What predicts intent to breastfeed exclusively? Breastfeeding knowledge, attitudes, and beliefs in a diverse urban population

Effects of Breastfeeding Knowledge and Health Beliefs Regarding Gestational Diabetes Mellitus on the Breastfeeding Intention of Pregnant Women

PURPOSE

This study aims to explore the relationships between gestational diabetes mellitus (GDM)-related breastfeeding knowledge, GDM-related breastfeeding health beliefs, and breastfeeding intention. It investigates the factors influencing breastfeeding intention among pregnant women in Nepal.

METHODS

A total of 229 healthy pregnant women visiting an antenatal clinic in Nepal participated in this study between January and March, 2023. They completed a questionnaire that assessed their GDM-related breastfeeding knowledge, GDM-related breastfeeding health beliefs, and breastfeeding intention. The data were analyzed using descriptive statistics, an independent t-test, one-way analysis of variance including Scheffé's post hoc test, and logistic regression analysis.

RESULTS

Of the participants, 86.9% (n = 199) indicated positive breastfeeding intention, even with a relatively low level of GDM-related breastfeeding knowledge. Logistic regression analysis of the factors influencing breastfeeding intention yielded a significant model (χ2 = 38.80, p < .001) with significant variables; GDM-related breastfeeding knowledge [odds ratio (OR): 1.0, 95% confidence interval (CI): 1.02-1.40], GDM-related breastfeeding health beliefs (OR: 1.09, 95% CI: 1.04-1.15), and immediate family experience with diabetes mellitus (OR: 5.38, 95% CI: 1.98-14.62).

CONCLUSION

Nurses should lead interventions to educate pregnant women about the benefits of breastfeeding that can help in mitigating the long-term effects of GDM and reinforce health beliefs through positive experiences. This study provides information demonstrating the need for nurse-led improvements in Nepal's GDM management system, from screening to comprehensive care.

Trajectories of Breastfeeding-Related Thoughts and Attitudes Among Low-Income Smoke-Exposed Pregnant Women: A Latent Class Growth Analysis

BACKGROUND

Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored.

RESEARCH AIM

The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women.

METHODS

We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at ≤ 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes.

RESULTS

Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure.

CONCLUSION

Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes.

High-risk pregnancy and risk of breastfeeding failure

BACKGROUND

There is growing evidence that supports the role of breastfeeding in reducing the burden of non-communicable diseases (NCDs). There are considerable gaps in breastfeeding outcomes in mothers with chronic diseases due to a lack of knowledge and support in the postpartum period. Mothers who have NCDs and pregnancy complications are at risk of breastfeeding failure.

AIM

To compare breastfeeding outcomes in mothers with NCDs with healthy mothers and determine the underlying challenges that lead to poor outcomes.

METHODS

A prospective cohort study was conducted among 150 women (50 with high-risk pregnancies (HRP) and 100 with normal pregnancies (NP)). They were recruited from those attending the immunization and outpatient clinics at Sohag General Hospital. Mothers were recruited at 34 weeks gestation and were followed up at 2 weeks, 6 weeks, and 6 months after delivery. A pretested and validated questionnaire was used to collect detailed epidemiological, personal, health-related status, medications, hospitalizations, reproductive history, current delivery, and previous breastfeeding experiences. On follow-up they were assessed for breastfeeding practices, their health and health and growth of their children, and social support.

RESULTS

Delivery by cesarean section and postpartum bleeding were commoner among HRP patients. Initiation of breastfeeding in the 1st hour of delivery was significantly lower among women with HRP than those with normal pregnancies (48.0% versus 71.0%, p = 0.006). The most common reason for not initiating breastfeeding among the NP group was insufficient milk (34.5%), while in the HRP group, it was the mother's illness (80.8%). Skin-to-skin contact with the baby after birth was significantly less practiced in the HRP than in the NP group (38.0% vs 64.0% at p = 0.003). Herbs (such as cumin, caraway, cinnamon, aniseed, and chamomile) were the most common pre-lacteal feeds offered (63.0% in NP vs 42.0% in HRP). Artificial milk was more used in HRP than NP (24.0% vs 4.0%). Breast engorgement was 3 times more common in the HRP compared to the NP group (61.5% vs19.6%). Stopping breastfeeding due to breast problems was 2.5 times higher in the HRP than in the NP group (38.5% vs. 15.2%, p = 0.003). Nipple fissures were twice as common among the NP than among the HRP group ((73.0%) vs. (38.5%), p = 0.026). Exclusive breastfeeding during the period of follow-up was lower in the HRP than in the NP group (40.0% vs 61.0%, p < 0.05) and formula feeding was twice as common in the HRP as in the NP group (34.0% vs. 18.0%, p = 0.015). Child illness was significantly higher among women with HRP than those with NP (66.0% vs 48.0%, p = 0.037).

CONCLUSIONS

Women with HRP are at a high risk of poor breastfeeding outcomes with increased lactation problems and formula feeding rates. Encouraging women especially those with HRP to achieve optimal breastfeeding practices is a simple intervention that can be included in daily practice and may have a positive impact on mothers' health.

Women with Gestational Diabetes Mellitus Have Greater Formula Supplementation in the Hospital and at Home Despite Intention to Exclusively Breastfeed

Background: Women with gestational diabetes mellitus (GDM) have lower rates of exclusive breastfeeding compared with women without diabetes. Objectives: To assess associations between GDM and breastfeeding intentions and attitudes, formula supplementation, reasons for formula supplementation, and knowledge of type 2 diabetes mellitus (T2DM) risk reduction associated with breastfeeding among U.S. mothers. Design/Methods: Participants completed an online survey assessing infant feeding knowledge, attitudes, and practices; demographics; and pregnancy-related medical history. Multivariable logistic regression was used to estimate adjusted odds ratios for formula supplementation in the hospital and at home. Results: Of 871 respondents, a smaller proportion of women with GDM compared with women without diabetes intended to exclusively breastfeed. There were no differences between groups in attitudes toward public breastfeeding, attitudes toward breastfeeding beyond infancy, or actual duration of any breastfeeding. Approximately one in four participants believed that breastfeeding mothers may be less likely to develop T2DM, regardless of GDM status. Among those who intended to exclusively breastfeed, GDM was associated with higher odds of formula supplementation in the hospital (adjusted odds ratio [OR] 1.75, 95% confidence interval [CI] 0.97-3.18) and at home (adjusted OR 2.02, 95% CI 1.05-3.89). "Medical reasons," which was reported as an important reason for formula supplementation, was reported more frequently by women with GDM. Conclusions: Women with GDM who intended to exclusively breastfeed had higher odds of in-hospital and at-home formula supplementation, cited medical reasons as a main reason for formula supplementation more often, and were largely unaware of T2DM risk reduction associated with breastfeeding.

Breastfeeding Intention and Breastfeeding Postpartum Outcomes between High-Risk and Low-Risk Pregnant Women: A Greek Prospective Cohort Study

BACKGROUND

This prospective cohort study, conducted from pregnancy to six months postpartum and grounded in STROBE methodology, quantitatively explores the relationship between antenatal breastfeeding intentions and subsequent breastfeeding outcomes among high-risk pregnant women, compared to a low-risk pregnancy group.

METHODS

The study was conducted in one of the largest public hospitals in Attica that provides care to pregnant women, enrolling 380 participants divided into high-risk (n = 200) and low-risk (n = 180) cohorts. Data were collected over 20 months (starting from the end of May 2020 until January 2022), spanning from pregnancy to six months postpartum, via comprehensive questionnaires.

RESULTS

Statistical analysis revealed a pronounced correlation between prenatal breastfeeding intentions and actual breastfeeding behaviors across both groups. Specifically, 81.1% of women in the high-risk group and 82.5% in the low-risk group expressed intentions of exclusively breastfeeding during pregnancy. By six months postpartum, 54.9% of the high-risk and 64.3% of the low-risk pregnancy group managed to sustain breastfeeding. Extended antenatal hospitalization emerged as a statistically significant factor (p = 0.045) negatively impacting exclusive breastfeeding intentions among high-risk pregnancies.

CONCLUSION

The findings illuminate the critical influence of antenatal intentions on breastfeeding outcomes, particularly among high-risk pregnancies. Moreover, the study identifies the detrimental effect of prolonged hospital stays on breastfeeding aspirations. These insights underscore the necessity for nuanced, supportive interventions aimed at bolstering breastfeeding rates, thereby advancing maternal and neonatal health objectives aligned with World Health Organization recommendations.

