Exploring the associations of food and financial insecurity and food assistance with breastfeeding practices among first-time mothers

OBJECTIVE

Social determinants of health (SDoH), such as food and financial insecurity and food assistance, are potentially modifiable factors that may influence breastfeeding initiation and duration. Knowledge gaps exist regarding the relationship between these SDoH and infant feeding practices. We explored the relationships of food and financial insecurity and food assistance with the continuation of breastfeeding at four months postpartum among mothers and whether race and ethnicity modified these associations.

DESIGN

Mothers retrospectively reported food and financial insecurity and receipt of food assistance (e.g. Women, Infants and Children and Supplemental Nutrition Assistance Program) during pregnancy with their first child and infant feeding practices (exclusive/mostly breastfeeding v. exclusive/mostly formula feeding) following the birth of their first child. Sociodemographic-adjusted modified Poisson regressions estimated prevalence ratios and 95 % CI.

SETTING

Minneapolis-St. Paul, Minnesota.

PARTICIPANTS

Mothers who participated in the Life-course Experiences And Pregnancy study (LEAP) (n 486).

RESULTS

Ten percent of mothers reported food insecurity, 43 % financial insecurity and 22 % food assistance during their pregnancies. At four months postpartum, 63 % exclusively/mostly breastfed and 37 % exclusively/mostly formula-fed. We found a lower adjusted prevalence of breastfeeding at four months postpartum for mothers who reported experiencing food insecurity (0·65; 0·43-0·98) and receiving food assistance (0·66; 0·94-0·88) relative to those who did not. For financial insecurity (aPR 0·92; 0·78, 1·08), adjusted estimates showed little evidence of an association.

CONCLUSIONS

We found a lower level of breastfeeding among mothers experiencing food insecurity and using food assistance. Resources to support longer breastfeeding duration for mothers are needed. Moreover, facilitators, barriers and mechanisms of breastfeeding initiation and duration must be identified.

Taking the path of least resistance: a qualitative analysis of return to work or study while breastfeeding

Background

In order to meet World Health Organization recommendations for breastfeeding, many women need to combine breastfeeding with return to work or study. Barriers are often encountered when returning to work or study, which can lead to premature cessation of breastfeeding. This study aimed to explore Australian women’s experiences of breastfeeding at one multi-campus university.

Method

This paper draws on the qualitative findings from a mixed-methods study conducted between April and November 2017. An online survey was used to explore women’s experiences of breastfeeding at university. In total, 108 people participated in the survey. After the deletion of incomplete surveys, 79 staff and students survey responses were analysed. In-depth interviews were also carried out with 10 staff and students. Open text responses and in-depth interviews were analysed using thematic analysis.

Results

The analysis revealed four themes. The first theme, University as a positive and progressive environment for breastfeeding, explores staff and students’ experiences of maternity leave, flexible work arrangements, and on-campus childcare, and their relationships with tutors, supervisors, managers and colleagues. The second theme, Finding private and safe spaces for breastfeeding, presents staff and students’ experiences of using designated rooms, car parks, corridors, classrooms, and offices to breastfeed and express breast milk, and their experiences related to storage of breast milk. The third theme, Feeling self-conscious and unprofessional, reflects women’s experiences of mixing their professional and personal lives, and feeling guilty for taking time out to breastfeed. The fourth theme, Developing resilience to judgement, captures women’s realisation that breastfeeding on campus requires the development of a “thick skin” and the capacity to not be offended easily.

Conclusions

Sustaining breastfeeding requires time and commitment on behalf of the mother, as well as a supportive workplace or study environment. Transforming university campuses into breastfeeding friendly environments is long overdue and requires organisational commitment to achieve genuine reform.

Maternal Perception of Adequacy of Mother's Milk Among Mothers Giving Birth at a Teaching Hospital in Sri Lanka

BACKGROUND:

Sri Lanka boasts high rates of early and exclusive breastfeeding. Perceived inadequacy of milk, a global problem, is the main cause for early cessation of breastfeeding.

