International Breastfeeding Journal - Latest Articles

Reasons given by mothers for discontinuing breastfeeding in Iran

Beheshteh Olang — 2012-05-06T00:00:00Z

Background: We have previously shown that in Iran, only 28% of infants were exclusively breastfed at six months, despite a high prevalence of breastfeeding at two years of age. The primary aim of this study was to investigate the reasons women discontinued exclusive breastfeeding.MethodThis retrospective study was based on questionnaires and interviews with 63,071 mothers of infants up to 24 months of age, divided into two populations: infants younger than six months and six months or older. The data were collected in 2005-2006 from all 30 provinces of Iran. Results: Only 5.3% of infants less than six months of age stopped breastfeeding (mean age of 3.2 months); more commonly in urban than rural areas. The most frequently cited reasons mothers gave for discontinuing exclusive breastfeeding were physicians' recommendation (54%) and insufficient breast milk (self-perceived or true, 28%). Breastfeeding was common after six months of age: only 11% of infants discontinued breastfeeding, at a mean of 13.8 months. The most common reason for discontinuation at this age was insufficient breast milk (self-perceived or true, 45%). Maternal illness or medication (10%), infant illness (6%), and return to work (3%) were uncommon causes. Use of a pacifier was correlated with breastfeeding discontinuation. Maternal age and education was not associated with duration of breastfeeding. Multivariate analysis showed that using a pacifier and formula or other bottle feeding increased the risk of early cessation of breastfeeding. Conclusions: Physicians and other health professionals have an important role to play in encouraging and supporting mothers to maintain breastfeeding.

Enquiry analysis and user opinion of the Drugs in Breastmilk Helpline: a prospective study

Paul Rutter — 2012-05-02T00:00:00Z

Background: Since breastfeeding is universally recognised as the ideal way to feed infants, it isunderstandable, and at times inevitable, that breastfeeding mothers will want, or be required,to take medication. To meet the information demands of breastfeeding mothers andhealthcare professionals, a UK charity, The Breastfeeding Network, established a freetelephone helpline to answer queries on medicines in breastmilk. This study reports on theenquiries received by the Drugs in Breastmilk Helpline and user opinion of the service. Methods: All enquirers to the Helpline between December 2010 and January 2011 were asked if theycould be contacted in 2 to 4 weeks to provide more information on their experience of usingthe service. A combination of telephone semi-structured interviews and email surveys wereused depending on whether the enquiry originated via telephone or email. Results: Information was gained from 101 participants; 77 women and 24 healthcare professionals.Women reported high levels of service satisfaction (94%, n = 72/77) and healthcareprofessionals found the information provided useful (92%, n = 22/24). Women used theservice for reassurance or because they had received conflicting information or distrustedhealthcare professional advice. Healthcare professionals often could not answer questions ortook a cautious approach to recommendation (i.e. advised avoidance of medicines whilstbreastfeeding); this was often at odds to advice given by staff from the Helpline. Healthcareprofessionals did not routinely access resources to answer questions, but when they did,showed a lack of confidence in data interpretation. Conclusions: The Breastfeeding Networks' Drugs in Breastmilk Helpline provides an important service tobreastfeeding women and healthcare staff to make informed decisions on medicine takingwhilst breastfeeding. Healthcare professional uncertainty and incorrect advice given tobreastfeeding women suggests that healthcare professional education needs improving andthat greater use of specialist services should be encouraged.

Constraints to exclusive breastfeeding practice among breastfeeding mothers in Southwest Nigeria: Implications for scaling up

Ojo Agunbiade — 2012-04-23T00:00:00Z

Background: The practice of exclusive breastfeeding is still low despite the associated benefits. Improving the uptake and appropriating the benefits will require an understanding of breastfeeding as an embodied experience within a social context. This study investigates breastfeeding practices and experiences of nursing mothers and the roles of grandmothers, as well as the work-related constraints affecting nurses in providing quality support for breastfeeding mothers in Southwest Nigeria. Methods: Using a concurrent mixed method approach, a structured questionnaire was administered to 200 breastfeeding mothers. In-depth interviews were also held with breastfeeding mothers (11), nurses (10) and a focus group discussion session with grandmothers. Results: Breastfeeding was perceived as essential to baby's health. It strengthens the physical and spiritual bond between mothers and their children. Exclusive breastfeeding was considered essential but demanding. Only a small proportion (19%) of the nursing mothers practiced exclusive breastfeeding. The survey showed the major constraints to exclusive breastfeeding to be: the perception that babies continued to be hungry after breastfeeding (29%); maternal health problems (26%); fear of babies becoming addicted to breast milk (26%); pressure from mother-in-law (25%); pains in the breast (25%); and the need to return to work (24%). In addition, the qualitative findings showed that significant others played dual roles with consequences on breastfeeding practices. The desire to practice exclusive breastfeeding was often compromised shortly after child delivery. Poor feeding, inadequate support from husband and conflicting positions from the significant others were dominant constraints. The nurses decried the effects of their workload on providing quality supports for nursing mothers. Conclusion: Breastfeeding mothers are faced with multiple challenges as they strive to practice exclusive breastfeeding. Thus, scaling up of exclusive breastfeeding among mothers requires concerted efforts at the macro, meso and micro levels of the Nigerian society.