Psychometric testing of the breastfeeding self-efficacy scale to measure exclusive breastfeeding in African American women: a cross-sectional study

Background

In United States, African American women are the least likely group to breastfeed exclusively compared with Hispanic and non-Hispanic white women. It is crucial to examine the perceived confidence of African American women towards practicing exclusive breastfeeding. Previous studies have examined breastfeeding self-efficacy and other factors influencing exclusive breastfeeding. However, there is no research on exclusive breastfeeding self-efficacy of this population. The purpose of this study was to examine the validity and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding, and the relationship between exclusive breastfeeding self-efficacy and general self-efficacy and demographic variables in African American women.

Methods

Descriptive cross-sectional design was used. A convenience sample of 53 pregnant African American women completed an online survey. Construct and criterion-related validity were assessed and reliability of the breastfeeding self-efficacy scale to measure exclusive breastfeeding (BSES-EBF) was examined using Cronbach's reliability. The general self-efficacy scale measured general self-efficacy. Descriptive statistics, bivariate correlation and non-parametric analyses were performed using statistical package for social sciences (v.28).

Results

The breastfeeding self-efficacy to measure exclusive breastfeeding scale had a Cronbach's alpha score of 0.907. One principal component was extracted from the BSES-EBF scale, with an Eigenvalue of 5.271 and which explained 58.57% of the variance in the instrument. The mean prenatal exclusive breastfeeding self-efficacy of participants was 35.15 (±7.41) from a range of 9 to 45. Exclusive breastfeeding was significantly associated with general self-efficacy (r = 0.503, p ≤ 0.001) and exclusive breastfeeding intention (p = 0.034).

Conclusion

Breastfeeding self-efficacy scale to measure exclusive breastfeeding is a valid and reliable tool to measure exclusive breastfeeding self-efficacy in African American women. African American women had high exclusive breastfeeding self-efficacy (internal motivation). Hence, there is a need to address breastfeeding barriers and provide access to culturally sensitive support (external motivation) to increase exclusive breastfeeding in African American women.

Prenatal Counseling and Preparation for Breastfeeding

Breastfeeding is the gold standard of infant nutrition and current guidelines suggest exclusive breastfeeding for 6 months, with continued breastfeeding through 24 months or beyond. Obstetric care professionals can encourage and educate their patients about breastfeeding through the prenatal period when many expectant parents make decisions about their infant feeding choices. Education and support should extend through the postpartum period and include parents who may have concerns surrounding medical comorbidities, breast augmentation, or substance use disorders.

Decision-making process of breastfeeding behavior in mothers with gestational diabetes mellitus based on health belief model

BACKGROUND

Gestational diabetes mellitus (GDM) threatens GDM mothers and their offspring's health and breastfeeding is one of the most effective ways to decrease the risk. However, the prevalence of breastfeeding among GDM mothers is far from optimal and how GDM mothers develop their feeding behavior is still unclear. Thus, this study aimed to explore the formation of GDM mothers' breastfeeding behaviors based on the health belief model (HBM).

METHODS

A questionnaire survey was conducted on 324 GDM mothers who have given birth within 6 months from January 1 to February 6, 2022. According to HBM, GDM mothers' knowledge, the perceived threat from GDM, the perceived value of breastfeeding, self-efficacy, social support and GDM mothers' breastfeeding behavior were measured. Exclusive breastfeeding (EBF) was defined as an infant who received only breast milk in the past 24 h before the survey. Structural equation modeling (SEM) was applied to explore how GDM mothers form their breastfeeding behaviors based on HBM.

RESULTS

The prevalence of EBF among GDM mothers was 33.95%. GDM mothers had limited knowledge of GDM (average 63.14% correct answer to 7 questions), especially poor on the long-term effect of GDM (39.81%) and protective effect of breastfeeding (34.57%-45.99%). Although GDM mothers showed high perceived benefits (Mean: 3.35, SD: 0.46), high self-efficacy (Mean: 3.43, SD: 0.97) and high level of social support for breastfeeding (Mean: 3.74, SD: 0.74), the various barriers (Mean: 2.20, SD: 0.47) hindered their success in EBF. The SEM results showed that a higher level of social support and more self-efficacy of breastfeeding resulted in a higher likelihood of EBF, while the higher level of knowledge of GDM, perceived higher barriers and benefits of breastfeeding and higher susceptibility to GDM consequences led to less EBF.

CONCLUSION

To promote EBF, physicians' education, emphasizing the protective effect of breastfeeding and how to correct breastfeeding, is highly recommended. In addition, social support for GDM mothers is also important to reduce their barriers to breastfeeding and help enhance self-efficacy in breastfeeding.

Either 'a blessing in disguise', or 'I couldn't get help,': Australian and Aotearoa NZ women's experiences of early infant feeding during COVID-19

BACKGROUND

To manage the COVID-19 pandemic, public health restrictions and a rapid pivot to telehealth occurred. Peripartum services were significantly affected by a strained infrastructure. Decreased face to face access to health services and support affected maternal experiences and confidence internationally, yet little was reported with the Australian and Aotearoa New Zealand context.

AIM

To explore the early parenting and infant feeding experiences of new mothers from Australia and Aotearoa New Zealand in the context of a pandemic.

METHODS

An interpretive qualitative approach and thematic analysis obtained an in-depth understanding of the experiences of 27 mothers who gave birth during the first wave of the COVID-19 pandemic in 2020.

FINDINGS

Australian and Aotearoa New Zealand women reported similar experiences, which varied contextually. Restrictions and requirements impacted favourably and unfavourably. Many women found the peace and space of social distancing an unexpected benefit and were proud of their achievements, whilst others shared feelings of isolation and distress. Some women felt they instinctively did what they needed to do. Experiences correlated with differing levels of self-efficacy.

DISCUSSION

While many women relished the freedom from social obligations when faced with feeding challenges, there was general dissatisfaction with the level of support available. Care was fragmented, and health care needs were unmet, impacting feeding and parenting decisions and mental health.

CONCLUSION

Access to timely and appropriate professional support is an important factor in establishing breastfeeding and developing parenting confidence, particularly in the context of a pandemic and should be a health policy priority.

Survey of Korean pediatrician's perceptions of barriers to and improvements in breastfeeding

BACKGROUND

Although the benefits of breastfeeding are broadly acknowledged with the efforts of the government and several medical societies, the rate of exclusive breastfeeding through 6 months is lower in Korea than in developed countries.

PURPOSE

This study aimed to investigate pediatricians' perceptions of breastfeeding barriers and the current breastfeeding counseling environment and propose government policies to encourage breastfeeding in Korea.

METHODS

Fourteen survey questions were developed during meetings of Korean Society of Breastfeeding Medicine experts. The Korean Pediatric Society emailed a structured questionnaire to domestic pediatricians registered as official members of the Korean Pediatric Society on May 4, 2021, and June 3, 2021. This study examined the survey responses received from 168 pediatricians.

RESULTS

The 168 respondents included 62 professors, 53 paid doctors, and 53 private physicians. Breastfeeding was recommended by 146 Korean pediatricians (86.9%). However, only 99 responders (59%) currently provide breastfeeding counseling in hospitals. Most respondents stated providing less than 15 minutes of breastfeeding counseling time in the clinic. Moreover, 89.88% of the respondents responded that they would participate in breastfeeding counseling education if an appropriate breastfeeding counseling program was newly established.

CONCLUSION

This study showed that, although Korean pediatricians had a positive attitude toward breastfeeding, limited counseling was provided for parents. Along with policy support to improve the medical environment through the establishment of an appropriate breastfeeding counseling program, high-quality counseling and an increased breastfeeding rate are expected.

Obesity in Children

Child obesity is widely prevalent, and general pediatricians play an important role in identifying and caring for patients with obesity. Appropriate evaluation and treatment require an understanding of the complex etiology of child obesity, its intergenerational transmission, and its epidemiologic trends, including racial/ethnic and socioeconomic disparities. The American Academy of Pediatrics has published screening, evaluation, and treatment guidelines based on the best available evidence. However, gaps in evidence remain, and implementation of evidence-based recommendations can be challenging. It is important to review optimal care in both the primary care and multidisciplinary weight management settings. This allows for timely evaluation and appropriate referrals, with the pediatrician playing a key role in advocating for patients at higher risk. There is also a role for larger-scale prevention and policy measures that would not only aid pediatricians in managing obesity but greatly benefit child health on a population scale.

Qualitative exploration of perceived barriers of exclusive breastfeeding among pregnant teenagers in the Greater Accra Region of Ghana

BACKGROUND

The World Health Organization endorses exclusive breastfeeding for the first six months of every child's life since exclusive breastfeeding has the potential of saving thousands of infants' lives. The global exclusive breastfeeding rate among mothers is sub-optimal. This predisposes infants born to teenage mothers to all types of ailments. Therefore, this study explored the factors that inhibit the practice of exclusive breastfeeding as perceived by pregnant teenagers in the Greater Accra Region of Ghana which is an urban area.

