Breast-feeding in Bangkok, Thailand: current status, maternal knowledge, attitude and social support

Supporting factors and structural barriers in the continuity of breastfeeding in the hospital workplace

BACKGROUND

The World Health Organization recommends that babies should receive exclusive breastfeeding (EBF) for six months, and mothers should be encouraged to breastfeed until their infant is aged two years or older. The breastfeeding rate in Thailand is currently much lower than the target. One critical factor is lactating mothers returning to work, especially in a hospital workplace with high job stress. In this study, we aimed to identify supporting factors and obstacles to sustaining breastfeeding in hospital-type workplaces.

METHODS

We conducted a mixed methods study between February 2021 and August 2021 at Chulabhorn Hospital, Thailand. Quantitative data were collected using questionnaires, and qualitative data were gathered in a focus group discussion among purposefully chosen participants, including mothers with both successful and unsuccessful continuation of breastfeeding after returning to work. We conducted multivariate analysis and thematic analysis in quantitative and qualitative data analysis, respectively.

RESULTS

Questionnaires were completed by 65 permanent employees of the hospital, and seven of these participated in focus group discussion. The rate of exclusive breastfeeding from birth to six months was sixty six percent, and was measured by the responses from questionnaires, which defined as a practice whereby the infants receive only breastmilk without mixing it with other food. Seventy-seven percent of participants were continuing to breastfeed when they returned to work, with 24% (12/50) having to stop after three months. Factors associated with exclusive breastfeeding was caesarean delivery (OR 7.9; 95% CI 2.00, 31.08). Additionally, childcare at the workplace and the attitude of colleagues were found to be supporting factors for sustaining breastfeeding. Barriers included inadequate private facilities (location and equipment), lack of a breastfeeding break, workload, and inconvenient uniform.

CONCLUSIONS

Effort is needed to sustain breastfeeding after maternal return to work. Our findings are crucial in determining how best to support nursing mothers in breastfeeding after returning to work, particularly during the ongoing COVID-19 pandemic. A breastfeeding-friendly policy with clear operating guidelines in the workplace is critical to sustaining breastfeeding. Learning from others who have had a positive experience will ensure that all breastfeeding women are better supported in the workplace in future.

What are the determinants of low exclusive breastfeeding prevalence in China? A cross‐sectional study

Exclusive breastfeeding (EBF) status is far from the national target in China. To identify the modifiable factors associated with EBF of infants aged under 6 months in China. A cross‐sectional study was conducted in 12 provinces/municipalities across China in 2017–2018. We used multistage stratified cluster sampling and collected data through face‐to‐face interviews with mothers using an electronic questionnaire. Totally, 5287 pairs of mother–infant aged <6 months were investigated. The EBF prevalence was 29.2% (1544/5287). Mothers with correct knowledge of colostrum (adjusted odds ratio [AOR]:1.32, 95% confidence interval [CI]: 1.07, 1.62), EBF (AOR: 1.39, 95% CI: 1.06, 1.81) and the highest scores of perceptions for breastfeeding benefits (AOR: 1.36, 95% CI: 1.14, 1.61) were more likely to exclusively breastfeed. However, mothers with more frequent unwillingness of breastfeeding during the first month postpartum were less likely to practice EBF (AOR: 0.68, 95% CI: 0.52, 0.90). Infants having their first breast milk within 24 h of birth increased the odds of EBF (AOR: 2.41, 95% CI: 1.86, 3.13). Infants were less likely to be exclusively breastfed in the families in which the main caregiver was the grandmothers. Mothers without receiving infant formula feeding suggestions via the health facilities, media, or the Internet (AOR: 1.57, 95% CI: 1.33, 1.85) or without the experience of infant formula feeding in public (AOR: 1.45, 95% CI: 1.23, 1.72) might more likely to practice EBF. To acquire comprehensively correct knowledge and keep a positive attitude of breastfeeding for the mothers are crucial for improving the EBF prevalence. Family supports are potential interventions worth focusing on. Infant formula promotion remains a great barrier for EBF in China.

This is the first study with a large sample size that examined determinants at individual, family, community and social levels potentially affecting EBF practice in China.

In this cross‐sectional study, mothers with completely correct knowledge and positive attitude of breastfeeding, infants having their first breast milk within 24 h of birth, and without exposure to infant formula feeding suggestions or experience might more likely to practice EBF.

