Breastfeeding: a woman's reproductive right

A prospective follow-up study on how long newborns are fasting in Debre Markos Comprehensive Specialized Hospital, Ethiopia, 2020

Background

At birth, continuous flow of nutrients to the fetus in utero interrupted due to cut of the route /umbilical cord/. Instead of the cord, breast-mouth connection will be the next route in the extra uterine life. Nevertheless, limited data in our locality show the duration for how long immediate newborns are fasting.

Objective

This study aimed to assess time to initiation of breastfeeding and its predictors among postnatal mothers within 12 hours of birth in Debre Markos Comprehensive Specialized Hospital, North West Ethiopia, 2020.

Methods

A Facility based prospective follow-up study was conducted among 475 participants who were selected using systematic random sampling techniques. To collect the data, techniques including interview, chart review and observation were used. Data was entered to Epi-data version 3.1 and analyzed by STATA 14 software. A cox proportional hazards regression model was fitted to identify predictors for survival time. Results of the final model were expressed in terms of adjusted hazard ratio (AHR) with 95% confidence interval, statistical significance was declared with P-value is less than 0.05.

Results

Newborns were fasting breast-milk for the median time of 2 hours. In this study, 25% of participants initiated breastfeeding within 1 hour, pre-lacteal while 75% initiated within 3 hours. Gave birth to multiple babies (AHR 0.37, 95% CI (0.19, 0.69)), operative delivery (AHR 0.77, 95% CI (0.62, 0.96)), got advice on timely initiation of breastfeeding immediately after delivery (AHR 0.79, 95% CI (0.63, 0.97)), pre-lacteal feeding initiation (AHR 10.41, 95% CI (2.82, 38.47)) and neonatal sickness (AHR 0.08, 95% CI (0.03–0.19)) were statistically significant predictors for time to initiation of breastfeeding.

Conclusion

Fifty percent of mothers initiated breastfeeding within 2 hours. Most of them didn’t initiate breastfeeding based on world health organization’s recommendation, within one hour after delivery. Multiple birth, operative delivery, getting advice on timely initiation of breastfeeding immediately after delivery, giving pre-lacteal feeding and neonatal sickness were found to be predictors of time to initiation of breastfeeding.

The visibility of breastfeeding as a sexual and reproductive health right: a review of the relevant literature

Background

Governments must protect and apply maximum feasible resourcing to the protection, promotion and support of breastfeeding in order to meet their international legal obligations with respect to the human rights of women and children. However, governments across the world have consistently failed in these duties. Breastfeeding has been notably absent from mainstream feminist advocacy on sexual and reproductive health rights (‘SRH rights’). Why is there this lack of focus on breastfeeding in feminist advocacy in this area? This review seeks to identify the extent to which the protection, promotion and support of breastfeeding is visible within the SRH rights and the gender responsive budgeting literature.

Method

A cross-disciplinary single scoping literature review of online and other databases was conducted to yield final samples of eighty-seven publications from the SRH rights literature and forty-four publications from the gender responsive budgeting literature. These publications were searched for references to breastfeeding.

Results

Only 21% of the sexual and reproductive health rights literature and just one gender responsive budgeting publication sampled referenced the protection, promotion and support of breastfeeding. Where breastfeeding was mentioned in the publications reviewed it was, in general, brief and on the periphery of discussion.

Conclusions

Reviews of the SRH rights literature and the gender budgeting literature both reveal an overwhelming absence of meaningful analysis on breastfeeding. The lack of attention to breastfeeding in the gender advocacy space represents a lost opportunity to advocate for the alleviation of the economic and social constraints imposed on breastfeeding women and caregivers.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13006-022-00457-w.

Breastfeeding in Public: Challenges and Evidence-Based Breastfeeding-Friendly Initiatives to Overcome the Barriers

Introduction

Breastfeeding is the safest mode of infant feeding that is readily available at the right temperature and does not require supplies for its preparation. Despite the many benefits of breastfeeding, it is often challenging for breastfeeding mothers to breastfeed in public.

Methods

A review of the literature was undertaken to explore challenges hindering breastfeeding in public and ascertain evidence-based breastfeeding-friendly strategies to overcome those barriers.

Results

Major barriers to breastfeeding in public include negative public perceptions of breastfeeding, sociocultural barriers, embarrassment/lack of comfort, stigmatization, sexualization of breast, and nonconducive environment in public spaces. Evidence-based strategies to support breastfeeding in public include normalization of breastfeeding in public, increasing the visibility of breastfeeding through social media and public events, empowerment of breastfeeding mothers, positive role modeling, social support, and environmental modifications.

