Trends in breastfeeding rates in Portugal: results from five National Health Interview Surveys

Abstract Background The World Health Organization advice breast milk as the perfect food for the newborn starting immediately after birth and exclusively up to at least 6 months of age. However, there are considerable differences in breastfeeding rates between countries related to their policies on breastfeeding promotion and duration of maternity leave. This study aims to describe changes in breastfeeding rates over time in Portugal as a way to inform social policies and public health initiatives on breastfeeding. Methods To examine the breastfeeding rates evolution we used data from five National Health Surveys. Breastfeeding was assessed based on information provided by the mothers of children born between 1982 and 2014. Birth cohorts were grouped in block of 3-year period. We estimated 3 and 6-months exclusive breastfeeding rates and 95% confidence intervals. Trends in breastfeeding rates for each outcome were assessed by linear regression weighting each cohort-specific estimate by the inverse of variance in the logit scale. Results We analyzed data on 9172 children; sample size by birth cohort ranged from 213 in 2012/14 to 1651 in 1994/96. Proportion of infants ever breastfed during the study period varied between 71.7% and 86.7%. The 3 months exclusive breastfeeding rate increased by 9.5% (CI95%:7.8-11.3%) per 3-year period, from 41.3% (CI95%:38.7-43.9%) in 1982/84 to 62.4% (CI95%:55.7-68.7%) in 2012/14. The 6 months exclusive breastfeeding rate raised up from 23.5% (CI 95%:21.2-25.7%) in 1982/84 to 31.9% (CI95%:26.0-38.5%) in 2012/14, corresponding to 5.6% increase per 3-year period. Conclusions This study shows a positive evolution in breastfeeding practices, with an increased in the prevalence of women who reported exclusively breastfeeding until the 3rd and 6th month after birth. Our results may be explained by changes in maternity leave duration. Furthermore, the results emphasize the need for further investment in breastfeeding support services and professionalś training. Key messages Positive evolution in breastfeeding practices in Portugal. Maternity leave duration could have a positive role.

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Evaluation of the impact of breastfeeding support groups in primary health centres in Andalusia, Spain: a study protocol for a cluster randomized controlled trial (GALMA project)

BMC Public Health ◽

10.1186/s12889-020-09244-w ◽

2020 ◽

Vol 20 (1) ◽

Cited By ~ 1

Author(s):

Isabel Rodríguez-Gallego ◽

Fatima Leon-Larios ◽

Cecilia Ruiz-Ferrón ◽

Maria-de-las-Mercedes Lomas-Campos

Keyword(s):

Support Groups ◽

Exclusive Breastfeeding ◽

Intervention Group ◽

World Health ◽

Control Group ◽

Breastfeeding Initiation ◽

Primary Health ◽

Breastfeeding Rate ◽

Breastfeeding Rates ◽

The Impact

Abstract Background In 2003, the World Health Organization recommended exclusive breastfeeding (EB) during the newborn’s first 6 months of life and, if possible, during the first 2 years. However, EB rates resist these recommendations. In developed countries, only 1 out of 3 babies is breastfed during its first 6 months of life, and great differences between areas and countries can be observed. Only 35% of the newborns receive breastfeeding at 3–4 months of age. There are diverse strategies described in the literature that have proven their efficiency in improving breastfeeding rates. It has also been proven that professional support is an effective tool to extend any kind of breastfeeding; besides, it has been observed that mother-to-mother support also increases breastfeeding initiation, sustainment, and exclusive duration. The overall aim of the study is to assess the impact of the support groups on the sustainment of exclusive breastfeeding until 6 months after birth. Methods/design This study is a cluster-random multicentric clinical trial with a control group and an intervention group, without blinding because it is impossible to mask the intervention. A randomization by centres of primary health (clusters) will be carried out. The women allocated to the intervention or control group will be randomized with a simple randomization sampling. The participants’ breastfeeding rate will be followed up at the first 10 days, and at 2, 4, and 6 months of their newborn’s life. Discussion There is a need to assess the impact of mother support groups on exclusive breastfeeding. This study aims to analyse the outcomes related to the support received and to identify what should the structure of these groups be; in other words, to describe factors related to a better breastfeeding experience in order to help women increase breastfeeding rates. Trial registration The trial is prospectively recorded at the ISRCTN registry (Trial ID: ISRCTN17263529). Date recorded: 17/06/2020.

