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Darvish N, Gómez AM, Marshall C, McDonald R, Rouse L, Dinsmore L, Hecht H, Berhanu R, Rajan G, Sandhu J. What Do Community Doulas Think About the Future of the Doula Workforce? Matern Child Health J 2024:10.1007/s10995-024-03943-1. [PMID: 39046655 DOI: 10.1007/s10995-024-03943-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/14/2024] [Indexed: 07/25/2024]
Abstract
INTRODUCTION Expanding access to doula care is a key strategy for improving the perinatal experiences and health outcomes of birthing people of color in the U.S. This study investigates the future of maternal healthcare in the U.S. from the perspective of doulas and highlights emerging technology and other opportunities related to strengthening the doula workforce. METHODS The study recruited community doulas from 12 unique U.S. states, ensuring at least half of the doulas predominantly served communities of color. Doulas (N = 26) participated in semi-structured, futures-oriented interviews that explored their experiences providing care during the COVID-19 pandemic and utilization of technology. A subset of doulas (n = 8) were engaged in interactive workshops where they envisioned alternative futures for doula care and childbirth. Interviews and workshops were analyzed using the Framework Method. RESULTS The COVID-19 pandemic heightened technology use among doulas and increased client accessibility. Social media serves as a unique space for critical community building and client outreach. Doulas reported opportunities to strengthen and mobilize the future workforce: recognizing doula care as a reimbursable service by health insurers, utilizing doula collectives for community practice to decrease burnout, increasing emotional support for doulas, and instilling a chain of learning through mentorship. DISCUSSION Futures thinking served as a valuable approach for doulas to illuminate the implications of present-day challenges and empowered doulas to design roadmaps toward better futures for doulas and maternal health. Doulas should be engaged as partners to hold a meaningful decision-making role when discussing policies, employment structures, emerging technology, and other aspects of doulas' positioning within the healthcare system.
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Affiliation(s)
- Nika Darvish
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA.
| | - Anu Manchikanti Gómez
- Sexual Health and Reproductive Equity Program, School of Social Welfare, University of California, Berkeley, Berkeley, CA, USA
| | - Cassondra Marshall
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | | | | | - Lauren Dinsmore
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Hannah Hecht
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Ruth Berhanu
- School of Public Health, Boston University, Boston, MA, USA
| | - Grace Rajan
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
| | - Jaspal Sandhu
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Alvarado G, Schultz D, Malika N, Reed N. United States Doula Programs and Their Outcomes: A Scoping Review to Inform State-Level Policies. Womens Health Issues 2024; 34:350-360. [PMID: 38724343 DOI: 10.1016/j.whi.2024.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 03/01/2024] [Accepted: 03/05/2024] [Indexed: 08/04/2024]
Abstract
BACKGROUND The field of maternal health has advanced significantly over the past decades. However, the United States continues to have poor outcomes in comparison with other industrialized nations. With emerging evidence on the promise of doula care, states are including doula care under their Medicaid programs. METHODS We conducted a scoping review across four academic databases and gray literature published between January 1, 2012, and March 10, 2022, to describe the landscape of literature on U.S. doula programs and their outcomes in order to inform state policy makers considering laws or programs related to doula care. FINDINGS Of 740 records identified, 100 met inclusion criteria. Outcomes fell into four areas: birthing people's outcomes, infant outcomes, systems of care and implementation, and cross-cutting issues. Data on outcomes related to doula care in the literature were predominantly clinical, even though doulas are not clinical providers. Although some studies have found associations between doula care and improved clinical outcomes for birthing people and infants, the evidence is limited due to small sample sizes, study methodology, or conflicting conclusions. Doula outcomes are underexplored in the literature, with mainly qualitative data describing low levels of diversity and equity within the doula workforce and ineffective payment models. When cost-effectiveness estimates have been calculated, they largely rely on savings realized from averted cesarean births, preterm births, and neonatal intensive care unit admissions. CONCLUSIONS As state Medicaid programs expand to include doula care, policymakers should be aware of the limitations in the evidence as they plan for successful implementation, such as the narrow focus on certain clinical outcomes to quantify cost savings and conflicting conclusions on the impact of doula care. An important consideration is the impact of the reimbursement rate on the adoption of doula care, which is why it is important to engage doulas in compensation determinations, as well as the development of improved metrics to untangle the components that contribute to maternal health outcomes in the United States.
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Collins IC, Blanchard CT, Tipre M, Oben A, Robinson A, Kako T, Joly JM, Cribbs MG, Casey B, Tita A, Sinkey R. Breastfeeding Practices in Patients with Heart Disease Stratified by Area Deprivation Index. Breastfeed Med 2024; 19:256-261. [PMID: 38502815 DOI: 10.1089/bfm.2023.0295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/21/2024]
Abstract
Objective: We sought to evaluate breastfeeding (BF) practices in patients with maternal cardiac disease (MCD) stratified by area deprivation index (ADI) to identity communities at risk. Study Design: Retrospective cohort of patients managed by the University of Alabama at Birmingham (UAB) Cardio-Obstetrics Program. Patients were included if they had ≥1 prenatal visit with the Cardio-Obstetrics team, delivered at UAB, and had a street address on file. The primary outcome was BF rate at hospital discharge. Secondary outcomes included BF intent on admission and BF at the postpartum (PP) visit. ADI reports socioeconomic disadvantage at the census tract level; 1 = least deprived and 100 = most deprived. Baseline characteristics and BF rates were compared by ADI categories: Low (ADI 1-33), medium (ADI 34-66), and high (ADI 67-100). Results: One hundred and forty-eight patients were included: 14 (10%) low, 42 (28%) medium, and 92 (62%) high ADI. Patients in the high ADI category were younger relative to those in the medium or low ADI (26 versus 28 versus 32 years; p < 0.01) and less likely to be married or living with a partner (30.4% versus 58.5% versus 71.4%; p < 0.01), There was no difference in BF intent between the lowest, medium, and highest ADI categories (85.7% versus 85.4% versus 81.6%; p = 0.38) or BF rates at hospital discharge (100% versus 92.7% versus 85.6%, p = 0.23). However, there was a significant difference in BF rates at the PP visit (90% versus 63.0% versus 38.6%; p < 0.01) even after controlling for differences in baseline characteristics (odds ratio = 0.11 (95% confidence interval [0.01-0.93]), p = 0.043). Conclusions: There was an association between living in a resource-poor community and early cessation of BF in our population of patients with MCD. Community-based interventions targeting mothers with heart disease living in high ADI communities may help these individuals achieve higher BF rates.
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Affiliation(s)
- Isabel C Collins
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina T Blanchard
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Meghan Tipre
- Division of Hematology/Oncology, Department of Medicine, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Ayamo Oben
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Ashton Robinson
- University of Alabama at Birmingham Marnix E. Heersink School of Medicine, Birmingham, Alabama, USA
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Tavonna Kako
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Joanna M Joly
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Marc G Cribbs
- Division of Cardiovascular Disease, Department of Medicine, University of Alabama at Birmingham, Alabama, USA
| | - Brian Casey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Alan Tita
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
| | - Rachel Sinkey
- Department of Obstetrics and Gynecology, University of Alabama at Birmingham, Birmingham, Alabama, USA
- Center for Women's Reproductive Health, Birmingham, Alabama, USA
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Wójcik-Brylska K, Pawlicka P, Tataj-Puzyna U, Szlendak B, Węgrzynowska M, Pięta B, Baranowska B. Cooperation between midwives and doulas in the context of perinatal care - a integrative review of qualitative and quantitative studies. Midwifery 2023; 124:103731. [PMID: 37321158 DOI: 10.1016/j.midw.2023.103731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 04/06/2023] [Accepted: 05/12/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND A doula is a person who provides support to women in the perinatal period without providing medical services. During childbirth, the doula becomes a member of the interdisciplinary team. This integrative review aims to analyse the nature of the cooperation between doulas and midwives, its efficiency and challenges and ways of strengthening this cooperation. METHODS A structured integrative review of empirical and theoretical studies written in English was conducted. The literature search included MEDLINE, Cochrane, Scopus, ProQuest, Science Direct, Web of Science, and Embase Health Source: Nursing/Academic Edition databases. The analysis included papers published in 1995-2020. Dedicated documents were searched for different combinations of terms and standard logical operators. A manual search of the studies was included for additional references. RESULTS Twenty-three articles from 75 full-text records were analysed. Three main themes emerged. (1) doulas are needed to prop up the system (2) barriers in collaboration between midwives and doulas; and (3) how cooperation between midwives and doulas can be strengthened. None of the articles referred directly to the impact of collaboration between midwives and doulas on the quality of perinatal care. CONCLUSION This is the first review to analyse the impact of collaboration between midwives and doulas on the quality of perinatal care. Ensuring adequate collaboration between doulas and midwives requires effort from both of these professional groups and the health care system. However, such collaboration is supportive for birthing women and the perinatal care system. Further research in terms of the impact of this collaboration on the quality of perinatal care is needed.
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Affiliation(s)
| | - Paulina Pawlicka
- Faculty of Social Sciences, Institute of Psychology, Division of Cross-Cultural and Gender Psychology, University of Gdansk, Gdansk 80-309, Poland.
| | - Urszula Tataj-Puzyna
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
| | - Beata Szlendak
- Foundation for Supporting Midwives, Warsaw 00-112, Poland
| | - Maria Węgrzynowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
| | - Beata Pięta
- Practical Midwifery Science Faculty, Poznan University of Medical Sciences, Poznań 60-512, Poland
| | - Barbara Baranowska
- Department of Midwifery, Centre of Postgraduate Medical Education, Warsaw 01-004, Poland
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Saldanha IJ, Adam GP, Kanaan G, Zahradnik ML, Steele DW, Chen KK, Peahl AF, Danilack-Fekete VA, Stuebe AM, Balk EM. Delivery Strategies for Postpartum Care: A Systematic Review and Meta-analysis. Obstet Gynecol 2023; 142:529-542. [PMID: 37535967 DOI: 10.1097/aog.0000000000005293] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Accepted: 06/05/2023] [Indexed: 08/05/2023]
Abstract
OBJECTIVE To systematically review the effects of postpartum health care-delivery strategies on health care utilization and maternal outcomes. DATA SOURCES We searched Medline, EMBASE, CENTRAL, CINAHL, and ClinicalTrials.gov for studies in the United States or Canada from inception to November 16, 2022. METHODS OF STUDY SELECTION We used duplicate screening for studies comparing health care-delivery strategies for routine postpartum care on health care utilization and maternal outcomes. We selected health care utilization, clinical, and harm outcomes prioritized by stakeholder panels. TABULATION, INTEGRATION, AND RESULTS We found 64 eligible studies (50 randomized controlled trials, 14 nonrandomized comparative studies; N=543,480). For general postpartum care, care location (clinic, at home, by telephone) did not affect depression or anxiety symptoms (low strength of evidence), and care integration (by multiple types of health care professionals) did not affect depression symptoms or substance use (low strength of evidence). Providing contraceptive care earlier (compared with later) was associated with greater implant use at 6 months (summary effect size 1.36, 95% CI 1.13-1.64) (moderate strength of evidence). Location of breastfeeding care did not affect hospitalization, other unplanned care utilization, or mental health symptoms (all low strength of evidence). Peer support was associated with higher rates of any or exclusive breastfeeding at 1 month and any breastfeeding at 3-6 months (summary effect size 1.10-1.22) but not other breastfeeding measures (all moderate strength of evidence). Care by a lactation consultant was associated with higher breastfeeding rates at 6 months (summary effect size 1.43, 95% CI 1.07-1.91) but not exclusive breastfeeding (all moderate strength of evidence). Use and nonuse of information technology for breastfeeding care were associated with comparable rates of breastfeeding (moderate strength of evidence). Testing reminders for screening or preventive care were associated with greater adherence to oral glucose tolerance testing but not random glucose or hemoglobin A 1c testing (moderate strength of evidence). CONCLUSION Various strategies have been shown to improve some aspects of postpartum care, but future research is needed on the most effective care delivery strategies to improve postpartum health. SYSTEMATIC REVIEW REGISTRATION PROSPERO, CRD42022309756 .
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Affiliation(s)
- Ian J Saldanha
- Center for Clinical Trials and Evidence Synthesis, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland; the Center for Evidence Synthesis in Health, the Department of Health Services, Policy, and Practice, and the Department of Epidemiology, Brown University School of Public Health, and the Departments of Emergency Medicine, Pediatrics, Medicine, and Obstetrics and Gynecology, Brown University Warren Alpert Medical School, Providence, Rhode Island; the Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan; the Center for Outcomes Research and Evaluation, Department of Internal Medicine, Yale University School of Medicine, New Haven, Connecticut; and the Department of Obstetrics and Gynecology, University of North Carolina School of Medicine, Chapel Hill, North Carolina
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Safon CB, Heeren T, Kerr S, Corwin M, Colson ER, Moon R, Kellams A, Hauck FR, Parker MG. Racial and Ethnic Disparities in Breastfeeding Continuation Among U.S. Hispanic Mothers: Identification of Mechanisms. Breastfeed Med 2023; 18:3-13. [PMID: 36378866 PMCID: PMC9889014 DOI: 10.1089/bfm.2022.0196] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objective: We examined the extent to which social, maternal, and infant factors and Theory of Planned Behavior (TPB) domains-attitudes, perceived control, and subjective norms-mediate the relationship between maternal race and ethnicity and birth country, and breastfeeding continuation. Materials and Methods: A nationally representative cohort of 2,810 mothers with self-reported race, ethnicity, and birth country was used. Main outcomes included any and exclusive breastfeeding at 2-6 months of infant age. A conceptual framework with the aforementioned mediators of interest was developed. Logistic regression was used to examine main associations, and structural equation modeling was used to identify the extent to which proposed mediators explained the relationship between independent and dependent variables. Results: One thousand two hundred twenty-one mothers were U.S.-born non-Hispanic white (NHW), 432 U.S.-born Hispanic, 329 Mexico-born Hispanic, 107 Central- or South America-born Hispanic, 33 Caribbean-born Hispanic, and 688 U.S.-born non-Hispanic black (NHB). No differences in breastfeeding continuation among U.S.-born NHW and U.S.-born Hispanic mothers were found. In contrast, compared with U.S.-born NHW mothers, Mexico-born (odds ratio [OR] 1.99, 95% confidence interval [CI] 1.46-2.72) and Central- or South America-born (OR 3.42, 95% CI 1.89-6.17) Hispanic mothers had higher odds, and Caribbean-born Hispanic mothers had lower odds (OR 0.45, 95% CI 0.26-0.76) of any breastfeeding. These relationships were mediated by attitudes and subjective norms. Conclusions: Breastfeeding continuation among U.S. Hispanic mothers varied by birth country, highlighting the heterogeneity of breastfeeding populations of Hispanic mothers in the United States. Tailored interventions should strengthen policies supportive of positive attitudes toward and subjective norms around breastfeeding.
