Dads make a difference: an exploratory study of paternal support for breastfeeding in Perth, Western Australia

Effectiveness of male partner-targeted breastfeeding education and support interventions on mothers' breastfeeding self-efficacy in central Ethiopia: a cluster-randomized controlled trial

The purpose of this study was to evaluate the effect of male partners' targeted antenatal and postnatal breastfeeding education and support interventions on maternal breastfeeding self-efficacy in central Ethiopia. A two-arm parallel group cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, central Ethiopia. A total of 408 couples from 16 clusters were randomly assigned to either the intervention (n = 204) or control group (n = 204). The analysis was conducted using an intention-to-treat approach. A generalized estimating equation (GEE) analysis was done to evaluate the effectiveness of the interventions. Maternal BFSE was significantly higher among mothers whose male partner received breastfeeding education and support interventions than those who did not receive the interventions (130 (65.0%) v 90 (45.9%), P < 0.001). The net effect of the intervention on improving maternal BFSE was 20.9% [95% CI: 16.9%-24.9%]. In the GEE model, maternal BFSE was 48% [RR = 1.48, 95% CI: 1.23, 1.79] higher in the intervention group than the control group. Involving male partners in breastfeeding promotion activities can enhance the mother's self-efficacy and confidence in breastfeeding.Trial registration: ClinicalTrials.gov identifier (NCT number), NCT05173454. Registered on 30/12/2021.

Breastfeeding - a survey of fathers' support needs and preferred sources of information

BACKGROUND

Fathers can be a critical source of breastfeeding support for their partner, but little is known about what fathers would like to learn about breastfeeding. Partner's support and encouragement enhances mother's breastfeeding confidence and boost the capacity to address breastfeeding difficulties effectively. The aims of this study were to explore what fathers regard as important to learn around breastfeeding, and their current and preferred sources of information.

METHODS

A structured online survey was conducted, between September 2022 and November 2022, with fathers containing three sections: (1) sociodemographic variables; (2) perceived importance of 26 breastfeeding topics; and (3) sources of breastfeeding information. A convenience sample of expectant and current fathers aged 18 years or older, who were expecting a baby or had a child aged one year or younger, living in Australia, and able to complete survey in English was recruited. Participants were recruited on Facebook advertisement.

RESULTS

A total of 174 fathers participated in the study, majority (75%) were aged 30-39 years, current dads (74%), and university educated (69%). The breastfeeding topics that fathers perceived as the most important/ important to learn about were how to work with their partner to overcome breastfeeding challenges, how fathers can be involved with their breastfed baby, the types of support fathers can provide to breastfeeding mothers, what to expect in the first week and the benefits of breastfeeding. The most preferred health professional sources of breastfeeding information were midwives, child and family nurses and doctors. Among non-health professional sources of support, mobile app, friends and family were most popular.

CONCLUSION

Breastfeeding information to enhance fathers' knowledge and awareness of common breastfeeding challenges, and fathers' role in supporting their breastfeeding partner, appear to be (most) important for fathers. Mobile app appears to be among the most preferred non-health professional ways to provide breastfeeding information to fathers.

Fathers' needs of breastfeeding support: Perspective of health nurses

PURPOSE

To explore the improvement of health education on father's participation in breastfeeding from the perspective of maternal and child health nurses.

METHODS

Qualitative phenomenological research was used, and 15 maternal and child health nurses who provided breastfeeding support were invited. With semi-structured deep interviews and on-site recordings, data were analyzed through content analysis.

RESULTS

Four main themes were extracted, including 'cultivating fathers' awareness of participation in breastfeeding', 'collaboration of multiple disciplines to improve health education on breastfeeding for fathers in hospital', 'Simulated scenarios to develop fathers' skills in solving breastfeeding problems', and 'establishing a hospital-community interface network to improve breastfeeding continuation care after hospital discharge'.

CONCLUSIONS

Medical and health care departments should attach importance to guidance on health education for fathers' breastfeeding participation, cultivate fathers' awareness of participation in breastfeeding, provide multi-disciplinary collaboration-based health education on breastfeeding for fathers from the prenatal period and improve post-discharge health education on breastfeeding. The additional education being suggested would contribute to fathers being able to play an important role in breastfeeding.

Fathers' Attitudes Toward Mothers with Infants and its Association with Exclusive Breastfeeding in a Rural Community of Karnataka

Male participation in reproductive and child health improves breastfeeding rates. The role of fathers in breastfeeding may be crucial in improving exclusive breastfeeding (EBF) rates. This study explored the fathers' attitudes and support and its association with EBF in mothers with infants attending a rural primary health center in Karnataka. A cross-sectional descriptive study was conducted on mothers with infants visiting a rural primary health center between December 2020 and February 2021. A pretested semi-structured questionnaire was used to collect data to ascertain the exclusivity of breastfeeding and other sociodemographic factors. The fathers' attitudes and support toward mothers during and after pregnancy were measured on a 5-point Likert scale. Quantitative variables were expressed in median and interquartile ranges, and qualitative variables were expressed using percentages and proportions. The association was determined using the Chi-square test and Spearman's correlation test. The data were collected using Epi Data and analyzed using Epi info v 3. A total of 169 mothers participated in the study. The self-reported EBF was 148 (87.1%). The fathers' attitudes and support to the mothers were found to be more favorable during the antenatal period in 97% of the women. The fathers' attitudes and support in the antenatal period and after delivery were not associated with the mothers' exclusivity in breastfeeding. The present study concluded that there is no association between the fathers' attitudes and support before and after the delivery of the infant and mothers' exclusivity in breastfeeding.

Investigating Maternal Perspectives of Breastfeeding Support Targeted Towards Fathers in the Milk Man Mobile App Intervention

BACKGROUND

The support of her infant's father is one of the most important factors influencing a mother's breastfeeding success, and an increasing number of interventions are targeted towards fathers. Engaging fathers as agents to influence a maternal behavior is potentially problematic, yet few studies report on maternal experiences.

OBJECTIVE

This study aims to explore mothers' perspectives of their partners' use of Milk Man, a father-focused breastfeeding smartphone app, and the acceptability of this approach.

MATERIALS AND METHODS

New mothers (N = 459) whose partners had access to the app completed a questionnaire at six weeks postpartum. These data were used to determine knowledge, use and perspectives of the app. A sentiment analysis was conducted on responses to an open-ended question seeking maternal perspectives of the app.

RESULTS

Just over a quarter of mothers (28%) had been shown something from the app, and 37% had discussed something from Milk Man with their partner. There were 162 open-ended responses related to mothers' perspectives of the app. Relevant responses (n = 129) were coded to an overall sentiment node and then to a total of 23 child nodes (sub-nodes). Most comments were positive (94), with a smaller number either negative (25) or neutral (21). Negative comments related to the usability of the app and not its intent or content.

CONCLUSION

Mothers found the father-focussed breastfeeding app to be acceptable. When designing interventions targeting one group to affect the behaviour of another, inclusion of measures to gain the perspectives of both should be seen as an imperative.

"Don't Feel Like You Have to Do This All on Your Own": Exploring Perceived Partner Support of Breastfeeding Among Black Women in Kentucky

BACKGROUND

Few researchers have explored partner breastfeeding support among Black women, who report low breastfeeding rates compared to women of other cultural groups. Ways to encourage partner support of Black women's breastfeeding can be understood from an Afrocentric perspective.

RESEARCH AIM

To explore perceptions of partner support among Black mothers to develop a culturally relevant framework of partner breastfeeding support.

METHODS

Secondary data analyses of qualitative data from a larger prospective, cross-sectional mixed methods study were utilized. Participants from Kentucky (N = 14), aged 23-71, who breastfed for at least 6 months, were recruited to participate in individual interviews. Professionally transcribed interviews were analyzed using Braun and Clarke's (2006) thematic analysis.

RESULTS

By integrating the Breastfeeding Coparenting Framework and Optimal Conceptual Theory, we identified four culturally affirming partner support themes that participants believed impacted their breastfeeding experiences: (a) doing research, (b) offering care, (c) verbalizing praise, and (d) achieving teamwork, and three culturally incongruent partner support barrier themes: (e) withdrawing commitment, (f) politicking bodies, and (g) stripping agency.

CONCLUSION

Participants who breastfed for at least 6 months largely attributed their breastfeeding success to the support received from their partners. Our findings offer a culturally relevant framework of partner breastfeeding support that can facilitate intervention efforts with participants and their partners to increase breastfeeding rates among this population.

