Impact of attitudes on maternal decisions regarding infant feeding

Well-Informed and Willing, but Breastfeeding Does Not Work: A Qualitative Study on Perceived Support from Health Professionals among German Mothers with Breastfeeding Problems

Although exclusive breastfeeding is recommended for the first six months of life, a large number of women worldwide do not practice it successfully. Our study aimed to investigate the perceived support from health professionals for women who experienced difficulties in breastfeeding. Furthermore, we examined women’s knowledge about breastfeeding and motivation to breastfeed. We conducted a qualitative exploratory study (June to October 2019) among 15 women who had experienced breastfeeding problems in Germany. Semi-structured interviews were audiotaped, transcribed verbatim, and analyzed using qualitative content analysis following Mayring’s approach. Prior to giving birth, the women’s motivation to breastfeed and theoretical knowledge were high, and breastfeeding problems were not anticipated. Difficulties in breastfeeding after giving birth created a highly demanding situation for the mothers. Health professionals were either perceived as very supportive, for example, by providing helpful technical advice or being emotional assistance, or they could be perceived as nonhelpful, thereby worsening the situation, for example, by pressuring the women to breastfeed or making improper remarks. Adequate support for young mothers in childbed consists of the provision of useful and realistic information concerning breastfeeding and a sensitive treatment when breastfeeding problems occur. Paying attention to this specific group of women who are experiencing difficulties in breastfeeding may improve maternal and child well-being and potentially enable breastfeeding.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women

OBJECTIVES

The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women.

METHODS

Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors.

RESULTS

The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035).

CONCLUSIONS

Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

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).

Latino-American Mothers’ Perspectives on Feeding Their Young Children: A Qualitative Study

OBJECTIVE. We explored the cultural beliefs that influence Latino-American mothers’ feeding practices with their young children and the sources they referenced in making food choices for their children.

METHOD. We conducted semistructured interviews with 12 Latino-American mothers focusing on their experiences of feeding their young children. Data analysis, based in grounded theory, consisted of interview transcription, content analysis, coding, and theme development.

RESULTS. We identified four themes summarizing the mothers’ feeding practices: (1) “Grandma knows best,” (2) “I want my child(ren) to be healthy,” (3) “always soup and always rice,” and (4) “mealtime is family time.”

CONCLUSION. Occupational therapy practitioners need to obtain accurate information from families about feeding practices and to understand and interpret those practices in broader cultural contexts to design and implement targeted feeding intervention strategies that avoid stereotyping or misinterpreted information. To promote family-centered, meaningful interventions, practitioners must understand the cultural influences on feeding practices and be sensitive to mothers’ needs.

People and places shaping food procurement among recipients of Supplemental Nutrition Assistance Program (SNAP)

A key gap in existing food environment research is a more complex understanding of the interplay between physical and social contexts, including the influence of social networks on food habits. This mixed methods research examined the nature of social connections at food procurement places among a sample of 30 people receiving Supplemental Nutrition Assistance Program (SNAP) benefits in an urban setting. Results highlight the significance of social connections as motivators to use food places, the value of access to information and other resources at food places, and the role of weak ties with actors within food places to facilitate utilization and interaction. Social connections at the varied places individuals procure food may be leveraged to disseminate information and resources to further healthy food access.

Infant feeding decisions and behaviours among low-income smoke-exposed women: timing and change during pregnancy

Objective

The present study aimed to describe change in feeding intentions and predictors of breast-feeding intentions during the course of pregnancy.

Design

Analysis of prospectively collected data from a larger randomized controlled trial of a health education intervention to reduce environmental smoke exposure among women during and after pregnancy.

Setting

Participants were recruited from prenatal clinics, but all further communication occurred with participating women living in the community.

Subjects

Low-income, adult women (n399) were interviewed during the 16th and 32nd week of pregnancy to ascertain prenatal feeding intentions and breast-feeding knowledge, attitudes and self-efficacy. Characteristics of women by infant feeding intention were assessed along with differences in intention from 16 to 32 weeks of pregnancy and feeding behaviours after delivery. Differences in psychosocial variables between women of different intention for infant feeding were measured. Women in each category of feeding intention were assessed for changes in psychosocial factors by eventual infant feeding behaviour.

Results

Feeding intention early in pregnancy was strongly, but not consistently, associated with feeding intention late in pregnancy, feeding initiation and later feeding patterns. Over one-third of women who were undecided at 16 weeks’ gestation or earlier initiated breast-feeding. Increases in knowledge and improvement in time, social factors and social support barriers were found among those who exclusively breast-fed.

Conclusions

Results indicate that feeding decisions may change during pregnancy. Determining when women make feeding decisions during their pregnancy warrants more research. Interventions to increase breast-feeding intentions should target knowledge, self-efficacy and barriers.

Norwegian general practitioners' knowledge and beliefs about breastfeeding, and their self-rated ability as breastfeeding counsellor

BACKGROUND

Breastfeeding is considered the best infant-feeding method. Norway is one of the leading countries in terms of breastfeeding initiation and duration. To maintain this high breastfeeding rate, it is important to understand the factors that influence breastfeeding. A doctor s advice can improve the rates of breastfeeding initiation and duration, but not all doctors are competent in breastfeeding counselling.

OBJECTIVES

The aim of this study was to identify the knowledge and beliefs of general practitioners (GPs) about breastfeeding in Norway and to investigate how important they considered guidance about breastfeeding initiation and duration before and after birth.

DESIGN

A questionnaire study about knowledge and beliefs according to predefined correct responses and about self-perceived competence as an advisor.

SUBJECTS

122 GPs engaged in apprenticeship for medical students.

RESULTS

The response rate was 57%, 69 GPs participated. The questions were answered correctly according to national consensus for 49 % for the knowledge items and 64 % of the belief items. The GPs believed that their guidance was more important after than before birth. Female GPs had more confidence in their guidance ability than male GPs. Confidence in the GPs own guidance after birth was associated with knowledge about contraindications to breastfeeding.

CONCLUSION

Although the GPs expressed beliefs favouring breastfeeding they partly lacked basic knowledge. The GPs confidence in own guidance was better after than before birth and was higher among those with more knowledge. Improved knowledge and emphasis on guidance before birth should be promoted among GPs. Key points Breastfeeding is the best infant-feeding method. Doctors' advice improves the rates of breastfeeding, but not all doctors have sufficient knowledge. This study mapped the knowledge and beliefs among Norwegian GPs. The study revealed that: GPs partly lacked basic knowledge to effectively promote breastfeeding. GPs had less confidence as advisers during pregnancy than after delivery. Most GPs agreed that knowledge about breastfeeding is basic and should be taught as an integral part of medical school programmes.

Effectiveness of a Breastfeeding Intervention on Knowledge and Attitudes Among High School Students in Taiwan

OBJECTIVE

To evaluate the effectiveness of an educational intervention on the breastfeeding knowledge and attitudes of female high school students living in Taiwan.

