The effect of changes in population characteristics on breastfeeding trends in fifteen developing countries

BACKGROUND

Extended breastfeeding is known to benefit the health of children in developing countries and despite widespread expectations of a decline in breastfeeding in these countries, it has been demonstrated that the incidence and duration of breastfeeding are in fact increasing many countries.

METHODS

In this paper, trends in breastfeeding duration are examined in 15 developing countries, using data from two comparable surveys for each country, the World Fertility Survey (conducted in the late 1970s) and the Demographic and Health Survey (conducted in the late 1980s). Multivariate regression models are used to examine differentials in breastfeeding behaviour across population subgroups in these countries for each time period, and these differentials are used to determine the extent to which the observed trends are due to changes in population characteristics and to what extent behaviour has changed within population subgroups.

RESULTS

Results show that changes in the characteristics of the population have almost universally pushed breastfeeding durations in the downward direction. On the other hand, trends within population subgroups have been positive in all but two of the 15 countries examined.

CONCLUSIONS

Changes in population characteristics can be expected to continue for most developing countries, exerting a downward pressure on breastfeeding. Policies that promote breastfeeding are needed to counter these changes, especially in the most vulnerable population subgroups.

Predictors of exclusive breastfeeding in early infancy: operational implications

OBJECTIVES

To evaluate the independent predictors of exclusive breastfeeding in early infancy.

DESIGN

Cross sectional multivariate comparison of different breastfeeding categories.

SETTING

Urban teaching hospital Outpatient Department.

SUBJECTS

Mothers of 501 children between the age group of 0-6 months were questioned in detail on a standardized pretested proforma about various sociodemographic, parental, infant, feeding related, antenatal and perinatal characteristics likely to affect breastfeeding practices. Mother's height and weight and infant's weight were also recorded.

RESULTS

The exclusive breastfeeding, predominant breastfeeding, bottle feeding, ever breastfed and timely first suckling rates were 44.9%, 67.8%, 31.5%, 99.4% and 10.4%, respectively. Amongst the 29 factors subjected to univariate analyses, 16 clinically relevant or significant (p < 0.1) variables were included for multiple logistic regression models. The significant (p < 0.05) positive independent association for exclusive and partial breastfeeding were (OR) infant's present weight (1.45 to 9.64); breastmilk as first feed (1.53 to 2.22); and lower age of child (1.02 to 1.05). Additional important predictors for exclusive breastfeeding versus total top feeding) were (OR) breastfeeding propagation (1.34 and 2.99); less educated mother (1.09 and 1.23); normal vaginal delivery (1.60) and taller mother (1.21).

CONCLUSIONS

Breastfeeding propagation plays a key role in promoting exclusive breastfeeding. Other independent negative predictors represent a high risk subset for whom intensive propagation is desirable since these factors by themselves may not be amenable to intervention.

Breastfeeding practices in Chengdu, Sichuan, China

Barriers to increased breastfeeding rates in Chengdu, Sichuan were investigated in 1992 and 1993. Responses of focus groups showed that ignorance about breastfeeding and belief that the mother's milk was inadequate, and lack of support from their families, places of employment, and the health system acted as barriers to the women's breastfeeding their infants up to the age of four to six months. Subsequently, 363 mothers of 4- to 12-month-old Chengdu infants were surveyed. Although most mothers in both studies said breastmilk was the best food for their infant up to age of four to six months, only about half of the mothers breastfed for longer than one month. Both studies showed that infants who roomed with their mothers after birth were more likely to have been put to their mother's breast earlier, fed colostrum, breastfed somewhat longer, and exclusively breastfed for a somewhat longer period, although their mothers' infant feeding knowledge did not differ. The researchers conclude that Chengdu health workers should teach parents and parents-to-be more about breastfeeding, and that rooming-in be expanded in Chengdu hospitals.

