Enablers and barriers of exclusive breastfeeding among employed women in low and lower middle-income countries

Abstract Aims Observational studies have shown a relationship between maternal mental health (MMH) and child development, but few studies have evaluated whether MMH interventions improve child-related outcomes, particularly in low- and middle-income countries. The objective of this review is to synthesise findings on the effectiveness of MMH interventions to improve child-related outcomes in low- and middle-income countries (LMICs). Methods We searched for randomised controlled trials conducted in LMICs evaluating interventions with a MMH component and reporting children's outcomes. Meta-analysis was performed on outcomes included in at least two trials. Results We identified 21 trials with 28 284 mother–child dyads. Most trials were conducted in middle-income countries, evaluating home visiting interventions delivered by general health workers, starting in the third trimester of pregnancy. Only ten trials described acceptable methods for blinding outcome assessors. Four trials showed high risk of bias in at least two of the seven domains assessed in this review. Narrative synthesis showed promising but inconclusive findings for child-related outcomes. Meta-analysis identified a sizeable impact of interventions on exclusive breastfeeding (risk ratio = 1.39, 95% confidence interval (CI): 1.13–1.71, ten trials, N = 4749 mother–child dyads, I2 = 61%) and a small effect on child height-for-age at 6-months (std. mean difference = 0.13, 95% CI: 0.02–0.24, three trials, N = 1388, I2 = 0%). Meta-analyses did not identify intervention benefits for child cognitive and other growth outcomes; however, few trials measured these outcomes. Conclusions These findings support the importance of MMH to improve child-related outcomes in LMICs, particularly exclusive breastfeeding. Given, the small number of trials and methodological limitations, more rigorous trials should be conducted.

Download Full-text

Mapping inequalities in exclusive breastfeeding in low- and middle-income countries, 2000–2018

Nature Human Behaviour ◽

10.1038/s41562-021-01108-6 ◽

2021 ◽

Author(s):

Natalia V. Bhattacharjee ◽

Lauren E. Schaeffer ◽

Simon I. Hay ◽

Dan Lu ◽

Megan F. Schipp ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

World Health ◽

Middle Income ◽

Middle Income Countries ◽

Child Morbidity ◽

Prevalence Estimates ◽

Administrative Units ◽

Changes Over Time ◽

Global Nutrition ◽

Low And Middle Income

AbstractExclusive breastfeeding (EBF)—giving infants only breast-milk for the first 6 months of life—is a component of optimal breastfeeding practices effective in preventing child morbidity and mortality. EBF practices are known to vary by population and comparable subnational estimates of prevalence and progress across low- and middle-income countries (LMICs) are required for planning policy and interventions. Here we present a geospatial analysis of EBF prevalence estimates from 2000 to 2018 across 94 LMICs mapped to policy-relevant administrative units (for example, districts), quantify subnational inequalities and their changes over time, and estimate probabilities of meeting the World Health Organization’s Global Nutrition Target (WHO GNT) of ≥70% EBF prevalence by 2030. While six LMICs are projected to meet the WHO GNT of ≥70% EBF prevalence at a national scale, only three are predicted to meet the target in all their district-level units by 2030.

Download Full-text

Infant Formula Consumption Is Positively Correlated with Wealth, Within and Between Countries: A Multi-Country Study

Journal of Nutrition ◽

10.1093/jn/nxz327 ◽

2019 ◽

Vol 150 (4) ◽

pp. 910-917 ◽

Cited By ~ 3

Author(s):

Paulo A R Neves ◽

Giovanna Gatica-Domínguez ◽

Nigel C Rollins ◽

Ellen Piwoz ◽

Phillip Baker ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Pearson Correlation ◽

