Do women's breastfeeding experiences with their first-borns affect whether they breastfeed their subsequent children?

Is proactive telephone-based breastfeeding peer support a cost-effective intervention? A within-trial cost-effectiveness analysis of the 'Ringing Up about Breastfeeding earlY' (RUBY) randomised controlled trial

OBJECTIVE

The 'Ringing Up about Breastfeeding earlY' (RUBY) randomised controlled trial showed increased breastfeeding at 6 months in participants who received the proactive telephone-based peer support breastfeeding intervention compared with participants allocated to receive standard care and supports. The present study aimed to evaluate if the intervention was cost-effective.

DESIGN

A within-trial cost-effectiveness analysis.

SETTING

Three metropolitan maternity services in Melbourne, Victoria, Australia.

PARTICIPANTS

First time mothers intending to breastfeed their infant (1152) and peer volunteers (246).

INTERVENTION

The intervention comprised proactive telephone-based support from a peer volunteer from early postpartum up to 6 months. Participants were allocated to usual care (n=578) or the intervention (n=574).

MAIN OUTCOME MEASURES

Costs during a 6-month follow-up period including individual healthcare, breastfeeding support and intervention costs in all participants, and an incremental cost-effectiveness ratio.

RESULTS

Costs per mother supported were valued at $263.75 (or $90.33 excluding costs of donated volunteer time). There was no difference between the two arms in costs for infant and mothers in healthcare and breastfeeding support costs. These figures result in an incremental cost-effectiveness ratio of $4146 ($1393 if volunteer time excluded) per additional mother breast feeding at 6 months.

CONCLUSION

Considering the significant improvement in breastfeeding outcomes, this intervention is potentially cost-effective. These findings, along with the high value placed on the intervention by women and peer volunteers provides robust evidence to upscale the implementation of this intervention.

TRIAL REGISTRATION NUMBER

ACTRN12612001024831.

Effects of short birth spacing on birth-order differences in child stunting: Evidence from India

Do firstborn children have a height advantage? Empirical findings have found mostly that, yes, second or higher-order children often lag behind firstborns in height outcomes, especially in developing countries. However, empirical investigations of birth-order effects on child height overlook the potential impact that birth spacing can have. We provide an explanation for the negative birth-order effect on stunting outcomes for young Indian children and show it is driven by short preceding-birth spacing. We find that firstborn children are taller than children of higher birth order: The height-for-age gap for third (or higher)-order children is twice the gap for children second in birth order. However, this pattern is observed when spacing between later-born children and their immediate elder siblings is fewer than 3 y. Interestingly, the firstborn height advantage disappears when later-born children are born at least 3 y after their elder siblings. Thus, our findings indicate that spacing length between children explains differences in height, over birth order. Although India's family planning policy has resulted in a substantial reduction in total fertility, its achievement in spacing subsequent births has been less impressive. In showing that spacing can alleviate or aggravate birth-order effects on attained height, our study fills an evidence gap: Reducing fertility alone may not be sufficient in overcoming negative birth-order effects. To reduce the detrimental effects of birth order on child stunting, policy responses-and therefore research priorities-require a stronger focus on increasing the time period between births.

The Association Between Covariates, with Emphasis on Maternal Body Mass Index, and Duration of Exclusive and Total Breastfeeding

Objective: The aim of this study was to evaluate the association between possible covariates, with emphasis on maternal body mass index (BMI), on exclusive breastfeeding and on total breastfeeding during the first postnatal year. Design: A longitudinal study encompassing 723 women who were followed during the first postnatal year Methods: Data concerning pregnancy, delivery, neonatal period, and breastfeeding were extracted from respective medical records. Sociodemographic data on the participants were self-reported. The Cox Proportional Hazard Model was used for investigating the effects of different covariates. Results: Compared with women with BMI <25.0, obese women ran a higher risk of ceasing exclusive breastfeeding prematurely (Hazard ratio [HR] = 1.38, p = 0.009). Multiparous women had a lower risk of ceasing the exclusive breastfeeding prematurely, than primiparous women (HR = 0.78, p = 0.009). Concerning exclusive breastfeeding as well as total breastfeeding, the risk of prematurely ceasing the breastfeeding decreased with increasing age (p = 0.028 and p ≤ 0.001, respectively). Median duration of exclusive breastfeeding was shorter among obese women compared with women with BMI <30.0 (3.0 months versus 6.0 months). Corresponding figures for total breastfeeding were 4.0 months versus 8.0 months. Concerning parity and exclusive breastfeeding, there was no difference in median duration between primiparous women and multiparous women (4.0 months), whereas multiparous women had a longer median duration of total breastfeeding, than primiparous women (8.0 months versus 7.0 months). Conclusion: The risk of ceasing exclusive breastfeeding prematurely is high among obese women. This result indicates the need for targeted supportive interventions, individualized according to BMI. With increasing age, the risk of ceasing breastfeeding prematurely decreases, and compared with primiparous women, multiparous women run a lower risk of ceasing exclusive breastfeeding prematurely.