Breast-feeding in Egypt

Planning, implementation and evaluation of programmes to promote appropriate infant feeding practices require detailed, current information about these practices in the target populations. To estimate the prevalences and identify the correlates of overall breast-feeding and of exclusive breast-feeding in different age periods during infancy, a cohort of 152 apparently healthy neonates and their mothers were followed during October 1987 through April 1989 in rural Bilbeis, Sharqiya Governorate, Egypt. Feeding data were collected through twice weekly home visits thus reducing the potential for bias in our findings due to respondent recall errors. The prevalence of overall breastfeeding in the infants declined from 100% in age period 0-11 weeks to 89% in age period 36-47 weeks. Mothers with previous living children were associated with significantly higher (odds ratio [OR]: 6.53, 95% confidence interval [CI]: 1.33-32.09) and ownership of refrigerators was associated with significantly lower (OR: 0.18, 95% CI: 0.05-0.67) overall breast-feeding prevalences in age periods 24-35 and 36-47 weeks, respectively. The prevalence of exclusive breast-feeding in breast-fed infants dropped from 20% in age period 0-11 weeks to 0% in age period 36-47 weeks. After multivariate adjustment, prelacteal feeding was significantly negatively (OR: 0.12, 95% CI: 0.04-0.37) associated with exclusive breast-feeding in age period 0-11 weeks. Nearly 90% of Bilbeis infants were breast-fed at age 47 weeks, but the initiation of supplementation at 0-11 weeks in 80% of breast-fed infants is contrary to current recommendations.(ABSTRACT TRUNCATED AT 250 WORDS)

Breast-feeding practices in Schedule Caste communities in Haryana state

A study was conducted to assess exclusive breast-feeding, continued breast-feeding, bottle-feeding, predominant breast-feeding, timely complementary feeding and other breast-feeding practices in 818 children in the age group of 0-3 years belonging to the Schedule Caste communities of Haryana. The exclusive breast-feeding rate was 0.15 and the predominant breast-feeding rate 0.75 in children < 4 months. Timely complementary feeding rate was 0.42. The continued breast-feeding rate at 1 year and 2 years was 0.84 and 0.58, respectively. The bottle-feeding rate, ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding rate by mother were 0.09, 1.0, 0.0 and 0.15, respectively. The median duration of breast-feeding was 16 months.

The effect of a culture-specific education program to promote breastfeeding among Vietnamese women in Sydney

The rate of breastfeeding among immigrant Vietnamese women in Western countries is low compared to those in Vietnam. To counteract this trend, a language and culture specific education program was developed. An experimental design was used to test the effectiveness of this program. The sample consisted of 182 prenatal Vietnamese women. Data collection included questionnaires and interviews. Results suggested that the education program had significant effects on knowledge, attitudes, planned and actual behaviour towards breastfeeding. However, the effect did not sustain until 6 months postpartum. Implications for nursing practice and further research are discussed.

[Variables associated with breast-feeding patterns in Tijuana, Mexico]

The aim of this study was to determine the prevalence of feeding patterns among infants born in four community hospitals of the city of Tijuana, Mexico. From a total of 1964 live births, a random sample of 236 was chosen from the clinical files and distributed according to the total number of births in each hospital. 182 mothers from the original sample were contacted and accepted to participate in the study: 61 in the three-month group, 60 in the six-month group, and 61 in the twelve-month group. The most usual feeding patterns were: at three months of age, breast milk plus formula; at six months, formula plus other foods; and, at twelve months, fresh milk plus other foods. Three infants (1.65%) were never breastfed; at three months of age, 43 per cent of the infants were not receiving their mother's milk; and, at six months of age, 90 per cent were dependent on formula and other food only. Furthermore, 20.4 per cent of the infants were weaned before reaching their first month of age; 61.3 per cent between 30 and 119 days of age, 16.8 per cent between 120 and 209 days of age, and the rest after 209 days of age. It may be concluded that infants born in community hospitals in Tijuana show tendencies in feeding patterns similar to those of Mexican-American infants and those of urban regions in developing countries; that is, the substitution of breastfeeding for formula, and early weaning.

Individual and community characteristics influencing breastfeeding duration in Vietnam

This analysis of selected community and maternal characteristics influencing duration of breastfeeding in Vietnam utilized data from the 1988 Demographic and Health Survey and 1990 Accessibility of Contraceptives Survey available for the 4434 children born to 2769 women having their last birth between 1983-88. Explanatory variables included as covariates in the hazards model were mother's education, age of the mother at the time of the child's birth, birth order, and gender of the child, urban versus rural residence, infant mortality risk in the child's province, locality (mountains and highlands compared to delta and coastal), and region of the country (north, south). Indicators of development in the child's village included availability of electricity and public transportation. Breastfeeding duration was longer among the more highly educated women and among those women living in provinces with higher infant mortality. However, there were no significant differences in the duration of breastfeeding with variations among certain development characteristics of the village. Although there were regional differences in the duration of breastfeeding for the rural population, there were no regional differences for the overall population. There were no significant variations in the duration of breastfeeding by age of the mother, birth order or gender of the child. Although there were significant variations in duration of breastfeeding by some maternal and community characteristics, between 80-90 per cent of all women breastfeed for at least the first year of the child's life.