Breastfeeding in the pandemic: A qualitative analysis of breastfeeding experiences among mothers from Canada and the United Kingdom

BACKGROUND

Previous research shows that the COVID-19 pandemic resulted in both barriers and facilitators to breastfeeding. However, little research has looked specifically at first-time mothers' experiences of breastfeeding during the pandemic or compared experiences of mothers living in different countries.

AIM

This research explores mothers' breastfeeding experiences to describe how the COVID-19 pandemic has affected breastfeeding journeys in Canada and the United Kingdom.

METHODS

Ten semi-structured online interviews were undertaken with first-time mothers who breastfed their baby at least once during the COVID-19 pandemic and are living in Canada or the United Kingdom. Interview transcripts were coded inductively using thematic analysis.

FINDINGS

One overarching theme (all on mother) and four sub-themes were identified: 1) accessing and advocating for health care, 2) social support, 3) becoming a mother in isolation, and 4) breastfeeding baby. Similar themes were constructed for both countries.

DISCUSSION

Mothers reported that diminished health care and social support created challenges in their breastfeeding journey. Many mothers reported receiving virtual breastfeeding support, which was largely experienced as unhelpful. Some mothers reported fewer distractions from visitors and more one-on-one time with their infant, which helped them to establish breastfeeding and a strong mother-infant bond.

CONCLUSION

In both Canada and the United Kingdom, new mothers need consistent, reliable health care and social support when breastfeeding. This study supports the need to protect breastfeeding support in the midst of a global emergency and beyond to ensure positive breastfeeding experiences for both mother and baby.

Validity and reliability of the Turkish version of the paternal breastfeeding self-efficacy scale - Short form for fathers

BACKGROUND

Women supported by their partners are more likely to initiate and maintain breastfeeding and overcome related challenges. Therefore, reliable measurement tools are needed to determine whether fathers can provide this support.

AIM

This study aimed to (1) examine the psychometric properties of the Paternal Breastfeeding Self-Efficacy Scale-Short Form (BSES-SF) in Turkish fathers, including internal consistency reliability, test-retest reliability, construct validity using Confirmatory Factor Analysis (CFA); and (2) assess the relationship between the BSES-SF and paternal demographic factors.

METHODS

A methodologically study was conducted between December 26-2018 and June 26-2019 at the pediatrics clinics of two research hospitals of medical schools in Konya, Turkey. The sample consisted of 221 fathers of infants aged 2 to 6 weeks who visited the clinics for routine examinations. Data were collected using a sociodemographic questionnaire and the Turkish version of the Paternal BSES-SF. After evaluating the language equivalence and content validity of the scale, test-retest reliability, internal consistency and construct validity were examined. In evaluation of the data frequency/percentage, mean, standard deviation, independent groups t test, ANOVA Analysis, Bartlett's Test of Sphericity, Confirmatory Factor Analysis, Pearson Product-Moment correlation and Cronbach α analysis were used. The study was approved by Interventional Clinical Research Ethics Committee of the Faculty of Health Sciences of Selcuk University in Turkey.

RESULTS

The translated Paternal BSES-SF had a Cronbach's alpha of 0.93 and a test-retest reliability coefficient of 0.96. The factor loadings ranged from 0.42 to 0.76. The Paternal BSES-SF had a one-factor structure similar to the original scale. Fathers who were unemployed, had lower economic status, and unplanned pregnancy had significantly lower mean Paternal BSES-SF scores. Paternal education regarding breastfeeding increased mean Paternal BSES-SF retest scores (p<0.05).

CONCLUSIONS

The Paternal BSES-SF was a valid and reliable measure to assess fathers' confidence in their ability to assist mothers with breastfeeding in Turkey. Turkish researchers and health workers can use this instrument as a reference for promoting exclusive breastfeeding.

Fathers involvement in child feeding and its associated factors among fathers having children aged 6 to 24 months in Antsokia Gemza Woreda, Ethiopia: Cross-sectional study

BACKGROUND

Father Involvement is exercising positive influences on child feeding. Mothers are usually the primary caregivers for young children. The role of fathers in the proper child feeding of young children has not been a frequent topic of study. Past research has found low rates and little is known about fathers' involvement in child feeding for children 6-23 months in Ethiopia. The aim of this study is to assess fathers' involvement in child feeding children aged 6-24 Months.

OBJECTIVES

To assess fathers' involvement in child feeding and associated factors among fathers having children aged 6 to 24 months.

METHODOLOGY

A community-based cross-sectional study design was conducted from Jan 23/2022 to April 07/2022. A systematic random sampling technique was applied to select study participants. A total of 408 respondents participated in the study. Data was entered into EPI data version 3.1 and then exported to SPSS version 25 for analysis. Bivariable and multivariable logistic regression was used for analysis.

RESULT

Father's involvement in child feeding was 43.1%. Factors that were significantly associated with good fathers involvement in child feeding include urban residence(AOR = 3.878, 95% CI = (1.408-10.678), male sex of the youngest child(AOR = 3.681, 95% CI = (1.678-8.075)), first birth order of the youngest child(AOR = 3.970, 95% CI = (1.212-13.005)), Better(secondary and higher) educational status (AOR = 4.945,95% CI = (1.043-23.454)) and AOR = 5.151, 95% CI = (1.122-23.651)), having ever heard information(AOR = 8.593, 95% CI = (3.044-24.261)), good knowledge (AOR = 3.843,95% CI = (1.318-11.210)), positive attitude (AOR = 8.565, 95% CI = (3.521-20.837)) and good culture (AOR = 10.582,95% CI = (2.818-39.734)).

CONCLUSIONS

Father involvement in child feeding was poor in Antsokia Gemza Woreda. Urban residences, male sex of the youngest child, first birth order of the youngest child, better (secondary and higher) educational status, having ever heard information, good knowledge, positive attitude, and good culture were significantly associated with fathers' involvement in child feeding. Health information dissemination on father involvement in child feeding should be strengthened.

Print media coverage of breastfeeding in Great Britain: Positive or negative?

Media can be a powerful communication tool to promote breastfeeding, influence mothers' breastfeeding behaviour, create positive social norms and generate support among stakeholders and policymakers for breastfeeding. However, negative stories could deter women from starting or continuing to breastfeed. This study aimed to describe the breadth and focus of the media coverage of breastfeeding and the message frames that are found in three of the most widely read national newspapers and three popular women's magazines in Great Britain over a 12-month period, as part of the Becoming Breastfeeding Friendly in Great Britain (BBF-GB) study. For this retrospective media analysis, 77 articles were identified and 42 were included in the study for coding and analysis. We conducted two content analyses to examine the articles' (1) message framing and (2) alignment with the eight components of an 'enabling breastfeeding environment' using the BBF Gear framework. Articles featuring breastfeeding appear in British newspapers and women's magazines all year round. Twenty-four per cent had a neutral tone, while 59% predominantly focused on the positive aspects or positive social support for breastfeeding, and 17% were predominantly focused on the negative aspects or negative social attitudes towards breastfeeding. The articles mainly focused on personal stories reflecting societal barriers and positive shifts (68%), with 12% presenting an analysis of breastfeeding evidence or barriers. There were fewer references to the legislation (5%) and availability of funding (2%) and support (9%). There was no coverage of national coordination and strategy, evaluation systems, or the political will to raise breastfeeding rates.

The Role of Fathers in Promoting Exclusive Breastfeeding

The cornerstone of a newborn's nutrition is breastfeeding. Due to its well-known benefits for mothers, children, and society in the short and long term, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend it as the best way of feeding the baby during the first six months of life. The family, particularly the spouse, may significantly influence the baby's quality of nursing. On a global scale, previous studies have demonstrated that family members (such as a mother's spouse, partner, or grandmother) not only affect her choice to start and endure breastfeeding but also significantly contribute to the early postnatal period's cessation of appropriate breastfeeding. A father's knowledge and attitude are fundamental in this regard, as he has the most critical role in helping women with parenting and feeding their babies. Furthermore, because the father's role is considered important in a family, the partner's or wife's perception of the father's attitude may alter her subjective criteria about exclusive breastfeeding (EBF). Future initiatives should target new mothers and their spouses to see how they may provide the most beneficial assistance to new mothers. The main focus should be on targeting newly married couples. The father's lack of involvement may be due to the hierarchical structure of power within households. Because of this hierarchical aspect, partners or fathers may significantly influence a mother's choice to nurse their child correctly. Household chores, childcare for grown-up children, guaranteeing the well-being of their spouse, preparing meals, recognizing a newborn's hunger cues, burping, and changing the infant's diaper after feedings, all these factors indirectly support the mother in initiating and enduring the nursing of a child.