Dissemination of comprehensively correct knowledge and operational skills of breastfeeding, initiation of breastfeeding as soon as possible, reducing the influence of infant formula might be effective methods for improving the EBF prevalence in China.

What does the world think of ankyloglossia?

AIM

The diagnosis of tongue-tie (or ankyloglossia) has increased more than 10-fold in some countries. Whether this is a global phenomenon or related to cultural and professional differences is uncertain.

METHODS

An online survey in English, Japanese, Chinese and Spanish was disseminated between May and November 2016 via 27 international professional bodies to >30 clinical professions chosen a priori to represent occupations involved in the management of neonatal ankyloglossia.

RESULTS

A total of 1721 responses came from nursing (51%), medical (40%), dental (6%) and allied health (4%) clinicians. Nurses (40%) and allied health (34%) professionals were more likely than doctors (8%) to consider ankyloglossia as important for lactation problems, as were western (83%) compared to Asian (52%) clinicians. Referrals to clinicians for ankyloglossia management originated mainly from parents (38%). Interprofessional referrals were not clearly defined. Frenectomies were most likely to be performed by surgeons (65%) and dentists (35%), who were also less likely to be involved in lactation support. Clinicians performing frenectomies were more likely to consider analgesia as important compared to those not performing frenectomies.

CONCLUSION

The diagnosis and treatment of ankyloglossia vary considerably around the world and between professions. Efforts to standardise management are required.

Breastfeeding practices, beliefs, and social norms in low-resource communities in Mexico: Insights for how to improve future promotion strategies

INTRODUCTION

Breastfeeding is recommended exclusively for the first 6 months after birth, with continued breastfeeding for at least 2 years. Yet prevalence of these recommendations is low globally, although it is an effective and cost-effective way to prevent serious infections and chronic illness. Previous studies have reported that social support greatly influences breastfeeding, but there is little evidence on perceived social norms in Mexico and how they affect actual behavior.

OBJECTIVE

Our objective was to investigate breastfeeding intention, practices, attitudes, and beliefs, particularly normative, among low-resource communities in central and southern Mexico.

METHODS

We performed a secondary analysis using the theory of planned behavior with cross-sectional data, which included semi-structured individual interviews with fathers (n 10), 8 focus groups with mothers (n 50), and 8 focus groups with women community leaders (n 44) with a total of 104 participants. Our data also included a quantitative survey among pregnant women and mothers (n 321).

RESULTS

Women reported supplementing breast milk with water and teas soon after birth, as well as introducing small bites of solid food a few months after birth. Social norms appeared to support breastfeeding, but not exclusive breastfeeding or breastfeeding for periods longer than about a year. This may be partially explained by: a) behavioral beliefs that for the first 6 months breast milk alone is insufficient for the baby, and that water in addition to breast milk is necessary to hydrate an infant and b) normative beliefs related to the appropriateness of breastfeeding in public and as the child gets older.

CONCLUSIONS

Future strategies should focus on positively influencing social norms to support recommended practices, and emphasize the specific reasons behind the recommendations. Future efforts should take a multi-pronged approach using a variety of influences, not only directed at healthcare providers but close family members, including fathers.

The influence of grandmothers on breastfeeding rates: a systematic review

Background

Exclusive breastfeeding for the first six months of an infant’s life has enormous potential to reduce mortality and morbidity. The older generation, particularly the infant’s grandmothers, play a central role in various aspects of pregnancy and child rearing decision-making within the family unit. This is particularly true in low- and middle-income countries where older women are seen as owners of traditional knowledge. Despite this, most health programs target the individual person most directly involved in the target behaviour – usually new mothers – without a commensurate understanding of who else influences those decisions. In this systematic review we aim to quantify the impact of the grandmother on influencing a mother’s breastfeeding practices.

Methods

We conducted a systematic review using Web of Science, Scopus, and Medline databases using search terms for grandmother and breastfeeding. Eligible studies reported on the duration of exclusive breastfeeding and included estimates of effect of a grandmother’s influence including whether or not the grandmother lived with the infant’s family, the grandmother’s education, and the grandmother’s attitudes towards and prior experience with breastfeeding.