Determinants of delayed initiation of breastfeeding: a community and hospital study from Guinea-Bissau

A prospective study on the timing of breastfeeding start in Bissau was undertaken in a periurban community (n = 734), and at the Central Hospital (n = 414). Only single, full-term, healthy children born by the vaginal route were included, the purpose being to characterize mothers who delay breastfeeding start for reasons not related to disease. Multivariate failure-time analysis (Cox' regression) was used to relate the child's age at breastfeeding start to a set of independent variables. In the community, those tending to delay breastfeeding start were mothers from the largest ethnic group in the country, mothers who had given birth at times other than the evening hours (6-12 pm) and mothers who had not attended antenatal clinics. At the hospital, delayed initiation was found among young mothers and mothers from one sparsely represented ethnic group. The most important determinant of delayed breastfeeding start was negative cultural ideas about colostrum.

The effects of rooming-in on the success of breastfeeding and the decline in abandonment of children

This study analyzed the effect of management of rooming-in, conducted in one of the regional hospitals in Thailand, on the success of breastfeeding. Data based on 2,000 infants born in 1987 and 1990 showed a significant improvement on separation time of infant and mother after delivery and predominant breastfeeding, where the infant's predominant source of nourishment has been breastmilk. Separation time was reduced from 6.3 +/- 3.2 to 1.62 +/- 0.42 hours and predominant breastfeeding was significantly increased from 85 to 99 percent. Data obtained from the community related to the initiation and predominant breastfeedings showed a significant increase (p less than 0.05). No significant difference was demonstrated, however, on current breastfeeding among infants who were delivery before and after initiation of the rooming-in system. Also analyzed were data on prevalence of deserted children. The findings showed a progressive reduction of deserted children after management of rooming-in. The study concludes that the practices of obstetricians were a key to successful breastfeeding. Promotion and management of rooming-in significantly improves the success of breastfeeding and reduction of deserted children in the hospital.

Determinants of breast-feeding and post-partum amenorrhoea in Orissa

A life table analysis is made of the duration of breast-feeding and post-partum amenorrhoea in Orissa, India, taking one variable at a time using data from a baseline survey of fertility and mortality (BSFM) conducted on the lines of the World Fertility Survey. Then a multivariate (proportional hazard) analysis showed that socioeconomic factors including residence, caste status and education influence the breast-feeding and post-partum amenorrhoea periods. There was no effect of maternal age on the length of breast-feeding, but mean length of post-partum amenorrhoea varied with age. The durations of breast-feeding and post-partum amenorrhoea are strongly related.

Breast-feeding among the urban poor in southern Brazil: reasons for termination in the first 6 months of life

A study of breast-feeding practices over the first 6 months of life among a cohort of urban poor infants in southern Brazil indicated that the median duration of breast-feeding was 18 weeks, and at 6 months 41% of the infants were still being breast-fed. The duration of breast-feeding was significantly associated with the following: the infant's sex, mother's colour, type of first feed, timing of the first breast-feed, breast-feeding regimen and frequency of breast-feeding at 1 month, and the use of hormonal contraceptives by the mother. The following were significant risk factors for early termination of breast-feeding: the infant's sex, type of first feed, use of supplementary feeds, frequency of breast-feeding, feeding regimen, weight-for-age, and weight-for-age after controlling for birth weight. Dissatisfaction with their infant's growth rate was the most frequent reason given by mothers for supplementing the diets of infants who were exclusively breast-fed in the first 3 months of life. Also, the mothers' perception that their milk output was inadequate was the most frequent reason expressed for stopping breast-feeding in the first 4 months. The roles of health services and family support in providing favourable conditions for increasing the duration of breast-feeding in the study population are discussed, as well as the possibility of bias being introduced into studies of the relationship between infant feeding and growth by the effect of the infant's rate of growth on the mother's decision to continue breast-feeding.

