'Both parents should care for babies': A cross-sectional, cross-cultural comparison of adolescents' breastfeeding intentions, and the influence of shared-parenting beliefs

Social representations of breastfeeding in health science students: A first step to strengthening their training

AIM

This study aims to describe the social representations of breastfeeding among Mexican health science students.

BACKGROUND

Breastfeeding is a complex phenomenon involving biological, affective and sociocultural aspects. Its definition includes diverse beliefs, attitudes, traditions and myths. Being aware of the connections between biological and sociocultural concepts in the social representations of breastfeeding in health science students may facilitate our comprehension of their attitudes/behaviors towards breastfeeding.

DESIGN

A qualitative study was carried out based on the structuralist approach of the social representations theory.

METHODS

Data were collected with free-listing questionnaires with breastfeeding as an inducer word among a random sample of nutrition, medical and nursing undergraduate students (n=124). The analyses used were similitude/meanings of words, prototypical and categorical analyses.

RESULTS

The findings suggest that the structure of the social representation is composed of breastfeeding essentials (baby, mother, & milk), affective (attachment, love & link), biological (nutrition, breasts, & health) and sociocultural elements (taboo, responsibility, & economic). Only instrumental elements are found in the nucleus, whereas biological, affective and sociocultural elements are observed in the peripheries. Moreover, emerging thematic categories such as the "affective bond" and "feeding" introduced additional dimensions, thereby emphasizing the complexity and richness of the social representation of breastfeeding in the context of health science students.

CONCLUSIONS

The structure of the social representation of breastfeeding among some Mexican undergraduate health science students focuses on the instrumental aspects, emphasizing essential elements. However, they downplay more scientifically oriented elements specific to their academic training. These findings, when extrapolated to different contexts, present an opportunity that could assist the development of tailored and culturally adapted educational strategies to strengthen breastfeeding training for health students. This approach can significantly contribute to enhancing breastfeeding promotion in society by addressing practical, scientific and language-inclusive aspects in the training of health professionals.

What shapes parental feeding decisions over the first 18 months of parenting: Insights into drivers towards commercial and home-prepared foods among different socioeconomic groups in the UK

Infants born into families experiencing socioeconomic disadvantage follow a high-risk trajectory for obesity and poor health in later life. Differences in early childhood food experiences may be contributing to these inequalities. This study aimed to explore the factors that influence parental decisions on when, how and what food to introduce over the first 18 months of their child's life and identify differences according to families' social position. Particular attention was given to social and environmental determinants within and outside the home. This research utilised a longitudinal qualitative methodology, with interviews and photo-elicitation exercises completed by participants when their children were 4-6; 10-12 and 16-18 months of age. Participants were parents (61 mothers; 1 father), distributed across low, medium and high socioeconomic position (SEP). During analysis, observable differences in factors directing parents to home-prepared or commercial foods were identified. Factors that undermined the provision of home-prepared meals included lack of time after returning to work, insufficient support from partners, uncertainty around infant and young child feeding (defined as the introduction and provision of solids) and an implicit trust in the messaging on branded products. These factors directed parents towards commercial foods and were most persistent among families experiencing socioeconomic disadvantage due to barriers accessing formal childcare, less flexible working conditions and fathers being less involved in infant feeding. To facilitate an enabling environment for healthy infant and young child feeding practices and address dietary inequalities, immediate steps that policy makers and healthcare providers can take include: i) changing the eligibility criteria for shared parental leave, ii) aligning claims on commercial infant food labels with international best practices, and iii) improving access to formal childcare.

Partners' experiences of breastfeeding: a qualitative evaluation of a breastfeeding support intervention in Sweden

BACKGROUND

The World Health Organization states that women and their families need breastfeeding support from the healthcare system. However, knowledge about the most effective way to involve the partner in breastfeeding is lacking. A qualitative evaluation can provide insight and knowledge about the partner's experiences towards a breastfeeding support intervention and thus contribute to how forthcoming breastfeeding support policies are designed. The aim of this study was to explore partners' experiences regarding breastfeeding while participating in The Breastfeeding Study.

