Review of Research on the Factors Associated with Choice and Duration of Infant Feeding in Less-Developed Countries

Research on factors associated with infant-feeding choice and duration has the following objectives: to describe the associated factors; to determine the degree of association; and to determine factors that are amenable to intervention in order to plan and implement infant nutrition programs. Underlying these objectives are a series of questions including: (1) What are the factors associated with the decision to breast-feed and/or bottle-feed at birth? (2) Among less-developed groups, in particular, what are the factors associated with use of prelacteal feeds before or in combination with breast-feeding or feeding by breast and bottle? (3) What are the factors associated with duration of exclusive breast-feeding, time of introduction of liquid breast milk substitutes, time of introduction of solids, and duration of partial breast-feeding? These questions are addressed in this review. This review encompasses research from a variety of disciplines—anthropology, epidemiology, nutrition, economics, and demography, for example. This is because infant feeding can be considered a behavior, a perception, a nutritional pattern, and a risk factor in infant growth and development. When infant feeding is classified as a behavior, the objective is to describe the infant's actions as he/she feeds at the breast or from the container for the breast milk substitute. The focus is on measuring the sucking action; the ability of the infant to latch onto the breast; and the frequency of, interval between, and duration of feeds. To examine a mother's perception of her infant-feeding practice requires answers to the following: Does the mother consider herself an exclusive breast-feeder, a breast-feeder and bottle-feeder, or an exclusive bottle-feeder? Does she feed on demand or on schedule? The focus of this research is on the mother's perception of her infant-feeding status rather than on the actual practice of infant feeding; the correlation between perception and practice may be examined but is commonly assumed.

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Factors Associated with the Choice and Duration of Infant-Feeding Practice

PEDIATRICS ◽

10.1542/peds.74.4.603 ◽

1984 ◽

Vol 74 (4) ◽

pp. 603-614 ◽

Cited By ~ 4

Author(s):

Artemis P. Simopoulos ◽

Gilman D. Grave

Keyword(s):

Infant Feeding ◽

Breast Feeding ◽

Infant Health ◽

Collaborative Study ◽

World Health ◽

Feeding Practice ◽

Economic Factors ◽

Member States ◽

Factors Associated ◽

Breast Feed

Breast-feeding makes a unique, fundamental contribution to the health and nutrition of infants. The World Health Organization International Code of Marketing of Breastmilk Substitutes is designed to encourage, promote, and protect breast-feeding in all WHO member states. The Code acknowledges that a number of social and economic factors affect the decisions of women to breast-feed and that breast-feeding has declined. Member states have been urged, therefore, to develop appropriate social support systems to overcome and adjust for factors associated with breastmilk substitutes. Although the Code does not so state, these factors are not fully understood. The reasons for unsuccessful breast-feeding and early termination are important concerns. So far only vague and rudimentary answers have been identified, eg, "the milk dried up"49 or "lack of satisfaction."7 The decision-making process involved in early weaning has yet to be carefully analyzed. Certainly, biologic variables are involved, such as maternal nutritional status, maternal nutrient intake, and volume and quality of milk produced. These factors have not been well studied, and they are presumably influenced by psychological, social, cultural, and economic factors. Vahlquist,55 writing in the introduction to the WHO Collaborative Study on Breast-Feeding, noted, "Whereas, up to the 1960's it had been widely held that the decline in breast-feeding was a `fact of modern life,' this premise began to be increasingly questioned, and it was wondered whether the trend was really irreversible." The stakes in reversing the trend are great, as breast-feeding is the safest, most economical way to promote infant health and sound nutrition. Since then, the literature on the determinants of infant-feeding choice has grown rapidly.