Conclusion

Implementation of evidence-based and innovative breastfeeding-friendly initiatives are essential to combat challenges surrounding breastfeeding in public spaces.

Breastfeeding Women in Academia

Breastfeeding is a reproductive right for mothers, including women in the workforce. Limited postpartum leave, reliance on expressing milk at work, and lack of access to lactation rooms pose challenges for working mothers. Specific to mothers in academia, the heavy demands of teaching, sustaining research, and attending meetings and conferences pose additional challenges. Many female academicians delay childbearing due to pressures to attain tenure as early as possible. Women who leave academic careers often do so in the early career period, which coincides with the childbearing years. Lack of support for these mothers is a social-justice issue that warrants close examination and a realignment of priorities to facilitate and ensure breastfeeding success. The following are recommendations for developing a network of support for breastfeeding mothers: (a) Improved and standardized family leave policies, (b) inclusive workplace infrastructure, (c) flexibility in work schedule and structure, (d) equal opportunity to advance on the tenure track, (e) establishment of onsite daycares, (f) supportive policies clearly communicated and enforced, and (g) change in attitude and culture.

Concept Analysis of Maternal Autonomy in the Context of Breastfeeding

PURPOSE

The purpose of this article is to analyze the concept of maternal autonomy in the context of breastfeeding and propose a clearer definition of the concept.

METHODS

A concept analysis was undertaken using Walker and Avant's eight-stage approach.

FINDINGS

The concept analysis suggests that maternal autonomy in the context of breastfeeding refers to a mother's ability to make autonomous decisions using her control, agency, independence, and ethical reasoning. The antecedents are maternal competence, availability of support, nature of the setting, and available alternatives with respect to breastfeeding. The consequences are improvement in child health, maternal-child bonding, breastfeeding decisions, and maternal healthcare-seeking behavior.

CONCLUSIONS

A clearer understanding of maternal autonomy in the context of breastfeeding will guide the development of a conceptual framework and expand nursing knowledge development.

CLINICAL RELEVANCE

A clearer definition of the concept of maternal autonomy in the context of breastfeeding will guide clinicians, researchers, and policy makers in protecting, promoting, and supporting breastfeeding globally towards achieving the United Nations Sustainable Development Goals, 2015-2030.

Antibiotic susceptibility, antibacterial activity and characterisation of Enterococcus faecium strains isolated from breast milk

Enterococci, which have useful biotechnological applications, produce bacteriocins, including those that exert anti-Listerial activity. The present study aimed to determine the antibiotic susceptibility patterns and antimicrobial activity of Enterococcus faecium strains isolated from human breast milk. The strains were identified using carbohydrate fermentation tests and ribotyping. Subsequently, the antibacterial activity of the isolates was investigated, and the quantities of lactic acid and hydrogen peroxide produced, and the proteolytic activity of E. faecium, were determined. In addition, biofilm formation by E. faecium strains was assessed. E. faecium strains exhibited antimicrobial activity against food-borne and clinical bacterial isolates. Furthermore, following 24 h incubation, the tested strains exhibited resistance to a pH range of 2.0–9.5 and tolerance of bile acid, lysozyme activity and phenol. Supernatants of the E. faecium TM13, TM15, TM17 and TM18 strains were shown to be effective against Listeria monocytogenes, and were also resistant to heat. Further studies are required in order to determine whether certain strains of E. faecium may be used for the development of novel antibacterial agents.

Baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding

BACKGROUND

Baby-led breastfeeding is recommended as best practice in determining the frequency and duration of a breastfeed. An alternative approach is described as scheduled, where breastfeeding is timed and restricted in frequency and duration. It is necessary to review the evidence that supports current recommendations, so that mothers are provided with high-quality evidence to inform their feeding decisions.

OBJECTIVES

To evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns.

SEARCH METHODS

We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (13 November 2013), CINAHL (1981 to 13 November 2013), EThOS, Index to Theses and ProQuest database and World Health Organization's 1998 evidence to support the 'Ten Steps' to successful breastfeeding (6 November 2013).

SELECTION CRITERIA

Randomised and quasi-randomised trials with randomisation at both the individual and cluster level. Studies presented in abstract form were eligible for inclusion if sufficient data were available. Studies using a cross-over design were not eligible for inclusion.

DATA COLLECTION AND ANALYSIS

We independently assessed for inclusion all the potential studies we identified as a result of the search strategy. We would have resolved any disagreement through discussion or, if required, consulted a third review author, but this was not necessary.

MAIN RESULTS

No studies were identified that were eligible for inclusion in this review.