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Comparing breastfeeding experiences between mothers spending the traditional Chinese confinement period in a confinement centre and those staying at home: a cohort study

10.21203/rs.3.rs-26168/v4 ◽

2020 ◽

Author(s):

Siew Cheng Foong ◽

May Loong Tan ◽

Wai Cheng Foong ◽

Jacqueline J Ho ◽

Fairuz Fadzilah Rahim

Keyword(s):

Logistic Regression ◽

Breast Milk ◽

Support Groups ◽

Exclusive Breastfeeding ◽

World Health ◽

Multiple Logistic Regression ◽

Breastfeeding Support ◽

Ethnic Chinese ◽

Chinese Mothers ◽

Breastfeeding Rates

Abstract BackgroundEthnic Chinese mothers in Malaysia adhere to 30 days of traditional postpartum practices (the “confinement period”) aimed at recuperation after delivery. Recently there has been an emergence of confinement centres (CCs) where mothers stay and receive traditional confinement care. Ethnic Chinese mothers have low breastfeeding rates. There are concerns that practices in CCs could contribute to this but no data exists. We described mother’s breastfeeding experience at CCs and identify areas for potential improvement in breastfeeding support.MethodsEthnic Chinese mothers intending to breastfeed their healthy infants were recruited post-delivery between August and October 2017 then, at 1 and 6 months, were telephone interviewed about their experience. For every participant going to a CC, another mother going home was recruited.Chi-square test was used to compare groups and multiple logistic regression was used to assess the effect of confinement place on exclusive breastfeeding. We defined exclusive breastfeeding according to the World Health Organisation’s definition which means no other food or drink, not even water, except breast milk (including milk expressed or from a donor).Results Of 187 mothers, 88(47%) went to CCs. Significantly more were primipara and fewer had previous breastfeeding experience. Response rates for the 1- and 6- month interviews were 88%(CC) versus 97%(home); and 77%(CC) versus 87%(home).Exclusive breastfeeding rates were similar between the groups: 62%(CC) versus 56%(home) at 1 month (p=0.4); and 37%(CC) versus 42%(home) at 6 months (p=0.5). Multiple logistic regression did not show that CCs were a factor affecting exclusive breastfeeding rates at 1 month, (adjusted odds ratio(aOR) 1.7, 95% confidence interval(CI) 0.9, 3.3), or 6 months (aOR 0.9, 95% CI 0.4, 1.7). However, significantly more CC participants only fed expressed breast milk. Despite 66% of CC participants reporting that their centre supported breastfeeding, only 6(8%) CC participants compared to 66(69%) of home participants slept with their baby (p<0.001). The proportion encountering breastfeeding difficulties were similar between groups. CC participants sought help for breastfeeding problems mainly from CC staff and support groups while home participants obtained help from friends and healthcare professionals.ConclusionBreastfeeding rates appeared to be similar at CCs and home but there were gaps in how CCs supported breastfeeding. Targeted training to CC staff to support breastfeeding may result in better outcomes for mothers staying in CCs.

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Determinants of Exclusive Breastfeeding Practices of Female Healthcare Workers in Jakarta, Indonesia

Kesmas National Public Health Journal ◽

10.21109/kesmas.v16i1.2715 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Siti Rapingah ◽

Nova Muhani ◽

Besral Besral ◽

Poppy Yuniar

Keyword(s):

Exclusive Breastfeeding ◽

Healthcare Workers ◽

Optimal Growth ◽

Influential Factor ◽

World Health ◽

Cross Sectional ◽

Factors Associated ◽

Breastfeeding Practices ◽

Breastfeeding Rate ◽

Worker Support

The World Health Organization (WHO) recommended that mothers worldwide exclusively breastfeed their infants for the child's first six months to achieve optimal growth, development, and health. Indonesia had not fulfilled the global standard of breastfeeding rate so that there was low coverage of exclusive breastfeeding in East Jakarta, especially for female healthcare workers. This study aimed to determine the factors associated with exclusive breastfeeding practices of healthcare workers. This was a quantitative study using a cross-sectional design. The recruited sample consisted of 85 female public health center workers with infants aged 6-24 months. Data were collected using self-administered questionnaires. Logistic regression analysis was applied to identify factors associated with exclusive breastfeeding. The results showed that the proportion of exclusive breastfeeding was 54.1%. Variables associated with exclusive breastfeeding were knowledge, attitude, family support, co-worker support, and healthcare worker support. Multivariate analysis showed that knowledge and age were the dominant factors of exclusive breastfeeding practices with an odds ratio (OR) adjusted OR of 14 and 5, re¬spectively. Knowledge was an influential factor in the success of exclusive breastfeeding. Therefore, creating a training program related to breastfeeding would be expected to improve knowledge. Besides, a supportive policy such as providing breastfeeding facilities was needed.