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Executive Summary

PEDIATRICS ◽

10.1542/peds.74.4.579 ◽

1984 ◽

Vol 74 (4) ◽

pp. 579-583

Keyword(s):

Developing Countries ◽

Breast Milk ◽

Infant Feeding ◽

Breast Feeding ◽

Maternal Employment ◽

The United States ◽

Attitudinal Factors ◽

Rate Of Increase ◽

Breast Feed ◽

Breast Fed

Domestic Although the rate of breast-feeding is increasing in the United States, it appears that the rate of increase has been much slower among less well educated and economically disadvantaged women. Relatively little is known about the behavioral and attitudinal factors that affect the decisions to breast-feed or to stop if already breast-feeding. Breast-feeding does appear to decrease an infant's risk of gastrointestinal infection and otitis media. The effect of method of infant feeding on risk of other infections and allergic illness is less certain. International The rate of breast-feeding in developing countries appears to have declined, especially among urban women. Although some sociodemographic correlates of infant-feeding choice have been examined, little is known about the behavioral and attitudinal factors that influence choice and duration of infant-feeding practices. Milk insufficiency, maternal employment, and pregnancy frequently are given as reasons for terminating breast-feeding. Rates of gastrointestinal illness are lower among breast-fed infants and when such illness is an important cause of death, infant mortality from this cause appears to be reduced. A randomized clinical trial carried out among high-risk infants found a significantly lower rate of infections among those given breast milk than those fed with infant formula. The evidence of the effect of breast-feeding on respiratory tract and other infections from other studies was less clear. Direct comparison of the growth of predominately breast-fed v artificially fed infants in the same populations from developing countries generally show faster growth for the breast-fed infants for the first 6 months of life. After 6 months, severe growth faltering occurs regardless of the method of feeding. In communities where the nutritional adequacy of supplementary foods is poor, breast milk is an extremely important, high-quality food during the second half of infancy and beyond.

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Breast-feeding: motivation and outcome

Journal of Biosocial Science ◽

10.1017/s0021932000014814 ◽

1984 ◽

Vol 16 (1) ◽

pp. 81-88 ◽

Cited By ~ 14

Author(s):

Donelda J. Ellis ◽

Roberta J. Hewat

Keyword(s):

British Columbia ◽

Breast Milk ◽

Infant Feeding ◽

Influencing Factors ◽

Breast Feeding ◽

Post Partum ◽

Hospital Records ◽

Feeding Motivation ◽

Breast Feed ◽

Insufficient Milk

SummaryTo determine patterns of infant feeding and influencing factors, 131 women, interested in breast-feeding and giving birth in one hospital in British Columbia, Canada, were followed for 6 months post-partum. Data were collected from hospital records and each participant completed mail-in questionnaires when their babies were 1, 3 and 6 months old. At 6 months 3·9% were exclusively breast-feeding, 26·5% were feeding their infants breast-milk and semi-solids and 26·5% were combining breast-feeding with formula and/or semi-solids. Over 50% discontinued breast-feeding before their stated intentions. Most women had chosen to breast-feed because of benefits to the baby, and most gave up breastfeeding because of perceived insufficient milk.

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Traite de Dietitique du Nourrisson

PEDIATRICS ◽

10.1542/peds.2.6.751 ◽

1948 ◽

Vol 2 (6) ◽

pp. 751-751

Author(s):

HAROLD K. FABER

Keyword(s):

Breast Milk ◽

Infant Feeding ◽

Breast Feeding ◽

Infant Nutrition ◽

Artificial Feeding ◽

Fourth Edition ◽

Milk Substitutes ◽

Behavioral Growth

This volume on infant feeding contains chapters on the criteria of nutrition (physical and behavioral growth, relation between weight and height, physical peculiarities of the infant, etc.); breast milk and breast feeding; artificial feeding, including analyses of various species of milk, and of milk substitutes, and of various supplemental foods; vitamins and minerals; the modifications of milk; the technics of feeding; diet lists; and the feeding of premature and debilitated infants. In general, the outline parallels rather closely that of Jeans and Marriott' "Infant Nutrition" (fourth edition).