DESIGN

A prospective, two-group, quasi-experimental, repeated measure design.

SETTING

A high school in Taichung, Taiwan.

PARTICIPANTS

Two hundred four female high school students.

METHODS

Data were collected through a self-administered questionnaire at baseline, after the intervention, and 1 month later. After administration of the questionnaire at baseline, the experimental group (n = 103) received a 30-minute breastfeeding education; the control group (n = 101) did not.

RESULTS

Findings showed that students in the experimental group had significantly greater breastfeeding knowledge immediately after the intervention and at 1 month postintervention. Also, compared with the control group, the experimental group had significantly greater positive breastfeeding attitudes after the intervention period, and the effect lasted at least 1 month.

CONCLUSIONS

Breastfeeding interventions in schools improve adolescents' knowledge and attitudes. School nurses are well positioned to promote breastfeeding as a healthy lifestyle behavior within the school setting.

Breastfeeding Self-Efficacy Scale: Validation of the Italian Version and Correlation With Breast-feeding at 3 Months

Psychological factors can influence breast-feeding. We translated into Italian and validated the Breastfeeding Self-Efficacy Scale Short Form (BSES-SF) and investigated its predictive ability and its relation with postpartum depression symptoms.BSES-SF and Edinburgh Postnatal Depression Scale (EPDS) were administered 2 to 3 days after delivery to 122 mothers. Breast-feeding was assessed at 3 months.The BSES-SF displayed good validity (receiver operating characteristic area = 0.69) for predicting full breast-feeding at 3 months. In multivariate analysis, the probability of full breast-feeding increased 2.4% for 1-point increase of BSES-SF. The BSES-SF and EPDS scores were inversely correlated. BSES-SF is a useful tool to identify the risk of early breast-feeding attrition.

First hour initiation of breastfeeding and exclusive breastfeeding at six weeks: prevalence and predictors in a tertiary care setting

OBJECTIVE

To assess the prevalence of first hour breastfeeding initiation and exclusive breastfeeding at 6 wk and identify its barriers in healthy term babies born in a tertiary hospital setting.

METHODS

A prospective observational cohort study was carried out in consecutively selected 400 mothers who delivered (normal, instrumental or cesarean) term healthy babies in a tertiary care hospital setting. All mother-infant dyads were enrolled within 48 h of delivery.

RESULTS

Breastfeeding was initiated within first hour in 255 out of 400, i.e., 64 % of babies. Cesarean delivery and male gender were strongest risk factors for delayed initiation of breastfeeding [OR (95 % CI) = 1.99 (1.14-3.48) and 34.17 (17.10-70.40) respectively]. Among the babies followed up till 6-8 wk, 83 % were exclusively breastfed. Breast milk substitutes were given in 172/400 (43 %) babies on day one, which emerged as an independent predictor of failure to continue exclusive breastfeeding at 6 wk (OR 2.96; 95 % CI 1.09-8.06). Odds of exclusive breastfeeding were two times higher in babies breastfed within first hour (n = 255/400, 64 %) when compared to babies initiated breastfeeds beyond first hour (n = 145/400, 36 %) (OR 2.01;05 % CI 1.12-3.61).

CONCLUSIONS

Cesarean section and male gender emerged as significant risk factors for delayed initiation (beyond first hour) of breastfeeding in the index study cohort. In addition, use of breast milk substitute emerged as the only predictor for failure to continue exclusive breastfeeding at six weeks in a tertiary care hospital.

Attitudes of high school and vocational school students toward breastfeeding in taiwan

Infant feeding decisions depend on breastfeeding attitudes. This study examined the high school and the vocational school students' attitudes toward breastfeeding. The descriptive cross-section survey was applied. A stratified random sample of 1,319 male and female students was carried out. The results revealed that female students were more positive than male students in breastfeeding attitudes. Of the female students, 34.7% (n = 458) reported that they will plan to breastfeed, and 29% (n = 382) male students indicated that they will encourage breastfeeding. Moreover, two-thirds (60.7%, n = 801) of the participants favored the inclusion of breastfeeding information in the school curriculum. Findings from this study suggest that breastfeeding information needs to be addressed earlier among adolescent students to increase positive breastfeeding attitudes.

Is paternal infant care associated with breastfeeding? A population-based study in Japan

BACKGROUND

One qualitative study has reported that more paternal infant care and housework contributed to the maintenance of breastfeeding. However, few studies have quantitatively investigated these relationships.

OBJECTIVE

This study aimed to examine the association of paternal involvement in infant care and housework with exclusive breastfeeding during the first 6 months of life.

METHODS

Data from a population-based birth cohort study in Japan, the Longitudinal Survey of Babies in the 21st Century, were analyzed. We extracted information on infants who were singletons, term, normal birth weight, and living with both parents (n = 39 742). The associations between degree of paternal involvement in infant care and housework (high, middle, low) and breastfeeding patterns (exclusive, partial, formula only) were analyzed using ordered logistic regression adjusted for covariates. Maternal anxiety about childrearing was considered as a mediator.

RESULTS

Compared with the low level of paternal infant care group, infants in the middle and high level groups were significantly less likely to have been breastfed (adjusted odds ratio: 0.90, 95% confidence interval [CI], 0.84-0.97; and 0.73, 95% CI, 0.67-0.79, respectively). In contrast, the amount of housework carried out by fathers was not associated with breastfeeding pattern. Maternal anxiety about childrearing did not attenuate the association between paternal infant care and breastfeeding.

CONCLUSION

Paternal infant care was inversely associated with breastfeeding during the first 6 months of life. An additional intervention study about the importance of breastfeeding that aims to educate fathers who tend to involve themselves in infant care is needed.

Telephone-based support prolongs breastfeeding duration in obese women: a randomized trial

BACKGROUND

Obese women often have difficulties breastfeeding.

OBJECTIVE

We evaluated whether telephone-based support could increase the duration of breastfeeding in obese women and, thereby, reduce offspring growth.

DESIGN

We recruited 226 dyads of obese mothers and their singleton, healthy, term infants. The women were randomly assigned to 6 mo of breastfeeding support or standard care controls. At 6 mo, there were 207 dyads in the study; 105 dyads received support, and 102 dyads were control subjects. One International Board Certified Lactation Consultant carried out the intervention, which was based on structured interviews and consisted of encouraging telephone calls.

RESULTS

The support group breastfed exclusively for a median of 120 d (25th-75th percentiles: 14-142 d) compared with 41 d (3-133 d) for control subjects (P = 0.003). Any breastfeeding was maintained for a median of 184 d (92-185 d) for the support group compared with 108 d (16-185 d) for control subjects (P = 0.002). Support increased the adjusted ORs for exclusive breastfeeding at 3 mo and the ratios for partial breastfeeding at 6 mo to 2.45 (95% CI: 1.36, 4.41; P = 0.003) and 2.25 (95% CI: 1.24, 4.08; P = 0.008, respectively). Although the duration of exclusive breastfeeding was inversely associated with infant weight (β = -4.39 g/d; 95% CI: -0.66, -8.11 g/d; P = 0.021) and infant length at 6 mo (β = -0. 012 cm/d; 95% CI: -0.004, -0.02 cm/d; P = 0.004), the breastfeeding support did not achieve a significant effect on infant growth at 6 mo (n = 192).