Infant feeding practices at routine PMTCT sites, South Africa: results of a prospective observational study amongst HIV exposed and unexposed infants - birth to 9 months

Ameena Goga — 2012-04-03T00:00:00Z

Background: We sought to investigate infant feeding practices amongst HIV-positive and -negative mothers (0-9 months postpartum) and describe the association between infant feeding practices and HIV-free survival. Methods: Infant feeding data from a prospective observational cohort study conducted at three (of 18) purposively-selected routine South African PMTCT sites, 2002-2003, were analysed. Infant feeding data (previous 4 days) were gathered during home visits at 3, 5, 7, 9, 12, 16, 20, 24, 28, 32 and 36 weeks postpartum. Four feeding groups were of interest, namely exclusive breastfeeding, mixed breastfeeding, exclusive formula feeding and mixed formula feeding. Cox proportional hazards models were fitted to investigate associations between feeding practices (0-12 weeks) and infant HIV-free survival. Results: Six hundred and sixty five HIV-positive and 218 HIV-negative women were recruited antenatally and followed-up until 36 weeks postpartum. Amongst mothers who breastfed between 3 weeks and 6 months postpartum, significantly more HIV-positive mothers practiced exclusive breastfeeding compared with HIV-negative: at 3 weeks 130 (42%) versus 33 (17%) (p < 0.01); this dropped to 17 (11%) versus 1 (0.7%) by four months postpartum. Amongst mothers practicing mixed breastfeeding between 3 weeks and 6 months postpartum, significantly more HIV-negative mothers used commercially available breast milk substitutes (p < 0.02) and use of these peaked between 9 and 12 weeks. The probability of postnatal HIV or death was lowest amongst infants living in the best resourced site who avoided breastfeeding, and highest amongst infants living in the rural site who stopped breastfeeding early (mean and standard deviations: 10.7% ± 3% versus 46% ± 11%). Conclusions: Although feeding practices were poor amongst HIV-positive and -negative mothers, HIV-positive mothers undertake safer infant feeding practices, possibly due to counseling provided through the routine PMTCT programme. The data on differences in infant outcome by feeding practice and site validate the WHO 2009 recommendations that site differences should guide feeding practices amongst HIV-positive mothers. Strong interventions are needed to promote exclusive breastfeeding (to 6 months) with continued breastfeeding thereafter amongst HIV-negative motherswho are still the majority of mothers even in high HIV prevalence setting like South Africa.

Infant feeding practices among mildly wasted children: a retrospective study on Nias Island, Indonesia

Dyah Ayu Inayati — 2012-03-21T00:00:00Z

Background: This study investigated the infant feeding practices of participating mothers who were recruited into a research project aimed at improving the nutritional status of mildly wasted children (< -1.0 to ≥ -1.5 Weight-for-Height Z-scores) aged ≥ 6 to < 60 months on Nias Island, Indonesia. Methods: Cross-sectional, questionnaire-based interview of mothers of the index children (n = 215) who were admitted to the community program for mildly wasted children in the study area. Four focus groups and twenty in-depth interviews were conducted to explore further information on infant feeding practices in the study area. Results: Retrospective results indicated that 6% of the mothers never breastfed. Fifty two percent of mothers initiated breastfeeding within six hours of birth, but 17% discarded colostrum. Exclusive breastfeeding until 6 months of age was practiced by 12%. Seventy-four percent of the mothers offered supplementary liquids besides breast milk within the first 7 days of life, and 14% of infants received these supplementary liquids from 7 days onwards until 6 months of age. Moreover, 79% of the infants were given complementary foods (solid, semi-solid, or soft foods) before 6 months of age. About 9% of the children were breastfed at least two years. Less than one in five of the mildly wasted children (19%) were breastfed on admission to the community program. Qualitative assessments found that inappropriate infant feeding practices were strongly influenced by traditional beliefs of the mothers and paternal grandmothers in the study areas. Conclusion: Generally, suboptimal infant feeding was widely practiced among mothers of mildly wasted children in the study area on Nias Island, Indonesia. To promote breastfeeding practices among mothers on Nias Island, appropriate nutrition training for community workers and health-nutrition officers is needed to improve relevant counseling skills. In addition, encouraging public nutrition education that promotes breastfeeding, taking into account social-cultural factors such as the influence of paternal grandmothers on infant feeding practice, is needed.

