ArticleLiterature Review

Prevalence of breastfeeding in industrialized countries

July 2012
Revue d Épidémiologie et de Santé Publique 60(4):305-20

DOI:10.1016/j.respe.2012.02.008

Source
PubMed

Authors:

Gladys Ibanez

Sorbonne University

Marie-Josephe Saurel-Cubizolles

French Institute of Health and Medical Research

Show all 6 authorsHide

Given the benefits of breastfeeding (BF), healthcare institutions recommend that a child should be breastfed for the first 6 months of its life. This study provides a review of BF as a function of socioeconomic criteria in various industrialized countries. A review was carried out between 1st January 1998 and 1st March 2009, using Medline and the Public Health Database. The papers were selected independently by two persons, using a methodological grid designed to evaluate the quality of the studies. From 1126 initially selected papers, 26 from 16 different countries were retained for further analysis. The prevalence of exclusive BF initiation was the highest in Norway, Denmark, and Japan with, respectively, 99, 98.7, and 98.3%. This prevalence was the lowest in the United Kingdom, the United States, and France with, respectively, 70, 69.5, and 62.6%. Women who breastfeed less were most commonly found to be young, single, from a low socioeconomic group, or with a low level of education. Women from immigrant population groups breastfed more than the native-born population during their pregnancy. Knowledge of the sociodemographic distribution of women who breastfeed is essential for the definition of preventive policies, which are needed to reduce health-related social inequalities. An in-depth analysis of existing primary healthcare programs would allow new strategies to be defined.

Establishing trust through home visits during pregnancy: a realist evaluation of a Danish breastfeeding support intervention

Article

Full-text available

Jan 2025

Background Breastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. A Danish intervention included a home visit by a health visitor during pregnancy to prolong breastfeeding and reduce social inequality in its rates. The purpose of this study was to investigate how this home visit affected breastfeeding support across socioeconomic groups with attention to how, and for whom, it activated a mechanism of improved relationship and trust between the health visitor and the family. Methods Our study used a realist evaluation approach and was embedded in a cluster randomized trial carried out in 20 municipalities. In the intervention arm, we observed 35 home visits delivered by the health visitors, interviewed 16 mothers and conducted 6 focus groups with a total of 34 health visitors to examine the intervention mechanisms and contextual factors that influence the generation of outcomes. The analysis applied Luhmann’s, and Brown and Meyers’ concepts of trust as middle-range theories. Results The pregnancy home visit helped early establishment of trust which enhanced the subsequent breastfeeding support postpartum in numerous ways. In realist terms, our central mechanism of change, the establishment of trust, had optimal conditions for success in the contextual setting of the pregnancy home visit where there was time, peace, undisturbed conversations, mental capacity to reflection, and a perceived more even power balance between the family and the health visitor which resulted in a range of positive outcomes. The mechanism resulted in improved tailored breastfeeding support postpartum, families reaching out to the health visitor sooner when experiencing breastfeeding difficulties, and families expressing a more positive experience of breastfeeding. The mechanism was activated across the different socioeconomic groups. Conclusions The circumstances of the pregnancy home visit helped to establish trust between the health visitor and the family. Especially for families in vulnerable positions, the pregnancy home visit seems to be a potent driver for enhancing the gains from breastfeeding support.

Does regular antenatal exercise promote exclusive breastfeeding during the first 3 months of life? Secondary analyses of a randomized controlled trial

Article

Full-text available

Aug 2023

Introduction: Exclusive breastfeeding (EBF) and antenatal exercise are independently associated with positive short- and long-term health effects for women and their children. The aims of the study were to investigate whether antenatal exercise promotes EBF three months postpartum and further to explore factors associated with EBF at three months postpartum. Methods: This study was a follow-up of a Norwegian two-center randomized controlled trial to assess the effect of an antenatal exercise protocol. The recruited pregnant women were randomized to either a 12-week standardized antenatal exercise program with one weekly group training led by a physiotherapist and two weekly home training sessions or standard antenatal care. Women reported breastfeeding status in a questionnaire at three months postpartum. Results: Of the 726 women, 88% were EBF at three months postpartum. There was no significant difference in EBF rates between the intervention group (87%) and the control group (89%). EBF was positively associated with maternal education (AOR=3.4; 95% CI: 1.7-6.7) and EBF at discharge from the hospital (AOR=22.2; 95% CI: 10-49). Admission to neonatal intensive care unit was identified as a significant barrier to EBF (AOR=0.2; 95% CI: 0.1-0.4). Significantly more women in the non-EBF group had sought professional help compared to women in the EBF group (p≤0.001). Conclusions: Regular physical exercise during pregnancy did not influence the exclusive breastfeeding rates at three months postpartum. Considering the health effects of exclusive breastfeeding and antenatal physical exercise, studies with follow-up periods beyond three months postpartum are warranted.

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

Article

Full-text available

Mar 2023
BMC PUBLIC HEALTH

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

Increase of breast-feeding in the past decade in Greece, but still low uptake: cross-sectional studies in 2007 and 2017

Article

Jan 2020

Objective To estimate breast-feeding prevalence in Greece in 2007 and 2017, compare breast-feeding indicators and maternity hospital practices between these years, and investigate breast-feeding determinants. Design Two national cross-sectional studies (2007 and 2017) using systematic cluster sampling of babies with the same sampling design, data collection and analysis methodology. Setting Telephone interview with babies’ mothers or fathers. Participants Representative sample of infants who participated in the national neonatal screening programme ( n 549 in 2017, n 586 in 2007). Results We found that breast-feeding indicators were higher in 2017 compared with 10 years before. In 2017, 94 % of mothers initiated breast-feeding. Breast-feeding rates were 80, 56 and 45 % by the end of the 1st, 4th and 6th completed month of age, respectively. At the same ages, 40, 25 and <1 % of babies, respectively, were exclusively breast-feeding. We also found early introduction of solid foods (after the 4th month of age). Maternity hospital practices favouring breast-feeding were more prevalent in 2017, but still suboptimal (63 % experienced rooming-in; 51 % experienced skin-to-skin contact in the first hour after birth; 19 % received free sample of infant formula on discharge). Conclusions We observed an increasing trend in all breast-feeding indicators in the past decade in Greece, but breast-feeding rates – particularly rates of exclusive breast-feeding – remain low. Systematic public health initiatives targeted to health professionals and mothers are needed in order to change the prevailing baby feeding ‘culture’ and successfully implement the WHO recommendations for exclusive breast-feeding during the first 6 months of life.

How do home visits during pregnancy strengthen breastfeeding support postpartum? A realist evaluation of a large Danish breastfeeding intervention

Preprint

Full-text available

Jun 2024

Background Breastfeeding has numerous health benefits but social inequality in breastfeeding is documented in many high-income countries. The evidence for improving breastfeeding support through prenatal encounters is conflicting, but points towards a mechanism activated through a positive relationship between the families and their health care providers. In Denmark, an intervention including a pregnancy home visit from a health visitor with focus on breastfeeding was implemented in a cluster randomized design in 20 municipalities to prolong and reduce social inequality in breastfeeding. The purpose of this study was to investigate how the pregnancy home visit affected breastfeeding support across socioeconomic groups with attention to how, and for whom, the pregnancy visit activated a mechanism of improved relationship and trust between the health visitor and the family. Methods We used a realist evaluation approach. In the intervention arm, we observed 35 home visits delivered by the health visitors, interviewed 16 mothers and conducted 6 focus groups with a total of 34 health visitors to examine the intervention mechanisms and contextual factors that influence the generation of outcomes. The analysis applied Luhmann’s, and Brown and Meyers’ concepts of trust as middle-range theories. Results The pregnancy home visit enabled early establishment of trust which enhanced the subsequent breastfeeding support postpartum in numerous ways. In realist terms, our central mechanism of change, the establishment of trust, had optimal conditions for success in the contextual setting of the pregnancy home visit where there was time, peace, undisturbed conversations, mental capacity to reflection, and a perceived more even power balance between the family and the health visitor which resulted in a range of positive outcomes. The mechanism resulted in improved tailored breastfeeding support postpartum, families reaching out to the health visitor sooner when experiencing breastfeeding difficulties, and families expressing a more positive experience of breastfeeding. The mechanism was activated across the different socioeconomic groups. Conclusions The circumstances of the pregnancy home visit increase the chances of establishment of trust between the health visitor and the family. Especially for families in vulnerable positions, the pregnancy home visit is a potent driver for enhancing the gains from breastfeeding support.

Breastfeeding after Returning to Work: A Systematic Review and Meta-Analysis

Article

Full-text available

Aug 2021
Int J Environ Res Publ Health

Background: The benefits of breastfeeding are widely known; however, continuation after returning to work (RTW) is not. We aimed to conduct a systematic review and meta-analysis to assess the prevalence of breastfeeding after RTW. The secondary objectives were to compare the economic statuses between continents. Method: PubMed, Cochrane Library, Base, and Embase were searched until 1 September 2020, and two independent reviewers selected the studies and collated the data. To be included, articles needed to describe our primary outcome, i.e., prevalence of breastfeeding after RTW. Results: We included 14 studies, analyzing 42,820 women. The overall prevalence of breastfeeding after RTW was 25% (95% CI, 21% to 29%), with an important heterogeneity (I2 = 98.6%)-prevalence ranging from 2% to 61%. Stratification by continents and by GDP per capita also showed huge heterogeneity. The Middle East had the weakest total prevalence with 10% (6% to 14%), and Oceania the strongest with 35% (21% to 50%). Despite the prevalence of breastfeeding in general increasing with GDP per capita (<US

5000: 19%, US

5000-30,000: 22%; US

30,000 to 50,000: 25%, >US

50,000 42%), the prevalence of non-exclusive breastfeeding follows more of a U-curve with the lowest and highest GDP per capita having the highest percentages of breastfeeding (<US

5000: 47% and >US

50,000: 50%, versus <28% for all other categories). Conclusion: Breastfeeding after RTW is widely heterogeneous across the world. Despite economic status playing a role in breastfeeding after RTW, cultural aspects seem influential. The lack of data regarding breastfeeding after RTW in most countries demonstrates the strong need of data to inform effective preventive strategies.

Comparison of national cross-sectional breast-feeding surveys by maternal education in Europe (2006-2016)

Article

Full-text available

Apr 2019

Objective Breast-feeding is an important determinant of health of mothers and their offspring. The present study aimed to compare breast-feeding rates across Europe disaggregated by maternal education and establish what proportion achieves at least 50 % exclusive breast-feeding (EBF) at 6 months. Design/Setting Secondary analysis of national or sub-national studies’ breast-feeding data for EU Member States plus Norway and Iceland, published in 2006–2016. Nineteen EU Member States plus Norway reported rates of EBF and any breast-feeding disaggregated by maternal education, of which only thirteen could be matched to the International Standard Classification of Education. Participants Mothers and their infants aged 0–12 months. Results Data on EBF rates at 6 and 4 months were found in only four and six countries, respectively. At 6 months, EBF rates of 49 % in Slovakia and 44 % in Hungary were closest to WHO’s target of at least 50 % EBF. At 4 months, mothers with high education level in Denmark, the Netherlands and Germany had the highest EBF rates (71, 52 and 50 %, respectively). Mothers with low education level were less likely to initiate breast-feeding and cessation occurred early. The inequality gap ranged from 63 % in Irish mothers to no gap or very low levels of inequality in Poland, Sweden and Norway. Conclusions More mothers with high, compared with low, education initiate breast-feeding and practise EBF for longer. More European policies should be targeted to protect, support and promote breast-feeding, especially among mothers with only mandatory education.

Practice of exclusive breastfeeding and its associated factors in a suburban area in Angola: a cross-sectional study

Article

Full-text available

Dec 2018
SAO PAULO MED J

Background: Exclusive breastfeeding for six months is one of the measures with highest impact on prevention of child deaths. The determinants of breastfeeding practices are complex and differ between populations. This study aimed to identify factors associated with the prevalence of exclusive breastfeeding in a suburban area in Angola. Design and setting: Population-based cross-sectional study in the municipality of Cacuaco, Luanda. Methods: A random sample of children under two years of age and their mothers was included. -Prevalence ratios (PR) were estimated using Poisson regression based on a hierarchical model. Results: 749 children and their mothers were surveyed, including 274 children under six months. Theprevalence of exclusive breastfeeding among children under six months was 51.5% (95% confidence interval, CI, 46.3-56.6%). Four variables were positively associated with exclusive breastfeeding at ages of under six months: number of prenatal visits (PR 1.11 for each visit after the first one; 95% CI 1.04-1.18), maternal occupation (other occupations versus self-employed) (PR 1.54; 95% CI 1.05-2.26), younger child age (PR 0.77 for each month; 95% CI 0.71-0.84) and female child (PR 1.34; 95% CI 1.02-1.76). Conclusions: Our findings showed that the prevalence of exclusive breastfeeding at six months was satisfactory, according to international recommendations. Factors associated with exclusive breastfeeding practices that had never been surveyed before in Angola were identified through this study. These data are particularly relevant in the context of high infant mortality and may be useful in planning actions aimed at improving child health through promotion of exclusive breastfeeding, in Angola and other countries.

Early Initiation of Breastfeeding and Exclusive Breastfeeding in Anglophone and Francophone West African Countries: Systematic Review and Meta‐Analysis of Prevalence

Article

Full-text available

Jan 2025
MATERN CHILD NUTR

Early initiation of breastfeeding (EIBF) and exclusive breastfeeding (EBF) are highly effective forms of preventive medicine in many low‐ and middle‐income countries, including Anglophone and Francophone West African countries. Despite the proven benefits of EIBF and EBF in reducing mortality and morbidity, there is limited systematic evidence from West African countries. Hence, the aim of this systematic review and meta‐analysis was to estimate the pooled prevalence of EIBF and EBF in Anglophone and Francophone West African countries. Six databases were searched for eligible studies based on inclusion criteria and a systematic review and a further meta‐analysis were done. The weighted prevalence of EIBF was 51.7% (95% CI: 48.8, 54.6) in Anglophone West African countries and 45.5% (95% CI: 42.0, 48.9) in Francophone West African countries. The pooled prevalence of EBF was 41.2% (95% CI: 36.9, 45.5) in Anglophone West African countries and 30.1% (95% CI: 26.7, 33.5) in Francophone West African countries. Our study showed that the weighted average EIBF and EBF prevalence tended to be higher from studies in Anglophone West African countries than in Francophone West African countries. Despite these findings, EIBF and EBF rates overall in West African countries were suboptimal. A substantial improvement is necessary in promoting EIBF and EBF in West African countries. Programmes should target all mothers in the region no matter their colonial allegiance to achieve Sustainable Development Goals 2 and 3 by 2030.

Development of a complex intervention to strengthen municipality-based breastfeeding support to reduced social inequity in breastfeeding

Article

Full-text available

Oct 2024

Background: Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization's recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of a municipality-based intervention. Methods: During a 15-month period in 2020-21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O'Cathain et al.'s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors. Results: In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus' 'learning cycles' as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation. Conclusion: The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development. Trial registration: Registered at Clinical Trials NCT05311631.

A web-based and mobile randomised controlled trial providing complementary feeding guidelines to first-time parents in France to promote responsive parental feeding practices, healthy children’s eating behaviour and optimal body mass index: the NutrienT trial study protocol

Article

Full-text available

Sep 2024
BMC PUBLIC HEALTH

Background Childhood obesity is a crucial public health issue. Early childhood is a critical time to foster the establishment of healthy eating behaviours and growth, which are partly shaped by parental feeding practices. To inform French parents of the recently updated national complementary feeding guidelines for 0–3 years (in terms of nutrition and responsive feeding as a mean to encourage infant appetite control skills and promote healthy growth), an official printed brochure was developed and nationally disseminated in 2021 by the French public health agency, Santé publique France. This randomised controlled trial aims to investigate whether the provision of guidelines through digital (smartphone application) and printed (brochure) tools (vs. the printed brochure alone, usual service) results in healthier parental feeding practices, infant eating behaviours and weight status. Methods This double-blinded monocentric 2-arm trial is currently conducted among first-time parents living in the area of Dijon (France) and recruited in a maternity ward. From child age 3 to 36 months (mo), an app provides a range of 106 age-adapted messages, including dietary recommendations, educational advice, recipes, and tips (intervention group only). Additionally, parents of both groups are provided with 48 messages related to child general development and the printed brochure at child age 2.7 mo. The primary outcome is the body mass index (BMI) z-score at child age 36 mo. Secondary outcome measures include a combination of online parents’ reports and behavioural assessments (experimental meals) of parental feeding practices and infant eating behaviours from inclusion to 36 months of age. Analyses of covariance on these outcomes will assess the effect of the intervention, adjusted for relevant confounders. Complementary mediation and moderation analyses will be conducted. Sample size was determined to be n = 118 in each arm of the trial, plus 20% to compensate for potential attrition. Discussion This is the first public eHealth randomised control trial in France to assess the effect of a web-based and mobile intervention targeted to first-time parents to improve child feeding practices and child growth. Trial registration This trial was registered at clinicaltrials.gov as NCT05285761 (March 18, 2022).

