfeeding images to promote breastfeeding among young adults

Young adults’ reactions to breastfeeding images were assessed using varied approaches. In Study 1, participants viewed posters from a breastfeeding campaign; many anticipated negative reaction to the campaign. In Study 2, participants viewed novel infant-feeding posters; breastfeeding posters were viewed for less time than bottle-feeding posters, regardless of the task assigned. In Study 3, participants were asked to rate their comfort level viewing infant-feeding images; greater discomfort was reported for breastfeeding images. Taken together, we argue that many young adults expect, and experience, discomfort viewing breastfeeding, but it is important to continue using breastfeeding images in promotion efforts.

Views of fathers in Ireland on the experience and challenges of having a breast-feeding partner

OBJECTIVE

this study investigated the relationship between fathers and breast feeding in Ireland.

DESIGN AND METHOD

a cross-sectional semi-quantitative questionnaire with closed-ended and open-ended questions was posted to 1398 men with an Irish partner who had given birth 4-7 months previously. Fathers who specified that their partner breast fed their last or only child were questioned about their: influence on the breast feeding decision; ability to assist with breast feeding challenges; preferred type of information on breast feeding; perceived advantages and disadvantages to breast feeding; and views on breastfeeding in public. Data from closed-ended questions on breast feeding were presented using frequencies and associated percentages. Answers to open-ended questions on breast feeding were categorised into themes using content analysis. Each theme was assigned a numerical code and the themes developed were quantitatively counted and presented as frequencies and percentages.

FINDINGS

of the 583 respondents (42% response rate), 417 (71.5%) had a partner who had breast-fed their last or only child. Most of the 417 fathers were employed (95.7%, n399), college-educated (76.7%, n320) and married (87.8%, n366). Most (75.5%, n315) fathers were involved in the breast feeding decision. The majority (77.5%, n323) of fathers were unprepared for at least one aspect of breast feeding, most commonly that their partner encountered difficulties in establishing breast feeding. Of those fathers with a partner who experienced difficulties with breastfeeding (56.8%, n237), half (49.4%, n117) were unable to help their partner to overcome her breast feeding difficulties. Two-fifths (41.0%, n133) of fathers felt deprived of bonding time. Almost one in ten (9.4%, n39) fathers felt uncomfortable with an unrelated woman breast feeding in public, and this increased to three in ten or one third (34.3%, n143) if the woman in question was their partner.

KEY CONCLUSION

while fathers in a well-educated and socially advantaged sample are largely supportive of breast feeding, significant challenges remain in terms of their ability to support breast feeding in an informed and practical manner.

IMPLICATIONS FOR PRACTICE

women who are practically and emotionally supported by their partners are more likely to successfully breast feed, but the male perspective of breast feeding in Ireland has been given little attention. This study supports earlier and more effective engagement of fathers throughout the breast feeding process, and highlights areas of concern with respect to the role of fathers in breast feeding.

Exploring Fathers' Role in Breastfeeding Practices in the Urban and Semiurban Settings of Karachi, Pakistan

This study explored fathers' perceptions about breastfeeding infants. A qualitative exploratory study design was used. Study setting was urban and semiurban areas of Karachi, Pakistan. In-depth interviews were conducted with 12 fathers. The following themes emerged from the data collected: knowledge and awareness and enabling and impeding factors. Most fathers seemed eager to get involved and assist their partners in proper breastfeeding practices because they believed that doing so is in accordance with their faith. Fathers felt that adequate support from their family members and employers could enable them to encourage their partners to initiate and maintain exclusive and optimum breastfeeding practices. Exploring fathers' perception regarding breastfeeding in the context of Pakistan is still a new field of study.

The Ability of Posters to Enhance the Comfort Level with Breastfeeding in a Public Venue in Rural Newfoundland and Labrador

BACKGROUND

The acceptance and support of breastfeeding in public venues can influence breastfeeding practices and, ultimately, the health of the population.

OBJECTIVE

The primary aim of this study was to investigate whether posters targeted at the general public could improve acceptability of breastfeeding in public places.