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Breastfeeding promotion: evidence and problems

La Pediatria Medica e Chirurgica ◽

10.4081/pmc.2017.156 ◽

2017 ◽

Vol 39 (2) ◽

Cited By ~ 3

Author(s):

Roberto Bellù ◽

Manuela Condò

Keyword(s):

Complex System ◽

Environmental Factors ◽

Preterm Infants ◽

Exclusive Breastfeeding ◽

World Health ◽

Breastfeeding Support ◽

Breastfeeding Promotion ◽

International Data ◽

Breastfeeding Rates ◽

Health Organization

Although breastfeeding is associated with many health benefits in children and mothers, and World Health Organization (WHO) recommends exclusive breastfeeding until 6 months of age and continued breastfeeding until 2 years of age, overall breastfeeding rates remain low. Italian rates of exclusive breastfeeding do not differ from international data. The aim of this review is to evaluate evidence of breastfeeding promotion interventions and the remaining problems to achieve them. We found that breastfeeding support is a complex system of interventions, including individual, structural and environmental factors. Many systematic reviews report evidence that breastfeeding support offered to women increases duration and exclusivity of breastfeeding, both in full term healthy newborns and in preterm infants. Political and economic efforts should be made to ensure breastfeeding support to all women in the different settings, assuming it as a collective target.

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Determinants of exclusive breastfeeding for the first six months in China: a cross-sectional study

International Breastfeeding Journal ◽

10.1186/s13006-021-00388-y ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Huifeng Shi ◽

Yumei Yang ◽

Xiaohan Yin ◽

Jia Li ◽

Jin Fang ◽

...

Keyword(s):

Breast Milk ◽

Exclusive Breastfeeding ◽

Infant Health ◽

Maternity Leave ◽

Sociocultural Factors ◽

Breastfeeding Support ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Breastfed Infants ◽

Breastfeeding Rate

Abstract Background Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China. Methods Data were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding. Results About 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding. Conclusions The exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.

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Effectiveness of Breastfeeding Support Packages in Low- and Middle-Income Countries for Infants under Six Months: A Systematic Review

Nutrients ◽

10.3390/nu13020681 ◽

2021 ◽

Vol 13 (2) ◽

pp. 681

Author(s):

Ritu Rana ◽

Marie McGrath ◽

Ekta Sharma ◽

Paridhi Gupta ◽

Marko Kerac

Keyword(s):

At Risk ◽

Severe Acute Malnutrition ◽

Acute Malnutrition ◽

World Health ◽

Cochrane Library ◽

Breastfeeding Support ◽

Middle Income ◽

Middle Income Countries ◽

Breastfeeding Practices ◽

Low And Middle Income

Small and nutritionally at-risk infants under six months, defined as those with wasting, underweight, or other forms of growth failure, are at high-risk of mortality and morbidity. The World Health Organisation 2013 guidelines on severe acute malnutrition highlight the need to effectively manage this vulnerable group, but programmatic challenges are widely reported. This review aims to inform future management strategies for small and nutritionally at-risk infants under six months in low- and middle-income countries (LMICs) by synthesising evidence on existing breastfeeding support packages for all infants under six months. We searched PubMed, CINAHL, Cochrane Library, EMBASE, and Global Health databases from inception to 18 July 2018. Intervention of interest were breastfeeding support packages. Studies reporting breastfeeding practices and/or caregivers’/healthcare staffs’ knowledge/skills/practices for infants under six months from LMICs were included. Study quality was assessed using NICE quality appraisal checklist for intervention studies. A narrative data synthesis using the Synthesis Without Meta-analysis (SWiM) reporting guideline was conducted and key features of successful programmes identified. Of 15,256 studies initially identified, 41 were eligible for inclusion. They were geographically diverse, representing 22 LMICs. Interventions were mainly targeted at mother–infant pairs and only 7% (n = 3) studies included at-risk infants. Studies were rated to be of good or adequate quality. Twenty studies focused on hospital-based interventions, another 20 on community-based and one study compared both. Among all interventions, breastfeeding counselling (n = 6) and education (n = 6) support packages showed the most positive effect on breastfeeding practices followed by breastfeeding training (n = 4), promotion (n = 4) and peer support (n = 3). Breastfeeding education support (n = 3) also improved caregivers’ knowledge/skills/practices. Identified breastfeeding support packages can serve as "primary prevention" interventions for all infants under six months in LMICs. For at-risk infants, these packages need to be adapted and formally tested in future studies. Future work should also examine impacts of breastfeeding support on anthropometry and morbidity outcomes. The review protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO 2018 CRD42018102795).