Pregnancy in patients affected by axial-spondyloarthritis: a narrative review of disease activity and obstetric outcomes

Article

Full-text available

Sep 2024

Objective. This review aims to summarize the most recent and updated data on pregnancy in patients with axial spondyloarthritis (axSpA), focusing on the recurrence of pregnancy-related complications, the disease activity throughout gestation and the postpartum, and the latest indications for the treatments of future mothers. Methods. We have conducted a narrative review with an online literature search on Medline and PubMed. We selected only studies written in English published until January 2024, including observational and retrospective studies, meta-analyses, and systematic reviews. Results. Proper preconception counseling and maternal-fetal monitoring are necessary to ensure the best outcome for both the mother and her baby. Despite the limited and conflicting evidence about the prevalence of adverse pregnancy outcomes in women with axSpA compared to healthy controls, primary findings demonstrate an increased risk of preterm delivery (PTD), low birth weight (LBW), and elective cesarean section (CS). Concerning disease activity, data suggests that 25-80% of women with ankylosing spondylitis experience disease flares during pregnancy, particularly around 20 weeks of gestation. On the contrary, the data on the postpartum disease flare are heterogeneous. The use of biological drugs in pregnancy is safe and effective in controlling disease activity. Conclusions. Data on pregnancy outcomes in patients with axSpA are scarce and discordant. Probably the difference in maternal disease classification, the evolution of treatment indications, and the differences emerging from study designs can account for these discrepancies. The main evidence shows an increased risk of PTD, LBW, and elective CS (although the latter may reflect cultural influences rather than medical needs due to axSpA itself). The majority of drugs used to treat axSpA, including TNFi, are safe in pregnancy without harming mothers or fetuses. Further data is needed to clarify many controversial aspects in this area.

Development of a complex intervention to strengthen municipality-based breastfeeding support to reduced social inequity in breastfeeding

Preprint

Full-text available

Jun 2024

Background Breastfeeding is the ideal nutrition for infants and protects infants and mothers from a range of adverse health outcomes during their lifespan. In Denmark, while the breastfeeding initiation rate is high, only 14% of mothers meet the World Health Organization’s recommendation of exclusive breastfeeding at six months. Furthermore, a notable social inequity exists among those who achieve this recommendation. Knowledge of effective interventions to reduce breastfeeding inequity is limited. A previous hospital-based intervention succeeded in increasing breastfeeding duration. However, most breastfeeding support is provided in Danish municipalities by health visitors. This called for adapting the intervention to the health visiting program and developing an intensified intervention addressing the social inequity in breastfeeding. This article describes the adaptation and development process of the intervention ‘Breastfeeding – a good start together’. Methods During a 15-month period in 2020-21, the municipal intervention was iteratively developed using a three-stage framework for developing complex health interventions described by Hawkins et al. The three stages were 1) need assessment and stakeholder consultation, 2) co-production and 3) prototyping. The process was inspired by O’Cathain et al.’s principles for a user-centred, co-created and theory- and evidence-based approach, involving parents and health visitors. Results In stage 1, we identified the needs and priorities of the target groups of the intervention. In stage 2, the intervention was developed through action research design and inspired by Duus’ ‘learning cycles’ as the method to enhance motivation and ownership and to strengthen the implementation process by creating a joint room for learning and reflection with health visitors and developers. In stage 3, the intervention was tested for feasibility and usefulness during a 2.5-month period accompanied by monthly dialogue meetings with health visitors and developers. In this period, the intervention was refined based on the gathered experiences and was subsequently prepared for evaluation. Conclusion The description of the development of this complex intervention, aimed at increasing breastfeeding duration and reducing inequity, offers breastfeeding practitioners and researchers a transparent foundation for continuously improving breastfeeding support and a methodology for complex intervention development. Trial registration Registered at Clinical Trials NCT05311631.

Strengthening health visitors’ breastfeeding support: Results from a cluster randomised study

Article

Jun 2024
Nurse Educ Pract

Maternal employment characteristics as a structural social determinant of breastfeeding after return to work in the European Region: a scoping review

Article

Full-text available

May 2024

Background The European Region has the lowest rate of exclusive breastfeeding at 6 months worldwide. Improving work-related breastfeeding issues is important given that women may have difficulties combining work and breastfeeding, especially those in precarious working situations, which adds to their adversity. This scoping review overviews research on the maternal employment characteristics that support breastfeeding continuation after return to work in the European Region. Methods Studies published from 2013 to 2023 were collected from Scopus, PubMed, and PsycInfo. Quantitative and qualitative studies published in English or French that explored the association between maternal employment characteristics and any breastfeeding status, duration, or experience were included. Participants included were mothers of healthy children who continued breastfeeding after resuming work. The main determinants were work-related factors that can lead to socially differentiated working conditions, including type of employment (e.g., occupation, employed/self-employed status, type of contract, working time, occupational prestige), working conditions (e.g., work schedule, decision latitude, latitude to organize worktime), and work environment (e.g., occupational exposure, family-friendly workplace policy, social support). The geographic area encompassed countries included in the World Health Organization European Region. Results Of the 693 single studies retrieved and screened, 13 were included in the review. Eight studies focused on combining work and breastfeeding, while the others had a broader spectrum by investigating breastfeeding determinants. The represented countries were Spain (n = 4), France (n = 4), UK (n = 2), Ireland (n = 2), and the Netherlands (n = 1). Results highlighted the heterogeneity of measures, time frames, and fields of inquiry, thus revealing a lack of conceptual framework regarding the links between work, breastfeeding, and social health inequalities. Nonetheless, being self-employed, working in a non-manual profession with time flexibility, having lactation rooms at work, being supported by co-workers, and having a breastfeeding workplace policy were salient factors that supported breastfeeding in working mothers. Conclusions Supporting working mothers who choose to breastfeed is important given the myriad of adverse factors faced by mothers and their children. These results advocate for targeted actions at the workplace such as time flexibility, breastfeeding facilities, and the promotion of breastfeeding-friendly policies.

Breast milk oxytocin and s-IgA modulate infant biomarkers and social engagement; The role of maternal anxiety

Article

Full-text available

Dec 2023

Breastfeeding has long been known to improve infants' health and mental development and to enhance the mother-infant bond, but much less research focused on the biological composition of breast milk and its associations with the infant's biomarkers and social development. In this exploratory study, we measured oxytocin (OT) and secretory immunoglobulin-A (s-IgA), the most abundant antibody in breast milk, and evaluated their associations with the same biomarkers in infant saliva and, consequently, with infant social engagement behavior. Fifty-five mother-infant dyads were home-visit and OT and s-IgA were assessed from breast milk and from infant saliva before and after a free-play interaction. Infant social behavior was coded offline using the Coding Interactive Behavior (CIB) and maternal anxiety self-reported. A path model revealed that mother's breast milk s-IgA impacted child social engagement via its links with child OT. In parallel, maternal breast milk OT was linked with infant social behavior through its association with the infant's immunity. This path was moderated by maternal anxiety; only in cases of high anxiety breast milk OT was positively connected to infant s-IgA. Our study, the first to measure OT and s-IgA in both breast milk and infant saliva in relation to observed social behavior, underscores the need for much further research on the dynamic interplay between breast milk composition, infant biomarkers, maternal mental health, and infant social outcomes. Results may suggest that biological systems in breast milk integrate to prepare infants to function in their social ecology through bio-behavioral feedback loops that signal the degree of stress in the environment.

Cognitive Development in Bottle Versus Breastfed Children up to Two Years: A Comparative Study from Islamabad

Article

Jun 2023

Objectives: To evaluate the proportion of exclusively breastfeeding and to determine the association of various types of feeding with cognitive development in children up to two years of age. Study Design: Cross-sectional analytical study. Place and Duration of Study: Outpatient Department of Pediatrics, Pakistan Air Force Hospital, Islamabad Pakistan, from Jan to Aug 2019. Methodology: Mothers of children under two years of age visiting the hospital were recruited by systematic sampling. The data was collected through interviews using a semi-structured questionnaire. A score of each child has dichotomized into satisfactory and unsatisfactory cognitive development overall and separately for each domain viz communication, fine motor, gross motor, problem-solving and personal social skills. Results: Out of 192 children, less than half, 77(40.1), were exclusively breastfed. Feeding practices had a statistically significant effect on overall cognitive development (p<0.002) and also individually on communication (p<0.006), fine motor (p<0.022), gross motor (p<0.001) and problem-solving skills (p<0.011) of children under two years of age. Exclusive breastfeeding showed better cognitive development (p<0.003). Conclusion: Promoting breastfeeding practices is necessary as it leads to better children's cognitive development. This research revealed that the longer duration of exclusive breastfeeding was a more satisfactory cognitive development.Keywords: Breastfeeding, Cognitive development, Feeding practices.

Annelerin Bebek Beslenmesi Tutumları ve Etkileyen FaktörlerAttitudes of Mothers on Infant Nutrition and Affecting Factors

Article

Full-text available

May 2023

Amaç: Bu çalışmanın amacı, 0-6 aylık bebeği olan annelerin bebek beslenmesi tutumlarının değerlendirilmesi ve bu tutum ile ilişkili faktörlerin belirlenmesidir. Gereç ve Yöntem: Çalışmaya 18 yaş ve üstü, 0-6 aylık bebeği olan anneler dâhil edilmiştir. Katılımcılara üç bölümden oluşan çevrimiçi anket uygulanmıştır. İlk bölümde sosyodemografik özellikler ve antropometrik ölçümler sorgulanırken, ikinci bölümde Iowa Bebek Beslenmesi Tutum Ölçeği (Iowa Infant Feeding Attitude Scale, IIFAS), üçüncü bölümde ise Edinburgh Postpartum Depresyon Ölçeği uygulanmıştır. Bulgular: Araştırmaya katılan 417 annenin yaş ortanca değeri 28 yıl, IIFAS puan ortalamaları 65,08 ± 6,83’tür. Bebek beslenmesi tutumları ile ilişkili faktörleri belirlemek için oluşturulan çoklu doğrusal regresyon modellerinde, annelerin lise ve üzeri eğitim almış olması IIFAS’ta 3,60 puan artış, gelirinin giderinden az olması ise 1,97 puan azalış ile ilişkili bulunmuştur. Ayrıca IIFAS’taki 2,82 puan artış, bebeğini son 24 saatte sadece anne sütüyle besleme ile ilişkili iken, 2,09 puan azalış ise bebeğin hafif şişman olması ile ilişkilidir. Bu faktörler annede postpartum depresyon riski olup olmamasına göre incelendiğinde, risk olmayanlarda lise ve üzeri eğitim almış olmak ve son 24 saatte sadece anne sütü alımı IIFAS’ta sırasıyla 4,01 ve 2,96 puan artışla, gelirinin giderinden az olması ve bebeğin hafif şişman olması ise sırasıyla 1,69 ve 2,76 puan azalışla ilişkilidir. Bununla birlikte, depresyon riski olan annelerde IIFAS puanları ile ilişkili herhangi bir faktör saptanmamıştır. Sonuç: Annelerin bebek beslenmesi tutumu eğitim durumu, sosyoekonomik düzey, doğum haftası ve depresyon gibi birçok faktörden etkilenmektedir. Özellikle postpartum depresyon riskinin varlığı, bebek beslenmesi tutumunu tek başına olumsuz etkileyebildiği gibi diğer faktörlerin olası etkisini de değiştirebilir.

What to Expect when Women with Axial Spondyloarthritis are Expecting: Prevalence of Complications of Pregnancies in Women with Axial Spondyloarthritis

Article

Full-text available

Mar 2022
SEMIN ARTHRITIS RHEU

Background : Understanding of axSpA is evolving rapidly. Unfortunately, for women with axSpA there is limited data available on pregnancy complications. The Ankylosing Spondylitis Registry of Ireland (ASRI) is a source of epidemiological data on axSpA in Ireland. The aim of this study was to examine the prevalence of pregnancy and fetal complications in axSpA women. Methods : The ASRI records cross-sectional information on demographics, imaging, treatment, and patient outcomes. A dedicated section collects data on pregnancy, fertility and breastfeeding. For each axSpA woman, data on all pregnancies was recorded. Results were compared to global reference norms (GRN). All patients were diagnosed with axSpA by a Rheumatologist and met the ASAS classification criteria. Informed consent was obtained from all patients, with ethical approval obtained from local hospital ethics committees. Results : Data was available on 98 women with axSpA. There were 335 pregnancies resulting in 279 live births. Of these pregnancies 51.6% (173) were uncomplicated and 48.5% (162) were complicated, with 13.1% (44) encountering multiple complications. Preterm birth (12.5% vs 5.2%, p<0.01) and pre-eclampsia (6.8% vs 2.8%, p<0.01) were more prevalent in axSpA pregnancies than GRN. Low birth weight was more prevalent in axSpA pregnancies (8.2% vs 2.9%, p<0.01), however small for gestational age was less prevalent (5.4% vs 11%, p<0.01). Conclusions : Preterm birth, pre-eclampsia and low birth weight are significantly more prevalent in pregnancies of axSpA women. Furthermore, there is a high prevalence of complications in axSpA pregnancies overall. These results provide essential insight into the impact of axSpA in pregnancy and call for further research to understand the pathogenesis of these complications.

Superomedial Reduction Mammoplasty Affects Patients’ Ability to Breastfeed in a Distinct Manner: A Multicenter Study of 303 Patients

Article

Jun 2021

Background Breast reduction using the superomedial technique can relieve symptoms related to breast hypertrophy; however, as the lateral and inferior portion of the breast parenchyma is removed and displaced, reduction mammoplasty may lead to an impaired ability to breastfeed. Objectives To assess the patient's ability to breastfeed after superomedial reduction mammoplasty. Methods This was a cross-sectional study including patients treated with superomedial reduction mammoplasty between January 2009 and December 2018 at two tertiary hospitals in Denmark. Patients were stratified into two cohorts, depending on whether they had childbirth before or after their reduction mammoplasty. Patients were sent specific questionnaires regarding maternity, breastfeeding before and after reduction mammoplasty, nipple sensitivity, and current demographic information. Operative details were retrieved from electronic medical records. Results We identified 303 patients eligible for this study (37 patients giving birth after and 266 before reduction mammoplasty). Fewer patients were able to breastfeed exclusively for the recommended six months after reduction mammoplasty (2/37 = 5.41%) compared to before (92/266 = 34.59%, p<0.05). Also, fewer patients were able to breastfeed at all after reduction mammoplasty (18/37 = 48.64%) compared to before mammoplasty (241/266 = 90.60%, p<0.001). Patients unable to breastfeed after reduction mammoplasty had less nipple sensitivity and more breast tissue excised (p<0.05). Conclusions Superomedial reduction mammoplasty seems to impair the patient's ability to breastfeed exclusively for the recommended 6 months. Patients of childbearing age considering reduction mammoplasty should be made aware that reduction mammoplasty reduces their breastfeeding capacity.