CONCLUSIONS

Telephone-based advisory support was very effective in prolonging breastfeeding in obese mothers who often terminate the breastfeeding of their infants prematurely. A longer duration of breastfeeding may decrease risk of noncommunicable diseases in these infants. This trial was registered at clinicaltrials.gov as NCT01235663.

A focused ethnographic assessment of Middle Eastern mothers' infant feeding practices in Canada

The aim of this study was to examine the barriers to following complementary feeding guidelines among Middle Eastern mothers and the cultural considerations of practitioners from an emic perspective. This is a two-phase focused ethnographic assessment of infant feeding among 22 Middle Eastern mothers in Western Canada who had healthy infants aged <1 year. Data were collected through four focus groups conducted in Arabic/Farsi, and were further complemented by comprehensive survey data collected in the second phase of study. Mothers' main criterion for choosing infant foods was whether or not foods were Halal, while food allergens were not causes for concern. Vitamin D supplements were not fed to 18/22 of infants, and mashed dates (Halawi), rice pudding (Muhallabia/Ferni) and sugared water/tea were the first complementary foods commonly consumed. Through constant comparison of qualitative data, three layers of influence emerged, which described mothers' process of infant feeding: socio-cultural, health care system and personal factors. Culture was an umbrella theme influencing all aspects of infant feeding decisions. Mothers cited health care professionals' lack of cultural considerations and lack of relevance and practicality of infant feeding guidelines as the main reasons for ignoring infant feeding recommendations. Early introduction of pre-lacteal feeds and inappropriate types of foods fed to infants among immigrant/refugee Middle Eastern mothers in Canada is cause of concern. Involving trained language interpreters in health teams and educating health care staff on cultural competency may potentially increase maternal trust in the health care system and eventually lead to increased awareness of and adherence to best practices with infant feeding recommendations.

Predictors of exclusive breastfeeding: observations from the Alberta pregnancy outcomes and nutrition (APrON) study

BACKGROUND

Despite growing evidence that supports the importance of 6-month exclusive breastfeeding, few Canadian mothers adhere to this, and early weaning onto solids is a common practice. This study assessed infant feeding transitions during the first 6 months postpartum and factors that predicted exclusive breastfeeding to 3 and 6 months.

METHODS

This prospective cohort study was part of the Alberta Pregnancy Outcomes and Nutrition study (APrON). From an initial sample of 600 pregnant women recruited from Edmonton and Calgary, 402 mothers provided complete details at 3 months postpartum; 300 stayed on to provide information at 6 months postpartum. During pregnancy and at 3 and 6 months postpartum, data on maternal and infant socio-demographic, behavior, and feeding were collected.

RESULTS

Even though there was a high rate of "ever having breastfed" (98.6%), exclusive breastfeeding rates for 3 and 6 months were 54.0% and 15.3%, respectively. After controlling for potential confounders, the study showed that mothers who held post-graduate university degrees were 3.76 times more likely to breastfeed exclusively for 6 months than those without a university degree (95% CI: 1.30-10.92; p = 0.015). In addition, mother of previous children were more likely to breastfeed exclusively for 6 months (OR: 2.21, 95% CI: 1.08-4.52; p = 0.031). Mothers who were in the highest quartile of the Iowa Infant Feeding Attitude Score were 4.29 and 5.40 times more likely to breastfeed exclusively for 3 months (95% CI: 1.31-14.08; p-trend < 0.001) and 6 months (95% CI: 2.75-10.60; P-trend < 0.001), respectively.

CONCLUSIONS

The 6-month exclusive breastfeeding rate in Alberta is considerably below national and international breastfeeding recommendations. Professional advice that focuses on prenatal maternal knowledge, attitudes, and misperceptions may promote adherence to World Health Organization breastfeeding guidelines. Knowing that exclusive breastfeeding is less likely to take place among lower-educated, primiparous women may help health practitioners focus their support and education for this group.

Factors influencing initiation and duration of breast feeding in Ireland

The aim of this research was to identify factors associated with mothers breast feeding and to identify, for those who breast fed, factors associated with breast feeding for as long as planned.

BACKGROUND

breast feeding rates in Ireland are amongst the lowest in Europe. Research evidence indicates that in order for mothers to be successful at breast feeding, multiplicities of supports are necessary for both initiation and duration. The nature of these supports in tandem with other influencing factors requires analysis from an Irish perspective.

DESIGN

cross-sectional study involving public health nurses and mothers in Ireland. This paper presents the results of the mothers' evaluation.

METHOD

mothers (n=1715) with children less than three years were offered a choice of completing the self-report questionnaires online or by mail. Data were analysed and reported using descriptive and inferential statistics.

FINDINGS

four in every five participants breast fed their infant and two thirds of them breast fed as long as planned. The multivariate logistic regression analysis identified that third level education, being a first time mother or previously having breast fed, participating online, having more than two public health nurse visits, and having a positive infant feeding attitude were independently and statistically significantly associated with breast feeding. Among mothers who breast fed, being aged at least 35 years, participating online, having a positive infant feeding attitude and high breast feeding self-efficacy were independently and statistically significantly associated with breast feeding for as long as planned.

CONCLUSIONS

findings from this study reinforce health inequalities therefore there needs to be a renewed commitment to reducing health inequalities in relation to breast feeding.

RELEVANCE TO CLINICAL PRACTICE

this study has identified factors associated with initiation and duration of breast feeding that are potentially modifiable through public health interventions.

Evaluation of a theory of planned behaviour-based breastfeeding intervention in Northern Irish schools using a randomized cluster design

OBJECTIVE

The aim of this research was to evaluate the effectiveness of a school-based intervention designed to enhance young people's motivations to breastfeed.

DESIGN

A cluster randomized controlled trial was conducted involving 50 post-primary schools from across Northern Ireland. However, dropout and exclusion criteria utilized for the current study resulted in an effective sample size of 42 schools.

METHODS

The intervention was delivered in two 35-min classroom sessions targeting those beliefs identified by the theory of planned behaviour (TPB) as significant in predicting motivation to breastfeed. Questionnaires incorporating the key components of the TPB were administered to all intervention and control schools at baseline, 1 and 6 months post-intervention. Multi-level modelling was used to analyse the data.

RESULTS

Findings suggest that the intervention was effective in that it increased females' intentions to breastfeed, expanded their knowledge and led to more favourable attitudes and perceptions of subjective norms. Notably, females' knowledge increased more in secondary schools than in grammar schools irrespective of whether they were control or intervention schools.