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Infant-Feeding Practices and Their Relationship With Diarrheal and Other Diseases in Huascar (Lima), Peru

PEDIATRICS ◽

10.1542/peds.83.1.31 ◽

1989 ◽

Vol 83 (1) ◽

pp. 31-40 ◽

Cited By ~ 1

Author(s):

Kenneth H. Brown ◽

Robert E. Black ◽

Guillermo Lopez de Romaña ◽

Hilary Creed de Kanashiro

Keyword(s):

Breast Milk ◽

Breast Feeding ◽

Feeding Practices ◽

Feeding Practice ◽

Skin Infections ◽

Prevalence Rates ◽

Breast Feed ◽

Increased Risk ◽

Tract Infections ◽

Breast Fed

Longitudinal studies of the feeding practices and morbidity from infectious diseases of 153 Peruvian newborns from an underprivileged, periurban community were completed during their first year of life. Feeding practices were assessed by monthly questionnaires, and illnesses were identified by thrice-weekly, community-based surveillance. All infants were initially breast-fed, but only 12% were exclusively breast-fed at 1 month of age. At 12 months of age, 86% of children still received some breast milk. Incidence and prevalence rates of diarrhea in infants younger than 6 months of age were less among those who were exclusively breast-fed compared with those who received other liquids or artificial milks in addition to breast milk. The diarrheal prevalence rates doubled with the addition of these other fluids (15.2% v 7.1% of days ill, P < .001). Infants for whom breast-feeding was discontinued during the first 6 months had 27.6% diarrheal prevalence. During the second 6 months of life, discontinuation of breast-feeding was also associated with an increased risk of diarrheal incidence and prevalence. Upper and lower respiratory tract infections occurred with lesser prevalence among exclusively breast-fed younger infants. The prevalences of skin infections by category of feeding practice were not as consistent, but exclusively breast-fed infants tended to have fewer skin infections during the initial months of life and older infants who continued to breast-feed had fewer infections than those who did not. None of the results could be explained by differences in the socioeconomic status of the infants' families.

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Breast milk zinc and copper concentrations in Bangladesh

British Journal Of Nutrition ◽

10.1079/bjn19900094 ◽

1990 ◽

Vol 63 (1) ◽

pp. 91-96 ◽

Cited By ~ 21

Author(s):

Dkaren SIMMER ◽

Shameen Ahmed ◽

Linda Carlsson ◽

R. P. H. Thompson

Keyword(s):

Trace Elements ◽

Breast Milk ◽

Infant Nutrition ◽

Daily Intake ◽

Developed Countries ◽

National Academy Of Sciences ◽

Additional Food ◽

Zn Concentration ◽

Academy Of Sciences ◽

Breast Fed

Breast-fed infants in Bangladeshi villages were weighed at 1, 2, 6, 9 and 12 months. The concentrations of zinc and copper in the breast milk were measured and the daily intake of these elements calculated. Breast milk Zn concentration decreased over the year but was comparable with that found in developed countries. The calculated daily intake decreased from 17·7 to 8·0 μmol (10–30% of recommended dietary allowances (RDA); National Academy of Sciences, 1980). Breast milk Cu concentration also fell over the year and was lower than that reported from developed countries. Calculated daily Cu intake was 1·95–2·63 μmol (RDA 7·81–15·63 μmol). Deficiencies of trace elements may therefore be a problem in poorly nourished communities where breast feeding is continued for several years with only small amounts of additional food. Breast milk may not be adequate as the only source of infant nutrition after the first few months of life in Bangladesh.