Demographic, socioeconomic, and sociocultural factors associated with any breastfeeding in homeless mothers

Article

Full-text available

Mar 2021
MATERN CHILD NUTR

In high‐income countries, breastfeeding has been shown to be positively associated with socioeconomic position. However, less is known about breastfeeding practices and their associated factors among extremely disadvantaged populations. We aimed to assess the associations of cultural origins and socioeconomic factors with any breastfeeding initiation and duration in homeless families. We analyzed data from 456 children aged 6 months to 5 years from the cross‐sectional ENFAMS survey, conducted in 2013 among a random sample of homeless families in shelters in the Greater Paris area. Data were collected by bilingual interviewers in 17 languages. Four nested multivariable robust Poisson regression models were run in a hierarchical framework to determine the factors associated with breastfeeding initiation and with any breastfeeding for 6 months or more. Most of the children (86.0%) had previously been or were currently being breastfed at the time of the survey; 58.9% were fed with breast milk ≥6 months. A higher maternal age and African origin were positively associated with breastfeeding ≥6 months, although the relation to the region of origin was moderated by education level. Migration to escape war, unrest or other violence and the child's birth in France were inversely associated with breastfeeding ≥6 months. Any breastfeeding by these homeless mothers seems influenced predominantly by their cultural origin and complicated by a difficult migration trajectory. The possible influence of poor material circumstances and cumulative hardship should encourage interventions targeted at homeless mothers that emphasize social/family support with a commitment to improving the family's living conditions.

Exploration des comportements des femmes allaitantes vis-à-vis des médicaments. Contribution à la conception d'interventions éducatives en santé

Thesis

Full-text available

Feb 2018

Laurence Spiesser

L'allaitement maternel est un réel enjeu de santé publique au regard de ces bénéfices pour la santé de la mère comme de son enfant. La prise de médicaments représente un obstacle à l'allaitement et peut conduire à la non initiation de l'allaitement ou à son sevrage prématuré quelques soient les données biomédicales disponibles. La compréhension des comportements maternels face à la prise de médicament est essentielle à explorer pur pouvoir apporter des interventions éducatives adaptées pour répondre à cette problématique [...].

Infant feeding clusters are associated with respiratory health and allergy at school age in the PARIS birth cohort

Article

Full-text available

Oct 2020
ALLERGY

Background As infant feeding may influence allergy development, we aimed to identify groups of infants based on feeding practices and to examine their associations with respiratory health/allergy at 8 years in the PARIS birth cohort. Methods Data on breastfeeding, consumption of infant formula (regular, pre‐/probiotics, partially hydrolysed with hypoallergenic label [pHF‐HA], extensively hydrolysed [eHF], soya) and solid food introduction were collected using repeated questionnaires at 1, 3, 6, 9 and 12 months. Infants with similar feeding practices over the first year of life were grouped using multidimensional longitudinal cluster analysis. Respiratory/allergic morbidity was studied at 8 years as symptoms, doctor's diagnoses (asthma, hay fever, eczema, food allergy), and measurement of lung function, FeNO and specific IgE. Associations between feeding‐related clusters and respiratory/allergic morbidity were investigated using multivariable logistic and linear regression models adjusted for potential confounders including early respiratory/allergic outcomes and parental history of allergy. Results Five clusters were identified among 3446 infants: Cluster 1 (45%) mainly fed with regular formula, Cluster 2 (27%) exclusively breastfed during the first 3 months, and three other clusters consuming different types of formula (pre‐/probiotics for Cluster 3 [17%], pHF‐HA for Cluster 4 [7%], eHF/soya for Cluster 5 [4%]). Compared to Cluster 1, children from Cluster 2 tended to have a lower risk of asthma and children from Cluster 4 had a significant lower lung function (FEV1, FVC), higher FeNO and higher risk of sensitization at 8 years. Conclusion Early pHF‐HA use was negatively associated with objective measures of respiratory/allergic morbidity at school age, while children breastfed for at least 3 months seem protected against asthma at 8 years old.

Associations between maternity or parental leave and breastfeeding duration: results from the ELFE cohort

Article

Full-text available

Jul 2019

Previous studies have shown a high level of noncompliance with recommendations on breastfeeding duration, especially in France. The objective was to describe the association between breastfeeding initiation and duration and the statutory duration of postnatal maternity leave, the gap between the end of legal maternity leave and the mother's return to work, and maternal working time during the first year postpartum. Analyses were based on 8,009 infants from the French nationwide ELFE cohort. We assessed the association with breastfeeding initiation by using logistic regression and, among breastfeeding women, with categories of breastfeeding duration by using multinomial logistic regression. Among primiparous women, both postponing return to work for at least 3 weeks after statutory postnatal maternity leave (as compared with returning to work at the end of the statutory period) and working less than full‐time at 1 year postpartum (as compared with full‐time) were related to higher prevalence of breastfeeding initiation. Among women giving birth to their first or second child, postponing the return to work until at least 15 weeks was related to a higher prevalence of long breastfeeding duration (at least 6 months) as compared with intermediate duration (3 to <6 months). Working part‐time was also positively related to breastfeeding duration. Among women giving birth to their third child or more, working characteristics were less strongly related to breastfeeding duration. These results support extending maternity leave or working time arrangements to encourage initiation and longer duration of breastfeeding.

A comparison of exclusive breastfeeding in Belgian maternity facilities with and without Baby-friendly Hospital status

Article

Full-text available

Jun 2019

A retrospective cross-sectional study was carried out in Wallonia (the southern region of Belgium) in which a 20-question breastfeeding (BF) module was included in an immunization survey. The purpose of this paper is to compare exclusive breastfeeding (EBF) prevalences and BF practices for mothers giving birth in Baby-friendly Hospital Initiative (BFHI) and non-BFHI maternity facilities. A total of 557 mothers responded to BF questions when their child was 18-24 months old; 26.7% of them delivered in a BFHI maternity facility. At discharge, a larger proportion of children were exclusively breastfed if they were born in a BFHI maternity facility (76.5% vs. 65.8%, p = .02). The median duration of EBF (15.0 vs. 12.9 weeks, p = .3), and the proportion of children exclusively breastfed at 5 months (16.8% vs 15.8%, p = 1.0) were similar in both groups. Few mothers knew that EBF was recommended for the first 6 months of life (28.6% in BFHI vs 23.1% in non-BFHI, p = .2). For most groups of the population examined, the rates of BF tended to be higher in BFHI facilities, but many differences were not significant. More specifically, BFHI seemed to boost BF practices among mothers more likely to breastfeed, but the Initiative did not seem to trigger enhanced BF practices in mothers traditionally less likely to breastfeed (except for indifferent/negative partner's attitude and mothers of Belgian origin). Influencing the BF practices of mothers less likely to breastfeed requires a special attention with complementary actions in maternity facilities as well as in community services.

Exclusive breastfeeding in belgian maternity facilities: comparing Baby‐friendly and non‐labeled

Article

Full-text available

May 2019

A retrospective cross‐sectional study was carried out in Wallonia (the southern region of Belgium), in which a 20‐question BF module was included in an immunization survey. The purpose of this paper is to compare exclusive breastfeeding (EBF) prevalence's and BF practices for mothers giving birth in Baby‐friendly Hospital Initiative (BFHI) and non‐BFHI maternity facilities. A total of 557 mothers responded to BF questions when their child was 18‐24 months old; 26.7% of them delivered in a BFHI maternity facility. At discharge, a larger proportion of children were exclusively breastfed if they were born in a BFHI maternity facility (76.5% vs. 65.8%, p=0.02). The median duration of EBF (15.0 weeks vs. 12.9 weeks, p= 0.3) and the proportion of children exclusively breastfed at 5 months (16.8% vs. 15.8%, p=1.0) were similar in both groups. Few mothers knew that EBF was recommended for the first six months of life (28.6% in BFHI vs. 23.1% in non‐BFHI, p=0.2). For most groups of the population examined, the rates of BF tended to be higher in BFHI facilities but many differences were not significant. More specifically, BFHI seemed to boost BF practices among mothers more likely to breastfeed, but the Initiative did not seem to trigger enhanced BF practices in mothers traditionally less likely to breastfeed (except for indifferent/negative partner's attitude and mothers of Belgian origin). Influencing the BF practices of mothers less likely to breastfeed requires a special attention with complementary actions in maternity facilities as well as in community services.

Anne Sütüyle Besleme Konusunda Kültürler Arası Farklılıklar

Chapter

Full-text available

Mar 2019

Emzirme ana ve çocuk sağlığı üzerinde olumlu etkileri olan bir toplum sağlığı konusudur. Dünya Sağlık Örgütü herhangi bir kontraendikasyon veya tıbbi gereklilik yoksa ilk 6 ay sadece anne sütü ile beslenme önermektedir. Ancak Dünya geneline bakıldığında sadece anne sütü kullanımları istenilen düzeyde değildir. Her üç bebekten sadece biri ilk altı ayında sadece anne sütü ile beslenmektedir. Bunun ötesinde dünya üzerinde değişik kültürlerde ve coğrafi alanlarda da emzirme düzeyleri farklılıklar göstermektedir. Emzirme pratiğinde kültürler arasında farklılıklar nedeniyle anne sütü teşvik programlarında hedef grupların kültürel örüntülerinin dikkate alınması bu programların etkinliğini arttıracaktır.

Breastfeeding Prevalence at Time of Vaccination: Results of a Pilot Study in 6 Italian Regions

Article

Jan 2019

Background: In Italy, there is no widespread standardized national monitoring system for breastfeeding practices. Research aims: To estimate breastfeeding indicators according to World Health Organization recommendations and associated socioeconomic factors, highlighting the potential and limitations of vaccination centers as sources of data. Methods: A cross-sectional study was conducted in the vaccination centers of 13 Local Health Districts in Italy. Data on breastfeeding practices were collected via structured questionnaires between February and November, 2015, from 14,191 mothers recruited during vaccination appointments for the 1st, 2nd and 3rd doses against Diphtheria, Tetanus, and Pertussis, and for the 1st dose against Measles, Mumps, and Rubella. Crude breastfeeding rates and direct age standardized rates were compared. Logistic regression models were used to explore socio-demographic characteristics associated with breastfeeding indicators. Results: Overall, 14,191 mothers were recruited, with a response rate higher than 94%. Exclusive breastfeeding rates among children aged 2-3 months and 4-5 months were 44.4% and 25.8%, respectively; breastfeeding rates among children aged 11-12 and 13-15 months were 34.2% and 24.9%; 10.4% never breastfed. Strong geographical and socioeconomic differences were found. Some differences also emerged between crude and standardized rates. Conclusions: We conclude that a survey system in vaccination centers is practicable and its use could produce, with standardized methodology, representative regional and national breastfeeding estimates that could monitor progress towards present and future targets.

Evaluation of an eHealth intervention aiming to promote healthy food habits from infancy -the Norwegian randomized controlled trial Early Food for Future Health

Article

Full-text available

Jan 2019
INT J BEHAV NUTR PHY

Background Strategies to optimize early-life nutrition provide an important opportunity for primary prevention of childhood obesity. Interventions that can be efficiently scaled-up to the magnitude needed for sustainable childhood obesity prevention are needed. The objective of this study was to evaluate the effects of an eHealth intervention on parental feeding practices and infant eating behaviors. Methods The Norwegian study Early Food for Future Health is a randomized controlled trial. Parents were recruited via social media and child health clinics during spring 2016 when their child was aged 3 to 5 months. In total 718 parents completed a web-based baseline questionnaire at child age 5.5 months. The intervention group had access to a webpage with monthly short video clips addressing specific infant feeding topics and age-appropriate baby food recipes from child age 6 to 12 months. The control group received routine care. The primary outcomes were child eating behaviors, dietary intake, mealtime routines and maternal feeding practices and feeding styles. The secondary outcomes were child anthropometry. This paper reports outcomes at child age 12 months. Results More than 80% of the intervention group reported viewing all/most of the video clips addressing infant feeding topics and indicated that the films were well adapted to the child’s age and easy to understand. Children in the intervention group were served vegetables/fruits more frequently (p = 0.035) and had tasted a wider variety of vegetables (p = 0.015) compared to controls. They were also more likely to eat family breakfast (p = 0.035) and dinner (p = 0.011) and less likely to be playing or watching TV/tablet during meals (p = 0.009) compared to control-group children. We found no group differences for child anthropometry or maternal feeding practices. Conclusions Our findings suggest that the eHealth intervention is an appropriate and feasible tool to propagate information on healthy infant feeding to Norwegian mothers. Our study also suggests that anticipatory guidance on early protective feeding practices by such a tool may increase young children’s daily vegetable/fruit intake and promote beneficial mealtime routines. Trial registration ISRCTN, ISRCTN13601567. Registered 29 February 2016, http://www.isrctn.com/ISRCTN13601567 Electronic supplementary material The online version of this article (10.1186/s12966-018-0763-4) contains supplementary material, which is available to authorized users.

Association of Exclusive Breastfeeding with Risk of Obesity in Childhood and Early Adulthood

Article

Nov 2018

Objective: To explore the effects of exclusive breastfeeding and its duration on the development of childhood and early adulthood obesity. Materials and methods: A random sample of 5,125 dyad children and their mothers was extracted from a national database. With the use of a standardized questionnaire, telephone interviews were carried out for the collection of maternal lifestyle factors (e.g., breastfeeding). The body mass index was determined based on International Obesity Task Force criteria. Body weight and height of the offspring at the age of 8 was calculated from measurements derived from the national database, while the corresponding body measurements at early adulthood were self-reported. Results: Mothers who had breastfed or exclusively breastfed ≥6 months were 22.4% and 15.2%, respectively. Exclusive breastfeeding ≥6 months (versus never) was associated with a lower risk of overweight in childhood (8 years old; odds ratio [OR] = 0.89; 95% confidence interval [95% CI], 0.82-0.96) and adolescence/adulthood (15-25 years old; OR = 0.83; 95% CI, 0.68-0.97). Also, exclusive breastfeeding ≥6 months (versus never) was associated with a decreased risk of childhood and adolescence obesity by 30% (95% CI, 0.54-0.91) and 38% (95% CI, 0.40-0.83), respectively. Conclusions: Exclusive breastfeeding had a favorable influence on offspring's overweight and obesity not only in childhood but also in adolescence/adulthood.

Breastfeeding initiation and duration in France: The importance of intergenerational and previous maternal breastfeeding experiences — results from the nationwide ELFE study

Article

Oct 2018
MIDWIFERY

Objective: To assess the role of the mother's mother and mothers’ previous personal experiences with breastfeeding and childcare in breastfeeding practices. Design and setting: The analysis included 13,774 mother–infant dyads from the French national birth cohort ELFE. Feeding practices were assessed by face-to-face interview in maternity wards in 2011, by phone interviews at months 2 and 12 post-partum and by Internet/paper questionnaires monthly from months 3–10. Sociodemographic, maternal and newborn-related factors were collected in the maternity unit and by postnatal phone interview at month 2. Multivariable logistic and linear regression was used to assess the association of mother's mother and mothers’ previous personal experiences with breastfeeding initiation and duration. Findings: Previous breastfeeding experience (i.e., whether mothers had breastfed their previous children) was positively associated with both breastfeeding initiation and duration. Mothers who had been breastfed themselves as infants were more likely to initiate and continue breastfeeding than non-breastfed mothers. Conversely, non-breastfed mothers who had received care advice from their own mother were less likely to start and maintain breastfeeding. The effect of having been breastfed in infancy was especially important for primiparous mothers and to a lesser extent, multiparous mothers with no previous breastfeeding experience. Also, formal experience in childcare, in a professional context, was associated with breastfeeding initiation but not duration. Key conclusions and implications for practice: Mother's mother and mother's previous breastfeeding experience have a strong influence on breastfeeding practices. Breastfeeding interventions should be tailored to the mother's level of experience and should provide extra support for multiparous mothers with no previous breastfeeding experience.

Prevalence of breastfeeding and factors associated with the start and duration of exclusive breastfeeding in the Community of Madrid among participants in the ELOIN

Article

Full-text available

May 2018

Introduction Breastfeeding has important benefits for population health. The aims of this study are: (i) to determine the prevalence and duration of breastfeeding and exclusive breastfeeding; (ii) analyse the reasons for not starting or abandoning of breastfeeding, and (iii) describe the factors associated with the initiation and duration of exclusive breastfeeding. Material and methods Cross sectional study using the baseline data of the ELOIN cohort, obtained using an epidemiological questionnaire. A sample of 2627 children born in 2008–2009 from the Community of Madrid was studied. Logistic regression models were used. Results Prevalence of exclusive breastfeeding and breastfeeding was 77.6% and 88% respectively; prevalence of exclusive breastfeeding at 6 months 25.4%, and prevalence of breastfeeding at 2 years was 7.7%. The most common reasons for abandoning breastfeeding were insufficient milk (36%), and incorporation to work (25.9%). The variables associated with starting or maintaining of exclusive breastfeeding were: mother older than 35 years, medium-high economic status, foreigner residing in Spain less than 10 years, and having participated in a breastfeeding workshop. Conclusions Breastfeeding prevalence in the Community of Madrid did not reach the international recommendations in 2008–2009. It is necessary to intensify strategies for breastfeeding promotion, protection, and support, including their periodic monitoring.