Results

We identified 568 articles and, after review, 13 articles were assessed as meeting the selection criteria. They were conducted in both developed and developing countries and included cross-sectional surveys, prospective cohort studies and one randomised controlled trial. Eight studies examined the effects of attitudes or experiences of older generations with respect to breastfeeding and five of the eight found a significant positive impact on breastfeeding when grandmothers of the infants had had their own breastfeeding experience or were positively inclined towards breastfeeding, resulting in effects of between 1.6 to 12.4 times more likely to exclusively breastfeed or refrain from introducing solid foods. A Chinese study however found that highly educated grandmothers were associated with decreased exclusive breastfeeding. The majority of the studies were assessed to be of weak or moderate quality.

Conclusions

This review found evidence that demonstrates that grandmothers have the capacity to influence exclusive breastfeeding. Programs that seek to influence exclusive breastfeeding should include grandmothers in their interventions to achieve maximum impact.

Maternal return to paid work and breastfeeding practices in Bangkok, Thailand

This study explored the association between mothers' work-related factors and breastfeeding practices in Bangkok, Thailand. Data were collected from 84 working mothers with a child aged 6 to 24 months who visited the breastfeeding mobile clinic at a nursery goods exhibition. Thai interviewers collected data using a structured questionnaire. Analysis of the data showed that exclusive breastfeeding for 3 months was 78.6%, and for 6 months it was 38.1%. Mothers who returned to work 3 months or more after giving birth exclusively breastfed more than the mothers who returned to work in less than 3 months (crude odds ratio [OR] = 4.26, 95% confidence interval [CI] = 1.39-13.05; adjusted OR = 4.15, 95% CI = 1.15-14.95). Moreover, mothers who worked at self-employed or family-owned businesses and some mothers working at private companies showed tendencies of returning to work in less than 3 months. Results suggest that longer maternity leave would help extend the duration of exclusive breastfeeding. In addition, the improvement of a breastfeeding supportive environment in the workplace would be valuable and may be an effective means to improve breastfeeding practices and infant health.

Predictors of exclusive breast-feeding in early infancy: a survey report from Phnom Penh, Cambodia

BACKGROUND

Exclusive breast-feeding (EBF) is recommended in the first 6 months of an infant's life. This study aims to investigate the present status of infant feeding practices and identify factors that affect EBF practices during the first 6 months following infant birth in Phnom Penh, Cambodia.

METHODS

A cross-sectional survey with a semistructured questionnaire was given to 312 mothers with children aged 6 to 24 months who visited the immunization clinic in the National Maternal and Child Health Centre in Phnom Penh, Cambodia, from December 2005 to February 2006.

RESULTS

Eighty-three percent of mothers fed breast milk exclusively in the first month, whereas only 51.3% continued EBF in the first 6 months. Within 30 minutes after delivery, 39% of mothers began breast-feeding. Results from logistic regression analysis indicate that the lack of a maternal antenatal EBF plan (odds ratio [OR] = 10.01, 95% confidence interval [CI] = 3.68-27.24, p < .001), working mothers (OR = 4.71, 95% CI = 2.77-8.01, p < .001), and lack of paternal attendance at breast-feeding classes (OR = 1.93, 95% CI = 1.13-3.28, p < .05) have independently positive associations with cessation of EBF during the first 6 months of infant life.

CONCLUSION

The findings have helped to identify some important factors affecting EBF practices in the study area in Cambodia. The findings revealed that it is important to educate pregnant mothers, probably through exposure to trained midwives and media, so they may recognize the significance of EBF and will develop intention and plan to feed their babies, keeping in mind the benefits it may yield. Paternal involvement in breast-feeding classes may increase their awareness and consequently complement EBF practices. Finally, development of conducive working environments and policies for working mothers should be carefully explored because it could have positive influence in better care and promotion of EBF.

Early postpartum discharge and breastfeeding: an observational study from France

BACKGROUND

Early postpartum discharge is a recent practice in France, but the influence of a shortened hospital stay on subsequent breastfeeding is unknown. The objective of the present study was to compare the breastfeeding mode after early discharge (ED) and conventional discharge (CD) from a hospital maternity unit.

METHODS

An observational study was conducted in a French university hospital among 135 breastfeeding mothers, who delivered between 1 January and 31 July 2006. Forty-five ED mothers were matched with 90 CD mothers on 13 criteria. A structured questionnaire was used to collect data regarding feeding practices at 10 weeks postpartum, the period corresponding to paid maternity leave.