Community volunteers can improve breastfeeding among children under six months of age in the Democratic Republic of Congo crisis

Ghislain Balaluka — 2012-02-24T00:00:00Z

Background: Malnutrition is a major public health problem in developing countries and exclusive breastfeeding is an efficient strategy that can be used to prevent malnutrition and reduce child mortality. The objective of this study is to evaluate the effectiveness of community volunteers in promoting exclusive breastfeeding from birth in an area of endemic malnutrition. Methods: This evaluation analyzed the impact of the community-based nutrition project in Katana health district of the Democratic Republic of Congo from 2004 to 2006. Each of the villages in this sector had a nutritional village committee made up of five members responsible for continuously working to raise awareness of the importance of exclusive breastfeeding from birth among pregnant women and community leaders in their respective villages. The program worked with community volunteers with a mean age of 37 years, most of whom were married (86%). Eighty percent of the community volunteers had completed secondary school or a higher level of education. Data related to the period of exclusive breastfeeding and to the number of visits made to the health services for 208 children. The data were compared with data from 178 infants collected from another health sector, which had never developed a community-based nutrition program. Results: The duration of exclusive breastfeeding from birth (median, range) was 6 months (2 to 7) in the intervention area compared with 4 months (1 to 6) in the comparison area (p < 0.001). The proportion of infants receiving exclusive breastfeeding at six months of age was higher in the intervention area than in the comparison area: 57.7% (95% Confidence Interval, CI, 50.9 to 64.5) versus 2.7% (95%CI, 1.1 to 6.6) (p < 0.001). The intervention group had a higher mean weight at 12 months (standard deviation): 8.42 kg (1.41) compared to 7.97 kg (1.02), although this difference was not statistically significant (p = 0.055). Conclusions: The promotion of breastfeeding by community volunteers in an area of endemic malnutrition in rural Democratic Republic of Congo increased the duration of exclusive breastfeeding from birth.

Infant feeding practices in Bhaktapur, Nepal: A cross-sectional, health facility based survey

Manjeswori Ulak — 2012-01-10T00:00:00Z

Background: Promotion of proper breastfeeding practices for the first six months of life is the most cost-effective intervention for reducing childhood morbidity and mortality. However, the adherence to breastfeeding recommendations in many developing countries is not satisfactory. The aims of the study were to determine breastfeeding and infant feeding patterns at nine months of age and to assess factors influencing exclusive breastfeeding practices. Methods: In Bhaktapur, Nepal, we carried out a cross-sectional survey of 325 infants who came for measles vaccination at the age of nine months. Mothers were interviewed on details regarding feeding of their child and health since birth. Results: Three quarters of all mothers reported that they did not receive any information on breastfeeding during the antenatal visit. Two hundred and ninety five (91%) mothers gave colostrum and 185 (57%) initiated breastfeeding within one hour of delivery. The prevalence of exclusively breastfeeding at 1, 3 and 6 months were 240 (74%), 78 (24%) and 29 (9%), and partial feeding was initiated in 49 (15%), 124 (38%) and 257 (79%) babies, respectively. The main reason, according to the mother, for introducing other foods before six months of age was insufficient breast milk. In logistic regression analyses, mother's knowledge on how long child should be given only breast milk and not living in joint families were associated positively with exclusive or predominant breastfeeding for four months or beyond. Conclusions: Despite the high proportion of mothers who initiated breastfeeding immediately after birth, continuation of exclusive breastfeeding for up to six months was not common. Very few mothers received any information on breastfeeding during the antenatal visit, indicating a need for counseling on exclusive breastfeeding. Possible options for this counseling could be during antenatal visits and at regular clinic visits for vaccination.