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Affiliation(s)
- Cara B. Safon
- Department of Health Law, Policy, and Management and Boston University School of Public Health, Boston, Massachusetts, USA
| | - Timothy Heeren
- Department of Biostatistics, Boston University School of Public Health, Boston, Massachusetts, USA
| | - Stephen Kerr
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
| | - Michael Corwin
- Slone Epidemiology Center at Boston University, Boston, Massachusetts, USA
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Eve R. Colson
- Department of Pediatrics, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Rachel Moon
- Department of Pediatrics and University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Ann Kellams
- Department of Pediatrics and University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Fern R. Hauck
- Department of Family Medicine, University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Margaret G. Parker
- Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts, USA
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Pereira EL, Estabrooks PA, Arjona A, Cotton-Curtis W, Lin JCP, Saetermoe CL, Blackman KCA. A systematic literature review of breastfeeding interventions among Black populations using the RE-AIM framework. Int Breastfeed J 2022; 17:86. [PMID: 36528606 PMCID: PMC9758845 DOI: 10.1186/s13006-022-00527-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 10/15/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Lactation support resources are less likely to be located in close proximity to where Black families live and there is a systemic racist health care belief that Black women prefer bottle feeding (with infant formula) over breastfeeding. Together, these lead to lower reported breastfeeding rates of Black babies compared to other racial / ethnic groups. It is imperative to have a deeper understanding of the cultural aspects as well as the underlying limitations that prevent Black women / persons from being supported to breastfeed. There is a need to know how effective breastfeeding interventions are in reaching the intended population; how well they work in promoting breastfeeding initiation and continuation; and how successful they are when implemented at the setting and staff level. The purpose of this investigation was to establish the level of internal and external validity that was reported by breastfeeding intervention studies among Black communities. METHODS Studies on breastfeeding interventions on Black people that were published between the years 1990 and 2019 were carefully examined through PubMed, EBSCOhost, Web of Science, and OneSearch. A total of 31 studies fulfilled the requirements to be included for this evaluation. In order to extract the information from the articles, the reach, effectiveness, adoption, implementation, and maintenance (RE-AIM) framework extraction tool was utilized. RESULTS On average, the proportion of studies that reported across reach, effectiveness, adoption, implementation, and maintenance indicators was 54, 35, 19, 48, and 9%, respectively. Across core RE-AIM indicators only sample size (100%) and breastfeeding outcomes (90%) were reported consistently. External validity indicators related to representativeness of participants (16%) and sites (3%) were rarely reported. Similarly, adherence to intervention protocol, and indicator of internal validity, was reported in a small proportion of articles (19%). CONCLUSION This body of literature under-reported on aspects associated to both internal and external validity across all RE-AIM domains. The reporting of the individual level of representativeness; the setting level of representativeness; the intervention's adherence to the protocol; the expenses; and the factors of sustainability would benefit from improvement in future research.
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Affiliation(s)
| | - Paul A Estabrooks
- Department of Health & Kinesiology, University of Utah, Salt Lake City, USA
| | - Alejandro Arjona
- Department of Family & Consumer Sciences, California State University Northridge, Northridge, USA
| | - Wyconda Cotton-Curtis
- Department of Health Sciences, California State University Northridge, Northridge, USA
| | - Judith C P Lin
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Carrie L Saetermoe
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA
| | - Kacie C A Blackman
- Department of Health Sciences, California State University Northridge, Northridge, USA.
- The Health Equity Research and Education Center, California State University Northridge, Northridge, USA.
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [DOI: https:/doi.org/10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 10/31/2023] Open
Abstract
AbstractBackgroundAccess to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents’ beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village.MethodsAn interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan “ enjoy meals like a baby”. The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods.ResultsThere was marked and significant improvement in the awareness and of the majority of the weaning practices’ indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3–5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the “Minimum Dietary Diversity” (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%).ConclusionTargeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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9
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Metwally AM, Sallam SF, Mawla MAA, Alian KM, Abdel-Latif GA, Hasanin HM, Kamal AN, Hanna C, Shebini SME, Ahmed NH, Mabrok HB, Mahmoud MH, Ismail AS, Boseila SAW, El-Alameey IR, Mahfouz NN, Shaaban FA, Ibrahim NA, Hassan NE, El-Masry SA, Naga MM, Khalil A. Promoting weaning practices and growth of Egyptian infants by using communication for behavioral development approach. BMC Pediatr 2022; 22:689. [PMID: 36456920 PMCID: PMC9713754 DOI: 10.1186/s12887-022-03741-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Accepted: 11/10/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Access to various affordable and nutritious foods is considered a challenging factor for households with limited resources affecting the proper weaning practices. In order to motivate communities to adhere to the right and proper weaning practices, the social aspect should be considered through close communication with the targeted communities. This study aimed to evaluate how impactful the use of the principles of Communication for Development (C4D) that respect parents' beliefs and their cultural norms is in improving the weaning practices and growth of infants in an Egyptian village. METHODS An interventional three-phase study was conducted for three years. The intervention targeted 464 mothers of infants up to 2 years of age. C4D interventions encouraged each mother to provide her baby with nutritious and varied options through age-appropriate introduction and diversification of nutrient-rich complementary foods under the slogan " enjoy meals like a baby". The effectiveness of the approach was measured by five essential weaning practices: Introduction of solid, semi-solid, or soft foods, Minimum dietary diversity, minimum meal frequency, Minimum acceptable diet, and consumption of iron-rich foods. RESULTS There was marked and significant improvement in the awareness and of the majority of the weaning practices' indicators as a result of the interventions. This was noticed for the timely introduction of complementary foods which increased from 36.7% to 82.0%, the minimum meal frequency indicator (3-5) which increased from 25.3% to 67.3%, iron-rich or fortified food (68.0% to 82%) as well as a regular checkup for baby health at the health unit (71.3%). Indicators that were improved but failed to achieve the target were the "Minimum Dietary Diversity" (reached 32%) and the minimum acceptable diet (reached 22.0%). A significant effect on linear growth especially for females is evidenced by the remarkable decrease in wasting (from 31.5% to 11.1%) and obesity (from 12.0% to 0%) associated with a considerable decrease in underweight (from 40% to 16.7%). CONCLUSION Targeting caregivers through the C4D approach have succeeded in providing them with the support required for the provision of adequate nutrition for their infants that had significantly marked improvement in growth indices of their infants.
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Affiliation(s)
- Ammal M. Metwally
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sara F. Sallam
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Mohamed A. Abdel Mawla
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Khadija M. Alian
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ghada A. Abdel-Latif
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hasanin M. Hasanin
- grid.419725.c0000 0001 2151 8157Pediatrics Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ayat N. Kamal
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Carine Hanna
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Salwa M. El Shebini
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad H. Ahmed
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Hoda B. Mabrok
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maha H. Mahmoud
- grid.419725.c0000 0001 2151 8157Nutrition and Food Science Department, Food Technology and Nutrition Research Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Ahmed S. Ismail
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Samia A. W. Boseila
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Inas R. El-Alameey
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt ,Faculty of Applied Medical Sciences, Clinical Nutrition Department, Taibahu University, Almadina almunawara, Saudi Arabia
| | - Nermine N. Mahfouz
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Fatma A. Shaaban
- grid.419725.c0000 0001 2151 8157Child Health Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nihad A. Ibrahim
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Nayera E. Hassan
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Sahar A. El-Masry
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Maie M. Naga
- grid.419725.c0000 0001 2151 8157Community Medicine Research Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
| | - Aya Khalil
- grid.419725.c0000 0001 2151 8157Biological Anthropology Department, Medical Research and Clinical Studies Institute, National Research Centre, Dokki, Cairo, 60014618 Egypt
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10
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Liese K, Stewart K, Pearson P, Lofton S, Mbande T, Patil C, Liu L, Geller S. Melanated Group Midwifery Care: Centering the Voices of the Black Birthing Community. J Midwifery Womens Health 2022; 67:696-700. [PMID: 36480019 PMCID: PMC10107514 DOI: 10.1111/jmwh.13438] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 09/26/2022] [Accepted: 09/26/2022] [Indexed: 12/13/2022]
Abstract
Access to safe and dignified pregnancy, childbirth, and postpartum experiences is a fundamental right for all pregnant and postpartum people. In the United States, systemic racism fuels distrust and disengagement in a health care system that continues to dehumanize the Black community. The respectful maternity care literature explains how these systemic, structural, and institutional failings produce maternal health disparities and expose a pattern whereby Black women receive less adequate maternity care. The implementation of trustworthy policies and practices is urgently needed because no single intervention has or will substantially reduce maternal disparities. The purpose of this article is to describe a multicomponent maternity care innovation, Melanated Group Midwifery Care (MGMC). MGMC was codesigned with community partners and is responsive to the needs and desires of Black women, making MGMC a culturally adapted and patient-centered model. Racial concordance among care providers and patients, group prenatal care, perinatal nurse navigation, and 12 months of in-home postpartum doula support are 4 evidence-based interventions that are bundled in MGMC. We posit that a model that restructures maternity care to increase health system accountability and aligns with the needs and desires of Black pregnant and postpartum people will increase trust in the health care system and result in better clinical, physical, emotional, and social outcomes.
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Affiliation(s)
- Kylea Liese
- Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinois
| | - Karie Stewart
- Department of Obstetrics and GynecologyUniversity of Illinois Chicago College of MedicineChicagoIllinois
| | - Pam Pearson
- Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinois
| | - Saria Lofton
- Population Health Nursing ScienceUniversity of Illinois College of NursingChicagoIllinois
| | - Tayo Mbande
- Chicago Birthworks CollectiveChicagoIllinois
| | - Crystal Patil
- Human Development Nursing ScienceUniversity of Illinois Chicago College of NursingChicagoIllinois
| | - Li Liu
- Division of Epidemiology and BiostatisticsSchool of Public HealthUniversity of Illinois ChicagoChicagoIllinois
| | - Stacie Geller
- Center for Research on Women and GenderDepartment of Obstetrics and GynecologyCollege of MedicineUniversity of Illinois ChicagoChicagoIllinois
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11
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Gavine A, Shinwell SC, Buchanan P, Farre A, Wade A, Lynn F, Marshall J, Cumming SE, Dare S, McFadden A. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2022; 10:CD001141. [PMID: 36282618 PMCID: PMC9595242 DOI: 10.1002/14651858.cd001141.pub6] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES 1. To describe types of breastfeeding support for healthy breastfeeding mothers with healthy term babies. 2. To examine the effectiveness of different types of breastfeeding support interventions in terms of whether they offered only breastfeeding support or breastfeeding support in combination with a wider maternal and child health intervention ('breastfeeding plus' support). 3. To examine the effectiveness of the following intervention characteristics on breastfeeding support: a. type of support (e.g. face-to-face, telephone, digital technologies, group or individual support, proactive or reactive); b. intensity of support (i.e. number of postnatal contacts); c. person delivering the intervention (e.g. healthcare professional, lay person); d. to examine whether the impact of support varied between high- and low-and middle-income countries. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (which includes results of searches of CENTRAL, MEDLINE, Embase, CINAHL, ClinicalTrials.gov, WHO International Clinical Trials Registry Platform (ICTRP)) (11 May 2021) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. Support could be provided face-to-face, over the phone or via digital technologies. All studies had to meet the trustworthiness criteria. DATA COLLECTION AND ANALYSIS: We used standard Cochrane Pregnancy and Childbirth methods. Two review authors independently selected trials, extracted data, and assessed risk of bias and study trustworthiness. The certainty of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 116 trials of which 103 contribute data to the analyses. In total more than 98,816 mother-infant pairs were included. Moderate-certainty evidence indicated that 'breastfeeding only' support probably reduced the number of women stopping breastfeeding for all primary outcomes: stopping any breastfeeding at six months (Risk Ratio (RR) 0.93, 95% Confidence Interval (CI) 0.89 to 0.97); stopping exclusive breastfeeding at six months (RR 0.90, 95% CI 0.88 to 0.93); stopping any breastfeeding at 4-6 weeks (RR 0.88, 95% CI 0.79 to 0.97); and stopping exclusive breastfeeding at 4-6 (RR 0.83 95% CI 0.76 to 0.90). Similar findings were reported for the secondary breastfeeding outcomes except for any breastfeeding at two months and 12 months when the evidence was uncertain if 'breastfeeding only' support helped reduce the number of women stopping breastfeeding. The evidence for 'breastfeeding plus' was less consistent. For primary outcomes there was some evidence that 'breastfeeding plus' support probably reduced the number of women stopping any breastfeeding (RR 0.94, 95% CI 0.91 to 0.97, moderate-certainty evidence) or exclusive breastfeeding at six months (RR 0.79, 95% CI 0.70 to 0.90). 'Breastfeeding plus' interventions may have a beneficial effect on reducing the number of women stopping exclusive breastfeeding at 4-6 weeks, but the evidence is very uncertain (RR 0.73, 95% CI 0.57 to 0.95). The evidence suggests that 'breastfeeding plus' support probably results in little to no difference in the number of women stopping any breastfeeding at 4-6 weeks (RR 0.94, 95% CI 0.82 to 1.08, moderate-certainty evidence). For the secondary outcomes, it was uncertain if 'breastfeeding plus' support helped reduce the number of women stopping any or exclusive breastfeeding at any time points. There were no consistent findings emerging from the narrative synthesis of the non-breastfeeding outcomes (maternal satisfaction with care, maternal satisfaction with feeding method, infant morbidity, and maternal mental health), except for a possible reduction of diarrhoea in intervention infants. We considered the overall risk of bias of trials included in the review was mixed. Blinding of participants and personnel is not feasible in such interventions and as studies utilised self-report breastfeeding data, there is also a risk of bias in outcome assessment. We conducted meta-regression to explore substantial heterogeneity for the primary outcomes using the following categories: person providing care; mode of delivery; intensity of support; and income status of country. It is possible that moderate levels (defined as 4-8 visits) of 'breastfeeding only' support may be associated with a more beneficial effect on exclusive breastfeeding at 4-6 weeks and six months. 'Breastfeeding only' support may also be more effective in reducing women in low- and middle-income countries (LMICs) stopping exclusive breastfeeding at six months compared to women in high-income countries (HICs). However, no other differential effects were found and thus heterogeneity remains largely unexplained. The meta-regression suggested that there were no differential effects regarding person providing support or mode of delivery, however, power was limited. AUTHORS' CONCLUSIONS: When 'breastfeeding only' support is offered to women, the duration and in particular, the exclusivity of breastfeeding is likely to be increased. Support may also be more effective in reducing the number of women stopping breastfeeding at three to four months compared to later time points. For 'breastfeeding plus' interventions the evidence is less certain. Support may be offered either by professional or lay/peer supporters, or a combination of both. Support can also be offered face-to-face, via telephone or digital technologies, or a combination and may be more effective when delivered on a schedule of four to eight visits. Further work is needed to identify components of the effective interventions and to deliver interventions on a larger scale.