Correlation Coefficients ◽

Strongly Correlated ◽

Middle Income ◽

Middle Income Countries ◽

Family Wealth ◽

Multiple Indicator ◽

Breastmilk Substitute ◽

Graphical Presentation

ABSTRACT Background In contrast with the ample literature on within- and between-country inequalities in breastfeeding practices, there are no multi-country analyses of socioeconomic disparities in breastmilk substitute (BMS) consumption in low- and middle-income countries (LMICs). Objective This study aimed to investigate between- and within-country socioeconomic inequalities in breastfeeding and BMS consumption in LMICs. Methods We examined data from the Demographic Health Surveys and Multiple Indicator Cluster Surveys conducted in 90 LMICs since 2010 to calculate Pearson correlation coefficients between infant feeding indicators and per capita gross domestic product (GDP). Within-country inequalities in exclusive breastfeeding, intake of formula or other types of nonhuman milk (cow/goat) were studied for infants aged 0–5 mo, and for continued breastfeeding at ages 12–15 mo through graphical presentation of coverage wealth quintiles. Results Between-country analyses showed that log GDP was inversely correlated with exclusive (r = −0.37, P < 0.001) and continued breastfeeding (r = −0.74, P < 0.0001), and was positively correlated with formula intake (r = 0.70, P < 0.0001). Continued breastfeeding was inversely correlated with formula (r = −0.79, P < 0.0001), and was less strongly correlated with the intake of other types of nonhuman milk (r = −0.40, P < 0.001). Within-country analyses showed that 69 out of 89 did not have significant disparities in exclusive breastfeeding. Continued breastfeeding was significantly higher in children belonging to the poorest 20% of households compared with the wealthiest 20% in 40 countries (by ∼30 percentage points on average), whereas formula feeding was more common in the wealthiest group in 59 countries. Conclusions BMS intake is positively associated with GDP and negatively associated with continued breastfeeding in LMICs. In most countries, BMS intake is positively associated with family wealth, and will likely become more widespread as countries develop. Urgent action is needed to protect, promote, and support breastfeeding in all income groups and to reduce the intake of BMS, in light of the hazards associated with their use.

Download Full-text

Peer Support and Exclusive Breastfeeding Duration in Low and Middle-Income Countries: A Systematic Review and Meta-Analysis

PLoS ONE ◽

10.1371/journal.pone.0045143 ◽

2012 ◽

Vol 7 (9) ◽

pp. e45143 ◽

Cited By ~ 38

Author(s):

Christopher R. Sudfeld ◽

Wafaie W. Fawzi ◽

Chandrakant Lahariya

Keyword(s):

Systematic Review ◽

Peer Support ◽

Exclusive Breastfeeding ◽

Meta Analysis ◽

Breastfeeding Duration ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Download Full-text

Does extending the duration of legislated paid maternity leave improve breastfeeding practices? Evidence from 38 low-income and middle-income countries

BMJ Global Health ◽

10.1136/bmjgh-2018-001032 ◽

2018 ◽

Vol 3 (5) ◽

pp. e001032 ◽

Cited By ~ 24

Author(s):

Yan Chai ◽

Arijit Nandi ◽

Jody Heymann

Keyword(s):

Low Income ◽

Exclusive Breastfeeding ◽

Maternity Leave ◽

Early Initiation ◽

Breastfeeding Duration ◽

Middle Income ◽

Percentage Point Increase ◽

Middle Income Countries ◽

Point Increase ◽

Initiation Of Breastfeeding

IntroductionAmong all barriers to breastfeeding, the need to work has been cited as one of the top reasons for not breastfeeding overall and for early weaning among mothers who seek to breastfeed. We aimed to examine whether extending the duration of paid maternity leave available to new mothers affected early initiation of breastfeeding, exclusive breastfeeding under 6 months and breastfeeding duration in low-income and middle-income countries (LMICs).MethodsWe merged longitudinal data measuring national maternity leave policies with information on breastfeeding related to 992 419 live births occurring between 1996 and 2014 in 38 LMICs that participated in the Demographic and Health Surveys. We used a difference-in-differences approach to compare changes in the prevalence of early initiation and exclusive breastfeeding, as well as the duration of breastfeeding, among treated countries that lengthened their paid maternity leave policy between 1995 and 2013 versus control countries that did not. Regression models included country and year fixed effects, as well as measured individual-level, household-level and country-level covariates. All models incorporated robust SEs and respondent-level sampling weights.ResultsA 1-month increase in the legislated duration of paid maternity leave was associated with a 7.4 percentage point increase (95% CI 3.2 to 11.7) in the prevalence of early initiation of breastfeeding, a 5.9 percentage point increase (95% CI 2.0 to 9.8) in the prevalence of exclusive breastfeeding and a 2.2- month increase (95% CI 1.1 to 3.4) in breastfeeding duration.ConclusionExtending the duration of legislated paid maternity leave appears to promote breastfeeding practices in LMICs. Our findings suggest a potential mechanism to reduce barriers to breastfeeding for working mothers.