RESULTS

Exclusive breast-, mixed, and bottle feedings were reported by, respectively, 35 (77.8%), three (6.7%) and seven (15.5%) ED mothers and 64 (71.1%), 12 (13.3%) and 14 (15.6%) CD mothers (no significant differences). Satisfaction with support for breastfeeding and reasons for switching to mixed or bottle feeding were comparable in the two groups. Multivariate analysis indicated that only the planned duration of breastfeeding and the mother's dissatisfaction with help significantly influenced breastfeeding prevalence.

CONCLUSIONS

Early postpartum hospital discharge organized by skilled professionals is compatible with a satisfactory rate of exclusive breastfeeding up to the return to work. Formalized programs of instruction for perinatal professionals would help to reduce early abandonment.

Factors influencing breastfeeding in children less than 2 years of age in Lao PDR

AIM

This study aimed to investigate the prevalence of, and factors influencing, exclusive breastfeeding (EBF) at 6 months and continued breastfeeding (CBF) at 2 years.

METHODS

Between January and February 2007, a cross-sectional study was conducted using a semi-structured questionnaire in 40 villages in the Vientiane capital and the Vientiane province of Lao PDR. A total of 400 mothers with children less than 2 years old were recruited by multistage random sampling. Based on the 1991 World Health Organization Breastfeeding Indicators, children were classified into three groups, 6-23-month-old children for assessing EBF at 6 months, 12-15-month-old children for CBF at 1 year and 20-23-month-old children for CBF at 2 years.

RESULTS

The prevalence of EBF at 6 months and CBF at 2 years were 19.4% (n= 283) and 18.6% (n= 43), respectively. Some of the factors influencing EBF at 6 months in a univariate logistic regression model included: location of residence, (OR: 19.19, 95% CI 6.96-57.01), ethnicity (OR: 3.15, 95% CI 1.63-6.08), encouragement of the child's father (OR: 9.03, 95%CI 1.21-67.57) and inter-spousal communication (OR: 5.20, 95% CI 2.34-11.56). A majority of the mothers (75.0%) had watched television advertisements for infant formula from Thailand, and 48.4% reported that they wanted to buy formula milk after having watched them.

CONCLUSION

This study showed a low prevalence of EBF at 6 months in the studied area in Lao PDR. Some of the factors that had a strong impact on EBF at 6 months included: location of residence, ethnicity, father's involvement, early breastfeeding plan, Mother's Card in antenatal care and television advertisement. There may be opportunities for government to review a range of policies relating to paternal involvement, antenatal care and formula advertising that could help to improve EBF rate.

Longitudinal study of the frequency and duration of breastfeeding in rural Bangladeshi women

A 27-month longitudinal study of 140 Bangladeshi mothers living in three tea gardens examined the effect of maternal factors (mother's age, number of live births, birth interval, and mother's work status) and sex of the infant on the duration and bout frequency of breastfeeding over 8-hr daytime periods. Prolonged breastfeeding of the infant was observed, but there was a sharp decline in duration of breastfeeding over the first 6 months, followed by a more gradual diminution thereafter. The feeding bouts showed a different pattern, with a more gradual decline over time. Housewives consistently showed a greater duration and bout frequency than women in paid employment as tea-pluckers. Over the first 6 months, primigravid mothers breastfed more frequently, but not thereafter. Older mothers (>35 years of age) breastfed with higher frequency during the first 2 months, but thereafter, the bout frequency decreased with increasing age of the infant. Over the 27-month study, maternal work status was the main factor associated with the duration and frequency of breastfeeding, with significantly higher frequency and duration among housewives. However, in the first 6 months after birth, there was very little difference in frequency or duration of breastfeeding between tea-workers and housewives, indicating that working mothers probably adjusted their time to breastfeed their infants before going, or after coming back, from work.

Couples' relationships and breastfeeding: is there an association?