METHODS

An exploratory, longitudinal and qualitative design was used. This study was part of The Breastfeeding Study, which took place in Sweden. The intervention was performed in line with the Ten Steps to Successful Breastfeeding. Partners in the in the intervention group (IG) were part of a structured breastfeeding support programme. An individual breastfeeding plan was established in cooperation with the parents-to-be during pregnancy, and the plan was followed up at the child healthcare centre. A purposive sample was recruited from March to December 2021. Interviews and diary entries from IG (n = 8) and control group (CG) (n = 8) during pregnancy and 2 months after birth were analysed by content analysis, in accordance with the COREQ guidelines.

RESULTS

Partners' experiences can be summarised under the main category of 'Striving to be part of the family and important that the family's everyday life was well-functioning'. IG partners experienced that both parents were involved and cooperated in the breastfeeding process and that guidance from healthcare professionals (HCPs) helped them to feel secure. CG partners experienced feeling excluded and not receiving support from HCPs.

CONCLUSION

Both parents need to be targeted in breastfeeding support policies to meet the support needs. Midwives at antenatal care and child healthcare nurses at the child healthcare centre have important roles to play in providing structured breastfeeding support and a breastfeeding plan. Both IG and CG partners strived to become a part of the infant's life and to make family life work. Midwives should involve both parents in a reflective dialogue on how the partner can be involved, apart from just feeding the infant.

TRIAL REGISTRATION

Retrospectively registered in ACTRN12623000648628.

Factors associated with intention to breastfeed in Vietnamese mothers: A cross-sectional study

INTRODUCTION

Breastfeeding has many benefits for mothers, children, and the environment over both the short and longr-term. Prenatal intention to breastfeed is a powerful predictor of short-term breastfeeding outcomes.

OBJECTIVE

This study aims to analyze breastfeeding intentions, including the intention to feed infants with breastmilk only and to continue exclusive breastfeeding to 6 months among pregnant mothers in Hanoi, Vietnam.

METHODS

The analysis included 1230 singleton mothers, between 24- and 36-weeks' gestation, who attended antenatal clinics in two hospitals in Hanoi in 2020.

RESULTS

The proportion of mothers with an "breastfeeding intention" (i.e., intention to feed an infant with breastmilk only) and "exclusive breastfeeding intention" to 6 months was 59.9% and 41.7%, respectively. Mothers who were 25 years or older (aOR = 1.35, 95%CI:1.00-1.81), had an undergraduate educational degree or higher (aOR = 1.38, 95%CI: 1.08-1.76), had observed another woman breastfeeding (aOR = 1.43, 95%CI: 1.03-2.00), were not living with parents-in-law (aOR = 1.34, CI: 1.05-1.70), and were multiparous (aOR = 1.60, 95%CI: 1.16-2.19) had higher odds of "exclusive breastfeeding intention" to 6 months. Among primiparous women, those who thought their husbands support breastfeeding were more likely to intend to feed an infant with breastmilk only. Among multiparous women, feeding the previous child with breastmilk exclusively before the introduction of complementary foods and not giving solid foods together with water until 6 months, were significant predictors for both breastfeeding intentions.

CONCLUSION

Mothers without exclusive breastfeeding experience should be provided with greater support to promote exclusive breastfeeding intention and outcomes.

Validity and Reliability of the Chinese Version of the Edinburgh Postnatal Depression Scale for Fathers of Newborns

Studies often use the Edinburgh Postnatal Depression Scale (EPDS) or the Beck Depression Inventory-II (BDI-II) as a screening tool for depression in new mothers or fathers following the birth of an infant, but no studies have evaluated EPDS as a predictor of postnatal depression for new fathers in a Chinese population. This study aimed to test the validity and reliability of a Chinese version of the EPDS for fathers of newborns in Taiwan. The study included 368 parents with newborns ≤2 months of age and without any health problems. Construct and criterion-related validities were assessed and Cronbach's alpha was used for measuring internal consistency reliability. The receiver operating characteristic (ROC) curve analyzed the optimal cutoff score for the EPDS. Scores for the Chinese EPDS were significantly higher for fathers who were >34 years of age, employed in a professional occupation, and participated in feeding their infant (p < .05). Mean scores among the fathers for the EPDS and BDI-II were significantly correlated (r = .64, p < .001). The Cronbach's alpha was .83 for the EPDS; ROC curve analysis revealed the optimal cutoff of the EPDS was ≥8 points and the area under the ROC curve was 0.91. The EPDS had good validity and reliability and should therefore be considered suitable for the evaluation of postnatal depression in fathers of newborn infants in Taiwan.