CONCLUSION

The research has provided evidence to support the use of the TPB in the design and evaluation of an intervention to increase females' intentions to breastfeed.

Modified breastfeeding attrition prediction tool: prenatal and postpartum tests

In earlier studies, the Breastfeeding Attrition Prediction Tool (BAPT) demonstrated predictive validity in the postpartum period. The purpose of this study was to compare the effectiveness of a modified version of the BAPT when given in the last trimester (BAPT1) and following delivery (BAPT2) in predicting breastfeeding attrition among 117 women who planned to breastfeed for at least 8 weeks. Subjects completed the BAPT during a prenatal breastfeeding class and again at delivery, and they received a phone call at 8 weeks to determine breastfeeding status. In this study, neither of the two administrations of the BAPT was predictive of breastfeeding status at 8 weeks. Findings here may differ because subjects in the current study were all committed enough to attend breastfeeding class and, thus, varied less on commitment than women in earlier studies. Significant associations were found with level of education and having a close relative who breastfed. To assist the perinatal educator in identifying women most at risk for early cessation of breastfeeding, the use of three questions regarding level of education, family support, and breastfeeding preparation is suggested.

Survey on breastfeeding among Chinese female physicians and nurses

The present study investigated knowledge of and beliefs about breastfeeding among Chinese female physicians and nurses and their breastfeeding practices. This study documented knowledge, attitudes and practices of breastfeeding among Chinese medical staff. A total of 367 female physicians and nurses completed a self-administered, anonymous questionnaire; 96.2% indicated that breastfeeding was natural, but 29.2% thought it difficult. Only 18.5% of the participants questioned breastfeeding women on feeding status, and 12.8% gave breastfeeding advice when asked. After graduation from school, 79.3% of the participants stated that they did not receive training in breastfeeding. In personal practice, 69.2% initiated breastfeeding; 19.1% were still breastfeeding at 4 months, and only three nurses continued breastfeeding for more than 1 year. In conclusion, breastfeeding-related knowledge is surprisingly poor, and attitudes are less positive. The exclusive breastfeeding rate was found to be low among Chinese female physicians and nurses. The findings highlight the need to re-educate medical staff on breastfeeding, and imply the need for Baby-Friendly Hospital Initiative implementation/training.

An Internet-based education program improves breastfeeding knowledge of maternal-child healthcare providers

BACKGROUND AND OBJECTIVES

Breastfeeding rates in the United States remain below the Surgeon General's Healthy People 2010 goals. Encouragement of breastfeeding and education by maternal-child healthcare (MCH) providers (physicians, residents, and midlevel providers) improves breastfeeding initiation and duration. Surveys of MCH providers show lack of knowledge about breastfeeding. This study evaluated the effect of usage of "BreastfeedingBasics," a free Internet-based educational course, on the knowledge of MCH providers and evaluation of the baseline knowledge of course users.

METHODS

A before and after intervention study was done of MCH providers using the "BreastfeedingBasics" website between 1999 and 2008. Baseline knowledge and change in knowledge were assessed by computer-scored pretests and posttests.

RESULTS

Of 3,456 MCH providers enrolled, 2,237 (65%) completed one or more pretest. Total mean pretest/posttest scores were as follows: midlevel providers, 81%/89%; residents, 84%/93%; and physicians, 85%/92% (p < 0.001 among groups and between pretests and posttests). Mean pretest/posttest scores of the modules were as follows: Anatomy/Physiology, 79%/93%; Growth/Development, 72%/91%; Mother-Infant Couple (normal newborn), 82%/92%; and Breastfed Infant with Problems, 77%/91% (p < 0.001 for all). Specific topics with the lowest pretest scores and subsequent posttest scores were as follows (pretest/posttest): supplementation with vitamin D, 61%/93%; breastfeeding physiology, 38%/65%; growth of breastfed infants at 10 days, 80%/95%, 14 days, 72%/91%, and 3-4 months, 39%/84%; and stopping breastfeeding for maternal problems when not indicated, 69%/93% (p < 0.001 for all).

CONCLUSIONS

Use of an Internet-based educational program improved knowledge of MCH providers as measured by pretest and posttest scores. Knowledge of the growth of breastfed infants is particularly poor. Increasing knowledge is the first step in improving clinical practice that is necessary for increasing breastfeeding rates and duration.

Prevalence and predictors of 6-month exclusive breastfeeding in a rural area in Egypt

OBJECTIVES

This study was conducted to determine prevalence of exclusive breastfeeding during the first 6 months of life and to identify factors that interfere with this practice in the study area.

METHODS

A retrograde cross-sectional study included 1,059 mothers who attended the rural health unit to immunize their young children (6-24 months old) in Al Der village in Kaliubia Governorate, Egypt.

RESULTS

We found 95.8% of mothers (1,015 of 1,059) breastfeeding their babies, whereas only 9.7% (103 of 1,059) were exclusively breastfeeding their infants for 6 months. Among the different sociodemographic, maternal, and infant factors studied, only antenatal care (four or more visits), early breastfeeding initiation after delivery, male infant, and absence of breastfeeding difficulties were the significant predictors associated with higher chance for exclusive breastfeeding.

CONCLUSIONS

This study indicates that the prevalence rate of exclusive breastfeeding is low in Egypt and that interventions are needed to bridge the gap between the current practices of breastfeeding and the World Health Organization recommendations.

Men and infant feeding: perceptions of embarrassment, sexuality, and social conduct in white low-income British men

BACKGROUND

The views of fathers have been shown to be important determinants of infant feeding decisions, but men's perceptions of breastfeeding and formula feeding are rarely explored. Our objectives were to address this gap and examine cultural associations and beliefs concerning infant feeding practices among men.

METHODS

Five focus groups were conducted with low-income men (n = 28) living in areas of social deprivation in Leeds, northeast of England, and low-income areas of Glasgow, west of Scotland. Participants were white British men, aged between 16 and 45 years, and included fathers, expectant fathers, and potential fathers.

RESULTS

Overarching themes concerning sexuality, embarrassment, and social conduct were identified across all groups. Participants perceived breastfeeding as "natural" but problematic, whereas formula feeding was mainly considered as convenient and safe. Participants without direct experience of breastfeeding assumed that it involved excessive public exposure and attracted unwanted male attention. Underpinning these fears were strong cultural associations between breasts and sexuality and anxieties concerning appropriate gender roles.

CONCLUSIONS

In some communities few opportunities may occur to witness breastfeeding, and thus existing fears concerning the activity as attracting predatory male attention remain unchallenged. Perceptions of breastfeeding as a sexual activity and the dominant mass media emphasis on breasts as a sexual site may present additional obstacles to breastfeeding. Antenatal or perinatal education with men should address not only practical issues but also provide advice on tackling problems generated by wider sociocultural issues of sexuality and masculinity.

What Knowledge and Expectations are Ethiopian Girls Bringing with Them into Parenthood?

