Breastfeeding in the Community-How Can Partners/Fathers Help? A Systematic Review

Knowledge and attitude of spouses of puerperas towards breastfeeding

OBJECTIVE

To investigate the extent of knowledge about breastfeeding and attitudes towards infant feeding among spouses of puerperas at the time of discharge from hospital, and explore the factors influencing spousal attitudes toward breastfeeding.

METHODS

We conducted a questionnaire survey among 204 spouses of puerperas who were admitted in the maternity wards at a tertiary hospital in Shaanxi Province between October 2021 and December 2021. Respondents who fulfilled the inclusion criteria were identified using convenient sampling.

RESULTS

(1) The score of breastfeeding knowledge among spouses prior to discharge from the hospital was (10.56 ± 3.78), with an accuracy rate of 59.6%, and the lowest accuracy rate was for Item 1 "Newborns should be fed on time, not on demand" (42.6%) and Item 5 "Breastfeeding can prevent infant rickets" (49.5%). (2) The average score of spouses' infant feeding attitudes was (58.15 ± 5.55), and the lowest scoring was for Item 17 "Daily urine volume of infants is a reliable indicator to judge whether they get enough breast milk" (1.99 ± 1.14). (3) Generalized linear model analysis showed a more positive attitude (higher score) among spousal attitudes towards infant feeding in those who had received breastfeeding education [OR = 4.588, 95% CI (0.160 ∼ 3.598)] and those with a master's degree or above [OR = 18.278, 95% CI (3.471 ∼ 9.346)].

CONCLUSION

(1) Spouses that received breastfeeding education and those that had a Masters Degree and above had more positive attitude towards infant feeding. (2) Medical staff should focus on puerperas'spouses with degrees below master's level who had not received breastfeeding education. We recommend using a variety of education methods to enable them to acquire more knowledge on breastfeeding and develop a more positive attitude towards breastfeeding, which will further enhance spousal support for breastfeeding, thus positivizing postpartum co-parenting attitudes and improving the rate of exclusive breastfeeding.

Fathers' needs of breastfeeding support: Perspective of health nurses

PURPOSE

To explore the improvement of health education on father's participation in breastfeeding from the perspective of maternal and child health nurses.

METHODS

Qualitative phenomenological research was used, and 15 maternal and child health nurses who provided breastfeeding support were invited. With semi-structured deep interviews and on-site recordings, data were analyzed through content analysis.

RESULTS

Four main themes were extracted, including 'cultivating fathers' awareness of participation in breastfeeding', 'collaboration of multiple disciplines to improve health education on breastfeeding for fathers in hospital', 'Simulated scenarios to develop fathers' skills in solving breastfeeding problems', and 'establishing a hospital-community interface network to improve breastfeeding continuation care after hospital discharge'.

CONCLUSIONS

Medical and health care departments should attach importance to guidance on health education for fathers' breastfeeding participation, cultivate fathers' awareness of participation in breastfeeding, provide multi-disciplinary collaboration-based health education on breastfeeding for fathers from the prenatal period and improve post-discharge health education on breastfeeding. The additional education being suggested would contribute to fathers being able to play an important role in breastfeeding.

The perceived mental health experiences and needs of postpartum mothers living in the United Arab Emirates : A focus group study

BACKGROUND

After childbirth, mothers are particularly vulnerable to mental health problems including anxiety and depression, which often remain undetected and untreated. In the United Arab Emirates (UAE), recent figures revealed a substantial prevalence of postpartum depression. However, postpartum mental health remains largely understudied in the country's clinical and research settings. Therefore, given the paucity of literature in the UAE and building upon previous epidemiological findings, this study aimed to explore the perceived mental health experiences and needs of mothers during the postpartum period to guide the development of targeted interventions that address mothers' unique mental health challenges.

METHODOLOGY

Four focus groups were conducted, involving a total of 27 Emirati and multicultural expatriate mothers aged 32.47 ± 4.56 years old, living in the UAE and within their first year postpartum. Descriptive interpretive thematic analysis was employed to analyze the data.

ANALYSIS

Six themes were generated that capture the mothers postpartum experiences and mental health needs: (1) distinct postpartum experiences of primiparous and multiparous mothers, (2) experiences of emotional distress in the initial postpartum stage, (3) multifaceted challenges in breastfeeding, (4) multifactorial influences on postpartum mental health, (5) postpartum social support resources and providers, and (6) the need for formal and informal resources.

CONCLUSIONS

The findings highlight the importance of considering the unique cultural and societal factors that impact maternal mental health in the UAE, given its diverse population. A collaborative multidisciplinary approach, integrating culture sensitivity, is vital to address the mental health needs of postpartum mothers and to guide the development of tailored evidence-based interventions.

Correlates of early breastfeeding cessation and breastmilk expression in Uganda: a case-control study

OBJECTIVE

To identify the correlates of early breastfeeding (BF) cessation and breastmilk expression (BE) among mothers 12 months after childbirth.

METHODS

We used a case-control study design to compare characteristics between mothers who stopped BF and expressed breastmilk 12 months after childbirth in Uganda. BF practices were determined in 12-month follow-up interviews using an adapted World Health Organization infant feeding questionnaire. Univariate and bivariate logistic regression models identified correlates of early BF cessation and BE as distinct but related outcomes.

RESULTS

The odds of early BF cessation were higher among mothers who expressed breastmilk irrespective of maternal age (adjusted odds ratio: 2.82; 95% confidence interval: 1.39, 5.68). Mothers who stopped BF and did not express breastmilk were more likely to be older than those who continued BF and did not express breastmilk during the first 12 postpartum months.

CONCLUSION

Mothers living with human immunodeficiency virus infection have disproportionately high odds of early BF cessation that may contribute to disparities in child health outcomes. Promotion of safe BF practices coupled with family and social support could be a viable preventive strategy for attenuating such disparities, especially among young mothers at risk of early BF cessation.

An interpretive phenomenological analysis of the experiences of mothers who continue to breastfeed despite facing difficulties

BACKGROUND

Breastfeeding offers many health benefits to mother and infant.

PROBLEM

Breastfeeding difficulties are common and are linked with postnatal distress.

AIM

To explore the lived experiences of breastfeeding continuation despite facing difficulties.

METHODS

Qualitative semi-structured interviews were conducted with eight women who had experienced breastfeeding difficulties yet continued breastfeeding. Interviews were analysed using Interpretative Phenomenological Analysis (IPA).

FINDINGS

The first superordinate theme, 'Radical acceptance of the imperfect' included sub-themes of: 'Taking it day-by-day', 'Breastfeeding takes a community', and, 'Finding what works for you'. The second superordinate theme, 'Determination and persistence' included sub-themes of: 'Adopting a headstrong attitude' and 'Transient challenges versus lifelong achievement'.

DISCUSSION

Participants found radical acceptance of breastfeeding as an imperfect, variable process which enabled them to sustain breastfeeding despite challenges. Participants proactively drew on social and personal resources to navigate guidance and to find solutions which worked for their individual circumstances. Finally, open-mindedness, optimism, self-compassion, and being headstrong and determined were all personal qualities which facilitated breastfeeding during exceptionally difficult moments on their breastfeeding journey.

CONCLUSION

Recommendations are made for healthcare professionals: to provide emotional counselling during routine care (with an aim to instil breastfeeding self-efficacy) and to encourage breastfeeding advocacy among fathers and the maternal social support network (with an aim to further scaffold successful breastfeeding). Recommendations are also made for mothers: to develop and refine maternal confidence, patience, flexibility, self-compassion, and trust.

Too hot to thrive: a qualitative inquiry of community perspectives on the effect of high ambient temperature on postpartum women and neonates in Kilifi, Kenya

OBJECTIVE

To understand community perspectives on the effects of high ambient temperature on the health and wellbeing of neonates, and impacts on post-partum women and infant care in Kilifi.

DESIGN

Qualitative study using key informant interviews, in-depth interviews and focus group discussions with pregnant and postpartum women (n = 22), mothers-in-law (n = 19), male spouses (n = 20), community health volunteers (CHVs) (n = 22) and stakeholders from health and government ministries (n = 16).

SETTINGS

We conducted our research in Kilifi County in Kenya's Coast Province. The area is largely rural and during summer, air temperatures can reach 37˚C and rarely go below 23˚C.

DATA ANALYSIS

Data were analyzed in NVivo 12, using both inductive and deductive approaches.