METHODS

The study used techniques in qualitative descriptive exploration to collect data from 30 pregnant teenagers through focus group discussions. Six focus group discussions were conducted and each group was made up of five participants. Informed consent was obtained from participants who were 18 years and above as well as parents of participants below 18 years while informed assent was obtained from participants below 18 years after purposive sampling. Interviews were audiotaped, transcribed and data were analysed through content analysis.

RESULTS

Two major themes and eight sub themes emerged from the data after analysis. Personal related barriers (negative emotional feelings, irrational thinking, perceived health risks to the baby and perceived self-inefficacy) and social related barriers (provider-client interaction, disapproval of exclusive breastfeeding by close relatives, unfriendly workplace policies and social myths) were the perceived factors that discouraged exclusive breastfeeding among teenage mothers.

CONCLUSION

Health professionals should be trained to provide culturally sensitive care to teenage mothers in order to promote exclusive breastfeeding. The media, religious leaders and politicians should help debunk misconceptions about breastfeeding expressed by participants in the study.

The Impact of Prenatal Lectures in Breastfeeding and Neonatal Care in Romania - Our Experience

Objective:The aim of the study was to identify the impact of prenatal lectures in breastfeeding and neonatal care in Romania. Methods:We distributed a questionnaire to mothers who gave birth at the Bucur Maternity, Bucharest, Romania. A study group was constituted from women who attended prenatal lectures and their answers were compared with those from women who did not have prenatal education. Results:The study included 122 women. Primiparous women tend to participate in educational lectures to a greater extent than others (p=0.001). Participants in prenatal lectures breastfeed longer than non-participants (.0.001) and they had at least university studies in a higher proportion (94.06%) than non-attenders (52.38%). Women without prenatal lectures live predominantly in rural areas (p=0.003). Most women who attended classes (86.2%) considered that information provided by prenatal lectures was useful. Exclusively breastfeeding was more frequent among participants (47.49%) than non-participants (38.89%). Conclusion:Primiparity, high level of education and living in urban areas are the main characteristics of female participants in prenatal lectures, who tend to breastfeed longer and ensure exclusive human milk feeding for their babies in a higher proportion than non-participants.

Educating fathers to improve exclusive breastfeeding practices: a randomized controlled trial

BACKGROUND

Fathers' involvement is crucial for promoting breastfeeding. There are a few studies on the effectiveness of fathers' educational programs to promote exclusive breastfeeding. This study aims to assess the effectiveness of a fathers' educational program on their support for breastfeeding, mothers' breastfeeding practice, and exclusive breastfeeding status.

METHODS

This was a randomized controlled trial on 76 fathers who were randomly assigned to two groups of intervention and control, in a selected health center in Iran, 2018. The tools for data collection were: 1) a questionnaire for "Demographic and Maternal-Infant Information"; 2) a questionnaire to assess "Fathers' support for Breastfeeding", and 3) an observational checklist to assess "Mothers' Breastfeeding Practice"; and 4) a questionnaire to assess "Exclusive Breastfeeding Status". The questionnaires were filled up through an interview. The checklist was completed through observation by the researcher. The fathers (with the mothers) of the intervention group were educated using individual face-to-face education and counseling, in two sessions, with the duration of about 40 min and one-week interval, whereas, the fathers of the control group did not receive any education and only mothers were educated with the same instruction. The content of the education was: fathers' education about "benefits of breast milk" and "the supporting ways for breastfeeding including the women encouragement". Then, the scores of "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" were compared before and after 4 months of intervention in each group, and also between groups. Data were analyzed using SPPS-23, and t- and paired-tests, Chi-square, and Generalized-Estimating-Equations (GEE) tests.

RESULTS

The results showed two groups were not significantly different regarding the demographic and any other possible confounding variables before the intervention (P < 0.05). The before and after comparisons also demonstrated significant improvements in the two variables including "father's support for breastfeeding", and "mothers' breastfeeding practice after 4 months, in the intervention group (Paired t-test: P<0.001 and P<0.0001, respectively) however, there was a significant decrease in "father's support for breastfeeding" and no improvement in "mothers' breastfeeding practice" after 4 months in the control group (Paired t-test: P < 0.001 and P = 0.07, respectively). Between groups comparison showed also significant higher scores for "father's support for breastfeeding", "mothers' breastfeeding practice" and "exclusive breastfeeding status" in the intervention group comparing to the control group, after 4 months (T-test: P < 0.001 and P < 0.0001; Chi2: P < 0.001, respectively). The interaction effects of time and group were significant in the GEE test for the fathers' support for breastfeeding (B-group = 31.93, B-time = 22.15, p < 0.001) and mothers' breastfeeding practice (B-group = 26.32, B-time = 12.86, p < 0.0).

CONCLUSION

The results showed that the father's education improves mothers' breastfeeding practice and increases the rate and continuity of exclusive breastfeeding.

TRIAL REGISTRATION

IRCT201508248801N10. "31/08/2016".

Modifiable predictors of breastfeeding status and duration at 6 and 12 months postpartum

BACKGROUND

Breastfeeding practices are determined by complex multilevel factors. This study assessed pregnant women's knowledge of breastfeeding and intention to breastfeed and investigated modifiable predictors for breastfeeding status (exclusive or any breastfeeding) and duration at 6 and 12 months postpartum.

MATERIALS AND METHODS

Longitudinal data were extracted from a trial in Sydney, Australia, 2017-19. Women (n = 1155) were recruited from antenatal clinics and followed up for telephone interviews at baseline (third trimester), then at 6 and 12 months postpartum. Data collected included mothers' demographics; knowledge of breastfeeding and intention to breastfeed; work status; support from caregivers; breastfeeding environment; breastfeeding status and duration. Multiple logistic and Cox regression models were built to identify predictors for breastfeeding.

RESULTS

At baseline, most mothers knew the recommendation to exclusively breastfeed until 6 months (66%) and the benefits (65%). The modifiable predictors for breastfeeding duration at 12 months included the following: mothers' knowledge of the recommendation (adjusted hazard ratio (AHR) 0.73, 95% confidence interval (CI) 0.60-0.90) and the benefits of exclusive breastfeeding (AHR 0.68, 95% CI 0.55-0.82), intention to meet the recommendation (AHR 0.76, 95% CI 0.63-0.93), and intention to breastfeed for two years (AHR 0.38, 95% CI 0.27-0.52) measured at baseline; mothers not working or studying (AHR 0.70, 95% CI 0.55-0.89), having support from other caregivers (AHR 0.64, 95% CI 0.43-0.96), and having breastfeeding women around (AHR 0.80, 95% CI 0.65-0.98) measured at 6 months.

CONCLUSIONS

Support for women to meet the breastfeeding recommendations should commence during pregnancy and focus on breastfeeding education and enabling environments.

It's just a breast: an examination of the effects of sexualization, sexism, and breastfeeding familiarity on evaluations of public breastfeeding

BACKGROUND

Despite the legal right to breastfeed in public, women may be concerned about negative reactions from others, which may in turn impact their decision to breastfeed in public. The current study examined whether women breastfeeding in public (e.g., at a coffee shop) would be evaluated differently than women breastfeeding in private (e.g., at home) and explored several explanations for the possible differences: sexualization of the female breast (including the perceivers' gender and sexual comfort level, as well as the exposure of the breast while breastfeeding), sexist attitudes, and familiarity with breastfeeding.

METHODS

In August 2018, 506 adult participants, residing in the United States and recruited from Amazon Mechanical Turk, were randomly assigned to view an image of a woman breastfeeding (or not) while wearing a cover (or not), in a private or public location. Participants then completed measures of their emotional responses, perceptions, and behavioral intentions toward the woman in the image as well as their sexual comfort level, hostile and benevolent sexism, and knowledge of and experience with breastfeeding.

RESULTS

People had more favorable evaluations of breastfeeding (vs. non-breastfeeding) women, especially when they had greater sexual comfort, were more knowledgeable about breastfeeding, and were parents with at least one child who was breastfed. The location (public vs. private) and the presence or absence of a cover did not differentially influence evaluations of breastfeeding and non-breastfeeding women, nor did participants' gender or level of sexist attitudes.

CONCLUSIONS

In general, people's evaluations of breastfeeding appear to be favorable to the degree that the location of the breastfeeding is not particularly relevant to those evaluations.

A Pilot Study of the Impact of Brief Exposure to Images of Breastfeeding Mothers on Attitudes Toward Mother's Breastfeeding in Public

The wider societal attitudes held toward mothers' breastfeeding in public seem to impact infant feeding choices. The present study employed an online (N = 396) experimental pretest-posttest design set to examine whether a mere exposure effect of briefly viewing and rating the valence of four different images of public breastfeeding (i.e., mother and baby alone, females in background, males in background, and females and males in background) would impact on participants' attitudes toward a mother breastfeeding in public. There was a marginal increase in the positive attitudes toward public breastfeeding at Time 2 when compared with Time 1 following exposure to the four images. These findings support a potential positive mere exposure effect in enhancing attitudes toward breastfeeding in public. This suggests a greater use of promotional material using visual stimuli may improve societal acceptance of breastfeeding in public.