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Affiliation(s)
- Anna Gavine
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Shona C Shinwell
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | | | - Albert Farre
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Angela Wade
- Centre for Paediatric Epidemiology and Biostatistics, Institute of Child Health, London, UK
| | - Fiona Lynn
- School of Nursing and Midwifery, Medical Biology Centre, Queen's University Belfast, Belfast, UK
| | - Joyce Marshall
- Division of Maternal Health, University of Huddersfield, Huddersfield, UK
| | - Sara E Cumming
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
- Mother and Infant Research Unit, University of Dundee, Dundee, UK
| | - Shadrach Dare
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
| | - Alison McFadden
- Mother and Infant Research Unit, School of Health Sciences, University of Dundee, Dundee, UK
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12
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Innovations in Breastfeeding Support. Clin Obstet Gynecol 2022; 65:648-662. [PMID: 35894738 DOI: 10.1097/grf.0000000000000736] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Despite the numerous benefits that breastfeeding confers to those who breastfeed and their infants, the United States' exclusive breastfeeding rates and any breastfeeding rates at 12 months remain low and inequitable. This public health crisis has been prioritized in the US Healthy People 2030 goals. Current evidence-based practices to support lactation have afforded limited progress, thus, achieving national breastfeeding goals requires innovative ideas in thinking, technology, and care. This article highlights potential innovative strategies in the field of lactation to improve outcomes and work toward achieving health equity, while underscoring the critical role that perinatal caregivers play in lactation support.
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13
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Buckland C, Hector D, Kolt GS, Thepsourinthone J, Arora A. Experiences of young Australian mothers with infant feeding. BMC Pregnancy Childbirth 2022; 22:489. [PMID: 35705921 PMCID: PMC9199343 DOI: 10.1186/s12884-022-04796-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Accepted: 05/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Despite the overwhelming evidence of health and other benefits of breastfeeding and recommendations to breastfeed by peak health bodies, breastfeeding rates are significantly lower than recommended in Australia and globally. Young mothers are identified as being at high risk of not breastfeeding their infants according to infant feeding recommendations. This study aimed to gain an in-depth understanding of young Australian mothers' experiences of infant feeding, and to explore the factors which facilitated or hindered adherence to recommended breastfeeding practices. METHODS Purposive and snowball sampling were used to recruit young mothers in Australia (n = 17) aged 18-25 years who had given birth to their first child within the last two years. Data were collected through semi-structured interviews via online videoconferencing. Interviews were audio-recorded, transcribed verbatim, coded, and subsequently analysed. Thematic analysis was conducted using Quirkos, a qualitative data management and analysis software. RESULTS Four major themes were identified: Breastfeeding is challenging; Feeling judged about infant feeding choices; Experiences with breastfeeding support; and Experiences and views on breastfeeding education. Most mothers reported experiencing breastfeeding challenges, particularly those arising from lactation difficulties, yet many were able to overcome these challenges through their determination to breastfeed. Many mothers expressed perceiving judgement from others for breastfeeding in public. Some mothers who were bottle feeding their infants, whether with expressed breast milk or infant formula, felt that they were being judged for using a bottle. Many mothers reported professional, partner, family, and peer support as critical facilitators to the continuation of breastfeeding. Most mothers shared positive experiences of attending breastfeeding education sessions, but indicated the need for community education to reduce judgement toward mothers' infant feeding decisions. CONCLUSIONS The barriers and enablers to infant feeding experienced by young mothers are similar to those experienced by mothers of all ages. Young mothers experience significant breastfeeding challenges and need support from partner, family, peers, and professionals to continue breastfeeding in line with recommendations. Breastfeeding campaigns to support young mothers should be aimed at the wider community to increase awareness of breastfeeding challenges, reduce stigma associated with breastfeeding in public, and to support mothers in their infant feeding decisions.
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Affiliation(s)
- Christa Buckland
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia. .,Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.
| | - Debra Hector
- Cancer Australia, Surry Hills, NSW, 2010, Australia
| | - Gregory S Kolt
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Jack Thepsourinthone
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Health Equity Laboratory, Campbelltown, NSW, 2560, Australia
| | - Amit Arora
- School of Health Sciences, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Health Equity Laboratory, Campbelltown, NSW, 2560, Australia.,Translational Health Research Institute, Western Sydney University, Locked Bag 1797, Penrith, NSW, 2751, Australia.,Discipline of Child and Adolescent Health, Sydney Medical School, Faculty of Medicine and Health, The University of Sydney, Westmead, NSW, 2145, Australia.,Oral Health Services, Sydney Local Health District and Sydney Dental Hospital, NSW Health, Surry Hills, NSW, 2010, Australia
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14
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Aderibigbe O, Lucas R. Exclusive breastfeeding in African American women: A concept analysis. J Adv Nurs 2022; 79:1699-1713. [PMID: 35621344 DOI: 10.1111/jan.15301] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/25/2022] [Accepted: 05/07/2022] [Indexed: 11/29/2022]
Abstract
AIM To report an analysis of the concept of exclusive breastfeeding (EBF) in African American women. BACKGROUND EBF is the gold standard for infant nutrition from birth until 6 months. The rate of EBF in United States is low-26%, with African American women having the lowest rates. The low rates of EBF in this population are strongly attributed to bias, racism and generational trauma. Therefore, clarifying the concept of EBF with respect to these factors is important for promoting EBF rates of this population. DESIGN Concept analysis. DATA SOURCES Search was conducted in four databases (CINAHL, PubMed, PsycINFO and Scopus) for articles published between 2001 and 2021. A total of 30 articles (20 quantitative, seven qualitative and three mixed methods) clarified the concept. Relevant literature emanated from diverse disciplines examining historical and present maternal and infant health. METHODS Concept analysis using Rodger's evolutionary method. RESULTS An operational definition of the concept of EBF in African American women was developed from the identified antecedents (modifiable and non-modifiable), defining attributes and consequences of the concept. Access to breastfeeding resources, maternal (prenatal intention to breastfeed, smoking status, attitude towards breastfeeding), infant (skin-to-skin care, successful latching and weight) and contextual factors (socioeconomic, occupational and cultural) predict EBF. The primary attributes of EBF were physiological, physical, psychological and relational. Consequences of EBF were positive health outcomes for, and increased bonding between, mother and infant. CONCLUSION This concept analysis is the first identifying modifiable and non-modifiable antecedents of EBF. The analysis provides an operational definition for EBF in African American women which is useful to promote understanding of breastfeeding. This new concept examines the historic societal trauma associated with wet nursing and reframes breastfeeding as a positive maternal and infant health behaviour.
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Affiliation(s)
| | - Ruth Lucas
- University of Connecticut School of Nursing, Storrs, Connecticut, USA
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15
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Helena L, Amani E, Anna W, Nataliia T, Rhonda S, Erica S. Multi-tasking community-based bilingual doulas are bridging gaps-Despite standing on fragile ground. A qualitative study of doulas' experiences in Sweden. Midwifery 2021; 105:103231. [PMID: 34979361 DOI: 10.1016/j.midw.2021.103231] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 12/16/2021] [Accepted: 12/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Community-based Bilingual Doulas (CBDs) are women from migrant communities trained to support and comfort migrant women during labour and birth, and to facilitate linguistic and cultural communication between women, their partners and staff. The aim of the study was to describe CBDs' experiences of supporting migrant women during labour and birth, working alongside caregivers, and to explore CBDs perceptions of their work situation in a Swedish setting. METHODS As part of an ongoing randomised trial of CBD support in XX, Sweden, semi-structured individual interviews were conducted with nine of the 35 participating CBDs. The interviews were conducted in each CBD's first language (Arabic, Somali, Tigrinya, Russian, Polish) or in Swedish, and were audio recorded, transcribed verbatim and translated into English. Thematic analysis of data identified, analysed, interpreted and reported patterns and themes across the data. RESULTS The overarching theme which emerged was "Multi-tasking bilingual doulas bridging gaps - despite standing on fragile ground". To reach out a helping hand and receive appreciation from the women when their needs were met, motivated the CBDs to continue despite the constraints related to roles, working conditions and boundaries. The CBDs felt proud of being acknowledged, although they did also feel a need for more supervision and education. CONCLUSIONS The CBDs experienced their doula tasks as meaningful and emotionally rewarding, which mostly outweighed the challenges of their work which they saw as insecure, exhausting and underpaid. If CBDs are implemented on a larger scale, the scope of their role (including boundaries), education, access to supervision and working conditions all need to be better addressed.
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Affiliation(s)
- Lindgren Helena
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden.
| | - Eltayb Amani
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Wahlberg Anna
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Tsekhmestruk Nataliia
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden
| | - Small Rhonda
- Judith Lumley Centre, La Trobe University, Melbourne Victoria 3086, Australia
| | - Schytt Erica
- Division of Reproductive Health, Department of Women's and Children's Health, Karolinska Institutet, Tomtebodavägen 18a, 171 77 Stockholm, Sweden; Centre for Clinical Research Dalarna - Uppsala University, Nissers väg 3, 791 82 Falun, Sweden; Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Møllendalsveien 6, Postboks 7030, 5020 Bergen, Norway
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16
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Louis-Jacques AF, Vereen S, Hernandez I, Običan SG, Deubel TF, Miller EM, Spatz DL, Wilson RE. Impact of Doula-Led Lactation Education on Breastfeeding Outcomes in Low-Income, Minoritized Mothers. J Perinat Educ 2021; 30:203-212. [PMID: 34908819 DOI: 10.1891/j-pe-d-20-00022] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Prenatal education may improve breastfeeding outcomes among low-income women. Our objective was to assess breastfeeding intentions and knowledge among women participating in doula-facilitated prenatal education classes from August 2016 to October 2017. Breastfeeding knowledge and infant feeding intentions were assessed before and after the classes. Breastfeeding rates were assessed at birth, 2-4 weeks postpartum, and 6-8 weeks postpartum. Paired t-tests tests were conducted. A total of 121 racially diverse, low-income women were enrolled. Intentions to breastfeed increased pre- to post-intervention (p = 0.007). Breastfeeding knowledge scores increased pre- to post-intervention (p <.001); specifically, among women who were exclusively breastfeeding or breastfeeding while supplementing with formula at birth (p < .001 and p = 0.046, respectively). Doula-facilitated breastfeeding education may help improve breastfeeding outcomes for low-income women.
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17
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Hornsby PP, Conaway MR, Medico TJ, Gurka KK, Kellams A. Timing of Introduction of Complementary Foods and Beverages to Infants of Low-Income Women. Breastfeed Med 2021; 16:547-552. [PMID: 33781096 DOI: 10.1089/bfm.2020.0352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Background: Although rates of complementary food and beverage (CFB) consumption among infants under 4 to 6 months of age have been declining, they remain well above the American Academy of Pediatrics (AAPs) recommendations. It is unclear if women with low income in the United States are more likely than other women to introduce CFBs early. We examined timing of introduction of CFBs to infants of mothers with low income to further illuminate infant feeding practices in this potentially vulnerable population. Materials and Methods: We analyzed infant feeding data collected prospectively from 443 mother-infant dyads. Data were obtained by interview at 1, 3, and 6 months postpartum. We used Kaplan-Meier curves to show time to introduction of CFBs overall and by type of CFB, and log-rank tests to compare timing by demographic and clinical characteristics. Results: Participants were mostly non-Hispanic black or white, with a high school education or less. By month 3, 48% of infants were fed at least one CFB, increasing to over 83% by month 5. Women who did not work outside the home introduced CFBs significantly earlier than those who worked, as did women who smoked compared with those who did not. Timing did not differ by other participant characteristics. Conclusions: Introduction of CFBs before 4-6 months was common. Clinical guidance and intervention programs should support mothers toward the goal of improving infant diets in this at-risk population.