RESULTS

High ambient temperature is perceived by community members to have direct and indirect health pathways in pregnancy and postpartum periods, including on the neonates. The direct impacts include injuries on the neonate's skin and in the mouth, leading to discomfort and affecting breastfeeding and sleeping. Participants described babies as "having no peace". Heat effects were perceived to be amplified by indoor air pollution and heat from indoor cooking fires. Community members believed that exclusive breastfeeding was not practical in conditions of extreme heat because it lowered breast milk production, which was, in turn, linked to a low scarcity of food and time spend by mothers away from their neonates performing household chores. Kangaroo Mother Care (KMC) was also negatively affected. Participants reported that postpartum women took longer to heal in the heat, were exhausted most of the time and tended not to attend postnatal care.

CONCLUSIONS

High ambient temperatures affect postpartum women and their neonates through direct and indirect pathways. Discomfort makes it difficult for the mother to care for the baby. Multi-sectoral policies and programs are required to mitigate the negative impacts of high ambient temperatures on maternal and neonatal health in rural Kilifi and similar settings.

Mediating role of birth at a baby-friendly hospital in the association between parental socioeconomic status and infant exclusive breastfeeding at six months old

BACKGROUND

Current evidence suggests that the exclusive breastfeeding (EBF) rate at six months postpartum in China falls considerably below the targets recommended by the World Health Organization (WHO). Socioeconomic disparities in EBF have been observed in developing countries, with significant heterogeneity across studies. Despite the implementation of the Baby-Friendly Hospital Initiative (BFHI) in China since the 1990s to promote breastfeeding, there has been a lack of assessment concerning infants from different socioeconomic backgrounds. This study sought to investigate the association between socioeconomic status (SES) and EBF and explore the potential impact of giving birth at a Baby-Friendly Hospital (BFH) on this association.

METHODS

We analyzed data from 98,469 mother-child dyads selected from the Maternal and Child Health Management Information System. We used log-binomial models to examine the relationships between SES and EBF, SES and giving birth at a BFH, as well as BFH births and EBF. Additionally, we explored a counterfactual mediation approach to assess the mediating role of BFH births in the SES-EBF association.

FINDINGS

We identified a significant association between SES and EBF (RRMedium vs. Low = 1.47, 95% CI 1.39-1.55; RRHigh vs. Low = 1.40, 95% CI 1.32-1.49). Mothers with higher SES were more likely to give birth at BFHs (RRMedium vs. Low = 1.85, 95% CI 1.81-1.88; RRHigh vs. Low=2.29, 95% CI 2.25-2.33). The significance of the SES-EBF association was attenuated when the type of hospital for childbirth was considered, revealing the significant mediating effect of BFH births in the SES-EBF association.

CONCLUSION

Socioeconomic disparities are linked to infant EBF rates, with giving birth at a BFH mediating this association, especially for cases with low SES in rural areas.

Untold Narratives: Perceptions of Human Milk Banking and Donor Human Milk Among Ghanaian Immigrant Women Living in the United States

BACKGROUND

Donor human milk (DHM) though primarily administered in the NICU setting is increasingly being offered in well baby nurseries to promote exclusive breastfeeding. Despite the evidence supporting the use of DHM as a preferred supplement when mother's own milk (MOM) is unavailable or insufficient, foreign-born non-Hispanic black women are less likely to use DHM. Recognizing the cultural diversity and uniqueness among foreign-born non-Hispanic black communities in the USA, this exploratory study sought to understand perceptions of DHM and human milk banking (HMB) as well as factors influencing decision-making toward DHM among Ghanaian immigrant women living in the USA.

METHODS

Semi-structured interviews were conducted with 16 Ghanaian women living in the USA. Using a narrative thematic approach, interview transcripts were coded, analyzed, and organized into categories and themes.

RESULTS

Findings indicate mixed sentiments toward DHM/HMB among Ghanaian immigrant women. Regarding decision-making toward DHM utilization and donation, four themes were identified: (1) women's decision-making which is informed by external influences, (2) health provider's role in promoting human milk utilization, (3) the importance of addressing barriers to human milk utilization and donation, and (4) superstition and spirituality.

CONCLUSIONS

Maternal perceptions of DHM/HMB are influenced by individual-, interpersonal-, and community-level factors. It is imperative that health promotion efforts adopt multi-level approaches to addressing the disparities in DHM access and utilization as well as factors that impact milk donation in order to ensure optimum health outcomes for neonates of foreign-born non-Hispanic black populations.

Parental Decision-Making Around Introducing Complementary Foods: An Integrative Review

A primary role in infant parenting is feeding, and this role undergoes a significant transition when introducing complementary foods (CF), with important long-term health implications. Understanding the influences on parental decision-making around timing the introduction to CF can help health care providers provide parents with effective support for feeding; however, the factors that influence parental decision-making have not been recently reviewed in the United States. To determine influences and information sources, this integrative review examined the literature from 2012 to 2022. Results indicated that parents are confused and distrustful of inconsistent and changing guidelines around CF introduction. Instead, developmental readiness signs may be a more appropriate way for practitioners and researchers to support parents in appropriate CF introduction. Future work is needed to evaluate interpersonal and societal influences on parental decision-making, as well as to develop culturally sensitive practices to support healthful parental decisions.

Stress, social support, and racial differences: Dominant drivers of exclusive breastfeeding

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001-0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.

Breastfeeding among South Sudanese refugees in protracted settlements in Adjumani district, Uganda: facilitators and barriers

BACKGROUND

Evidence suggests that forced migration and refugee status may adversely impact mothers' breastfeeding choices. Furthermore, suboptimal breastfeeding practices have been reported among vulnerable populations including those living in refugee settlements. Therefore, this study investigated the barriers and facilitators of breastfeeding in protracted settlements in Adjumani district, in the West Nile region in Uganda.

METHODS

This study was conducted among refugees living in protracted settlements located in Uganda in July 2019. Participants, originally from South Sudan, included mothers (n = 63) and fathers (n = 32) of children less than 24 months of age. Agojo, Ayilo-I, and Nyumanzi were randomly selected among the 17 refugee settlements in Adjumani. Participants formed a total of six focus group discussions (FGDs); four FGDs for mothers and two FGDs for fathers. Each FGD consisted of 15-16 participants. Data were transcribed verbatim and back-translated into English. Thematic analysis was used and data were analyzed using NVivo, v. 12.

RESULTS

Facilitators of breastfeeding included knowledge of breastfeeding benefits, support from husband/father, support from the community, and support from non-governmental organizations. Mothers and fathers noted that breastfeeding protected children from diseases and breastfed children grew well. Fathers, the community, and organizations provided material support for breastfeeding mothers. Four themes were identified as barriers to breastfeeding: physical, socioeconomic, knowledge, and psychosocial. Mothers and fathers described physical barriers such as mothers stop breastfeeding when they are sick or they feel they are not producing enough breastmilk. Mothers reported that working or educated mothers may use other milk to feed their infant. Some mothers and fathers believed infants under six months needed more than breastmilk. Fathers described psychosocial barriers such as mothers' fear of pain during breastfeeding and maternal mental health issues.

CONCLUSION

Interventions and policies that aim to improve breastfeeding in protracted settlements should consider addressing the barriers to breastfeeding at each level: physical, socioeconomic, knowledge, and psychosocial. Involving and encouraging support from husbands/fathers, relatives, and the community may increase adherence to breastfeeding recommendations.

Effectiveness of a community-based support programme to reduce social inequality in exclusive breastfeeding: study protocol for a cluster-randomised trial

BACKGROUND

Breastmilk is the ideal nutrition for infants, and breastfeeding protects infants and mothers from a range of adverse health outcomes. In Denmark, most mothers initiate breastfeeding but many cease within the first months resulting in just 14% reaching the World Health Organization recommendation of six months of exclusive breastfeeding. Furthermore, the low breastfeeding proportion at six months is characterised by a marked social inequality. A previous intervention tested in a hospital setting succeeded in increasing the proportion of mothers breastfeeding exclusively at six months. However, most breastfeeding support is provided within the Danish municipality-based health visiting programme. Therefore, the intervention was adapted to fit the health visiting programme and implemented in 21 Danish municipalities. This article reports the study protocol, which will be used to evaluate the adapted intervention.

METHODS

The intervention is tested in a cluster-randomised trial at the municipal level. A comprehensive evaluation approach is taken. The effectiveness of the intervention will be evaluated using survey and register data. Primary outcomes are the proportion of women who breastfeed exclusively at four months postpartum and duration of exclusive breastfeeding measured as a continuous outcome. A process evaluation will be completed to evaluate the implementation of the intervention; a realist evaluation will provide an understanding of the mechanisms of change characterising the intervention. Finally, a health economic evaluation will assess the cost-effectiveness and cost-utility of this complex intervention.