Parenting stress in the early years – a survey of the impact of breastfeeding and social support for women in Finland and the UK

Background

Being a new parent can be both joyful and stressful. Parenting stress is associated with poorer health and well-being for parents and infant and increased psychological distress. For new mothers, physical and hormonal changes, expectations of mothering and demands of a new baby may cause additional stress. Breastfeeding is promoted as optimal for maternal and infant health, but can have both positive and negative psychological impacts. Formal and informal social support can offset parenting and breastfeeding stress. Source, content and context of support for new parents are important considerations. This study compares two countries with different parenting and breastfeeding contexts, Finland (more supportive) and the UK (less supportive), investigating the role of breastfeeding stress, self-efficacy and social support as predictors of stress and role strain for new mothers.

Methods

A cross-sectional online survey was completed by 1550 breastfeeding mothers of infants up to 2 years old, recruited via social media platforms in Finland and the UK. Predictors of parenting stress and strain, including demograpic factors, childbirth experiences, breastfeeding and social support were investigated.

Results

We found fewer differences between countries than expected, perhaps due to demographic and contextual differences. Women in Finland reported better childbirth experiences, more positive breastfeeding attitudes, and more self-efficacy than in the UK. Levels of parenting stress were similar in both countries. Women in the UK reported more parental role strain, but fewer breastfeeding stressors. Participants accessed more informal than formal supports, including their partner for parenting and facebook groups and family for breastfeeding. Analysis suggested breastfeeding stress and social support had significant direct effects – respectively increasing and reducing parenting stress and role strain, but no moderating effects of social support suggesting support did not change the relationship between breastfeeding and parenting stress.

Conclusions

Results have important implications for the provision of breastfeeding and parenting support for new mothers. Simple interventions to manage stress for mothers in the postnatal period could be beneficial and are easily delivered by supporters. As shown elsewhere, socio-economic and cultural factors are crucial influences on parenting experiences.

The Social Value of Implementing the Ten Steps to Successful Breastfeeding in an Indonesian Hospital: A Case Study

Background: Despite the known importance of breastfeeding for women's and children's health, global exclusive prevalence among infants under 6 months old is estimated at only 41%. In 2018, Indonesia had a lower exclusive breastfeeding rate of 37% at 6 months postpartum; ranging from 20% to 56%, showing unequal breastfeeding support throughout the country. The World Health Organization (WHO) launched the Ten Steps to Successful Breastfeeding (Ten Steps) in 1989, later embedded in UNICEF's Baby-Friendly Hospital Initiative (BFHI) program in 1991. The BFHI aims to encourage maternity facilities worldwide to ensure adequate education and support for breastfeeding mothers by adhering to the Ten Steps and complying with the International Code of Marketing of Breastmilk Substitutes. An Indonesian survey in 2011 found that less than one in 10 government hospitals implemented the Ten Steps. It has been common for Indonesian health services to collaborate with infant formula companies. While no Indonesian hospitals are currently BFHI-accredited, the WHO/UNICEF Ten Steps (updated in 2018) have been adopted in Indonesia's national regulation of maternity facilities since 2012. Internationally, implementation of the Ten Steps individually and as a package has been associated with benefits to breastfeeding rates and maternal and infant health. However, to date, few studies have examined the impact of implementing the Ten Steps in economic terms. This study aims to measure the economic benefit of Ten Steps implementation in an Indonesian hospital. Methods: The study was conducted in January 2020 in Airlangga University Hospital, Surabaya, Indonesia, which has implemented the Ten Steps since it was established in 2012. To understand and generate evidence on the social value of the Ten Steps, we conducted a "Social Return on Investment (SROI)" study of implementing the Ten Steps in this maternity facility. To estimate the costs relating to the Ten Steps we interviewed the financial and nursing managers, a senior pediatrician, and senior midwife due to their detailed understanding of the implementation of the Ten Steps in the hospital. The interview was guided by a questionnaire which we developed based on the 2018 WHO/UNICEF Ten Steps to Successful Breastfeeding. The analysis was supported with peer-reviewed literature on the benefits of Ten Steps breastfeeding outcomes. Results: The total per annum value of investment (cost) required to implement Ten Steps in Airlangga University Hospital was US$ 972,303. The estimate yearly benefit was US$ 22,642,661. The social return on the investment in implementing Ten Steps in this facility was calculated to be US$ 49 (sensitivity analysis: US$ 18-65). Thus, for every US$ 1 invested in Ten Steps implementation by Airlangga Hospital could be expected to generate approximately US$ 49 of benefit. Conclusions: Investment in the Ten Steps implementation in this Surabaya maternity facility produced a social value 49 times greater than the cost of investment. This provides novel evidence of breastfeeding as a public health tool, demonstrating the value of the investment, in terms of social impact for mothers, babies, families, communities, and countries. Breastfeeding has the potential to help address inequity throughout the lifetime by providing the equal best start to all infants regardless of their background. Indonesia's initial moves towards implementing the WHO/UNICEF Ten Steps can be strengthened by integrating all elements into the national regulation and health care system.