METHODS

A convenience sample of 255 participants was surveyed at shopping centers in 2 rural communities of Newfoundland and Labrador. Experimentally, questions were posed to 117 participants pre- and post-exposure to 2 specific posters designed to promote public acceptance of breastfeeding in public.

RESULTS

Initially, we surveyed that only 51.9% of participants indicated that they were comfortable with a woman breastfeeding anywhere in public. However, context played a role, whereby a doctor's office (84.5%) or park (81.4%) were the most acceptable public places for breastfeeding, but least acceptable was a business office environment (66.7%). Of participants, 35.4% indicated previously viewing specific posters. We used a visual analog scale to test poster viewing on the acceptability of public breastfeeding in the context of a doctor's office and a restaurant. Results of pre- versus post-viewing of the promotional posters indicated significant improvements in both scenarios: in a doctor's office (P = .035) and in a restaurant (P = .021).

CONCLUSION

Nearly 50% of the surveyed population indicated discomfort with a mother breastfeeding in public. Both cross-sectional and interventional evidence showed that posters significantly improved the reported level of comfort toward seeing breastfeeding in public.

Problems With Breastfeeding/Breast Milk Feeding Reported by Women Participating in a Workplace Lactation Program

Purpose: The purpose of this study, which was part of a larger study, was to explore the problems with breastfeeding and/or breast milk expression experienced by women participating in a workplace lactation program at a large public sector employer.

Methods: A cross-sectional mailed survey approach was used. The sample (n = 128) consisted of women who had used at least one component of the lactation program in the past 3 years and who were still employed at the same organization.

Findings: Women who reported having a problem with breastfeeding during the first 2 weeks of their baby’s life or after they returned to work or if they had problems expressing milk all had a shorter mean duration of any breastfeeding/breast milk feeding. However, in this study, the mean duration of breastfeeding/breast milk feeding for all respondents was 10.4 months, and 57% of respondents were exclusively feeding breast milk for milk feedings at 6 months.

Conclusions: It is common for women to experience problems in breastfeeding during the first 2 weeks after their baby’s birth and when they return to work. There is some evidence that participation in a workplace lactation program supported a longer duration of breastfeeding in spite of problems experienced by the women. More research is needed.

Experiential Perceptions of Relactation: A Phenomenological Study

BACKGROUND

Relactation is the process of re-establishing a breast milk supply that has diminished or ceased.

OBJECTIVE

This study aimed to explore the lived experiences of women living in Montana who chose to attempt relactation.

METHODS

A phenomenological approach was used to understand the lived experiences of 10 women in Montana who attempted relactation. In-depth interviews were conducted, and a 21-item categorical and open-ended demographic and experiential questionnaire was completed.

RESULTS

An overarching theme that could have affected the initial breastfeeding experience, and furthered the need for relactation, was having a difficult baby. Examples of being difficult included colic, latching issues, or a lack of bonding felt by the participant.

CONCLUSION

When asked about the experience of relactation, participants reflected on the emotional aspects of the process rather than the physical process. The most common feelings expressed were rejection, anger, stress, and failure. Future studies could examine what factors are present with women who continue nursing versus factors that are absent in women who discontinue nursing difficult babies, which could help prevent the need for relactation.

Breastfeeding knowledge, attitude, perceived behavior, and intention among female undergraduate university students in the Middle East: the case of Lebanon and Syria

BACKGROUND

The Middle East has one of the lowest rates of exclusive breastfeeding in the world, highlighting the need to promote breastfeeding in this region. Young adults represent a key population of interest, since decisions about infant-feeding appear to be made before children are even conceived.

OBJECTIVE

To examine breastfeeding knowledge, attitude, and perceived behavior among female undergraduate students in Lebanon and Syria and determine factors associated with intention to breastfeed in this population.

METHODS

This cross-sectional study was conducted in 2010/11 in Damascus and Beirut. Four universities were selected in each city. A multicomponent questionnaire was administered to a convenience sample of participants (n = 194 from Beirut and n = 199 from Damascus). The questionnaire included breastfeeding knowledge (measured by the Infant Feeding Knowledge Test Form), attitude (Iowa Infant Feeding Attitude Scale), perceived behavior (Breastfeeding Behavior Questionnaire), and intention (Infant Feeding Intention Scale). Factors associated with intention to breastfeed were examined by multivariate linear regression analysis.