RESEARCH AIMS:

The aims of this study are to (a) determine the prevalence, (b) identify the risk factors, and (c) ascertain the association that maternal psychological distress has with perceived inadequacy of milk (PIM), among mothers during the early postpartum period. Identifying and addressing modifiable risk factors for PIM may improve mothers' satisfaction with breastfeeding.

METHODS:

A cross-sectional descriptive study of mothers ( n = 249) during the first week after birth was conducted at Colombo North Teaching Hospital (Ragama, Sri Lanka) from May 1, 2016, to June 10, 2016. Participants were recruited when the infant was more than 24 hours but less than 7 days old. A self-administered questionnaire, including the six-item Kessler Psychological Distress Scale, was used.

RESULTS:

The majority of mothers (78%) perceived their milk quantity to be adequate. A family member telling mothers that their milk supply was low had the most significant associations with perceived inadequacy. Other associations were antenatal maternal complications and birth by cesarean section. Kessler scores indicating psychological distress occurred in 26% of all participating mothers, with a higher mean score in those with PIM.

CONCLUSIONS:

Sri Lankan family members should be educated further about normal patterns of milk production during the postpartum period. The authors recommend that PIM be included in screening tools for postpartum depression in Sri Lanka.

The Use, Perceived Effectiveness and Safety of Herbal Galactagogues During Breastfeeding: A Qualitative Study

The World Health Organization recommends breastfeeding as the normal infant feeding method and that infants being breastfed should be regarded as the control group or norm reference in all instances. There are many factors which could contribute to a new mother ceasing breastfeeding early, with the most commonly reported reason being perceived insufficient breast milk supply. The use of herbal galactagogues is increasingly common worldwide. Literature review identified a need for more research in the area of herbal galactagogue use during breastfeeding. Twenty in-depth semi-structured interviews were undertaken with breastfeeding women who used herbal galactagogues, to document use and explore their perceived effectiveness and safety of herbal galactagogues. Several indicators of breastfeeding adequacy were mentioned as participants described their experiences with the use of herbal galactagogues. Confidence and self-empowerment emerged as an over-arching theme linked to positive experiences with the use of herbal galactagogues. Despite the lack of clinical trial data on the actual increase in measured volume of breast milk production, indicators of breastfeeding adequacy boosted participants’ confidence levels and resulted in psychological benefits. This study highlighted the importance of considering the potential psychological benefits of using herbal galactagogues, and how this translates into breastfeeding adequacy.

"Be positive as well as realistic": a qualitative description analysis of information gaps experienced by breastfeeding mothers

Background

Early breastfeeding cessation is common in many regions of the world despite high breastfeeding initiation rates and strong evidence of the health benefits to both mother and infant. This research investigated mothers’ perceived breastfeeding information needs in order to increase our understanding of this phenomenon.

Methods

Surveys were distributed by public health nurses in a health region in Western Canada to mothers who had initiated breastfeeding and whose infants were six to eleven months old to learn more about their infant feeding experiences during the birth to six month period. Two open-ended survey questions asked: (1) What support or advice did you receive that helped you with feeding your baby?” and (2) “What support or information on feeding your baby would you have found helpful but did not receive?” A total of 191 eligible mothers submitted a survey (response rate 35%) between January and October 2012. Qualitative description was used in analyzing the responses of the women who provided comments for the open-ended questions.

Results

While many mothers felt their information needs were met, others outlined important content areas where more information and guidance was desired. These areas included milk supply management, frequency/duration of feeds, proper latch and feeding positions, nipple care, expression/pumping, other nutrition sources, and realistic information regarding common breastfeeding concerns.

Conclusions

The results suggest that several of the information gaps highlighted by respondents in this study closely align with commonly cited reasons for breastfeeding cessation including perceived insufficient milk supply, latching difficulties and nipple discomfort. The findings emphasize the need for lactation support with systematic measures to ensure breastfeeding mothers are universally provided with information on these key content areas. Lactation supports should reinforce critical information and seek feedback to ascertain that mothers have clearly understood the information provided. Ensuring mothers receive and understand key breastfeeding information is a modifiable factor in efforts to increase breastfeeding duration rates.