Prenatal perception of breastfeeding recommendations predicts early breastfeeding outcomes of participants in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)

BACKGROUND

Prenatal psychosocial factors predict breastfeeding practices but are not assessed in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC).

OBJECTIVES

This study examined how prenatal perceptions of WIC's breastfeeding recommendations were associated with early breastfeeding outcomes.

METHODS

This study used longitudinal data from a national sample of 2053 pregnant participants in the WIC Infant and Toddler Feeding Practices Study-2 (WIC ITFPS-2) in 2013, the only national data assessing prenatal perceptions of WIC's breastfeeding recommendations. Early breastfeeding outcomes included breastfeeding initiation, breast milk first fed after birth, breastfeeding in the first hour, breast milk first fed after leaving the hospital, and breastfeeding status at the first and third months. The primary predictor was the participant's prenatal perception of whether WIC recommended breastfeeding only or not. Log-binomial regression was used with adjustment for socio-demographics, previous breastfeeding, WIC participation, breastfeeding support, and infant feeding intentions (IFI).

RESULTS

Without controlling for IFI, the perception of WIC recommending breastfeeding only predicted breastfeeding outcomes positively. The risk ratio (RR) associated with prenatal perceptions varied from 1.14 (95% CI: 1.03, 1.25; P = 0.008) for breastfeeding in the first hour, to 1.27 (95% CI: 1.12, 1.43; P < 0.001) for breast milk first fed after leaving hospital, to 1.66 (95% CI: 1.35, 2.04; P < 0.001) for 3-mo breastfeeding only. After controlling for IFI, the RRs were 1.13 (95% CI: 1.02, 1.24; P = 0.017) for breastfeeding in the first hour, 1.20 (95% CI: 1.06, 1.35; P = 0.004) for breast milk first fed after leaving hospital, and 1.49 (95% CI: 1.21, 1.84; P < 0.001) for 3-mo breastfeeding only, suggesting that prenatal perception was independently associated with breastfeeding outcomes.

CONCLUSIONS

Prenatal perception of WIC's breastfeeding recommendations can be regarded as a new psychosocial predictor of breastfeeding and a possible target for future intervention.

The Beliefs About Breastfeeding Questionnaire (BAB-Q): A psychometric validation study

Objectives

Questionnaires used to assess women’s beliefs as a predictor of breastfeeding behaviour are not theoretically informed or tested for psychometric validity and reliability. This study conducted a psychometric evaluation of the Beliefs About Breastfeeding Questionnaire (BAB‐Q).

Design

A two‐phase evaluation in an online cross‐sectional questionnaire study (N = 278) and cohort study sample (N = 264). A ten‐item questionnaire was proposed to assess women’s beliefs about the benefits and efforts of breastfeeding.

Methods

Exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) assessed construct validity and reliability. Multivariate regression analyses assessed validity in predicting breastfeeding behaviour and experiences.

