Promoting the Practice of Exclusive Breastfeeding: A Philosophic Scoping Review

Background The World Health Organization recommends exclusive breastfeeding for the first 6 months of an infant’s life and continued breastfeeding for 2 years. The global rate of exclusive breastfeeding is low at 33%. Thus, it is important to identify philosophical and theory-based strategies that can promote exclusive breastfeeding. The aim of the study is to identify philosophical schools of thought and theories used in research on promoting the practice of exclusive breastfeeding. Methods A scoping review using Arksey and O'Malley's framework explored the phenomenon of exclusive breastfeeding practice promotion. Searches were conducted using CINAHL Plus full-text, PubMed, APA PsycInfo and Academic Search Premier. Search terms included theory, philosophy, framework, model, exclusive breastfeeding, promotion, support, English, and publication between 2000 - 2020. Results The online search yielded 877 articles, however, only 40 met the inclusion criteria for the scoping review. The articles promoting exclusive breastfeeding used pragmatism (n=1) or phenomenology (n = 2) philosophies and theories of self-efficacy (n = 10), theory of planned behaviour (n = 10) and social cognitive theories (n = 17). Theories of self-efficacy and planned behaviour were the most effective theories that increased exclusive breastfeeding rates. Conclusions Theory-based exclusive breastfeeding promotion strategies are effective to increase the rates of exclusive breastfeeding. Theory of planned behaviour is better compared with theories of self-efficacy for program content development and implementation in Randomized Controlled Trial studies. Future breastfeeding interventions should be based on relevant philosophies and guided by theories of self-efficacy and planned behaviours.

Breastfeeding media coverage and beliefs during the COVID-19 pandemic in Mexico: implications for breastfeeding equity

Background Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19. Methods We conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults’ beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status. Results A total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status. Conclusions While the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Breastfeeding Promotion and Nursing Care for Infants with Cleft Palate and/or Cleft Lip in Northeastern Craniofacial Center, Thailand

Background: The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process. Objective: To evaluate the treatment and breastfeeding rate in infants with CP and CLP. Methods: A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected. Results: A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively. Conclusion: Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.

Perception and practice of early initiation of breastfeeding and associated factors among postnatal mothers in East Sikkim

Background: Breastfeeding is the most desirable method for achieving a normal growth and development of the child. Breastfeeding practice is multifactorial, and number of variables influence mothers’ decisions and ability to breastfeed. This study aimed to assess the perception and practice regarding early initiation of breastfeeding and factors associated with breastfeeding among hospitalized postnatal mothers in East Sikkim.Methods: The descriptive study was carried out among 80 postnatal mothers who delivered term healthy babies either through normal vaginal delivery (n=34) or lower segment caesarean section (n=38), selected through purposive sampling technique and were interviewed within six hours of postpartum. Data were collected over a period of one month through an interview schedule to get information on feeding practice, perception and the factors responsible for delayed breastfeeding. Data analysis was done using Statistical package for social sciences (SPSS) version 16. Chi square test was used to examine the factors associated with perception and practice of early initiation of breastfeeding (within one hour of birth).Results: The result shows that early initiation of breast feeding within one hour of birth was done by 36% of mothers after the delivery and few adopted prelacteal feeding (19%) where as 86% had positive perception towards it. The factors that mostly influenced early initiation of breastfeeding were planned pregnancy (100%) and support from family members during pregnancy and delivery (100%). There was a statistically significant association between mother’s educational status and information regarding early initiation of breastfeeding and influencing factors like breastfeeding education during antenatal period and guidance from the health professional (p<0.05).Conclusions: Early initiation of breastfeeding within one hour was found extremely low which is an alarming. The findings also suggest the need of breastfeeding promotion programs among the mothers who are less educated. Such breastfeeding promotion programmes could be implemented through network of community-based workers.

Breastfeeding Promotion in German Maternity Hospitals and Consecutive Rates of Exclusive Breastfeeding During the First 4 Months of Life – The Prospective SuSe II Study