The Effect of a Father's Support on Breastfeeding: A Systematic Review

Aim: Including fathers in breastfeeding education programs may raise infant breastfeeding rates and durations. The aim of the study was to assess the effect on breastfeeding of breastfeeding education and/or psychosocial interventions in which fathers are included. Method: The study is based on the PRISMA method, the technique that is used in systematic reviews. A search was conducted in the literature over the period November 1, 2021-December 1, 2021 using keywords and without imposing any time restrictions. The databases "PubMed," "Web of Science," Scopus," "Medline," and "CINAHL" were scanned. Results: A total of 462 publications were reached. However, only 7 studies were considered for review on the basis of the inclusion criteria. Six of these 7 studies indicated that the support of the father increased the breastfeeding rate. Conclusions: This review shows that a father's support of breastfeeding improves breastfeeding outcomes. Including fathers in the breastfeeding process and ensuring their active participation increase breastfeeding rates.

Postnatal mental health, breastfeeding beliefs, and breastfeeding practices in rural China

Background

The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems, breastfeeding beliefs and breastfeeding practices in rural China.

Methods

Cross-sectional data were collected in November and December 2019 from 742 mothers of infants under 6 months old in rural Sichuan Province, China. Maternal mental health (depression, anxiety, and stress symptoms) was assessed using the Depression, Anxiety, and Stress Scale (short form). Breastfeeding beliefs were assessed using the Iowa Infant Feeding Attitude Scale and Breastfeeding Self-Efficacy Scale (short form). Breastfeeding practices were assessed through a 24-h dietary recall questionnaire. Ordinary least squares regression, multiple logistic regression and heterogeneous effects analyses were used to identify associations between symptoms of mental health problems and breastfeeding outcomes.

Results

The average age of sample infants was 2.7 months. Among mothers, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of exclusive breastfeeding in the previous 24 h was 38.0%. Depression symptoms were significantly associated with breastfeeding attitude (𝛽= − 1.11, 95% CI: − 2.07, − 0.14) and breastfeeding self-efficacy (𝛽= − 3.19, 95% CI: − 4.93, − 1.45). Anxiety and stress symptoms were significantly associated with breastfeeding self-efficacy (𝛽= − 1.81, 95% CI: − 3.43, − 0.18 and 𝛽 = − 2.88, 95% CI: − 4.98, − 0.78, respectively). There were no significant associations between symptoms of mental health problems and exclusive breastfeeding. The heterogeneous effects analyses revealed that less educated mothers with symptoms of stress had lower odds of exclusive breastfeeding than educated mothers without symptoms of stress (OR: 0.53, 95% CI: 0.25,1.10). Mothers of younger infants had higher odds of exclusive breastfeeding than the mother of older infants, regardless of depression, anxiety, or stress symptoms.

Conclusion

Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy; however, these symptoms are not associated with breastfeeding practices. Maternal educational level and infant age may play a role in mothers’ breastfeeding practices. To improve breastfeeding practices, interventions should employ a multi-dimensional approach that focuses on improving maternal mental well-being and considers demographic characteristics.

Relationship Between Feeders and Exclusive Breastfeeding and Mixed Feeding During the First Month of Life

BACKGROUND

The critical time to continue or stop breastfeeding is during the first month after hospital discharge. Mothers receive lactation and physical support by fathers and others bottle-feeding human or formula milk to their infants.

PURPOSE

To describe the effect of feeders (mothers, fathers, and others) and different milk feeding on infants' weekly exclusive breastfeeding rates, from birth to 1 month after discharge.

METHODS

This study was a secondary analysis of a descriptive longitudinal study of mothers' (full-term: n = 77; late preterm: n = 39) breastfeeding experience, frequency of feeding, and infant feeding behaviors. Mothers completed a weekly questionnaire of who (mothers, fathers, and others) fed their infants human or formula milk by direct breastfeeding or bottle-feeding.

RESULTS

More than 60% of mothers reported fathers and others bottle-fed their infants. Exclusive breastfeeding rates were significantly higher when only mothers fed their infants at week 1 (P < .001), week 3 (P < .05), and week 4 (P < .05). Exclusive breastfeeding rates were negatively affected across time by bottle-feeding any human or formula milk for all feeders. When fathers bottle-fed their infants at week 1, the relative rates of exclusive breastfeeding at week 4 decreased to 52% (OR = 0.103; 95% CI, 0.26-0.404; P < .0001).

IMPLICATION FOR PRACTICE

Individuals providing early bottle-feeding adversely affect breastfeeding outcomes. Providers need to address maternal and paternal knowledge gaps about early breastfeeding practice.

IMPLICATIONS FOR RESEARCH

Further research is needed to explore clinical standard of care for management of infant weight loss, early supplementation, and support of exclusive breastfeeding outcomes.

What are LGBTQI+ parental experiences of healthcare support and decision-making regarding infant feeding options? A grounded theory study

OBJECTIVE

To explore LGBTQI+ parental experiences regarding their interactions with healthcare professionals as a resource for feeding options during the prenatal-to-neonatal period.

STUDY DESIGN

This single-center, interview-based qualitative study of LGBTQI+ parents utilized grounded theory to identify and verify emergent themes and subthemes. We developed a conceptual framework to illustrate relationships among themes and subthemes, as well as opportunities for healthcare professionals and families to improve LGBTQI+ parental support.

RESULTS

Thematic saturation was attained after interviewing 21 parents from 12 families. Analyses revealed four main themes representing opportunities for improvement: education, continuity of care, parental engagement and open communication. Personal and interpersonal factors influenced parental experiences and decisions, which shaped ultimate feeding outcomes.

CONCLUSIONS

LGBTQI+ parents revealed challenges of establishing feeding practices that best aligned with their values and goals. Recognizing these factors can help healthcare professionals improve their counseling, engagement and support of LGBTQI+ parents.

Cumulative childhood interpersonal trauma and parenting stress: The role of self-capacities disturbances among couples welcoming a newborn

BACKGROUND

The birth of a child is a life-defining event which tends to widen the gap between parents' resources and the demands they face, generating parenting stress. In this regard, individuals who experienced childhood trauma, particularly cumulative childhood interpersonal trauma (CCIT), appear more vulnerable, with higher rates of parenting stress. However, dyadic studies are lacking and the mechanisms explaining the association between CCIT and parenting stress remain unknown, limiting the promotion of resilience in parental couples.

OBJECTIVE

Based on the Self-Trauma Model and the Actor-Partner Interdependence Model, this study examined the role of self-capacities disturbances (i.e., affect dysregulation, identity impairment and interpersonal conflicts) in the association uniting CCIT and parenting stress.

PARTICIPANTS AND SETTINGS

A randomly selected sample of 421 parental couples of an infant.

METHODS

Participants completed self-reported measures online.

RESULTS

Path analyses revealed that CCIT was associated to greater parenting stress through affect dysregulation and identity impairment, in both mothers and fathers (R² = 22.4%; 20.7%). APIM modeling revealed a dyadic association between mothers' proneness to interpersonal conflicts and fathers' parenting stress, in addition to indirect effects involving all three self-capacities in the associations between one parent's CCIT and their partner's parenting stress.

CONCLUSIONS

CCIT-exposed individuals may experience parenting stress through difficulties with self-capacities at the individual and dyadic level, highlighting these capacities as promising intervention targets during the postpartum period, and emphasizing the need to involve both parents since intricate dyadic patterns may be at play.

Breastfeeding, nutrition and type 1 diabetes: a case-control study in Izmir, Turkey

Background

The relationship between infant breastfeeding and type 1 diabetes mellitus (DM) is unclear but it has been suggested that there may be a link between many environmental factors, including dietary antigens affecting diabetes epidemiology.

The main objective of this study is to investigate nutritional risk factors, especially breastfeeding early in life that may be associated with the development of type 1 DM and to determine the relationship these factors have with the disease.

Methods

This research is a case-control study and was carried out in Ege University Children’s Hospital in İzmir, Turkey between 13 January 2020 and 5 March 2020. A total of 246 children aged between 4 and 14 years were included in the study. The case group consisted of patients diagnosed with type 1 DM followed-up by Ege University Children’s Hospital’s Endocrinology Unit and the control group included non-diabetic children attending the same hospital’s General Pediatric Outpatient Clinic. A structured questionnaire was created by the researchers after reviewing the literature related to nutritional and other risk factors for type 1 DM. The questionnaire was administered by interviewing the parents and it was related to the child, mother and family of the child. In this study, breastfeeding duration was defined as the total duration of breastfeeding and exclusive breastfeeding meant that the child received only breast milk from the mother.