Understanding Breastfeeding Women’s Behaviors Toward Medication: Healthcare Professionals’ Viewpoint

Article

May 2018

Background:: Taking medication during breastfeeding is often a major concern for mothers. Knowledge, representations, and attitudes condition a mother's behavior in this situation. Healthcare professionals, whose medication advice for breastfeeding women is often described in scientific literature as inappropriate, play a major role in counseling mothers. Healthcare professionals' perceptions of mothers' behaviors regarding medication use during breastfeeding may influence mothers' behaviors. Research aim:: The aim of this study was to identify healthcare professionals' perceptions of breastfeeding women's knowledge, representations, and attitudes and behaviors about medication use. Method:: A cross-sectional, prospective qualitative design was used. Semistructured interviews were conducted with a broad array of healthcare professionals ( N = 20) in different practice settings in the Angers area (France). Thematic analysis of the interview transcripts was carried out using the planned behavior theory of Ajzen. Results:: Seventy themes concerning medication use while breastfeeding were identified and then combined into 8 categories. Healthcare professionals perceived that maternal behaviors regarding medication were mostly focused on the child's safety and were linked to poor knowledge and negative representations, attitudes, and feelings toward medication. Healthcare professionals also perceived significant negative influences from the mother's friends and family in regard to breastfeeding. Relationships between healthcare professionals and women were problematic when it came to drug use during breastfeeding. Conclusion:: Taking into account healthcare professionals' perceptions of maternal behavior will help improve education for these professionals. Indeed, knowing precisely what difficulties are met by healthcare professionals when they encounter medication use during breastfeeding can help educators improve training for these professionals.

The impact of historical breastfeeding practices on the incidence of cancer in France in 2015

Article

Full-text available

Mar 2018
CANCER CAUSE CONTROL

Purpose: The purpose of the study was to estimate the number of new breast cancer cases in France in 2015 attributable to breastfeeding for durations below recommendations (at least 6 months per child), and cases prevented through historical breastfeeding. As a secondary analysis, the corresponding numbers for ovarian cancer were estimated. Methods: Historical breastfeeding data were obtained from population surveys. Duration of breastfeeding data were obtained from the French Épifane cohort study. Relative risks were obtained from meta-analyses, cohort, and case-control studies. Cancer incidence data were obtained from the French Network of Cancer Registries. A 10-year latency period was assumed. Results: Among parous women 25 years of age and older, 14.1% breastfed for at least 6 months per child born before 2006. As a result, 1,712 new breast cancer cases (3.2% of all new breast cancer cases) were attributable to breastfeeding for < 6 months per child, while actual breastfeeding practices prevented 765 breast cancer cases. Furthermore, 411 new ovarian cancer cases (8.6% of all new ovarian cancer cases) may be attributable to breastfeeding for < 6 months per child, with breastfeeding preventing 163 ovarian cancer cases. Conclusions: The historically low breastfeeding prevalence and duration in France led to numerous avoidable cancer cases.

Fear of Childbirth Impairs Breastfeeding Success Independent of Mode of Birth

Article

Oct 2024

Background: The good qualities of breastfeeding are well known. The aim of this study was to closely examine the impact of specific maternal, prenatal, obstetric, and early neonatal factors on the success of breastfeeding. Materials and Methods: We used data from the Kuopio Birth Cohort study and analyzed 2,521 online questionnaires, which were answered by women 1 year after giving birth. Breastfeeding variables were divided into successful breastfeeding (breastfeeding exclusively with one's own breast milk ≥4 months or breastfeeding with formula ≥6 months) and poor breastfeeding (breastfeeding exclusively with one's own milk <4 months and duration of all breastfeeding <6 months) for univariate and multivariable analyses. Results: In this study, 97.8% (N = 2,466) reported breastfeeding their newborns for ≥1 postnatal week, and 75.2% (N = 1,896) breastfed newborns for ≥6 months. The rate of breastfeeding for ≥6 months increased from 71.3% to 84.7% between 2013 and 2020. In the multivariable analysis, poor breastfeeding success was associated most significantly with smoking during pregnancy (adjusted odds ratio [aOR] 4.64; 95% confidence interval [CI] 2.75-7.81), twin pregnancy (aOR 4.13; 95% CI: 2.10-8.15), maternal obesity (body mass index > 35) (aOR 3.27; 95% CI: 2.15-4.99), fear of childbirth (aOR 2.80; 95% CI: 1.89-4.13), and birth during the period of 2013-2014 (aOR 2.94; 95% CI: 2.08-4.14) or 2015-2016 (aOR 2.62; 95% CI: 1.85-3.70). Other significant factors related to poor success were younger maternal age, nonmarried family relationships, passive or quitting smoking before or in the first trimester, any hypertensive disorder during pregnancy, birth by nonelective cesarean, and lowest or highest quartiles of birth weight. Conclusions: Mother's fear of childbirth is strongly associated with the poor breastfeeding success even after controlling for mode of birth.

Current Knowledge and Attitude to Exclusive Breastfeeding Practice among Lactating Mothers Visiting a Health Facility in Lagos State, Nigeria

Article

Full-text available

Nov 2023
Open Publ Health J

Background: Information about maternal knowledge and attitude toward exclusive breastfeeding (EBF) practice is consequential to the actualization of the goals of the baby-friendly initiative and Millennium Development Goals (MDGs) 4 and 5. This paper assessed the current knowledge and attitude of EBF practices among nursing mothers attending a health facility in Lagos, Nigeria. Methods: The study employed a descriptive cross-sectional descriptive design. One hundred and twenty (120) nursing mothers attending the Isheri Olofin Primary Health Centre (IOPHC) and currently breastfeeding children between 0-24 months were interviewed. A pre-tested questionnaire that elicits information on maternal socio-demographic characteristics, child index, 24-point knowledge scale, 30-point attitude scale, and 12-point practice scale of EBF was employed. Data was analysed using descriptive, Chi-square, and adjusted odd ratios (aORs) generated from a logistic regression model. Results: About 89.2% of the respondents demonstrated good knowledge, while 81.7% depicted a positive attitude. All respondents (100%) had heard about EBF. About 86.7% believed that EBF is only adequate in the first six months of a newborn baby. Respondents with good knowledge of EBF were 3 folds more likely to have good EBF practice than those with poor knowledge (aOR=3.07, 95% confidence interval [CI]: 1.74, 9.52), while those with a positive attitude towards EBF were twice as likely to have good EBF practice than those with a negative attitude (aOR=2.17, 95% CI: 1.16, 5.73). Conclusion: Respondents had good knowledge and a positive attitude towards EBF practice. The study also affirmed a strong relationship between maternal EBF knowledge and attitude and current practice among the respondents. Highlights: Respondents exhibited good knowledge and a positive attitude toward exclusive breastfeeding (EBF) practice. Respondents initiated breastfeeding within 24hrs of birth and fed their infants with colostrum. Current practices have a significant relationship with maternal EBF knowledge and maternal attitude.

Supporting early childhood routines to promote cardiovascular health across the life course

Article

Oct 2023

Strengthening health visitors' breastfeeding support - results from a cluster randomised study

Preprint

Full-text available

Sep 2023

Health professionals are key in supporting breastfeeding women but studies report gaps in health professionals’ breastfeeding support competencies. In an intervention study, we aimed to strengthen the breastfeeding support of families to improve breastfeeding rates. Health visitors received an interactive training programme to enhance their breastfeeding support self-efficacy, action competence and knowledge, including e-learning and a two-day course of lectures, role plays, and discussions. The training programme improved the self-reported breastfeeding support self-efficacy, action competence and knowledge of health visitors. The factor structures of the instruments used to measure effects were confirmed by confirmatory factor analysis.

Allaiter en France aujourd’hui

Article

Sep 2021

Bénédicte Coulm

Maternal Health Literacy and Pregnancy Outcomes: Does any Association Exist?

Article

Full-text available

Dec 2022

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

Preprint

Full-text available

Dec 2022

Identifying target areas of medicines information efforts to pregnant and breastfeeding women by reviewing questions to SafeMotherMedicine: A Norwegian web-based public medicines information service Open Access

Article

Full-text available

Dec 2022

Background Online information about safety of medications during pregnancy and breastfeeding is shown to be conflicting, resulting in anxiety and abstaining from use. The aim of this study was to characterize questions to SafeMotherMedicine, a web-based medicines information service for pregnant and breastfeeding women, to identify target areas that could guide subsequent development of medicines information directed at pregnant and breastfeeding women. Methods The SafeMotherMedicine database contains all questions received through the web-based service and their corresponding answers. A retrospective database analysis of questions received from January 2016 to September 2018 was performed, using descriptive statistics. Results A total of 11 618 questions were received including 5 985 questions (51.5%) concerning pregnancy, 4 878 questions (42.0%) concerning breastfeeding, and 755 questions (6.5%) concerning both conditions. The medications in question represented all therapeutic groups with paracetamol (7.0%), ibuprofen (4.1%), cetirizine (3.3%), desloratadine (3.2%) and meclizine (2.8%) being the top five. The 20 medications most frequently asked about for either pregnancy, breastfeeding or both pregnancy and breastfeeding, constituted half of all questions and were used to identify target areas. These included both symptomatic relief of common complaints, such as pain, nausea, and rhinitis, as well as treatment of chronic conditions such as allergy, psychiatric disorders, and asthma. Analysis of a subset of questions showed that most of these questions were asked before use of medications in a current pregnancy (49%) or during breastfeeding (72%). The questions concerned use of medications in all stages of pregnancy and breastfeeding. For 81.6% of the questions concerning pregnancy, and for 84.2% of the questions concerning breastfeeding, information of no or low risk for the foetus or the breastfed infant was provided by SafeMotherMedicine. Conclusions We found that target areas for medicines information directed at pregnant and breastfeeding women included both symptomatic relief of common complaints as well as treatment of chronic conditions. The questions concerned a wide range of medications and involved use in all stages of pregnancy and breastfeeding. Our findings indicate that developing medicines information addressing the identified target areas will meet the information need for a large proportion of this patient group.

Successful breastfeeding among women with intention to breastfeed: From physiology to socio-cultural factors

Article

Full-text available

Nov 2021
EARLY HUM DEV

Background Even if women have intention to breastfeed, they do not always achieve a successful breastfeeding. Aim This study aims to analyse factors affecting breastfeeding prevalence among mothers that intended to breastfeed. Methods This is a prospective observational study involving 401 pregnant women that intended to breastfeed (asked at the 20th week). Breastfeeding prevalence was evaluated in reference to health-related, socio-cultural factors and healthcare professionals' interventions at 1 month, 6 months and 12 months after birth. Data were analysed using descriptive statistical methods, bivariate logistic regression and multivariate logistic regression modelling. Results Independent factors negatively affecting breastfeeding prevalence related to mothers' and newborns' health parameters and birth characteristics included smoking during pregnancy, anaemia and use of analgesia during labour. Regarding sociocultural parameters, being an immigrant, higher education level, intention to breastfeed before pregnancy, comfort with public breastfeeding and bedsharing were positively linked to breastfeeding, while teat or pacifier use in the first week was negatively linked. Regarding healthcare professionals' practices, mother and father/partner antenatal education course attendance and exclusive breastfeeding at the hospital were positively associated with breastfeeding. Conclusion Breastfeeding is a very complex phenomenon affected by multiple and diverse variables. Physiological factors only affect the short term (1st month), while middle and long term BF affecting variables are mainly identical and include mostly socio-cultural factors and also BF related practices, especially in the first days after birth. These data should help to develop more effective breastfeeding promotion strategies.

The Mothers Who Have 0-6 Baby, Attitudes About Feeding Babies And The Time That They Get To Use Supplementary Food

Article

Apr 2021

Breastfeeding and Infections in Early Childhood: A Cohort Study

Article

Nov 2020

Background: Studies on the association between breastfeeding and infections in children beyond the first year of life reveal conflicting results. In a population-based birth cohort, we investigated whether the duration of breastfeeding was associated with the number of hospitalizations due to infection and symptoms of infection at home. Methods: In the Odense Child Cohort, text message questionnaires were used to register information on breastfeeding (weekly until end of weaning) and symptoms of infection (biweekly; 12-36 months of age). Hospitalization data were obtained from the Danish National Patient Registry. Results: Of the 1087 invited, 815 mother-infant pairs were included. The median duration of any breastfeeding was 7.6 (interquartile range: 3.5-10.4) months and of exclusive breastfeeding was 2.1 (interquartile range: 0.7-4.4) months. Hospitalization due to infection was seen in 207 (25.4%) infants during the first 3 years of life. The adjusted incidence rate ratio (IRR) for hospitalization due to any infection decreased with a longer duration of any breastfeeding (adjusted IRR: 0.96; 95% confidence interval 0.93-0.99; P < .001). The strongest associations between the duration of any breastfeeding and hospitalizations due to infection were found within the first year of life, for lower respiratory tract infections, and other infections (P ≤ .05). For infants exclusively breastfed, the adjusted IRR for hospitalization was 0.88 (95% confidence interval: 0.80-0.96; P = .006). No protective associations were present between breastfeeding and infection symptoms registered at home from ages 12 to 36 months. Conclusions: The results suggest that increased duration of breastfeeding, especially exclusive breastfeeding, protects against infections requiring hospitalization in the first year of life but not hospitalizations or symptoms of infection at home beyond the first year.

Same-sex parents facing parenting standards. First results from three longitudinal studies

Article

Aug 2020

How do same‐sex parents take on the “job” of parenting and the institutional norms that define it during the first months of the child's life? What are the proximities and differences between same‐sex parents and heterosexual parents in matters of eating habits, hygiene, emotional regulation, and play habits? This paper answers these questions by using a systematic comparison of data provided by the French Longitudinal Study of Children (Étude Longitudinale Française depuis l'Enfance or ELFE) and the DEVHOM project. We first underline the fact that the habits of gay and lesbian families are close to those of the families belonging to social groups which they most often originate from: educated middle and upper classes. However, they differ on a greater sensitivity to breastfeeding norms and a greater concern for some aspects of their children's development. We offer three hypotheses to explain this difference: primary socialisation, specific forms of family organisation and a greater normative pressure felt by homosexual couples.

La situation de l'allaitement maternel en Wallonie et à Bruxelles au travers d'enquêtes de couverture vaccinale

Thesis

Sep 2016

Emmanuelle Robert

Personality Traits Predict Meeting the WHO Recommendation of 6 Months' Breastfeeding: A Prospective General Population Cohort Study

Article

Oct 2018
Adv Neonatal Care

Background: Although personality as well as anxiety and depression are recognized as predictors for breastfeeding initiation, evidence of an association of these factors with 6 months' exclusive breastfeeding as recommended by the World Health Organization (WHO) is sparse. Purpose: The purpose of this study was to investigate the associations of personality and symptoms of anxiety and depression during and after pregnancy with meeting the WHO recommendation of 6 months' exclusive breastfeeding. Methods: In their first trimester of pregnancy, 5784 pregnant women were enrolled in Dutch primary obstetric care centers and hospitals, of which 2927 completed the breastfeeding assessments 6 months postpartum. We performed logistic regression analyses to test the associations of "big five" personality traits (NEO Five Factor Inventory), anxiety (State-Trait Anxiety Inventory), and depression (Edinburgh Postnatal Depression Scale) symptom levels during pregnancy and postpartum with meeting the WHO recommendation of 6 months' exclusive breastfeeding. Results: Agreeableness (odds ratio [OR] = 1.18, P = .006) and openness (OR = 1.31, P < .001) were positively associated with meeting the WHO recommendation, whereas extraversion (OR = 0.83, P = .005) and neuroticism (OR = 1.18, P = .006) were negatively associated. After adjustment for both antenatal and postpartum symptom levels of anxiety and depression, the associations of the agreeableness, extraversion, and openness personality traits remained strong and statistically significant (P < .05). Implications for practice: Patient-centered care should take personality into account in an effort to tailor interventions to optimize breastfeeding behavior. Implications for research: In contrast to earlier findings, personality traits may be of greater importance than symptoms of anxiety and depression for meeting the WHO recommendation of 6 months' exclusive breastfeeding.

