The relationship between postpartum social support and attitudes towards breastfeeding: A cultural perspective

Aim: This study intends to provide an analysis of the relationship between postpartum social support and women’s breastfeeding attitudes from different cultural perspectives. Method: This study was conducted between April-September 2019.The study population comprised of 430 women with 4-24 week old babies who visited health centers in the provinces of Adıyaman (Region 1), Kahramanmaraş (Region 2) and Malatya (Region 3). Findings: The mean scores of women from the BAES were 105.54 ± 13.16 in Region 1, 103.30 ± 15.77 in Region 2, and 99.46 ± 13.47 in Region 3 (P<0.05).The mean scores of women from the “Importance of the Need” subscale on the PSQ were 157.38±45.57 in Region 1, 140.73±55.18 in Region 2, and 144.89±48.144 in Region 3 (P<0.05).The mean scores of women from the “Support Received” subscale on the PSQ were 112.39±51.58 in Region 1; 116.87±52.69 in Region 2, and 108.89±50.79 in Region 3 (P>0.05).In Region 2, a significant and positive correlation was found between the subscales “Importance of the Need” and the “Perceived Support” on the BAES and the PSQ (r=0.259, r=0.255, P<0.05, respectively). Conclusion: A comparison of the relationship between postpartum social support and attitudes towards breastfeeding revealed major differences between the Regions.

Evaluation of Breastfeeding Attitudes, Education, and Training Among Gynecology Healthcare Professionals in Greece

Background There is strong evidence suggesting that support from a trained healthcare professional can have a positive effect on initiation, duration, and experiences of breastfeeding. It is therefore important that nursing, medical and other students in healthcare, acquire knowledge about breastfeeding, and develop skills to effectively support and care for pregnant women and new mothers. This study tried to investigate the knowledge level, attitudes, and perceptions of gynecology healthcare professionals in Greece towards breastfeeding. Methods A self-administered questionnaire was provided asking the healthcare professionals and students to answer multiple choice questions. The study was conducted mainly at the facilities of Medical Faculty Aristotle University of Thessaloniki. The questionnaire was administered to 312 healthcare professionals (midwifes, students, physicians, and other healthcare professionals). Results The questionnaire demonstrated that 70% of the respondents had moderate breastfeeding knowledge at best while 30% lacked knowledge concerning the management of special breastfeeding scenarios. 84% had previous personal breastfeeding experience or at least are willing to do so in the future (themselves or their partners) with 39.1% aiming to breastfeed approximately for one year. The same pattern was observed in terms of their breastfeeding recommendations to other mothers regardless of their sex. 59.6% admitted that they did not have the necessary time to properly inform mothers about breastfeeding while 72.4% acknowledged improper breastfeeding information as an important factor for the low breastfeeding rates in Greece. Finally, 80.4% stated that their education was lacking in didactic depth and their training in hands-on experience while 88.8% clearly underlined that there was room for improvement in their education/training curriculum. Expert teams, well-organized educational programs and advanced computing could contribute to the personnel’s harmonization with the various breastfeeding objectives to create a “breastfeeding-friendly” social environment. Conclusions This study revealed that although most Greek gynecology healthcare professionals have very positive attitudes towards breastfeeding, their breastfeeding knowledge was moderate at best and could be further improved.

The Attitudes of Polish Women towards Breastfeeding Based on the Iowa Infant Feeding Attitude Scale (IIFAS)

Background: The Iowa Infant Feeding Attitude Scale (IIFAS), which is used for the assessment of attitudes towards breastfeeding, has been found to be reliable and valid in a number of countries, but has not yet been psychometrically tested in Polish women. The purpose of the study was to report on the cultural adaptation of the IIFAS to Polish settings and on its validation, to evaluate the breastfeeding attitudes in Polish women who recently gave birth, and to identify the determinants of these attitudes. Methods: The study was performed in a group of 401 women in their first postpartum days. Results: Cronbach’s α for the scale was 0.725. Discriminative power coefficients of all questionnaire items were higher than 0.2. Subscales were strongly correlated with the total score, with a correlation coefficient of 0.803 for the “favorable toward breastfeeding” subscale (p < 0.001), and 0.803 for the “favorable toward formula feeding” subscale (p < 0.05). For the item “A mother who occasionally drinks alcohol should not breastfeed her baby”, the factor loading did not reach the criterion value, and so the item was not included in further analyses. The mean IIFAS score was 63.12 (±7.34). Conclusions: The Polish version of the IIFAS is a reliable and appropriate measure of women’s attitudes towards infant feeding in Polish settings, with acceptable psychometric properties and construct validity.

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.

Breastfeeding and diversification attitudes among Romanian mothers

Introduction: Recommended by the World Health Organization as the optimal way of infant feeding, maternal breast milk represents the best nourishment for the newborn baby during its first six months. The purpose of this study was to evaluate some of the Romanian mothers’ characteristics that can influence their attitude towards breastfeeding and food diversification. Methods: A questionnaire about 32 questions, including demographics items and breastfeeding attitudes, was sent online (socializing platforms) in 2020 to mothers from all Romania districts. Our sample included at the end 1768 subjects, who fully completed the questionnaire. Statistical analysis was carried out using the GraphPad statistical software. Results: The prevalence of breastfeeding for more than six months was only 32.18% in our group, and most of them were educated mothers who lives in urban areas (OR=2.76), were married (OR=1.98), had over 30 years old (OR=1.43) and have more than one child (OR=1.74). Conclusions: We underline the importance of tackling in our future community interventions some of the socio-demographic characteristics of pregnant women (like groups education, good and accessible information about breastfeeding, young age, first pregnancy, or mothers from rural areas as well) in developing good habits of breastfeeding or complementary feeding, in order to improve their children health status and proper development.