Results

The mean age at diagnosis was 6.30 ± 4.03 years for cases and 7.48 ± 2.56 years for controls. We found that each monthly increase in exclusive breastfeeding duration provided a 0.83-fold (95% CI 0.72, 0.96) decrease in the risk of type 1 DM. Introduction of cereals in the diet at the sixth month or earlier was associated with a 2.58-fold (95% CI 1.29, 5.16) increased risk.

Conclusions

Determining the contribution of exclusive breastfeeding to the disease is important in establishing preventive policies. A longer duration of exclusive breastfeeding may be an important role in preventing the disease. This free intervention that truly works will be cost-effective. Future studies are needed to clarify the role of both exclusive and non-exclusive breastfeeding on the development of type 1 DM.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00470-z.

Neighborhood Disadvantage, Greenness, and Population Density as Predictors of Breastfeeding Practices: A Population Cohort Study from Finland

BACKGROUND

Many environmental factors are known to hinder breastfeeding, yet the role of the family living environment in this regard is still poorly understood.

OBJECTIVES

We used data from a large cohort to identify associations between neighborhood characteristics and breastfeeding behavior.

METHODS

Our observational study included 11,038 children (0-2 years) from the Southwest Finland Birth Cohort. Participant information was obtained from the Medical Birth Register and municipal follow-up clinics. Neighborhood socioeconomic disadvantage, greenness, and population density were measured for a period of 5 years prior to childbirth within the residential neighborhood on a 250 × 250-m grid. Any breastfeeding and breastfeeding at 6 months were the primary outcomes. Binary logistic regression models were adjusted for maternal health and socioeconomic factors.

RESULTS

Adjusted analyses suggest that mothers living in less populated areas were less likely to display any breastfeeding (OR: 0.46; 95% CI: 0.36, 0.59) and breastfeeding at 6 months (OR: 0.37; 95% CI: 0.34, 0.40). Mothers living in highly disadvantaged neighborhoods were less likely to display any breastfeeding if the neighborhood was less populated (OR: 0.54; 95% CI: 0.30, 0.95) but more likely to breastfeed at 6 months if the neighborhood was highly populated (OR: 3.74; 95% CI: 1.92, 7.29). Low greenness was associated with higher likelihood of any breastfeeding (OR: 3.82; 95% CI: 1.53, 9.55) and breastfeeding at 6 months (OR: 4.41; 95% CI: 3.44, 5).

CONCLUSIONS

Our results suggest that neighborhood characteristics are associated with breastfeeding behavior in Finland. Unravelling breastfeeding decisions linked to the living environment could help identify interventions that will allow the appropriate support for all mothers and infants across different environmental challenges.

Parental Cohabitation and Breastfeeding Outcomes Among United States Adolescent Mothers

AbstractBackground: Adolescent mothers in the United States experience disproportionately lower rates of breastfeeding compared to older mothers. Evidence suggests that paternal support helps improve breastfeeding outcomes; however, support is difficult to quantify. Parental cohabitation is easy to identify and could be used to quantify paternal support. Research Aim: Our study is to investigate the association between parental cohabitation and breastfeeding initiation and duration among US adolescent mothers. Materials and Methods: Data from the 2011-2017 National Survey of Family Growth were used. Our study sample included primipara, adolescent mothers (aged 15-19 years) who gave birth to a singleton (n = 1,867). Multivariate logistic regression and Cox Proportional Hazards models were used to analyze the relationship between cohabitation and breastfeeding initiation and duration, respectively. All models were subsequently stratified by race/ethnicity due to evidence of effect modification. Results: After adjusting for all a priori confounders, cohabiting with the infant's father at birth was associated with increased odds of breastfeeding initiation compared to noncohabiting adolescent mothers (odds ratio [OR]: 1.5, 95% confidence interval [CI]: 1.08-2.16). After stratifying by race/ethnicity, both Hispanic and non-Hispanic white adolescent mothers were more likely to initiate breastfeeding if cohabiting with the infant's father (OR_Hispanic: 1.9, 95% CI: 1.10-3.35; OR_{Non-Hispanic white}: 1.7, 95% CI: 1.05-2.87). We found no evidence of an association between parental cohabitation and breastfeeding duration. Conclusions: Our study found evidence that cohabitation status at birth increases the odds of breastfeeding initiation in adolescent mothers. Practitioners should consider cohabitation status when working with adolescent mothers.

Exclusive breastfeeding in rural Western China: does father's co-residence matter?

BACKGROUND

China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father's co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father's co-residence and breastfeeding family support as well as maternal decision-making power.

METHODS

A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding.

RESULTS

The exclusive breastfeeding (0-6 months) rate was 16% in rural western China. Fathers' co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227-0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (β =0.109, P = 0.105; β =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (β = - 0.196, P = 0.007).

CONCLUSIONS

Fathers' co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father's education to help them better involvement and show more respect to mothers' decisions.

Relationships between paternal attitudes, paternal involvement, and infant-feeding outcomes: Mixed-methods findings from a global on-line survey of English-speaking fathers

The breastfeeding intention-behaviour gap remains wide in developed countries. Current studies have focused on maternal attitudes and behaviours concerning infant feeding in order to explore barriers to breastfeeding continuation. There has been limited consideration of the impact of paternal attitudes and behaviours, despite contemporary parenthood evolving and evidence indicating that there are greater levels of paternal involvement in routine childcare tasks. This mixed-methods study used a triangulation design to examine the associations between paternal attitudes towards parenthood and infant-feeding methods, levels of paternal involvement, infant-feeding outcomes, and father-infant relationships. Fathers of infants <52 weeks completed an online survey providing quantitative data (N = 212) and qualitative data (N = 208). For the quantitative data, fathers completed validated measures about their attitude towards parenthood and infant feeding, levels of paternal involvement, and infant-feeding history. For the qualitative data, questions explored influences on paternal attitudes towards infant feeding and the father-infant relationship. After controlling for covariates, regression analyses found egalitarian attitudes towards parenthood were positively associated with both attitudes towards breastfeeding and levels of paternal involvement. Positive paternal attitudes towards breastfeeding were significantly associated with increased likelihood of breastfeeding. A thematic framework analysis indicated fathers' attitudes towards infant feeding were largely influenced by their families and partners or healthcare professionals. Polarised views were expressed about the impact infant-feeding methods had on the father-infant relationship, although fathers were united in their desire to bond with their infant. Addressing paternal attitudes and the importance of father-infant involvement in domains other than feeding maybe beneficial in supporting breastfeeding and the father-infant relationship.

Relatively speaking? Partners' and family members' views and experiences of supporting breastfeeding: a systematic review of qualitative evidence

This review aimed to synthesize qualitative evidence of views and experiences of partners and other family members who provided breastfeeding support for a relative. The Joanna Briggs Institute (JBI) methodology for systematic reviews of qualitative evidence was followed. Seven databases: CINAHL, MEDLINE, EMBASE, PsycINFO, Scopus, Maternal and Infant Care, and Web of Science were searched. Partners and other family members (e.g. grandmothers, siblings) of women in any countries were included. Included papers were critically appraised. The JBI meta-aggregative approach was used to analyze data and form synthesized findings. Seventy-six papers from 74 studies were included. Five synthesized findings were: (i) spectrum of family members' breastfeeding knowledge, experiences and roles; (ii) the complexity of infant feeding decision making; (iii) the controversy of breastfeeding in front of others; (iv) impact of breastfeeding on family; and (v) it takes more than just family members: support for family members. Partners' and family members' views and experiences of breastfeeding support reflected multi-faceted personal, social, financial, cultural, religious, emotional, psychological, and societal factors of the support they provided (or not). Healthcare professionals should engage them in breastfeeding discussions with the woman, and offer tailored and practical guidance relevant to help them to appropriately support the woman. This article is part of the theme issue 'Multidisciplinary perspectives on social support and maternal-child health'.

Maternal perception of paternal breastfeeding support: A secondary qualitative analysis

OBJECTIVE

To describe how women perceive paternal support of breastfeeding and identify actions women value during the early breastfeeding postpartum.

DESIGN

A qualitative secondary analysis of semi-structured interviews using thematic analysis collected after birth and via telephone at 1, 2, 3, and 4 weeks after discharge.

SETTING

A regional medical center in the southeast region of the United States.