Download Full-text

Effectiveness and cost-effectiveness of home-based postpartum care on neonatal mortality and exclusive breastfeeding practice in low-and-middle-income countries: a systematic review and meta-analysis

BMC Pregnancy and Childbirth ◽

10.1186/s12884-019-2651-6 ◽

2019 ◽

Vol 19 (1) ◽

Cited By ~ 3

Author(s):

Gizachew Tadele Tiruneh ◽

Chalachew Bekele Shiferaw ◽

Alemayehu Worku

Keyword(s):

Neonatal Mortality ◽

Exclusive Breastfeeding ◽

Postnatal Care ◽

Home Visits ◽

Cost Effective ◽

Community Mobilization ◽

Middle Income ◽

Middle Income Countries ◽

Home Based ◽

Low And Middle Income

Abstract Background Early postpartum facility discharge negatively impacts mothers’ proper and effective use postnatal care. Cognizant of these facts, home-based postnatal care practices have been promoted to complement facility-based care to reduce neonatal mortality. This systematic review evaluated the effectiveness and cost-effectiveness of home-based postnatal care on exclusive breastfeeding practice and neonatal mortality in low-and-middle-income countries. Methods Randomized trials and quasi-experimental studies were searched from electronic databases including PubMed, Popline, Cochrane Central Register of Controlled Trials and National Health Service Economic Evaluation databases. Random-effects meta-analysis model was used to pool the estimates of the outcomes accounting for the variability among studies. Results We identified 14 trials implementing intervention packages that included preventive and promotive newborn care services, home-based treatment for sick neonates, and community mobilization activities. The pooled analysis indicates that home-based postpartum care reduced neonatal mortally by 24% (risk ratio 0.76; 95% confidence interval 0.62–0.92; 9 trials; n = 93,083; heterogeneity p < .01) with no evidence of publication bias (Egger’s test: Coef. = − 1.263; p = .130). The subgroup analysis suggested that frequent home visits, home visits by community health workers, and community mobilization efforts with home visits, to had better neonatal survival. Likewise, the odds of mothers who exclusively breastfed from the home visit group were about three times higher than the mothers who were in the routine care group (odds ratio: 2.88; 95% confidence interval: 1.57–5.29; 6 trials; n = 20,624 mothers; heterogeneity p < .01), with low possibility of publication bias (Coef. = − 7.870; p = .164). According to the World Health Organization’s Choosing Interventions that are Cost-Effective project recommendations, home-based neonatal care strategy was found to be cost-effective. Conclusions Home visits and community mobilization activities to promote neonatal care practices by community health workers is associated with reduced neonatal mortality, increased practice of exclusive breastfeeding, and cost-effective in improving newborn health outcomes for low-and-middle-income countries. However, a well-designed evaluation study is required to formulate the optimal package and optimal timing of home visits to standardize home-based postnatal interventions.

Download Full-text

Maternal education and equity in breastfeeding: trends and patterns in 81 low- and middle-income countries between 2000 and 2019

International Journal for Equity in Health ◽

10.1186/s12939-020-01357-3 ◽

2021 ◽

Vol 20 (1) ◽

Author(s):

Paulo A. R. Neves ◽

Aluisio J. D. Barros ◽

Giovanna Gatica-Domínguez ◽

Juliana S. Vaz ◽

Phillip Baker ◽

...