DISCUSSION

This study protocol reports on the design and evaluation of the Breastfeeding Trial - a cluster-randomised trial implemented within the Danish Municipal Health Visiting Programme from April 2022 to October 2023. The purpose of the programme is to streamline breastfeeding support provided across healthcare sectors. The evaluation approach is comprehensive using a multitude of data to analyse the effect of the intervention and inform future efforts to improve breastfeeding for all.

TRIAL REGISTRATION

Prospectively registered with Clinical Trials NCT05311631 https://clinicaltrials.gov/ct2/show/NCT05311631.

Factors associated with breastfeeding initiation and maintenance for Aboriginal and Torres Strait Islander women in Australia: A systematic review and narrative analysis

BACKGROUND

Australian Aboriginal and Torres Strait Islander (hereafter referred to as Aboriginal) women breastfeed at lower rates than non-Aboriginal women. Little is known about factors associated with breastfeeding specific to Aboriginal women and infants.

AIM

Determine the protective and risk factors associated with breastfeeding for Aboriginal women in Australia.

METHODS

CINAHL, Medline, EMBASE, SCOPUS, PsycINFO, and the Cochrane library were searched for peer-reviewed literature published between 1995 and 2021. Quantitative studies written in English reporting protective and risk factors associated with breastfeeding for Aboriginal women or women having an Aboriginal infant were included. Ten percent of papers were co-screened, and two reviewers completed data extraction. Narrative data synthesis was used.

FINDINGS

The initial search identified 12,091 records, with 31 full text studies retrieved, and 17 reports from 14 studies met inclusion criteria. Protective factors included living in a remote area, attending an Aboriginal-specific service, attending a regional service, higher levels of education attainment, increased maternal age, living in larger households, being partnered, and having a higher reported number of stressful events and social health issues. The identified risk factors were smoking in pregnancy, admission to SCN or NICU, and being multiparous.

CONCLUSION

This review identified factors associated with breastfeeding for Aboriginal women. Government focus, support, and consistent funding are required to plan and implement evidence-based interventions and services for Aboriginal women and infants in urban, rural, remote, and very remote locations. Rigorous research is required to understand the Aboriginal-specific factors associated with breastfeeding to improve rates and health outcomes for Aboriginal women and infants.

Breastfeeding within the circle of motherhood, restriction, and patriarchy: A qualitative study

Our purpose in the present study is to analyze the opinions of women regarding the factors that support and hinder their breastfeeding. This is a phenomenological and qualitative study. The present study included 32 breastfeeding women who live in different provinces in the Central Anatolia Region of Turkey. The data were collected using a semi-structured interview form and were evaluated using the content analysis method. Three themes and ten sub-themes about women's experience on breastfeeding their babies and factors affecting their breastfeeding were found. The themes identified were: motherhood, restriction, patriarchy.Supplemental data for this article is available online at https://doi.org/10.1080/07399332.2021.1935958 .

Factors influencing infant feeding for Aboriginal and Torres Strait Islander women and their families: a systematic review of qualitative evidence

BACKGROUND

Breastfeeding provides all the necessary energy and nutrients for an infant and provides many benefits for mothers and babies. The effects of colonisation have contributed to reduced prevalence and duration of breastfeeding among Australian Aboriginal women and widespread use of infant formula as a substitute for breastmilk. This review aimed to synthesise qualitative evidence about the factors that influence breastfeeding and infant feeding practices of Aboriginal and Torres Strait Islander women and their families.

METHODS

MEDLINE, CINAHL, Informit and Google Scholar were systematically searched for qualitative studies that included the perspective of Aboriginal and Torres Strait Islander women and their families about the factors influencing infant feeding decisions. Included studies were appraised using an Indigenous quality assessment tool and were synthesised via inductive thematic analysis informed by an ecological framework.

RESULTS

The search identified 968 studies with 7 meeting the inclusion criteria. Key factors influencing breastfeeding and infant feeding practices of Aboriginal women included cultural practices, normalisation of bottle feeding, shame associated with breastfeeding in public, access to culturally safe nutrition education, support services and health professionals, family/partner support, knowledge of the benefits of breastfeeding, experiences with previous babies and concern that the baby was not getting enough milk.

CONCLUSION

The perspectives of Aboriginal and Torres Strait Islander women must be considered when providing breastfeeding and infant feeding advice. This can be achieved through Aboriginal and Torres Strait Islander people designing, implementing, and leading the delivery of education and information regarding breastfeeding and health infant feeding practices that have been influenced by the priorities of Aboriginal and Torres Strait Islander communities.

Exploring Successful Breastfeeding Behaviors Among Women Who Have High Body Mass Indices

BACKGROUND

Women with high body mass indices are at risk of lower breastfeeding rates but the drivers of successful breastfeeding in this population are unclear.

RESEARCH AIM

We aimed to (a) explore the barriers and enablers to breastfeeding among women with high body mass indices and (b) map specific behaviors suitable for intervention across the antenatal to postpartum periods.

METHODS

This was a prospective, cross-sectional qualitative study. We conducted semi-structured interviews with women with high body mass indices who successfully breastfed for 6 months or more (n =20), partners (n = 22), and healthcare professionals (n =19) in Ireland during 2018. Interviews were audio recorded, and transcribed verbatim. Data were inductively coded using reflexive thematic analysis and deductively mapped within the Capability, Opportunity, Motivation-Behavior model.

RESULTS

The three themes developed were knowledge, support, and self-efficacy. Knowledge supported a participant's psychological and physical capability to engage in breastfeeding. Support was related to the social and physical opportunity to enable performance of breastfeeding behaviors. Self-efficacy influenced reflective and automatic motivation to perform breastfeeding behaviors. A multifactorial intervention design is needed to support successful breastfeeding.

CONCLUSION

The barriers and enablers identified for participants with high body mass indices were similar to those for the broader population; however, the physicality and associated social bias of high body mass indices mean that additional support is warranted. Antenatal and postpartum breastfeeding services need a multifaceted, inclusive, and high-quality program to provide the necessary support to women with higher body mass indices.

A Systematic Review of the Correlation Between Marital Relationship and Breastfeeding Self-Efficacy, and Duration of Breastfeeding

Background: Breastfeeding as an important key to sustainable development strategies is the best nutrition for ensuring healthy growth and development in the first 1,000 days of life. Objective: The current systematic review and meta-analysis were conducted to evaluate the correlation between marital relationship satisfaction and breastfeeding self-efficacy and duration of breastfeeding. Method: A systematical search was carried out in main electronic databases (PubMed, Scopus, Embase, ProQuest, and Web of Science) and gray literature until June 2022. The study's risk of bias was assessed using the Newcastle-Ottawa risk-of-bias tool. Publication bias was evaluated using a funnel plot, and Begg's and Egger's tests. The degree of heterogeneity was assessed using the I² test. To estimate common effect size r coefficient (r) and confidence intervals (95% CIs), random-effect models were fitted, and the results were presented using forest plots. Results: In total, 13 studies with 5,843 subjects were included in the meta-analysis. Overall, the pool estimates show a positive correlation between marital relationship satisfaction, and breastfeeding self-efficacy (r = 0.27, 95% CI (0.09-0.50), p = 0.024), but this relationship was not found in the term of breastfeeding duration (r = 0.11, 95% CI [-0.01 to 0.23], p = 0.079). The heterogeneity of studies was high (I² = 95.2%) Conclusion: Our finding confirms a positive and moderate level of correlation between marital relationship satisfaction and breastfeeding self-efficacy. It is suggested to conduct more studies to reach appropriate conclusions regarding marital relationship satisfaction and breastfeeding duration.

"Don't Feel Like You Have to Do This All on Your Own": Exploring Perceived Partner Support of Breastfeeding Among Black Women in Kentucky

BACKGROUND

Few researchers have explored partner breastfeeding support among Black women, who report low breastfeeding rates compared to women of other cultural groups. Ways to encourage partner support of Black women's breastfeeding can be understood from an Afrocentric perspective.

RESEARCH AIM

To explore perceptions of partner support among Black mothers to develop a culturally relevant framework of partner breastfeeding support.

METHODS

Secondary data analyses of qualitative data from a larger prospective, cross-sectional mixed methods study were utilized. Participants from Kentucky (N = 14), aged 23-71, who breastfed for at least 6 months, were recruited to participate in individual interviews. Professionally transcribed interviews were analyzed using Braun and Clarke's (2006) thematic analysis.