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Affiliation(s)
- Paige P Hornsby
- Department of Public Health Sciences and University of Virginia, Charlottesville, Virginia, USA
| | - Mark R Conaway
- Department of Public Health Sciences and University of Virginia, Charlottesville, Virginia, USA
| | - Tegan J Medico
- Department of Nutrition Services, University of Virginia, Charlottesville, Virginia, USA
| | - Kelly K Gurka
- Department of Epidemiology, University of Florida, Gainesville, Florida, USA
| | - Ann Kellams
- Department of Pediatrics, University of Virginia, Charlottesville, Virginia, USA
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18
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Segura-Pérez S, Hromi-Fiedler A, Adnew M, Nyhan K, Pérez-Escamilla R. Impact of breastfeeding interventions among United States minority women on breastfeeding outcomes: a systematic review. Int J Equity Health 2021; 20:72. [PMID: 33676506 PMCID: PMC7936442 DOI: 10.1186/s12939-021-01388-4] [Citation(s) in RCA: 62] [Impact Index Per Article: 20.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 01/18/2021] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the U.S., strong ethnic/racial, socioeconomic, demographic, and geographic breastfeeding (BF) inequities persist, and African American and Hispanic women are less likely to meet their breastfeeding goals compared to White women. This systematic review (SR) was designed to answer the question: What is the impact of breastfeeding interventions targeting ethnic/racial minority women in the U.S. on improving BF initiation, duration and exclusivity rates? METHODS The SR was conducted following the Institute of Medicine Guidelines and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses checklist. The study protocol was developed and registered a priori in PROSPERO (ID#CRD42020177764). The electronical databases searched was MEDLINE All (Ovid). Search strategies were led by the team's expert public health librarian using both controlled vocabulary and free text queries and were tested against a validated set of relevant papers included in existing reviews. The GRADE methodology was used to assess the quality of the studies. RESULTS We included 60 studies that had randomized (n = 25), observational (n = 24), quasi-experimental (n = 9), or cross-sectional (n = 2) designs. The studies focused on populations that were multi-ethnic/racial (n = 22), only Hispanic (n = 24), only Black (n = 13), and only American Indian (n = 1). The study interventions were classified following the socioecological model: macrosystem/policy level (n = 6); community level (n=51), which included healthcare organizations (n = 34), The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) (n = 9), and community organizations/public health institutions (n = 8); and interpersonal level (n = 3). CONCLUSIONS Policy and community level interventions delivered through WIC, healthcare facilities, and community agencies) are likely to improve BF outcomes among women of color. The combination of interventions at different levels of the socioecological model has not been studied among minority women in the U.S. Implementation science research is needed to learn how best to scale up and sustain effective BF interventions, taking into account the needs and wants of minority women. Thus, it is strongly recommended to conduct large scale implementation research studies addressesing how to strengthen the different health and social environments surrounding women of color in the U.S. to improving their BF outcomes.
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Affiliation(s)
| | | | - Misikir Adnew
- Yale School of Public Health, 135 College Street, New Haven, CT 06510 USA
| | - Kate Nyhan
- Harvey Cushing/John Hay Whitney Medical Library, Yale School of Public Health, New Haven, USA
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19
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Acquaye SN, Spatz DL. An Integrative Review: The Role of the Doula in Breastfeeding Initiation and Duration. J Perinat Educ 2020; 30:29-47. [PMID: 33488045 DOI: 10.1891/j-pe-d-20-00037] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
The objective of this integrative review was to assess birth and postpartum doulas' roles in supporting breastfeeding initiation and duration. The electronic databases Cumulative Index to Nursing and Allied Health Literature (CINAHL), Embase, PubMed, and Scopus were searched using the key terms doula and breastfeeding. Fourteen articles met inclusion criteria. Six key themes were identified. Doulas may acquire only modest amounts of lactation-specific education; however, doula care still enhances the breastfeeding care provided by health-care professionals. Doulas offer prenatal and intrapartum support that encourages breastfeeding initiation in the hospital, as well as providing breastfeeding support in the community and home settings. This reinforces the unique role of the doula in bolstering maternal-infant health. The effect of doulas on breastfeeding duration is less clear.
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20
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Kåks P, Målqvist M. Peer support for disadvantaged parents: a narrative review of strategies used in home visiting health interventions in high-income countries. BMC Health Serv Res 2020; 20:682. [PMID: 32703302 PMCID: PMC7376883 DOI: 10.1186/s12913-020-05540-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 07/14/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Disparities in health persist even in high-income countries, and healthcare systems do not reach disadvantaged families as needed. A number of home-visiting interventions in high-income countries offering peer support for parents have been implemented to bridge the gaps in health in a cost-effective way. The lack of standard for intervention design has however resulted in a large variety of the strategies used. The objective for this article is to conduct a review of peer support home visiting interventions for parents and children in high-income countries, aiming to assess the strategies used, their outcomes and the challenges faced by peer supporters. METHODS Relevant articles published in English between January 2004 and August 2019 were identified using PubMed, and reference lists were reviewed to identify additional articles. Studies were included if they reported on individual peer support health interventions, delivered at home to socioeconomically disadvantaged parents in high-income countries. Nineteen studies were found that met the inclusion criteria, and data were extracted on study characteristics, intervention design and outcomes. Data on intervention design was characterized iteratively to generate overarching categories of strategies used in the programs. RESULTS Most studies used healthcare facilities for recruitment, even when the interventions were not delivered by the formal healthcare system. The strategies used to engage supported parents included (1) connection in the form of emotional support, relationship building and matching for background, (2) flexibility in regards to content, intensity, location and mode of contact, and (3) linking through referrals and facilitation of other contacts. A number of significant quantifiable improvements could be demonstrated. Due to large heterogeneity of outcomes, meta-analyses were not viable. Peer supporters experienced challenges with involving other family members than the supported parent as well as with finding their role in relation to other support structures. CONCLUSIONS Peer support delivered as home visiting interventions have been used for hard-to-reach parents in a variety of high-income contexts and for a multitude of health concerns. Overall, despite variation in intervention design, the strategies employed followed common themes and were generally well received.
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Affiliation(s)
- Per Kåks
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, SE-75185, Sweden.
| | - Mats Målqvist
- Uppsala Global Health Research on Implementation and Sustainability (UGHRIS), Department of Women's and Children's Health, Uppsala University, Uppsala, SE-75185, Sweden
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McFadden A, Siebelt L, Marshall JL, Gavine A, Girard LC, Symon A, MacGillivray S. Counselling interventions to enable women to initiate and continue breastfeeding: a systematic review and meta-analysis. Int Breastfeed J 2019; 14:42. [PMID: 31649743 PMCID: PMC6805348 DOI: 10.1186/s13006-019-0235-8] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 09/04/2019] [Indexed: 11/10/2022] Open
Abstract
Background Many infants worldwide are not breastfeeding according to WHO recommendations and this impacts on the health of women and children. Increasing breastfeeding is identified as a priority area supported by current policy targets. However, interventions are complex and multi-component and it is unclear which elements of interventions are most effective to increase breastfeeding in which settings. Breastfeeding counselling is often part of complex interventions but evidence is lacking on the specific effect of counselling interventions on breastfeeding practices. The aim of this systematic review is to examine evidence on effectiveness of breastfeeding counselling to inform global guidelines. Methods A systematic search was conducted of six electronic databases in January 2018. Randomised controlled trials comparing breastfeeding counselling with no breastfeeding counselling or different formulations of counselling were included if they measured breastfeeding practices between birth and 24 months after birth. Results From the 5180 records identified in searches and a further 11 records found by hand searching, 63 studies were included. Of these, 48 were individually-randomised trials and 15 were cluster-randomised trials. A total of 69 relevant comparisons were reported involving 33,073 women. There was a significant effect of counselling interventions on any breastfeeding at 4 to 6 weeks (Relative risk [RR] 0.85, 95% CI 0.77, 0.94) and 6 months (RR 0.92, 95% CI 0.87, 0.94). Greater effects were found on exclusive breastfeeding at 4 to 6 weeks (RR 0.79, 95% CI 0.72, 0.87) and 6 months (RR 0.84, 95% CI 0.78, 0.91). Counselling delivered at least four times postnatally is more effective than counselling delivered antenatally only and/or fewer than four times. Evidence was mostly of low quality due to high or unclear risk of bias of the included trials and high heterogeneity. Conclusions Breastfeeding counselling is an effective public health intervention to increase rates of any and exclusive breastfeeding. Breastfeeding counselling should be provided face-to-face, and in addition, may be provided by telephone, both antenatally and postnatally, to all pregnant women and mothers with young children. To inform scale-up globally there is a need to further understand the elements of breastfeeding interventions such as counselling and their effectiveness in different contexts and circumstances. Study registration This systematic review was registered in Prospero (CRD42018086494).
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Affiliation(s)
- Alison McFadden
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Lindsay Siebelt
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Joyce L Marshall
- 2School of Human and Health Sciences, Harold Wilson Building, University of Huddersfield, Queensgate, Huddersfield, HD1 3DH Scotland
| | - Anna Gavine
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Lisa-Christine Girard
- 3School of Health in Social Science, The University of Edinburgh, Doorway 6, Room 1m04, Old Medical School, Edinburgh, EH8 9AG Scotland
| | - Andrew Symon
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
| | - Stephen MacGillivray
- 1School of Nursing and Health Sciences, University of Dundee, 11 Airlie Place, Dundee, DD1 4HJ Scotland
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Abstract
Reproductive justice advocates emphasize the rights of women to choose to have children, to decide the conditions under which they give birth, and to parent their children with support, safety, and dignity. This article examines what a reproductive justice perspective contributes to infant mental health work with teenage mothers and their families. It explores the historical framing of teenage pregnancy in which young mothers are the cause of a variety of social problems and in which the primary policy and practice approach is pregnancy prevention. The article offers alternative framings of teenage childbearing, based on reproductive justice principles, which focus on social conditions surrounding teenage parenthood and the meaning of motherhood in the lives of young women. These alternative frames shift the practice agenda to eradicating unjust social conditions and providing supports for young women in their roles as parents. The article then describes ways in which two infant mental health programs have incorporated reproductive justice principles into their work with young families: Chicago's community doula model and Florida's Young Parents Project for court-involved teenage parents. Finally, the article extracts a set of principles deriving from a reproductive justice perspective that are relevant to infant mental health work with young families.
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Affiliation(s)
- Sydney L. Hans
- School of Social Service AdministrationUniversity of ChicagoChicagoIllinois
| | - Barbara A. White
- Center for Prevention & Early Intervention PolicyFlorida State UniversityTallahasseeFlorida
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Hmiel L, Collins C, Brown P, Cherney E, Farmer C. "We have this awesome organization where it was built by women for women like us": Supporting African American women through their pregnancies and beyond. SOCIAL WORK IN HEALTH CARE 2019; 58:579-595. [PMID: 30933655 DOI: 10.1080/00981389.2019.1597007] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 02/20/2019] [Accepted: 03/15/2019] [Indexed: 06/09/2023]
Abstract
Infant mortality is a problem that disproportionately affects infants of African American women, particularly residents in underserved neighborhoods. Chronic stress due to racism has been identified as an important factor in infant mortality. This study examined a novel community-based perinatal support professional (PSP) program, Birthing Beautiful Communities (BBC), in Cleveland, Ohio. BBC provides services for pregnant African American women in underserved neighborhoods with the goal of decreasing infant mortality and low birthweight rates by addressing chronic stress. Focus groups and one individual interview were conducted with the program's 14 PSPs, and 25 clients were interviewed individually. Interviews were analyzed inductively using qualitative thematic analysis to identify pervasive themes. Coders identified major themes of stress, resilience, community, cultural matching, advocacy, self-care, transformation, and self-actualization. BBC PSPs and clients alike reported the program is transforming the lives of clients by helping them address stressors. Findings suggest the community-based PSP model is an important but underused intervention in addressing infant mortality.
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Affiliation(s)
- Laura Hmiel
- a Department of Medicine , Case Western Reserve University , Cleveland , OH , USA
| | - Cyleste Collins
- b Department of Social Work , Cleveland State University , Cleveland , OH , USA
| | | | - Emily Cherney
- b Department of Social Work , Cleveland State University , Cleveland , OH , USA
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24
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Wint K, Elias TI, Mendez G, Mendez DD, Gary-Webb TL. Experiences of Community Doulas Working with Low-Income, African American Mothers. Health Equity 2019; 3:109-116. [PMID: 31289769 PMCID: PMC6608698 DOI: 10.1089/heq.2018.0045] [Citation(s) in RCA: 34] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Purpose: The aim of this study was to learn from doulas the components of their services that might best serve low-income, African American (AA) women and to show the significance of doulas in helping these women have healthy, positive, birth experiences. Methods: Ten doulas were recruited from a local community doula program and through word-of-mouth referrals from participants and completed in-depth interviews. Interviews were transcribed verbatim and analyzed using Atlas.ti software to identify emerging themes. Thematic saturation was achieved in interviews. Results: Several themes emerged from the interviews including: (1) The influence of similarities of race, culture, and lived experience on doula care; (2) How doulas often provide birthing persons with support and resources beyond birth; and (3) How doulas recognize the institutional biases that exist in the health care system and try to mediate their effect on birthing persons. Conclusions: These themes highlight how doulas can support birthing persons to mitigate the negative effects of social determinants of health, specifically racism and classism, and highlight potential avenues for doulas to consider when working with birthing persons who have low income and are AA.