Breastfeeding as the Foundation of Care

Breastfeeding, which unites food, health, and care, enhances the child's abilities to elicit good care through superior attachment, rhythmic synchrony, and vision and brain development. Parental responsiveness is increased by bonding, child spacing, and time with the baby Breastfeeding and other forms of care for nutrition share the aspects of interaction, cultural mediation, erosion of traditions, endemic misinformation, small-scale decision-making, and vulnerability to institutional mismanagement. Breastfeeding differs in requiring continuity of the caretaker and in facing social and profit-motivated opposition. Research is needed on adequate care for siblings, effective help for high-risk infants, improved duration, and nutrition of both mother and child in the second year of breastfeeding Despite effective strategies, such as the baby-friendly hospital initiative and community support groups, the challenge remains to move from motivating women to ensuring access to practical and confidence-building support.

Discordance in Couples Pregnancy Intentions and Breastfeeding Duration: Results from the National Survey of Family Growth 2011-2013

Background

Parental disagreement in pregnancy intention elevates the risk of adverse health events for mother and child. However, research surrounding parental pregnancy intention discrepancies and breastfeeding duration is limited. This study aims to examine the relationship between couple's discordant pregnancy intention and breastfeeding duration.

Methods

Data from the 2011–2013 National Survey of Family Growth was analyzed. Parental pregnancy intention was categorized as “intended by both parents,” “unintended by both parents,” “father intended and mother unintended,” and “father unintended and mother intended.” Breastfeeding duration was categorized as “never breastfed,” “breastfed less than six months,” and “breastfed at least six months.” Multinomial logistic regression, odds ratios, and 95% confidence intervals were calculated.

Results

Couples with a concordant unintended pregnancy were more likely to have a child who was never breastfed or breastfed less than six months compared to couples with a concordant intended pregnancy. Similarly, couples with a discordant pregnancy were more likely to have a child who was never breastfed or breastfed less than six months.

Conclusions

Findings from this study show a relationship between couples' pregnancy intentions and subsequent breastfeeding behaviors. Healthcare professionals should be cognizant of parents' differing opinions surrounding pregnancy intention and the implications on breastfeeding outcomes.

Why invest, and what it will take to improve breastfeeding practices?

Despite its established benefits, breastfeeding is no longer a norm in many communities. Multifactorial determinants of breastfeeding need supportive measures at many levels, from legal and policy directives to social attitudes and values, women's work and employment conditions, and health-care services to enable women to breastfeed. When relevant interventions are delivered adequately, breastfeeding practices are responsive and can improve rapidly. The best outcomes are achieved when interventions are implemented concurrently through several channels. The marketing of breastmilk substitutes negatively affects breastfeeding: global sales in 2014 of US$44·8 billion show the industry's large, competitive claim on infant feeding. Not breastfeeding is associated with lower intelligence and economic losses of about $302 billion annually or 0·49% of world gross national income. Breastfeeding provides short-term and long-term health and economic and environmental advantages to children, women, and society. To realise these gains, political support and financial investment are needed to protect, promote, and support breastfeeding.

Previous breastfeeding experience and duration of any and exclusive breastfeeding among multiparous mothers

BACKGROUND

High breastfeeding attrition rates have been attributed to a number of factors, but the effect of previous breastfeeding experience on subsequent breastfeeding duration has not been adequately investigated.

METHODS

In this study, 559 multiparous mothers were recruited and followed prospectively for 12 months or until the infant was weaned.

RESULTS

When compared with having previously breastfed for > 3 months, no previous breastfeeding experience (HR 3.24 [95% CI 2.37-4.42]) or a breastfeeding duration of ≤ 3 months (HR 2.56; 95% CI 2.05?3.20) substantially increased the risk of early weaning. Similarly, participants who had not exclusively breastfed (HR 1.82 [95% CI 1.46?2.26]) or who had exclusively breastfed for ≤ 2 months (HR 1.65 [95% CI 1.29?2.10]) were more likely to stop exclusive breastfeeding when compared with those who had exclusively breastfed for > 2 months. More than 40 percent of the participants who had previously breastfed for > 3 months had shorter current breastfeeding durations. The median decreases in any and exclusive breastfeeding for this group were 16.4 weeks and 13.1 weeks, respectively.