RESULTS

By integrating the Breastfeeding Coparenting Framework and Optimal Conceptual Theory, we identified four culturally affirming partner support themes that participants believed impacted their breastfeeding experiences: (a) doing research, (b) offering care, (c) verbalizing praise, and (d) achieving teamwork, and three culturally incongruent partner support barrier themes: (e) withdrawing commitment, (f) politicking bodies, and (g) stripping agency.

CONCLUSION

Participants who breastfed for at least 6 months largely attributed their breastfeeding success to the support received from their partners. Our findings offer a culturally relevant framework of partner breastfeeding support that can facilitate intervention efforts with participants and their partners to increase breastfeeding rates among this population.

Early newborn bathing and associated factors among mothers in Afar Region, Northeast Ethiopia

BACKGROUND

Delaying newborn bathing for 24 h after childbirth protects the baby from hypothermia, infection and hypoglycaemia and provides an opportunity for mother-baby emotional bonding. However, no previously published study has investigated the early newborn bathing practices of pastoral mothers in Ethiopia. This study aims to investigate early newborn bathing and associated factors among mothers in Afar Region, Northeast Ethiopia.

METHODS

Institution-based cross-sectional study was conducted from May to June 2021. A systematic random sampling technique was used to recruit 386 mothers, and the data collection was performed using an interviewer-administered questionnaire. Multivariable logistic regression modelling was used to examine the association between explanatory variables (including sociodemographic, obstetric, health service and health literacy factors) and early newborn bathing.

RESULTS

The overall prevalence of early newborn bathing among postpartum mothers was 73.1% with a 95% confidence interval (CI) from 68.4 to 77.5%. Mothers who attained college or higher education [adjusted odds ratio (AOR) = 0.21; 95% CI 0.06-0.66], those who were from urban areas (AOR = 0.19; 95% CI 0.09-0.42) and those who gave birth using operational delivery (e.g. caesarean section and instrumental delivery) (AOR = 0.01; 95% CI 0.01-0.04) were less likely to practice early newborn bathing.

CONCLUSION

The practice of early newborn bathing was unacceptably high in pastoral communities of the Afar Region. There is a need for interventions specifically targeting at uneducated and rural mothers as part of the implementation to improve the essential newborn care practices of mothers in pastoral communities in Ethiopia.

Amamentação na primeira hora de vida em município do interior do Rio de Janeiro: fatores associados

Resumo Objetivo analisar a amamentação na primeira hora de vida e os fatores associados em um município do interior do Rio de Janeiro. Método estudo online transversal, realizado entre maio de 2021 e agosto de 2022, com 97 parturientes do município de Rio das Ostras. Na associação entre variáveis, adotaram-se o Teste Qui-Quadrado e regressão logística. Resultados entre as participantes, 77,3% pariram na maternidade pública e 22,7% na maternidade privada. A prevalência da amamentação na primeira hora de vida na sala de parto e no alojamento conjunto foi, respectivamente, de 21,6% e 58,3%, com diferenças significativas entre as maternidades. Puérperas da maternidade pública tiveram mais chances de não amamentar na primeira hora de vida. Ter ensino básico aumentou as chances de o bebê não ser amamentado na sala de parto e não realizar contato pele a pele precoce, além de não ser amamentado no alojamento conjunto. Conclusão e implicações para a prática a amamentação na primeira hora de vida não atingiu níveis preconizados, e distintos fatores associados à sua ocorrência foram identificados, como nível de instrução, local do parto e contato pele a pele. Recomenda-se que maternidades implementem as práticas humanizadas no cuidado ao recém-nascido, para elevar as taxas da amamentação na primeira hora de vida.

Breastfeeding in the first hour of life in a city in the countryside of Rio de Janeiro: associated factors

Abstract Objective to analyze breastfeeding in the first hour of life and associated factors in a city in the countryside of Rio de Janeiro. Method a cross-sectional online study, carried out between May 2021 and August 2022, with 97 parturient women in the municipality of Rio das Ostras. In the association between variables, the chi-square test and logistic regression were used. Results among the participants, 77.3% gave birth in the public maternity hospital and 22.7% in the private maternity hospital. The prevalence of breastfeeding in the first hour of life in the delivery room and in rooming-in was, respectively, 21.6% and 58.3%, with significant differences between maternity hospitals. Postpartum women from the public maternity hospital were more likely to not breastfeed in the first hour of life. Having basic education increased the chances of the baby not being breastfed in the delivery room and not having early skin-to-skin contact and not breastfeeding breastfed in rooming-in. Conclusion and implications for practice breastfeeding in the first hour of life did not reach recommended levels and different factors associated with its occurrence were identified, such as education level, place of childbirth and skin-to-skin contact. It is recommended that maternity hospitals implement humanized practices in newborn care to increase breastfeeding rates in the first hour of life.

First-time Mothers' Understanding and Use of a Pregnancy and Parenting Mobile App (The Baby Buddy App): Qualitative Study Using Appreciative Inquiry

BACKGROUND

Internationally, there is increasing emphasis on early support for pregnant women to optimize the health and development of mothers and newborns. To increase intervention reach, digital and app-based interventions have been advocated. There are growing numbers of pregnancy health care apps with great variation in style, function, and objectives, but evidence about impact on pregnancy well-being and behavior change following app interaction is lacking. This paper reports on the qualitative arm of the independent multicomponent study exploring the use and outcomes of first-time mothers using the Baby Buddy app, a pregnancy and parenting support app, available in the National Health Service App Library and developed by a UK child health and well-being charity, Best Beginnings.

OBJECTIVE

This study aims to understand when, why, and how first-time mothers use the Baby Buddy app and the perceived benefits and challenges.

METHODS

This paper reports on the qualitative arm of an independent, longitudinal, mixed methods study. An Appreciative Inquiry qualitative approach was used with semistructured interviews (17/60, 28%) conducted with new mothers, either by telephone or in a focus group setting. First-time mothers were recruited from 3 study sites from across the United Kingdom. Consistent with the Appreciative Inquiry approach, mothers were prompted to discuss what worked well and what could have been better regarding their interactions with the app during pregnancy. Thematic analysis was used, and findings are presented as themes with perceived benefits and challenges.

RESULTS

The main benefit, or what worked well, for first-time mothers when using the app was being able to access new information, which they felt was reliable and easy to find. This led to a feeling of increased confidence in the information they accessed, thus supporting family and professional communication. The main challenge was the preference for face-to-face information with a health care professional, particularly around specific issues that they wished to discuss in depth. What could have been improved included that there were some topics that some mothers would have preferred in more detail, but in other areas, they felt well-informed and thus did not feel a need to seek additional information via an app.

CONCLUSIONS

Although this study included a small sample, it elicited rich data and insights into first-time mothers' app interactions. The findings suggest that easily accessible pregnancy information, which is perceived as reliable, can support first-time mothers in communicating with health care professionals. Face-to-face contact with professionals was preferred, particularly to discuss specific and personalized needs. Further studies on maternal and professional digital support preferences after the COVID-19 global pandemic and how they facilitate antenatal education and informed decision-making are recommended, particularly because digital solutions remain as a key element in pregnancy and early parenting care.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.1017/S1463423618000294.

The Role of Fathers in Promoting Exclusive Breastfeeding

The cornerstone of a newborn's nutrition is breastfeeding. Due to its well-known benefits for mothers, children, and society in the short and long term, the World Health Organization (WHO) and United Nations Children's Fund (UNICEF) recommend it as the best way of feeding the baby during the first six months of life. The family, particularly the spouse, may significantly influence the baby's quality of nursing. On a global scale, previous studies have demonstrated that family members (such as a mother's spouse, partner, or grandmother) not only affect her choice to start and endure breastfeeding but also significantly contribute to the early postnatal period's cessation of appropriate breastfeeding. A father's knowledge and attitude are fundamental in this regard, as he has the most critical role in helping women with parenting and feeding their babies. Furthermore, because the father's role is considered important in a family, the partner's or wife's perception of the father's attitude may alter her subjective criteria about exclusive breastfeeding (EBF). Future initiatives should target new mothers and their spouses to see how they may provide the most beneficial assistance to new mothers. The main focus should be on targeting newly married couples. The father's lack of involvement may be due to the hierarchical structure of power within households. Because of this hierarchical aspect, partners or fathers may significantly influence a mother's choice to nurse their child correctly. Household chores, childcare for grown-up children, guaranteeing the well-being of their spouse, preparing meals, recognizing a newborn's hunger cues, burping, and changing the infant's diaper after feedings, all these factors indirectly support the mother in initiating and enduring the nursing of a child.