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Trends in Breast-Feeding

PEDIATRICS ◽

10.1542/peds.74.4.591 ◽

1984 ◽

Vol 74 (4) ◽

pp. 591-602

Author(s):

Gerry E. Hendershot

Keyword(s):

Infant Feeding ◽

Breast Feeding ◽

Market Research ◽

The United States ◽

Upward Trend ◽

Disadvantaged Women ◽

Breast Feed ◽

Statistical Studies ◽

Low Levels ◽

Short Section

Starting from very high levels in the 1940s, breast-feeding declined steadily to low levels in the early 1970s, and then began an upward trend which has apparently continued until the present (Fig. 1). In the 1940s, breast-feeding was more common among disadvantaged women. The subsequent decline was also more rapid among the disadvantaged, however, so that by the early 1970s, disadvantaged women were considerably less likely than others to breast-feed. Because the increase since the early 1970s has not been so pronounced among the disadvantaged, they continue to have relatively low levels of breast-feeding. The causes of these trends and differentials are not well understood. These are the principal conclusions drawn from a review of statistical studies of trends and differentials in breast-feeding in the United States. The studies included national health surveys conducted by the federal government, market research surveys conducted by infant formula manufacturers, and infant feeding surveys conducted by medical researchers. The studies differed markedly in their methods—a fact that affects their validity, reliability, and comparability. The first section of this paper discusses these data sources and their limitations. The next two sections discuss the downward trend in breast-feeding from the 1940s to the early 1970s, and the upward trend since. Each of these sections examines demographic differences in these trends. A short section that addresses possible causes of the trends and differentials follows those two sections. SOURCES AND LIMITATIONS OF THE DATA The principal sources of data on trends and differentials in breast-feeding are national fertility surveys, market research surveys, and special purpose infant-feeding surveys.

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Breast-feeding counselling mitigates the negative association of domestic violence on exclusive breast-feeding duration in rural Bangladesh. The MINIMat randomized trial

Public Health Nutrition ◽

10.1017/s1368980017001136 ◽

2017 ◽

Vol 20 (15) ◽

pp. 2810-2818 ◽

Cited By ~ 3

Author(s):

Amy L Frith ◽

Shirin Ziaei ◽

Ruchira Tabassum Naved ◽

Ashraful Islam Khan ◽

Iqbal Kabir ◽

...

Keyword(s):

Domestic Violence ◽

Sexual Violence ◽

Infant Feeding ◽

Breast Feeding ◽

Health Messages ◽

Feeding Practice ◽

Cox Regression Analysis ◽

Exclusive Breast Feeding ◽

Controlling Behaviour ◽

Group Experience

AbstractObjectiveTo determine if exclusive breast-feeding counselling modifies the association of experience of any lifetime or specific forms of domestic violence (DV) on duration of exclusive breast-feeding (EBF).DesignIn the MINIMat trial pregnant women were randomized to receive either usual health messages (UHM) or usual health messages with breast-feeding counselling (BFC) in eight visits. During pregnancy (30 weeks), lifetime experience of any or specific forms of DV was measured. Infant feeding practice information was collected from 0 to 6 months at 15 d intervals.SettingMatlab, Bangladesh.SubjectsPregnant and postpartum women (n 3186) and their infants.ResultsAmong women in the UHM group, those who had experienced any lifetime DV exclusively breast-fed for a shorter duration than women who did not experience any lifetime DV (P=0·02). There was no difference, however, in duration of EBF among women in the BFC group based on their experience of any lifetime DV exposure (P=0·48). Using Cox regression analysis, there was an interaction of exposure to any lifetime DV, sexual violence and controlling behaviour, and counselling group with duration of breast-feeding at or before 6 months (P-interaction≤0·08). Among the UHM group, experience of any lifetime DV, sexual violence or controlling behaviour was associated with fewer days of EBF (P<0·05). In contrast, among the BFC group, experience of DV was not associated with duration of EBF.ConclusionsThe experience of DV compromises EBF and the support of breast-feeding counselling programmes could assist this vulnerable group towards better infant feeding practices.