Déterminants de l’allaitement maternel et place du médecin généraliste dans la promotion et la poursuite de l’allaitement

Thesis

Sep 2017

Stéphanie Gaisnon

Objectifs- Déterminer les facteurs qui influencent le choix de l’allaitement maternel à la maternité du Groupe Hospitalier du Havre et évaluer le rôle du médecin généraliste dans la promotion et la poursuite de l’allaitement maternel après l’accouchement. Matériels et Méthodes- Étude descriptive réalisée entre septembre 2015 et juillet 2016 incluant les couples mères-enfants nés à terme, en bonne santé à la maternité du Groupe Hospitalier du Havre. L’étude s’est déroulée dans un premier temps sur une période de quatre mois, par une enquête reposant sur un questionnaire remis aux patientes venant d’accoucher (entre J1 et J5) qu’elles allaitaient ou non. La deuxième partie de l’étude incluait les patientes qui allaitaient à la maternité, en leur proposant un entretien téléphonique 6 mois après leur accouchement. Résultats- Au total 207 patientes ont pu êtres incluses : 128 dans le « groupe AM » (allaitement maternel) et 79 dans le « groupe AA » (allaitement artificiel). Parmi les 62% de mères ayant initié l’allaitement, la médiane de la durée d’allaitement était de 12 semaines et celle de l’allaitement exclusif était de 4 semaines. Le choix de l’allaitement maternel était plus fréquent chez les femmes d’âge plus élevé, mariées, d’origine étrangère et ayant eu une ou plusieurs expériences d’allaitement. Le médecin généraliste ne semble pas être assez impliqué dans la promotion de l’allaitement. En post-partum, il reste le premier professionnel vers lequel les femmes se tournent en cas de question sur l’allaitement. Conclusion- La connaissance des facteurs déterminants le choix de l’allaitement maternel permet de mieux cibler les femmes « à risque » de ne pas allaiter ou de sevrage précoce. Le rôle du médecin généraliste doit être renforcé et des dispositions nécessaires à sa mise en oeuvre prises afin d’améliorer la promotion de l’allaitement et le soutien des femmes qui allaitent.

Social Factors Associated with Non-initiation and Cessation of Predominant Breastfeeding in a Mother–Child Cohort in Spain

Article

Full-text available

May 2018
MATERN CHILD HLTH J

Objective The aim of the study was to identify factors associated with non-initiation and cessation of predominant breastfeeding (PBF) in a mother–child cohort from Spain. Materials and Methods The analysis included 2195 mother-infant from birth to 14 months post- delivery recruited between 2004 and 2008. Maternal characteristics were collected during the pregnancy. Lactation data were obtained at 6 and 14 months after delivery. PBF was defined as intake of breast milk plus liquids like juices or water. The PBF cessation was calculated using the date that women started PBF and the date that she reported to start giving infant formula and/or food. The relationship between maternal variables and PBF initiation and cessation was modeled using logistic and Cox proportional hazards regression analysis. Results The prevalence of PBF at hospital discharge was 85.3, 53.4% at 3 months, 46.1% at 4 months and 7.2% at 6 month. Only two women continued PBF at 12 months and none at 14 months. The initiating of PBF was associated with higher levels of maternal education, being a first-time mother and worked in a non-manual occupation. Higher level of physical activity, not smoking and having a healthy BMI, were also positively associated with PBF initiation. PBF cessation was higher in young, obese women, who had had complications during the pregnancy, and who had lower levels of education and smoked. The employment status of women, in week 32 of pregnancy and also in month 14 post-delivery, determined likelihood of PBF cessation. Conclusions Healthier habits and education positively influenced PBF initiation and duration. Decrease in PBF duration rates in Spain can be interpreted in part as a consequence of women returning to work.

Systematic review and meta-analysis of randomized controlled trials evaluating primary care-based interventions to promote breastfeeding in low-income women

Article

Full-text available

Oct 2011
FAM PRACT

Given the benefits of breastfeeding (BF), health care institutions recommend that a child should be breastfed for the first 6 months of its life. However, differences between social groups as regards BF behaviour are very prevalent. To identify effective programmes that can be implemented by GPs to promote BF in low-income women. A review of the literature was based on the Medline, Cochrane and Public Health databases (1985-2009), using index terms relating to BF, general medicine and social inequalities in health. Randomized controlled trials were included in our analysis. Two people independently selected which studies would be used by rating the quality of the articles. The results of these studies were presented in raw form and in terms of a pooled relative risk. We analysed 10 studies (of the 343 articles originally selected) involving a population of 1445 'mother and child' pairs. The studies that assessed ways of encouraging the initiation of any form of BF showed that educational programmes are effective [relative risk (RR) for starting BF, 1.46, 95% confidence interval (CI): 1.03-2.08]. As regards the studies that involved ways to encourage mothers to continue BF, the programmes used showed significant success rates after 3-month postpartum (RR: 1.15, 95% CI: 1.01-1.30). The successful programmes usually involved multiple 'short' follow-up appointments (<20 to 30 minutes). Educational programmes delivered in the context of ongoing personal contact with a health professional are effective in promoting BF in low-income women.

Effect of socioeconomic status on breastfeeding duration in mothers of preterm and term infants

Article

Full-text available

Dec 2007

The propensity to breastfeed is not only of importance with regard to the beneficial effects on the individual, but is also of concern as an indicator of health behaviour related to social conditions. Thus, our aim was to investigate the impact of socioeconomic status (SES) on breastfeeding duration in mothers of preterm and term infants. Prospective population based cohort study. Data for infants registered in breastfeeding databases of two Swedish counties 1993-2001 were matched with data from two national registries-the Medical Birth Registry and Statistics Sweden. A total of 37,343 mothers of 2093 preterm and 35,250 term infants participated. All socioeconomic factors; maternal educational level, maternal unemployment benefit, social welfare and equivalent disposable income, were strongly associated with breastfeeding when examined individually in mothers of preterm and term infants. Some of the associations attenuated when investigated simultaneously. Independently of SES and confounders, mothers of preterm infants were at higher risk of weaning before the infant was 2 months (adjusted odds ratio (OR) 1.70; 95% confidence interval ((CI) 1.46-1.99)), 4 months (OR 1.79; CI 1.60-2.01), 6 months (OR 1.48; CI 1.33-1.64), and 9 months old (OR 1.19; CI 1.06-1.34), compared with mothers of term infants. In Sweden, despite its social welfare support system and a positive breastfeeding tradition, SES clearly has an impact on the breastfeeding duration. Mothers of preterm infants breastfeed for a shorter time compared with mothers of term infants, even when adjustments are made for SES and confounders.

Prolonged and Exclusive Breastfeeding Reduces the Risk of Infectious Diseases in Infancy

Article

Full-text available

Jul 2010
Pediatrics

To examine the associations of duration of exclusive breastfeeding with infections in the upper respiratory (URTI), lower respiratory (LRTI), and gastrointestinal tracts (GI) in infancy. This study was embedded in the Generation R Study, a population-based prospective cohort study from fetal life onward in the Netherlands. Rates of breastfeeding during the first 6 months (never; partial for <4 months, not thereafter; partial for 4-6 months; exclusive for 4 months, not thereafter; exclusive for 4 months, partial thereafter; and exclusive for 6 months) and doctor-attended infections in the URTI, LRTI, and GI until the age of 12 months were assessed by questionnaires and available for 4164 subjects. Compared with never-breastfed infants, those who were breastfed exclusively until the age of 4 months and partially thereafter had lower risks of infections in the URTI, LRTI, and GI until the age of 6 months (adjusted odds ratio [aOR]: 0.65 [95% confidence interval (CI): 0.51-0.83]; aOR: 0.50 [CI: 0.32-0.79]; and aOR: 0.41 [CI: 0.26-0.64], respectively) and of LRTI infections between the ages of 7 and 12 months (aOR: 0.46 [CI: 0.31-0.69]). Similar tendencies were observed for infants who were exclusively breastfed for 6 months or longer. Partial breastfeeding, even for 6 months, did not result in significantly lower risks of these infections. Exclusive breastfeeding until the age of 4 months and partially thereafter was associated with a significant reduction of respiratory and gastrointestinal morbidity in infants. Our findings support health-policy strategies to promote exclusive breastfeeding for at least 4 months, but preferably 6 months, in industrialized countries.

Socioeconomic status and rates of breastfeeding in Australia: Evidence from three recent national health surveys

Article

Full-text available

Oct 2008

To investigate whether the relationship between socioeconomic status and breastfeeding initiation and duration changed in Australia between 1995 and 2004. Secondary analysis of data from national health surveys (NHSs) conducted by the Australian Bureau of Statistics in 1995, 2001 and 2004-05. The Socio-Economic Indexes for Areas (SEIFA) classification was used as a measure of socioeconomic status. Rates of initiation of breastfeeding; rates of breastfeeding at 3, 6 and 12 months. Between the 1995 and 2004-05 NHSs, there was little change in overall rates of breastfeeding initiation and duration. In 2004-05, breastfeeding initiation was 87.8%, and the proportions of infants breastfeeding at 3, 6 and 12 months were 64.4%, 50.4% and 23.3%, respectively. In 1995, the odds ratio (OR) of breastfeeding at 6 months increased by an average of 13% (OR, 1.13 [95% CI, 1.07-1.19]) for each increase in SEIFA quintile; in 2001, the comparative increase was 21% (OR, 1.21 [95% CI, 1.12-1.30]); while in 2004-05, the comparative increase was 26% (OR, 1.26 [95% CI, 1.17-1.36]). Breastfeeding at 3 months and 1 year showed similar changes in ORs. There was little change in the ORs for breastfeeding initiation. Although overall duration of breastfeeding remained fairly constant in Australia between 1995 and 2004-05, the gap between the most disadvantaged and least disadvantaged families has widened considerably over this period.

Critical Appraisal of the Health Research Literature: Prevalence or Incidence of a Health Problem

Article

Full-text available

Feb 1998

This article identifies and discusses criteria that can be used by health professionals to critically appraise research articles that estimate the prevalence or incidence of a disease or health problem. These guidelines will help determine the validity and usefulness of such community assessment studies. The criteria relate to the validity of the study methods (design, sampling frame, sample size, outcome measures, measurement and response rate), interpretation of the results and applicability of the findings. The research question "What is the prevalence of dementia in Canada?" is used as an example for this paper.

Yngve A, Sjostrom M: Breastfeeding in countries of the European Union and EFTA: current and proposed recommendations, rationale, prevalence, duration and trends [published erratum appears in Public Health Nutr 2001; 4: 1306]. Public Health Nutr. 4, 631-645

Article

Full-text available

May 2001

Unlabelled: Recommendations suggest exclusive breast feeding for at least the first 4 to 6 months after birth. Paradoxically, an overwhelming proportion of breast feeding (BF) data in Europe refers to all BF, i.e. not only exclusive but also partial BF (including formula, juices, water, sweetened water etc). This makes it difficult to estimate to what extent the recommendations are met. There is currently strong evidence for recommending exclusive breast feeding for at least 6 months. Exclusive BF has progressively gained scientific support. Prevention of infections, allergies and chronic diseases and a favourable cognitive development are highlighted in the recent scientific literature. Further long-term studies on the effects of BF on prevention of chronic disease in the adult are needed. Great differences exist in BF prevalence and duration both within and between European countries. Trends point towards higher prevalence and duration, with some exceptions. Young mothers breast feed less than older mothers; single and/or less educated mothers breast feed less than married mothers with more education. However, inefficient and unreliable monitoring systems prevail, and the data are scarce, not only on exclusive BF but also on demographic, socio-economic, psychosocial and medical determinants of BF patterns. National BF coordinators have not been appointed in many countries, and only every second country has promotion of BF incorporated into their national plan of action for nutrition. Conclusions: Efficient surveillance systems, comparable across Europe and using common definitions and methodology, need to be developed. These should include determinants of breast feeding. A European consensus conference should urgently be organised, in which strategies for successful promotion of exclusive BF should be particularly considered. There is now strong evidence for a recommendation to breast feed exclusively for about 6 months, which is more than the duration recommended previously.

Breast-feeding in Spain

Article

Full-text available

Jan 2002

Human milk is the best way to nurture the human infant. By breast-feeding their babies, mothers provide them with the best opportunities to wholly develop their potential, while protecting the infants and themselves from a whole range of diseases in the near future and in the years to come. Even though these benefits are widely known and there is ample scientific evidence on the topic, it seems from published data that Spanish women are not breast-feeding their babies as much and for as long as they should. Less than 90% start breast-feeding, at 1 month there is already an attrition of 30%, at 3 months more than half of the infants are taking artificial milk and by 6 months only 10% continue to breast-feed their infants. Low birth weight, Caesarean section and low study level are among the more significant factors that negatively affect breast-feeding. There is still work to do to improve this situation. Promotion of breast-feeding among the general population, mothers and health professionals is needed.

Breastfeeding rates are increasing in Scotland

Article

Full-text available

Apr 2001
Health Bull

To measure the change in prevalence of breastfeeding between 1990/1991 and 1997/1998 in Scotland, using information collected on Guthrie cards when newborn infants are about seven days old. Analysis, by geographic postcode area, health board and maternity unit, for babies born in 1990/1991 and 1997/1998. For 1997, maternity unit and health board breastfeeding rates were also compared after standardisation for maternal age, deprivation and age of infant. Scotland. 131,759 babies born in 1990/1991 and 118,055 in 1997/1998. In 1990/1991, 46,949 (35.6%) were breastfed as were 49,615 (42.0%) in 1997/1998, an increase of 6.4% (95% CI 6.0, 6.8) over eight years. A 3.8% increase remained after adjustment for change in maternal age. Maternity units with the Baby Friendly award improved 8.1% (95% CI 7.0, 9.2) compared with those with a certificate of commitment 6.1% (95% CI 5.2, 7.0). Other units improved 2.2% (95% C1 1.6, 2.8) no more than estimates due to increase in maternal age. Standardised rates were higher on the East Coast of Scotland 111 (109, 112) than the West or Central Regions 97 (96, 99). Breastfeeding has increased over eight years in Scotland. Less than half can be explained by demographic change in maternal age. However present breastfeeding targets are unlikely to be met. Maternity units should be urged to participate fully in the UNICEF U.K. Baby Friendly Initiative. Effective interventions prior to pregnancy are required so that more young men and women want their babies to be breastfed.

Social Determinants of Initiation, Duration and Exclusivity of Breastfeeding at the Population Level: The Results of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998-2002)

Article

Full-text available

Jul 2003

According to Canadian public health recommendations, newborns should be fed exclusively with breast milk during their first 4 to 6 months of life. The aim of this paper is to identify the main social determinants of initiation, duration and exclusivity of breastfeeding from birth to 4 months, at the population level. The results will help the development of public health interventions aimed at improving the prevalence of exclusive breastfeeding for at least the first 4 to 6 months of babies' life. The analyses were performed with the data of the Longitudinal Study of Child Development in Quebec (ELDEQ 1998-2002). The study follows a representative sample (n = 2,223) of the children born in 1998 in the province of Quebec, in Canada. The relations between breastfeeding (all and exclusive) and mothers' education level, annual family income, family type, parents' working situation and mothers' age group have been evaluated by crude and adjusted odds ratios. Multivariate analyses were used to identify the most influential factors. In 1998, nearly three quarters (72%) of the Quebec newborns were breastfed at birth. When they reached 4 months, only 6% of the Quebec children were exclusively breastfed, thus following public health recommendations. Mothers' education level remains the strongest factor of influence on breastfeeding from birth to 3 months, and its impact increases with baby's age. At 4 months, it is also the most important factor for all breastfeeding, but mothers' age is more important for exclusive breastfeeding. When all the studied factors are considered equal for all children, being breastfed in accordance with public health recommendations, which refers to exclusive breasfeeding for at least 4 months, is mainly influenced by mothers' age, followed by mothers' education level. Family income, family type and parents' working situation do not influence exclusive breastfeeding at 4 months. It should be noted that when considering all breastfed children, if mothers' age and education level are equal, annual family income shows a negative relationship with breastfeeding at any of the studied ages. This negative relationship is also observed at 2 months for exclusive breastfeeding (dollar 40,000-dollar 59,999). From a public health perspective, it is important that newborns be breastfed at birth and exclusively breastfed during their first 4 to 6 months of life. The analysis indicates that once the decision to breastfeed is made, different social factors influence the duration of breastfeeding and its exclusivity. Public policy targets are necessary to evaluate whether the situation is improving from one year to another and whether disparities are increasing or decreasing for newborns accumulating the impact of material and social deprivation early in life.