CONCLUSIONS

Multiparous women with no previous breastfeeding experience and those with a short duration of previous breastfeeding should be provided with greater support to promote a longer duration of breastfeeding. Multiparous women with a longer duration of breastfeeding should be strongly encouraged to meet or exceed this duration with their current infant.

Prenatal investments, breastfeeding, and birth order

Mothers have many opportunities to invest in their own or their child's health and well-being during pregnancy and immediately after birth. These investments include seeking prenatal care, taking prenatal vitamins, and breastfeeding. In this paper, we investigate a potential determinant of mothers' investments that has been largely overlooked by previous research-birth order. Data are from the National Longitudinal Study of Youth 1979 (NLSY79) Child and Young Adult Survey, which provides detailed information on pre- and post-natal behaviors of women from the NLSY79. These women were between the ages of 14 and 22 in 1979, and form a nationally representative sample of youth in the United States. Our sample includes births to these women between 1973 and 2010 (10,328 births to 3755 mothers). We use fixed effects regression models to estimate within-mother differences in pre- and post-natal behaviors across births. We find that mothers are 6.6 percent less likely to take prenatal vitamins in a fourth or higher-order birth than in a first and are 10.6 percent less likely to receive early prenatal care. Remarkably, mothers are 15.4 percent less likely to breastfeed a second-born child than a first, and are 20.9 percent less likely to breastfeed a fourth or higher-order child. These results are not explained by changing attitudes toward investments over time. These findings suggest that providers may want to increase efforts to encourage these behaviors at women with higher parity. The results also identify a potential mechanism for the emergence of differences in health and other outcomes across birth orders.

Mothers' perceptions of introducing solids to their infant at six months of age: identifying critical belief-based targets to promote adherence to current infant feeding guidelines

We investigated critical belief-based targets for promoting the introduction of solid foods to infants at six months. First-time mothers (N = 375) completed a Theory of Planned Behaviour belief-based questionnaire and follow-up questionnaire assessing the age the infant was first introduced to solids. Normative beliefs about partner/spouse (β = 0.16) and doctor (β = 0.22), and control beliefs about commercial baby foods available for infants before six months (β = -0.20), predicted introduction of solids at six months. Intervention programs should target these critical beliefs to promote mothers' adherence to current infant feeding guidelines to introduce solids at around six months.

Predicting mothers' decisions to introduce complementary feeding at 6 months. An investigation using an extended theory of planned behaviour

In Australia and other developed countries there is poor adherence to guidelines recommending the introduction of complementary feeding to infants at 6 months of age. We aimed to investigate, via adopting a theory of planned behaviour framework and incorporating additional normative and demographic influences, mothers' complementary feeding intentions and behaviour. Participants were 375 primiparas who completed an initial questionnaire (infant age 13±3 weeks) that assessed the theory of planned behaviour constructs of attitude, subjective norm, and perceived behavioural control, as well as group norm and additional maternal and infant variables of mothers' age, education level, weight status perception, current maternal feeding practices, and infant birth weight. Approximately, 3 months after completion of the main questionnaire, mothers completed a follow-up questionnaire that assessed the age in months at which the infant was first introduced to solids. The theory of planned behaviour variables of attitude and subjective norm, along with group norm, predicted intentions, with intention, mothers' age (older more likely), and weight status perception (overweight less likely) predicting behaviour. Overall, the results highlight the importance of attitudes, normative influences, and individual characteristics in complementary feeding decision-making which should be considered when designing interventions aimed at improving adherence to current maternal feeding guidelines.

Variables associated with breastfeeding duration

OBJECTIVE

To identify the variables associated with breastfeeding duration.

DATA SOURCES

The health science reference databases of CINAHL, PubMed, and the Cochrane Database of Systematic Reviews.

STUDY SELECTION

Meta-analyses, Cochrane reviews, literature reviews, and quantitative and qualitative studies published in English from 1998 through 2008.

DATA EXTRACTION

Data included all variables, both positive and negative, that were found to influence the outcome of breastfeeding duration.

