Association of Voluntary Legal Paternity and Breastfeeding Duration and Exclusivity in a Sample of Mothers in NewYork State, United States

Background and Objective: Globally, father engagement is deemed an important factor in mothers’ breastfeeding practices. In the U.S., the role of the father in breastfeeding is understudied. This study examines the association between voluntary legal paternity and maternal breastfeeding outcomes. Methods: Using data from a modified Pregnancy Risk Assessment Monitoring System survey (Monroe County, NY, 2015-2017) linked to New York State’s birth certificate data, we assessed breastfeeding outcomes (exclusivity and duration) by voluntary legal paternity (VLP) establishment. We examined breastfeeding duration (breastfeeding cessation at 13 weeks or less) and exclusive breastfeeding (at 13 weeks) among mothers whose infants had VLP (i.e., married, acknowledgment at birth), and those who had no-VLP (i.e., a court-mandated Paternity Affidavit or no legal paternity established). Univariate analyses were conducted, with additional variables (parental demographics, maternal social and clinical) included subsequently. The backward elimination method was used to determine the set of covariates to adjust in the model. Results: Of the 1,753 mothers initiating breastfeeding, 1,364 had VLP and 389 had no-VLP established. Mothers of infants with a no-VLP were more likely to be Black (29.49%), Hispanic (17.74%), have lower income (80.21%), have lower-education levels (44.73%) and were more likely to be <30 years old (61.7%), and had higher levels (14.4%) of reported traumatic stress before and during the most recent pregnancy. Among mothers initiating breastfeeding, those with no-VLP had a higher risk of breastfeeding cessation at 13 weeks (OR: 2.06; 95% CI, 1.25-3.42) after adjusting for maternal resilience, social support, hospital breastfeeding support, pre-pregnancy BMI, paternal age, and paternal education; and higher risk of breastfeeding cessation at 13 weeks (OR:1.46; 1.01-2.09). Conclusion and Implications for Translation: Voluntary legal establishment of paternity is associated with maternal breastfeeding outcomes. Screening of mothers may include legal paternity status as a further indication of the need for additional breastfeeding support, especially among socio-economically disadvantaged populations. Copyright © 2021 Alio et al. Published by Global Health and Education Projects, Inc. This is an open-access article distributed under the terms of the Creative Commons Attribution License CC BY 4.0.

Exploring women’s perceptions of pain when breastfeeding using online forums

Background Despite numerous benefits, many mothers stop breastfeeding soon after birth. A common reason for this is the experience of pain or discomfort. One resource which women use to share their breastfeeding challenges and seek support are online forums. This study aimed to collect data from online forums to explore 1) usage of forums as social support for breastfeeding-related pain; 2) experiences of breastfeeding-related pain; 3) perceptions and strategies to deal with breastfeeding-related pain; and 4) the impact of pain on breastfeeding duration. Methods Data was gathered through searches of online forums based in the UK and USA: Netmums, What to Expect and Mumsnet using key terms: ‘painful breastfeeding’ and ‘sore breastfeeding’. Data extraction took place in July 2018 and included posts made between 2012 and 2018. Data included 123 posts and 193 replies, analysed using thematic analysis. Results The first theme identified was ‘variation in types of pain’, highlighting the variety of painful experiences and their descriptions. In particular, this theme reveals the large variety of different types of pain women experience at different stages throughout their breastfeeding journey, as well as the different pain characteristic they focus on in the description of their experience (i.e., location, sensory or physical aspects). Secondly, the theme ‘perceived causes and explanations for pain’ revealed how women interpret pain experiences either due to a recognised condition or behavioural cause. The third theme ‘cessation of breastfeeding related to pain’ identified. How women experience both physical and psychological struggles (e.g., guilt) related to breastfeeding cessation, with pain being a main factor in considering cessation of breastfeeding. Finally, the theme ‘shared experiences and support’ identified women’s strong need for both practical and emotional support to deal with pain. Many women look for this support through the knowledge exchange offered on the online forums. Conclusions Pain was a key reason for breastfeeding cessation, commonly associated with strong feelings of guilt. The online forums provide a unique form of social support for breastfeeding women to find ways to cope with the pain, while highlighting the urgent need for more appropriate antenatal education on realistic expectation surrounding breastfeeding.