Keyword(s):

Higher Education ◽

Middle East ◽

South Asia ◽

North Africa ◽

Exclusive Breastfeeding ◽

Formal Education ◽

Maternal Education ◽

Middle Income ◽

Middle Income Countries ◽

Low And Middle Income

Abstract Background In low- and middle-income countries (LMICs), low levels of formal maternal educational are positively associated with breastfeeding whereas the reverse is true among women with higher levels of formal education. As such, breastfeeding has helped to reduce health equity gaps between rich and poor children. Our paper examines trends in breastfeeding and formula consumption by maternal educational in LMICs over nearly two decades. Methods We used 319 nationally representative surveys from 81 countries. We used WHO definitions for breastfeeding indicators and categorized maternal education into three categories: none, primary, and secondary or higher. We grouped countries according to the World Bank income groups and UNICEF regions classifications. The trend analyses were performed through multilevel linear regression to obtain average absolute annual changes in percentage points. Results Significant increases in prevalence were observed for early initiation and exclusive breastfeeding across all education categories, but more prominently in women with no formal education for early breastfeeding and in higher level educated women for exclusive breastfeeding. Small decreases in prevalence were seen mostly for women with no formal education for continued breastfeeding at 1 and 2 years. Among formula indicators, only formula consumption between 6 and 23 months decreased significantly over the period for women with primary education. Analysis by world regions demonstrated that gains in early and exclusive breastfeeding were almost universally distributed among education categories, except in the Middle East and North Africa where they decreased throughout education categories. Continued breastfeeding at 1 and 2 years increased in South Asia, Latin America and the Caribbean, and Eastern Europe and Central Asia for primary or higher education categories. Declines occurred for the group of no formal education in South Asia and nearly all education categories in the Middle East and North Africa with a decline steeper for continued breastfeeding at 2 years. With a few exceptions, the use of formula is higher among children of women at the highest education level in all regions. Conclusions Over the course of our study, women with no formal education have worsening breastfeeding indicators compared to women with primary and secondary or higher education.

Download Full-text

Maternal employment and childhood overweight in low- and middle-income countries

Public Health Nutrition ◽

10.1017/s1368980017001720 ◽

2017 ◽

Vol 20 (14) ◽

pp. 2523-2536 ◽

Cited By ~ 5

Author(s):

Vanessa M Oddo ◽

Noel T Mueller ◽

Keshia M Pollack ◽

Pamela J Surkan ◽

Sara N Bleich ◽

...

Keyword(s):

High Education ◽

Maternal Employment ◽

Childhood Overweight ◽

Normal Weight ◽

Demographic And Health Surveys ◽

Middle Income ◽

Middle Income Countries ◽

Employed Mothers ◽

Employed Women ◽

Low And Middle Income

AbstractObjectiveTo investigate the association between maternal employment and childhood overweight in low- and middle-income countries (LMIC).Design/SettingWe utilized cross-sectional data from forty-five Demographic and Health Surveys from 2010 to 2016 (n268 763). Mothers were categorized as formally employed, informally employed or non-employed. We used country-specific logistic regression models to investigate the association between maternal employment and childhood overweight (BMIZ-score>2) and assessed heterogeneity in the association by maternal education with the inclusion of an interaction term. We used meta-analysis to pool the associations across countries. Sensitivity analyses included modelling BMIZ-score and normal weight (weight-for-ageZ-score≥−2 to <2) as outcomes.SubjectsParticipants included children 0–5 years old and their mothers (aged 18–49 years).ResultsIn most countries, neither formal nor informal employment was associated with childhood overweight. However, children of employed mothers, compared with children of non-employed mothers, had higher BMIZ-score and higher odds of normal weight. In countries where the association varied by education, children of formally employed women with high education, compared with children of non-employed women with high education, had higher odds of overweight (pooled OR=1·2; 95 % CI 1·0, 1·4).ConclusionsWe find no clear association between employment and child overweight. However, maternal employment is associated with a modestly higher BMIZ-score and normal weight, suggesting that employment is currently associated with beneficial effects on children’s weight status in most LMIC.

Download Full-text