PARTICIPANTS

Sixty-two women yielded 130 transcripts with 32 transcripts conducted after birth, and 19, 16, 27, and 36 transcripts conducted after discharge via telephone at weeks 1, 2, 3, and 4, respectively.

FINDING

Women reported three themes of paternal support of breastfeeding (1) participating in the breastfeeding decision, (2) being a partner of breastfeeding, and (3) caring for breastfeeding mothers.

CONCLUSION AND IMPLICATION FOR PRACTICE

Paternal support of breastfeeding is a learning process that requires teamwork for women and their partners to master breastfeeding. Women and their partners as co-parents solve breastfeeding problems and achieve their breastfeeding goals, which promotes maternal well-being and bonding with their infants. Future interventions will guide partners to support breastfeeding and women's postpartum physical and psychological needs.

The association between paternal characteristics and exclusive breastfeeding in Ghana

Background

Studies have shown that partners play an influential role in exclusive breastfeeding practice and that they can act as either deterrents or supporters to breastfeeding. However, there are limited studies on the influence of partners’ characteristics on exclusive breastfeeding in Ghana. This study examined the association between partners’ characteristics and exclusive breastfeeding in Ghana.

Methods

This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Infants less than 6 months old (exclusively breastfed or not) with maternal and paternal characteristics were included in the study. A total of 180 participants were used for the study. A binary logistic regression was used to examine the influence of partners’ characteristics on exclusive breastfeeding.

Results

Partners’ characteristics such as education, desire for children, religion, and children ever born were associated with exclusive breastfeeding. Mothers whose partners had primary education (AOR = 0.12; CI 95%: 0.02–0.93; p = 0.04) were less likely to practice exclusive breastfeeding compared to those whose partners had no formal education. Also, mothers whose partners desired more children (AOR = 0.20; CI 95%: 0.06–0.70; p = 0.01) were less likely to practice exclusive breastfeeding compared to those whose partners desire fewer children.

Conclusion

Improving EBF requires the involvement of partners in exclusive breastfeeding campaigns/programmes. A more couple-oriented approach is required by health practitioners to educate and counsel both mothers and partners on the importance of exclusive breastfeeding in Ghana.

Race and Ethnicity and Exclusive Breastfeeding Success

Introduction: Breast milk is the ideal food for infants. However, at 6 months of age, <25% of infants in the United States are exclusively breastfed. While racial disparities in breastfeeding have been documented, questions remain about the contributions of paternal race and ethnicity to breastfeeding. Materials and Methods: This single-site, prospective study investigated the association of parental characteristics and exclusive breastfeeding (EBF). EBF and non-EBF (N-EBF) infants who were >35 weeks gestational age were compared at nursery discharge and ∼30 days of age. Results: At nursery discharge (n = 499), mean birth weight (±standard deviation [SD]) was greater in the EBF versus N-EBF cohort (3.4 ± 0.4 versus 3.3 ± 0.5 kg, p = 0.01). When compared to the N-EBF cohort, infants in the EBF cohort were significantly more likely to have the following characteristics: (1) vaginal birth; (2) non-Hispanic parents; (3) parents with higher socioeconomic status, and (4) parents who are English-speaking (p < 0.01 for all). Similar findings persisted at 30 days. Non-Hispanic parents were 2 (95% confidence interval [CI]: 1.4-3.3) and 3.5 (95% CI: 1.5-7.9) times more likely to exclusively breastfeed than Hispanic parents at nursery discharge and 30 days, respectively. At nursery discharge, families with a Hispanic mother and non-Hispanic father were more likely to EBF than families with a Hispanic mother and father (odds ratio 2.9, 95% CI: 1.1-7.6). In multivariate model, parental ethnicity was associated with EBF at discharge (p = 0.03) and 30 days (p = 0.02). Conclusion: Paternal ethnicity may influence EBF. Addressing disparities in EBF may warrant investigations into culturally inclusive and family-centered interventions.

Barriers to Breastfeeding: Supporting Initiation and Continuation of Breastfeeding: ACOG Committee Opinion, Number 821

ABSTRACT

Breastfeeding has maternal, infant, and societal benefits. However, many parents experience obstacles to achieving their breastfeeding goals, leading to reduced rates of breastfeeding initiation and continuation. Despite efforts to increase rates of breastfeeding initiation and continuation, inequities still persist. The factors that influence an individual's desire and ability to breastfeed are varied and include individual parent considerations; practitioner influences; hospital barriers; societal factors, such as workplace and parental leave policies; access to lactation support; and social support of their breastfeeding goals. A multidisciplinary approach that involves community, family, parents, and health care professionals will strengthen the support for parents and help them achieve their breastfeeding goals.

Impact of a Face-To-Face Versus Smartphone App Versus Combined Breastfeeding Intervention Targeting Fathers: Randomized Controlled Trial

BACKGROUND

Despite the recognized health and economic benefits of exclusive breastfeeding, few Australian infants are exclusively breastfed beyond 5 months of age. Social support for breastfeeding, in particular the support of an infant's father, has been identified as a crucial element for successful breastfeeding.

OBJECTIVE

The objective of this study was to determine the effectiveness of various father-focused breastfeeding interventions in terms of key infant feeding outcomes.

METHODS

The study was a 4-arm, factorial, randomized controlled trial conducted in Perth, Australia. The trial arms included a control group and 3 interventions, consisting of a face-to-face father-focused antenatal breastfeeding class facilitated by a male peer facilitator; Milk Man, a breastfeeding smartphone app designed specifically for fathers; and a combination of both interventions. Expecting couples were recruited from hospital-based antenatal classes and block randomized to 1 of the 4 arms. Each partner completed surveys at recruitment and at 6 weeks and 26 weeks postpartum. Primary outcomes were duration of exclusive and any breastfeeding. Secondary outcomes included age of introduction of formula and complementary foods, maternal breastfeeding self-efficacy, and partner postpartum support.

RESULTS

A total of 1426 couples were recruited from public (443/1426, 31.1%) and private (983/1426, 68.9%) hospitals. Of these, 76.6% (1092/1426) of fathers completed the baseline questionnaire, 58.6% (836/1426) completed the 6-week follow-up questionnaire, and 49.2% (702/1426) completed the 26-week follow-up questionnaire. The average age of fathers who completed the baseline questionnaire was 33.6 (SD 5.2) years; the majority were born in Australia (76.4%) and had attended university (61.8%). There were no significant differences between the control and any of the intervention groups in any of the infant feeding outcomes or level of breastfeeding self-efficacy and postpartum partner support reported by mothers.

CONCLUSIONS

This study did not demonstrate that any intervention was superior to another or that any intervention was inferior to the standard care delivered in routine antenatal classes. Further studies are needed to test the effectiveness of these interventions in more socioeconomically diverse populations that are likely to benefit most from additional partner supports.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12614000605695.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1186/s12884-015-0601-5.

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

Background

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

Methods

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

Results

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

Conclusions

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

From dyad to triad: a survey on fathers' knowledge and attitudes toward breastfeeding

Fathers are known to impact breastfeeding outcomes. We aimed to explore paternal knowledge and attitude toward breastfeeding, and possible association with breastfeeding rates at discharge. In this cross-sectional study, we enrolled 200 fathers of healthy term neonates. At discharge, fathers were asked to rate their degree of agreement to 12 items on a 5-point Likert scale. A total score was obtained from their answers. Univariate binary logistic regression analysis was used to verify if the total score was predictive of exclusive breastfeeding at discharge. A multivariable logistic regression model was then used to adjust for possible confounders. ROC analysis was performed, and a Youden's total score cut-off value was determined to define total score's performance in predicting exclusive breastfeeding at discharge. Fathers showed a solid knowledge of maternal (87%) and neonatal (98%) benefits of breastfeeding, skin-to-skin (99.5%), rooming-in (79%), and responsive feeding (67.5%); conversely, only 51% knew about the recommended use of pacifiers. Fathers felt personally involved in babies' feeding in 79% of cases. An association was found between total score and exclusive breastfeeding at discharge at univariate (OR: 1.07, p = 0.04) but not at multivariable analysis (OR: 1.07, p = 0.067). ROC analysis was not statistically significant (AUC 0.58, p = 0.083).Conclusion: By using a novel instrument aimed at quantifying fathers' knowledge and overall attitude toward breastfeeding, this study underlines the importance of including fathers in the promotion of breastfeeding. Expanding the classic mother-baby dyad to a more modern mother-father-baby triad may impact breastfeeding outcomes at discharge. What is known: • Social support plays a major role in improving breastfeeding outcomes. • Fathers may greatly influence initiation and duration of breastfeeding; the more they know, the more helpful they can be. What is new: • A multidisciplinary team created a structured questionnaire aimed at quantifying fathers' knowledge and attitude toward breastfeeding. • The association between a higher questionnaire total score and exclusive breastfeeding rates at discharge highlights the importance of including fathers in the promotion of breastfeeding, as part of the breastfeeding team.