Breastfeeding counseling based on formative research at primary healthcare Services in Mexico

Background Breastfeeding rates in Mexico are far from World Health Organization (WHO) recommendations with 28.8% of Exclusive Breastfeeding (EBF) under 6 months of age, according to the 2018 National Health and Nutrition Survey. Formative research has shown that culturally appropriate counseling is an effective breastfeeding intervention. The objective of the current study was to evaluate the effect of interpersonal counseling on EBF in a primary healthcare center in Tijuana, México. Methods This was a randomized controlled trial pilot with a sample of mothers with infants under 4 months of age from a primary care center. Participants were randomized into two groups: 1) Control group, received counseling on immunizations and standard infant feeding information, and 2) Intervention group, receiving breastfeeding counseling using a socio-ecological framework. Changes in breastfeeding attitudes, self-efficacy and EBF were evaluated at 2 months post-intervention. Results A total of 80 mothers completed the 2 month follow up assessment (40 in each group). The mean age at baseline was 26.4 years for mothers and 1.4 months for infants. There was a 30% increase in EBF at 2 months follow up in the intervention group and 15% decrease in the control group post-intervention. We observed a significant improvement in breastfeeding attitudes (P = 0.0001), self-efficacy (P = 0.046) and EBF (P = 0.0001) in the intervention group. Reported obstacles were discomfort of breastfeeding in public (23%), infant dissatisfaction (23%), pain (19%), insufficient milk supply (15%) and returning to work (8%). Conclusions Breastfeeding counseling based on previous formative research improved breastfeeding attitudes, self-efficacy and practices in this population. These findings suggest that the promotion of breastfeeding utilizing a socio-ecological framework may improve breastfeeding rates by addressing the needs of women within their varying sociocultural contexts. Trial registration ACTRN: ACTRN12621000915853. Retrospectively registered.

Evaluation of breastfeeding attitudes and education of Greek gynecology professionals to improve the educational curriculum of Obstetrics & Gynecology Departments

Background To investigate the knowledge level, attitudes and perceptions of Gynecology healthcare professionals in Greece towards breastfeeding. Methods A self-administered questionnaire was provided asking to answer multiple choice questions. The study was conducted mainly at the facilities of Medical Faculty Aristotle University of Thessaloniki. The questionnaire was administered to 312 healthcare professionals (nurses, students, physicians and other healthcare professionals). Results Over 70% supported that their breastfeeding knowledge was moderate at best and could be further improved. 30% lacked knowledge concerning the management of special breastfeeding scenarios. 84% had previous personal breastfeeding experience or at least are willing to do so in the future (themselves or their partners) with 39.1% aiming to breastfeed approximately for one year. The same pattern was observed in terms of their breastfeeding recommendations to other mothers regardless of their sex. 59.6% admitted that they do not have the necessary time to properly inform mothers about breastfeeding while 72.4% acknowledged improper breastfeeding information as an important factor for the low breastfeeding rates in Greece. Finally, 80.4% stated that their education was lacking in didactic depth and their training in hands-on experience while 88.8% clearly underlined that there was definitely room for improvement in their education/training curriculum. Expert teams, well-organized educational programs and advanced computing could contribute to the personnel’s harmonization with the various breastfeeding objectives to create a “breastfeeding-friendly” social environment. Conclusions This study revealed that although most Greek gynecology healthcare professionals have very positive attitudes towards breastfeeding, their breastfeeding knowledge was moderate at best and could be further improved.

Validation of the Spanish-Mexican Version of the Australian Breastfeeding Attitude Questionnaire in Higher Education Health Students

Positive attitudes towards breastfeeding in health professionals/students have been associated with increasing their confidence to provide support and accompaniment to mothers. In Mexico, there is no valid/reliable tool to assess attitudes towards breastfeeding in this population. The Australian Breastfeeding Attitudes (and Knowledge) Questionnaire (ABAQ) measures attitudes in the Australian population. We aimed to adapt and validate the ABAQ in Mexican health students. We included 264 health students (nursing, nutrition, and medicine) from the University of Guadalajara. Bilingual translators carried out the Spanish adaptation with a reverse translation into English. Experts evaluated the content validity. Reliability was evaluated through an internal consistency analysis (Cronbach’s alpha) and construct validity through convergent–divergent validation, item–total correlation, exploratory factor analysis (by principal components), and confirmatory factor analysis. According to the exploratory factor analysis, only one component was identified. Seven items were removed (low correlation between items ≤0.2 and low factor load ≤0.3). The Cronbach’s alpha was 0.78. According to the confirmatory factor analysis, the one-factor solution of the ABAQ-13Mx showed a good model fit (X2 = 98.41, G = 62, p = 0.02, CFI = 0.940, and RMSEA = 0.048). The ABAQ-13Mx is a reliable and valid instrument for evaluating attitudes towards breastfeeding in Mexican health degree students.