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Affiliation(s)
- Kristina Wint
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Thistle I Elias
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Gabriella Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania
| | - Dara D Mendez
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
| | - Tiffany L Gary-Webb
- Department of Behavioral and Community Health Sciences, Pittsburgh, Pennsylvania.,Department of Epidemiology at the University of Pittsburgh Graduate School of Public Health in Pittsburgh, Pittsburgh, Pennsylvania
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Hans SL, Edwards RC, Zhang Y. Randomized Controlled Trial of Doula-Home-Visiting Services: Impact on Maternal and Infant Health. Matern Child Health J 2018; 22:105-113. [PMID: 29855838 PMCID: PMC6153776 DOI: 10.1007/s10995-018-2537-7] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
Introduction Although home-visiting programs typically engage families during pregnancy, few studies have examined maternal and child health outcomes during the antenatal and newborn period and fewer have demonstrated intervention impacts. Illinois has developed an innovative model in which programs utilizing evidence-based home-visiting models incorporate community doulas who focus on childbirth education, breastfeeding, pregnancy health, and newborn care. This randomized controlled trial (RCT) examines the impact of doula-home-visiting on birth outcomes, postpartum maternal and infant health, and newborn care practices. Methods 312 young (M = 18.4 years), pregnant women across four communities were randomly assigned to receive doula-home-visiting services or case management. Women were African American (45%), Latina (38%), white (8%), and multiracial/other (9%). They were interviewed during pregnancy and at 3-weeks and 3-months postpartum. Results Intervention-group mothers were more likely to attend childbirth-preparation classes (50 vs. 10%, OR = 9.82, p < .01), but there were no differences on Caesarean delivery, birthweight, prematurity, or postpartum depression. Intervention-group mothers were less likely to use epidural/pain medication during labor (72 vs. 83%; OR = 0.49, p < .01) and more likely to initiate breastfeeding (81 vs. 74%; OR = 1.72, p < .05), although the breastfeeding impact was not sustained over time. Intervention-group mothers were more likely to put infants on their backs to sleep (70 vs. 61%; OR = 1.64, p < .05) and utilize car-seats at three weeks (97 vs. 93%; OR = 3.16, p < .05). Conclusions for practices The doula-home-visiting intervention was associated with positive infant-care behaviors. Since few evidence-based home-visiting programs have shown health impacts in the postpartum months after birth, incorporating doula services may confer additional health benefits to families.
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Affiliation(s)
- Sydney L Hans
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA.
| | - Renee C Edwards
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
| | - Yudong Zhang
- School of Social Service Administration, University of Chicago, 969 E 60th Street, Chicago, IL, 60637, USA
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Everson CL, Cheyney M, Bovbjerg ML. Outcomes of Care for 1,892 Doula-Supported Adolescent Births in the United States: The DONA International Data Project, 2000 to 2013. J Perinat Educ 2018; 27:135-147. [PMID: 30364259 PMCID: PMC6193361 DOI: 10.1891/1058-1243.27.3.135] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
This is the largest study to-date to report on outcomes of care for a national sample of doula-supported adolescent births (n = 1,892, birth years 2000 to 2013). Descriptive statistics were calculated for maternal demographics, risk profiles, labor/birth interventions and occurrences, and birth outcomes. In this national sample, childbearing adolescents and their neonates experienced improved health outcomes and lower rates of intervention relative to national statistics for adolescent deliveries in the United States. Key findings are consistent with previous studies on the effects of doula care for marginalized and medically underserved communities. Results strengthen the case for doulas as a perinatal care strategy for improving maternal and infant health outcomes and decreasing inequities among childbearing adolescents.
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Arikpo D, Edet ES, Chibuzor MT, Odey F, Caldwell DM. Educational interventions for improving primary caregiver complementary feeding practices for children aged 24 months and under. Cochrane Database Syst Rev 2018; 5:CD011768. [PMID: 29775501 PMCID: PMC6494551 DOI: 10.1002/14651858.cd011768.pub2] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Although complementary feeding is a universal practice, the methods and manner in which it is practiced vary between cultures, individuals and socioeconomic classes. The period of complementary feeding is a critical time of transition in the life of an infant, and inappropriate complementary feeding practices, with their associated adverse health consequences, remain a significant global public health problem. Educational interventions are widely acknowledged as effective in promoting public health strategy, and those aimed at improving complementary feeding practices provide information about proper complementary feeding practices to caregivers of infants/children. It is therefore important to summarise evidence on the effectiveness of educational interventions to improve the complementary feeding practices of caregivers of infants. OBJECTIVES To assess the effectiveness of educational interventions for improving the complementary feeding (weaning) practices of primary caregivers of children of complementary feeding age, and related health and growth outcomes in infants. SEARCH METHODS In November 2017, we searched CENTRAL, MEDLINE, Embase, 10 other databases and two trials registers. We also searched the reference lists of relevant studies and reviews to identify any additional studies. We did not limit the searches by date, language or publication status. SELECTION CRITERIA Randomised controlled trials (RCTs), comparing educational interventions to no intervention, usual practice, or educational interventions provided in conjunction with another intervention, so long as the educational intervention was only available in the experimental group and the adjunctive intervention was available to the control group. Study participants included caregivers of infants aged 4 to 24 months undergoing complementary feeding. Pregnant women who were expected to give birth and commence complementary feeding during the period of the study were also included. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data on participants, settings, interventions, methodology and outcomes using a specifically-developed and piloted data extraction form. We calculated risk ratios (RR) and 95% confidence intervals (CIs) for dichotomous data, and mean differences (MD) and 95% CIs for continuous data. Where data permitted, we conducted a meta-analysis using a random-effects model. We assessed the included studies for risk of bias and also assessed the quality of evidence using the GRADE approach. MAIN RESULTS We included 23 studies (from 35 reports) with a total of 11,170 caregiver-infant pairs who were randomly assigned to receive an educational intervention delivered to the caregiver or usual care. Nineteen of the included studies were community-based studies while four were facility-based studies. In addition, 13 of the included studies were cluster-randomised while the others were individually randomised. Generally, the interventions were focused on the introduction of complementary feeding at the appropriate time, the types and amount of complementary foods to be fed to infants, and hygiene. Using the GRADE criteria, we assessed the quality of the evidence as moderate, mostly due to inadequate allocation concealment and insufficient blinding.Educational interventions led to improvements in complementary feeding practices for age at introduction of complementary foods (average RR 0.88, 95% CI 0.83 to 0.94; 4 studies, 1738 children; moderate-quality evidence) and hygiene practices (average RR 1.38, 95% CI 1.23 to 1.55; 4 studies, 2029 participants; moderate-quality evidence). For duration of exclusive breastfeeding, pooled results were compatible with both a reduction and an increase in the outcome (average RR 1.58, 95% CI 0.77 to 3.22; 3 studies, 1544 children; very low-quality evidence). There was limited (low to very low-quality) evidence of an effect for all growth outcomes.Quality of evidenceThere is moderate to very low-quality evidence that educational interventions can improve complementary feeding practices but insufficient evidence to conclude that it impacts growth outcomes. AUTHORS' CONCLUSIONS Overall, we found evidence that education improves complementary feeding practices.
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Affiliation(s)
- Dachi Arikpo
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Ededet Sewanu Edet
- University of Calabar Teaching HospitalDepartment of Community MedicineCalabarCross RiverNigeria540261
| | - Moriam T Chibuzor
- Cochrane Nigeria, Institute of Tropical Diseases Research and Prevention, University of Calabar Teaching HospitalCalabarCross River StateNigeria540261
| | - Friday Odey
- University of Calabar Teaching HospitalDepartment of PaediatricsPMB 1115CalabarCross River StateNigeria540261
| | - Deborah M Caldwell
- University of BristolPopulation Health Sciences, Bristol Medical SchoolCanynge Hall, 39 Whatley RoadBristolAvonUKBS8 2PS
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Fiks AG, Gruver RS, Bishop-Gilyard CT, Shults J, Virudachalam S, Suh AW, Gerdes M, Kalra GK, DeRusso PA, Lieberman A, Weng D, Elovitz MA, Berkowitz RI, Power TJ. A Social Media Peer Group for Mothers To Prevent Obesity from Infancy: The Grow2Gether Randomized Trial. Child Obes 2017; 13:356-368. [PMID: 28557558 PMCID: PMC5647509 DOI: 10.1089/chi.2017.0042] [Citation(s) in RCA: 47] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Few studies have addressed obesity prevention among low-income families whose infants are at increased obesity risk. We tested a Facebook peer-group intervention for low-income mothers to foster behaviors promoting healthy infant growth. METHODS In this randomized controlled trial, 87 pregnant women (Medicaid insured, BMI ≥25 kg/m2) were randomized to the Grow2Gether intervention or text message appointment reminders. Grow2Gether participants joined a private Facebook group of 9-13 women from 2 months before delivery until infant age 9 months. A psychologist facilitated groups featuring a curriculum of weekly videos addressing feeding, sleep, parenting, and maternal well-being. Feasibility was assessed using the frequency and content of participation, and acceptability using surveys. Maternal beliefs and behaviors and infant growth were assessed at birth, 2, 4, 6, and 9 months. Differences in infant growth between study arms were explored. We conducted intention-to-treat analyses using quasi-least-squares regression. RESULTS Eighty-eight percent (75/85) of intervention participants (42% (36/85) food insecure, 88% (75/85) black) reported the group was helpful. Participants posted 30 times/group/week on average. At 9 months, the intervention group had significant improvement in feeding behaviors (Infant Feeding Style Questionnaire) compared to the control group (p = 0.01, effect size = 0.45). Intervention group mothers were significantly less likely to pressure infants to finish food and, at age 6 months, give cereal in the bottle. Differences were not observed for other outcomes, including maternal feeding beliefs or infant weight-for-length. CONCLUSIONS A social media peer-group intervention was engaging and significantly impacted certain feeding behaviors in families with infants at high risk of obesity.
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Affiliation(s)
- Alexander G. Fiks
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Rachel S. Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Chanelle T. Bishop-Gilyard
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Justine Shults
- Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Senbagam Virudachalam
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Andrew W. Suh
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Marsha Gerdes
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Gurpreet K. Kalra
- Sloan Kettering Institute, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Patricia A. DeRusso
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Gastroenterology, Hepatology and Nutrition, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Alexandra Lieberman
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Daniel Weng
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
| | - Michal A. Elovitz
- Maternal and Child Health Research Program, Department of Obstetrics and Gynecology, University of Pennsylvania, Philadelphia, PA
| | - Robert I. Berkowitz
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Psychiatry, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Thomas J. Power
- Department of Child and Adolescent Psychiatry and Behavioral Sciences, The Children's Hospital of Philadelphia, Philadelphia, PA
- Department of Pediatrics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
- Division of Developmental and Behavioral Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA
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McGinnis S, Lee E, Kirkland K, Miranda-Julian C, Greene R. Let’s Talk About Breastfeeding: The Importance of Delivering a Message in a Home Visiting Program. Am J Health Promot 2017; 32:989-996. [DOI: 10.1177/0890117117723802] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Purpose: To examine the potential impact of paraprofessional home visitors in promoting breastfeeding initiation and continuation among a high-risk population. Design: A secondary analysis of program data from a statewide home visitation program. Setting: Thirty-six Healthy Families New York sites across New York State. Subjects: A total of 3521 pregnant mothers at risk of poor child health and developmental outcomes. Intervention: Home visitors deliver a multifaceted intervention that includes educating high-risk mothers on benefits of breastfeeding, encouraging them to breastfeed and supporting their efforts during prenatal and postnatal periods. Measures: Home visitor-reported content and frequency of home visits, participant-reported breastfeeding initiation and duration, and covariates (Kempe Family Stress Index, race and ethnicity, region, nativity, marital status, age, and education). Analysis: Logistic regression. Results: Breastfeeding initiation increased by 1.5% for each 1-point increase in the percentage of prenatal home visits that included breastfeeding discussions. Breastfeeding continuation during the first 6 months also increased with the percentage of earlier home visits that included breastfeeding discussions. Additionally, if a participant receives 1 more home visit during the third month, her likelihood of breastfeeding at 6 months increases by 11%. Effect sizes varied by months postpartum. Conclusions: Delivering a breastfeeding message consistently during regular home visits is important for increasing breastfeeding rates. Given that home visiting programs target new mothers least likely to breastfeed, a more consistent focus on breastfeeding in this supportive context may reduce breastfeeding disparities.
