Breast-feeding in the modern health sector in Indonesia: the mother's perspective

Patterns for the initiation of breastfeeding in humans

Establishment of lactation has important biological and emotional health consequences for the newborn. Even so, substantial variation within a culture and among different cultures is seen in the onset of breastfeeding. Parametric mixture models are used to explore this variation and to uncover general human patterns for the initiation of breastfeeding. The model components reflect two hypothesized patterns of behavior. The first component is a "natural" pattern of breastfeeding that reflects, to some extent, a general mammalian behavior. The second component arises through culturally mediated behaviors that affect the initiation of breastfeeding. The model was fit by maximum likelihood to interval- and right-censored observations on 26220 mother-infant pairs collected from 25 previously published studies of breastfeeding behavior. Both model components were clearly statistically identified. Effects of cultural and geographic covariates were found to have significant effects on all components of the model. Although there is clear evidence for two distinct patterns of behavior in the initiation of breastfeeding, the results suggest that learned behaviors play an important role in mediating even "natural" breastfeeding behavior.

Breast-feeding and the working mother in Nairobi

OBJECTIVE

In the fast growing city of Nairobi, women often combine the roles of mother and worker in trying to achieve better standards of living. The objective of this study was to document the effect of returning to work on breast-feeding by mothers in Kenya.

DESIGN

A cross-sectional survey.

SETTING

Outpatient clinics of two major hospitals in Nairobi, one government hospital in an economically deprived area and one high-fee private hospital.

SUBJECTS

Four hundred and forty-four working mothers from low and higher socio-economic areas in Nairobi. All working mothers with infants aged 4 to 12 months attending during the survey period were invited to participate.

RESULTS

The prevalence of breast-feeding at the time of interview was found to be 94.1%. The lower socio-economic group exhibited a higher prevalence of breast-feeding (99%), 10% greater than the higher socio-economic group. The mean number of hours the mothers were away from home due to work was 46.2 hours each week. The majority (54.4%) of the mothers employed a 'house-girl' to care for their infant while they were at work, while 28.4% were able to take their infants to work. Most of the breast-feeding mothers (95%) breast-fed their infants at least three times a day and only 23 mothers reported not being able to breast-feed their infants during the day. The lower socio-economic group had a mean of 5.09 breast-feeding times per day while the higher socio-economic group had a mean of 3 times a day. In a logistic regression analysis the mode of work (fixed working hours vs. shift working hours) was associated with exclusive breast-feeding at one month (odds ratio (OR)=0.45) and two months (OR=0.39).

CONCLUSION

In Western countries 'return to work' is often cited as the reason that breast-feeding is discontinued prematurely. In this study we have shown how mothers in Kenya are able to successfully continue breast-feeding after they have returned to work, often for very long hours.

The Effect of Breastfeeding on Fertility in Bangladesh

This study, based on the 1996–97 Bangladesh Demographic and Health Survey, attempts to find the effect of breastfeeding on fertility. The study reveals that breastfeeding status of the mothers placed a considerable role in the determination of fertility. The mean number of live births was lower in case of mothers who gave full breastfeeding compared to others. The relationship between the duration of breastfeeding and mean number of live births was direct and negative. A significant change in the breastfeeding pattern was observed by parity and age of mothers. The path analysis suggests that the longer the duration of breastfeeding, the lower will be the incidence of child mortality, and hence the lower will be the fertility.

Back to nature? Historical and cross-cultural perspectives on barriers to optimal breastfeeding

This article examines the discrepancy between the recommendations of international authorities concerning breastfeeding and the practices of a significant proportion of women all over the world who discontinue breastfeeding because of the reported insufficiency of their milk. Our review of the evidence on the insufficient milk syndrome suggests that the phenomenon is inextricably linked to the construction of family, gender and motherhood at different historical times and in different parts of the world, and that the prevention of early discontinuation of breastfeeding requires a better understanding of these issues in their historical and cultural context.

Infant feeding--knowledge and attitudes in a rural area of Karnataka

A study of the knowledge and attitude towards infant feeding was conducted in South India on a group of 300 mothers whose babies' ages from 3 days to 17 months. Most of the mothers opined that breast-feeding had to be initiated within 24 hours of birth. However, only 32% felt that breast milk should be the first feed, whereas 68% considered prelacteal feeds a necessity. 71% of the mothers considered 3 to 5 months to be the optimum duration of exclusive breast-feeding. 90% felt that cow's milk was an ideal supplement. 78.3% subscribed to the view that breast-feeding should continue beyond one year. A sizeable proportion expressed the need to discontinue breastfeeds during babies' or maternal illness, particularly diarrhoea. Our results will form the babies of the content and the target groups in our future health education programme.

Young child feeding in a rural area in the Red River delta, Vietnam

Infant and young child feeding practices were investigated in a sample survey (1132 mothers) in a rural area in northern Vietnam. Pre-lacteal feeding was almost universal. Mean duration of breast feeding was 17 months, but foods other than breast milk were introduced early. Only 50% of infants between 3 and 5 months of age were predominantly breast fed. The educational level of the mother was strongly associated with breast feeding duration, with illiterate mothers breast feeding the longest. Christian mothers breast fed for longer than non-Christians. Very few were using feeding bottles at the time of the study, although formulas and bottles have recently been appearing on the local market. The breast feeding pattern described together with the rapidly changing social and economic situation in Vietnam could mean a risk of rapid decline in breast feeding.