Grandparent Coresidence and Risk of Early Child Overweight and Obesity in Low-Income, Hispanic Families in New York City

OBJECTIVE

Children in low-income Hispanic families are at high risk of obesity and are more likely to live with grandparents than their non-Hispanic white counterparts. We aimed to determine if grandparent coresidence (prenatal through age 2 years) was associated with: 1) obesogenic feeding practices; and 2) child weight outcomes from birth to three years.

METHODS

We analyzed data from 267 low-income, Hispanic mother-infant pairs in the control group of an obesity prevention trial in New York City. Linear and logistic regression tested differences in obesogenic feeding practices and weight outcomes at 2 and 3 years, dependent upon grandparent coresidence. Multilevel modeling tested associations between grandparent coresidence and WFAz over time.

RESULTS

Persistent grandparent coresidence (vs none) was associated with putting cereal in the bottle (adjusted odds ratio [aOR] 3.46; 95% confidence interval [CI] 1.43, 8.40). Persistent grandparent coresidence (vs none) was associated with higher mean WFAz (2 years: B 0.83; 95% CI 0.41, 1.25; 3 years: B 0.79; 95% CI 0.32, 1.25) and higher odds of child overweight/obesity risk (2 years: aOR 4.38; 95% CI 1.64, 11.69; 3 years: aOR 3.15; 95% CI 1.19, 8.36). In multilevel models, more occasions of grandparent coresidence were associated with higher WFAz.

CONCLUSIONS

Grandparent coresidence may be associated with higher risk of child overweight/obesity in low-income, Hispanic families. Further research is needed to elucidate mechanisms of these associations and to inform obesity prevention strategies in the context of multigenerational families.

How breastfeeding behavior develops in women with gestational diabetes mellitus: A qualitative study based on health belief model in China

BACKGROUND

Gestational diabetes mellitus (GDM) is a condition in which women develop hyperglycemia during pregnancy, and is associated with long-term health burden on both mother and their offspring, such as future type 2 diabetes mellitus (T2DM). Although breastfeeding was expected to mitigate metabolic sequelae for both mothers and their newborns, the prevalence of breastfeeding in GDM mothers are sub-optimal worldwide.

OBJECTIVE

To explore the experience of disease among mothers with GDM and how they develop feeding behaviors.

METHODS

This study was conducted in three branches of an integrated tertiary hospital in the central area of China. Mothers who were diagnosed with GDM, had no other complications, and gave birth before no more than 6 months were approached based on a purposive sampling. GDM mothers' experience of the disease and breastfeeding were collected via in-depth interviews. A theory-driven thematic analysis based on Health Belief Model (HBM) was applied for data analysis. Inductive reasoning was used to identify emerging themes which were not included in HBM.

RESULTS

16 GDM mothers were included in the current study, with nine using breastfeeding, six mixed feeding and one artificial feeding, respectively. Nine themes were identified, including: 1) GDM diagnosis and severity; 2) information searching and GDM knowledge;3) GDM management; 4) perceived susceptibility of future diabetes;5) perceived severity of future diabetes;6) perceived benefits of breastfeeding;7) perceived barriers of breastfeeding;8) decision making process of feeding and social support. Generally, mothers with GDM lack reliable sources of information, considered the disease as a minor and transient illness during pregnancy, and failed to realize the long-term risk of GDM and the protective effect of breastfeeding to themselves and their babies. They rarely considered GDM in their feeding decision. Instead, the formation of feeding behaviors depends on the balance between the benefits and barriers of breastfeeding as well as the level of social support.

CONCLUSION

To promote breastfeeding, a multi-facet intervention targeted on healthcare providers (HCPs), GDM mothers and their networks was important to help GDM mothers better and correctly understand the disease and breastfeeding, and increase their capacity of breastfeeding.

Determinants of time-trends in exclusivity and continuation of breastfeeding in India: An investigation from the National Family Health Survey

Breastfeeding is an essential key factor for reducing child mortality and the risk of disease. Therefore, to ensure health and wellbeing for all (Sustainable Development Goal 03), and to reduce inequalities in child health status (SDG 10), understanding the determinants of breastfeeding is essential. Our research aims to investigate determinants of different breastfeeding practices from 2005-06 (NFHS-3) to 2015-16 (NFHS-4), and changes in different breastfeeding practices among various demographic, social, religious, and economic groups during this decade. We have used a multivariate binary logistic regression model to estimate significant determinants of different breastfeeding practices. The results show an 8.4% hike in Exclusive Breastfeeding (EBF), along with a 3.3% and 1% drop in the Continuation of Breastfeeding (CBF) up to one and two years respectively during this decade in India. Significant variation has been found in EBF, CBF1 and CBF2 among various categories of child's birth interval, place of residence, social groups, economic communities, and geographic regions. Maternal nutritional status and anemia levels had significant influence on CBF1 and CBF2, and gender of the children on EBF and CBF2 from 2005-06 to 2015-16. There was no significant variation in CBF1 and CBF2 among children born in different birth orders, whereas EBF was significantly less among higher birth orders children. A dramatic improvement in EBF was found among first birth ordered children, teenage and/or highly educated mother, rich families, and in north India, and CBF2 was significantly raised only among higher educated mothers. The estimation of determinants throughout the decade is essential for improving government policies related to supporting and encouraging breastfeeding. The study suggests more initiatives and investment for the promotion, support and improvement of CBF for one and two years, and reduction of inequality among various demographic and socio-economic groups and geographic regions.

Understanding Factors Influencing Breastfeeding Outcomes in a Sample of African American Women

OBJECTIVES

Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited.

METHODS

Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis.

RESULTS

Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) "milk supply" and "use of pump" education; and (4) self-motivation/willpower/perseverance.

CONCLUSIONS FOR PRACTICE

Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged.

Exploring the Impact of Offering an Undergraduate Lactation Elective Course as a Strategy for Normalizing Breastfeeding

Background

More breastfeeding interventions targeting female and male undergraduates before they become parents are needed to foster accurate breastfeeding knowledge, positive attitudes toward breastfeeding, and a greater intent to breastfeed. This study aimed to assess the impact of completing a lactation elective course on undergraduates' breastfeeding knowledge, attitudes, and intention.

Methods

Pre- and postcourse surveys were administered to 96 undergraduates from various majors enrolled in a lactation elective.

Results

From pre- to postcourse, this study found significant increases in undergraduates' breastfeeding knowledge, attitudes, and intent.

Conclusions

Because most undergraduates in the United States become parents only after graduation, universities have an opportunity to foster the knowledge and attitudes needed to breastfeed successfully. As breastfeeding knowledge and attitudes in men and women are strong predictors of breastfeeding intent, initiation, and duration, offering undergraduate lactation elective courses is a promising strategy to improve future parents' breastfeeding knowledge, attitudes, and intention, helping to normalize breastfeeding and improve breastfeeding rates.

Factors Associated with Perceived Insufficient Milk in the First Three Months of Breastfeeding

PURPOSE

Perceived insufficient milk is the predominant risk factor for early breastfeeding discontinuation globally. The purpose of this study was to explore the association between perceived insufficient milk in the first 3 months and infant factors, maternal factors, professional support, parenting decisions, and breastfeeding concerns. Sixty-nine mothers who had perceived insufficient milk and 301 mothers who did not were included.

STUDY DESIGN AND METHODS

A cross-sectional online survey design was used in a convenience sample of 370 U.S. mothers with a healthy singleton infant between 1 and 12 weeks who were breastfeeding directly on the breast as part of their feeding methods.

RESULTS

Using stratified multivariable logistic regression, we found that among 102 mothers of infants < 4 weeks of age, planned breastfeeding duration < 6 months (OR = 13.17; 95% CI [1.42, 122.48], p = .024), and concerns about infant crying or fussing (OR = 4.72; 95% CI [1.10, 20.00], p = .03) were associated with perceived insufficient milk. Among 256 mothers of infants 4 to 12 weeks of age, concerns about frequent feedings (OR = 4.05; 95% CI [1.95, 8.40], p = .000) and latching difficulty (OR = 2.95; 95% CI [1.33, 6.54], p = .008) were associated with perceived insufficient milk.

CLINICAL IMPLICATIONS

Association between factors and perceived insufficient milk differed based on infant age. Maternal perceptions of crying or fussing, frequent feedings, and latching difficulty need to be assessed because of its attribution to perceived insufficient milk.