The role of maternal ideations on breastfeeding practices in northwestern Nigeria: a cross-section study

Background

Early initiation of breastfeeding within the first hour of birth and exclusive breastfeeding (EBF) for the first six months of life are beneficial for child survival and long-term health. Yet breastfeeding rates remain sub-optimal in Northwestern Nigeria, and such practices are often influenced by complex psychosocial factors at cognitive, social and emotional levels. To understand these influences, we developed a set of breastfeeding-related ideational factors and quantitatively examined their relationship with early initiation of breastfeeding and EBF practices.

Methods

A cross‐sectional population‐based survey was conducted in Kebbi, Sokoto, and Zamfara states from September–October 2019. A random sample of 3039 women with a child under-2 years was obtained. Respondents were asked about the two main outcomes, early initiation of breastfeeding and EBF, as well as breastfeeding-related ideations according to the Ideation Model of Strategic Communication and Behavior Change. Average marginal effects were estimated from mixed-effects logistic regression models adjusted for ideational and socio-demographic variables.

Results

Among 3039 women with a child under 2 years of age, 42.1% (95% CI 35.1%, 49.4%) practiced early initiation of breastfeeding, while 37.5% (95% CI 29.8%, 46.0%) out of 721 infants aged 0–5 months were exclusively breastfed. Women who knew early initiation of breastfeeding was protective of newborn health had 7.9 percentage points (pp) [95% CI 3.9, 11.9] higher likelihood of early initiation of breastfeeding practice than those who did not know. Women who believed colostrum was harmful had 8.4 pp lower likelihood of early initiation of breastfeeding (95% CI -12.4, -4.3) and EBF (95% CI -15.7%, -1.0%) than those without that belief. We found higher likelihood of early initiation of breastfeeding (5.1 pp, 95% CI 0.8%, 9.4%) and EBF (13.3 pp, 95% CI 5.0%, 22.0%) among women who knew at least one benefit of breastfeeding compared to those who did not know. Knowing the timing for introducing complementary foods andself-efficacy to practice EBF were also significantly associated with EBF practices.

Conclusion

Ideational metrics provide significant insights for SBC programs aiming to change and improve health behaviors, including breastfeeding practices, Various cognitive, emotional and social domains played a significant role in women’s breastfeeding decisions. Maternal knowledge about the benefits of breastfeeding to the mother (cognitive), knowledge of the appropriate time to introduce complementary foods (cognitive), beliefs on colostrum (cognitive), self-efficacy to breastfeed (emotional) and perceived social norms (social) are among the most important ideations for SBC programs to target to increase early initiation of breastfeeding and EBF rates in northwestern Nigeria.

The Effect of a Father's Support on Breastfeeding: A Systematic Review

Aim: Including fathers in breastfeeding education programs may raise infant breastfeeding rates and durations. The aim of the study was to assess the effect on breastfeeding of breastfeeding education and/or psychosocial interventions in which fathers are included. Method: The study is based on the PRISMA method, the technique that is used in systematic reviews. A search was conducted in the literature over the period November 1, 2021-December 1, 2021 using keywords and without imposing any time restrictions. The databases "PubMed," "Web of Science," Scopus," "Medline," and "CINAHL" were scanned. Results: A total of 462 publications were reached. However, only 7 studies were considered for review on the basis of the inclusion criteria. Six of these 7 studies indicated that the support of the father increased the breastfeeding rate. Conclusions: This review shows that a father's support of breastfeeding improves breastfeeding outcomes. Including fathers in the breastfeeding process and ensuring their active participation increase breastfeeding rates.

Exclusive breastfeeding and women's psychological well-being during the first wave of COVID-19 pandemic in Italy

Background

At the onset of the COVID-19 pandemic, support for breastfeeding was disrupted in many countries. Italy was severely impacted by the pandemic and is known to have the lowest exclusive breastfeeding rate of all European countries. Considering the inverse association between anxiety and breastfeeding, maternal concerns about the COVID-19 emergency could reduce breastfeeding rates. The aim of the study is to explore the association between infant feeding practices and maternal COVID-19 concerns.

Methods

This paper is a secondary analysis of the cross-sectional study COVID-ASSESS conducted in Italy in 2020. The original survey was administered in two phases: during the first lockdown and during the reopening. The survey included five sections: socio-demographic, medical history, concerns about the COVID-19 pandemic, infant feeding practices and psychometric evaluation. Participants were considered eligible for the post-hoc analyses if they were exclusively breastfeeding or they were feeding with infant formula (either alone or with breastfeeding) at the time of the interview.

Results

Between phase 1 and phase 2 there was a decrease in anxiety and concerns about the danger of COVID-19 to general health, except for concerns about their baby's health. Women using formula were more concerned about all the health topics investigated. Moreover, they showed higher levels of stress, state anxiety, somatization and PTSD symptoms.

Conclusion

Breastfeeding during the first pandemic lockdown in Italy seems to have been an independent factor associated with lower anxiety about COVID-19, fewer psychopathological symptoms, and a positive experience of infant feeding.

Determinants of the interruption of exclusive breastfeeding at the 30th day after birth

Objective:

To estimate the prevalence of exclusive breastfeeding (EBF), introduction of water, herbal teas, or other milks, as well as to identify the factors associated with the interruption of EBF at the 30^th day after birth.

Methods:

This is a cross-sectional study using structured and pretested questionnaires applied to 310 mothers in two moments: in person, at the maternity ward; and at the time the infant was 30 days of age, by telephone call. Descriptive statistics and multivariate Poisson regression, following a multilevel hierarchical model according to the proximity to the outcome, were used to estimate the association between dependent and independent variables.

Results:

The maintenance of EBF at 30 days of age of the infant occurred in 85.2% of the sample, 1.6% receiving water, 11.5% herbal teas, and 8.2% other milk. Predictors for EBF interruption in the univariate analysis were the mothers’ return to work or study activities shortly after the baby's birth (IR 2.88; 95%CI 1.14–7.25) and the use of a pacifier (IR 3.29; 95%CI 1.52–6.22). The interruption of EBF was lower in the group of participants who received support from the infant's maternal grandmother (IR 2.71; 95%CI 1.11–6.56) and their partner (IR 4.78; 95%CI 1.90–12.06). After a multivariate analysis, only the use of a pacifier (IR 5.47; 95%CI 2.38–19.3) and the partner's support (IR 6.87; 95%CI 2.04–23.1) maintained the association with the outcome.

Conclusions:

The prevalence of EBF found in this study can be considered good, and future interventions aimed at increasing the duration of EBF in this population should take into account the participation of the partner and the reinforcement for not introducing the pacifier.

Antepartum Breast Pump Education for Mothers and Their Support Person: Effect on Time to First Expression and Lactation Outcomes-A Randomized Controlled Pilot Study

Objective: To determine the effect of providing antenatal education regarding milk expression to the support person (SP) of mothers of preterm infants on time to initial milk expression following delivery and daily volume of expressed mother's own milk. Methods: Sixty-one mothers delivering infants <35 weeks gestation and their SP were randomized to receive antenatal education regarding milk expression or to receive standard care. Time to initiation of milk expression was determined through self-report and verified through the electronic medical records. Expressed milk volume was measured on days 1-7 and weekly for 3 weeks. Results: No difference in time to first expression or expressed milk volume was found between groups. Posthoc analysis suggests those in the antenatal education group were more likely to express without nursing assistance and expressed more frequently during days 1-5. Conclusions: SP antenatal education may be an important step in supporting lactation in mothers of critically ill infants. Further research is needed to determine whether SP education during both the antenatal and early postpartum periods could improve lactation success. Clinical Trial Registration: ClinicalTrials.gov Identifier: NCT04006509.

Academy of Breastfeeding Medicine Clinical Protocol #2: Guidelines for Birth Hospitalization Discharge of Breastfeeding Dyads, Revised 2022

A central goal of the Academy of Breastfeeding Medicine is the development of clinical protocols for managing common medical problems that may impact breastfeeding success. These protocols serve only as guidelines for the care of breastfeeding mothers and infants and do not delineate an exclusive course of treatment or serve as standards of medical care. Variations in treatment may be appropriate according to the needs of an individual patient. The Academy of Breastfeeding Medicine recognizes that not all lactating individuals identify as women. Using gender-inclusive language, however, is not possible in all languages and all countries and for all readers. The position of the Academy of Breastfeeding Medicine (https://doi.org/10.1089/bfm.2021.29188.abm) is to interpret clinical protocols within the framework of inclusivity of all breastfeeding, chestfeeding, and human milk-feeding individuals.

