Healthcare Professionals’ Breastfeeding Attitudes and Hospital Practices During Delivery and in Neonatal Intensive Care Units: Pre and Post Implementing the Baby-Friendly Hospital Initiative

Background: The Baby-Friendly Hospital Initiative represents a global effort to support breastfeeding. Commitment to this program has been associated with the longer duration and exclusivity of breastfeeding and improvements in hospital practices. Further, healthcare professionals’ breastfeeding attitudes have been associated with the ability to provide professional support for breastfeeding. Research Aims: To determine healthcare professionals’ breastfeeding attitudes and hospital practices before and after the implementation of the Baby-Friendly Hospital Initiative. Methods: Using a quasi-experimental pretest–posttest study design, healthcare professionals ( N = 131) from the single hospital labor and delivery, maternity care, and neonatal intensive care were recruited before and after the Baby-Friendly Hospital Initiative intervention during 2017 and 2019. Breastfeeding attitudes with the validated Breastfeeding Attitude Questionnaire, breastfeeding-related hospital practices, and background characteristics were collected. Results: The healthcare professionals’ breastfeeding attitude scores increased significantly after the implementation of the Baby-Friendly Hospital Initiative, difference = 0.16, (95% CI [0.13, 0.19]) and became breastfeeding favorable among all professional groups in each study unit. Positive changes in breastfeeding-supportive hospital practices were achieved. The infants had significantly more frequent immediate and uninterrupted skin-to-skin contact with their mothers. The rate of early breastfeeding, as well as the number of exclusively breastfed infants, increased. Conclusions: After the Baby-Friendly Hospital Initiative and Baby-Friendly Hospital Initiative for neonatal wards (Neo-BFHI) interventions were concluded, we found significant improvements in the breastfeeding attitudes of healthcare professionals and in breastfeeding-related care practices. This RCT was registered (0307-0041) with ClinicalTrials.gov on 03/03/2017.

Attitudes and Barriers to Breastfeeding among Mothers in Princess Nourah Bint Abdulrahman University, Riyadh, Kingdom of Saudi Arabia

Background. Breastfeeding provides unsurpassed natural nutrition to the newborn and infant. It has a nearly perfect mix of food elements and vitamins that infants need to grow up. Nonetheless, the tendency for breastfeeding remains below the expected levels. Objectives. To explore the attitudes and barriers to breastfeeding among mothers in Princess Nourah Abdulrahman University (PNU), Riyadh, Saudi Arabia. Methods. A cross-sectional study was conducted, from January to April 2019; 399 PNU students, employees, and faculty mothers aged 18 years and above with experience of childbirth and breastfeeding were included in the study using a predesigned validated questionnaire. The questionnaire consisted of four scales: sociodemographic, attitude toward breastfeeding, barriers to breastfeeding, and induced lactation knowledge. Results. The participants’ mean age was 34.1 ± 10.4 years; most (87.8%) were Saudi; 92.8% were married; 62% had a bachelor’s degree; and 43% had “enough income.” While 40% of the mothers reported >6 months “exclusive breastfeeding” for the first baby, only 34.8% did so for the last baby, and 54.5% did so for most of all babies altogether. The mothers’ parity ranged between 1 birth and 4 births in 23.5% and 17.5% of the participants, respectively. An overall score of breastfeeding attitude averaged 59.6 ± 7.3. The tendency for scoring a negative attitude to breastfeeding was significantly reported ( p < 0.5 ) among 127 (31.8%) 31- to 40-year-old mothers; 153 (38.3%) bachelor’s degree holders; and 157 (39.3%) employees (χ2 (4) 14.6, p = 0.006; χ2 (4) 10.4, p = 0.034; and χ2 (4) 20.4, p < 0.001, respectively). “Mother’s illness” was the most commonly (63%) reported barrier to “not to breastfeed,” followed by “work” (45.5%) and “father not supporting breastfeeding” (14.8%). Conclusions. An overall negative attitude toward breastfeeding among PNU mothers was noted. Barriers included mother’s sickness and work. Efforts to minimize such negative attitudes and barriers among susceptible mothers are warranted.

Postnatal Mental Health, Breastfeeding Beliefs, and Breastfeeding Practices in Rural China