RESULTS

The participants had an average breastfeeding knowledge level (mean score, 10.39 +/- 2.09) and neutral perceived behavior (mean score, 22.00 +/- 3.68), while having relatively positive attitudes (mean score, 58.12 +/- 6.49). Knowledge gaps and negative perceptions were identified, particularly linked to breastfeeding in public and among working mothers. Breastfeeding intention was found to be significantly associated with knowledge and attitude in Lebanon (beta = 0.103 and beta = 0.230, respectively), and with perceived behavior in Syria (beta = -0.135).

CONCLUSIONS

By revealing specific knowledge gaps and misconceptions and identifying country-specific disparities in the predictors of the intention to breastfeed, the findings of this study may provide a basis for devising culture-specific interventions aimed at promoting breastfeeding.

An Exploration of Social Desirability Bias in Measurement of Attitudes toward Breastfeeding in Public

BACKGROUND

Measurement of attitudes toward breastfeeding has been based on self-report, which may be subject to social desirability. Increasing the perceived anonymity of questionnaires may reduce social desirability bias, producing more accurate results.

OBJECTIVE

We compare a standard questionnaire (SQ) with the unmatched count technique (UCT) to understand the effect of increased perceived anonymity on self-reported attitudes toward breastfeeding in public.

METHODS

Measures of attitudes toward breastfeeding in public were adapted from existing questionnaires, subjected to expert review, and pilot tested. A web-based survey was then constructed to compare the UCT and the SQ technique. Participants were recruited online and randomly assigned to either the SQ or the UCT condition.

RESULTS

In the overall sample (N = 1477), the UCT condition had significantly higher endorsement for the statement, "Breastfeeding in some public settings should be against the law" [χ²(1, n = 1455) = 9.58, P = .002]. Women more frequently endorsed that item in the UCT condition (15.6%) than in the SQ condition (7.1%) [χ²(1, n = 1025) = 18.27, P < .001]. In contrast, among men, rates of endorsement did not vary between experimental and control groups for that question.

CONCLUSION

Perceived anonymity may have influenced responses to some questions about attitudes toward breastfeeding in public. The effects of perceived anonymity may operate differently within demographic sectors. The direction of the effects was not always consistent with hypotheses, and future research is needed to fully explore the various dimensions of attitudes toward breastfeeding. The UCT method shows promise for improving the accuracy of reporting attitudes toward breastfeeding.

Discursive constructions of breastfeeding in U.S. state laws

Previous research has identified several ways that breastfeeding is constructed in public discourses, each with consequences for breastfeeding attitudes, policies, and practices. Researchers analyzed discursive constructions of breastfeeding in U.S. state laws regarding breastfeeding in public to see if common representations were replicated in law and to identify patterns among states that used similar language. Results indicated that laws varied in the level of protection they offered, with the least protective laws decriminalizing breastfeeding in public and the most protective laws criminalizing interference with breastfeeding. The least protective states were located in the Western and North-Central regions, Republican-leaning, and less urban, whereas the most protective states were located in the New England and North-Central regions, Democrat-leaning, and more urban. Most states that fell on either end of this continuum had breastfeeding rates above the national average. Laws also varied in the level of regulation implied in their language, with the most regulative laws specifying that "a mother" can breastfeed "her baby" only in certain places and under certain conditions (discreetly). The most regulative states were located in the Southern and North-Central regions and had low breastfeeding rates, whereas the least regulative states were Western and had high breastfeeding rates.

An initial validation of a measure of sexual perceptions regarding breastfeeding

Increasing breastfeeding initiation and duration in the United States has been identified as a major public health goal. This article presents an initial validation of the Sexual Perceptions of Breastfeeding Scale (SPBFS). The SPBFS was designed to assess the presence of sexual perceptions regarding breastfeeding that may interfere with a mother's choice to breastfeed an infant. This study establishes the initial psychometric properties of the SPBFS based on a sample of 140 mothers participating in the federal supplemental food program Women, Infants, and Children.