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Affiliation(s)
- Sandra McGinnis
- Center for Human Services Research, School of Social Welfare, University at Albany, Albany, NY, USA
| | - Eunju Lee
- School of Social Welfare, University at Albany, Albany, NY, USA
| | - Kristen Kirkland
- Bureau of Research, Evaluation and Performance Analytics, New York State Office of Children and Family Services, Rensselaer, NY, USA
| | - Claudia Miranda-Julian
- Bureau of Research, Evaluation and Performance Analytics, New York State Office of Children and Family Services, Rensselaer, NY, USA
| | - Rose Greene
- Center for Human Services Research, School of Social Welfare, University at Albany, Albany, NY, USA
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30
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Williams CM, Cprek S, Asaolu I, English B, Jewell T, Smith K, Robl J. Kentucky Health Access Nurturing Development Services Home Visiting Program Improves Maternal and Child Health. Matern Child Health J 2017; 21:1166-1174. [PMID: 28093688 DOI: 10.1007/s10995-016-2215-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVES Home visitation programs are one of the numerous efforts to help reduce the rates of preterm birth and low birth weight as well as offering other improvements in maternal and child health and development. The Kentucky Health Access Nurturing Development Services (HANDS) is a voluntary, home visiting program serving first-time, high-risk mothers. This study's objective was to evaluate the impact of HANDS on maternal and child health outcomes. METHODS HANDS administrative data, live birth certificate records and data from the Division of Child Protection and Safety were used in these analyses. We analyzed 2253 mothers who were referred to HANDS between July 2011 and June 2012 and received a minimum of one prenatal home visit (mean number of prenatal visits = 12.9) compared to a demographically similar group of women (n = 2253) who did not receive a visit. Chi square statistics and conditional logistic regression models were used to evaluate the impact of HANDS. RESULTS HANDS participants had lower rates of preterm delivery (OR 0.74, 95% CI 0.61-0.88) and low birth weight infants (OR 0.54, 95% CI 0.44-0.67). HANDS participants also were significantly less likely to have a substantiated report of child maltreatment compared to controls (OR 0.53, 95% CI 0.43-0.65). HANDS participants also had an increase in adequate prenatal care and a reduction in maternal complications during pregnancy. Of particular important, outcomes improved as the number of prenatal home visits increased: among women receiving 1-3 prenatal home visits was 12.1%, the rate among women receiving 4-6 prenatal home visits was 13.2%, while the rate of PTB among those receiving 7 or more prenatal home visits was 9.4%. CONCLUSIONS HANDS program participation appears to result in significant improvements in maternal and child health outcomes, most specifically for those receiving seven or more prenatal home visits. As a state-wide, large scale home visiting program, this has significant implications for the continued improvement of maternal and child health outcomes in Kentucky.
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Affiliation(s)
- Corrine M Williams
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA.
| | - Sarah Cprek
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA
| | - Ibitola Asaolu
- Department of Health, Behavior & Society, University of Kentucky, 111 Washington Avenue, Room 113B, Lexington, KY, USA
| | - Brenda English
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Tracey Jewell
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Kylen Smith
- Kentucky Department for Public Health, Frankfort, KY, USA
| | - Joyce Robl
- Kentucky Department for Public Health, Frankfort, KY, USA
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Abstract
BACKGROUND Historically, women have generally been attended and supported by other women during labour. However, in hospitals worldwide, continuous support during labour has often become the exception rather than the routine. OBJECTIVES The primary objective was to assess the effects, on women and their babies, of continuous, one-to-one intrapartum support compared with usual care, in any setting. Secondary objectives were to determine whether the effects of continuous support are influenced by:1. Routine practices and policies in the birth environment that may affect a woman's autonomy, freedom of movement and ability to cope with labour, including: policies about the presence of support people of the woman's own choosing; epidural analgesia; and continuous electronic fetal monitoring.2. The provider's relationship to the woman and to the facility: staff member of the facility (and thus has additional loyalties or responsibilities); not a staff member and not part of the woman's social network (present solely for the purpose of providing continuous support, e.g. a doula); or a person chosen by the woman from family members and friends;3. Timing of onset (early or later in labour);4. Model of support (support provided only around the time of childbirth or extended to include support during the antenatal and postpartum periods);5. Country income level (high-income compared to low- and middle-income). SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 October 2016), ClinicalTrials.gov, the WHO International Clinical Trials Registry Platform (ICTRP) (1 June 2017) and reference lists of retrieved studies. SELECTION CRITERIA All published and unpublished randomised controlled trials, cluster-randomised trials comparing continuous support during labour with usual care. Quasi-randomised and cross-over designs were not eligible for inclusion. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. We sought additional information from the trial authors. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS We included a total of 27 trials, and 26 trials involving 15,858 women provided usable outcome data for analysis. These trials were conducted in 17 different countries: 13 trials were conducted in high-income settings; 13 trials in middle-income settings; and no studies in low-income settings. Women allocated to continuous support were more likely to have a spontaneous vaginal birth (average RR 1.08, 95% confidence interval (CI) 1.04 to 1.12; 21 trials, 14,369 women; low-quality evidence) and less likely to report negative ratings of or feelings about their childbirth experience (average RR 0.69, 95% CI 0.59 to 0.79; 11 trials, 11,133 women; low-quality evidence) and to use any intrapartum analgesia (average RR 0.90, 95% CI 0.84 to 0.96; 15 trials, 12,433 women). In addition, their labours were shorter (MD -0.69 hours, 95% CI -1.04 to -0.34; 13 trials, 5429 women; low-quality evidence), they were less likely to have a caesarean birth (average RR 0.75, 95% CI 0.64 to 0.88; 24 trials, 15,347 women; low-quality evidence) or instrumental vaginal birth (RR 0.90, 95% CI 0.85 to 0.96; 19 trials, 14,118 women), regional analgesia (average RR 0.93, 95% CI 0.88 to 0.99; 9 trials, 11,444 women), or a baby with a low five-minute Apgar score (RR 0.62, 95% CI 0.46 to 0.85; 14 trials, 12,615 women). Data from two trials for postpartum depression were not combined due to differences in women, hospitals and care providers included; both trials found fewer women developed depressive symptomatology if they had been supported in birth, although this may have been a chance result in one of the studies (low-quality evidence). There was no apparent impact on other intrapartum interventions, maternal or neonatal complications, such as admission to special care nursery (average RR 0.97, 95% CI 0.76 to 1.25; 7 trials, 8897 women; low-quality evidence), and exclusive or any breastfeeding at any time point (average RR 1.05, 95% CI 0.96 to 1.16; 4 trials, 5584 women; low-quality evidence).Subgroup analyses suggested that continuous support was most effective at reducing caesarean birth, when the provider was present in a doula role, and in settings in which epidural analgesia was not routinely available. Continuous labour support in settings where women were not permitted to have companions of their choosing with them in labour, was associated with greater likelihood of spontaneous vaginal birth and lower likelihood of a caesarean birth. Subgroup analysis of trials conducted in high-income compared with trials in middle-income countries suggests that continuous labour support offers similar benefits to women and babies for most outcomes, with the exception of caesarean birth, where studies from middle-income countries showed a larger reduction in caesarean birth. No conclusions could be drawn about low-income settings, electronic fetal monitoring, the timing of onset of continuous support or model of support.Risk of bias varied in included studies: no study clearly blinded women and personnel; only one study sufficiently blinded outcome assessors. All other domains were of varying degrees of risk of bias. The quality of evidence was downgraded for lack of blinding in studies and other limitations in study designs, inconsistency, or imprecision of effect estimates. AUTHORS' CONCLUSIONS Continuous support during labour may improve outcomes for women and infants, including increased spontaneous vaginal birth, shorter duration of labour, and decreased caesarean birth, instrumental vaginal birth, use of any analgesia, use of regional analgesia, low five-minute Apgar score and negative feelings about childbirth experiences. We found no evidence of harms of continuous labour support. Subgroup analyses should be interpreted with caution, and considered as exploratory and hypothesis-generating, but evidence suggests continuous support with certain provider characteristics, in settings where epidural analgesia was not routinely available, in settings where women were not permitted to have companions of their choosing in labour, and in middle-income country settings, may have a favourable impact on outcomes such as caesarean birth. Future research on continuous support during labour could focus on longer-term outcomes (breastfeeding, mother-infant interactions, postpartum depression, self-esteem, difficulty mothering) and include more woman-centred outcomes in low-income settings.
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Affiliation(s)
- Meghan A Bohren
- World Health OrganizationDepartment of Reproductive Health and Research20 Avenue AppiaGenevaGeneveSwitzerland1211
| | - G Justus Hofmeyr
- Walter Sisulu University, University of the Witwatersrand, Eastern Cape Department of HealthEast LondonSouth Africa
| | - Carol Sakala
- National Partnership for Women & Families1875 Connecticut Avenue, NW, Suite 650Washington DCUSA20009
| | - Rieko K Fukuzawa
- University of TsukubaFaculty of Medicine1‐1‐1 TennodaiTsukubaIbarakiJapan305‐8575
| | - Anna Cuthbert
- The University of LiverpoolCochrane Pregnancy and Childbirth Group, Department of Women's and Children's HealthFirst Floor, Liverpool Women's NHS Foundation TrustCrown StreetLiverpoolUKL8 7SS
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McFadden A, Gavine A, Renfrew MJ, Wade A, Buchanan P, Taylor JL, Veitch E, Rennie AM, Crowther SA, Neiman S, MacGillivray S. Support for healthy breastfeeding mothers with healthy term babies. Cochrane Database Syst Rev 2017; 2:CD001141. [PMID: 28244064 PMCID: PMC6464485 DOI: 10.1002/14651858.cd001141.pub5] [Citation(s) in RCA: 233] [Impact Index Per Article: 33.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND There is extensive evidence of important health risks for infants and mothers related to not breastfeeding. In 2003, the World Health Organization recommended that infants be breastfed exclusively until six months of age, with breastfeeding continuing as an important part of the infant's diet until at least two years of age. However, current breastfeeding rates in many countries do not reflect this recommendation. OBJECTIVES To describe forms of breastfeeding support which have been evaluated in controlled studies, the timing of the interventions and the settings in which they have been used.To examine the effectiveness of different modes of offering similar supportive interventions (for example, whether the support offered was proactive or reactive, face-to-face or over the telephone), and whether interventions containing both antenatal and postnatal elements were more effective than those taking place in the postnatal period alone.To examine the effectiveness of different care providers and (where information was available) training.To explore the interaction between background breastfeeding rates and effectiveness of support. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and reference lists of retrieved studies. SELECTION CRITERIA Randomised or quasi-randomised controlled trials comparing extra support for healthy breastfeeding mothers of healthy term babies with usual maternity care. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data and checked them for accuracy. The quality of the evidence was assessed using the GRADE approach. MAIN RESULTS This updated review includes 100 trials involving more than 83,246 mother-infant pairs of which 73 studies contribute data (58 individually-randomised trials and 15 cluster-randomised trials). We considered that the overall risk of bias of trials included in the review was mixed. Of the 31 new studies included in this update, 21 provided data for one or more of the primary outcomes. The total number of mother-infant pairs in the 73 studies that contributed data to this review is 74,656 (this total was 56,451 in the previous version of this review). The 73 studies were conducted in 29 countries. Results of the analyses continue to confirm that all forms of extra support analyzed together showed a decrease in cessation of 'any breastfeeding', which includes partial and exclusive breastfeeding (average risk ratio (RR) for stopping any breastfeeding before six months 0.91, 95% confidence interval (CI) 0.88 to 0.95; moderate-quality evidence, 51 studies) and for stopping breastfeeding before four to six weeks (average RR 0.87, 95% CI 0.80 to 0.95; moderate-quality evidence, 33 studies). All forms of extra support together also showed a decrease in cessation of exclusive breastfeeding at six months (average RR 0.88, 95% CI 0.85 to 0.92; moderate-quality evidence, 46 studies) and at four to six weeks (average RR 0.79, 95% CI 0.71 to 0.89; moderate quality, 32 studies). We downgraded evidence to moderate-quality due to very high heterogeneity.We investigated substantial heterogeneity for all four outcomes with subgroup analyses for the following covariates: who delivered care, type of support, timing of support, background breastfeeding rate and number of postnatal contacts. Covariates were not able to explain heterogeneity in general. Though the interaction tests were significant for some analyses, we advise caution in the interpretation of results for subgroups due to the heterogeneity. Extra support by both lay and professionals had a positive impact on breastfeeding outcomes. Several factors may have also improved results for women practising exclusive breastfeeding, such as interventions delivered with a face-to-face component, high background initiation rates of breastfeeding, lay support, and a specific schedule of four to eight contacts. However, because within-group heterogeneity remained high for all of these analyses, we advise caution when making specific conclusions based on subgroup results. We noted no evidence for subgroup differences for the any breastfeeding outcomes. AUTHORS' CONCLUSIONS When breastfeeding support is offered to women, the duration and exclusivity of breastfeeding is increased. Characteristics of effective support include: that it is offered as standard by trained personnel during antenatal or postnatal care, that it includes ongoing scheduled visits so that women can predict when support will be available, and that it is tailored to the setting and the needs of the population group. Support is likely to be more effective in settings with high initiation rates. Support may be offered either by professional or lay/peer supporters, or a combination of both. Strategies that rely mainly on face-to-face support are more likely to succeed with women practising exclusive breastfeeding.