Breast-feeding and sexual abstinence in Papua New Guinea

Data collected in Papua New Guinea between November 1979 and March 1980 show that the main reason for prolonged breast-feeding and sexual abstinence is to ensure the welfare of the mother and child (which is indirectly a means of child spacing). The mean period of breast-feeding for the rural mothers is 21·8 months and for the urban mothers is 20·7 months. The mean duration of sexual abstinence for the rural male respondents is 21·4 months and for the female is 20·2 months. The figures for their urban counterparts are 19·5 months and 16·6 months respectively.

Determinants of breastfeeding in developing countries: overview and policy implications

Breastfeeding can play a major role in fertility regulation in developing countries. The effect of breastfeeding is enhanced when the incidence of breastfeeding is high and the duration extended. These factors are more likely to occur when suckling at the breast is frequent. Sociological and behavioral factors can also influence a woman's decision to initiate and terminate breastfeeding. The effects of urbanization, maternal education, and socioeconomic status act through the intervening variables of sociocultural factors, health services, employment status of women, and availability of breastmilk substitutes. Strategies to alter these intervening variables include educational campaigns and support groups for lactating women, changes in health services, availability of child care facilities near employment centers, and enforcement of the international code of marketing of breastmilk substitutes.

Breastfeeding and use of the health care system in Bahia State, Brazil: three multivariate analyses

Three multivariate methods--deviation from total proportion breastfeeding, polynomial regression, and proportional hazards--are used on current status breastfeeding data to explain an inverse relationship between use of the health care system and breastfeeding in Bahia State, Brazil. Among the intervening variables analyzed--urban/rural residence, educational attainment, age of woman, and place of last live birth--education and place of last live birth are found to have a net effect on breastfeeding by all three methods of analysis. The advantages and disadvantages of each method are described.

Breast-feeding as cultural or personal decision: sources of information and actual success in Japan and the United States

The impact of sources of information about breast-feeding used by Japanese and American primiparous women during pregnancy is examined in relation to subsequent maternal behaviour and success in breast-feeding infants during the 1st week, 1st month, and 3rd month after birth. Culture differences were found in the sources of information used. Japanese mothers used more sources reflecting a formal, impersonal, group-oriented ‘learning context’, while American mothers used a greater variety of sources, reflecting both an informal, private, personalized approach and a formal approach. Hospital classes taught by nurses were significantly negatively correlated with success in breast-feeding in both cultures (r = −0.78, P < 0·01). Private consultations with health professionals and reading materials (books, magazines, pamphlets) were found to have little or no correlation with success in breast-feeding. The findings indicate that present sources of information on breast-feeding are not achieving the desired result—assisting women in learning to breast-feed their infants successfully. Sources of information need to be re-evaluated in terms of content, tenor, and the culture learning context in which information is being disseminated.

Breast-feeding: motivation and outcome

To determine patterns of infant feeding and influencing factors, 131 women, interested in breast-feeding and giving birth in one hospital in British Columbia, Canada, were followed for 6 months post-partum. Data were collected from hospital records and each participant completed mail-in questionnaires when their babies were 1, 3 and 6 months old. At 6 months 3·9% were exclusively breast-feeding, 26·5% were feeding their infants breast-milk and semi-solids and 26·5% were combining breast-feeding with formula and/or semi-solids. Over 50% discontinued breast-feeding before their stated intentions. Most women had chosen to breast-feed because of benefits to the baby, and most gave up breastfeeding because of perceived insufficient milk.

Secondary school students' attitudes and beliefs about breastfeeding

The incidence and prevalence of breastfeeding has increased in the United States and Canada in the past decade, but in spite of its known benefits it is often abandoned before infants are two months of age. Society lacks the attitudes and knowledge necessary for breastfeeding success. A survey of the knowledge, beliefs and attitudes of 409 secondary school students in British Columbia, Canada, revealed misconceptions about the nature of breastfeeding. A high percentage felt it was unacceptable in social situations. The findings point to a need for the integration of information about breastfeeding into school health programs, biology, home economics/nutrition and family life/sexuality courses. Increased knowledge and discussion to foster positive attitudes could increase breastfeeding duration among parents in the future.