Retrospective Analysis of Exclusive Breastfeeding Practices among Four Hispanic Subgroups in New York's EFNEP

Disparities in Breastfeeding Duration of New York City Latinx Mothers by Birth Region

Background: Disparities in breastfeeding patterns by race and ethnicity in the United States have been documented, and Latinx ethnicity is often associated with higher rates of breastfeeding initiation and longer breastfeeding duration compared to other U.S. racial and ethnic groups. Despite marked differences in infant feeding practices in Latinx countries of origin, U.S. breastfeeding data are routinely presented with Latinx as a single category. Objective: To analyze breastfeeding duration of New York City Latinx mothers by birth region. Methods: Using data from the 2016 New York City Work and Family Leave Survey (WAFLS) surveying residents who gave birth in 2014, we conducted a survival analysis of breastfeeding duration in a sample of Latinx-identifying mothers (n = 271), who reported having ever breastfed their child. Kaplan-Meier survival curves for time to breastfeeding cessation were created for four birth regions (United States, Caribbean, Mexico/Central America, and South America) and compared using the log-rank test. Adjusted hazard ratios (AHRs) were calculated using Cox regression. Results: Survival curves and median breastfeeding duration were significantly different between the four regions. AHR models found that non-Caribbean birthplace was significantly associated with a lower risk of early breastfeeding cessation. Being partnered at the time of childbirth and neonate hospitalization of 6 days or longer was associated with a greater risk of earlier breastfeeding cessation. Conclusion: The significant differences reinforce the need to separate breastfeeding findings by birth region in the Latinx population. Within-group differences are lost in combined analyses and reinforce conclusions that Latinx mothers have optimal breastfeeding behaviors.

Comparison of Challenges and Problems Encountered in the Practice of Exclusive Breast Feeding by Primiparous and Multiparous Women in Rural Areas of Sindh, Pakistan: A Cross-Sectional Study

Introduction: The UNICEF (United Nations International Children Education Fund) and WHO (World Health Organization) recommend exclusive breastfeeding (EBF) for the first six months of life. EBF is considered to be an important practice for enhancing infant health and wellbeing. Breastfeeding offers a wide range of psychological and physical health benefits in the long-term and short-term for young children, infants, and mothers. This study aims to compare exclusive breastfeeding practice among primiparous and multiparous mothers including reasons for discontinuing exclusive breastfeeding and problems faced during breastfeeding.

Methodology: This cross-sectional study was conducted in rural areas of Sindh, registered with the Maternal Newborn Health Registry (MNHR). The study used a systematic sampling technique for the enrollment of study participants. A survey questionnaire was used to collect data from mothers about the practices of EBF. A total of 397 mothers were interviewed and analyzed.

Results: Among Primiparous mothers, 14.1% of mothers initiated breastfeeding within one hour of birth, while 22.4% of multiparous mothers, initiated breastfeeding within one hour of birth. The difference between the two is statistically insignificant (p-value=0.234). A high percentage of multiparous mothers exclusively breastfed their infants for six months (63.5%) as compared to primiparous mothers (51.5%). The most common reason for introducing pre-lacteal feed before six months among primiparous mothers is the lack of adequate milk production to fulfill baby needs; this was the case for 35.4% of mothers. On the other hand, the baby remaining hungry post breastfeeding was the major reason among multiparous mothers (44.0%) for introducing pre-lacteal feed before six months.

Conclusion: This study helped in the identification of issues faced by primiparous and multiparous mothers during exclusive breastfeeding. Interventions for promoting EBF need to be tailored as per the need and challenges of the population.

Acculturation and Intention to Breastfeed among a Population of Predominantly Puerto Rican Women

BACKGROUND

Latinas have high overall breastfeeding initiation rates, yet Puerto Ricans have among the lowest exclusive breastfeeding rates. This study sought to determine if acculturation was associated with intent to breastfeed in a predominantly Puerto Rican population.

METHODS

A cohort of Latina women were enrolled in Proyecto Buena Salud, and provided information on infant feeding intent (n = 1,323). Acculturation was assessed via the Psychological Acculturation Scale (PAS), language preference, and generation in the United States.

RESULTS

Increasing acculturation as measured by English language preference (aOR 0.61 [95% CI 0.42-0.88]) and second or third generation in the United States (aOR 0.70 [95% CI 0.52-0.95)] was inversely associated with odds of intending to exclusively breastfeed. Similarly, women with higher levels of acculturation as measured by the PAS (aOR 0.67 [95% CI 0.45-0.99]), English language preference (aOR 0.48 [95% CI 0.33-0.70]) and second or third generation in the United States (aOR 0.42 [95% CI 0.31-0.58]) were less likely to report intent to combination feed as compared with women with lower acculturation.

CONCLUSIONS

Acculturation was inversely associated with intent to exclusively breastfeed and intent to combination feed in this predominantly Puerto Rican sample.

Impact of breastfeeding self-efficacy and sociocultural factors on early breastfeeding in an urban, predominantly Dominican community

BACKGROUND

Latinas have high breastfeeding initiation rates that decrease significantly in the first postpartum months. Little is known about the effects of self-efficacy and sociocultural factors on early breastfeeding among low-income Latinas. This study quantifies early breastfeeding rates and identifies factors associated with breastfeeding at 4-6 weeks postpartum in our community.

SUBJECTS AND METHODS

Mothers were recruited from a newborn clinic (NBC) in the first postpartum week. Questionnaires in the NBC and 4-6 weeks later assessed feeding practices, breastfeeding self-efficacy, and sociocultural factors. Feeding practices in the well baby nursery (WBN) were obtained by chart review. A scale from "1" (exclusive formula feeding) to "5" (exclusive breastfeeding) characterized feeding practices. Paired-sample t tests assessed change in feeding practices, and regression analysis assessed the impact of factors on breastfeeding at 4-6 weeks.