RESULTS/CONCLUSIONS

the SPBFS was developed as a three-factor instrument. Preliminary findings confirm this structure and indicate that the SPBFS shows promise for helping explore how sexual perceptions of breastfeeding interact with the decisions a mother makes regarding breastfeeding.

Childbirth and Breastfeeding Over Three Decades: One Mother's Story

This article describes one mother's selected childbirth and breastfeeding experiences that transpired over the span of three decades. Her story is a source of inspiration and encouragement for breastfeeding mothers and health-care professionals who provide maternity care for today's childbearing women. Furthermore, this personal account reveals that, although breastfeeding support and childbirth services have improved over the past 30 years, more needs to be done to promote positive birth experiences and breastfeeding outcomes.

Exploring and influencing the knowledge and attitudes of health professionals towards extended breastfeeding

BACKGROUND

Although many U.S. professional health organizations have policy statements that support the breastfeeding of children beyond one year (extended breastfeeding), the actual attitudes of health workers towards this practice have not been explored. The purposes of this study were (1) to explore the knowledge and attitudes of various U.S. health professionals towards extended nursing and (2) to pilot an educational display for U.S. health professionals to promote their knowledge and attitudes towards extended breastfeeding.

METHODS

A total of 84 participants in a New York City academic medical center provided responses to a structured self-administered questionnaire given before and after an educational display.

RESULTS

Respondents reported negative attitudes towards extended breastfeeding at baseline, with negative attitudes increasing as the age of the breastfed child increased. After education, the percentage of participants who found breastfeeding acceptable for 1- or 2-year-old children increased from 61% to 89% (p < 0.001). Acceptability of 3- or 4-year-old children breastfeeding increased from 22% to 41% (p < 0.001).

CONCLUSIONS

Viewing educational media concerning older nursing children may lead to more positive attitudes towards extended breastfeeding among healthcare professionals.

A qualitative study of attitudes toward public breastfeeding among young Canadian men and women

This research aims to explore, in qualitative terms, attitudes held by a sample of university-educated young men and women residing in New Brunswick and Nova Scotia about breastfeeding in public places. In sum, 20 women and 27 men between the ages of 18 and 23 participated in moderated single-sex focus groups that discussed breastfeeding, following a list of prepared questions and using photographs as discussion cues. Although participants uniformly stated that they desired their future children to be breastfed, 31 of 47 expressed restrictive attitudes toward exposure of the breast (eg, "should use washrooms," "okay if discreet") and breastfeeding in restaurants. Eight expressed positive unrestricted statements about breastfeeding in public spaces. Addressing widely held attitudes toward breastfeeding in public spaces, in addition to providing information about breastfeeding's health benefits, may be helpful in campaigns promoting breastfeeding.

Breastfeeding support - the importance of self-efficacy for low-income women

Breastfeeding is a key determinant in promoting public health and reducing health inequality. Low-income women have a significantly lower level of breastfeeding. Midwives in the UK have been encouraged to implement the World Health Organization/United Nations Children's Fund's Ten Steps to Successful Breastfeeding, but to date, there has been no evaluation of the impact of the training initiative on the breastfeeding behaviours of low-income women. As part of a wider study, this qualitative component was designed to answer the question - what are the views and experiences of low-income women (defined by Jarman scores) in relation to their breastfeeding support received in the post-natal period? A sample of seven women was interviewed. The in-depth interviews were analysed using a qualitative, thematic approach based on the self-efficacy theory. The four themes that emerged from the data were the following: breastfeeding related to the woman's self-confidence, the social environment in which the woman lived, knowledge of breastfeeding and the influence of maternity services on breastfeeding outcomes. These themes were interpreted in relation to the self-efficacy theory. The findings suggest that the components that inform self-efficacy are consistent with the themes from the data, suggesting that midwives and other health professionals should take the psychosocial aspects of breastfeeding support into account. As this important feature of breastfeeding support is not explicitly part of the current Ten Steps to Successful Breastfeeding, we suggest that further research and debate could inform expansion of these minimum standards to include the psychosocial aspects.