Background

Because of rapid population growth, many countries now have very large cohorts of young people. Despite the population health importance of early child feeding practices, little work has explored the knowledge and expectations about infant feeding that youth bring with them as they transition into parenthood.

Objective

To examine adolescent girls' perceptions of infant and young child feeding practices in their communities, and to assess their knowledge and expectations regarding infant and young child feeding practices and explore their overlap with current feeding recommendations.

Methods

Cross-sectional data were obtained from a random sample of 1,018 girls 13 to 17 years of age living in rural, semiurban, and urban sites in southwestern Ethiopia. Surveys were used to collect information on respondents' attitudes, expectations, and perceptions within the domain of infant and young child feeding practices. Descriptive and bivariate statistics were used to describe the data.

Results

A total of 1,018 girls aged 13 to 17 years were interviewed. The girls were able to report the age at which infants in their communities were provided liquids, semisolids, and solids as well as the perceived duration of breastfeeding in their communities. The girls were generally able to report when they themselves planned to provide liquids and solids to their infants and their expected duration of breastfeeding. The girls' attitudes and expectations were not consistent with exclusive breastfeeding to 6 months, and planned durations of breastfeeding were shorter than they currently perceived in their communities.

Conclusions

Young nulliparous Ethiopian women have well-formed attitudes and expectations about infant and young child feeding. These are unlikely to promote currently accepted best practices. Our results suggest both the potential that suboptimal feeding practices will be reproduced and novel intervention points.

A qualitative study of the promotion of exclusive breastfeeding by health professionals in Niamey, Niger

BACKGROUND

The practice of exclusive breastfeeding depends on various factors related to both mothers and their environment, including the services delivered by health professionals. It is known that support and counseling by health professionals can improve rates, early initiation and total duration of breastfeeding, particularly exclusive breastfeeding. Mothers' decisions are influenced by health professionals' advice. However, in Niger the practice of exclusive breastfeeding is almost non-existent.The purpose of this exploratory study, of which some results are presented here, was to document health professionals' attitudes and practices with regard to exclusive breastfeeding promotion in hospital settings in the urban community of Niamey, Niger.

METHODS

Fieldwork was conducted in Niamey, Niger. A qualitative approach was employed. Health professionals' practices were observed in a sample of frontline public healthcare facilities.

RESULTS

The field observation results presented here indicate that exclusive breastfeeding is not promoted in healthcare facilities because the health professionals do not encourage it and their practices are inappropriate. Some still have limited knowledge or are misinformed about this practice or do not believe in it. They do not systematically discuss exclusive breastfeeding with mothers, or they mention it only briefly and without giving any explanation. Worse still, some encourage the use of breast milk substitutes, which are frequently promoted in healthcare facilities. Thus mothers often receive contradictory messages.

CONCLUSION

The results suggest the need to train or retrain health professionals with regard to exclusive breastfeeding, and regularly supervise their activities.

Reproductive-aged women's knowledge and attitudes regarding infant-feeding practices: an experimental evaluation

Using an experimental design, this study assessed knowledge, attitudes, and intentions regarding infant feeding practices among Canadian female university undergraduates (N = 285). Participants completed a survey of knowledge, attitudes, and intentions with respect to infant-feeding practices. Two versions of the survey were randomly distributed to participants: one containing a photograph of a woman breastfeeding her infant (n = 131) and the other containing a photograph of the same women bottle-feeding her infant (n = 154). Findings indicated that the majority of the sample had been breastfed (84%) and intend to breastfeed their own offspring (97%). The intention to breastfeed future offspring was predicted by knowledge, attitudes, and perceptions of social norms. Participants reported more positive attitudes toward visual depictions of breastfeeding compared with bottle-feeding but less positive views of breastfeeding in public compared with bottle-feeding in public. Participants also significantly underestimated the health benefits and optimal duration of breastfeeding. The findings highlight gaps in knowledge that may contribute to premature cessation of breastfeeding among Canadian women and suggest the need for breastfeeding education.

School Nurses and Teachers

School nurses and middle and high school teachers ( N = 107) participated in a survey that explored their attitudes and behaviors related to the inclusion of breastfeeding content to highlight the scientific and exceptional health advantages of breastfeeding and to promote a breastfeeding culture. Although some participants believed that breastfeeding content should not be part of school curriculum, the vast majority (86.9%) agreed that the benefits of breastfeeding should be taught to high school students; and over half (57.9%) supported teaching about the value of breastfeeding to middle school children. School nurses are well positioned to promote healthy lifestyle behaviors among student populations and play a pivotal and important role in the promotion of a breastfeeding culture and related positive behaviors.

The prevalence and determinants of breast-feeding initiation and duration in a sample of women in Ireland

OBJECTIVE

To assess breast-feeding initiation and prevalence from birth to 6 months in a sample of mothers in Dublin, and to determine the factors associated with breast-feeding initiation and 'any' breast-feeding at 6 weeks in a sample of Irish-national mothers.

DESIGN

This prospective cross-sectional study involved the recruitment of women during the antenatal period, with subsequent follow-up of mothers who delivered healthy, term singleton infants, at 6 weeks and 6 months postpartum.

SETTING

Participants were recruited from antenatal clinics in the Coombe Women and Infants University Hospital, Dublin.

SUBJECTS

In all, 401 Irish-national and forty-nine non-Irish-national mothers met the criteria for inclusion in the present study.

RESULTS

Breast-feeding initiation rates of the Irish-national and non-Irish-nationals were 47% and 79.6%, respectively. Factors that were significantly (P = 0.000) associated with both breast-feeding initiation and 'any' breast-feeding at 6 weeks included mothers who were >or=35 years, educated to third level, reported positive postnatal encouragement to breast-feed from their partners and had a positive antenatal intention to breast-feed. The maternal negative perception that breast-feeding is an embarrassing way to feed an infant was demonstrated as a major barrier to initiation.

CONCLUSIONS

Breast-feeding initiation and prevalence rates of the Irish-national population remain low and lag considerably behind national and international targets. Inclusion of the partner in breast-feeding promotional initiatives during the antenatal period may be crucial to increase breast-feeding rates in Ireland. Public health campaigns that focus on increasing the social acceptability of breast-feeding may prove effective in addressing this cultural barrier.

Determinants of exclusive breastfeeding in South gujarat region of India

Objective

To estimate the situation of breastfeeding in Surat among infants and to determine variables associated to major risks for early weaning.

Design and settings

Mothers coming to the well baby clinic for immunization of infants at Government Medical College and Hospital were interviewed using pretested questionnaire.

Subjects

Mothers with their infants who have not completed one year of age.

Methods

In this cross sectional study, 498 mothers were selected for study from May to September, 2008. Survival analysis was the method used to calculate the prevalence and the median duration of breastfeeding. The Chi-square test was performed to compare the proportions; significance level was set at 5%. Odds ratio was used to measure the significance of association, with a 95% confidence interval. Logistic regression analysis was used to identify the risk factors for early weaning.