The influence of psychosocial factors on the duration of breastfeeding

Article

Full-text available

Jun 2004

A study was undertaken to examine to what extent psychosocial factors are related to the length of breastfeeding. A cohort of Danish mothers giving birth to a single child was followed up for four months. Information on mother and baby including psychosocial variables was obtained from a self-report questionnaire. Breastfeeding status was subsequently monitored by a health visitor. A total of 471 (88%) mothers participated, 98.7 % initiated breastfeeding and after four months 277 (59%) were still exclusive breastfeeding; 99 mothers, 51% of those who stopped, stopped within the first five weeks. In Cox regression analyses the duration of breastfeeding showed a positive association with mother's schooling (p=0.002), her intention to breastfeed (p=0.001), previous experience with breastfeeding (p<0.001), self-efficacy with respect to breastfeeding (p<0.001), her confidence in breastfeeding (p=0.012) and knowledge about breastfeeding (p=0.001). The effect of the mother's knowledge depended on the parity of the child. Among primiparous mothers high knowledge was associated with long duration of breastfeeding, but this association was not found among the multiparous. To help the mothers who would like to breastfeed their baby, we must improve our ability to identify mothers at risk of early cessation. Mother's schooling, her intention, self-efficacy and earlier breastfeeding experience can be used as early predictors. An intervention should aim at improving the self-efficacy and resources of these mothers, with a focus on practical knowledge. The first five weeks, when the largest proportion of the cessations occurred, require special attention.

Breast-feeding initiation and exclusive duration at 6 months by social class - Results from the Millennium Cohort Study

Article

Full-text available

Jul 2005

To assess breast-feeding initiation and rates of exclusive breast-feeding for the first 6 months after birth, and to examine social class differences in breast-feeding rates. First sweep of a longitudinal population-based survey, the Millennium Cohort Study. Four countries of the UK. Subjects were 18 125 singletons born over a 12-month period spanning 2000-01. Data were collected by parental interview on the initiation of breast-feeding and exclusivity at 1, 4 and 6 months after birth. Overall breast-feeding was initiated for 71% of babies, and by 1, 4 and 6 months of age the proportions being exclusively breast-fed were 34%, 3% and 0.3%, respectively. There were clear social class differences and mothers with routine jobs with the least favourable working conditions were more than four times less likely (odds ratio (OR) 0.22, 95% confidence interval (CI) 0.18-0.29) to initiate breast-feeding compared with women in higher managerial and professional occupations. Women in routine jobs were less likely to exclusively breast-feed their infants at 1 month (OR 0.42, 95% CI 0.36-0.50) and 4 months (OR 0.5, 95% CI 0.31-0.77) compared with women in higher managerial and professional occupations. Clear social class differences in breast-feeding initiation and exclusivity for the first 4 months were apparent in this large UK sample. By 6 months, less than 1% of babies were being exclusively breast-fed. A co-ordinated multi-faceted strategy is required to promote breast-feeding, particularly among lower-income women.

Infant milk feeding practices in the Netherlands and associated factors

Article

Full-text available

Jul 2005

The aim of the study was to describe infant feeding practices and associated factors, and to explore mothers' main reasons for starting and stopping breastfeeding. We performed a national inquiry into milk feeding practices among 9133 Dutch infants aged < 7 mo by means of a questionnaire. 78% of mothers initiated breastfeeding. At 1 and 4 mo, respectively, 51 and 25% of infants were fed primarily on human milk; after 6 mo, only 15% of mothers still provided human milk as the only source of milk feeding. During the whole 6-mo period, another 11 to 18% was fed on both breast and formula milk. Women initiating breastfeeding were more likely to be higher educated, have a higher-educated partner, be non-smokers, have a full-time job, and be primiparous. In addition, breastfeeding initiation rate was higher for women born outside the Netherlands. Longer duration of breastfeeding was mostly found amongst higher-educated, non-smoking women. The odds for continuation of breastfeeding after 4 mo increased when mothers' working hours did not exceed 16 h/wk. Infant delivery at home was associated with a higher initiation rate as well as longer duration of breastfeeding compared to hospital delivery. Infants born after 38 wk of gestation, with a birthweight of 3500 g had higher odds to be breastfed for a longer period. Only a minority of Dutch infants is breastfed for 6 mo. Maternal and infant characteristics are important predictors of breastfeeding initiation and duration.

Factors Associated with Exclusive Breast-feeding in Japan: for Activities to Support Child-rearing with Breast-feeding

Article

Full-text available

Apr 2006

Benefits of breast-feeding are not only limited to nutrition and sanitation in developing countries but also extend to cost-saving health care and alleviation of anxiety related to childrearing in developed countries. This study aims to elucidate factors associated with exclusive breast-feeding in Japan and use this information to achieve child-rearing support worldwide by promoting breast-feeding. This cross-sectional study used data from a survey conducted by Ministry of Health, Labour and Welfare of the Japanese government, the First Longitudinal Survey of Babies in 21st Century. All subjects were infants (n=53,575) born in Japan in 2001 between January 10 and 17 and between July 10 and 17. According to the data, the exclusive breast-feeding rate in Japan during the first 6 months of life was 21.0%. We examined the factors associated with exclusive breast-feeding using univariate and multivariate logistic regression analyses. Among the factors examined, the adjusted odds ratio (OR) for exclusive breast-feeding was low for late childbearing, low birth weight infants, multiple births, smoking parents, living with grandparents, and feeling burdened by childrearing. The adjusted OR was high for factors that included sufficient childcare leave and consultation about childrearing with the spouse, a birth attendant and/or nurse, and a peer in a child-rearing circle. Exclusive breast-feeding is associated not only with medical factors but also with social factors. This study clarifies the necessity of social support to reduce the child rearing burden and a political system to promote paternal participation in childrearing and to improve the childcare leave system.

Lower Breastfeeding Rates Persist Among the Special Supplemental Nutrition Program for Women, Infants, and Children Participants, 1978–2003

Article

Full-text available

May 2006
Pediatrics

We set out to compare rates of breastfeeding between women who participated in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) with those of non-WIC mothers from 1978 to 2003. The Ross Laboratories Mothers Survey is a national survey designed to determine patterns of milk feeding during infancy. Mothers were asked to recall the type of milk fed to their infant in the hospital and during each month of age. Rates of breastfeeding in the hospital and at 6 months of age were evaluated. Logistic regression analyses identified significant predictors of breastfeeding in 2003. From 1978 through 2003, rates for the initiation of breastfeeding among WIC participants lagged behind those of non-WIC mothers by an average of 23.6 +/- 4.4 percentage points. At 6 months of age, the gap between WIC participants and non-WIC mothers (mean: 16.3 +/- 3.1 percentage points) steadily increased from 1978 through 2003 and exceeded 20% by 1999. Demographic factors that were significant and positive predictors of breastfeeding initiation in 2003 included some college education, living in the western region of the United States, not participating in the WIC program, having an infant of normal birth weight, primipary, and not working outside the home. For mothers of infants 6 months of age, WIC status was the strongest determinant of breastfeeding: mothers who were not enrolled in the WIC program were more than twice as likely to breastfeed at 6 months of age than mothers who participated in the WIC program. Breastfeeding rates among WIC participants have lagged behind those of non-WIC mothers for the last 25 years. The Healthy People 2010 goals for breastfeeding will not be reached without intervention. Food package and programmatic changes are needed to make the incentives for breastfeeding greater for WIC participants.

Exclusive and any breast-feeding rates of Pacific infants in Auckland: Data from the Pacific Islands Families First Two Years of Life study

Article

Full-text available

Oct 2006

To present current breast-feeding rates for Pacific infants resident in New Zealand. Reasons for the introduction of complementary liquid foods were also explored. A longitudinal study using hospital discharge summary records and maternal home interviews undertaken at 6 weeks, 12 and 24 months postpartum. Turnbull's non-parametric survival analysis was used to model exclusive breast-feeding rates. Auckland, New Zealand. The cohort comprised 1376 infants at 6 weeks, 1223 infants at 12 months and 1142 infants at 24 months. Exclusive breast-feeding rates at hospital discharge, 6 weeks, 3 and 6 months postpartum were 84% (95% confidence interval (CI): 80-88%), 49% (95% CI: 43-55%), 37% (95% CI: 32-42%) and 9% (95% CI: 7-11%), respectively. Significant ethnic difference existed, with Samoan mothers having higher exclusive breast-feeding rates than Tongan mothers (P = 0.002). The percentage of infants receiving any breast milk at hospital discharge, 6 weeks, 12 and 24 months was 96% (95% CI: 94-97%), 95% (95% CI: 94-96%), 31% (95% CI: 28-34%) and 15% (95% CI: 13-17%), respectively. Again ethnic differences emerged. Common reasons cited for discontinuation of exclusive breast-feeding included uncertainty of breast milk supply (56%), problems with breasts (30%) and difficulties breast-feeding in work or educational environments (26%). However, 691 (50%) mothers sought no advice about their breast-feeding concerns within the first six weeks of life. Exclusive breast-feeding rates for Pacific infants are ethnically heterogeneous, have declined since the 1990s and fall short of the World Health Organization recommendations. The principal reasons cited for exclusive breast-feeding discontinuation echo those reported over a decade ago.

Nativity/Immigrant Status, Race/Ethnicity, and Socioeconomic Determinants of Breastfeeding Initiation and Duration in the United States, 2003

Article

Full-text available

Mar 2007
Pediatrics

Previous research has shown substantial racial/ethnic and socioeconomic disparities in US breastfeeding initiation and duration rates. However, the role of immigrant status in understanding such disparities has not been well studied. In this study we examined the extent to which breastfeeding initiation and duration varied by immigrant status overall and in conjunction with race/ethnicity and socioeconomic status after controlling for other relevant social and behavioral covariates. The cross-sectional data for 33121 children aged 0 to 5 years from the 2003 National Survey of Children's Health were used to calculate ever-breastfeeding rates and duration rates at 3, 6, and 12 months by social factors. Multivariate logistic regression was used to estimate relative odds of never breastfeeding and not breastfeeding at 6 and 12 months. More than 72% of mothers reported ever breastfeeding their infants, with the duration rate declining to 52%, 38%, and 16% at 3, 6, and 12 months, respectively. Ever-breastfeeding rates varied greatly among the 12 ethnic-immigrant groups included in this analysis, from a low of 48% for native black children with native parents to a high of 88% among immigrant black and white children. Compared with immigrant Hispanic children with foreign-born parents (the least acculturated group), the odds of never breastfeeding were respectively 2.4, 2.9, 6.5, and 2.4 times higher for native children with native parents (the most acculturated group) of Hispanic, white, black, and other ethnicities. Socioeconomic patterns also varied by immigrant status, and differentials were greater in breastfeeding at 6 months. Immigrant women in each racial/ethnic group had higher breastfeeding initiation and longer duration rates than native women. Acculturation was associated with lower breastfeeding rates among both Hispanic and non-Hispanic women. Ethnic-immigrant and social groups with lower breastfeeding rates identified herein could be targeted for breastfeeding promotion programs.

Breastfeeding and Maternal Health and Infant Health Outcomes in Developed Countries

Article

Full-text available

May 2007

We reviewed the evidence on the effects of breastfeeding on short- and long-term infant and maternal health outcomes in developed countries. We searched MEDLINE(R), CINAHL, and the Cochrane Library in November of 2005. Supplemental searches on selected outcomes were searched through May of 2006. We also identified additional studies in bibliographies of selected reviews and by suggestions from technical experts. We included systematic reviews/meta-analyses, randomized and non-randomized comparative trials, prospective cohort, and case-control studies on the effects of breastfeeding and relevant outcomes published in the English language. Included studies must have a comparative arm of formula feeding or different durations of breastfeeding. Only studies conducted in developed countries were included in the updates of previous systematic reviews. The studies were graded for methodological quality. We screened over 9,000 abstracts. Forty-three primary studies on infant health outcomes, 43 primary studies on maternal health outcomes, and 29 systematic reviews or meta-analyses that covered approximately 400 individual studies were included in this review. We found that a history of breastfeeding was associated with a reduction in the risk of acute otitis media, non-specific gastroenteritis, severe lower respiratory tract infections, atopic dermatitis, asthma (young children), obesity, type 1 and 2 diabetes, childhood leukemia, sudden infant death syndrome (SIDS), and necrotizing enterocolitis. There was no relationship between breastfeeding in term infants and cognitive performance. The relationship between breastfeeding and cardiovascular diseases was unclear. Similarly, it was also unclear concerning the relationship between breastfeeding and infant mortality in developed countries. For maternal outcomes, a history of lactation was associated with a reduced risk of type 2 diabetes, breast, and ovarian cancer. Early cessation of breastfeeding or not breastfeeding was associated with an increased risk of maternal postpartum depression. There was no relationship between a history of lactation and the risk of osteoporosis. The effect of breastfeeding in mothers on return-to-pre-pregnancy weight was negligible, and the effect of breastfeeding on postpartum weight loss was unclear. A history of breastfeeding is associated with a reduced risk of many diseases in infants and mothers from developed countries. Because almost all the data in this review were gathered from observational studies, one should not infer causality based on these findings. Also, there is a wide range of quality of the body of evidence across different health outcomes. For future studies, clear subject selection criteria and definition of "exclusive breastfeeding," reliable collection of feeding data, controlling for important confounders including child-specific factors, and blinded assessment of the outcome measures will help. Sibling analysis provides a method to control for hereditary and household factors that are important in certain outcomes. In addition, cluster randomized controlled studies on the effectiveness of various breastfeeding promotion interventions will provide further opportunity to investigate any disparity in health outcomes as a result of the intervention.

Influence of moving to the UK on maternal health behaviours: Prospective cohort study

Article

Full-text available

Jun 2008
Br Med J

To compare health behaviours during pregnancy (smoking and alcohol consumption) and after birth (initiation and duration of breast feeding) between British/Irish white mothers and mothers from ethnic minority groups; and, in mothers from ethnic minority groups, to examine whether indicators of acculturation (generational status, language spoken at home, length of residency in the United Kingdom) were associated with these health behaviours. Prospective nationally representative cohort study. England. 6478 British/Irish white mothers and 2110 mothers from ethnic minority groups. Any smoking during pregnancy; any alcohol consumption during pregnancy; initiation of breast feeding; breast feeding for at least four months. Compared with British/Irish white mothers, mothers from ethnic minority groups were less likely to smoke (15% v 37%) or consume alcohol (14% v 37%) during pregnancy but more likely to initiate breast feeding (86% v 69%) and breast feed for at least four months (40% v 27%). Among mothers from ethnic minority groups, first and second generation mothers were more likely to smoke during pregnancy (odds ratio 3.85, 95% confidence interval 2.50 to 5.93, and 4.70, 2.49 to 8.90, respectively), less likely to initiate breast feeding (0.92, 0.88 to 0.97, and 0.86, 0.75 to 0.99), and less likely to breast feed for at least four months (0.72, 0.62 to 0.83, and 0.52, 0.30 to 0.89) than immigrants, after adjustment for sociodemographic characteristics. There were no consistent differences in alcohol consumption. Among immigrants, for every additional five years spent in the UK the likelihood of mothers smoking during pregnancy increased by 31% (4% to 66%) and they were 5% (0% to 10%) less likely to breast feed for at least four months. After immigration, maternal health behaviours worsen with length of residency in the UK. Health professionals should not underestimate women's likelihood of engaging in risky health behaviours because of their ethnicity.