Formative infant feeding experiences and education of NICU nurses

PURPOSE

To explore the formative infant feeding experiences and education of NICU nurses.

STUDY DESIGN AND METHODS

An ethnography was undertaken over 14 months in a level IV NICU in a free standing pediatric hospital in the Northeastern U.S. Purposeful sampling was used to select informants. General informants included 114 NICU nurses who were observed and informally interviewed an average of 3.5 times. Eighteen of these served as key informants and each was formally interviewed once with an additional average of 12 observations/informal interviews. Descriptions of feeding experiences and education were coded and analyzed for recurring patterns using NUD*IST software.

FINDINGS

The NICU nurses identified a norm for formula feeding during their formative experiences as children. The nurses described increased exposure to varied feeding methods during their adulthood, but breastfeeding was often associated with difficulties among their families and friends. The nurses in this study recounted minimal exposure to breastfeeding in nursing school. The nurses' personal experiences with breastfeeding were laden with strong emotional reactions intertwined with their feelings about motherhood.

CLINICAL IMPLICATIONS

Nurses' past experiences and education must be addressed if efforts are to be made to promote breastfeeding in the NICU. Breastfeeding education programs for nurses should include reflective components to help nurses identify structural barriers and reframe any negative personal experiences.

Prescription medication borrowing and sharing among women of reproductive age

OBJECTIVE

The purpose of this study was to describe the patterns of prescription medication borrowing and sharing among adults, particularly women of reproductive age.

METHODS

Data were collected from the 2001-2006 HealthStyles surveys, an annual mail survey conducted in the United States concerning trends in health behavior. The total responses received were 26,566 of 36,420 surveys mailed (response rate 73%). Of these total responses, there were 7,456 women of reproductive age (18-44 years). Survey questions included whether participants had ever shared or borrowed a prescription medication, how often participants shared or borrowed medications in the past year, and types of medications shared or borrowed. Data were weighted by matching sex, age, income, race, and household size variables to annual U.S. census data. Associations between demographic factors and borrowing and sharing were studied.

RESULTS

Overall, 28.8% of women and 26.5% of men reported ever borrowing or sharing prescription medications. Women of reproductive age were more likely to report prescription medication borrowing or sharing (36.5%) than women of nonreproductive age (>or=45 years) (19.5%) (rate ratio [RR] 1.87, 95% confidence interval [CI] 1.77-1.99). Of reproductive-aged women who borrowed or shared prescription medication, the most common medications borrowed or shared were allergy medications (43.8%) and pain medications (42.6%).

CONCLUSIONS

Prescription medication borrowing and sharing is a common behavior among adults and is more common among reproductive-aged women than among women in other age groups.

Why mothers stop breastfeeding: mothers' self-reported reasons for stopping during the first year

OBJECTIVES

Our goal was to determine why women stop breastfeeding at various times during their infant's first year.

METHODS

We analyzed self-reported data from 1323 mothers who participated in the Infant Feeding Practice Study II. Mail questionnaires were sent to mothers approximately 2, 3, 4, 5, 6, 7, 9, 10 1/2, and 12 months after their child's birth, in which they were asked to rate the importance of 32 reasons for their decision to stop breastfeeding. We applied exploratory factorial analysis to extract meaningful constructs of mothers' responses to the 32 reasons. We then compared the percentages of mothers who indicated that each reason was important in their decision to stop breastfeeding among various weaning ages and used multiple logistic regression models to examine sociodemographic differences in the most frequently cited reasons for stopping breastfeeding.

RESULTS

The perception that their infant was not satisfied by breast milk alone was cited consistently as 1 of the top 3 reasons in the mothers' decision to stop breastfeeding regardless of weaning age (43.5%-55.6%) and was even more frequent among Hispanic mothers and mothers with annual household incomes of <350% of the federal poverty level. Mothers' concerns about lactation and nutrition issues were the most frequently cited reasons for stopping breastfeeding during the first 2 months. Starting from the third month, self-weaning reasons were increasingly cited as important, with the statements "My baby began to bite" (31.7%), "My baby lost interest in nursing or began to wean himself or herself" (47.3%), and "Breast milk alone did not satisfy my baby" (43.5%) cited as the top 3 reasons at > or = 9 months of age.