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EXCLUSIVE BREAST FEEDING

The Professional Medical Journal ◽

10.29309/tpmj/2010.17.02.2384 ◽

2010 ◽

Vol 17 (02) ◽

pp. 286-290

Author(s):

SOHAIL ASLAM ◽

FAROOQ AKRAM ◽

MEHBOOB SULTAN

Keyword(s):

Breast Feeding ◽

Feeding Practice ◽

Care Hospital ◽

Cross Sectional ◽

Exclusive Breast Feeding ◽

Lower Socioeconomic ◽

Primary Care Hospital ◽

Breast Feed ◽

Study Setting ◽

Breast Fed

Objective To study the duration and factors influencing exclusive breast feeding practice. Design: A cross sectional descriptive study Setting: A primary care hospital Gilgit, northern area of Pakistan. Period: Ten months from March 2007 to December 2007. Material & Method This study include 125 mothers with mean age of 24.3 years (SD 4.8),37% were illiterate while only 14% were matriculate or above among 125 babies (male 61%: female 39%). Results Out of total 125, eighty one (64.8%) babies were exclusively breast fed (EBF) for first six months of life and only five(4%) infants were not given breast milk at all . among 76 male infants ,52 (68.4%) were EBF for six months in comparison to 29 female (59.2%) out of 49. among 36 first born infants only 15 (41.7%) were EBF for six months in comparison to 66 (74.2%)out of 89 not first born(p<0.05). Conclusion: Exclusive breast feeding for complete 6 months is still not routinely practised by most of mothers and first born are deprived of this right in majority lower socioeconomic group and illiterate mothers are more likelyto breast feed, gender bias was also observed as a significantly high percentage of male babies were observed to be breast fed as compared to females. More efforts are required by health depart. And NGO’s to promote good breast feeding practices in our setup.

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Infant feeding practice on growth velocity in 4-6 month-olds

Paediatrica Indonesiana ◽

10.14238/pi1.1.2018.36-41 ◽

2018 ◽

Vol 1 (1) ◽

pp. 36

Author(s):

Joko Kurniawan ◽

Alifah Anggraini ◽

Madarina Julia

Keyword(s):

Breast Milk ◽

Infant Feeding ◽

Growth Velocity ◽

Failure To Thrive ◽

Optimal Growth ◽

Cross Sectional Study ◽

Complementary Food ◽

Feeding Practice ◽

Cross Sectional ◽

The Mean

Background In developing countries, 5-10% of infants suffer from failure to thrive. Adequate feeding is the most crucial factor for optimal growth in early life.Objective To assess the differences in growth velocity at 4 to 6 months of age, based on the infant feeding practices.Methods This cross-sectional study involving 4 to 6 month-old babies from 6 public health centres in Yogyakarta was performed from August to November 2016. Data on body weight, and growth velocity as they related to weight at birth were collected. Subjects were divided into groups according to their feeding practices.Results Of 173 subjects, 130 (75%) infants were exclusively breastfed, 19 infants (11%) were given breast milk and formula, 14 (8%) infants were given breast milk and complementary food (8%), and 10 (6%) infants were given formula and complementary food. The mean growth velocity z-scores by group were as follows: exclusively breastfed 0.04 (SD 1.15) (95%CI -0.16 to 0.24), breast milk and formula -0.61 (SD 0.84) (95%CI -1.01 to -0.21), breast milk and complementary food -0.69 (SD 1.14) (95%CI -1.35 to -0.04), formula and complementary food 0.23 (SD 1.50) (95%CI: -0.84 to 1.31). The mean difference in growth velocity between the exclusively breastfed vs. breast milk and formula groups was 0.65 (SD 0.28) (95%CI: 0.10 to 1.20; P=0.02); vs. breast milk and complementary food was 0.73 (SD 0.32) (95%CI: 0.10 to 1.37; P=0.02); and vs. formula and complementary food was -0.19 (SD 0.37) (95%CI: -0.93 to 0.55; P=0.61).Conclusion Exclusively breastfed have the most optimal growth velocity compared to infants who experience other feeding practices.

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