Association of prenatal medical risk with breastfeeding outcomes up to 12 months in the All Our Families community-based birth cohort

Background Prenatal medical risk describes physical health issues or biological factors that predate or arise during pregnancy which heighten the risk of adverse outcomes, and often warrant specialized obstetric care. The influence of the nature and magnitude of prenatal risk on breastfeeding outcomes remains poorly understood. The objective of this study was to determine the association between prenatal medical risk and breastfeeding initiation and duration up to 1 year postpartum. Methods We analysed a subset of data from the All Our Families longitudinal cohort (n = 2706) of women in Calgary, Canada who delivered a liveborn infant between 2008 and 2010. Data were collected from self-report questionnaires and medical records. Women with complete data on prenatal medical risk factors and breastfeeding outcomes were included in this analysis. Prenatal medical risk was operationalized as one integer score of risk severity and four binary risk types capturing pre-pregnancy characteristics, past obstetric problems, current obstetric problems, and substance use. Outcomes were breastfeeding initiation defined as the infant ever receiving breast milk, and duration operationalized as still breastfeeding at 4 months, at 12 months, and time to breastfeeding cessation in weeks. We used logistic regression and Cox regression with right censoring at 52 weeks or attrition to calculate odds ratios (OR) and hazard ratios (HR), respectively, adjusting for sociodemographic vulnerability, parity, mode of delivery, and gestational age. Results Prenatal medical risk severity and type were not significantly associated with breastfeeding initiation, with the exception of pre-pregnancy risk type (OR 0.45; 95% CI 0.26, 0.77). Risk severity was associated with lower odds of breastfeeding to 4 months (OR 0.94; 95% CI 0.90, 0.99), 12 months (OR 0.93; 95% CI 0.87, 0.98), and earlier breastfeeding cessation (HR 1.05; 95% CI 1.02, 1.08). Associations with shorter breastfeeding length across the first postpartum year were observed for pre-pregnancy, current obstetric, and substance use risk types, but not past obstetric problems. Conclusion Prenatal medical risk is associated with shortened duration of breastfeeding. Women with prenatal medical risk may benefit from the proactive arrangement of lactation support before and following delivery to promote continued breastfeeding.

Exclusive Breast Feeding and Its Determinants in Infants Born in Zanjan Hospitals: A Longitudinal Study

Background: Exclusive breastfeeding (EBF), especially during the first six months of life, is one of the primary health indicators in infants. Objectives: The present study intended to describe the frequency of EBF in infants and its determinants until six months after birth. Methods: This longitudinal study was conducted on 673 mother-newborn pairs visiting obstetrics and gynecology departments of two main hospitals in Zanjan. Information on the frequency of EBF up to six months, socio-demographic and reproductive information, and attitudes of mothers towards breastfeeding was gathered using questionnaires. Data were analyzed using chi-square test and logistic regression in SPSS. Results: The proportion of neonates who were receiving EBF at discharge was 95.7%. The EBF proportions in the second week, the first, fourth, and sixth months were 95%, 88.1%, 80.7%, and 77.3%, respectively. The multivariate analysis of data indicated that living in urban areas (P = 0.02), lower education of mothers (P = 0.008), having more than three years of birth interval (P = 0.006), no experience of breastfeeding in mothers (P = 0.01), no prior decision for breastfeeding in mothers (P < 0.0001), and use of artificial nipples (P = < 0.0001) were independently associated with non-EBF. Conclusions: In this study, despite a high proportion of EBF at discharge, we found that the proportion of EBF reduced during six months. The determinants of non-EBF at six months, including urban and less educated mothers, highlight a need to promote awareness regarding EBF and perform interventions for women at a greater risk for early breastfeeding cessation.