Determinants of Successful Exclusive Breastfeeding for Saudi Mothers: Social Acceptance Is a Unique Predictor

Recent guidelines motivate health care professionals to promote exclusive breastfeeding (EBF). The reported rate of EBF is low in Saudi Arabia. This study aimed to explore the determinants of successful exclusive breastfeeding for Saudi mothers. A cross-sectional, survey-based study was conducted in family medicine clinics. The dependent variable was the actual practice of EBF. Independent variables were the mothers’ demographic information, comfortableness with breastfeeding in public, knowledge and attitudes about breastfeeding, previous experience of successful breastfeeding, and a previous feeding plan. Statistical analysis was carried out using bivariate analysis and multinomial logistic regression. Out of the 322 respondents, only 28% practiced exclusive breastfeeding for the first six months. Perceived insufficient milk (p = 0.011) was associated with a lower EBF rate. Mothers’ degrees of comfort with breastfeeding in front of their relatives (p = 0.024) and in front of friends (p = 0.028) were significantly associated with their infants’ actual feeding practices for the first six months of their infants’ lives. Mothers reported that the absence of a suitable place for breastfeeding caused them to stop breastfeeding (p = 0.043) and was associated with their infant’s actual feeding practices for the first six months of their infant’s lives. An antenatal breastfeeding intention was considered a significant predictor of EBF; OR: 7.31 (95% CI: 2.24—23.84). Mothers who do not stop breastfeeding when they get sick have a 5.054 times higher chance of continuing EBF (95% CI: 1.037—24.627) than the formula-only feeding group. Thus, social acceptance is a unique predictor for their success in exclusive breastfeeding. Mothers have good intentions and a desire to breastfeed. Therefore, they must be guided through their pregnancy and postpartum period to overcome breastfeeding issues.

Postpartum Nipple Symptoms: Risk Factors and Dermatologic Characterization

Background: Nipple discomfort inhibits breastfeeding goals, particularly between 0 and 8 weeks postpartum (PP), and yet the specific dermatologic entities that contribute to nipple soreness have not been clearly delineated. Moreover, there remains a lack of evidence-based guidelines for nipple symptoms and skin diseases. Methods: A survey was distributed to 6-8-week PP women, 18-50 years of age, with an intent to exclusively or partially breastfeed ("at the breast" or "pump"). The study aimed to characterize nipple skin symptoms (pain and itching) and lesions (eczema, redness, cuts, or wounds) and any association between these nipple problems and past dermatologic history, breastfeeding outcomes, and the ability to meet her breastfeeding goals. Results: Findings paralleled Centers for Disease Control and Prevention (CDC) statistics with a 25% decline in breastfeeding rates between birth, 86.3% (189), and 6-8 weeks PP, 64.5% (145). By 6-8 weeks PP, exclusive "formula" and "exclusive feeding at the breast" showed the largest increase (+16.4%) and decrease (-22.9%), respectively. Although no significant difference was found in comparison of nipple problems to feeding methods or skin history, women who reported pumping or PP redness/eczema had higher odds ratios of a change in feeding practice, history of eczema, and sensitive skin. Strong pumping intentions were also associated with the highest risk of unmet breastfeeding goals. Conclusion: Regardless of feeding method, product, or provider use, PP nipple problems predominantly arose between 1 and 3 weeks PP. Clinical Trial Registration number 201901737.

Barriers and benefits to breastfeeding with gestational diabetes

Gestational diabetes mellitus (GDM) is a disease of glucose intolerance during pregnancy and is associated with infant macrosomia, infant hypoglycemia, and increased risk of type 2 diabetes development for both mother and infant. Although breastfeeding potentially mitigates metabolic sequelae for both mother and her offspring, women with GDM are more likely to introduce formula and, therefore, are less likely to exclusively breastfeed, and some studies show less initiation and shorter breastfeeding duration as well. Therefore, women with GDM and their infants warrant investigation of methods by which to increase breastfeeding exclusivity and duration. Exploration of the barriers to breastfeeding for women with GDM demonstrate not only biologic complications such as maternal obesity, increased prevalence of cesarean section, and infant hypoglycemia, but also maternal report of less provider support of breastfeeding and reduced breastfeeding self-efficacy. Consequently, interventions designed to optimize breastfeeding outcomes in this high-risk population should not only focus on the biology but also on provider behavior and maternal social factors.

Breastfeeding initiation among women with preeclampsia with and without severe features

BACKGROUND

Timely delivery and magnesium sulfate (MgSO4) are mainstay in the treatment of preeclampsia with severe features (PWSF). Premature delivery, severity of illness and mother-infant separation may increase the risk for breastfeeding (BF) initiation failure.

OBJECTIVE

To compare BF initiation among women with late-onset PWSF treated with MgSO4 to women with late-onset preeclampsia without severe features (WOSF) who did not receive MgSO4.

METHODS

Retrospective study of 158 women with PWSF and 104 with WOSF who delivered at ≥34 weeks. Intention to BF, formula feed (FF) or partially BF was declared prenatally. At discharge, exclusive BF included direct BF or direct BF with expressed breast milk (EBM).

RESULTS

PWSF and WOSF groups were similar in age, race, and obstetric history. PWSF and WSOF differed in primiparity (65 & 51%), late preterm births (73 vs 15%), admission to NICU (44 &17%) and mother (5 & 4d) and infant (6 & 3d) hospital stay. Both groups were similar in intention to BF (80 & 84%), to FF (16 & 13%) and to partially BF (5 & 5%). At discharge, exclusive BF (37 & 39%), partial BF (33 & 31%) and FF (30 & 30%) were similar. Exclusive BF in the PWSF group was 43% direct BF, 28% direct BF and EBM and 29% EBM alone whereas in the WOSF group exclusive BF was 93% direct BF and 7% direct BF and EBM.

CONCLUSION

BF initiation rates for women with PWSF and WOSF were similar. EBM alone or with direct BF enabled infants in the PWSF group to exclusively BF at discharge.

Breastfeeding attitudes of refugee women from Syria and influencing factors: a study based on the transition theory

AIMS

This review was designed to systematically examine studies that determine the breastfeeding attitudes of Syrian mothers, and factors influencing their breastfeeding behavior.

METHODS

Studies published between 2010 and 2020 were examined using 'Syria OR Syrian mother OR Syrian refugee AND breastfeeding OR breastfeeding practices OR intention OR attitudes OR exclusive breastfeeding' as keywords on PubMed, GoogleScholar, MEDLINE, Scopus, ProQuest, National Thesis Center, Web of Science, ScienceDirect and CINAHL; and five publications meeting the inclusion criteria were included in the study. The researchers independently used JBI Critical Appraisal Checklist for Analytical Cross-Sectional Studies and JBI Critical Appraisal Checklist for Systematic Reviews and Research Syntheses, developed by Joanna Briggs Institute, to assess the methodological quality.

RESULTS

A total of 6546 studies were accessed as a result of the literature review. Five studies meeting the inclusion criteria were included in the study. Women who are in this process experience a developmental and situational transition according to the framework of Meleis' theory. Factors affecting their breastfeeding attitudes were grouped under three main and four sub-themes. It was determined that personal factors (socioeconomic factors, cultural beliefs, the significance of breastfeeding practice, preparation), factors related to the immediate environment and social factors affect these women's attitudes toward breastfeeding.

CONCLUSION

It was found that most of the Syrian women had positive attitudes toward breastfeeding; however, the breastfeeding duration was less than 6 months for most of the refugees. Furthermore, according to the results of the studies, refugee women from Syria who did not receive social support from their spouses and relatives stopped breastfeeding.

Mixed milk feeding: a systematic review and meta-analysis of its prevalence and drivers

CONTEXT

Extensive literature is available on exclusive breastfeeding and formula-feeding practices and health effects. In contrast, limited and unstructured literature exists on mixed milk feeding (MMF), here defined as the combination of breastfeeding and formula feeding during the same period in term infants > 72 hours old (inclusion criterion).

OBJECTIVE

A systematic review and meta-analysis were performed, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, on the global prevalence of MMF (primary outcome) and related drivers and practices (secondary outcomes).

DATA SOURCES

The search of MMF in generally healthy populations was conducted across 6 databases, restricted to publications from January 2000 to August 2018 in English, Spanish, French, and Mandarin.

DATA EXTRACTION

Two reviewers independently performed screenings and data extraction according to a priori inclusion and exclusion criteria.

DATA ANALYSIS

Of the 2931 abstracts identified, 151 full-text publications were included for data extraction and 96 of those were included for data synthesis (the majority of those were cross-sectional and cohort studies). The authors summarized data across 5 different categories (feeding intention prenatally, and 4 age intervals between > 72 hours and > 6-23 months) and 5 regional subgroups. The overall prevalence of MMF across different age intervals and regions varied between 23% and 32%; the highest rate was found for the age group 4-6 months (32%; 95% confidence interval, 27%-38%); regional comparisons indicated highest MMF rates in Asia (34%), North and South America (33%), and Middle East and Africa together (36%), using a random effects meta-analysis model for proportions. Some drivers and practices for MMF were identified.