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BREASTFEEDING EXPERIENCES OF WORKING MOTHERS IN VIETNAM

Belitung Nursing Journal ◽

10.33546/bnj.454 ◽

2018 ◽

Vol 4 (3) ◽

pp. 279-286

Author(s):

Nguyen Thi Truong Xuan ◽

Nhan Thi Nguyen

Keyword(s):

Working Mothers ◽

Qualitative Content Analysis ◽

World Health ◽

Breastfeeding Support ◽

Breastfeeding Practices ◽

Optimal Health ◽

Returning To Work ◽

Need For Support ◽

Health Organization ◽

Depth Interviews

Background: World Health Organization recommends mothers all over the world should continue breastfeeding up to the age of two years or beyond to achieve optimal health, growth and development for their infants. However, the breastfeeding practices among working mothers have been decreased by the time passed.Objective: to describe the breastfeeding experiences of mothers who returned to work after childbirth.Methods: This study was utilized a qualitative design. Purposive sampling was used to recruit the participant who met the inclusion criteria. Data were collected from 10 semi-structured in-depth interviews. All interviews were audio-recorded and transcribed verbatim. The interview transcriptions were analyzed by using the qualitative content analysis approach.Results: The breastfeeding period of 10 working mothers ranging from 7 to 15 months. Five categories emerged from the data were: 1) Attitude towards breastfeeding, 2) Breastfeeding support during working, 3) Strategic plan for breastfeeding, 4) Psychological distress, and 5) A need for support facilities and resources for breastfeeding during working.Conclusion: This research provided a better understanding of breastfeeding experiences of working mothers in Vietnam. The findings can help nurses and other healthcare professionals in providing anticipatory guidance to mothers who plan to continue breastfeeding after returning to work.

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Have interventions been effective at increasing the rates of breastfeeding in the UK?

British Journal of Midwifery ◽

10.12968/bjom.2019.27.5.312 ◽

2019 ◽

Vol 27 (5) ◽

pp. 312-319

Author(s):

Elizabeth Shortis

Keyword(s):

World Health Organization ◽

Exclusive Breastfeeding ◽

Literature Search ◽

World Health ◽

Exclusion Criteria ◽

The World ◽

Breastfeeding Rates ◽

Health Organization ◽

The Uk ◽

Combined Interventions

Background The World Health Organization recommends exclusive breastfeeding for the first 6 months of life; however, UK breastfeeding rates are some of the lowest worldwide. As such, various interventions have been trialled, aiming to increase breastfeeding rates. Aims To evaluate the effectiveness of interventions to increase breastfeeding rates in the UK and determine the features of successful interventions. Methods A literature search was performed, using four databases. The results were refined by applying inclusion and exclusion criteria. Two additional articles were recognised by scanning the references sections of identified studies, resulting in 12 articles for review. Findings Support-based interventions had predominantly insignificant effects upon breastfeeding rates. Incentives were associated with increases in rates, while combined interventions had mixed success. The interventions were well received by mothers and clinicians and may help to normalise breastfeeding. Conclusions Future interventions should provide targeted, personalised support to overcome breastfeeding difficulties, and reward mothers for their efforts.