Socio-cultural factors for breastfeeding cessation and their relationship with child diarrhoea in the rural high-altitude Peruvian Andes – a qualitative study

Background In some areas of the world, breast milk is seen as a potential source of child diarrhoea. While this belief has been explored in African and Southeast Asian countries, it remains vastly understudied in Latin American contexts. We investigate socio-cultural factors contributing to breastfeeding cessation in rural high-altitude populations of the Peruvian Andes. The role of socio- cultural factors in the local explanatory model of child diarrhoea, and whether these perceptions were integrated in the local healthcare system were assessed. Methods Within the framework of a randomised controlled trial, we conducted semi-structured interviews with 40 mothers and 15 health personnel from local healthcare centres involved in the trial. Results Cultural beliefs on breastfeeding cessation included the perception that breast milk turned into “blood” after six months and that breastfeeding caused child diarrhoea. We identified eight local types of child diarrhoea, and women linked six of them with breastfeeding practices. “Infection” was the only diarrhoea mothers linked to hygiene and the germ disease concept and perceived as treatable through drug therapy. Women believed that other types of diarrhoea could not be treated within the formal healthcare sector. Interviews with health personnel revealed no protocol for, or consensus about, the integration of the local explanatory model of child diarrhoea in local healthcare and service provision. Conclusions The local explanatory model in rural Andean Peru connected breastfeeding with child diarrhoeas. Cultural beliefs regarding diarrhoea management may increase home treatments, even in cases of severe diarrhoeal episodes. Future national breastfeeding support programmes should promote peer-counselling approaches to reduce negative attitudes towards breastfeeding and health practitioners. Local explanatory models should be incorporated into provincial and regional strategies for child diarrhoea management to promote equity in health and improve provider-patient relationships.

Trends in breastfeeding practices and mothers’ experience in the French NutriNet-Santé cohort

Background France has one of the lowest rates in the world regarding breastfeeding initiation and duration. Few studies have explored breastfeeding practices in France since the middle of the twentieth century, or following from initiation to cessation. The purpose of our study was to determine trends in breastfeeding over the past decades regarding public health recommendations, and to examine mothers’ perceptions about factors known to have an impact on breastfeeding support and cessation. Methods From the NutriNet-Santé cohort, 29,953 parous women (launched in 2009 to study relation between nutrition and health), were included in the present study. Using web-questionnaires, they were asked retrospectively if they had breastfed their youngest child or not, and if so, the duration of exclusive and total breastfeeding. For those who had breastfed, we investigated their perceptions about support at initiation and during the entire breastfeeding period and reasons for breastfeeding cessation. We also asked those who did not breastfeed about their perceptions and reasons for infant formula feeding their youngest child. Analyses were weighted according to the French census data. Results In the NutriNet-Santé cohort, 67.3% of mothers breastfed their youngest child. The proportion of breastfed children increased over the past few decades, from 55.0% (95% CI 54.3, 55.6) in the 1970s to 82.9% (82.4, 83.4) in the 2010s. Total and exclusive breastfeeding duration went from 3.3 months and 2.4 months respectively in the 1970s to 5.9 months and 3.2 months respectively in the 2010s. Most mothers felt supported at initiation and during the breastfeeding period. A reported desire to have breastfed longer than two months was 59.5%. Mothers who did not breastfeed did it by choice (64.3%). They did not feel guilty (78.2%) and did not perceive a problem not to breastfeed (58.8%), but almost half of them would have liked to have breastfed (45.9%). Conclusion Breastfeeding duration has increased in the past decades but did not reach the public health recommendations threshold. Targets other than mothers have to be considered for breastfeeding education, like the partner and her environment, to increase breastfeeding practices. Trial registration The study was registered at ClinicalTrials.gov (NCT03335644).

