Which factors influence women in the decision to breastfeed?

The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study

Background

Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices.

Methods

A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September–October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables.

Results

Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0–5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices.

Conclusion

Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women’s breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.

Determinants of Delayed Initiation of Breastfeeding: A Cross-Sectional Multicenter Study in Abu Dhabi, the United Arab Emirates

One of the best practices to reduce the risk of infant morbidity and mortality is the early initiation of breastfeeding, specifically within the first hour of birth, as the World Health Organization (WHO) recommends. Limited data exist on breastfeeding initiation and its related factors in the United Arab Emirates (U.A.E.). Therefore, the purpose of this research study was to evaluate and analyze the determinant factors associated with delayed initiation of breastfeeding among mothers with children aged <2 years old in a cross-sectional multicenter setting in Abu Dhabi, U.A.E. Seven governmental community and healthcare centers participated in the study from diverse geographic areas of Abu Dhabi. A trained female research assistant collected information from mothers with young children attending the centers. All participants were informed in detail about the purpose of the study and signed a written consent form. A total of 1610 mother−child pairs were included in the study. The mean (standard deviation) of maternal age and children’s age was 30.1 (5.1) years and 8.1 (5.9) months, respectively. Six hundred and four (604) (37.5%) reported delayed initiation of breastfeeding. Factors associated with delayed breastfeeding initiation were being of non-Arab nationality (adjusted odds ratio (A.O.R.) 1.30, 95% confidence interval (CI) 1.03, 1.63), caesarean section (AOR 2.85, 95% CI 2.26, 3.58), non-rooming-in (AOR 2.82, 95% CI 1.53, 5.21), first birth order (AOR 1.34, 95% CI 1.07, 1.69), and mothers with low-birth-weight children (AOR 3.30, 95% CI 2.18, 4.99) as was analyzed by multivariate logistic regression analysis. In conclusion, approximately four out of ten mothers delayed initiation of breastfeeding for more than one hour after delivery. The results of this study call for urgent policy changes to improve the early initiation rates of breastfeeding mothers in the U.A.E.

Mothers’ strategies for creating positive breastfeeding experiences: a critical incident study from Northern Sweden

Background

Positive breastfeeding experiences positively influence subsequent attitudes towards breastfeeding, and increase mothers’ confidence, self-efficacy, motivation and intention to breastfeed. However, the strategies that mothers find useful and effective for creating positive breastfeeding experiences remain largely unknown. The aim of our study was thus to describe experience-based knowledge from mothers about strategies for creating positive breastfeeding experiences.

Methods

The study followed a qualitative design involving the critical incident technique. Data were collected with an online survey containing open-ended questions that was administered to a Sweden-based parenting group on Facebook in September 2018. Ultimately, 340 incidents from 176 women were identified as offering strategies for creating positive breastfeeding experiences. Data from the written replies were extracted as textual units, condensed and categorised until categories were mutually exclusive, which resulted in six categories.

Results

Participating women were on average 31.2 years old and the median number of children per participant was two. Mothers’ strategies for creating positive breastfeeding experiences generally included being calm and accepting that initiating breastfeeding takes time and can be difficult initially. Participants described feeling close to the baby by maintaining skin-to-skin contact and being present in the moment by taking time to appreciate the child and the breastfeeding situation, and temporarily forgetting about the world and simply being with the child in the here and now. Participants advocated baby-led breastfeeding and following correct techniques. They also described the importance of keeping an effortless mindset about breastfeeding to prevent perceiving breastfeeding as a compulsion. Mothers described acquiring knowledge about breastfeeding so that they could be prepared if breastfeeding problems occurred and getting support from professionals and family was described as significant for having a positive breastfeeding experience. Caring for oneself and one’s body, with aids if necessary, were described as important strategies, as were having a positive attitude and a strong desire to breastfeed.

Conclusion

Because positive breastfeeding experiences and support are predictors of future breastfeeding initiation and duration, assisting women in creating positive breastfeeding experiences is important. Asking mothers to formulate strategies that they find useful could facilitate breastfeeding by making their approaches more conscious and visible.

Factors Influencing Uptake of Breastfeeding: The Role of Early Promotion in the Maternity Hospital

BACKGROUND

This study aimed to explore the prevalence of breastfeeding at birth points in Sicily and the relevance of the factors influencing the adoption of exclusive breastfeeding during hospitalization linked to childbirth.