Results

EFA found a shortened 8‐item, 2‐factor model had good fit (χ² = 23.3, df = 13, p < .040; CFI = .99, TLI = .99, RMSEA = .05), with significant factor loadings. Factor 1 (benefit beliefs) and factor 2 (effort beliefs) accounted for 47 and 19.4% of the explained variance and correlated moderately (r = −.40). CFA confirmed the solution in the cohort sample (χ² = 49.6 df = 19, p < .010; CFI = .97, TLI = .96, and RMSEA = .078). Adjusted regression analyses found beliefs did not reliably predict infant feeding practices. Women’s beliefs significantly predicted the likelihood that women experienced breastfeeding as ‘much more’ positive and negative than they expected.

Conclusions

The eight‐item questionnaire showed good model fit with acceptable loadings, and good reliability for all subscales. The utility of the BAB‐Q at predicting breastfeeding behaviour remains unclear and unsupported by empirical evidence. Further assessments of the predictive validity of the questionnaire in longitudinal studies with diverse beliefs and infant feeding practices are required.

Exploring Breastfeeding Knowledge and Attitudes among Noncaregivers: A Narrative Review

Exclusive breastfeeding to 6 months with continued breastfeeding up to 2 years and beyond are well-established infant feeding recommendations based on evidence that breastfeeding has unparalleled maternal and infant health benefits as well as environmental and economic benefits. As with many high-income countries, breastfeeding rates remain suboptimal with only a quarter of Canadian and European infants receiving breast milk exclusively for the first 6 months. Breastfeeding promotion efforts have largely targeted caregivers in the prenatal and postnatal period; however, breastfeeding outcomes have been shown to be associated with broader sociocultural factors. Noncaregivers play an influential role in infant feeding at both an individual level (e.g., cues and input from health care practitioners and caregivers' social networks; as future parents) as well as a broader population level (sociocultural norms and policy decisions). This paper outlines recent research on breastfeeding knowledge and attitudes of noncaregivers by population subgroup. Positive correlations have been identified between breastfeeding attitudes, infant feeding knowledge, breastfeeding exposure, and breastfeeding intention among different subgroups; however, key knowledge gaps, lack of exposure to breastfeeding, and negative public perceptions of breastfeeding persist. Dietitians can advocate for breastfeeding promotion strategies that consider the role of noncaregivers to address sociocultural norms around breastfeeding.

Relationship among Breastfeeding Exposure, Knowledge, and Attitudes in Collegiate Males Residing in East Texas

BACKGROUND

Researchers exploring breastfeeding attitudes and knowledge among women suggest the decision to breastfeed is influenced by the male partner, yet few studies address males. Because collegiate males will soon enter fatherhood, assessment of their attitudes and knowledge may inform interventions aimed at increasing intention to breastfeed.

RESEARCH AIM

This study aimed to describe collegiate males' exposure to, attitude toward, and knowledge about breastfeeding.

METHODS

A cross-sectional online survey was used with males ≥ 18 years of age enrolled at a Texas public university. Attitude indices measured included social limitations, public displays of breastfeeding, and employer accommodations. Descriptive statistics, correlational and regression analyses were employed.

RESULTS

The participants' (N = 949) average age was 25.48 years; > 80% reported not being fathers. Exposure to breastfeeding was high; > 80% witnessed breastfeeding and/or had someone close breastfeed. High attitude scores indicated social acceptability of breastfeeding. Knowledge appeared limited: only 16% identified the recommendation of exclusive breastfeeding for the first 6 months of life; > 50% overlooked the reduced risk for overweight/obesity, ear infections, diarrhea, or food allergies. Correlations between knowledge, exposure, total attitude, and index scores were positive (p < .01) except for the public displays index. Stepwise multiple regression determined that breastfeeding exposure, knowledge scores, and father's educational level predicted total attitude score, (R² = 0.13, F (3,851) = 44.02, p < .01).

CONCLUSION

The positive attitudes outcome among this male population is promising for breastfeeding support and advocacy. Education efforts improving knowledge will likely increase behavioral intention, resulting in increased breastfeeding rates and duration.