DATA SYNTHESIS

Demographic factors that influence breastfeeding duration are race, age, marital status, education, socioeconomics, and Special Supplemental Nutrition Program for Women, Infants, and Children status. Biological variables consisted of insufficient milk supply, infant health problems, maternal obesity, and the physical challenges of breastfeeding, maternal smoking, parity, and method of delivery. Social variables included paid work, family support, and professional support. Maternal intention, interest, and confidence in breastfeeding were psychological variables.

CONCLUSION

Human lactation is a complex phenomena and the duration of breastfeeding is influenced by many demographic, physical, social, and psychological variables.

Birth order and breastfeeding initiation: results of a national survey

BACKGROUND

Because of numerous health benefits for both mothers and babies, breastfeeding is the recommended method of infant feeding. We sought to determine the association between birth order and breastfeeding practices in families with multiple children.

METHODS

The 2002 National Survey of Family Growth was used to analyze the demographic characteristics of a national probability sample of 2,115 U.S. mothers aged 15 to 44 with two, three, four, and five or more children younger than age 19. In-person, computer-assisted interviews were conducted by trained female interviewers. The main variable of interest was birth order; the main outcome measure was breastfeeding initiation for each mother-child pair. We used multiple logistic regression models to determine the demographic predictors of breastfeeding the second child in families with two children.

RESULTS

Mothers with two, three, four, and five or more children breastfed all of their children 52.6%, 48.4%, 44.7%, and 57.1% of the time, respectively (p = 0.46). In families with multiple children, more than 70% of women made the same feeding choice for each of their children, whether it was breastfeeding or bottlefeeding. After controlling for demographic factors, Hispanic women and women with more than a high school education were significantly more likely to breastfeed their second child if they had breastfed the first child.

CONCLUSION

U.S. mothers are likely to choose the same feeding method for each of their children, independent of the number of children they have. Breastfeeding promotion must take into consideration previous infant feeding experiences, if any.

Factors influencing full breastfeeding in a southwestern ontario community: assessments at 1 week and at 6 months postpartum

Factors associated with full breastfeeding (FBF) at 1 week and at 6 months postpartum were examined in a cohort of 856 mother-infant dyads. Questionnaires were mailed at 4 time points over the first 6 months postpartum. At 1 week, 68% of infants were FBF; at 6 months, 23% were FBF. Factors significantly associated with FBF at 1 week were hospital of delivery, residing with a smoker, maternal shiftwork during pregnancy, and having no prior breast-feeding experience. Cox proportional hazards regression analysis showed that residing with a smoker, having consumed caffeine during pregnancy, reporting elevated maternal trait anxiety at 1 week postpartum, having been employed full-time outside the home prior to delivery, and having received anesthesia/analgesia during labor/delivery were associated with earlier cessation of FBF, whereas not having previous breastfeeding experience predicted its continuation. Although most mothers are breastfeeding early on, a number of factors adversely affect its successful continuation.

What Do Québec Children Eat During Their First Six Months?

Study objectives were to describe the introduction of foods and beverages and the use of vitamin and/or mineral supplements among infants aged six months, and to identify factors associated with following Québec recommendations on introducing foods and beverages. Study subjects were primiparous women interviewed by phone when their infants were approximately six months old. Data were gathered on foods and beverages offered to infants, the age at which these were introduced, and supplements. The use of each food, beverage, and supplement was evaluated according to recommendations. Mean age at which foods were introduced and proportions of women who followed recommendations were calculated. Multivariate logistic regression models were used to identify the factors associated with following recommendations. Results indicated that among the 1,937 interviewed mothers, 212 (10.9%) exclusively breast-fed their infants before age four months, 1,073 (55.4%) breast-fed their infants at birth but gave them formula or foods before age four months, and 652 (33.7%) formula-fed their infants at birth. Factors associated with adherence to recommendations were breast-feeding exclusively, being older than 30 years, an annual family income of at least $60,000, and being a non-smoker. Few mothers followed all the recommendations.

Incidence and correlates of breast milk feeding in hospitalized preterm infants

The majority of epidemiological studies of breast feeding have been conducted in healthy, fullterm infant samples. Little is known about the incidence and correlates of breast milk feeding in preterm infants, particularly in those born outside of metropolitan areas. Therefore, hospital medical charts of 151 consecutively admitted preterm infants (</=34 weeks gestational age), in the US, were reviewed and daily feeding, maternal demographic, pregnancy, and infant medical condition information was recorded. About half of the preterm infant sample was fed breast milk, receiving at least one breast milk feeding per day for 44% of their hospital stay. Although maternal demographic variables were important predictors of breast milk feeding, perinatal medical condition of the infant played a unique role in feeding practices in preterm infants. Specific interventions could be targeted to families with preterm infants to modestly increase population breast feeding rates.