Results

The median length of exclusive breastfeeding was 6 months. Risk factors for early weaning were primiparity (OR = 3.01, 95% CI = 2.01- 4.51), consecutive delivery interval less than 24 months (OR = 1.79, 95% CI = 1.09 - 2.92), maternal age below 20 years (OR = 6.49, 95% CI = 2.69 - 15.61), and paternal occupation as labor (OR = 2.02, 95% CI = 1.36 - 3.00).

Conclusions

Exclusive breastfeeding practices are not in a better situation than at national level. The factors related to early weaning denote a weak breastfeeding support given by maternal and infant health services.

Keywords

Exclusive breastfeeding; Weaning; Antenatal care; Postnatal care; Education

Breastfeeding knowledge, attitudes, and practices among providers in a medical home

OBJECTIVE

Breastfeeding offers numerous health advantages to children, mothers, and society. From obstetrics to pediatrics, breastfeeding dyads come in contact with a wide range of healthcare providers. The American Academy of Pediatrics (AAP) calls for pediatricians to support breastfeeding enthusiastically and for all children to have a medical home. We studied an inner-city healthcare system with a Dyson Community Pediatrics Training Initiative Model Medical Home clinic, to explore how a breastfeeding/baby-friendly medical home might be built upon this framework. We describe breastfeeding knowledge, attitudes, and practices among a full range of providers and healthcare system-level barriers to effective and coordinated breastfeeding services.

METHODS

We conducted eight focus groups using semistructured interviews: (1) pediatricians; (2) obstetricians; (3) pediatric nurses and allied health professionals; (4) obstetric nurses and allied health professionals; (5) 24-hour telephone triage answering service nurses; (6) public health nurses; (7) Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) personnel; and (8) lactation consultants and peer counselors.

RESULTS

We identified gaps in providers' breastfeeding knowledge, counseling skills, and professional education and training. Providers' cultures and attitudes affect breastfeeding promotion and support. Providers used their own breastfeeding experiences to replace evidence-based knowledge and AAP policy statement recommendations for breastfeeding dyads. There were communication disconnects between provider groups. Providers underestimated their own, and overestimated others', influence on breastfeeding. The system lacked a coordinated breastfeeding mission.

CONCLUSIONS

This study illuminated key disconnectedness challenges (and, hence, opportunities) for a model medical home in fostering continuous, comprehensive, coordinated, culturally effective, and evidence-based breastfeeding promotion and support.

Attributions of breastfeeding determinants in a French population

BACKGROUND

The rates of initiation and duration of breastfeeding in France are low when compared with those in other European countries. The objective of this study was to determine attributions of breastfeeding determinants in a French population.

METHODS

A self-report survey listing 68 reasons for or against breastfeeding was developed. Nine hundred nine participants from the general population rated their level of agreement with each reason by means of a Likert-type scale. The survey explored gender, age, parenthood, decision to breastfeed, having friends who had breastfed, having family members who had breastfed, and having been breastfed themselves when younger. Exploratory factorial analyses extracted six factors for breastfeeding and five factors against breastfeeding. All the factors were entered in regression analyses to predict demographic variables that determined attributions for and against breastfeeding. Individuals were measured at two points in time to account for test-retest reliability (28.1 days +/- 6.95 day lapse).

RESULTS

Determinants varied significantly with respect to gender, age, parenthood, and breastfeeding history. High endorsement for breastfeeding involved breastfeeding to fulfill gender roles, to prevent health risks, and because of external encouragement; little endorsement was given for the physiological advantages for babies, pleasant sensations, and preference factors. In terms of not breastfeeding, high endorsement was observed in lack of support, negative attitudes, and infant formula reasoning factors; medical and physiological reasons for not breastfeeding showed low endorsement.

CONCLUSIONS

The results of this study showed a strong impact of society and cultural norms on feeding choice. If breastfeeding initiation and duration rates are to be increased, we suggest approaching the rest of the population in addition to pregnant women and mothers since society as a whole influences the decision to breastfeed.

Maternal self-concept and breastfeeding

To test the hypothesis that mothers with high self-concept will be more likely to breastfeed their infants than those with lower self-concept, 2 cohorts of mothers of term newborns were assessed by different forms of the Tennessee Self-Concept Scale. In study 1, mothers exclusively breastfeeding at 1 month postpartum had significantly higher self-concept than those exclusively formula feeding. In study 2, exclusively breastfeeding mothers had higher scores for total self-concept compared with those exclusively formula feeding. Exclusively breastfeeding mothers also scored higher on several individual dimensions of self-concept, notably those reflecting self-satisfaction, behavior, moral worth, value as a family member, and physical appearance. Mothers partially breastfeeding had intermediate levels of self-concept in both studies. Even after controlling for demographic and social factors and for breastfeeding initiation in regression analyses, self-concept remained significantly associated with exclusive breastfeeding in both studies. Thus, compared with mothers who exclusively formula feed their infants, exclusively breastfeeding mothers have higher levels of self concept.

The breastfeeding experience of women with major difficulties who use the services of a breastfeeding clinic: a descriptive study

Background

Many women experience breastfeeding difficulties. Sometimes these difficulties lead to breastfeeding cessation. Breastfeeding clinics provide support for women facing such problems. This study aims to describe the breastfeeding experience of women, particularly those who use the services of the breastfeeding clinic located in the Greater Quebec City area.

Methods

This is a descriptive study based on information gathered through telephone questionnaires that were administered in 2006 to a sample of 86 women and semi-structured interviews conducted with 12 of these women.

Results

Painful nipples/breasts, low milk supply and latching difficulties were the three most frequent major breastfeeding problems identified by women. Their personal characteristics as well as the moral and physical support provided by family and friends and by health professional and clinicians at the breastfeeding clinic were the factors identified most often as having a positive influence on the breastfeeding experience.

Conclusion

The results suggest that breastfeeding clinics have a critical role to play in improving the breastfeeding experience of women with major difficulties.

Breastfeeding duration and postpartum psychological adjustment: role of maternal attachment styles

AIM

Depressive and anxiety symptoms are common in new mothers. The aim of this study is to explore the link between postpartum psychological adjustment and feeding preferences of the mothers.

METHODS

Sixty mothers and newborns were enrolled in this prospective, longitudinal study. Maternal depressive symptoms were screened by the Edinburgh Postpartum Depression Scale (EPDS), and maternal anxiety level was assessed by the State-Trait Anxiety Inventory at 1 month postpartum. The Multidimensional Scale of Perceived Social Support was used for the assessment of maternal social support. The Adult Attachment Scale was used to determine the attachment style of the mother. Infants were examined and evaluated at 1 and 4 months of life.