AUTHORS' CONCLUSIONS

This review demonstrates that there is no evidence from randomised controlled trials evaluating the effect of baby-led compared with scheduled (or mixed) breastfeeding for successful breastfeeding, for healthy newborns, therefore no conclusions could be taken at this point. It is recommended that no changes are made to current practice guidelines without undertaking further robust research, to include many patterns of breastfeeding and not limited to baby-led and scheduled breastfeeding. Further research is needed to also evaluate the effects of baby-led compared with scheduled (or mixed) breastfeeding on successful breastfeeding, for healthy newborns. However, conducting such a study, particularly a randomised controlled trial is unlikely to receive ethical approval, as the issue of obtaining informed consent from new mothers or mothers-to-be for randomisation between baby-led and scheduled breastfeeding is a difficult one and it is likely that the Baby Friendly Hospital Initiative practices would prohibit such a study.

Factors affecting the demarketing of breastmilk substitutes in Palestine

BACKGROUND

Although medical research has proven that breastfeeding is unparalleled in providing the ideal nutrition for infants, "the demarketing of breastmilk substitutes" is a little-known concept. This empirical study tackled the origin and definition of demarketing, examined the different factors affecting the demarketing of breastmilk substitutes in Palestine from the breastfeeding woman's point of view, and developed an appropriate model for the demarketing of breastmilk substitutes. The article subsequently concludes with recommendations for areas of further academic research in the World Health Assembly, for policy makers in Palestine, and for the breastfeeding women themselves.

SUBJECTS AND METHODS

An empirical study was conducted to collect the primary data using a questionnaire as a tool in order to test the hypotheses. The questionnaire was distributed to 400 breastfeeding women who were randomly selected from the population.

RESULTS

The findings proved that there is a relationship between independent variables (i.e., product, price, place, and promotion) and the dependent variable (i.e., demarketing of breastmilk substitutes) based on several reasons discussed thoroughly in this article.

CONCLUSIONS

Product, price, place, and promotion affect the demarketing of breastmilk substitutes in Palestine.

Breastfeeding throughout legal separation: women's experiences of the Australian Family Law system

In 2006, the Australian Government introduced the Family Law Amendment (Shared Parental Responsibility) Act 2006 (Cth), which put in place a legal presumption of shared parental responsibility for children after separation and which emphasizes "equal-time" parenting arrangements regardless of the child's age. A qualitative approach was taken to investigate breastfeeding women's experiences of the implementation of the act and its impact on their ability to maintain breastfeeding. Fifteen women responded to questions related to their breastfeeding and their engagement with the family law system. Interviews were audio recorded and transcribed, and data were then analyzed thematically. These women experienced inconsistent advice from all facets of legal services, including opinions about the inappropriateness of breastfeeding for infants over 6 months of age. Breastfeeding was considered only as nutrition, without recognition of its immunological and cognitive benefits and the security and comfort it provides. Many participant women felt that they had been persuaded against discussing breastfeeding in the legal system, resulting in a sense of disempowerment.

Breast functions perceived by Korean mothers: infant nutrition and female sexuality

The descriptive cross-sectional study of 2,235 Korean postpartum women was conducted to explore (a) feeding types with related factors, (b) the perceived benefits of each feeding type, (c) the perceived sexuality-related barriers to breast-feeding, and (d) the perceived relative significance of breast functions. The most frequently utilized feeding type was breast-feeding only. The gender of infants, vaginal delivery, not being employed, having a nuclear family, previous breast-feeding experience, and previously receiving breast-feeding education were statistically significant factors of breast-feeding. Breast-feeding and mixed feeding mothers indicated that their feeding choices were based on nutritional benefits, convenience, and improving family relationships. Only breast-feeding mothers reported changes in breast shape as a perceived sexuality-related barrier to breast-feeding. All mothers reported that infant feeding was a more significant concern than female sexual functioning, but post hoc Schéffe revealed that the breast-feeding mothers appreciated infant feeding function more than female sexual functioning.

Exploration of guilt among mothers who do not breastfeed: the physician's role

Physicians commonly state the concern that, if they promote breastfeeding, they may "impose guilt upon those who do not breastfeed." This article explores the genesis of this fear, who may benefit from this construct, and the terminology of guilt, shame, and loss. The article also explores the responsibility for both lactation failure and associated shame, considering the roles and responsibilities of physicians, the media, and society as a whole. An alternative construct for the guilt is offered, based on the consideration that the woman experiences lack of breastfeeding as a loss at some level, conscious or subconscious, and whether the choice to not breastfeed is her decision or imposed. Proposed approaches for acting to prevent and to treat shame and guilt are presented.