Effectiveness of an integrated breastfeeding education program to improve self-efficacy and exclusive breastfeeding rate: A single-blind, randomised controlled study

BACKGROUND

Low self-efficacy affects new mothers' ability to sustain breastfeeding. Interventions that increase self-efficacy could improve sustained breastfeeding.

OBJECTIVES

To develop an integrated breastfeeding education program based on self-efficacy theory, and evaluate the effect of the intervention on first-time mothers' breastfeeding self-efficacy and attitudes.

DESIGN

A single-blind, randomised controlled trial.

SETTING

A prenatal clinic of a teaching hospital.

PARTICIPANTS

First-time mothers with a singleton pregnancy (12-32 weeks' gestation) and their support partners were selected by convenience sampling (N = 104) and allocated by block-randomization to an intervention or control group.

METHODS

A 3-week breastfeeding intervention program was developed based on self-efficacy theory. The intervention group received the breastfeeding program; the control group received standard care. Data between groups were compared for scores on breastfeeding self-efficacy, infant feeding attitude, and breastfeeding practice, which were assessed using the Breastfeeding Self-Efficacy Scale-Short Form, the Iowa Infant Feeding Attitude Scale, and a structured questionnaire, respectively. Repeated data measurements were collected at baseline, 36-weeks' gestation, and postpartum at 1-week, and 1-, 3-, and 6-months.

RESULTS

Ninety-three mothers completed the study. Data were compared for the self-efficacy intervention group (n = 50) with the control group (n = 43). Baseline measures did not differ between groups. The intervention group had significantly higher breastfeeding self-efficacy at 36 weeks' gestation (mean difference (MD): 7.3, p < .001), and postpartum at 1-week (p < .001), 1-month (p < .001) and 3-months (p < .01) with MD: 6.7, 7.9, and 8.1, respectively; differences in scores from baseline were also significantly greater from 36 weeks' gestation to 3-months (MD from 9.1~9.9, p < .001) and 6-months postpartum (MD: 7.0, p < .05). Infant feeding attitude scores significantly improved from 36 weeks' gestation to 6-months postpartum for the intervention group (MD from 3.5~7.4, p < .05). Rates for exclusive and predominant breastfeeding postpartum were significantly higher for the intervention group vs control (p < .02) at 1-week (98% vs. 86%), 1-month (100% vs. 90.7%), and 3-months (94% vs. 76.7%). Odds ratio (OR) postpartum for exclusive and predominant breastfeeding was greater for the intervention group at 3-months (OR = 4.7, 95% Confidence interval (CI), 1.2 -18.6; p = .05) and for exclusive breastfeeding at 6-months (OR: 2.82, 95% CI 1.0-8.1; p = .05).

CONCLUSIONS

The breastfeeding education intervention improved breastfeeding self-efficacy, infant feeding attitudes, and exclusive breastfeeding rates. The breastfeeding education program could be effective for sustaining breastfeeding in new mothers.

TRIAL REGISTRATION

Registered with www.clinicaltrials.gov (NCT03807726).

Designing a model of breastfeeding support in Australia: An appreciative inquiry approach

In Australia, one of the most frequent reasons for not breastfeeding is a previously unsuccessful experience. This qualitative study used an appreciative inquiry approach to co-design a model of peer and professional breastfeeding support, in a metropolitan area of New South Wales (NSW) Australia, in collaboration with women who have had previous negative experiences of breastfeeding. In total, 30 mothers, health professionals and peer supporters participated in a two-part study, involving interviews and a collaborative workshop. The data were analysed using content analysis. The appreciative inquiry approach led to a solution focused attitude among participants and a commitment to improving breastfeeding support. We noted a level of apathy when the participant groups were interviewed individually prior to the collective workshop. During the collaborative workshop, all three participant groups came together to look at what was currently working well and designed improvements for the future. Midwifery care was identified as important for the start of the breastfeeding journey, during pregnancy and for the first 1-2 weeks after birth, but thereafter it was community and trained peer counsellors who were prioritised for breastfeeding support. Participants identified the need for a variety of support options including face-to-face meetings, Skype meetings, phone calls and/or texting. Workshop participants emphasised the need for women, especially those with previous negative experiences, to be linked in with their local peer support community group. An appreciative inquiry approach brought together all key stakeholders to develop practice-based change which included the end user and care providers. The collaborative workshop enabled participants to come together, as individuals, rather than as designated health professionals or trained peer counsellors, or breastfeeding women with negative experiences. This led to a unified approach and a harnessing of collective energy to initiate positive change.

Spouse's participation in perinatal care: a qualitative study

Background

Pregnancy is one of the most important periods of any woman’s life, wherein the support of her relatives, especially her spouse, enables her to tolerate the difficulties with good memories. However, in Iran, there are very few studies on the participation of spouses in the perinatal period. Therefore, the present study aimed to explain the concept of spouse participation in perinatal care.

Methods

This is a qualitative study that was carried out in 2018 on spouse participation in perinatal care in Qom, Iran. Purposive sampling from pregnant or postpartum women, spouses, midwifery care providers, and key informants was performed according to study inclusion criteria. Semi-structured in-depth interviews were carried out until the data saturation was met. Also, the data analysis was performed based on a conventional content analysis approach according to Graneheim & Lundman steps using MAXQDA software (v.10). Five Guba and Lincoln criteria were applied to ensure the trustworthiness of data.

Results

Fifty-three final codes were classified into 18 sub-categories, 7 categories, and 3 themes including empathy (emotional and cognitive understanding), accountability (supporting, position management, compassion), and consequences (help improvement of family function, improvement of maternal-neonatal health).

Conclusions

Based on the findings of this study, the concept of men’s participation in this period has been defined as a set of empathic and responsive behaviors that can lead to improvement of the family function and mother and baby health.

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

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

Surprising Differences in the Practice of Exclusive Breastfeeding in Non-Roma and Roma Population in Serbia

Background: Exclusive breastfeeding is essential for early childhood development, although the use of adaptive milk formulas instead of breastfeeding is widespread nowadays. This study aimed to examine the prevalence of exclusively breastfed infants under the age of 6 months in non-Roma and Roma population and factors associated with this practice.

Materials and Methods: This study is a secondary analysis of the Serbian Multiple Indicator Cluster Survey investigating non-Roma and Roma infants under the age of 6 months. The study included mothers of 321 non-Roma and 164 Roma infants younger than 6 months. Univariate and multivariate logistic regression served to analyze factors associated with the practice of exclusive breastfeeding in both populations.

Results: The prevalence of exclusive breastfeeding was almost the same among mothers in both non-Roma and Roma population (13.3 vs. 13%, p = 0.910). Exclusive breastfeeding was significantly more often (p < 0.001) among wealthier women, women whose newborns were over 2,500 g on birth, multipara, and women who had not established menstrual cycle among both populations. Living outside the capital significantly diminishes the chance for exclusively breastfed infants in the non-Roma community (Vojvodina: OR 0.16, CI 95% 0.03–0.92; eastern Serbia: OR 0.02, CI 95% 0.01–0.35) as well as living in the rural area (urban: OR 10.35, CI 95% 1.94–55.28). Unexpectedly, in the non-Roma population, not staying in the same room with the newborn in the maternity ward increases the chance for the baby to be exclusively breastfed (OR 7.19, CI 95% 1.80–28.68). The same pattern has been observed in Roma population. Non-Roma mothers multipara are more likely to exclusively breastfeed their children than primipara (OR 7.78, CI 95% 1.09–20.93), while among Roma mothers, the inverse association has been found although not significant (OR 0.42, CI 95% 0.14–1.23). Attending a childbirth preparation program more than 18 times increases the chances of infants being exclusively breastfed (OR 18.65, CI 95% 1.34–53.67). In the Roma population, there was no single woman that attended a childbirth preparation program.

Conclusion: The pattern of exclusive breastfeeding significantly differs between non-Roma and Roma populations. Preventive work should have focus on strengthening support to mothers and medical staff in maternity wards.