Female employees' perceptions of organisational support for breastfeeding at work: findings from an Australian health service workplace

Danielle Weber — 2011-11-30T00:00:00Z

Background: Women's return to work can be a significant barrier to continued breastfeeding. Workplace policies and practices to promote and support continued, and longer duration of, breastfeeding are important. In the context of the introduction of a new breastfeeding policy for Area Health Services in New South Wales, Australia, a baseline survey was conducted to describe current practices and examine women's reports of perceived organisational support on breastfeeding intention and practice. Methods: A cross sectional survey of female employees of the Sydney South West Area Health Service was conducted in late 2009. A mailed questionnaire was sent to 998 eligible participants who had taken maternity leave over the 20-month period from January 2008 to August 2009. The questionnaire collected items assessing breastfeeding intentions, awareness of workplace policies, and the level of organisational and social support available. For those women who had returned to work, further questions were asked to assess the perceptions and practices of breastfeeding in the work environment, as well as barriers and enabling factors to combining breastfeeding and work. Results: Returning to work was one of the main reasons women ceased breastfeeding, with 60 percent of women intending to breastfeed when they returned to work, but only 40 percent doing so. Support to combine breastfeeding and work came mainly from family and partners (74% and 83% respectively), with little perceived support from the organisation (13%) and human resources (6%). Most women (92%) had received no information from their managers about their breastfeeding options upon their return to work, and few had access to a room specially designated for breastfeeding (19%). Flexible work options and lactation breaks, as well as access to a private room, were identified as the main factors that facilitate breastfeeding at work. Conclusions: Enabling women to continue breastfeeding at work has benefits for the infant, employee and organisation. However, this baseline study of health employees revealed that women felt largely unsupported by managers and their organisation to continue breastfeeding at work.

Feeding practices among children attending child welfare clinics in Ragama MOH area: a descriptive cross-sectional study

Priyantha Perera — 2011-11-21T00:00:00Z

Background: Feeding during early childhood is important for normal physical and mental growth as well as for health in later life. Currently, Sri Lanka has adopted the WHO recommendation of exclusive breastfeeding for six months, followed by addition of complementary feeds thereafter, with continuation of breastfeeding up to or beyond two years. This study was conducted to evaluate the current feeding practices among Sri Lankan children during early childhood. Methods: This study was a descriptive cross-sectional study conducted in the Ragama Medical Officer of Health (MOH) area. It was conducted between 10 August 2010 and 30 October 2010. Children between the ages of 24 and 60 months, attending child welfare clinics, were included in the study on consecutive basis. An interviewer-administered questionnaire was used to collect data regarding sociodemographic characteristics and feeding practices. Results: There were 208 boys and 202 girls in the study population. Of them, 255 (62.2%) were exclusively breastfed up to 6 months. Younger children had a statistically significant, higher rate of exclusive breastfeeding compared to older children. Three hundred and fifty one (85.6%) children had received infant formula, and it was started before the age of 6 months in 61 children, and in 212 before one year. Sugar was added to infant formula in 330 (80.4%) children, and out of them 144 had sugar added within first year of life. Complementary foods were started before 4 months in 29 (7%) children. Of the 410 children, 294 (71.7%) were breastfed beyond 2 years and 41.6% of them were breastfed at regular intervals throughout the day. Three hundred and thirty eight (82.6%) children were receiving overnight feeding of either breast milk or infant formula even after 2 years. Conclusions: Though a high rate of exclusive breastfeeding was observed in this study population, there are many other issues related to feeding during the early years of life that need immediate intervention. Too early introduction of complementary food, using infant formula without an indication, adding sugar to infant formula, too frequent breastfeeding and overnight feeding of older children are among them.

Prevalence and predictors of exclusive breastfeeding among women in Kigoma Region, Western Tanzania: a community based cross-sectional study

Tiras Nkala — 2011-11-09T00:00:00Z

Background: Exclusive breastfeeding (EBF) for the first six months of infants' lives is a cost effective intervention in saving children's lives and can avert 13 - 15% of the 9 million deaths of children under 5 years old in resource poor settings. However, EBF rates have been shown to be low in resource poor settings, ranging between 20 and 40%. In Tanzania, the prevalence of EBF among infants under 6 months is 41%, with limited information on predictors of EBF. The aim of the study was to determine prevalence of EBF and its predictors in Kigoma Municipality, Western Tanzania. Methods: A cross-sectional study was conducted in March to May 2010 among 402 consenting women, with infants aged 6 to 12 months, from randomly selected households. A questionnaire was used to collect information on demographic characteristics, knowledge of EBF, infant feeding practices, and on HIV status. Results: The prevalence of EBF among women in Kigoma Municipality was 58%. Knowledge of EBF was relatively higher (86%) compared to the practice. In the multivariable analysis, women with adequate knowledge of EBF (AOR 5.4), women who delivered at health facilities (AOR 3.0) and women who had no problems related to breasts, like engorgement/cracked nipples (AOR 6.6) were more likely to exclusively breastfeed compared to others. Conclusions: Prevalence of EBF in Kigoma municipality was slightly higher than the national figure of 41%, however it was way below the EBF prevalence of 90% recommended by the WHO. Strategies that target improving knowledge and skills for lactation management among women, as well as strategies to improve health facility delivery, may help to improve EBF in this setting.