RESULTS

We interviewed 209 women: 86.1% Latina, 47.3% foreign-born, and 94.2% Medicaid-recipients. Breastfeeding increased from WBN to NBC (2.6±1.2 to 2.9±1.4; p<0.05) and then decreased by 4-6 weeks (2.9±1.4 to 2.5±1.44; p<0.05), without significant change between WBN and 4-6 weeks. Higher levels of education [β=0.21 (0.08, 0.56)], breastfeeding a previous child for ≥6 months [β=0.35 (0.57, 1.8)], foreign birth [β=0.2 (0.06, 1.07)], and higher breastfeeding self-efficacy scores [β=0.38 (0.02, 0.05)] were associated with more breastfeeding. Higher breastfeeding self-efficacy scores were associated with exclusive breastfeeding [adjusted odds ratio=1.18 (1.05, 1.32)].

CONCLUSIONS

Breastfeeding self-efficacy was the sole, modifiable factor associated with exclusive breastfeeding. Efforts to improve breastfeeding self-efficacy may serve to support breastfeeding in this population.

Las dos cosas: an analysis of attitudes of latina women on non-exclusive breastfeeding

BACKGROUND

Non-exclusive breastfeeding among Latina women is commonly seen in the newborn period. The reasons behind las dos cosas ("both things") are not well understood but have included the beliefs that formula has vitamins and that adding formula will result in a chubbier baby, which is desirable. Many previous studies involved Mexican and Puerto Rican women living in the mainland United States.

METHODS

We performed detailed semistructured interviews with 17 Latina mothers in late pregnancy or the newborn period at a community hospital and an affiliated clinic in Massachusetts, serving a large Dominican population. Women were asked about their beliefs about breastfeeding, colostrum, and infant formula. Transcripts were analyzed using Nvivo 9 software (QSR International Pty. Ltd., Melbourne, Australia) to identify the frequencies of common trends.

RESULTS

The most common reasons for introducing formula were treatment for insufficient milk, to keep the baby fuller longer, and planning for return to work. None of the women understood the potential risks of introducing formula on the establishment of breastfeeding, particularly on milk supply. Many thought that even limited amounts of breastfeeding were sufficient to produce a healthier child, failing to understand a negative dose-response effect of formula on health and milk production. While every woman saw breastfeeding as healthier, only one saw formula as unhealthy, an important distinction. None of the women expressed familiarity with medical recommendations around breastfeeding duration or exclusivity, with many believing that breastmilk alone would be insufficient to satisfy the hunger or nutritional needs of a growing child after as little as 3 months. Women consistently demonstrated a willingness to learn from health professionals.

CONCLUSIONS

In counseling Latina women, it may be important to discuss the risks of formula to infant health, breastfeeding, and milk supply and to include the medical recommendations for breastfeeding exclusivity. Educational opportunities exist in the prenatal setting and when postpartum women request formula.

Acculturative type is associated with breastfeeding duration among low-income Latinas

We sought to assess the relationship between acculturative type and breastfeeding outcomes among low-income Latinas, utilising a multidimensional assessment of acculturation. We analysed data derived from a breastfeeding peer counselling randomised trial. Acculturation was assessed during pregnancy using a modified Acculturation Rating Scale for Mexican Americans scale. Analyses were restricted to Latinas who completed the acculturation scale and had post-partum breastfeeding data (n = 114). Cox survival analyses were conducted to evaluate differences in breastfeeding continuation and exclusivity by acculturative type. Participants were classified as integrated-high (23.7%, n = 27), traditional Hispanic (36.8%, n = 42), integrated-low (12.3%, n = 14) and assimilated (27.2%, n = 31). The integrated-low group was significantly more likely to continue breastfeeding than the traditional Hispanic, assimilated, and integrated-high groups (P < 0.05, P < 0.05, and P < 0.01, respectively). The traditional Hispanic group was marginally more likely to continue breastfeeding than the integrated-high group (P = 0.06). Breastfeeding continuation rates vary significantly between acculturative types in this multinational, low-income Latina sample. Multidimensional assessments of acculturation may prove useful in better tailoring future breastfeeding promotion interventions.

Predictors of breastfeeding exclusivity in a WIC sample

OBJECTIVE

To examine predictors of breastfeeding exclusivity in low-income women who received services from a Chicago area clinic of the Special Supplemental Nutrition Program for Women, Infants and Children Program (WIC).

DESIGN

A secondary data analysis of existing clinical and administrative data.

SETTING

An urban community health center serving low-income families.

PARTICIPANTS

Two hundred and thirty-five (235) low-income women who initiated breastfeeding and received WIC services.

METHODS

Logistic regression models were fit to existing prenatal and postpartum data to determine predictors of breastfeeding exclusivity during the immediate postpartum period.

RESULTS

Only 23% of the sample breastfed exclusively. Women who received first-trimester prenatal care were more likely to exclusively breastfeed than women who entered prenatal care in later trimesters (OR = 2.02, p ≤ 0.05). Women who declared intentions prenatally to exclusively breastfeed were more likely to exclusively breastfeed than women who did not intend to breastfeed (OR = 3.85, p ≤ 0.001). Overweight/obese women were less likely to exclusively breastfeed than normal/underweight women (OR = 0.50, p ≤ 0.05).

CONCLUSION

Findings from this study can be used to develop tailored interventions to promote breastfeeding exclusivity among low-income WIC recipients.