Factors associated with initiation and duration of breastfeeding in Italy

Article

Apr 1999

To evaluate factors associated with initiation and duration of breastfeeding in Italy, 1601 (73%) respondents among 2192 randomly selected mothers were interviewed within 1 mo of delivery. Mothers who started breastfeeding (85%) were followed-up for 12 mo. A compliance rate of 100% was obtained. At multiple logistic regression analysis, mother having been breastfed herself (p < 0.01), nursing guidance in the maternity ward (p = 0.01) and higher social class (p = 0.03) were positively associated with initiation of breastfeeding. We found that 42%, 19%, 10% and 4% mothers were still breastfeeding at 3, 6, 9 and 12 mo after delivery, respectively. Cox multiple regression analysis showed a negative association between duration of breastfeeding and pacifier use (p < 0.01), and a positive association with a higher level of maternal education (p = 0.04). Formula supplementation in the maternity ward (given to 30% of infants) was associated with a shorter duration of exclusive breastfeeding (p = 0.03). Mothers need support with breastfeeding, particularly those from lower social backgrounds and with lower levels of education. Early use of the pacifier should be discouraged.

Breastfeeding and the use of human milk

Article

Dec 1997

This policy statement on breastfeeding replaces the previous policy statement of the American Academy of Pediatrics, reflecting the considerable advances that have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, in the mechanisms underlying these benefits, and in the practice of breastfeeding. This document summarizes the benefits of breastfeeding to the infant, the mother, and the nation, and sets forth principles to guide the pediatrician and other health care providers in the initiation and maintenance of breastfeeding. The policy statement also delineates the various ways in which pediatricians can promote, protect, and support breastfeeding, not only in their individual practices but also in the hospital, medical school, community, and nation.

WHO Global Strategy on Infant and Young Child Feeding

Article

Jan 2002

Young Child Feeding

Socioeconomic determinants, maternal smoking and coffee consumption, and exclusive breastfeeding in 10 205 children: Socioeconomic factors and exclusive breastfeeding

Article

Sep 2007
ACTA PAEDIATR

Aim: To examine socio‐economic factors, smoking, coffee consumption and exclusive breastfeeding duration. Methods: This study was part of a prospective cohort study of children born between 1 October 1997 and 1 October 1999 (the All Babies in Southeast Sweden (ABIS) study). Eleven socio‐economic characteristics (parental employment, civil status, whether parents were born in Sweden, parental education, residence at birth and during child's first year, crowded living), maternal smoking, coffee consumption, infant sex, siblings, parental age, and maternal alcohol consumption during pregnancy were analysed using logistic regression and Cox's proportional hazards method. All data were obtained through questionnaires distributed at infant birth and at 1 y of age. Exclusive breastfeeding duration <4 mo and actual breastfeeding duration were our main outcome measures. Results: Out of 10&!hairsp;205 infants, 2&!hairsp;206 (21.6%) were exclusively breastfed for less than 4 mo (“short exclusive breastfeeding”; SEBF). Backward stepwise regression analysis identified the following risk factors for SEBF: maternal smoking (95% confidence interval for adjusted odds ratio, 95% CI AOR 2.00–2.82), low maternal education (95% CI AOR 1.45–2.19), maternal employment less than 3 mo during pregnancy (95% CI AOR 1.17–1.54), paternal age 29 y (95% CI AOR 1.14–1.47), maternal age 29 y (95% CI AOR 1.08–1.39) and low paternal education (95% CI AOR 1.08–1.48). The odds ratio for SEBF increased with the number of cigarettes smoked. Coffee consumption was not associated with duration of exclusive breastfeeding. Conclusion: This study indicates that socio‐economic factors and smoking may be of importance to the risk of breastfeeding exclusively for less than 4 mo, while coffee consumption is not.

Durée de l'allaitement maternel en France

Article

May 2000
Arch Pediatr

The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis

Article

Apr 2010
Pediatrics

A 2001 study revealed that

3.6 billion could be saved if breastfeeding rates were increased to levels of the Healthy People objectives. It studied 3 diseases and totaled direct and indirect costs and cost of premature death. The 2001 study can be updated by using current breastfeeding rates and adding additional diseases analyzed in the 2007 breastfeeding report from the Agency for Healthcare Research and Quality. Using methods similar to those in the 2001 study, we computed current costs and compared them to the projected costs if 80% and 90% of US families could comply with the recommendation to exclusively breastfeed for 6 months. Excluding type 2 diabetes (because of insufficient data), we conducted a cost analysis for all pediatric diseases for which the Agency for Healthcare Research and Quality reported risk ratios that favored breastfeeding: necrotizing enterocolitis, otitis media, gastroenteritis, hospitalization for lower respiratory tract infections, atopic dermatitis, sudden infant death syndrome, childhood asthma, childhood leukemia, type 1 diabetes mellitus, and childhood obesity. We used 2005 Centers for Disease Control and Prevention breastfeeding rates and 2007 dollars. If 90% of US families could comply with medical recommendations to breastfeed exclusively for 6 months, the United States would save

13 billion per year and prevent an excess 911 deaths, nearly all of which would be in infants ($10.5 billion and 741 deaths at 80% compliance). Current US breastfeeding rates are suboptimal and result in significant excess costs and preventable infant deaths. Investment in strategies to promote longer breastfeeding duration and exclusivity may be cost-effective.

Factors that positively influence breastfeeding duration to 6 months: A literature review

Article

Mar 2010

What modifiable factors positively influence breastfeeding duration to 6 months postpartum? This question was posed in order to be able to develop a midwifery intervention aimed at prolonging breastfeeding. An online literature search was conducted in Medline, CINAHL, Maternity and Infant Care, and Cochrane Database of systematic reviews. The search strategy included the following keywords: breastfeeding, duration, initiation, cessation, factors, intervention, education, partner, intention, confidence, self-efficacy and support. Additional studies were located and extracted from online publications of New South Wales Department of Health, Australia. Bio-psycho-social factors that are positively associated with breastfeeding duration were identified. Modifiable factors that influence women's breastfeeding decisions are: breastfeeding intention, breastfeeding self-efficacy and social support. Existing midwifery breastfeeding promotion strategies often include social support but do not adequately address attempts to modify breastfeeding intention and self-efficacy. The modifiable factors that are positively associated with breastfeeding duration are the woman's breastfeeding intention, her breastfeeding self-efficacy and her social support. Intervention studies to date have focussed on modifying these factors individually with variable results. No interventional studies have been conducted with the aim of positively modifying all three factors simultaneously.

Exclusive and mixed breastfeeding in maternity unit: Situation in France in 2003

Article

Sep 2008
Arch Pediatr

To assess how exclusive and mixed breastfeeding varied depending on the characteristics of the mother, the newborn, and place of birth. A national representative sample of births included 14,580 live births. During the hospital stay, mothers were asked if the infant was exclusively breastfed, breast and bottle-fed (mixed), or only bottle-fed. The factors associated with exclusive breastfeeding and those associated with mixed breastfeeding were compared using a multinomial logistic regression model. Of the women studied, 56.3% breastfed exclusively and 6.3% used mixed breastfeeding. Exclusive and mixed breastfeeding were higher among primiparous, non-French, and highly educated women. Non-French nationality had a stronger effect on mixed breastfeeding than on exclusive breastfeeding (adjusted odds ratio [aOR], 9.9 and 5.2, respectively, among women from North Africa). A high level of education played a greater role in exclusive breastfeeding (aOR, 2.5) than mixed breastfeeding (aOR, 1.8). Breastfeeding was higher in the Ile-de-France, East, Central-East, and Mediterranean regions, with stronger variations in mixed breastfeeding than in exclusive breastfeeding. Clear social disparities in exclusive and mixed breastfeeding exist depending on maternal social class and nationality, and region of birth. Particular breastfeeding promotion actions could target groups or regions where women are less likely to breastfeed.

The effect of work status on initiation and duration of breast-feeding

Article

Jul 1998

In this study, longitudinal data are used to examine the effect of work status on breast-feeding initiation and duration. Mothers from a mail panel completed questionnaires during late pregnancy and 10 times in the infant's first year. Mother's work status was categorized for initiation by hours she expected, before delivery, to work and for duration by hours she worked at month 3. Covariates were demographics; parity; medical, delivery, and hospital experiences; social support; embarrassment; and health promotion. Expecting to work part-time neither decreased nor increased the probability of breast-feeding relative to expecting not to work (odds ratios [ORs] = .83 and .89, P > .50), but expecting to work full-time decreased the probability of breast-feeding (OR = .47, P < .01). Working full-time at 3 months postpartum decreased breast-feeding duration by an average of 8.6 weeks (P < .001) relative to not working, but part-time work of 4 or fewer hours per day did not affect duration, and part-time work of more than 4 hours per day decreased duration less than full-time work. Part-time work is an effective strategy to help mothers combine breast-feeding and employment.

Factors associated with the duration of breastfeeding in Italy

Article

Apr 1999

[Duration of maternal breastfeeding in France]

Article

Jun 2000
Arch Pediatr

Breast-feeding Practices among Adolescent and Adult Mothers in the Missouri WIC Population

Article

Oct 2000
J AM DIET ASSOC

Rates of breastfeeding in Australia by State and socio-economic status: Evidence from the 1995 National Health Survey

Article

Dec 2000

To estimate rates of breastfeeding in the first year of life in Australia, according to state and socioeconomic status. Analysis of data from the 1995 Australian National Health Survey. Estimated breastfeeding rates are 81.8% on discharge from hospital, 57.1% fully breastfed at three months and 62.6% fully or partially breastfed at three months. At six months, it is estimated that 18.6% of babies are fully breastfed and 46.2% fully or partially breastfed. At one year, 21.2% of infants are receiving some breastmilk. Comparison between states demonstrates that there is considerable variation in breastfeeding practice within Australia. Rates of breastfeeding also vary according to the socioeconomic status of the geographic area in which the child is living, with a strong inverse relationship between rates of breastfeeding and socioeconomic status. Australia's target for breastfeeding in the year 2000 is to have 80% of babies at least partially breastfed for the first six months of life. Although Australia has good rates of initiation of breastfeeding these levels are not maintained over time, and it seems unlikely that we will reach the year 2000 targets.

Duration of breastfeeding and associated factors in Western and Eastern Germany

Article

Sep 2001

Unlabelled: Ten years after the German political reunification, specific lifestyle habits still vary between the former Western (FRG) and Eastern (GDR) sectors of Germany. We have analysed data from the first nationwide SuSe Study on breastfeeding 1997-1998 (n = 1593 healthy, term German infants) stratified in a Western (80.3%) and Eastern (19.7%) subgroup. In the Eastern subgroup, breastfeeding was higher for the first 2 wk but decreased more rapidly thereafter. The adjusted relative risk (odds ratios, OR) for short-term breastfeeding was strongly associated (OR >2) with maternal age, supplementary feeding, single parent status, maternal educational status, breastfeeding problems and partner's attitude towards breastfeeding. In the multivariate model, not the geographical location where the mother grew up but the different distribution of risk factors was associated with short-term breastfeeding. Moreover, mothers from both the Western and Eastern sectors mentioned different reasons for giving up breastfeeding. Conclusion: More breastfeeding promotion is necessary for women from the former GDR.

Support for Breastfeeding Mothers

Article

Feb 2002

Both observational and recent experimental evidence support the promotion of breastfeeding as the optimal form of infant nutrition. There is, however, uncertainty as to the most effective way of providing support to women who choose to breastfeed their children. A systematic review was performed to describe studies undertaken in this area and to assess the effectiveness of supplementary support. The objective of this review was to assess the effects of breastfeeding support. We searched the Cochrane Pregnancy and Childbirth Group trials register, the Cochrane Controlled Trials Register, MEDLINE and EMBASE. These were last searched in March 2001. Secondary references were searched and researchers in the field were contacted. Controlled trials of acceptable quality comparing extra support for breastfeeding mothers with usual maternity care. Data were extracted by one reviewer and checked by a second reviewer. Twenty eligible randomised or quasi-randomised controlled trials from 10 countries were identified involving 23,712 mother-infant pairs. There was a beneficial effect on the duration of any breastfeeding in the meta-analysis of all forms of extra support (relative risk (RR) for stopping any breastfeeding before six months 0.88 [95% confidence interval (CI) 0.81,0.95]; 15 trials, 21,910 women). The effect was greater for exclusive breastfeeding (RR 0.78 [95% CI 0.69,0.89]; 11 trials, 20,788 women). Extra professional support appeared beneficial for any breastfeeding (RR 0.89 [95% CI 0.81,0.97]; 10 trials, 19,696 women) and for exclusive breastfeeding (RR 0.90 [95% confidence interval 0.81,1.01]; six trials, 18,258 women) although the latter effect did not achieve full statistical significance. Lay support was effective in reducing the cessation of exclusive breastfeeding (RR 0.66 [95% CI 0.49,0.89]; five trials, 2530 women) but its effect on any breastfeeding did not reach statistical significance (RR 0.84 [95% CI 0.69,1.02]; five trials, 2224 women). Professional support in the largest trial to assess health outcomes produced a significant reduction in the risk of gastro-intestinal infections and atopic eczema. In two trials with children suffering from diarrhoeal illness extra support was highly effective in increasing short term exclusive breastfeeding rates and reducing recurrence of diarrhoea. Consideration should be given to providing supplementary breastfeeding support as part of routine health service provision. There is clear evidence for the effectiveness of professional support on the duration of any breastfeeding although the strength of its effect on the rate of exclusive breastfeeding is uncertain. Lay support is effective in promoting exclusive breastfeeding while the strength of its effect on the duration of any breastfeeding is also uncertain. Evidence supports the promotion of exclusive breastfeeding as central to the management of diarrhoeal illness in partially breastfed infants. Further trials are required to assess the effectiveness (including cost-effectiveness) of both lay and professional support in different settings - in particular in those communities with low rates of breastfeeding initiation. Research is also required into the most appropriate training for those, whether lay or professional, who support breastfeeding mothers.

A Longitudinal Study of Breastfeeding and Weaning Practices During the First Year of Life in Dunedin, New Zealand

Article

Aug 2002
J AM DIET ASSOC

To investigate infant feeding practices during the first year of life in a group of white infants in Dunedin, New Zealand. Prospective study of infants from birth to 12 months of age. A self-selected sample of 74 white mothers and their infants born in Dunedin, New Zealand, between October 1995 and May 1996. Statistical analyses Regression analyses were performed to determine factors associated with successful breastfeeding initiation and duration. Among mothers, 88% (n=65) initiated breastfeeding, 42% (n=31) were exclusively breastfeeding at 3 months, and 34% (n=25) were partially breastfeeding at 12 months. Intention to breastfeed increased the likelihood of successful breastfeeding initiation. Mothers who reported that they did not have enough breastmilk tended to exclusively breastfeed for a shorter period of time. Tertiary education and exclusively breastfeeding at 1 month were associated with a longer duration of breastfeeding. Perception of breastfeeding in public as embarrassing was associated with a shorter duration of breastfeeding. Among infants, 45% (n=33) were given nonmilk foods before 4 months of age, and 69% (n=51) were given unmodified cow's milk as a beverage before 12 months. Breastfeeding rates in this study, although higher than in many Western countries, were still lower than current recommendations. Our findings suggest that women should be taught how to increase their breastmilk supply. Parents should also be informed of the importance of delaying the introduction of nonmilk foods until their infant is 4 to 6 months of age and cow's milk until they are 12 months of age. Society also needs to address the social issue of embarrassment many mothers feel when breastfeeding in public.

[Social inequalities in infant mortality are narrowing]

Article

Feb 1998

Q C Dinh

PIP: Recent trends in infant mortality in France are analyzed using official data. "The increase in public health care to cover pregnancy, birth and early infancy has helped to reduce social inequalities in infant mortality. The gaps have narrowed from one generation to the next and the social groups with the highest infant mortality rates have posted the largest decreases. Remarkable convergence in infant mortality rates is therefore found across all the social groups. The greater part of this decrease has occurred during the neonatal period (deaths in the first month), which demonstrates the protective role of the health system." (EXCERPT)

Infant feeding practices and associated factors in the first six months of life: The Norwegian Infant Nutrition Survey

Article

Feb 2003

To describe and evaluate infant feeding practices during the first 6 mo of life in relation to recommendations, and to study infant feeding practices in relation to maternal and infant characteristics. Data from 2383 Norwegian infants aged 6 mo were collected by a self-administered semi-quantitative food-frequency questionnaire measuring feeding practices at 6 mo and feeding practices retrospectively at < or = 5.5 mo of age. Only 1% of the infants had never been breastfed. The proportion of breastfed infants was 96% at 1 mo, 85% at 4 mo and 80% at 6 mo. The proportion of exclusively breastfed infants was 90% at 1 mo, 44% at 4 mo and 7% at 6 mo. Twenty-one percent of the infants were introduced to solid foods before the age of 4 mo. For exclusive breastfeeding at 4 mo, breastfeeding at 6 mo and timely introduction of solid foods (not before 4 mo) significant positive trends were found for maternal age, education and degree of urbanization. Negative associations were found for maternal smoking. Furthermore, exclusive breastfeeding at 4 mo was associated with infant gender and marital status, and the odds of breastfeeding at 6 mo significantly decreased with decreasing infant birthweight. Finally, both the odds of exclusive breastfeeding at 4 mo and of breastfeeding at 6 mo increased with increasing numbers of children. These results indicate that a majority of Norwegian infants are fed in accordance with infant feeding recommendations during their first 6mo of life. However, the duration of exclusive breastfeeding is shorter than recommended. Infant feeding practices are significantly associated with maternal and infant characteristics.