Determinantes para a interrupção do aleitamento materno exclusivo aos 30 dias de vida

RESUMO Objetivo: Estimar a prevalência de aleitamento materno exclusivo (AME), introdução de água, chás ou outros leites, bem como identificar os fatores associados à interrupção do AME aos 30 dias de vida. Métodos: Estudo transversal que utilizou questionários estruturados e pré-testados, aplicados a 310 mães em dois momentos: presencialmente, na maternidade, e aos 30 dias de vida da criança, mediante ligação telefônica. Estatística descritiva e regressão multivariada de Poisson, seguindo modelo hierárquico multiníveis conforme a proximidade com o desfecho, estimaram a associação entre as variáveis dependentes e independentes. Resultados: A manutenção do AME aos 30 dias de idade da criança ocorreu em 85,2% da amostra, e 1,6 % receberam água, 11,5 % chás e 8,2% outro leite. Preditores para a interrupção do AME na análise univariada foram o retorno das mães ao trabalho ou estudo logo após o nascimento do bebê (razão de incidência — RI 2,88; intervalo de confiança — IC95% 1,14–7,25) e o uso de chupeta (RI 3,29; IC95% 1,52–6,22). A interrupção do AME foi menor no grupo de participantes que recebeu apoio da avó materna do lactente (RI 2,71; IC95% 1,11–6,56) e do companheiro (RI 4,78; IC95% 1,90–12,06). Após a análise multivariada, apenas o uso de chupeta (RI 5,47; IC95% 2,38–19,3) e o apoio do companheiro (RI 6,87; IC95% 2,04–23,1) mantiveram associação com o desfecho. Conclusões: A prevalência de AME encontrada neste estudo pode ser considerada boa, e futuras intervenções que visem ao aumento da duração do AME nessa população devem levar em consideração a participação do companheiro e o reforço para a não introdução da chupeta.

Prevalence and determinants of early initiation of breastfeeding (EIBF) and prelacteal feeding in Northern Ghana: A cross-sectional survey

BACKGROUND

There is suboptimal early initiation of breastfeeding (EIBF) with widespread prelacteal feeding in Ghana. However, studies exploring the determinants of EIBF and prelacteal feeding are limited in Ghana. The study was conducted to assess the prevalence and determinants of EIBF and prelacteal feeding in Northern Ghana.

METHODS

This cross-sectional study was conducted among 508 mothers with infants aged 0-24 months in the Sagnarigu Municipality of Northern Ghana. The quantitative data were collected using a structured questionnaire adapted from Ghana's demographic and health survey. Multivariate logistic regression was used to identify the independent determinants of EIBF and prelacteal feeding.

RESULTS

The prevalence of EIBF and prelacteal feeding was 72% and 21%, respectively. The independent positive determinants of EIBF were partner support to breastfeed [adjusted Odds ratio (AOR): 1.86, 95% Confidence interval (CI): 1.09-3.17] and exposure to breastfeeding information during pregnancy (AOR = 1.63 (95% CI: 1.01-2.64). Lower odds of EIBF were observed among mothers from extended family (AOR = 0.62, 95% CI: 0.41-0.95). Regarding prelacteal feeding, negative determinants were having a normal weight baby (AOR: 0.50, 95% CI: 0.27-0.90), exposure to breastfeeding information during pregnancy (AOR: 0.54, 95% CI: 0.31-0.92), while experiencing delayed onset of lactation was a risk factor for prelacteal feeding practice (AOR: 2.35, 95% CI: 1.41-3.94).

CONCLUSION

In this study, EIBF was slightly higher than the 2030 global target on EIBF with widespread prelacteal feeding practice. Health programs aimed at improving EIBF should focus on the women partners, nutrition counselling, and support to mothers from the extended family. In the same vein, programs aimed at discouraging prelacteal feeding practice should also target women at risk, such as those with low birthweight babies and women experiencing delayed lactation onset.

Exclusive breastfeeding in rural Western China: does father's co-residence matter?

BACKGROUND

China suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father's co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father's co-residence and breastfeeding family support as well as maternal decision-making power.

METHODS

A cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding.

RESULTS

The exclusive breastfeeding (0-6 months) rate was 16% in rural western China. Fathers' co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227-0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (β =0.109, P = 0.105; β =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (β = - 0.196, P = 0.007).

CONCLUSIONS

Fathers' co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father's education to help them better involvement and show more respect to mothers' decisions.

Infant and young child feeding (IYCF) practices and their determinants in two Urban districts of India

Introduction:

It is essential to maintain optimal nutrition during the early years of life when the growth rate is maximum.

Aims and Objectives:

Our study investigated the prevalence of various feeding practices. We also explored their association with different sociodemographic, biomedical variables, and childhood morbidity.

Methodology:

This was a cross-sectional community-based study. Data were collected through a questionnaire-based survey of mothers of school-going children aged 2–6 years in the districts of Anand and Vadodara, Gujarat.

Results:

A total of 367 mothers participated in the study. About 78% of the mothers did early initiation of breastfeeding within 1 h of birth, and 68% gave colostrum to the newborn. Around 30% of the mothers practiced bottle feeding, and 25% gave prelacteal feeds. Most mothers received good family support for breastfeeding (93.73%). On univariate analysis, we found the following associations of feeding practices—breastfeeding initiation with the gender of the baby (P value—0.006) and type of delivery (P value < 0.001); the duration of exclusive breastfeeding with the time difference between two deliveries (P value—0.027) and maternal age (P value—0.004); prelacteal feeds with the type of delivery (P value—0.034); feeding difficulty with the time difference between two deliveries (P value < 0.001) and breastfeeding at night with maternal education (P value—0.002). The time of the initiation of breastfeeding was associated with cough and cold episodes. No other association was found between breastfeeding variables and health indicators.

Conclusion:

Maternal age, maternal education, the time difference between two deliveries, the type of delivery, and gender of the baby were significantly associated with different Infant and Young Child Feeding (IYCF) practices. Identifying these factors might help in the development of strategies for optimizing feeding practices.

Factors that influence women's decision on infant feeding: An integrative review

BACKGROUND

Many women stop breastfeeding earlier than what they intended prior to birth. Although there are many studies that focus on the factors that influence women's antenatal breastfeeding decisions, the factors that influence women's decisions during the continuum of antenatal and postnatal period are less known.

AIM

To understand and synthesise the contemporary factors that influence women's decisions on infant feeding from the antenatal period and across the breastfeeding continuum.

METHOD

Five online databases (CINAHL, Medline, PubMed, Scopus and Web of Science) were searched. We included original search articles that were published since 2015 to August 2021 and were available in English. The framework of Whittemore and Knafl was used to guide this integrative literature review. Out of the 872 articles identified, 14 studies met the inclusion criteria of our study. We used theory of birth territory and midwifery guardianship to synthesise the interactions between the themes.

FINDINGS

Five main themes were identified: (a) Women's own views, (b) Family and friend's preferences and advice, (c) Health professional's preference, advice and practice, (d) Sociocultural norms, and (e) Media representation. The interaction between the themes was explained based on women's intrinsic and extrinsic power outlined in the birth territory and midwifery guardianship theory.

CONCLUSION

The factors that influence women's decisions towards infant feeding methods are complex and multi-dimensional. Promoting and supporting women towards breastfeeding need to focus on the factors that are tailored for a woman within her social network where she can feel safe about her breastfeeding decisions.

Nurses' and midwives' perspectives on how the pursuit for the 'perfect' body image affects their own breastfeeding practices: a qualitative study in Ghana

Background

Body image concerns have been widely documented in the literature as one reason why most women shorten the breastfeeding duration of their infants. Negative body image concerns among breastfeeding mothers may lead to depressive symptoms. There is a paucity of literature on how body image affects the breastfeeding practices of nurses and midwives. Therefore, this study explored the perspectives of breastfeeding nurses and midwives on how their body image affected their breastfeeding practices.

Methods

A qualitative design was used in this study. Five focus group discussions were conducted with each group having five members. The study was conducted in the Greater Accra Region of Ghana between November and December of 2020. Participants were recruited into the study using a purposive sampling method. Focus group sessions were audiotaped and transcribed verbatim. Data were analyzed using a content analysis.

Results

Three main themes emerged from the data analysis: body image concerns and breastfeeding, sociocultural pressures and breastfeeding and coping strategies. Participants had concerns regarding weight gain due to the need to eat adequately while breastfeeding. Body image concerns included increase in abdominal size, sagging breasts and generalized weight gain. These concerns and pressures negatively affected the breastfeeding practices of participants. Body image concerns reflected sociocultural pressures such as negative comments from loved ones and in the social media. The coping strategies adopted by the mothers were self-motivation and the love they had for their children.