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Affiliation(s)
- Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Angela Wade
- Institute of Child HealthCentre for Paediatric Epidemiology and Biostatistics30 Guilford StLondonUKWC1N 1 EH
| | | | | | - Emma Veitch
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Anne Marie Rennie
- NHS Grampian, Aberdeen Maternity HospitalCornhill RoadAberdeenUKAB25 2ZL
| | - Susan A Crowther
- Robert Gordon UniversityFaculty of Health and Social Care, School of Nursing and MidwiferyGarthdee RoadAberdeenUKAB10 7AQ
| | - Sara Neiman
- Breastfeeding NetworkPaisleyRenfrewshireUKPA2 8YB
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR), School of Nursing and Health Sciences, Dundee Centre for Health and Related Research11 Airlie PlaceDundeeUKDD1 4HJ
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Lumbiganon P, Martis R, Laopaiboon M, Festin MR, Ho JJ, Hakimi M. Antenatal breastfeeding education for increasing breastfeeding duration. Cochrane Database Syst Rev 2016; 12:CD006425. [PMID: 27922724 PMCID: PMC6463791 DOI: 10.1002/14651858.cd006425.pub4] [Citation(s) in RCA: 62] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Breast milk is well recognised as the best food source for infants. The impact of antenatal breastfeeding (BF) education on the duration of BF has not been evaluated. OBJECTIVES To assess the effectiveness of antenatal breastfeeding (BF) education for increasing BF initiation and duration. SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register on 1 March 2016, CENTRAL (The Cochrane Library, 2016, Issue 3), MEDLINE (1966 to 1 March 2016) and Scopus (January 1985 to 1 March 2016). We contacted experts and searched reference lists of retrieved articles. SELECTION CRITERIA All identified published, unpublished and ongoing randomised controlled trials (RCTs) assessing the effect of formal antenatal BF education or comparing two different methods of formal antenatal BF education, on the duration of BF. We included RCTs that only included antenatal interventions and excluded those that combined antenatal and intrapartum or postpartum BF education components. Cluster-randomised trials were included in this review. Quasi-randomised trials were not eligible for inclusion. DATA COLLECTION AND ANALYSIS We assessed all potential studies identified as a result of the search strategy. Two review authors extracted data from each included study using the agreed form and assessed risk of bias. We resolved discrepancies through discussion. We assessed the quality of the evidence using the GRADE approach. MAIN RESULTS This review update includes 24 studies (10,056 women). Twenty studies (9789 women) contribute data to analyses. Most studies took place in high-income countries such as the USA, UK, Canada and Australia. In the first five comparisons, we display the included trials according to type of intervention without pooling data. For the 'Summary of findings' we pooled data for a summary effect.Five included studies were cluster-randomised trials: all of these adjusted data and reported adjustments as odds ratios (OR). We have analysed the data using the generic inverse variance method and presented results as odds ratios, because we were unable to derive a cluster-adjusted risk ratio from the published cluster-trial. We acknowledge that the use of odds ratio prevents the pooling of these cluster trials in our main analyses. One method of BF education with standard (routine) careThere were no group differences for duration of any BF in days or weeks. There was no evidence that interventions improved the proportion of women with any BF or exclusive BF at three or six months. Single trials of different interventions were unable to show that education improved initiation of BF, apart from one small trial at high risk of attrition bias. Many trial results marginally favoured the intervention but had wide confidence intervals crossing the line of no effect. BF complications such as mastitis and other BF problems were similar in treatment arms in single trials reporting these outcomes. Multiple methods of BF education versus standard careFor all trials included in this comparison we have presented the cluster-adjusted odds ratios as reported in trial publications. One three-arm study found the intervention of BF booklet plus video plus Lactation Consultant versus standard care improved the proportion of women exclusively BF at three months (OR 2.60, 95% CI 1.25 to 5.40; women = 159) and marginally at six months (OR 2.40, 95% CI 1.00 to 5.76; women = 175). For the same trial, an intervention arm without a lactation consultant but with the BF booklet and video did not have the same effect on proportion of women exclusively BF at three months (OR 1.80, 95% CI 0.80 to 4.05; women = 159) or six months (OR 0.90, 95% CI 0.30 to 2.70; women = 184). One study compared monthly BF sessions and weekly cell phone message versus standard care and reported improvements in the proportion of women exclusively BF at both three and six months (three months OR 1.80, 95% CI 1.10 to 2.95; women = 390; six months OR 2.40, 95% CI 1.40 to 4.11; women = 390). One study found monthly BF sessions and weekly cell phone messages improved initiation of BF over standard care (OR 2.61, 95% CI 1.61 to 4.24; women = 380). BF education session versus standard care, pooled analyses for 'Summary of findings' (SoF)This comparison does not include cluster-randomised trials reporting adjusted odds ratios. We did not downgrade any evidence for trials' lack of blinding; no trial had adequate blinding of staff and participants. The SoF table presents risk ratios for all outcomes analysed. For proportion of women exclusively BF there is no evidence that antenatal BF education improved BF at three months (RR 1.06, 95% CI 0.90 to 1.25; women = 822; studies = 3; moderate quality evidence) or at six months (RR 1.07, 95% CI 0.87 to 1.30; women = 2161; studies = 4; moderate quality evidence). For proportion of women with any BF there were no group differences in BF at three (average RR 0.98, 95% CI 0.82 to 1.18; women = 654; studies = 2; I² = 60%; low-quality evidence) or six months (average RR 1.05, 95% CI 0.90 to 1.23; women = 1636; studies = 4; I² = 61%; high-quality evidence). There was no evidence that antenatal BF education could improve initiation of BF (average RR 1.01, 95% CI 0.94 to 1.09; women = 3505; studies = 8; I² = 69%; high-quality evidence). Where we downgraded evidence this was due to small sample size or wide confidence intervals crossing the line of no effect, or both.There was insufficient data for subgroup analysis of mother's occupation or education. AUTHORS' CONCLUSIONS There was no conclusive evidence supporting any antenatal BF education for improving initiation of BF, proportion of women giving any BF or exclusively BF at three or six months or the duration of BF. There is an urgent need to conduct a high-quality, randomised controlled study to evaluate the effectiveness and adverse effects of antenatal BF education, especially in low- and middle-income countries. Evidence in this review is primarily relevant to high-income settings.
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Affiliation(s)
- Pisake Lumbiganon
- Khon Kaen UniversityDepartment of Obstetrics and Gynaecology, Faculty of Medicine123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Ruth Martis
- The University of AucklandLiggins InstitutePark RoadGraftonAucklandNew Zealand1142
| | - Malinee Laopaiboon
- Khon Kaen UniversityDepartment of Epidemiology and Biostatistics, Faculty of Public Health123 Mitraparb RoadAmphur MuangKhon KaenThailand40002
| | - Mario R Festin
- World Health OrganizationDepartment of Reproductive Health and ResearchGenevaSwitzerland
| | - Jacqueline J Ho
- Penang Medical CollegeDepartment of Paediatrics4 Sepoy LinesPenangMalaysia10450
| | - Mohammad Hakimi
- Universitas Gadjah MadaDepartment of Obstetrics and Gynaecology, Faculty of MedicineJl. Farmako, SekipYogyakartaDaerah Istimewa YogyakartaIndonesia55281
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Balogun OO, O'Sullivan EJ, McFadden A, Ota E, Gavine A, Garner CD, Renfrew MJ, MacGillivray S. Interventions for promoting the initiation of breastfeeding. Cochrane Database Syst Rev 2016; 11:CD001688. [PMID: 27827515 PMCID: PMC6464788 DOI: 10.1002/14651858.cd001688.pub3] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
BACKGROUND Despite the widely documented risks of not breastfeeding, initiation rates remain relatively low in many high-income countries, particularly among women in lower-income groups. In low- and middle-income countries, many women do not follow World Health Organization (WHO) recommendations to initiate breastfeeding within the first hour after birth. This is an update of a Cochrane Review, first published in 2005. OBJECTIVES To identify and describe health promotion activities intended to increase the initiation rate of breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding.To evaluate the effectiveness of different types of breastfeeding promotion activities, in terms of changing the number of women who initiate breastfeeding early (within one hour after birth). SEARCH METHODS We searched Cochrane Pregnancy and Childbirth's Trials Register (29 February 2016) and scanned reference lists of all articles obtained. SELECTION CRITERIA Randomised controlled trials (RCTs), with or without blinding, of any breastfeeding promotion intervention in any population group, except women and infants with a specific health problem. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trial reports for inclusion, extracted data and assessed trial quality. Discrepancies were resolved through discussion and a third review author was involved when necessary. We contacted investigators to obtain missing information. MAIN RESULTS Twenty-eight trials involving 107,362 women in seven countries are included in this updated review. Five studies involving 3,124 women did not contribute outcome data and we excluded them from the analyses. The methodological quality of the included trials was mixed, with significant numbers of studies at high or unclear risk of bias due to: inadequate allocation concealment (N = 20); lack of blinding of outcome assessment (N = 20); incomplete outcome data (N = 19); selective reporting (N = 22) and bias from other potential sources (N = 17). Healthcare professional-led breastfeeding education and support versus standard care The studies pooled here compare professional health workers delivering breastfeeding education and support during the prenatal and postpartum periods with standard care. Interventions included promotion campaigns and counselling, and all took place in a formal setting. There was evidence from five trials involving 564 women for improved rates ofbreastfeeding initiation among women who received healthcare professional-led breastfeeding education and support (average risk ratio (RR) 1.43, 95% confidence interval (CI) 1.07 to 1.92; Tau² = 0.07, I² = 62%, low-quality evidence) compared to those women who received standard care. We downgraded evidence due to design limitations and heterogeneity. The outcome of early initiation of breastfeeding was not reported in the studies under this comparison. Non-healthcare professional-led breastfeeding education and support versus standard care There was evidence from eight trials of 5712 women for improved rates of breastfeeding initiation among women who received interventions from non-healthcare professional counsellors and support groups (average RR 1.22, 95% CI 1.06 to 1.40; Tau² = 0.02, I² = 86%, low-quality evidence) compared to women who received standard care. In three trials of 76,373 women, there was no clear difference between groups in terms of the number of women practicing early initiation of breastfeeding (average RR 1.70, 95% CI 0.98 to 2.95; Tau² = 0.18, I² = 78%, very low-quality evidence). We downgraded the evidence for a combination of design limitations, heterogeneity and imprecision (wide confidence intervals crossing the line of no effect). Other comparisonsOther comparisons in this review also looked at the rates of initiation of breastfeeding and there were no clear differences between groups for the following comparisons of combined healthcare professional-led education with peer support or community educator versus standard care (2 studies, 1371 women) or attention control (1 study, 237 women), breastfeeding education using multimedia (a self-help manual or a video) versus routine care (2 studies, 497 women); early mother-infant contact versus standard care (2 studies, 309 women); and community-based breastfeeding groups versus no breastfeeding groups (1 study, 18,603 women). None of these comparisons reported data on early initiation of breastfeeding. AUTHORS' CONCLUSIONS This review found low-quality evidence that healthcare professional-led breastfeeding education and non-healthcare professional-led counselling and peer support interventions can result in some improvements in the number of women beginning to breastfeed. The majority of the trials were conducted in the USA, among women on low incomes and who varied in ethnicity and feeding intention, thus limiting the generalisability of these results to other settings.Future studies would ideally be conducted in a range of low- and high-income settings, with data on breastfeeding rates over various timeframes, and explore the effectiveness of interventions that are initiated prior to conception or during pregnancy. These might include well-described interventions, including health education, early and continuing mother-infant contact, and initiatives to help mothers overcome societal barriers to breastfeeding, all with clearly defined outcome measures.
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Affiliation(s)
- Olukunmi O Balogun
- National Center for Child Health and DevelopmentDepartment of Health Policy2‐10‐1 Okura, SetagayaTokyoTokyoJapan157‐8535
| | | | - Alison McFadden
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Erika Ota
- St. Luke's International University, Graduate School of Nursing SciencesGlobal Health Nursing10‐1 Akashi‐choChuo‐KuTokyoJapan104‐0044
| | - Anna Gavine
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR)11 Airlie PlaceDundeeUKDD1 4HJ
| | - Christine D Garner
- Cornell UniversityDivision of Nutritional Sciences244 Garden AvenueIthacaNYUSA14853
| | - Mary J Renfrew
- University of DundeeMother and Infant Research Unit, School of Nursing and Health Sciences11 Airlie PlaceDundeeTaysideUKDD1 4HJ
| | - Stephen MacGillivray
- University of Dundeeevidence Synthesis Training and Research Group (eSTAR)11 Airlie PlaceDundeeUKDD1 4HJ
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Silva EPD, Lima RTD, Osório MM. Impacto de estratégias educacionais no pré-natal de baixo risco: revisão sistemática de ensaios clínicos randomizados. CIENCIA & SAUDE COLETIVA 2016; 21:2935-48. [DOI: 10.1590/1413-81232015219.01602015] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2015] [Accepted: 07/12/2015] [Indexed: 11/22/2022] Open
Abstract
Resumo O objetivo deste estudo foi analisar a partir de uma revisão sistemática o impacto de estratégias educacionais desenvolvidas no pré-natal de baixo risco em resultados obstétricos. Foi feita a busca nas bases de dados PubMed, Medline, SciELO e Lilacs por ensaios clínicos randomizados com os desfechos de nascimento: peso ao nascer, prematuridade e aleitamento materno. Foram utilizados os descritores em combinação: prenatal, antenatal visits, education, health education, pregnancy outcomes, birthweight, prematurity, breastfeeding e randomized clinical trials. Após a avaliação da qualidade, incluiu-se nove estudos. As ações mostraram-se mais eficazes quando estendidas até o período pós-parto. A maior parte delas aconteceu durante as visitas domiciliares e apresentou impacto positivo na prática do aleitamento materno e peso ao nascer. A formação de grupos de gestantes contribuiu para menor prevalência de prematuridade. A amamentação mostrou-se o desfecho mais sensível às estratégias educativas. Práticas educativas durante o pré-natal contribuem para resultados obstétricos favoráveis por minimizarem dúvidas e anseios da mulher durante o processo de gestação, preparando-a para o parto e pós-parto, devendo ser incorporadas no processo de trabalho dos serviços de saúde.