Monitoring breastfeeding rates in Italy: National surveys 1995 and 1999

Article

Mar 2003

To assess and compare the rates of initiation and duration of breastfeeding in Italy in 1995 and 1999, and to examine the adherence to the ten steps to successful breastfeeding recommended by WHO. Two cohorts of mothers who delivered healthy infants in November 1995 (n = 1601) or November 1999 (n = 2450) were interviewed by telephone within 4 wk of delivery and when their infant were 3, 6, 9 and 12 mo of age. Type of breastfeeding was classified according to the WHO definitions. Adherence to the WHO ten steps was evaluated as experienced by the mothers. Initiation and duration of breastfeeding increased during the 1995-1999 period (p < 0.0001). The rate of breastfeeding at birth, at discharge and when the infants were 3, 6, 9 and 12 mo of age was 85%, 83%, 42%, 19%, 10% and 4%, in 1995 and 91%, 89%, 66%, 47%, 25% and 12% in 1999. The rate of exclusive breastfeeding was higher in 1999 than 1995 at birth (39% vs 30%, p < 0.0001) and at discharge (77% vs 70%, p < 0.0001), but overall no longer duration was observed in 1999. At 4 and 6 mo of age the rate of exclusive breastfeeding was 25% and 8% in 1995 and 31% and 5% in 1999. The adherence to each WHO step was higher in 1999 than in 1995 (p < 0.05) but concomitant adherence was low (<3%). Although an increase in initiation and duration of breastfeeding occurred in Italy during the 1995-1999 period, the duration of breastfeeding and exclusive breastfeeding is currently unsatisfactory, as is adherence to the ten steps specified by WHO. Promotion of breastfeeding and education and improvement in adherence to the WHO recommendations are still needed in Italy.

Incidence and Duration of Breastfeeding for Term Infants in Canada, United States, Europe, and Australia: A Literature Review

Article

Dec 2004

Analysis of differences in the incidence and duration of breastfeeding across countries may provide information about practices that encourage breastfeeding. This comparative review examines variation in the incidence and duration of breastfeeding for term infants that has been reported in studies from Canada, the United States, Europe, and Australia. Searches were conducted in PubMed, MEDLINE (from 1966), CINHAL (from 1982), and the Cochrane Database of Systematic Reviews. Studies were limited to nonexperimental and observational research that addressed term infants (>37 weeks gestational age), performed in developed countries, written in the English language, and published since 1990. Additional studies were located from reference lists of meta-analyses, systematic reviews, and previous articles. All studies that met study criteria were included in the review, regardless of the quality of methodology. Although studies had methodological limitations that precluded conducting a formal systematic review or meta-analysis, this comparative review revealed consistent differences among countries. For example, Europe and Australia reported a higher initiation and duration of breastfeeding term infants compared with Canada and the United States. Studies that examined reasons for a higher incidence and duration of breastfeeding term infants consistently document that women who initiate and continue to breastfeed are older, married, better educated, and have higher family incomes than women who do not breastfeed.

Breastfeeding and the Use of Human Milk

Article

Mar 2005
Pediatrics

This Policy Statement was revised. See https://doi.org/10.1542/peds.2022-057988 Considerable advances have occurred in recent years in the scientific knowledge of the benefits of breastfeeding, the mechanisms underlying these benefits, and in the clinical management of breastfeeding. This policy statement on breastfeeding replaces the 1997 policy statement of the American Academy of Pediatrics and reflects this newer knowledge and the supporting publications. The benefits of breastfeeding for the infant, the mother, and the community are summarized, and recommendations to guide the pediatrician and other health care professionals in assisting mothers in the initiation and maintenance of breastfeeding for healthy term infants and high-risk infants are presented. The policy statement delineates various ways in which pediatricians can promote, protect, and support breastfeeding not only in their individual practices but also in the hospital, medical school, community, and nation.

Factors Influencing the Initiation and Duration of Breastfeeding Among Low-Income Women Followed by the Canada Prenatal Nutrition Program in 4 Regions of Quebec

Article

Aug 2005

The factors that influence the actual initiation and duration of breastfeeding were studied among low-income women followed by the Canada Prenatal Nutrition Program (CPNP). A group of 196 pregnant women were selected at random from a sample of 6223 pregnant women who registered with the CPNP. Two 24-hour recalls and information regarding lifestyle habits, peer support, and infant-feeding practices were obtained between 26 and 34 weeks of gestation and 21 days and 6 months after birth. Women who received a university education (completed or not completed) versus women with < or = high school education (odds ratio [OR], 8.40; 95% confidence interval [CI], 1.02-69.50), women born outside Canada (OR,8.81; 95% CI, 3.34-23.19), and women of low birth weight infants (OR, 0.39; 95% CI, 0.16-0.96) were more likely to initiate breastfeeding. Late introduction of solid foods (P = .004), nonsmoking (P = .005), multiparity (P = .012), and a higher level of education (P = .049) were positively associated with the duration of breastfeeding among initiators. Understanding factors associated with initiation and duration of breastfeeding among low-income women is critical to better target breastfeeding promotion.

Socio-economic determinants, maternal smoking and coffee consumption, and exclusive breastfeeding in 10205 children

Article

Oct 2005

To examine socio-economic factors, smoking, coffee consumption and exclusive breastfeeding duration. This study was part of a prospective cohort study of children born between 1 October 1997 and 1 October 1999 (the All Babies in Southeast Sweden (ABIS) study). Eleven socio-economic characteristics (parental employment, civil status, whether parents were born in Sweden, parental education, residence at birth and during child's first year, crowded living), maternal smoking, coffee consumption, infant sex, siblings, parental age, and maternal alcohol consumption during pregnancy were analysed using logistic regression and Cox's proportional hazards method. All data were obtained through questionnaires distributed at infant birth and at 1 y of age. Exclusive breastfeeding duration<4 mo and actual breastfeeding duration were our main outcome measures. Out of 10205 infants, 2206 (21.6%) were exclusively breastfed for less than 4 mo ("short exclusive breastfeeding"; SEBF). Backward stepwise regression analysis identified the following risk factors for SEBF: maternal smoking (95% confidence interval for adjusted odds ratio, 95% CI AOR 2.00-2.82), low maternal education (95% CI AOR 1.45-2.19), maternal employment less than 3 mo during pregnancy (95% CI AOR 1.17-1.54), paternal age<or=29 y (95% CI AOR 1.14-1.47), maternal age<or=29 y (95% CI AOR 1.08-1.39) and low paternal education (95% CI AOR 1.08-1.48). The odds ratio for SEBF increased with the number of cigarettes smoked. Coffee consumption was not associated with duration of exclusive breastfeeding. This study indicates that socio-economic factors and smoking may be of importance to the risk of breastfeeding exclusively for less than 4 mo, while coffee consumption is not.

Breast-feeding in Athens, Greece

Article

Oct 2006
J PEDIATR GASTR NUTR

To determine the prevalence, examine the influence of hospital practices and investigate potential determinants of breast-feeding in Athens. Three hundred twelve mothers provided information regarding feeding practices at certain maternity hospitals in Athens, at 40 days and 6 months postpartum. Multiple logistic regression analysis was performed to evaluate the association between the initiation and maintenance of breast-feeding and potential risk factors. Although almost 90% of newborn infants were given a breast milk substitute one or more times during the first 2 days at the maternity hospital, the exclusive breast-feeding percentage on the last day of hospital stay reached 85%. Breast-feeding and exclusive breast-feeding percentages dropped to 55% and 35%, respectively, at 40 days postpartum and to 16% and 12%, respectively, at 6 months postpartum. While in the hospital, 3% of mothers initiated breast-feeding within 1 hour of labor, only 34% were informed about the advantages of breast-feeding by health professionals and 42% were trained to breast-feed by the midwives. "Rooming-in" was not practiced in the private hospitals. The educational level was positively associated with the initiation of breast-feeding [odds ratio (OR): 1.36, confidence interval (CI): 1.02-1.81], the mother's body mass index was negatively associated with the maintenance of breast-feeding for 40 days (OR: 0.56, CI: 0.32-0.98) and 6 months (OR: 0.28, CI: 0.06-1.26) and a caesarean section was negatively associated with the initiation (OR: 0.24, CI: 0.11-0.49) and maintenance of breast-feeding (OR: 0.42, CI: 0.20-0.89). Breast-feeding is not appropriately supported in certain maternity hospitals in Athens, and this is probably the cause of observed low breast-feeding prevalence.

Support for Breastfeeding Mothers (Review)

Article

Feb 2007

There is extensive evidence on the short-term and long-term health benefits of breastfeeding for infants and mothers. In 2003, the World Health Organization recommended that, wherever possible, infants should be fed exclusively on breast milk until six months of age. However, in some high-income countries, many mothers stop breastfeeding before they want to and this causes disappointment for the mothers and more health problems for the infants. This review looked at whether providing support for breastfeeding mothers, either from professionals, or from trained lay people, or both, would help mothers to continue to breastfeed. The review found 34 studies, from 14 countries, including almost 30,000 women. Both professional and lay support were effective, and together they were also effective, in areas where initiation and continuation of breastfeeding was not high. Further research is needed to identify the aspects of support that are the most effective.

Do early infant feeding practices vary by maternal ethnic group?

Article

Oct 2007

To examine UK country and ethnic variations in infant feeding practices. Cohort study. Infants enrolled in the Millennium Cohort Study, born between September 2000 and January 2002. A total of 18 150 natural mothers (11 286 (8207 white) living in England) of singleton infants. Breast-feeding initiation, breast-feeding discontinuation and introduction of solid foods before 4 months. EXPLANATORY VARIABLES: Maternal ethnic group, education and social class. Seventy per cent of UK mothers started to breast-feed, of whom 62% stopped before 4 months. Median age at discontinuing breast-feeding was 14, 13, 10 and 6 weeks in Scotland, England, Wales and Northern Ireland, respectively. Thirty-six per cent of UK mothers (34% in England) introduced solids before 4 months. White mothers were more likely to discontinue breast-feeding (62%) and introduce solids early (37%) than most other ethnic minority groups; those stopping before 4 months were more likely to introduce solids early compared with those continuing to breast-feed beyond this age (adjusted rate ratio (95% confidence interval): 1.3 (1.1-1.2)). Educated mothers were less likely to stop breast-feeding before 4 months (white mothers, 0.8 (0.8-0.9); non-white mothers, 0.9 (0.8-1.0)) than those with no/minimal qualifications but, among ethnic minorities, were more likely to introduce solids early (1.3 (1.0-1.6)). Socio-economic status was positively associated with breast-feeding continuation among white women, and with age at introduction of solids among non-white women. We have identified important geographic, ethnic and social inequalities in breast-feeding continuation and introduction of solids within the UK, many of which have not been reported previously. The factors mediating these associations are complex and merit further study to ensure that interventions proposed to promote maternal adherence to current infant feeding recommendations are appropriate and effective.

Factors influencing breastfeeding rates in south-western Sydney

Article

Apr 2007

To explore the socio-demographic factors and other maternal characteristics that influence breastfeeding initiation rates. In particular, this paper aims to (i) estimate the rate of breastfeeding by maternal socio-demographic factors and other maternal characteristics at first well-baby visit; and (ii) investigate the relationship between breastfeeding rates and these maternal factors. Cross-sectional data were obtained for 9618 babies in south-western Sydney in New South Wales from the Ingleburn Baby Information Systems database from January 2000 to June 2004 and included information on breastfeeding status, socio-demographic factors and other maternal characteristics. At first visit, 59.8% of mothers were breastfeeding. The factors that increased the risk for NOT breastfeeding on multivariate analysis were being Australian-born (OR=1.67, 95% CI 1.45-1.89, P<0.001), unmarried (OR=1.79, 95% CI 1.52-2.11, P<0.001), living in disadvantaged accommodation (OR=1.90, 95% CI 1.60-2.26, P<0.001), having lower levels of education (OR=1.88, 95% CI 1.38-2.54, P<0.001) and current smoking (OR=1.72, 95% CI 1.51-1.96, P<0.001). The results from this large population-based study suggest that breastfeeding rates are significantly influenced by socio-demographic factors and maternal characteristics. Consequently, subgroups of the population 'at risk' for not breastfeeding can be identified and targeted for further strategies to promote breastfeeding.

Differential trends in breastfeeding according to maternal and hospital characteristics: Results from the French National Perinatal Surveys

Article

Sep 2007

To assess breastfeeding trends in hospital, between 1998 and 2003, according to several characteristics of mothers and maternity units. Two representative national samples of births, comprising 13,600 live births in 1998 and 14,580 in 2003 were used. Data were collected during hospital stay. All newborns fed entirely or partly on breast milk were considered 'breastfed'. Univariate and multivariate analyses were used to compare the results for the 2 years. Breastfeeding increased in all groups, but this increase varied slightly according to maternal age and the size of the maternity unit. For example, high rates of breastfeeding tended to be concentrated in large maternity units (> or = 1500 deliveries per year) in 1998, but were also found in middle-size units (1000-1499 deliveries per year) in 2003. In 2003, women were more likely to breastfeed if they were at least 25 years old, primiparous, non-French or from a highly qualified occupational group, or if they gave birth in a university hospital or in a maternity unit with more than 1000 deliveries per year. Despite recent efforts to increase the breastfeeding rate, clear social disparities persist and further efforts are required, targeting particular groups of mothers less likely to breastfeed.

Ethnic Variation in Infant-Feeding Practices in the Netherlands and Weight Gain at 4 Months

Article

Feb 2008

This prospective study of 4438 infants (0-4 months) examined differences in infant-feeding patterns in relation to the ethnic origin of their mothers, based on the mother's native language: Dutch (87%), Turkish (4%), Moroccan (3%), other European languages (3%), and various other languages (4%). Breastfeeding at birth varied between 75% and 94%. Dutch and Moroccan mothers breastfed for a shorter period (32% and 37% at 4 months, respectively) than did Turkish mothers and mothers with a native European language other than Dutch (47% and 51% at 4 months, respectively; P < .001). Of all mothers, 71% started exclusive breastfeeding at birth, and 21% continued exclusive breastfeeding for at least 4 months. The reasons why mothers discontinued breastfeeding (both exclusive breastfeeding and breastfeeding) were generally infant related. The average weight gain between birth and day 133 was 3.45, 3.87, and 3.69 kg for Dutch, Turkish, and Moroccan infants, respectively. Weight gain was influenced by ethnicity of the mothers and exclusive breastfeeding.

Allaitement maternel -[Mise en oeuvre et poursuite dans les 6 premiers mois de vie de l'enfant]. Recommandation pour la pratique clinique

Jan 2001

Haute Autorité
Santé

Haute Autorité de Santé. Allaitement maternel -[Mise en oeuvre et poursuite dans les 6 premiers mois de vie de l'enfant]. Recommandation pour la pratique clinique, 2001.

Complé de cadrage: disparité sociales et apports d'autres sources

Jan 2003

A Vilain
C Peretti
Herbet

Vilain A, de Peretti C, Herbet J.-B. Enquê nationale pé 2003, Complé de cadrage: disparité sociales et apports d'autres sources. DREES 2005. http://www.sante.gouv.fr/IMG/pdf/perinat2003t2. pdf (accessed on 3 june 2011).

Inégalité sociales de santé des dé multiples La santé de l'homme, n o 397

Jan 2008
17-9

M-J Moquet

Moquet M-J. Inégalité sociales de santé des dé multiples La santé de l'homme, n o 397. 2008. 17–9.

Prevalence of breastfeeding in industrialized countries

Abstract

No full-text available

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