CONCLUSION

MMF is a widespread feeding reality. A shared and aligned definition of MMF will help shed light on this feeding practice and evaluate its influence on the duration of total breastfeeding, as well as on infants' nutrition status, growth, development, and health status in the short and long terms. PROSPERO registration number CRD42018105337.

Barriers and facilitators to breastfeeding during the immediate and one month postpartum periods, among Mexican women: a mixed methods approach

BACKGROUND

Evidence suggests that inadequate hospital practices, as well as sociocultural and community factors have detrimental effects on timely initiation as the first breastfeed within first hour after birth, and exclusive breastfeeding. The purpose of the study was to examine the factors that influence timely initiation of breastfeeding and exclusive breastfeeding at birth and 1 month postpartum in Mexican women delivering in public and private hospitals.

METHODS

Mixed methods were conducted between May and July 2017, including surveys (n = 543) and semi-structured interviews (n = 60) in the immediate (7 h) and intermediate (30 days) postpartum periods. Participants were women aged 15-49 years, in public and private hospitals, of urban and rural municipalities of Chihuahua and Puebla, Mexico.

RESULTS

Timely initiation was reported by 49.4% of mothers, and 34.7% reported that their children received infant formula at the hospital. Only 44.8% of women reported exclusive breastfeeding at 1 month postpartum. Timely initiation of breastfeeding was higher in women with vaginal delivery (62.1 vs 35.5%; p < 0.05) and those who received information during pregnancy (OR 1.07; p = 0.018). Exclusive breastfeeding at 1 month postpartum was related to older maternal age (OR 1.05; p < 0.001) and the fact that the mothers had received more information about breastfeeding during pregnancy (OR 1.13; p = 0.0001). Infant formula use was less associated with timely initiation (OR 0.46; p = 0.001). Participants in qualitative data identified the emotional, physical and economic benefits of breastfeeding, however, the perception about insufficient production of human milk, and the belief that infant formula is recommended, persists.

CONCLUSIONS

Modification of hospital practices, such as decreasing the number of cesarean and the use of infant formula, as well as the support of the initiation and continuation of exclusive breastfeeding by health personnel and family members, could help increase breastfeeding practices in Mexican women.

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

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

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

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

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

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

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

Actitudes y beneficios acerca de la lactancia materna en Guatemala

Introducción: La leche materna es el alimento de elección para el recién nacido debido a sus múltiples ventajas y beneficios tanto para el lactante como para la madre sin embargo, la decisión de brindar Lactancia Materna Exclusiva (LME) debe de ser debidamente informada ya que el éxito de dicha práctica está condicionado por múltiples factores, siendo uno de ellos el nivel de conocimiento sobre LME. Objetivo: Evaluar el conocimiento de las madres sobre la importancia de la lactancia materna exclusiva y relacionarlo con la duración de la misma. Metodología: Estudio descriptivo y prospectivo de 100 encuestas realizadas a madres que acuden a consulta externa del Grupo Pediátrico Multimédica y a consulta externa de Pediatría en el Hospital Roosevelt durante los meses de junio y julio del 2019. Se utilizó la prueba estadística coeficiente de correlación y t de Student. Resultados: Se encontró un resultado positivo con la prueba estadística de correlación r = 0.9993 y t de Student se obtuvo un valor P de 0.0007 con un nivel de confianza de 0.05, por lo que es posible decir que el conocimiento de las madres sobre LME se relaciona con la duración de la misma.

Maternal religion and breastfeeding intention and practice in the US Project Viva cohort

BACKGROUND

Religion has rarely been studied as a determinant of infant feeding practices. We examined whether religious affiliation is associated with formula feeding vs breastfeeding intention and practice in women from the United States Project Viva cohort.

METHODS

Between 1999 and 2002, 2128 pregnant women were recruited in the area of Boston, Massachusetts. They reported by questionnaire their religious affiliation, and their intended and practiced infant feeding mode (exclusive formula feeding vs partial vs exclusive breastfeeding) at different time points. We examined associations of religious affiliation with infant feeding intention and practice by modified Poisson regression and multinomial logistic regression adjusted for known sociodemographic confounders.

RESULTS

Of 1637 women with complete data, 52% reported being Catholic, 29% Protestant, 11% unaffiliated, 4% Jewish, and 4% other religion. Overall, 8.5% and 15.9% women intended and initiated exclusive formula feeding, respectively. Compared with unaffiliated women, Catholics were more at risk to intend to exclusively formula-feed their infant at birth (risk ratio [95% CI]: 6.4 [1.6-26.0]) and to exclusively formula-feed after delivery (2.4 [1.3-4.2]) and 3 months postpartum (1.3 [0.98-1.8]). The odds ratio for intending and practicing partial (vs exclusive) breastfeeding did not differ by religious affiliation at most examined time points. Associations of Protestant women with infant feeding exhibited estimates closer to unaffiliated than to Catholic women.

CONCLUSIONS

Catholic women are more at risk to intend and practice exclusive formula feeding than women of other religious affiliations. Our findings may help health care practitioners adapt their breastfeeding promotion to the mother's religious affiliation.

Breastfeeding as a balancing act - pregnant Swedish women's voices on breastfeeding

BACKGROUND

Breastfeeding provides health benefits to both women and children. The rationale behind an individual woman's decision to breastfeed or not can depend on several factors, either independently or in combination. The aim of the current study was to explore attitudes towards breastfeeding among pregnant women in Sweden who intend to breastfeed.

METHODS

Eleven mothers-to-be, one of whom had previous breastfeeding experience, participated in the study. The women were interviewed either by telephone or face-to-face during late pregnancy, with the aim of exploring their attitudes towards breastfeeding. A semi-structured interview-guide was used, and the transcripts of the interviews were analyzed using thematic analysis. The social ecological model of health is the theory-based framework underpinning this study. The model provides a comprehensive approach to understanding the factors that influence breastfeeding intention.

RESULTS

When interviewed during pregnancy, women described breastfeeding as a balancing act between societal norms and personal desires. The women perceived a societal pressure to breastfeed, however it was accompanied by boundaries and mixed messages. This perceived pressure was balanced by their own knowledge of breastfeeding, in particular their knowledge of other women's experience of breastfeeding. When envisioning their future breastfeeding, the women made uncertain and preliminary plans, and negotiated the benefits and drawbacks of breastfeeding. There was a wish for individual breastfeeding support and information.

CONCLUSIONS

Pregnant Swedish women perceive their future breastfeeding as a balancing act between societal norms and personal desires. These findings suggest that while discussing breastfeeding during pregnancy, it could be of interest to collect information from pregnant women on their knowledge of breastfeeding and from where they have gained this knowledge, since stories from family and friends may make them question their own capacity to breastfeed. A thorough review of the woman's experiences and attitudes of breastfeeding is important in order to offer the best evidence-based breastfeeding support.

TRIAL REGISTRATION

Ethical approval for the study was obtained from the Regional Ethical Review Board in Uppsala (Dnr: 2017/256).

Prior breastfeeding experience and infant feeding at discharge among women with pregestational diabetes mellitus

OBJECTIVE

To compare multiparous women with pregestational diabetes mellitus (PGDM) with and without prior breastfeeding (BF) experience and to ascertain their infants' feeding type during hospitalization and at discharge.

METHODS

A retrospective cohort study of 304 women with PGDM who delivered at ≥34 weeks gestational age (GA). Prior BF experience and infant feeding preference was declared prenatally. At discharge, BF was defined as exclusive or partial.

RESULTS

BF experience and no experience groups were similar in diabetes type 1 and 2, race and number of pregnancies. Women with no experience had more spontaneous abortions (35 vs 27%), fewer term deliveries (51 vs 61%) and living children (median 1 vs 2). In the current pregnancy, mode of delivery: vaginal (36 & 37%), cesarean (64 & 63%), birthweight (3592 & 3515 g), GA (38 & 37 w), NICU admission (14 & 11%) and hypoglycemia (44 & 43%) were similar. Women with experience intended to BF (79 vs 46%), their infants' first feeding was BF (64 vs 36%) and had lactation consults (96 vs 63%) more often than those without experience. At discharge, women with BF experience were different in rate of exclusive BF (33 vs 11%), partial BF (48 vs 25%) and formula feeding (19 vs 64%).

CONCLUSION

Prior BF experience leads to better BF initiation rates while the absence of BF experience adds a risk for BF initiation failure. A detailed BF history could provide insight into obstacles that lead to unsuccessful BF experiences and may help define appropriate preventive or corrective strategies.

Variability in clinician intentions to implement specific cognitive-behavioral therapy components

BACKGROUND

CBT comprises many discrete components that vary in complexity, but implementation and training efforts often approach CBT as a single entity. We examined variability in clinician intentions to use different structural and interventional components of CBT for three different clinical groups: clients receiving CBT, clients with depression, and clients with anxiety.