Determinants of Full Breastfeeding at 6 Months and Any Breastfeeding at 12 and 24 Months among Women in Sydney: Findings from the HSHK Birth Cohort Study

The aim of this study was to report on breastfeeding duration up to 24 months and determine the predictors of breastfeeding duration among women in South Western Sydney, one of the most culturally diverse and socioeconomically disadvantaged regions of New South Wales (NSW), Australia. Mother–infant dyads (n = 1035) were recruited to the Healthy Smiles Healthy Kids birth cohort study. Study data were collected through telephone interviews at 2, 4, 8, 12, and 24 months postpartum. Cox proportional hazards models were used to determine factors associated with the risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. The majority of mothers (92.3%) had initiated breastfeeding. At six months, 13.5% of infants were fully breastfed, while 49.9% received some breast milk. Only 25.5% and 2.9% of infants received some breast milk at 12 and 24 months, respectively. Lower maternal education level, lower socioeconomic status, full-time employment, maternal smoking during pregnancy, and caesarean delivery were associated with increased risk of stopping full breastfeeding at six months and any breastfeeding at 12 and 24 months. Older maternal age and partner’s preference for breastfeeding were associated with an increased likelihood of continuing any breastfeeding at 12 and 24 months. These findings present a number of opportunities for prolonging breastfeeding duration in disadvantaged communities in NSW.

Fathers' Experiences and Perspectives of Breastfeeding: A Scoping Review

During the transition to parenthood, fathers may experience significant challenges, including finding a place for themselves as important participants in the context of infant breastfeeding by female partners. Although generally viewed as a healthy process and the preferred method of infant feeding, breastfeeding may result in some fathers feeling excluded, inadequate, and helpless. Breastfeeding is known to adversely affect various aspects of a father’s life, including parenting self-efficacy, quality of life (QOL), the relationship with the partner, and the perception that breastfeeding limits time available for father–infant bonding. The current scoping review explores the experiences, roles, and needs of fathers of breastfed infants by synthesizing and discussing the findings from relevant published research studies (n = 18). Recommendations, drawn from the scoping review findings, are offered to guide primary health providers and services.

Women's Perceptions about Breastfeeding: A Preliminary Study

Background: Breastfeeding rates are low in many communities in the United States and require attention to come up with ideas that will help increase breastfeeding. This study investigated the effects of income, age, race and education on mothers’ perceptions about breastfeeding and whose needs and views should be considered in a women’s breastfeeding journey. Methods: A survey was distributed via email and Facebook to 525 participants; 453 participants (86.3%) responded to the survey. Results: Younger adults were more likely to agree that fathers should have some say about breastfeeding. Those earning USD 0–USD 50,000 were more likely to agree relative to those with higher incomes on children being entitled to mother’s milk, and children’s needs over-riding those of others. There was a statistically significant difference by education about women's wishes about breastfeeding being considered more important than those of their spouses. However, there was no statistically significant difference for any demographic group for breastfeeding decisions coming from women only. On women’s breasts being primarily for infant's nutrition, people who earned USD 0–USD 50,000 were more likely to agree relative to those who earned more than USD 50,000; younger adults were significantly more likely to agree. Those who earned USD 0–USD 50,000 were more likely to agree relative to those in other income brackets that extended family members should have input regarding babies being breastfed; minority participants were significantly more likely to agree relative to white participants; those with less than 4-year college education were more likely to agree relative to those with a minimum of four-year college education. Younger adults were more likely to agree that employers must provide extended maternity leave to make it easier for mothers to breastfeed. On women having the right to breastfeed in public places, younger adults were significantly more likely to agree compared to older adults. Conclusion: Women have favorable views about breastfeeding and prefer being in charge about decisions to breastfeed.

Breastfeeding in the Community-How Can Partners/Fathers Help? A Systematic Review

Support from partners/fathers and families can play a significant role in a mother’s decision to initiate, continue or cease breastfeeding postnatally. This study systematically reviewed published studies to determine the impact of specific types of partner support on breastfeeding initiation, duration and exclusivity. We used the 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines for the review. Seven computerized bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) were searched. Of a total of 695 articles retrieved from the databases, seven studies met the inclusion criteria and reported on breastfeeding initiation, duration and exclusivity. Four of the seven studies found that partner support in the form of verbal encouragement to new mothers increased breastfeeding duration and exclusivity. Other types of partner supportive actions that led to improved breastfeeding behavior included sensitivity of the partner to the nursing mother’s needs, assistance in preventing and managing breastfeeding difficulties, and helping with household and child care duties. This review showed that specific supportive actions of partners/fathers in the community positively improved breastfeeding practices. To maximise the impact of breastfeeding policies and interventions among new mothers, breastfeeding programmes should consider the involvement of partners/fathers and their specific roles.

Fathers' Involvement in Their Wives'/Partners' Breastfeeding: A Descriptive Correlational Study

BACKGROUND

Fathers' involvement has been identified as a significant predictor in maternal breastfeeding outcomes. Its benefits have been well-documented, but limited studies have examined its influencing factors.

RESEARCH AIM

To investigate factors influencing fathers' involvement in their partners' breastfeeding.

METHODS

A descriptive correlational design was used. Data were collected from 151 fathers from four obstetrics wards of a public hospital in Singapore from October 2016 to December 2016. Self-administered questionnaires were used to examine factors such as fathers' knowledge and involvement in breastfeeding, attitudes towards breastfeeding, and perceived improvements of knowledge and attitudes for fathers' involvement in breastfeeding on the discharge day of their partners' and 2 weeks post-birth. Data were analyzed using IBMSPSS24.0.

RESULTS

Fathers' involvement in their partners' breastfeeding yielded a moderate to high mean score. The multiple linear regression analysis showed that five independent factors significantly influenced fathers' involvement in their partners' breastfeeding: (1) perceived approval of family members and friends in fathers' breastfeeding involvement; (2) knowledge regarding breastfeeding and their involvement; (3) perceived behavioral control for fathers' breastfeeding involvement; (4)marital relationship; and (5) perceived improvements of knowledge and attitudes 2 weeks post-birth.

CONCLUSIONS

The study provided evidence on the significant factors that influenced fathers' involvement in their partners' breastfeeding, which can be used to guide healthcare professionals when providing appropriate support to facilitate fathers' involvement. Future studies should continue to evaluate fathers' involvement in breastfeeding longitudinally so that relevant support can be rendered.

Determinants of Exclusive Breastfeeding Cessation in the Early Postnatal Period among Culturally and Linguistically Diverse (CALD) Australian Mothers

There are limited epidemiological data on exclusive breastfeeding (EBF) among culturally and linguistically diverse (CALD) Australian mothers to advocate for targeted and/or culturally-appropriate interventions. This study investigated the determinants of EBF cessation in the early postnatal period among CALD Australian mothers in Sydney, Australia. The study used linked maternal and child health data from two local health districts in Australia (N = 25,407). Prevalence of maternal breastfeeding intention, skin-to-skin contact, EBF at birth, discharge, and the early postnatal period (1-4 weeks postnatal), were estimated. Multivariate logistic regression models were used to investigate determinants of EBF cessation in the early postnatal period. Most CALD Australian mothers had the intention to breastfeed (94.7%). Skin-to-skin contact (81.0%), EBF at delivery (91.0%), and at discharge (93.0%) were high. EBF remained high in the early postnatal period (91.4%). A lack of prenatal breastfeeding intention was the strongest determinant of EBF cessation (adjusted odds ratio [aOR] = 23.76, 95% CI: 18.63-30.30, for mothers with no prenatal breastfeeding intention and aOR = 6.15, 95% CI: 4.74-7.98, for those undecided). Other significant determinants of EBF cessation included a lack of partner support, antenatal and postnatal depression, intimate partner violence, low socioeconomic status, caesarean birth, and young maternal age (<20 years). Efforts to improve breastfeeding among women of CALD backgrounds in Australia should focus on women with vulnerabilities to maximise the benefits of EBF.

Hospital practices and family support in maternity wards

This study aims to determine the hospital practices implemented before, during, and after birth in Turkey, and to identify the support to families during this process. Purposive sampling was used in the study to identify the hospitals to be surveyed. Ankara, İstanbul, and İzmir, the provinces with the highest number of hospitals in Turkey, were selected for the collection of data. There were 178 eligible private hospitals in these provinces. The questionnaire form of the Canadian Hospitals Maternity Policies and Practices Survey was used to collect data and the necessary permissions were obtained. There are many restrictions and variations in maternity-related hospital practices in Turkey. 71.4% of the responding private hospitals identified themselves as baby-friendly. 57.1% had a policy facilitating families being together immediately after birth, 39.5% encouraged the presence of the father in the delivery room. 44.9% did not have any policy for assessing women who were going home to potentially violent situations. Eighty-five percent reported that they did not have a written policy or guidelines about procedures regarding labor, birth, or postpartum periods. This study recommended that private hospitals should review their maternal practices and routines in an evidence-based way that helps parents, culturally sensitive standards for mothers should be developed and supervised by related health authorities, and structures should be created to effectively deal with patients’ complaints.