METHODS

A survey was conducted to monitor the prevalence of breastfeeding in seven out of nine facilities providing maternity services in the province of Catania (Sicily, Southern Italy) in the years 2016-2018. An online questionnaire was administered using an electronic tablet by the midwife to the mother after discharge.

RESULTS

Women who had a higher educational qualification breastfed in a greater proportion (59.6%; odds ratio OR 0.60 for abandoning breastfeeding). Having had a caesarean section moderately impaired breastfeeding uptake, with an almost double chance of declining exclusive breastfeeding (OR = 1.74). Starting breastfeeding within 1 h from delivery showed a significant facilitating effect (OR = 0.58). Rooming-in had a strong facilitating effect on exclusive breastfeeding. A breastfeeding advocacy program was shown to protect from abandoning breastfeeding.

CONCLUSIONS

It is important to offer in all hospitals the possibility and support for breastfeeding in the first moments after childbirth to increase the number of those who will then continue with exclusive breastfeeding.

SOCIODEMOGRAPHIC CHARACTERISTICS RELATED TO KNOWING THE BENEFITS OF BREASTFEEDING

OBJECTIVE

To describe the characteristics of women according to the reported number of benefits of breastfeeding and to verify its association with the duration of this practice until the sixth month of the child's life.

METHODS

This was a qualitative and prospective observational study performed with postpartum mothers in two stages (n=78, and after six months n=62). Generalized linear models were used to identify the profile of the mothers as well as to determine the factors associated with the duration of breastfeeding until the sixth month of the child's life.

RESULTS

The profile of women who reported fewer benefits (≤3) was: younger age (p=0.008), with lower schooling (p<0.001), single (p=0.02), unemployed (p=0.04) and who attended prenatal care at the public health service (p=0.01). The analysis of the interaction of these factors indicated that women who had only completed elementary school and who attended prenatal care at the public health service (p<0.001) or privately (p=0.01) reported fewer benefits. Factors such as: level of education, marital status, previous education/training about breastfeeding, place of prenatal care and the reported number of benefits were not associated with the duration of breastfeeding until the sixth month of the child's life.

CONCLUSIONS

The lowest number of breastfeeding benefits was reported by women with elementary education and who undewent prenatal care in the public health system or privately. The number of reported benefits was not associated with the duration of this practice until the age of sixth months of the child.

¿Consejería para la madre lactante o para la técnica de lactancia materna?

Introducción. En Colombia, pese a la implementación de iniciativas como la consejería en lactancia materna (CLM), las tasas de lactancia materna exclusiva (LME) son bajas. Objetivo. Comprender la experiencia de un grupo de madres lactantes respecto a la consejería en lactancia materna exclusiva (CLME) recibida en Instituciones Amigas de la Mujer y la Infancia (IAMI) en Bogotá D.C., Colombia. Materiales y métodos. Investigación cualitativa con enfoque fenomenológico. Se aplicaron entrevistas a profundidad a 19 madres lactantes que recibieron CLME en 3 IAMI entre agosto de 2016 y enero de 2017. Las unidades de significado (US) se identificaron mediante un análisis comprensivo realizado en el programa N-Vivo versión 10 y basado en la lectura de las transcripciones textuales de las entrevistas y la identificación de estructuras esenciales en los relatos relacionadas con la experiencia que tuvieron durante la CLME en tres momentos (gestación, parto/posparto inmediato y puerperio). Resultados. La edad promedio fue de 23 años. Solo el 37% lactó exclusivamente hasta los 4 meses. Se identificaron 9 US. Durante la gestación y el posparto inmediato las madres recibieron indicaciones sobre como lactar, pero no recibieron CLME por parte del personal de salud. En el puerperio, la familia y la red de apoyo de las madres les brindaron ayuda y acompañamiento respecto a la lactancia materna. Conclusión. Es posible que en el país no se estén cumpliendo las disposiciones legales sobre la CLM e iniciativas como las IAMI, ya que se evidencian dificultades para su correcta realización, por lo que es necesario plantear y desarrollar estrategias efectivas para la formación de consejeros en lactancia materna entre el personal de salud.