CONCLUSIONS

Our findings about the major reasons why mothers stop breastfeeding at various times during their child's first year should be useful to health professionals when attempting to help mothers overcome breastfeeding barriers and to health officials attempting to devise targeted breastfeeding interventions on those issues prominent for each infant age.

An analysis of infant feeding content found within the Hong Kong print media

Worldwide public media greatly affect women's decisions about infant feeding and may not reflect evidence-based practices. The aims of this research were to (1) describe the characteristics of printed articles having infant-feeding content, (2) describe this thematic content, and (3) compare the thematic content found in groupings based on media type and language (English and Chinese). Four Chinese-language newspapers, the English-language newspaper, and 3 bilingual parenting magazines were analyzed. A multiphase qualitative and quantitative content analysis found 5 themes (social context, mothers' information, effects on baby, the value of breast milk, and the utility of formula). Significant differences were found based on media type and language. Although breastfeeding was usually positively framed in all the media, Chinese media had more inaccurate information. Through this analysis, areas where actions could be taken to improve the quality of information about infant feeding received by the public have been identified.

Is breastfeeding fair? Tensions in feminist perspectives on breastfeeding and the family

Breastfeeding is widely acknowledged to have health benefits for mothers and infants. Because it is sex-specific, it challenges the feminist principle of gender-neutral childbearing. Various feminist theories addressing breastfeeding from the perspective of gender ideology, cultural feminism, and history are reviewed and contrasted. Employment and race disparities are addressed within feminist contexts. Feminist health activism is suggested as a unifying perspective.

Attitudes, knowledge, and intentions related to breastfeeding among university undergraduate women and men

The purpose of the current study was to examine university undergraduate women's and men's attitudes and knowledge toward breastfeeding. Data were gathered for 111 women and 50 men. Data showed a significant relationship between positive attitudes toward breastfeeding and exposure to breastfeeding. Women and participants older than 20 years scored higher on measures of knowledge and attitudes. Results indicated that positive attitude toward breastfeeding was a significant predictor of intention to breastfeed among women and men. In conclusion, the results suggest that understanding attitudes among young adults is an important line of research. Further studies are needed to develop and evaluate interventions aimed at improving attitudes about breastfeeding and increasing initiation of breastfeeding among this population.

Knowledge, Attitudes, Exposure, and Future Intentions of Hong Kong University Students Toward Infant Feeding

OBJECTIVE

To explore relationships between university students' infant feeding knowledge, attitudes, breastfeeding exposures, and future infant feeding intentions.

DESIGN

Descriptive cross-sectional survey.

SETTING

This study was conducted at a large publicly funded university in Hong Kong. Student enrollment in the university is approximately 15,000.

PARTICIPANTS

Four hundred three male and female Chinese university students. Participants were young (94.4% less than 25 years of age), undergraduate students (92.2%), unmarried (99.2%), and without children (100%).

RESULTS

Sixty-three percent of participants wanted their future child to be breastfed. Infant feeding knowledge scores ranged from 28.6% to 100%, with a mean of 71.1% (SD= 13.3), indicating overall high knowledge levels. Participants who intended to breastfeed were more likely to have positive attitudes, to have been breastfed themselves, or to know someone who had breastfed.

CONCLUSIONS

The results provide information to health care providers on the planning of effective breastfeeding promotion programs. Findings from this study suggest that promoting breastfeeding solely to childbearing couples is unlikely to result in significant improvements in either breastfeeding initiation or duration. Future infant feeding campaigns should be directed at the societal level to change negative attitudes and to increase acceptance of breastfeeding as a normal and natural feeding method.