One hundred fifty-three Brazilian families with 4-month-old infants--51 cases (breastfeeding had ceased) and 102 controls (breastfeeding maintained)--were recruited to verify if a problematic couple relationship is associated with early breastfeeding termination. The relationships of the 118 cohabiting couples were assessed by clinical interviews and the Global Assessment of Relational Functioning and Beavers-Timberlawn scales, examining marital and parental functions, parents' satisfaction with the quality of care each partner provided to their infants, mothers' opinions of paternal breastfeeding support, and interviewers' assessments of paternal breastfeeding support and involvement in the infants' care. The quality of a couple relationship was not associated with the interruption of breastfeeding before 4 months postpartum. However, a good couple relationship was associated with more paternal breastfeeding support (P < .01) and involvement in the infant's care (P < .0001).

Feeding practice of infants and their correlates in urban areas of Beijing, China

BACKGROUND

Optimal feeding practice in the first year of life is crucial for the survival and health of infants, and has long-term consequences in later life. However, non-optimal feeding practices exist widely. The present study aims to explore various constraints to optimal feeding practices in the first year of life of infants in urban areas of Beijing, China.

METHODS

A cross-sectional study was conducted in urban areas of Beijing from 4 July to 20 August, 1998. Two hundred and fifty-one mothers of infants aged 6-12 months were chosen from six child health centers in three different urban districts in Beijing. A self-administered structured questionnaire was used to collect data regarding feeding practices and potentially related factors.

RESULTS

Feeding practice for most of the infants was in accordance with the national and international recommendations. However, the rate of incidence of exclusive breast-feeding at 3 months of age was lower than that recommended by the World Health Organisation (WHO) (55.8%), and the introduction of solid/semisolid food before 4 months of age was found in approximately 19.3% of the infants. Cow's milk was given to 21.2% of infants from 6 months of age as the sole source of milk or as a supplement. Maternal education level (OR = 2.44, 95% CI: 1.42-4.19, P < 0.05), employment (OR = 2.05, 95% CI: 1.13-3.74, P < 0.05) and antenatal nonexclusive breast-feeding plans (OR = 4.10, 95% CI: 2.24-7.50, P < 0.001) were found to be correlated to inappropriate feeding practices.

CONCLUSIONS

The feeding practices for most of the urban infants was found to be in accordance with the Chinese government and WHO recommendations; however, non-optimal feeding practices presenting as the early cessation of breast-feeding and the introduction of solid/semisolid foods existed. Information regarding optimal feeding practices should be disseminated to mothers and medical professionals in China, to ensure optimal infant health.

Prevalence of breast-feeding and its correlates in Ho Chi Minh City, Vietnam

BACKGROUND

The health benefits of breast-feeding are widely acknowledged and breast-feeding is crucial for the survival of the infants in developing countries. The present study aims to elucidate the prevalence of breast-feeding and the possible risk factors affecting the breast-feeding of infants at the age of 3 months in Ho Chi Minh City, Vietnam after the World Health Organization and the United Nations Children's Fund launched "the Baby-Friendly Hospital" Initiative in 1989.

METHODS

A cross-sectional study was conducted in the urban areas of Ho Chi Minh City, Vietnam in February, 2000. Two hundred and sixty mother-infant pairs were conveniently recruited in three child health centers in Ho Chi Minh City. Mothers of infants aged 6-12 months were interviewed and completed a well-structured questionnaire regarding the feeding types of the infant, the maternal knowledge, attitudes and behaviors related to breast-feeding.

RESULTS

The results indicated that although about 86.4% newborns in the maternity wards and 88.5% infants at 3 months were at least partially fed with breast milk, the prevalence of breast-feeding were 57.4 and 53.1%, respectively. About 47.5% newborns were fed with breast milk in the first feeding. The multivariate logistic regression analysis shows that the risk factors for the introduction of breast milk substitutes at 3 months of age were maternal antenatal plan of mixed or artificial feeding (odds ratio (OR) = 6.59, 95% confidence interval (CI): 3.18-13.64, P < 0.001) and the supplement of breast milk substitutes in the maternity ward (OR = 4.30, 95% CI: 2.10-8.77, P < 0.001). Higher maternal education levels were beneficial to the continuation of breast-feeding. About 18.5% mothers had attended antenatal breast-feeding education. Most of the mothers (94.1%) and families (95.4%) indicated supportive attitudes to breast-feeding.

CONCLUSION

The prevalence of breast-feeding was relatively low in Ho Chi Minh City, Vietnam. The antenatal education in breast-feeding needs to be improved and the implementation of the "Baby-Friendly Hospital" policy needs to be strengthened.