Determinants of breastfeeding practice in Pujehun district, southern Sierra Leone: a mixed-method study

Mixed Methods Studies on Breastfeeding: A Scoping Review

Prenatal and postnatal health guidance, along with women's individual experiences, greatly influences mothers' breastfeeding decisions and duration. To understand this better, a methodology combining quantitative and qualitative data is essential. Objective: To map the scientific production on the promotion, protection, and support of breastfeeding developed from mixed methods research. Method: A scoping review that followed the JBI and PRISMA-ScR methodology. The search was carried out in the following databases: Medline/PubMed, EMBASE, Cochrane, BVS, CINAHL, Web of Science, and BDTD. The guiding question was: Which studies on the promotion, protection, and support of breastfeeding were developed using mixed methods? The research took place from December 2023 to June 2024. Results: Of the 3569 studies found, 36 studies using mixed methods were included, with a prevalence of explanatory sequential approaches. Breastfeeding rates in the selected studies remain lower than global recommendations. The barriers to breastfeeding reported by mothers include biological; emotional; cultural; unfavorable social and hospital environment; difficulties in clinical management; lack of support from family, friends, health professionals, and employers; and skepticism about the benefits of breastfeeding. On the other hand, the main facilitators of breastfeeding reported were education and counseling during prenatal, childbirth, and postpartum periods; women's intention to breastfeed; support from family, employer, spouse, and health professionals. Conclusions: The studies highlighted various issues related to breastfeeding rates, barriers, and facilitators across different contexts and cultures worldwide. The findings demonstrate that employing mixed methods enables a comprehensive and nuanced assessment of breastfeeding practices and the evaluation of relevant interventions.

The Effect of Breastfeeding Practices of Undernourished Mothers in Rural Sierra Leone on Infant Growth and Mortality

Breastfeeding provides optimal infant nutrition; however, <50% of infants are exclusively breastfed (EBF) for 6 months. We aimed to describe breastfeeding practices and their effects on growth and mortality among a high-risk mother-infant cohort in rural Sierra Leone. This was a secondary analysis of data from a randomized nutrition intervention trial among undernourished pregnant women. The study's primary outcomes were infant weight and length gains at 6 weeks of age. We included 1270 singleton infants in the analysis, with 1092 (85.6%) having 24-week outcome data. At 6 weeks, 88% were EBF, but the rate of EBF decreased to 17% at 24 weeks. The EBF infants at 6 weeks had improved length (difference of 0.9 mm/week; 95% CI 0.4 to 1.3; p < 0.001) and weight (difference of 40 g/week; 95% CI 24 to 53; p < 0.001) gains compared to the non-EBF infants. At 12 weeks, the EBF infants had improved weight (difference of 12 g/week; 95% CI 2 to 22; p = 0.024) gain. The EBF infants had lower mortality than the infants who were not EBF (hazard ratio of 0.39; 95% CI 0.18 to 0.84; p = 0.017). In summary, the infants who were EBF had greater weight and length gain and reduced mortality than those who were not EBF. Efforts to improve breastfeeding should thus be prioritized to improve infant health.

Breastfeeding among Hispanic and Black Women: Barriers and Support

We describe barriers and supports for the practice of breastfeeding, with particular focus on Black and Hispanic women in the United States. We note that breastfeeding patterns reported by WIC agencies is highly variable across the country and within states. The global campaign to support breastfeeding, Baby Friendly Hospital Initiative, and its implementation in the US is described, as well as Healthy People goals and the mixture of policies across the US that provide incomplete support for breastfeeding mothers.

Disparities in Infant Nutrition: WIC Participation and Rates of Breastfeeding in Florida

Being cognizant of the pronounced health advantages of breastfeeding for both the nursing mother and her infant, the breastfeeding dyad, we examined breastfeeding rates among Floridian women who gave birth from 2012 to 2014 (N = 639,052). We investigated the associations between breastfeeding initiation and WIC-based breastfeeding support (the Special Supplemental Nutrition Program for Women, Infants, and Children), education level, and race and ethnicity. We compared the percentage of breastfeeding mothers between those in the WIC program and those who were not, and we compared breastfeeding rates across racial and ethnic groups. Consistent with previous reports, black newborns in this study were breastfed at lower rates than other racial groups, and WIC program participants were less likely to breastfeed than non-WIC program participants. However, by breaking down the data by education level and race, and ethnicity, we see a significantly increased rate of breastfeeding due to WIC participation for both Hispanic and black women with less than a high school education. Further, we assessed differences by insurance type, race, and WIC participation. In multivariable logistic regression, we showed that the WIC program has a significant positive impact on breastfeeding rates for all but white non-Hispanic mothers, independent of sociodemographic and geographic variables. We also note a trend of increasing breastfeeding rates over the study period (p-value < 0.0001), which has positive public health implications.