Changes in public attitudes toward breastfeeding in the United States, 1999-2003

Data from the HealthStyles survey, an annual national mail survey to US adults, were examined to understand changes in public attitudes toward breastfeeding. The 1999 and 2003 HealthStyles surveys included four breastfeeding items related to public attitudes toward breastfeeding in public and toward differences between infant formula and breastmilk. The percentage of respondents in agreement with the statement, "Infant formula is as good as breastmilk," increased significantly from 14.3% in 1999 to 25.7% in 2003. The increase was particularly large among people of low socioeconomic status. The percentage increase in agreement that "feeding a baby formula instead of breastmilk increases the chances the baby will get sick" grew at a statistically significant level, but the total change was small (2.7 percentage points). No significant total changes were found for the other two survey items. The perception that infant formula is as good as breastmilk would be expected to soften a woman's commitment to breastfeeding should she be faced with obstacles to doing so. The findings underscore the need to educate the general public that breastfeeding is the best method of feeding and nurturing infants. Pediatricians and other health professionals should recommend human milk for all infants for whom breastfeeding is not specifically contraindicated.

Student nurses' attitudes and beliefs about breast-feeding

This study explored the breast-feeding attitudes and beliefs of students newly enrolled in an urban university baccalaureate nursing program. A qualitative approach was used to conduct in-depth semistructured interviews with 12 students prior to their formal course work in maternal-child nursing. Four themes emerged from the data analysis: 1. Personal experiences are important in the development of breast-feeding attitudes and beliefs. 2. The students generally believed that breast-feeding offered benefits for babies and mothers, but the beliefs were stronger for those who grew up with breast-feeding as the norm. 3. All the students believed that there were barriers to breast-feeding in the United States that they identified as the societal view of the breast, dependence/independence conflicts, and concerns about intimacy. 4. The students identified an educational rather than promotional role for nurses in breast-feeding because of conflicts about personal choice. This study suggests that students need help identifying their attitudes and beliefs about breast-feeding and reflecting how their personal experiences influence breast-feeding promotion.

Baccalaureate nursing students' breastfeeding knowledge: a descriptive survey

This descriptive survey study assessed the breastfeeding knowledge of junior and senior baccalaureate nursing students (N=80) who had successfully completed their obstetric nursing course. With a possible perfect knowledge score of 100, participants' scores ranged from 35 to 85 with a sample mean score of 60. Surprisingly, most (85%) did not know that breastfeeding is recommended for the first year of an infant's life, and only five participants knew the proper management of mastitis. Well over one third (41.3%) of the participants opposed breastfeeding in public. Findings reveal the need to strengthen both the didactic and clinical components of the obstetric course curriculum. The acquisition of breastfeeding knowledge at the student level will better equip novice nurses to provide more effective breastfeeding counsel and support for childbearing women and to promote the achievement of the breastfeeding objectives of both the United States and the World Health Organization.

Clinical lactation practice: 20 years of evidence

Lactation consultants depend on a vast multidisciplinary knowledge base to support their practices. To coincide with the 20-year anniversary of the International Lactation Consultant Association, the authors sought to highlight the knowledge base to demonstrate how practice has been affected. Using standard databases, they extracted English-language scientific literature related to breastfeeding and maternal and infant health outcomes; factors associated with breastfeeding initiation, exclusivity, and duration; lactation physiology; common breastfeeding challenges; breastfeeding practices within vulnerable populations; health professional support of breastfeeding; and breastfeeding practices in developing countries of Africa. Summaries of research are provided to demonstrate scientific method and knowledge evolution. As the knowledge of the biological, behavioral, and environmental factors that affect breastfeeding continues to grow, researchers and lactation consultants will identify additional research areas. Thus, the cycle of describing and explaining phenomena, testing interventions to improve practice, and ultimately improving breastfeeding outcomes worldwide will continue.

Sharing the science on human milk feedings with mothers of very-low-birth-weight infants

Mother's milk provides protection from serious and costly morbidity for very-low-birth-weight infants (<1500 g), including enteral feeding intolerance, nosocomial infection, and necrotizing enterocolitis. However, NICU and maternity nurses may be hesitant to encourage mothers to initiate lactation because of a reluctance to make mothers feel guilty or coerced. This article reviews the evidence for the health outcomes of mothers' milk feeding in very-low-birth-weight infants and provides examples of ways to share this science with mothers so that they can make an informed feeding decision.