METHODS

Clinicians (n = 107) trained in CBT completed a one-time electronic survey. Clinicians' intentions were measured using established item stems from social psychology adapted to examine intentions to use six specific CBT components: exposure therapy, cognitive restructuring, behavioral activation, planning homework, reviewing homework, and agenda-setting.

RESULTS

Intentions were weakest, on average, for exposure. They were strongest, on average, for reviewing homework. A series of ANOVAs with Tukey's post-hoc tests revealed that participants intended to use exposure with clients receiving CBT (p = .015) and clients with anxiety (p < .001) significantly more than for clients with depression. Participants intended to use behavioral activation with clients with depression (p = .01) significantly more than for clients with anxiety. No other intentions to use CBT components differed among these three clinical populations.

CONCLUSIONS

When studying determinants of CBT use and designing interventions to increase use, implementers should consider that different CBT components may require different implementation strategies.

TRIAL REGISTRATION

Not applicable.

Reliability and Validity of the Greek Version of the Iowa Infant Feeding Attitude Scale Among Pregnant Women

Introduction:

A modifiable factor related to breastfeeding is breastfeeding attitudes. The Iowa Infant Feeding Attitude Scale (IIFAS) is used to evaluate this factor. Although the breastfeeding rates in Greece are declined there is not available any validated instrument to evaluate infant feeding attitudes.

Aim:

to determine the psychometric properties of the Greek adaptation of the IIFAS in a sample of pregnant women.

Materials and Methods:

Pregnant women (N=203) from a University Hospital in Athens, Greece, were administered the Greek version of the IIFAS, while being in hospital, and their infant feeding mode at six months postpartum was recorded by telephone. The reliability of the scale was assessed by using corrected item-total correlations and Cronbach’s alpha. Construct validity of the scale was assessed by using confirmatory factor analysis and predictive validity by using t-tests. Multiple linear regression analyses in a stepwise method (p for removal was set at 0.1 and p for entry was set at .05) was performed in order to find variables independently associated with IIFAS total score.

Results:

The mean IIFAS score was 70.0 (SD=7.6). The corrected item-total correlation ranged from 0.22 to 0.51. Cronbach’s alpha was equal to 0.71. The confirmatory factor analysis indicated an adequate fit of the one-factor model. Concerning the predictive validity of IIFAS it was significant for breastfeeding at six months. The mean IIFAS score was significantly greater (p=0.001) for women that had exclusive breastfeeding at six months (mean (SD): 68.4(6.6)) as compared with those that did not (mean (SD): 64.0(7.5)). Higher IIFAS scores were found in older women, with higher educational level and in those that had breastfed children in their social environment.

Conclusion:

The Greek version of the IIFAS demonstrated satisfying reliability and validity for measuring women’s infant feeding attitudes in the Greek context. Also, the results of the present study provide further evidence of the international applicability of the IIFAS.

Investigating Predictors of Prenatal Breastfeeding Self-Efficacy

Background

While breastfeeding is considered the optimal method of infant feeding, Canadian breastfeeding rates remain below the World Health Organization recommendations. Breastfeeding self-efficacy is known to positively influence breastfeeding outcomes. While previous research has identified predictors of breastfeeding self-efficacy in the immediate postpartum, this study identified predictors of breastfeeding self-efficacy in the prenatal period. Research aim: The aim of this study was to identify predictors of breastfeeding self-efficacy in the prenatal period among both primiparous and multiparous women.

Methods

A sample of 401 Canadian pregnant women in their third trimester completed an online survey. Stepwise multiple linear regression identified predictors of breastfeeding self-efficacy.

Results

The following variables explained 41.2% of the variance in breastfeeding self-efficacy among the entire sample: feeling prepared for labor and birth, number of children, breastfeeding knowledge, anxiety, length of plan to exclusively breastfeed, income, plan to exclusively breastfeed, and type of health-care provider. Among primiparous women, the following variables explained 31.6% of the variance in breastfeeding self-efficacy: feeling prepared for labor and birth, income, anxiety, length of plan to exclusively breastfeed, education, and marital status. Among the multiparous women, the following variables explained 33.6% of the variance in breastfeeding self-efficacy: anxiety, length of prior exclusive breastfeeding experience, breastfeeding knowledge, and plan to exclusively breastfeed.

Conclusion

Through the identification of predictors of breastfeeding self-efficacy in the prenatal period, health-care providers can strategically target women at risk of low breastfeeding self-efficacy and intervene early to promote breastfeeding.

Validation of the Infant Feeding Beliefs Questionnaire (IFBQ) among pregnant African- American women and their study partners

Maternal feeding beliefs and practices have been associated with weight gain in infants and young children. Less work examines feeding beliefs prenatally or the feeding beliefs of other non-maternal caregivers (NMCs) who play important roles in infant feeding. This study validates a scale, the Infant Feeding Beliefs Questionnaire (IFBQ), to assess feeding beliefs during pregnancy among African-American women and other caregivers and tests whether the resulting belief constructs (laissez-faire, restrictive, responsive, pressuring and indulgent) are associated with maternal and NMC characteristics. Data come from 429 pregnant women and 374 NMCs including fathers, grandmothers and other family and friends enrolled in the baseline 28-week gestation visit of the Mothers and Others Study, a family-based, randomized control trial to support healthy infant feeding and prevent obesity. Confirmatory factor analysis (CFA) was used to test the fit of four a priori feeding constructs. Models were modified iteratively in mothers and then separately tested in the NMCs sample. Construct scores were created by averaging the remaining items and scale reliability was assessed. External validity was tested using bivariate and multivariable regression models. We validated five feeding belief constructs, measured through 8 sub-constructs. Reliability coefficients ranged from 0.58 for laissez faire to 0.76 for pressuring. Goodness of fit indices for CFA models indicated good fit with CFIs from 0.97 to 0.99 and RMSEA from 0.00 to 0.06. Construct scores differed significantly by depressive symptoms, obesity, education, income, and previous children in mothers and NMCs. The IFBQ may be used among mothers and NMCs to assess feeding beliefs beginning in the prenatal period, providing a tool to assess the longitudinal development of feeding beliefs and to highlight avenues for intervention on feeding practices during a critical period for behavior change.

Psychosocial dimensions of human milk sharing

Breastfeeding is critical to maternal and infant health. Psychosocial factors are associated with lactation outcomes, and perinatal mood disorders (PMDs) are often linked with breastfeeding difficulties and early, unexpected weaning. Parents may utilize human milk sharing to ensure their infant receives human milk when breastfeeding requires supplementation or is not possible, but this practice carries health risks and is often stigmatized. Milk sharing recipient mothers may be particularly vulnerable to PMDs associated with breastfeeding difficulties. The study objective was to explore factors associated with emotional responses to a parent's decision to feed their infant with shared human milk. An online cross-sectional survey of 205 milk sharing recipients was analysed with linear regression. Controlling for participants' education and breastfeeding difficulties, higher perceived social stigma was associated with more negative emotional responses (p < .01). Receiving strong spousal/partner support for milk sharing (p < .001) and screening donors regarding the health of their nursling(s) (p < .05) were associated with more positive emotional responses. Social stigmatization of milk sharing may negatively influence emotional responses among recipient mothers. Based on these results, it can be recommended that health professionals screen breastfeeding mothers with lactation difficulties for emotional distress that may lead to PMDs and provide evidence-based information about milk sharing in a nonstigmatizing way. Health professionals may support informed decision-making for infant feeding practices, including human milk sharing, by providing information on milk sharing risks and risk mitigation, developing evidence-based practices and guidelines that facilitate safe milk sharing, and directing families to available resources for psychosocial support.

"It's natural and healthy, but I don't want to see it": Using Entertainment-Education to Improve Attitudes Toward Breastfeeding in Public

While it has been well established that breastfeeding provides the best nourishment for children, few women achieve the recommended breastfeeding duration. Negative media messages have been identified as one explanation for the lack of individual and public support for breastfeeding. This study explored the influence of media on the knowledge and attitudes of a nearly childless population to ascertain if and how entertainment media can positively impact perceptions of breastfeeding. Using cultivation and parasocial interaction, this research measured entertainment television's effect on breastfeeding attitudes using randomized-group experiments involving 375 students. Overall, participants generally held positive attitudes but were uncomfortable seeing breastfeeding. Moreover, results indicate that viewing a prime-time television clip that depicted public breastfeeding not only significantly lessened the extent to which participants believed that breastfeeding was a private activity but also improved attitudes and support for breastfeeding in public. This study concludes that more pro-breastfeeding media messages in entertainment media could help create a climate conducive to breastfeeding success.