Conclusions

The perspectives of breastfeeding nurses and midwives on the ways their body image affected their breastfeeding practices identified the need for support in order to successfully breastfeed.

Women's experiences of infant feeding support: Findings from a cross-sectional survey in Victoria, Australia

OBJECTIVE

To evaluate new mothers' experiences of infant feeding support.

DESIGN

A postal survey developed for this study was sent to all new mothers in ten local government areas in Victoria, Australia when their baby was six months of age. Questions explored infant feeding methods, feeding support services, and experiences of infant feeding support. This survey made up one component of the Supporting breastfeeding In Local Communities (SILC) cluster randomised controlled trial.

FINDINGS

997/4127 women (24%) completed the survey between 15 April 2013 and 31 July 2013. Women received infant feeding support from multiple sources, including professionals, family members, and peers. Overall, 88% reported receiving adequate infant feeding support. Women who reported not receiving adequate infant feeding support were less likely to be giving any breast milk at six months compared to those reporting adequate support (OR = 0.59; 95% CI 0.40, 0.88). Adjusting for breastfeeding intention and parity did not alter the association (Adj. OR = 0.60; 95% CI 0.40, 0.90). Women were most satisfied when they received accessible, available, consistent professional infant feeding support provided in a non-judgemental and reassuring way. Women were dissatisfied when there were barriers restricting access to support, or when they received conflicting advice or support that made them feel guilty, pressured or judged.

KEY CONCLUSIONS

Regardless of infant feeding method, women wanted accessible, non-judgemental support. Given that receiving adequate support was associated with more breast milk feeding at six months, care providers should ensure accessible infant feeding support is available to all new mothers.

Interventions to improve infant and young child feeding practices in Ethiopia: a systematic review

OBJECTIVE

In Ethiopia, despite the implementation of several interventions to improve infant and young child feeding (IYCF) practices, no published studies have highlighted the most effective IYCF interventions in the country. This systematic review investigated the impacts of various interventions on IYCF in Ethiopia.

SOURCE OF INFORMATION

A systematic search was conducted on seven computerised bibliographic databases (Embase, ProQuest Central, Scopus, PsycINFO, Web of Science, MEDLINE/PubMed and CINAHL) to locate experimental or quasi-experimental studies published between the year 2000 and May 2021.

STUDY ELIGIBILITY CRITERIA

Interventional studies that measured IYCF indicators (early initiation of breast feeding (EIBF), exclusive breast feeding (EBF), the introduction of complementary foods, minimum dietary diversity (MDD), minimum meal frequency (MMF) and minimum acceptable diet) as outcome variables were included.

STUDY APPRAISAL AND SYNTHESIS

All included studies were examined for biases related to interventional studies (ie, selection bias, performance bias, attrition bias, detection bias and reporting bias). Author reports of effect size measures were used to narratively report the findings of each study.

RESULTS

Of the 23 eligible studies, 14 studies were quasi-experimental and 9 studies were cluster randomised trials (CRTs). Eight quasi-experimental studies had a serious risk of bias, while two CRTs had a high risk of bias. Four studies for EBF and six studies for EIBF showed significant impacts of policy advocacy, health service strengthening, interpersonal communication, community mobilisation and mass media campaigns. Six studies for MDD and three studies for MMF indicated significant effects of community-level and health facility complementary feeding promotions on infants and young children. Interventions that delivered in combination increased the impacts in improving EIBF, MDD and MMF compared with a single intervention.

CONCLUSION

Our review showed that 12 out of 21 eligible studies that implemented in the form of community-level and health facility interventions improved EIBF, EBF, and/or MDD in Ethiopia.

PROTOCOL REGISTRATION NUMBER

PROSPERO, CRD42020155519.

Knowledge of breastfeeding practice and associated factors among fathers whose wife delivered in last one year in Gurage Zone, Ethiopia

BACKGROUND

Breastfeeding is the feeding of an infant or young child with breast milk directly from female human breasts. It confers short-term and long-term benefits for both child and mother, including helping to protect children against a variety of acute and chronic disorders. In mothers, breastfeeding (BF) reduces postpartum bleeding, enhances accelerated involution of the uterus, and plays a crucial role in child spacing. Fathers have an important but often neglected role in the promotion of healthy breastfeeding practices. Evidence shows that mothers who have a supportive and encouraging partner are more likely to plan to breastfeed for a longer duration. So, this study was aimed to assess knowledge and associated factors towards breastfeeding practice among fathers.

METHODS

A community-based cross-sectional study was conducted in Gurage Zone among 597 fathers. One stage cluster sampling technique was used to select study participants. An interviewer-administered questionnaire was used to collect the data and it was checked for consistency and completeness and entered into epi data and exported to SPSS for analysis. Bivariate and multivariate logistic regression analysis was done to identify independent predictors. P-value < 0.05 was considered to declare a result as statistically significant.

RESULT

In this study, a total of 585 participants were involved making a response rate of 98%. The overall knowledge status of participants was 341 (58.3%). The mean age of participants was 29.5 (SD±4.5). Urban residence, educational status, exposure to media, having more than one baby at home, and accompany his wife during health-seeking were independent predictors of knowledge status.

CONCLUSION

This study has shown the level of knowledge of fathers towards breastfeeding in the study area was low (58.3%). Residence, two or more babies at home, accompany during ANC, and indexed infant illness was independent predictors of knowledge status of fathers towards breastfeeding. Policymakers and possible stack holders should better focus on the improvement of knowledge because the knowledge determines the overall condition of the family including the psychological development of the children that affect their life especially in a country like Ethiopia in which most of the decisions are made by them. Other researchers focus on the interaction of parents and the child and feeding disorders.

Maternal perception of paternal breastfeeding support: A secondary qualitative analysis

OBJECTIVE

To describe how women perceive paternal support of breastfeeding and identify actions women value during the early breastfeeding postpartum.

DESIGN

A qualitative secondary analysis of semi-structured interviews using thematic analysis collected after birth and via telephone at 1, 2, 3, and 4 weeks after discharge.

SETTING

A regional medical center in the southeast region of the United States.

PARTICIPANTS

Sixty-two women yielded 130 transcripts with 32 transcripts conducted after birth, and 19, 16, 27, and 36 transcripts conducted after discharge via telephone at weeks 1, 2, 3, and 4, respectively.

FINDING

Women reported three themes of paternal support of breastfeeding (1) participating in the breastfeeding decision, (2) being a partner of breastfeeding, and (3) caring for breastfeeding mothers.

CONCLUSION AND IMPLICATION FOR PRACTICE

Paternal support of breastfeeding is a learning process that requires teamwork for women and their partners to master breastfeeding. Women and their partners as co-parents solve breastfeeding problems and achieve their breastfeeding goals, which promotes maternal well-being and bonding with their infants. Future interventions will guide partners to support breastfeeding and women's postpartum physical and psychological needs.

The association between paternal characteristics and exclusive breastfeeding in Ghana

Background

Studies have shown that partners play an influential role in exclusive breastfeeding practice and that they can act as either deterrents or supporters to breastfeeding. However, there are limited studies on the influence of partners’ characteristics on exclusive breastfeeding in Ghana. This study examined the association between partners’ characteristics and exclusive breastfeeding in Ghana.

Methods

This cross-sectional study used data from the 2014 Ghana Demographic and Health Survey. Infants less than 6 months old (exclusively breastfed or not) with maternal and paternal characteristics were included in the study. A total of 180 participants were used for the study. A binary logistic regression was used to examine the influence of partners’ characteristics on exclusive breastfeeding.

Results

Partners’ characteristics such as education, desire for children, religion, and children ever born were associated with exclusive breastfeeding. Mothers whose partners had primary education (AOR = 0.12; CI 95%: 0.02–0.93; p = 0.04) were less likely to practice exclusive breastfeeding compared to those whose partners had no formal education. Also, mothers whose partners desired more children (AOR = 0.20; CI 95%: 0.06–0.70; p = 0.01) were less likely to practice exclusive breastfeeding compared to those whose partners desire fewer children.

Conclusion

Improving EBF requires the involvement of partners in exclusive breastfeeding campaigns/programmes. A more couple-oriented approach is required by health practitioners to educate and counsel both mothers and partners on the importance of exclusive breastfeeding in Ghana.