Mothers' decisions to change from formula to mothers' milk for very-low-birth-weight infants

OBJECTIVE

The purpose of this study was to examine maternal decisions about providing milk for a very-low-birth-weight (VLBW) infant, when the initial maternal intent was to formula-feed.

DESIGN

Using prospective, purposive sampling, semistructured interviews were conducted with 21 of 23 eligible mothers over a 9-month period. Audio-recorded data were transcribed verbatim, coded, categorized, and subjected to dimensional analysis.

SETTING

The study took place in a 52-bed, tertiary urban neonatal intensive-care unit.

PATIENTS/PARTICIPANTS

Mean maternal age was 26.5 years (range = 18-38), and mean infant birth weight and gestational age were 705.4 g (range = 504-1,310), and 25.8 weeks (range = 23-33), respectively. Of the 21 mothers, 76% were African American or Latina; 62% were low income.

MAIN OUTCOME MEASURES

We evaluated mothers' initial reasons for selecting formula and changing the decision to provide their milk, whether they were made to feel guilty or coerced, the processes of establishing and maintaining lactation, and breastfeeding outcomes at 1-month postbirth.

RESULTS

Mothers initially chose formula because they had no breastfeeding role models and were fearful of pain and lifestyle modifications. They changed this decision after the nurse or physician talked with them about the health benefits for their infant. Of the 21 women, all denied feeling pressured, coerced, or guilty about the decision change, and all identified rewards to themselves and their infants. All mothers provided milk for greater than or equal to 30 days, 19 went on to feed at breast, and 2 became certified breastfeeding peer counselors for the Rush Mothers' Milk Club.

CONCLUSION

These findings underscore the role of nurses and physicians in providing evidence-based information about mothers' milk and indicate that sharing this knowledge does not make mothers of VLBW infants feel pressured, coerced, or guilty.

Breastfeeding rates in the United States by characteristics of the child, mother, or family: the 2002 National Immunization Survey

OBJECTIVE

In the third quarter of 2001, the National Immunization Survey (NIS) began collecting data on the initiation and duration of breastfeeding and whether it was the exclusive method of infant feeding. Using the data from the 2002 NIS, this study estimates breastfeeding rates in the United States by characteristics of the child, mother, or family.

METHODS

The NIS uses random-digit dialing to survey households nationwide with children 19 to 35 months old about vaccinations and then validates the information through a mail survey of the health care providers who gave the vaccinations. In 2002, approximately 3500 households from the NIS were randomized to 1 of the 3 rotating topical modules that covered breastfeeding.

RESULTS

More than two thirds (71.4%) of the children had ever been breastfed. At 3 months, 42.5% of infants were exclusively breastfed, and 51.5% were breastfed to some extent. At 6 months, these rates dropped to 13.3% and 35.1%, respectively. At 1 year, 16.1% of infants were receiving some breast milk. Non-Hispanic black children had the lowest breastfeeding rates. Breastfeeding rates also varied by participation in day care or the Women, Infants, and Children program, socioeconomic status, and geographic area of residence.

CONCLUSIONS

Although the rate of breastfeeding initiation in the United States is near the national goal of 75%, at 6 and 12 months postpartum the rates of breastfeeding duration are still considerably below the national goals of 50% and 25%, respectively. In addition, rates of exclusive breastfeeding are low. Strenuous public health efforts are needed to improve breastfeeding behaviors, particularly among non-Hispanic black women and socioeconomically disadvantaged groups.

Public beliefs about breastfeeding policies in various settings

To understand the public beliefs about breastfeeding policies in various settings and to examine the associations of these beliefs with sociodemographic characteristics, we analyze the data from the 2001 Healthstyles survey, which is an annual national mail survey to US adults. We found that establishing workplace breastfeeding policies and lactation rooms in public places are the most acceptable breastfeeding policies surveyed, especially among African Americans and low-income populations. The overall population appears to approve of breastfeeding in public, but less-educated or older people (aged >/=45 years) are less likely to do so. In general, there is relatively less public support for breastfeeding education in high schools. The results indicate that many Americans, especially African Americans and those with low household income, believe that women who breastfeed need extra support both at work and in public places. A variety of policy strategies would be appropriate to create a favorable environment for breastfeeding.