RESULTS

All mothers started breastfeeding their infants postpartum; 91% and 68.1% continued exclusive breastfeeding at 1 and 4 months, respectively. The first-month median EPDS score of mothers who breastfeed at the fourth month was statistically significantly lower than those who were not breastfeeding (6 and 12, respectively) (P = 0001). The first-month median EPDS score of mothers with secure attachment was lower than the median score of mothers with insecure attachment (5 and 9, respectively) (P < 0001). Exclusive breastfeeding rate was not statistically different among mothers with secure and insecure attachment styles. The median state and trait anxiety scores and social support scores of mothers were not different between groups according to breastfeeding status.

CONCLUSIONS

This study has shown an association between higher EPDS scores and breastfeeding cessation by 4 months after delivery.

The Effects of an Infant-Feeding Classroom Activity on the Breast-feeding Knowledge and Intentions of Adolescents

This study examined the impact of an infant-feeding classroom activity on the breast-feeding knowledge and intentions of adolescents living in Nova Scotia, Canada. One hundred twenty-one students attending two high schools were administered one pretest and two posttest questionnaires. Students were arbitrarily assigned to a control or intervention group. The intervention group partook in a 60-minute classroom activity on infant feeding. Findings indicated that students in the intervention group demonstrated significantly greater breast-feeding knowledge at Posttest 1 and at 10 weeks postintervention. Students in the intervention group reported a significantly greater intention toward breast-feeding their own future children; an increase was sustained at 10 weeks. These findings suggest that adolescents’ knowledge of and intention toward breast-feeding may be positively influenced during their teen years. School nurses are well positioned to support and encourage the inclusion of breast-feeding content in school curricula to enhance adolescents’ knowledge and intentions toward breast-feeding.

Social networks and infant feeding in Oaxaca, Mexico

The health benefits of delaying the introduction of complementary foods to infants' diets are widely known. Many studies have shown that mothers with the support of close social network members are more compliant with medical recommendations for infant feeding. In our study, we examine the effects of a broader spectrum of network members (40 people) on mothers' infant feeding decisions. The survey was conducted in Oaxaca, Mexico as part of a follow-up to a nationwide Mexican Social Security Institute survey of infant health. Sixty mothers were interviewed from a stratified random sample of the original respondents. Multivariate tests were used to compare the efficacy of network-level variables for predicting the introduction of 36 foods into infants' diets, when compared with respondent-level variables. The study yields four findings. First, network-level variables were better predictors of the timing of food introduction than socio-demographic variables. Second, mothers with more indigenous networks delayed the introduction of some grains (oatmeal, cereal, noodle soup, rice) and processed pork products (sausage and ham) to the infant's diet longer than mothers with less indigenous networks. Third, mothers who had stronger ties to their networks delayed the introduction of rice and processed pork products (sausage and ham) to the infant's diet longer than mothers who had weaker ties to their networks. Fourth, mothers who heeded the advice of distant network members introduced some grains (rice and cereal) earlier than mothers who did not heed the advice of distant network members.

Breastfeeding attitudes and reported problems in a national sample of WIC participants

Recent reports indicate that breastfeeding rates continue to be dramatically lower among WIC participants, compared with other US mothers. The WIC Infant Feeding Practices Study was a nationally representative 1-year longitudinal study of WIC participants that obtained information about attitudes regarding infant feeding and about infant-feeding practices. Hispanic mothers were most likely to agree with statements about benefits of breastfeeding, and Black mothers were most likely to agree with statements about barriers. Concern about insufficient milk was common in all ethnic groups. Perceived benefits were associated with breastfeeding initiation (P < .05), longer breastfeeding duration (P < .01), and later formula initiation (P < .01); for barriers, the opposite pattern was found. Breastfeeding mothers who reported concern about insufficient milk breastfed for shorter durations (P < .001) and initiated formula earlier (P < .01). These results suggest possible messages that should be communicated as part of a re-energized WIC breastfeeding promotion campaign. In particular, maternal anxiety about insufficient breast milk must be addressed.

Identifying predictors of the reasons women give for choosing to breastfeed

The aims of this article are to outline the reasons Australian women give for initiating breastfeeding, identify unique predictors for these reasons, and use principal components factor analysis to determine factors that influence a woman's decision to breastfeed. Data were collected as part of a large longitudinal study investigating the breastfeeding behaviors and supports of women in Southern Queensland, Australia. The most common reason women (N = 562) gave for deciding to breastfeed was breast milk is better for my baby (95.5%). Reasons related to the mother such as breastfeeding is more convenient (84.3%) were also popular. Four significant components-mother-related reasons, health effects for the infant, moral and family influences, and advice from others-were determined after principal components factor analysis. As well as health benefits for the infant, convenience and other reasons related to the mother appear to be important factors in an Australian woman's decision to breastfeed.

Whom can I rely on? Mothers’ approaches to support for feeding: An interview study in suburban Dar es Salaam, Tanzania

OBJECTIVE

to explore and describe mothers' perceptions of baby feeding and approaches to support for baby feeding.

DESIGN

individual qualitative semi-structured interviews conducted with mothers. Method used for analysis was qualitative content analysis.

SETTING

suburban Dar es Salaam, Tanzania.

PARTICIPANTS

8 mothers with babies under 6 months of age.

FINDINGS

the study revealed four categories of mothers' perceptions of baby feeding: (1) baby feeding, housework and paid work have to adjust to each other; (2) breast feeding has many benefits; (3) water or breast milk can be given to quench baby's thirst; and (4) crying provides guidance for baby feeding. Four different themes describing approaches to support emerged from the data: (1) adhering to diverse sources; (2) relying wholeheartedly on a mother figure; (3) working as a parental team; and (4) making arrangements for absence from the child.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

knowledge of the different approaches to support for baby feeding described in this study can help define counselling and promotional strategies in order to reach mothers with more effective messages and support for optimal baby-feeding practices.

Knowledge, Attitudes, Exposure, and Future Intentions of Hong Kong University Students Toward Infant Feeding

OBJECTIVE

To explore relationships between university students' infant feeding knowledge, attitudes, breastfeeding exposures, and future infant feeding intentions.

DESIGN

Descriptive cross-sectional survey.

SETTING

This study was conducted at a large publicly funded university in Hong Kong. Student enrollment in the university is approximately 15,000.

PARTICIPANTS

Four hundred three male and female Chinese university students. Participants were young (94.4% less than 25 years of age), undergraduate students (92.2%), unmarried (99.2%), and without children (100%).

RESULTS

Sixty-three percent of participants wanted their future child to be breastfed. Infant feeding knowledge scores ranged from 28.6% to 100%, with a mean of 71.1% (SD= 13.3), indicating overall high knowledge levels. Participants who intended to breastfeed were more likely to have positive attitudes, to have been breastfed themselves, or to know someone who had breastfed.

CONCLUSIONS

The results provide information to health care providers on the planning of effective breastfeeding promotion programs. Findings from this study suggest that promoting breastfeeding solely to childbearing couples is unlikely to result in significant improvements in either breastfeeding initiation or duration. Future infant feeding campaigns should be directed at the societal level to change negative attitudes and to increase acceptance of breastfeeding as a normal and natural feeding method.