Barriers and Facilitators for Exclusive Breastfeeding in Women's Biopsychosocial Spheres According to Primary Care Midwives in Tenerife (Canary Islands, Spain)

(1) The objective of our study is to determine, from a primary care midwife's perspective, which biopsychosocial factors can favour or be detrimental to exclusive breast feeding. (2) The study was carried out in Tenerife (Canary Islands, Spain) and is based on qualitative methodology. Twenty in-depth interviews were carried out with midwives working in primary care centres in Tenerife, using a content analysis approach. The transcript data was then encoded following an inductive approach. (3) According to the perceptions of the primary care midwives who were interviewed, the barriers and facilitators that influence exclusive breastfeeding related to the biopsychosocial spheres of women are, at an individual level, the physical and emotional aspects during the postnatal period; at the relationship level, the presence or not of support from the close family and partner; at the community level, the environment and social networks the new mothers may have; and at the work level, characteristics of jobs and early return to work. (4) The findings of our research can help healthcare professionals to approach the promotion and encouragement of exclusive breast feeding at each of the levels studied, with the aim of increasing rates following recommendations issued by The World Health Organization.

Understanding the Enablers and Barriers to Appropriate Infants and Young Child Feeding Practices in India: A Systematic Review

Despite efforts to promote infant and young child feeding (IYCF) practices, there is no collective review of evidence on IYCF enablers and barriers in India. This review was conducted using 2015 Preferred Reporting Items for Systematic reviews and Meta-Analysis (PRISMA) guidelines. Six computerized bibliographic databases, Scopus, PubMed, PsycINFO, CINAHL, Embase, and Ovid MEDLINE, were searched for published studies on factors associated with IYCF practices in India from 1 January 1993, to 30 April 2020. IYCF practices examined were early initiation of breastfeeding, exclusive breastfeeding, continued breastfeeding at one year, introduction to solid semi-solid or soft foods, minimum dietary diversity, minimum meal frequency, minimum acceptable diet, continued breastfeeding at two years, predominant breastfeeding, and bottle feeding. In total, 6968 articles were retrieved, and 46 studies met the inclusion criteria. The common enablers of IYCF were higher maternal socioeconomic status (SES) and more frequent antenatal care visits (ANC) (≥3). Common barriers to IYCF practices were low SES and less frequent ANC. The review showed that the factors associated with IYCF practices in India are largely modifiable and multi-factorial. Improving IYCF practices would require the adoption of both facilities- and community-based policy interventions at the subnational and national levels in India.

Breastfeeding Practices among Adolescent Mothers and Associated Factors in Bangladesh (2004-2014)

Optimal breastfeeding practices among mothers have been proven to have health and economic benefits, but evidence on breastfeeding practices among adolescent mothers in Bangladesh is limited. Hence, this study aims to estimate breastfeeding indicators and factors associated with selected feeding practices. The sample included 2554 children aged 0-23 months of adolescent mothers aged 12-19 years from four Bangladesh Demographic and Health Surveys collected between 2004 and 2014. Breastfeeding indicators were estimated using World Health Organization (WHO) indicators. Selected feeding indicators were examined against potential confounding factors using univariate and multivariate analyses. Only 42.2% of adolescent mothers initiated breastfeeding within the first hour of birth, 53% exclusively breastfed their infants, predominant breastfeeding was 17.3%, and 15.7% bottle-fed their children. Parity (2-3 children), older infants, and adolescent mothers who made postnatal check-up after two days were associated with increased exclusive breastfeeding (EBF) rates. Adolescent mothers aged 12-18 years and who watched television were less likely to delay breastfeeding initiation within the first hour of birth. Adolescent mothers who delivered at home (adjusted OR = 2.63, 95% CI:1.86, 3.74) and made postnatal check-up after two days (adjusted OR = 1.67, 95% CI: 1.21, 2.30) were significantly more likely to delay initiation breastfeeding within the first hour of birth. Adolescent mothers living in the Barisal region and who listened to the radio reported increased odds of predominant breastfeeding, and increased odds for bottle-feeding included male infants, infants aged 0-5 months, adolescent mothers who had eight or more antenatal clinic visits, and the highest wealth quintiles. In order for Bangladesh to meet the Sustainable Development Goals (SDGs) 2 and 3 by 2030, breastfeeding promotion programmes should discourage bottle-feeding among adolescent mothers from the richest households and promote early initiation of breastfeeding especially among adolescent mothers who delivered at home and had a late postnatal check-up after delivery.

Current Resources for Evidence-Based Practice, November 2020

An extensive review of new resources to support the provision of evidence-based care for women and infants. The current column includes a discussion of diversity in the maternity care workforce and commentaries on reviews focused on burnout in midwifery and a cross-national comparison of guidelines for uncomplicated childbirth.

Predictors of early initiation of breastfeeding in Indonesia: A population-based cross-sectional survey

Introduction

Commencing breastfeeding within one hour of birth is defined as early initiation of breastfeeding (EIBF). Both the mother and child benefit from EIBF. This study aims to identify the predictors of EIBF among Indonesian women.

Methods

This paper analyses data from a weighted sample of 6,616 women collected at the Indonesia Demographic and Health Survey (IDHS) 2017.The frequency of EIBF is measured by the proportion of children born in the two years preceding the survey who received breastmilk within one hour of birth. The analysis uses bivariate and multivariate logistic regression for complex sample designs, adjusted for confounders to examine the relationship of EIBF with women’s individual, household and community level characteristics.

Results

Overall, 57% (95% CI: 54.9%-58.2%) of the children born in the two years preceding the survey had EIBF. Statistically significant (p<0.05) predictors of EIBF are women’s non-working status, second or higher order of the birth of the most recent child, average or large size of the most recent child at birth, poor status of the household and non-agricultural work of the woman’s husband; while statistically highly significant (p<0.01) predictors are skin-to-skin contact with the new-born (OR: 2.62; 95% CI: 2.28–3.00), Caesarean deliveries (OR: 0.47; 95% CI: 0.40–0.56), and skilled birth attendants (OR: 1.83; 95% CI: 1.65–2.08). Caesarean deliveries reduce the likelihood of EIBF by half compared to vaginal deliveries. Women’s age, education or rural-urban residence display no statistically significant relationship with EIBF.

Conclusion

Skin-to-skin contact, mode of delivery and type of birth attendance exert the strongest influence on EIBF in Indonesia in 2017. EIBF should be continuously promoted and supported particularly among mothers who do not have early skin-to-skin contact with their new-born, who have Caesarean deliveries and who have no skilled birth attendant.

Associations between infant and young child feeding practices and acute respiratory infection and diarrhoea in Ethiopia: A propensity score matching approach

BACKGROUND

Acute respiratory infection (ARI) and diarrhoea are the leading causes of childhood morbidity and mortality in Ethiopia. Understanding the associations between infant and young child feeding (IYCF) and ARI and diarrhoea can inform IYCF policy interventions and advocacy in Ethiopia. This study aimed to investigate the relationship between IYCF practices and ARI and diarrhoea in Ethiopian children.

METHODS

This study used the Ethiopia Demographic and Health Survey (EDHS) data for the years 2000 (n = 3680), 2005 (n = 3528), 2011 (n = 4037), and 2016 (n = 3861). The association between IYCF practices and (i) ARI and (ii) diarrhoea were investigated using propensity score matching and multivariable logistic regression models. The IYCF practices include early initiation of breastfeeding, exclusive breastfeeding (EBF), predominant breastfeeding, introduction of complementary foods, continued breastfeeding at two years and bottle feeding.

RESULTS

Infants and young children who were breastfed within 1-hour of birth and those who were exclusively breastfed had a lower prevalence of ARI. Infants who were exclusively and predominantly breastfed had a lower prevalence of diarrhoea. Early initiation of breastfeeding (Odds ratio [OR]: 0.81; 95% confidence interval [CI]: 0.72, 0.92) and EBF (OR: 0.65; 95% CI: 0.51, 0.83) were associated with lower risk of ARI. Bottle-fed children had higher odds of ARI (OR: 1.36; 95% CI: 1.10, 1.68). Early initiation of breastfeeding and EBF were associated with lower odds of diarrhoea (OR: 0.88; 95% CI: 0.79, 0.94 for Early initiation of breastfeeding and OR: 0.51; 95% CI: 0.39, 0.65 for EBF). Infants who were predominantly breastfed were less likely to experience diarrhoea (OR: 0.69; 95% CI: 0.53, 0.89).

CONCLUSION

The recommended best practices for preventing ARI and diarrhoeal diseases in infants and young children namely: the early initiation of breastfeeding, EBF and avoidance of bottle feeding should be institutionalized and scale-up in Ethiopia as part of implementation science approach to cover the know-do-gaps.