The effect of breastfeeding training on exclusive breastfeeding: a randomized controlled trial

INTRODUCTION

Although exclusive breastfeeding is very beneficial for children's and mothers' health, a limited number of infants are exclusively breastfed for 6 months.

AIM

This randomized controlled intervention study aims to determine the effect of breastfeeding training on mothers' knowledge, behaviors, and exclusive breastfeeding for 6 months.

MATERIALS AND METHODS

The participants were selected randomly for training (n = 60) and control groups (n = 60) among the pregnant women admitted to the obstetrics and gynecology polyclinics of a baby-friendly hospital. The training group received breastfeeding training during the prenatal and postnatal periods. The data were collected using a questionnaire during admission and at the postpartum 1st and 24th weeks through face-to-face interviews. The study was completed with 34 and 30 mother-infant pairs in the training and control groups, respectively. Analyzed using the chi-square, Student t, Mann-Whitney U, and Wilcoxon t-tests.

RESULTS

The difference between the number of correct answers in pre- and posttest was higher in the training group (four questions) than in the control group (two questions) (p < .001). The number of mothers exclusively breastfeeding for 6 months was significantly higher in the training group (26.5%) than in the control group (3.3%) (p = .015). The median of the exclusive breastfeeding period was longer in the training group (5 months) than in the control group (4 months) (p = .013).

CONCLUSION

Training and supporting pregnant women and breastfeeding mothers on breastfeeding increased their knowledge, the period of exclusive breastfeeding, and the rate of 6-month exclusive breastfeeding.

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

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

It's okay to breastfeed in public but…

Background

Decisions about infant feeding are embedded and are continuously made within a woman's social and cultural context. Despite the benefits of breastfeeding to both women and infants, and government policies and laws to protect and promote breastfeeding, breastfeeding in public remains a controversial issue. The purpose of this paper is to present findings from an Australian study that explored the perceptions and beliefs held by first time expectant mothers and their family and social networks towards breastfeeding in public.

Methods

This study collected data through fifteen family conversations to explore the views and beliefs of first time mothers and those in her social network towards breastfeeding. Breastfeeding in public was discussed in nine of the family conversations with 50 individual people contributing. We used a process of a descriptive contextual analysis drawing out specific elements of the family conversations to identify an underlying ideology around breastfeeding in public within these groups.

Results

The analysis focused on four key elements of the conversations. These included the descriptions of the event, the actions, the locations and feelings of the dominant players. Descriptions of the event outlined different beliefs and feelings related to breastfeeding in public and whether it should occur at all. Suggestions for not breastfeeding in public were timing your outings so feeding could take place at home, expressing breastmilk or using the dummy. When breastfeeding in public was considered acceptable, there were requisite social norms. Breastfeeding in public requires women to be discrete and covered-up, so as not to expose her breast. She is also required to feed in an appropriate place to avoid discomforting others, guard against judgement, and to protect herself from the unwanted male gaze.

Conclusions

Our findings suggest that controversy remains as to whether breastfeeding should occur in public at all. Even where breastfeeding in public is seen as a woman's choice, there are social rules that govern how it should be undertaken to make it an 'appropriate' activity. As a result, women need to take responsibility for others feelings, minimise the discomfort of others and 'keep themselves safe' if and when they breastfeed in public spaces.

Are adolescents ready for future responsibilities? Experience from a cross-sectional study regarding Breastfeeding knowledge and attitude

BACKGROUND

Breastfeeding plays an important role in the holistic development of a child. Current knowledge and attitude of future parents will significantly influence breastfeeding practices. Therefore, ascertaining current knowledge and attitude of both soon-to-be parents will help to formulate breastfeeding promotion strategies.

RESEARCH AIM

To ascertain the knowledge and attitude of adolescents towards breastfeeding and its correlates with socioeconomic and demographic factors.

MATERIALS AND METHODS

A cross-sectional institutional based study in which participants were recruited from Punjab, state of India. A total of 392 adolescents from January to June 2017 were evaluated on the basis of a pretested, reliable, and valid instrument. The instrument consisted of questions on knowledge and attitude regarding breastfeeding.

RESULTS

One-hundred two (26%) participants had good knowledge and 290 (74%) had poor knowledge regarding breastfeeding. A bothersome fact is that only 25% of the participants knew about the age till which a child should be breastfed. There was a statistically significant (OR = 2.93; 95% CI: [1.45--5.93]) association between high knowledge and positive attitude.

CONCLUSION

The level of knowledge amongst adolescents showed variation ranges from 15.82% to 93.11% on various aspects of breastfeeding. Despite this glaring variation, 75% of the participants had a positive attitude towards breastfeeding. Thus, there is a need for implementing modified and improved breastfeeding promotion strategies in India.

The perceptions and experiences of women with a body mass index ≥ 30 kg m2 who breastfeed: A meta-synthesis

Breastfeeding has copious health benefits for both mother and child, but rates of initiation and maintenance among women with a body mass index (BMI) ≥ 30 kg m² are low. Few interventions aiming to increase these rates have been successful, suggesting that breastfeeding behaviour in this group is not fully understood. Therefore, this review aimed to systematically identify and synthesise the qualitative literature that explored the perceptions and experiences of women with a BMI ≥ 30 kg m² who breastfed. The search identified five eligible papers, and a meta‐ethnographic approach was taken to synthesise the findings. One theme was identified: “weight amplifies breastfeeding difficulties,” revealing that women with a BMI ≥ 30 kg m² experience common breastfeeding difficulties to a greater degree. In particular, women with a BMI ≥ 30 kg m² struggle with the impact of medical intervention, doubt their ability to breastfeed, and need additional support. These findings can inform understanding of breastfeeding models, future research directions, intervention development, and antenatal and post‐natal care for women with a BMI ≥ 30 kg m².

Images of women breastfeeding in public: solitude and sociality in recent photographic portraiture

Contemporary images of women breastfeeding — from breastfeeding selfies to fine art — celebrate breastfeeding outside the home by displaying visual records of these occasions to a wider audience. From brelfies posted by celebrities and ordinary parents on social media, to the photography of Tara Ruby and Ivette Ivens, media coverage of lactivist nurse-ins, or fine-art works by Ashlee Jenkins and Sky Boucher, the repertoire of breastfeeding images in developed Western nations has grown and diversified exponentially in the past ten years. A subject that was once the province of religious painting, ethnography, public health advocacy or obscure corners of pornography, is increasingly made visible within the everyday, not only through self-portraiture on social media but also through the work of celebrated photographers and visual artists.

Despite this, there is still an absence of images of women breastfeeding in social circumstances, suggesting a reluctance to make the leap from understanding breastfeeding as a solitary activity, regardless of the space the mother inhabits at the time, to a companionable behaviour integral to our social landscape. Images predominate of women breastfeeding alone, or at best with other breastfeeding women, revealing a further binary dividing the acceptable from the unacceptable, where the private vs. public has been conflated with the solitary vs. social.

This article provides a textual analysis of contemporary photographic portraiture to interpret the meanings of key works, and their patterns of signification. It asks to what extent these images advance efforts to normalize breastfeeding and make it publicly commonplace, or reinforce unhelpful binaries, using an iconography based on the religious origins of portraiture itself: the virtuous, devoted mother, unaccompanied but for her child. I conclude that the lack of images where breastfeeding women are integrated into social occasions is partly due to the lack of opportunities for women to breastfeed socially, and few motives for these instances to be recorded, and that there is an unspoken proxemics of viewing space yet to be traversed.

Positive Effect of Baby-Friendly Hospital Initiatives on Improving Mothers' Intention for Successful Breastfeeding in Korea

BACKGROUND

In Korea, the breastfeeding (BF) rate of infants aged 6 months or more is drastically decreasing, and this phenomenon is particularly worrisome for the future health of the population. The present study aimed to identify an antenatal strategy for initiation and continuation of human BF, and to identify how Baby-Friendly Hospitals (BFHs) may positively influence the intention to breastfeed.

METHODS

A total of 414 pregnant Korean antenatal women were surveyed using questionnaires to determine current knowledge of the benefits of human breast milk, whether they planned to breastfeed after delivery, to continue BF after reinstatement in the workforce, are willing to abide by rooming-in care for infants, and plan to give birth at BFHs.

RESULTS

We found that planning room-in care, greater awareness of BF benefits for infant and mother, participation in antenatal education programs, and provision of BF facilities in the workplace were positively associated with plans for exclusive breastfeeding (EBF) and longer BF duration. The mothers who planned to give birth at BFHs also desired to breastfeed immediately after birth, implement in-room care, continue BF at their workplace, participate in antenatal BF educational programs, and were more aware of the benefits of BF.

CONCLUSION

If the beneficial effects of BFHs were well known to individuals, these would enhance the success rate of BF in Korea. Antenatal education and consequent acquisition of better knowledge of the benefits of BF are important for increasing the rate of BF practices.