Gamifying Breastfeeding for Fathers: Process Evaluation of the Milk Man Mobile App

BACKGROUND

Mobile technology offers unique opportunities to reach people with health promotion interventions. Breastfeeding is an important public health issue, and fathers are a key support. Milk Man is a father-focused breastfeeding app that sought to engage fathers with information and conversation about breastfeeding, with the goal to impact positively on breastfeeding duration.

OBJECTIVE

The study aimed to describe the process evaluation of the Milk Man app that was trialed in the Parent Infant Feeding Initiative randomized controlled trial.

METHODS

The app used an information library, gamification, push notifications, and social connectivity via a Web-based conversation forum, which included polls and conversation starters, to engage fathers with breastfeeding information. Fathers had access to the app from approximately 32 weeks of gestation to 6 months postpartum. Process evaluation data were collected from a self-completed questionnaire administered via a Web-based link sent to participants at 6 weeks postpartum, and app analytics data were collected directly from the app. Quantitative data from both sources and qualitative responses to open-ended questions were used to triangulate findings to investigate patterns of usage and the effectiveness of each app engagement strategy to motivate and engage users.

RESULTS

A total of 80.3% (586/730) of participants, who were randomized to receive the app, downloaded Milk Man. Push notifications and interest in what other fathers had posted in the forum were the 2 main motivators to app use. Fathers used the app most while their partners were still pregnant and in the weeks immediately after the birth of their baby. Perspectives on the gamification strategy were varied. However, at 6 weeks postpartum, approximately one-third of fathers still using the app said that the gamification elements were encouraging the app use. The ease of use of the app and the design were important elements that were rated positively. The conversation forum emerged as the hub of app activity; all but 1 of the most accessed library articles and external organization links had been prompted as part of a conversation starter. Fathers posted comments in the conversation forum 1126 times (average of 2.21 per user) and voted in polls 3096 times (average of 6 per user).

CONCLUSIONS

These results demonstrate that the Milk Man app was an acceptable source of breastfeeding information and support that fathers and fathers-to-be are prepared to use throughout the perinatal period. The app showed encouraging results with facilitating conversation between partners. The conversation forum was clearly central to the success of the app, and fathers provided suggestions for improvement. Gamification results were varied, yet it was a key motivator for some users. These results provide valuable insight into the acceptability of the engagement strategies, including motivations for use and user perspectives on the app.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12614000605695; https://www.anzctr.org.au /Trial/Registration/TrialReview.aspx?ACTRN=12614000605695.

Women's experiences of ceasing to breastfeed: Australian qualitative study

OBJECTIVE

To investigate mothers' infant feeding experiences (breastfeeding/formula milk feeding) with the aim of understanding how women experience cessation of exclusive breastfeeding.

DESIGN

Multimethod, qualitative study; questionnaire, focus groups and interviews.

SETTING

Northern and Southern Tasmania, Australia.

PARTICIPANTS

127 mothers of childbearing age from a broad sociodemographic context completed a questionnaire and participated in 22 focus groups or 19 interviews across Tasmania, 2011-2013.

RESULTS

Mothers view breastfeeding as 'natural' and 'best' and formula milk as 'wrong' and 'unnatural'. In an effort to avoid formula and prolong exclusive breastfeeding, mothers will endure multiple issues (eg, pain, low milk supply, mastitis, public shaming) and make use of various forms of social and physical capital; resources such as father/partner support, expressing breast milk, bottles and dummies. The cessation of exclusive breastfeeding was frequently experienced as unexpected and 'devastating', leaving mothers with 'breastfeeding grief' (a prolonged sense of loss and failure).

CONCLUSIONS AND IMPLICATIONS

For many mothers, the cessation of exclusive breastfeeding results in lingering feelings of grief and failure making it harmful to women's emotional well-being. Reframing breastfeeding as a family practice where fathers/partners are incorporated as breastfeeding partners has the potential to help women negotiate and prolong breastfeeding. Proactive counselling and debriefing are needed to assist women who are managing feelings of 'breastfeeding grief'.

Perinatal breastfeeding interventions including fathers/partners: A systematic review of the literature

OBJECTIVE

Support from fathers is consistently associated with improved breastfeeding duration and exclusivity rates. Additionally, there is growing evidence that fathers want to be included in breastfeeding interventions provided by health care professionals. The objective of this review was to determine the effect of partner-inclusive educational and psychosocial interventions on breastfeeding initiation, duration, and exclusivity.

DESIGN

A systematic review was conducted using a search strategy developed with an expert health sciences librarian. Electronic databases MEDLINE, EMBASE, CINAHL, and PsycINFO were systematically searched for randomized controlled trials and quasi-experimental studies from inception to August 4, 2018. Independent data extraction and quality assessments were conducted by authors using Cochrane Collaboration tools. Due to significant heterogeneity in intervention content, outcome measures, and follow-up time points, data were synthesized qualitatively.

FINDINGS

3982 articles were identified, of which 12 studies in 15 publications met the inclusion criteria and were included. All of the studies improved at least one breastfeeding outcome, including duration (n = 5/9) and exclusivity (n = 8/10) up to 24 weeks postpartum. Six studies examined increasing paternal breastfeeding support and all found beneficial effects. Biases were identified in the studies with the most common bias relating to the randomization process and the blinding of outcome assessors.

IMPLICATIONS FOR PRACTICE

The inclusion of fathers/partners in breastfeeding interventions improves breastfeeding initiation, duration, and exclusivity rates. Interventions that include face-to-face information delivery, are designed in a culturally appropriate manner, and provide information on how partners can support breastfeeding are more likely to have a beneficial effect. Research is warranted to examine the underlying intervention mechanisms.

A qualitative study to explore fathers' attitudes towards breastfeeding in South West England

Aim

To explore the beliefs, attitudes, and behaviours of fathers towards breastfeeding and how they impact either positively or negatively on their partners’ decisions to initiate or continue breastfeeding.

Background

Despite policy initiatives at a national and international level and the increased number of baby-friendly hospitals within the UK, breastfeeding rates are slow to rise. Support from both parents has been proven to increase uptake and continuation rates, but there is little research into the emotional experience of fathers when it comes to breastfeeding.

Methods

We conducted qualitative interviews with 18 fathers in Wiltshire, England. Principles of grounded theory were used throughout this study to guide the sampling, data collection, and data analysis.

Findings

Fathers knew the health benefits of breastfeeding and wanted their child to breastfeed but were unsure of their place in the feeding process because they felt it was not their body. While they were aware of the benefits of breast milk for infants, fathers felt less informed of the practicalities of breastfeeding and the potential challenges they and their partner might have to overcome to breastfeed successfully for the recommended six-month period. Based on these findings, three segments were identified: the problem bonders, the dual bonders, and the pragmatists. All segments were concerned with the well-being of their partner and child and wanted their child to be breastfed. Health professionals can use the results of this study to create prenatal educational resources that take more of a preventive and problem-solving approach as opposed to promoting breastfeeding in efforts to comply with National Health Service guidelines, without offering solutions to common breastfeeding problems.

Participation of father in perinatal care: a qualitative study from the perspective of mothers, fathers, caregivers, managers and policymakers in Iran

Background

The participation of the father during the perinatal period is an important strategy for improving the mother’s health. Very few studies exist about the father’s role in promoting the health of the mother in Iran; thus, the present study was conducted to examine the role of fathers in perinatal care.

Methods

The present study was a qualitative research. Participants were selected using purposeful sampling with maximum variation and the data was collected through in-depth interviews, focus group discussions and field notes. The data was analyzed using conventional content analysis.

Results

After data analysis, the main categories extracted were: “help in maintaining the health of the mother and fetus”, “emotional support of mother”, “comprehensive participation of father in married life”, “preparing for safe delivery” and “postpartum support”.

Conclusions

The results of the present study provide different perspectives on the participation of fathers when designing culture-based intervention for their participation in perinatal care.

Electronic supplementary material

The online version of this article (10.1186/s12884-018-1928-5) contains supplementary material, which is available to authorized users.