Background The importance of breastfeeding in low- and middle- income countries is well recognized, yet the importance of postnatal mental health on breastfeeding practices and beliefs in these settings has been understudied. This study investigates the associations between maternal mental health problems and breastfeeding beliefs as well as practices in rural China. Methods Cross-sectional data were collected from 742 mothers of infants under six months old in rural Sichuan Province, China. Surveys collected data on maternal mental health problems (depression, anxiety, and stress symptoms), breastfeeding beliefs (attitudes and self-efficacy), and breastfeeding practices. Ordinary least squares regression, multiple logistic regression and heterogeneous effect analyses were used to determine the associations between maternal mental health and breastfeeding outcomes. Results Among all respondents, 13% showed symptoms of depression, 16% anxiety, and 9% stress. The prevalence of full breastfeeding was 59.3%. Breastfeeding attitude was significantly associated with symptoms of depression (p = 0.023) and breastfeeding self-efficacy with symptoms of depression (p = 0.001) and symptoms of stress (p = 0.020). However, there were no significant associations between symptoms of mental health problems and full breastfeeding. The heterogeneous effects analyses revealed that full breastfeeding was negatively associated with stress symptoms when the infant was from a high-income family (p = 0.011). In addition, full breastfeeding was negatively associated with the father having a higher education level (p = 0.026, p = 0.048, and p = 0.020) and the infant being older than 2 months old (p = 0.000, p = 0.000, p = 0.00), regardless of maternal mental health problem symptoms. Conclusion Symptoms of maternal mental health problems are significantly associated with breastfeeding attitude and self-efficacy, yet has less of an association with breastfeeding practices. To improve breastfeeding practices, interventions need a multi-dimensional approach that should not only focus on improving maternal mental well-being but also consider demographic background characteristics.

Social Determinants of Breastfeeding Preferences among Black Mothers Living with HIV in Two North American Cities

The study is motivated by the need to understand the social determinants of breastfeeding attitudes among HIV-positive African, Caribbean, and Black (ACB) mothers. To address the central issue identified in this study, analysis was conducted with datasets from two North American cities, where unique country-specific guidelines complicate infant feeding discourse, decisions, and practices for HIV-positive mothers. These national infant feeding guidelines in Canada and the US present a source of conflict and tension for ACB mothers as they try to navigate the spaces between contradictory cultural expectations and national guidelines. Analyses in this paper were drawn from a broader mixed methods study guided by a community-based participatory research (CBPR) approach to examine infant feeding practices among HIV-positive Black mothers in three countries. The survey were distributed through Qualtrics and SPSS was used for data cleaning and analysis. Results revealed a direct correlation between social determinants and breastfeeding attitude. Country of residence, relatives’ opinion, healthcare providers’ advice and HIV-related stigma had statistically significant association with breastfeeding attitude. While the two countries’ guidelines, which recommend exclusive formula feeding, are cardinal in preventing vertical transmission, they can also be a source of stress. We recommend due consideration of the cultural contexts of women’s lives in infant feeding guidelines, to ensure inclusion of diverse women.

Knowledge, Attitude, Prior Exposure and Intention to Breastfeed among Undergraduate University Students

Introduction: The Theory of Planned Behaviour by Ajzen (1985) states that breastfeeding intention which is made prior to pregnancy predicted future breastfeeding outcomes and also influenced by factors including attitude, knowledge and exposure. The goal of this study was to investigate the level of breastfeeding knowledge, attitude, prior exposure and intention to breastfeed and the relationship between these factors among non-pregnant, single undergraduates. There are limited studies in Malaysia involving young adults who will be future parents. Methods: This cross-sectional study involved 377 students in UiTM Puncak Alam, Selangor. Self- administered questionnaires adapted from Infant Feeding Knowledge Test and Iowa Infant Feeding Attitude Score (IIFAS) were included as research instruments. Results: Overall study population had a low level of knowledge (10.61±2.10) and attitude (60.64± 5.02) towards breastfeeding, high exposure (2.7±0.52) and intention (4.74±0.64) to breastfeed especially in females. Breastfeeding knowledge is significantly associated with breastfeeding attitude and prior breastfeeding exposure. Breastfeeding intention also established an association with breastfeeding attitude and prior breastfeeding exposure. Subsequent predictive analysis found that breastfeeding attitude impacts breastfeeding intention. Conclusion: Breastfeeding intervention should target undergraduate university students in preparing these future parents with adequate and accurate knowledge and positive attitudes towards breastfeeding thus, resulting in higher breastfeeding intention and greater efforts of initiation and sustenance of breastfeeding. KEYWORDS: Breastfeeding knowledge, breastfeeding attitude, breastfeeding exposure, breastfeeding intention, university undergraduates

Pengaruh Pendidikan Kesehatan dengan Lembar Balik Terhadap Perilaku Pemberian Asi pada Ibu Post Partum

One of the obstacles in breastfeeding attitude is the lack of lactation communication and counseling. Breastfeeding health education is designed to enforce healthy lifestyle of breastfeeding by delivering proof based information. Flipchart media usage can be easily understood by health counsellors and clients. The study is to investigate the influence of health education using flipchart over breastfeeding attitude in post-partum mothers. This research was used a quasi experiment design with posttest only design with control group. A random assignment sampling design was used to 42 respondents which were divided into 2 groups; intervention group and control group. The samples were randomized using numbers and were divided into intervention and control group. The intervention group was given health education after delivery and questionnaires were given in intervention and control group a week after postpartum. The average score postpartum maternal behavior in the intervention group (18,43) is higher than the control group (15,14). The results of chi square test p = 0.00; RR = 3.16; CI = 1,58-6,31. External variables related to the behavior of breastfeeding is the education level of p = 0.02. Health education using flipchart significantly affects breastfeeding behavior in postpartum mothers.