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A study on effectiveness of lactational amenorrhea as a method of contraception

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20183837 ◽

2018 ◽

Vol 7 (10) ◽

pp. 3946 ◽

Cited By ~ 1

Author(s):

Kamlesh Tiwari ◽

Ishmat Khanam ◽

Neha Savarna

Keyword(s):

Exclusive Breastfeeding ◽

World Health ◽

Contraceptive Methods ◽

Monthly Basis ◽

Breastfeeding Practices ◽

Lactating Mothers ◽

Lactational Amenorrhea ◽

The World ◽

Lactational Amenorrhea Method ◽

Natural Hormones

Background: The lactational amenorrhea method, known as LAM, is part of the World Health Organization’s list of accepted and effective methods of family planning. Studies show LAM to be 98% effective, as effective as the pill and other modern methods, when used according to guidelines. As LAM costs nothing, easy and natural to use, no medication or any devise needed, no interference with natural hormones, no interruption in conjugal life and more over the mother enjoying her motherhood life, it sounds very good as a method of contraception.Methods:This is a prospective non-comparative study. A total of 298 mothers participated in this study. The benefits of exclusive breast feeding with particular emphasis on timely breastfeeding and must feeding during the night hours were explained to the mothers and the physiology of lactational amenorrhea was explained to them. All the mothers were interviewed and followed up on monthly basis. Results:No lactating mothers conceived within the first six months of delivering their baby and only 4% mothers had evidence of pregnancy mainly after the 10th months after delivery.Conclusions:The lactational amenorrhea method is a highly effective method of contraception for 6 months if exclusive breastfeeding practices are followed. In a country like India where use of contraceptive methods are very meager, LAM may prove a boon as it provides dual benefit of exclusive breastfeeding and prevention of pregnancy.

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Familiar but neglected: identification of gaps and recommendations to close them on exclusive breastfeeding support in health facilities in Malawi

International Breastfeeding Journal ◽

10.1186/s13006-021-00418-9 ◽

2021 ◽

Vol 16 (1) ◽

Author(s):

Alinane Linda Nyondo-Mipando ◽

Mai-Lei Woo Kinshella ◽

Sangwani Salimu ◽

Brandina Chiwaya ◽

Felix Chikoti ◽

...

Keyword(s):

Exclusive Breastfeeding ◽

Qualitative Data ◽

Health Workers ◽

Newborn Care ◽

Health Systems Strengthening ◽

World Health ◽

Standards Of Care ◽

Routine Practice ◽

Breastfeeding Support ◽

Care Assessment

Abstract Background Exclusive breastfeeding is widely accepted as a key intervention with proven efficacy for improving newborn survival. Despite international commitments and targets to support and promote breastfeeding, there are still gaps in meeting and maintain coverage in many sub-Saharan African countries. This paper aimed to triangulate the perspectives of health workers, mothers, and their family members with facility assessments to identify gaps to improve breastfeeding support in in Malawi. Methods The study on breastfeeding barriers and facilitators was conducted in 2019 at one tertiary hospital and three secondary-level hospitals in Malawi. We conducted 61 semi-structured interviews with health workers, postnatal mothers, grandmothers, aunts, and fathers. In 2017, we carried out a neonatal care facility assessment using the World Health Organization (WHO) Integrated Maternal, Neonatal, and Child Quality of Care Assessment and Improvement Tool. Qualitative data were analysed using a thematic analysis approach within the Systems Framework for Health Policy. Results The district-level hospitals rated high with an average score of 4.8 out of 5 across the three facilities indicating that only minor improvements are needed to meet standards of care for early and exclusive breastfeeding. However, the score fell to an average of 3.5 out of 5 for feeding needs with sick neonates indicating that several improvements are needed in this area. The qualitative data demonstrated that breastfeeding was normalized as part of routine newborn care. However, the focus on routine practice and reliance on breastfeeding knowledge from prenatal counselling highlights inequities and neglect in specialized care and counselling among vulnerable mothers and newborns. Revitalisation of breastfeeding in Malawian facilities will require a systems approach that reinforces policies and guidelines; contextualises knowledge; engagement and empowerment of other relatives to the baby and task-sharing among health workers. Conclusions Breastfeeding is accepted as a social norm among health workers, mothers, grandmothers, aunts, and fathers in Malawi, yet vulnerable groups are underserved. Neglect in breastfeeding support among vulnerable populations exacerbates health inequities. Health systems strengthening related to breastfeeding requires a concerted effort among health workers, mothers, grandmothers, aunts, and fathers while remaining grounded in contexts to support family-centered hospital care.

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