Determinants of breastfeeding duration in Peninsular Malaysia

The health benefits of breastfeeding to infants and mothers have been well recognised. This study applies linear regression analysis to assess the determinants of breastfeeding duration of first born using data from the Second Malaysian Family Life Survey. The proportion of women who breastfed their first child is 82 percent, of which 97 percent reported their breastfeeding duration. The distribution of breastfeeding duration has a mean of 5.7 months and a median of two months. Important determinants of breastfeeding duration include maternal age, ethnicity, period of first birth, husband's occupation and work status of the woman.

The decision to breastfeed in the United States: does race matter?

OBJECTIVES

To estimate the effects of maternal and birth characteristics on the decision to breastfeed and to relate breastfeeding practices to racial differences in infant mortality.

METHODS

Using a sample of women with young children from the National Survey of Family Growth (NSFG), Cycle V, 1995, the likelihood of breastfeeding was modeled using logistic regression techniques. In addition, single, live births from the NSFG 1988 and 1995 surveys were analyzed to model the effects of race and breastfeeding on infant mortality using Cox regression methods.

RESULTS

After controlling for socioeconomic background and birth characteristics, race remained a strong predictor of breastfeeding. Black women were less likely to breastfeed than nonblack women were, and the primary reason indicated by black women for not breastfeeding was that they "preferred to bottle-feed." Analyses of infant mortality indicated that breastfeeding accounts for the race difference in infant mortality in the United States at least as well as low birth weight does.

CONCLUSIONS

Race is an important predictor of breastfeeding, with most black women reporting that they "preferred bottle-feeding." Efforts to increase breastfeeding of infants in the black community should help narrow the racial gap in infant mortality.

Effects of lactation and contraceptive use on birth-spacing in Bolivia

Based on the 1989 Demographic and Health Survey of Bolivia, analysis of the joint effects of breastfeeding and contraceptive use on birth-spacing showed the IUD to be the most effective contraceptive method used to delay conception. Breastfeeding significantly lengthened the birth interval, but only following second and higher parity births. In addition, conditions of poverty appeared to further inhibit the return of fecundity and delay conception.

Pregnancy experience, knowledge of pregnancy, childbirth and infant care and sources of information among obstetric patients at King Khalid Hospital, Riyadh

One hundred obstetrics patients were interviewed at King Khalid Hospital (Saudi Arabia) concerning their current pregnancy experience, knowledge of pregnancy and child care and sources of information on these topics. Interviews were conducted and a short knowledge test given to nulliparous, primaparous and multiparous patients. The overall mean score of respondents was 50.4%. Significant information deficits existed in: the implications of prescription drugs and dental care during pregnancy; time of conception; when to contact a physician for personal care. Nulliparous patients scored lower, and information deficits appeared in: when to call a physician for infant care, immunization for newborns and events during pregnancy. Respondents did not perceive physicians and nurses as significant sources of information when compared with alternative sources.

Why are teenagers in the United States less likely to breast-feed than older women?

Teenage mothers are much less likely than older mothers to breastfeed their infants. The lower breastfeeding rate among teenagers aged 16–19, compared with women aged 20–29, is due almost entirely to the fact that teenage mothers tend to have characteristics associated with a lower likelihood of breastfeeding among all women, such as lower educational level, lower income, and being unmarried. Even so, nearly 40% of the difference between teenage mothers aged 15 or less and mothers aged 20–29 remains unexplained by these factors and may be due to developmental aspects of adolescence, such as greater egocentricity and greater concern about body image.

Comparison of influences on breastfeeding initiation of firstborn children, 1960-69 vs 1970-79

This study compares the determinants of breastfeeding initiation of firstborn children in two periods, 1960-69 and 1970-79, using data on 782 women from the RAND Health Insurance Experiment. The 1960-69 period covers the end of the decline in breastfeeding rates in the U.S.; the 1970-79 period was one of rapid resurgence in those rates. Different combinations of sociodemographic and birth-specific variables are significant in each period. The effects of race and administration of painkiller on breastfeeding changed significantly between periods. However, increased interest in health-promoting behavior is responsible for most of the upward pressure on breastfeeding rates over the period studied.