Breastfeeding in Hospitals: Factors Influencing Maternal Choice in Italy

Monitoring the prevalence of breastfeeding is one of the actions provided for in Italian National Health System. This study aims to observe the prevalence of breastfeeding in a representative set of birthing hospitals in the province of Catania, in Sicily, Italy, to assess the factors influencing women in their decisions to breastfeed during hospitalization after delivery. We conducted an observational study on 3813 questionnaires administered to mothers of newborns during their hospital stay from the years 2016 to 2018 in eight hospitals of various types. The average maternal age was 31.3 years ± 5.8. Sixty-nine percent of women did not attend a prenatal course. From childbirth to discharge, the percentage of women who breastfed was 88%, of whom 45% did exclusive breastfeeding. Only 35% of women who had a caesarean section adopted exclusive breastfeeding. In our experience, rooming-in was not associated with an increase in breastfeeding. We observed that both attendance to prenatal courses and the mother's education level played a minor role in influencing the mother's decision in breastfeeding A fairly high percentage of exclusive breastfeeding, 75%, was attained just in one hospital, where dedicated staff was deployed to encourage breastfeeding. The lowest percentage (12%) of exclusive breastfeeding was observed in a large private accredited health facility. Hospital presence of professionals trained in human lactation is a smart investment for society.

A systematic review examining the association between female body image and the intention, initiation and duration of post-partum infant feeding methods (breastfeeding vs bottle-feeding)

A systematic review was conducted to examine female body image in relation to the intention, initiation and duration of post-partum infant feeding methods. A search of 10 databases was conducted to identify studies. A total of nine studies were included in the systematic review. All studies were of a non-randomised control design with a total of 13,046 participants. Findings suggest that exclusive breastfeeding is more likely in pregnant women with a higher body image, while those with body concerns had less intention to breastfeed or initiate, with those who start having a shorter duration.

Subconjunto terminológico da classificação internacional para a prática de enfermagem (CIPE®) para assistência à amamentação: estudo de validação de conteúdo

Resumo Objetivo: Realizar a validação de conteúdo dos enunciados de diagnósticos, resultados e intervenções de enfermagem contidos no subconjunto terminológico da Classificação Internacional para a Prática de Enfermagem (CIPE®) para assistência à mulher, à criança e à família em processo de amamentação. Métodos: Estudo de validação de conteúdo com 74 juízes que avaliaram 98 diagnósticos/resultados de enfermageme de 396 intervenções relacionadas aos diagnósticos/resultados validados. Resultados: Treze diagnósticos/resultados obtiveram IVC ≥ 0,8 (13,3%); 34 de 0,6 a 0,79 (34,7%) e; 51 menores que 0,6 (52%). Após a validação, para os diagnósticos “Falta de privacidade”, “Tomada de decisão pela amamentação, eficaz”, “Desempenho de papel de mãe, eficaz” e “Desempenho de papel de mãe, melhorado” foi necessário o estabelecimento de três enunciados de resultados de enfermagem. Na segunda etapa, 350 intervenções de enfermagem, obtiveram IVC ≥ 0,80. Conclusão: Foram validados 50 diagnósticos/resultados e 350 intervenções de enfermagem.

Fatores que influenciam o desmame precoce

Objetivos: identificar en la literatura científica los principales factores asociados al destete temprano. Materiales y método: se trata de una revisión sistemática realizada en las bases de datos LILACS y MEDLINE con artículos completos del periodo de 2004 a 2013, en inglés, español y portugués, desde la pregunta orientadora: “¿Cuáles son los factores que influyen el destete temprano?”. Resultados: se identificaron 1.481 artículos y 39 atendieron a los criterios de inclusión. Entre los principales factores que influyen el destete temprano, se encontraron trabajo materno (33,3 %); uso de chupo de entretención (30,8 %); leche materna débil (17,9 %); trauma y dolor mamilar (17,9 %); introducción de otros tipos de leche (15,4 %) y nivel educacional de la madre o del padre (15,4 %). Conclusiones: diversos factores están relacionados al destete temprano, lo que apunta fuerte determinación sociocultural e histórica que se puede evidenciar por la comparación de los estándares de lactancia entre diferentes poblaciones y a través de los tiempos.