The Role of Mixed-feeding in Undermining Breastfeeding: Analysis of the 2018 Scottish Infant Feeding Survey

Objectives Mixed-feeding (MF), the use of formula with breastfeeding is commonly followed by early breastfeeding cessation, but the actual mechanism for this is not yet clear. We aimed to investigate i) the reasons why breastfeeding mothers start mixed feeding, ii) its association with later lactation, and iii) the role health staff play in discouraging mixed-feeding and supporting continued breastfeeding. Methods Participants were mothers in the Scottish Maternal and Infant Feeding Survey (2018) cohort, who had ever breastfed their infants and completed questionnaires at infant age 8–12 weeks, reporting on feeding intentions, feeding practice, breastfeeding problems, reasons for use of formula and sociodemographic data. Mothers who planned to mixed-feed from the outset, were defined as early MF, while those who had not intended to mixed feed but did so, were defined as reactive MF. Results Of 1974 initially breastfeeding mothers, 65% had mixed-fed at some point. At 6 weeks, 32% had ceased breastfeeding, 22% were mixed-feeding and 46% were still exclusively breastfeeding. Early breastfeeding problems (&lt;2 weeks) were common (65%) and related to stopping breastfeeding (Relative Risk [RR]:3.23, 95% Confidence Interval [CI]: 2.0, 5.3). Using survival modelling, adjusting for early and late breastfeeding problems, and sociodemographic factors, reactive MF were less likely than early MF to have stopped breastfeeding (Hazard Ratio [HR]:0.57, 95% CI: 0.4, 0.8). In multivariate analysis, increased risk of breastfeeding cessation was associated with intention to mixed-feed (RR:3.39, 95%CI: 2.4, 4.9), and introduction of formula due to convenience (RR:3.21, 95%CI: 2.3, 4.4); the latter was also associated with later lactational issues (RR:1.76, 95%CI: 1.3, 2.3). Mothers who received specialist lactation support were less likely to cease breastfeeding (RR:0.63, 95%CI: 0.5, 0.9) but other input was not protective. Conclusions Mothers often choose to mix-feed their infants from the first weeks, even in absence of breastfeeding problems. Maternal and child health programs need to counsel mothers against mixed-feeding and provide skilled help for breastfeeding issues. Funding Sources N/A.

Breastfeeding behavior is not associated with health literacy: evidence from the German KUNO-Kids birth cohort study

Purpose Despite the health benefits of full breastfeeding for both infants and mothers, less than 50% of mothers in Germany practice this method for at least 4 months after childbirth. Because of the growing importance of health literacy to improve public health, we investigated the role of maternal health literacy in breastfeeding behavior. Methods We analyzed the data of 1172 mother–child dyads of the KUNO-Kids health study of the University Children’s and Maternity Hospital Regensburg. Maternal health literacy was assessed with the HLS-EU-Q47 questionnaire (sub-index health care) up to 48 h after childbirth. Outcome was analyzed 6 months after childbirth and categorized into full breastfeeding for less than 4 months or for at least 4 months. The association between breastfeeding and maternal health literacy was calculated with univariable and multivariable logistic regression analyses. Results 38.8% of mothers showed inadequate or limited health literacy. 75.9% of mothers had fully breastfed their child for at least 4 months. Univariable logistic regression analysis showed that health literacy and full breastfeeding for at least 4 months were not associated (OR = 0.995 [CI 0.977–1.015], p = 0.60). After adjusting for all potentially confounding variables with a significant association (p ≤ 0.05) on both health literacy and breastfeeding, the multivariable model showed no association between health literacy and breastfeeding (OR = 0.984 [CI 0.963–1.007], p = 0.170). Conclusion Surprisingly, we found no association between health literacy and breastfeeding behavior in our study. Therefore, future research with comparable measurements of health literacy and breastfeeding is required to validate this result and to identify reasons for early breastfeeding cessation.