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Gruver RS, Bishop-Gilyard CT, Lieberman A, Gerdes M, Virudachalam S, Suh AW, Kalra GK, Magge SN, Shults J, Schreiner MS, Power TJ, Berkowitz RI, Fiks AG. A Social Media Peer Group Intervention for Mothers to Prevent Obesity and Promote Healthy Growth from Infancy: Development and Pilot Trial. JMIR Res Protoc 2016; 5:e159. [PMID: 27485934 PMCID: PMC4987492 DOI: 10.2196/resprot.5276] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2015] [Revised: 02/22/2016] [Accepted: 03/18/2016] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Evidence increasingly indicates that childhood obesity prevention efforts should begin as early as infancy. However, few interventions meet the needs of families whose infants are at increased obesity risk due to factors including income and maternal body mass index (BMI). Social media peer groups may offer a promising new way to provide these families with the knowledge, strategies, and support they need to adopt obesity prevention behaviors. OBJECTIVE The aim of this study is to develop and pilot test a Facebook-based peer group intervention for mothers, designed to prevent pediatric obesity and promote health beginning in infancy. METHODS We conducted in-depth semi-structured interviews with 29 mothers of infants and focus groups with 30 pediatric clinicians, to inform the development of a theory-based intervention. We then conducted a single-group pilot trial with 8 mothers to assess its feasibility and acceptability. All participants were recruited offline at pediatric primary care practices. Participants in the pilot trial joined a private Facebook group, moderated by a psychologist, with a weekly video-based curriculum, and also had the option to meet at a face-to-face event. Within the Facebook group, mothers were encouraged to chat, ask questions, and share photos and videos of themselves and babies practicing healthy behaviors. Consistent with the literature on obesity prevention, the curriculum addressed infant feeding, sleep, activity, and maternal well-being. Feasibility was assessed using the frequency and content of group participation by mothers, and acceptability was measured using online surveys and phone interviews. RESULTS Based on preferences of mothers interviewed (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 27, all Black), we designed the intervention to include frequent posts with new information, videos showing parents of infants demonstrating healthy behaviors, and an optional face-to-face meeting. We developed a privacy and safety plan that met the needs of participants as well as the requirements of the local institutional review board (IRB), which included use of a "secret" group and frequent screening of participant posts. Clinicians, 97% (29/30) women and 87% (26/30) pediatricians, preferred no direct involvement in the intervention, but were supportive of their patients' participation. In our 8-week, single group pilot trial, all participants (mean BMI 35 kg/m(2), all Medicaid-insured, mean age 28, all Black) viewed every weekly video post, and interacted frequently, with a weekly average of 4.4 posts/comments from each participant. All participant posts were related to parenting topics. Participants initiated conversations about behaviors related to healthy infant growth including solid food introduction, feeding volume, and managing stress. All 8 pilot group participants reported that they found the group helpful and would recommend it to others. CONCLUSIONS Our methodology was feasible and acceptable to low-income mothers of infants at high risk of obesity, and could be adapted to implement peer groups through social media for underserved populations in varied settings. CLINICALTRIAL ClinicalTrials.gov NCT01977105; https://clinicaltrials.gov/ct2/show/NCT01977105 (Archived by WebCite at http://www.webcitation.org/6iMFfOBat).
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Affiliation(s)
- Rachel S Gruver
- Division of General Pediatrics, The Children's Hospital of Philadelphia, Philadelphia, PA, United States
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Williams DR, Mohammed SA, Shields AE. Understanding and effectively addressing breast cancer in African American women: Unpacking the social context. Cancer 2016; 122:2138-49. [PMID: 26930024 PMCID: PMC5588632 DOI: 10.1002/cncr.29935] [Citation(s) in RCA: 115] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 01/20/2016] [Accepted: 01/25/2016] [Indexed: 12/12/2022]
Abstract
Black women have a higher incidence of breast cancer before the age of 40 years, more severe disease at all ages, and an elevated mortality risk in comparison with white women. There is limited understanding of the contribution of social factors to these patterns. Elucidating the role of the social determinants of health in breast cancer disparities requires greater attention to how risk factors for breast cancer unfold over the lifecourse and to the complex ways in which socioeconomic status and racism shape exposure to psychosocial, physical, chemical, and other individual and community-level assaults that increase the risk of breast cancer. Research that takes seriously the social context in which black women live is also needed to maximize the opportunities to prevent breast cancer in this underserved group. Cancer 2016;122:2138-49. © 2016 American Cancer Society.
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Affiliation(s)
- David R. Williams
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health
- Department of African and African American Studies, Harvard University
- Department of Psychiatry and Mental Health, University of Cape Town, South Africa
| | - Selina A. Mohammed
- School of Nursing and Health Studies, University of Washington Bothell, Bothell, WA
| | - Alexandra E. Shields
- Harvard/MGH Center on Genomics, Vulnerable Populations, and Health Disparities, Mongan Institute for Health Policy, Massachusetts General Hospital
- Department of Medicine, Harvard Medical School
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Abbott LS, Elliott LT. Eliminating Health Disparities through Action on the Social Determinants of Health: A Systematic Review of Home Visiting in the United States, 2005-2015. Public Health Nurs 2016; 34:2-30. [PMID: 27145717 DOI: 10.1111/phn.12268] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVE The purpose of this systematic literature review was to synthesize the results of transdisciplinary interventions designed with a home visit component in experimental and quasi-experimental studies having representative samples of racial and ethnic minorities. DESIGN AND SAMPLE The design of this systematic review was adapted to include both experimental and quasi-experimental quantitative studies. MEASURES The predetermined inclusion criteria were studies (a) having an experimental or quasi-experimental quantitative design, (b) having a home visit as a research component, (c) including a prevention research intervention strategy targeting health and/or safety issues, (d) conducted in the United States, (e) having representation (at least 30% in the total sample size) of one or more racial/ethnic minority, (f) available in full text, and (g) published in a peer-reviewed journal between January, 2005 and December, 2015. RESULTS Thirty-nine articles were included in the review. There were 20 primary prevention, 5 secondary prevention, and 14 tertiary prevention intervention studies. CONCLUSIONS Community and home visitation interventions by nurses can provide an effective means for mitigating social determinants of health by empowering people at risk for health disparities to avoid injury, maintain health, and prevent and manage existing disease.
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Affiliation(s)
- Laurie S Abbott
- Florida State University College of Nursing, Tallahassee, Florida
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Rosen-Carole C, Hartman S. ABM Clinical Protocol #19: Breastfeeding Promotion in the Prenatal Setting, Revision 2015. Breastfeed Med 2015; 10:451-7. [PMID: 26651541 PMCID: PMC4685902 DOI: 10.1089/bfm.2015.29016.ros] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient.
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Affiliation(s)
- Casey Rosen-Carole
- Department of General Pediatrics, University of Rochester, Rochester, New York
| | - Scott Hartman
- Department of Family Medicine, University of Rochester, Rochester, New York
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Abstract
This article's aim is to review the literature on racial and ethnic disparities in breastfeeding rates and practices, address barriers to breastfeeding among minority women, conduct a systematic review of breastfeeding interventions, and provide obstetrician-gynecologists with recommendations on how they can help increase rates among minority women. In order to do so, the literature of racial and ethnic disparities in breastfeeding rates and barriers among minority women was reviewed, and a systematic review of breastfeeding interventions among minority women on PubMed and MEDLINE was conducted. Racial and ethnic minority women continue to have lower breastfeeding rates than white women and are not close to meeting the Healthy People 2020 goals. Minority women report many barriers to breastfeeding. Major efforts are still needed to improve breastfeeding initiation and duration rates among minority women in the United States. Obstetrician-gynecologists have a unique opportunity to promote and support breastfeeding through their clinical practices and public policy, and their efforts can have a meaningful impact on the future health of the mother and child.
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Affiliation(s)
- Katherine M. Jones
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
- Department of Psychology, American University, Washington, D.C
| | - Michael L. Power
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
| | - John T. Queenan
- Department of Obstetrics and Gynecology, Georgetown University School of Medicine, Washington, D.C
| | - Jay Schulkin
- Department of Research, American College of Obstetricians and Gynecologists, Washington, D.C
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Sipsma HL, Jones KL, Cole-Lewis H. Breastfeeding among adolescent mothers: a systematic review of interventions from high-income countries. J Hum Lact 2015; 31:221-9; quiz 321-2. [PMID: 25480018 DOI: 10.1177/0890334414561264] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 11/03/2014] [Indexed: 11/17/2022]
Abstract
Despite growing evidence of the benefits of breastfeeding, rates of breastfeeding remain disproportionately low among adolescent mothers compared with older mothers in the United States. Current interventions primarily target adult women, and little evidence is available for breastfeeding promotion among young women. Accordingly, we aim to review interventions designed to improve breastfeeding rates among adolescents to make recommendations for future research and practice. We searched MEDLINE and PsycINFO for articles that evaluated interventions aiming to improve rates of breastfeeding initiation, duration, or exclusivity among adolescents. Inclusion criteria included interventions targeting pregnant or postpartum adolescents (mean/median age <22 years) that were conducted in high-income settings. Six interventions met our inclusion criteria; of these, 4 interventions aimed to increase breastfeeding initiation, 5 aimed to increase breastfeeding duration, and 4 aimed to increase breastfeeding exclusivity. Interventions included school-based programs, home visits, and telephone support that were implemented by a combination of peer counselors, nurse clinicians, doulas, and lactation consultants. Only 1 intervention, a combination of education and counseling provided by a lactation consultant-peer counselor team, significantly improved both breastfeeding initiation and duration. Other results were mixed, and studies were subject to several methodological limitations. We recommend that more interventions should be developed and evaluated. In addition, interventions should be less resource intensive, be more theoretically driven, and specifically include mothers and partners of adolescents to successfully promote breastfeeding among adolescent mothers.
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Affiliation(s)
- Heather L Sipsma
- Department of Women, Children and Family Health Science, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Krista L Jones
- Department of Health Systems Sciences, University of Illinois at Chicago College of Nursing, Chicago, IL, USA
| | - Heather Cole-Lewis
- Department of Biomedical Informatics, Columbia University Medical Center, New York, NY, USA ICF International, Rockville, MD, USA
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Edwards RC, Thullen MJ, Henson LG, Lee H, Hans SL. The association of breastfeeding initiation with sensitivity, cognitive stimulation, and efficacy among young mothers: a propensity score matching approach. Breastfeed Med 2015; 10:13-9. [PMID: 25375024 PMCID: PMC4307095 DOI: 10.1089/bfm.2014.0123] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVE This study examined the association between breastfeeding initiation and maternal sensitivity, efficacy, and cognitive stimulation among young, low-income, African American mothers. SUBJECTS AND METHODS Two hundred twenty-one mothers were interviewed during pregnancy, at birth, and at 4 months postpartum regarding breastfeeding and parenting. Medical records were collected after birth, and mother-infant interactions were videotaped at 4 months. Propensity score matching was used to address selection bias by matching breastfeeding and nonbreastfeeding mothers on characteristics measured prior to breastfeeding. RESULTS One hundred twenty-four (56%) mothers initiated breastfeeding. After matching, mothers who initiated breastfeeding reported greater parenting efficacy (effect size, d=0.44) and were observed to be more sensitive with their 4-month-old infants (effect size, d=0.42) than nonbreastfeeding mothers. Breastfeeding was marginally associated with less maternal intrusiveness (effect size, d=0.28) but was not related to parenting attitudes or cognitive stimulation. CONCLUSIONS This study presents evidence supporting the claim that breastfeeding may enhance maternal efficacy and sensitivity. Providing breastfeeding support to young mothers may have effects that extend beyond maternal and child health outcomes to parenting and mother-child interactions.
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Affiliation(s)
- Renee C Edwards
- 1 School of Social Service Administration, The University of Chicago , Chicago, Illinois
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Laws R, Campbell KJ, van der Pligt P, Russell G, Ball K, Lynch J, Crawford D, Taylor R, Askew D, Denney-Wilson E. The impact of interventions to prevent obesity or improve obesity related behaviours in children (0-5 years) from socioeconomically disadvantaged and/or indigenous families: a systematic review. BMC Public Health 2014; 14:779. [PMID: 25084804 PMCID: PMC4137086 DOI: 10.1186/1471-2458-14-779] [Citation(s) in RCA: 97] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2014] [Accepted: 07/17/2014] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Children from disadvantaged families including those from low socioeconomic backgrounds and Indigenous families have higher rates of obesity, making early intervention a priority. The aim of this study was to systematically review the literature to examine the effectiveness of interventions to prevent obesity or improve obesity related behaviours in children 0-5 years from socioeconomically disadvantaged or Indigenous families. METHODS Searches of major electronic databases identified articles published from 1993-2013 targeting feeding practices, anthropometric, diet, activity or sedentary behaviour outcomes. This was supplemented with snowballing from existing reviews and primary studies. Data extraction was undertaken by one author and cross checked by another. Quality assessments included both internal and external validity. RESULTS Thirty-two studies were identified, with only two (both low quality) in Indigenous groups. Fourteen studies had a primary aim to prevent obesity. Mean differences between intervention and control groups ranged from -0.29 kg/m(2) to -0.54 kg/m(2) for body mass index (BMI) and -2.9 to -25.6% for the prevalence of overweight/obesity. Interventions initiated in infancy (under two years) had a positive impact on obesity related behaviours (e.g. diet quality) but few measured the longer-term impact on healthy weight gain. Findings amongst pre-schoolers (3-5 years) were mixed, with the more successful interventions requiring high levels of parental engagement, use of behaviour change techniques, a focus on skill building and links to community resources. Less than 10% of studies were high quality. Future studies should focus on improving study quality, including follow-up of longer-term anthropometric outcomes, assessments of cost effectiveness, acceptability in target populations and potential for implementation in routine service delivery. CONCLUSION There is an urgent need for further research on effective obesity prevention interventions for Indigenous children. The findings from the growing body of intervention research focusing on obesity prevention amongst young children from socioeconomically disadvantaged families suggest intervention effects are modest but promising. Further high quality studies with longer term follow up are required. TRIAL REGISTRATION PROSPERO Registration no: CRD42013006536.
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Affiliation(s)
- Rachel Laws
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Karen J Campbell
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Paige van der Pligt
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
| | - Georgina Russell
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Kylie Ball
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - John Lynch
- />School of Population Health, University of Adelaide, Adelaide, SA Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - David Crawford
- />Centre for Physical Activity and Nutrition Research, Deakin University, 221 Burwood Highway, Burwood, VIC 3125 Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Rachael Taylor
- />University of Otago, Dunedin, New Zealand
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Deborah Askew
- />Inala Indigenous Health Service, Inala, QLD, Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
| | - Elizabeth Denney-Wilson
- />Faculty of Health, University of Technology, Sydney, NSW Australia
- />Centre for Obesity Management and Prevention Research Excellence in Primary Health Care (COMPaRE-PHC), Kragujevac, Australia
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