Full breastfeeding during the postpartum hospitalization and mothers' report regarding baby friendly practices

OBJECTIVE

The objective of this study was to describe the opinion of a group of postpartum women about compliance with the Ten Steps in a hospital with the intention to be certified as a Baby Friendly Hospital.

METHODS

Two hundred (200) postpartum women age 20 or greater who had delivered a healthy full-term baby (37 weeks gestation) participated in the study. Data were gathered by means of a semi-structured questionnaire in the Spanish language. Descriptive and inferential statistics (Chi-square) were used for data analysis.

RESULTS

Thirty percent (30%) of participants were 21 to 26 years of age. Primiparas comprised 51% and legally or consensually married mothers comprised 89% of the study participants. Monthly family incomes with the highest frequencies were $0 to $2000 and $2001 to $3000, respectively. Full breastfeeding was being practiced by 43.5% of the mothers in the study, whereas 53.0% were breastfeeding partially. Compliance with the Ten Steps was perceived as deficient by 52% of the mothers, whereas only 5.5% perceived compliance as excellent. The perceived level of compliance with the Ten Steps is significantly associated with the type of breastfeeding (full or partial) in the inferential analyses (X(2) [3, n = 193] = 33.74, p = 0.00) and in the multiple logistic regression analyses (OR = 1.27, confidence interval [CI] = 1.14 - 1.43, p = 0.00). As the level of perceived compliance with the Ten Steps increases, the probability of full or exclusive breastfeeding also increases.

CONCLUSION

Compliance with the Ten Steps of the Baby Friendly Hospital from the perspective of the postpartum mother has an impact on the type of breastfeeding.

Breastfeeding, sensitivity, and attachment

OBJECTIVE

Our goal was to test the hypothesis that breastfeeding is associated with enhanced infant-mother attachment and its antecedent maternal sensitivity.

METHODS

Breastfeeding intent and practice were assessed by questionnaires administered to 152 mothers between 32 weeks of gestation and 12 months postpartum. Early maternal sensitivity was measured by the Sensitivity to Cues subscale of the Nursing Child Assessment Satellite Training Feeding Scale at 3 months, and quality of the mother-infant interaction was measured by the Nursing Child Assessment Satellite Training Feeding Scale at 6 months. Security of attachment was evaluated by the Ainsworth Strange Situation at 12 months.

RESULTS

A direct relationship between attachment security and breastfeeding practice was not identified. The quality of the mother-infant interaction at 6 months, rather than the type of feeding, predicted security of attachment. However, mothers who chose to breastfeed displayed greater sensitivity in dyadic interactions with their infants 3 months postnatally than those who chose to bottle feed, and intended breastfeeding duration prenatally correlated with sensitivity 3 months postpartum. Although a path analysis failed to demonstrate contributions of early breastfeeding duration to either sensitivity or security, it did substantiate a significant path between prenatal breastfeeding intent and attachment security mediated by sensitivity. In addition, multivariate analyses revealed that early sensitivity among breastfeeding mothers was an independent predictor of the duration of any and exclusive breastfeeding during the first year.

CONCLUSIONS

Although the quality of the dyadic interaction in infancy, rather than feeding type, is predictive of attachment security, mothers who choose to breastfeed display enhanced sensitivity during early infancy that, in turn, may foster secure attachment. Among breastfeeding mothers, higher sensitivity is associated with longer duration of breastfeeding during the first postpartum year. These findings suggest a link between attachment security and breastfeeding.

Effects of work-related factors on the breastfeeding behavior of working mothers in a Taiwanese semiconductor manufacturer: a cross-sectional survey

BACKGROUND

In recent years, the creation of supportive environments for encouraging mothers to breastfeed their children has emerged as a key health issue for women and children. The provision of lactation rooms and breast pumping breaks have helped mothers to continue breastfeeding after returning to work, but their effectiveness is uncertain. The aim of this study was to assess the effects of worksite breastfeeding-friendly policies and work-related factors on the behaviour of working mothers.

METHODS

This study was conducted at a large Taiwanese semiconductor manufacturer in August-September 2003. Questionnaires were used to collect data on female employees' breastfeeding behaviour, child rearing and work status when raising their most recently born child. A total of 998 valid questionnaires were collected, giving a response rate of 75.3%.

RESULTS

The results showed that 66.9% of survey respondents breastfed initially during their maternity leave, which averaged 56 days. Despite the provision of lactation rooms and breast pumping breaks, only 10.6% mothers continued to breastfeed after returning to work, primarily office workers and those who were aware of their company's breastfeeding-friendly policies.

CONCLUSION

In conclusion, breastfeeding-friendly policies can significantly affect breastfeeding behaviour. However, an unfavourable working environment, especially for fab workers, can make it difficult to implement breastfeeding measures. With health professionals emphasizing that the importance of breastfeeding for infant health, and as only females can perform lactation, it is vital that women's work "productive role" and family "reproductive role" be respected and accommodated by society.

Maternal and child characteristics associated with infant and toddler feeding practices

OBJECTIVE

To describe maternal/child characteristics associated with important practices of feeding US infants and toddlers aged 4 to 24 months.

DESIGN

Cross-sectional analysis of data collected in the 2002 Feeding Infants and Toddlers Study. Maternal/child characteristics associated with compliance to American Academy of Pediatrics feeding guidelines, and maternal/child characteristics associated with specific feeding patterns were assessed.

SUBJECTS

A national random sample of mothers (n=2,515) whose infants and toddlers aged 4 to 24 months made up the Feeding Infants and Toddlers Study cohort.

STATISTICAL ANALYSIS

Student t tests were used to compare the means and standard errors and were considered significant if P<.05. To predict if the mother/child met a particular recommendation, logistic regression was used to calculate odds ratios (ORs) and 95% confidence intervals.

RESULTS

Having a college education was the maternal characteristic associated with the largest number of positive child feeding behaviors. Mothers with a college education were significantly more likely than mothers without a college education to initiate breastfeeding and breastfeed the child to age 6 and 12 months (OR 2.8, 3.2, and 3.9, respectively). College-educated mothers were significantly more likely to comply with the American Academy of Pediatrics juice and complementary feeding recommendations (OR 1.4 and 2.0). In addition, infants and toddlers whose mother had a college education were more likely to consume fruit and less likely to consume sweetened beverages and desserts or candy. Ever breastfeeding the sample child, living in the western region of the United States, and being married and older were also associated with multiple positive practices. The child being in day care was associated with decreased duration of breastfeeding at age 6 and 12 months as well as with consumption of salty snacks.

CONCLUSIONS

Initiatives to improve infant and toddler feeding practices should focus on assisting mothers who have less than a college education, who are unmarried, whose child is in day care, or who are enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children.