Objectives The implementation of the “10 Step” programme of WHO/UNICEF for breastfeeding promotion (BFP) in maternity hospitals is considered as a key for long-term breastfeeding success of mothers worldwide. The objective of this work was to determine whether this expectation also holds true for Germany. Methods The nationwide SuSe II study (2017–19) is a combination of a cross-sectional survey in maternity hospitals and a prospective follow-up of mother-infant pairs (0.5, 2, 4, 6, 12 months postpartum (pp)) recruited in the participating hospitals. All German maternity hospitals were invited to complete an online questionnaire assessing BFP based on the 10 Steps. Mothers reported if they were breastfeeding and if the infant received any other fluid or food. Relevant factors for exclusive breastfeeding (EBF) during the first 4 months pp were determined in 5 multivariable models with variable selection through backward elimination according to the likelihood ratio. Results One hundred and three hospitals (15% out of 692) recruited 929 mothers (33% of eligible mothers) who had tried to breastfeed, with a compliance of about 90%. During hospital stay, 74% of mothers exclusively breastfed, 77% at discharge, 74% 2 weeks, 70% 2 months and 58% 4 months pp. Hospitals had implemented between 2 and 10 Steps (median 7). Until 4 months pp, the rate of EBF was higher, if mothers had given birth in hospitals with a high BFP (≥9 Steps) compared to medium (6–8 Steps) or low promotion (≤5 Steps). Even after adjusting for potential confounders, high BFP compared to medium and low promotion significantly increased the modeled odds of mothers for EBF during hospital stay (p = 0.000), at discharge (p = 0.005) and 2 months pp (p = 0.002). Maternal breastfeeding experience and absence of a pacifier significantly increased the modeled odds of mothers for EBF at all 5 time points pp. Conclusions Implementation of at least 9 of the 10 Steps for BFP in hospitals was related to mothers' breastfeeding success in the first 2 months. It is noteworthy that this association was found even at the high level of BFP in hospitals and the high initial breastfeeding rates in the SuSe II study. Funding Sources Funding: Federal Ministry of Food and Agriculture Client: German Society for Nutrition.

Breastfeeding Media Coverage and Beliefs During the COVID-19 Pandemic in Mexico: Implications for Breastfeeding Equity.

Background: Breastfeeding offers short- and long- term health benefits to mothers and children and constitutes a priority for public health. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are presumably contained in breastmilk of mothers with history of COVID-19 infection or vaccination. Direct breastfeeding is the preferred infant feeding option during the pandemic, but conflicting practices have been adopted, which could widen existing disparities in breastfeeding. This study aims to describe how was information about breastfeeding communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19.Methods: A retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements, was done. For the content analysis, both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities and threats for breastfeeding promotion were performed. Also, we incorporated a descriptive analysis from the July 2020 wave of the ENCOVID-19 survey, which included questions on beliefs about breastfeeding. This information was stratified by gender, age, and socioeconomic status.Results: 1014 publications on breastfeeding were identified in internet, newspapers, TV, and magazines. Most information was published during World Breastfeeding Week, celebrated in August. Based on the sentiment analysis, 57.2% of all information was classified as positive, and based on the SWOT analysis, most information was classified either as strengths or opportunities for breastfeeding promotion. However, the ENCOVID-19 data showed that 67.3% of people living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% stated that they simply didn’t know. These beliefs showed differences both by gender and by socioeconomic status.Conclusions: While the Mexican government endorsed the recommendations on breastfeeding during the COVID-19 pandemic, communication of those messages was sporadic, inconstant and unequal across types of media. Moreover, there were also negative messages for breastfeeding circulating on the media. There continues to be a widespread notion that mothers with COVID-19 should not breastfeed and, due to differences on beliefs by socioeconomic status, health inequities could be exacerbated.

Client-Centered Breastfeeding-Promotion Strategies: Q Methodology

Fewer Korean women are choosing the 6 months of exclusive breastfeeding that are recommended for obtaining its maximal benefits despite an increasing effort to promote breastfeeding. Successful breastfeeding education and counseling need to be segmentally designed on the basis of client characteristics. This study explored the perceptions of breastfeeding in pregnant and 6 month postpartum Korean women using the Q methodology, a useful research approach to examine personal perceptions, feelings, and values about a concept or phenomenon of interest and identify typologies of perspectives. The Q sample consisted of 38 statements representing the universe of viewpoints on breastfeeding. The P sample (N = 49) included women who shared their perceptions of breastfeeding and filled each grid with a statement in the Q sorting table. Data were analyzed using the PC-QUANL program. Varimax (orthogonal) rotation revealed four factors that explained 53.0% of variance: maternal privilege (Factor 1), option based on emotion (Factor 2), option if efficient (Factor 3), and option if I have sufficient problem-solving skills (Factor 4). Korean women have changed their attitudes toward breastfeeding, with all participants viewing breastfeeding as optional. Breastfeeding-promotion campaigns and education need to consider societal norms and changes in women’s beliefs and perceptions.

An Intervention to Promote Breastfeeding

This article summarizes the study that aimed to demonstrate the impact of the Baby-Friendly Hospital Initiative on breastfeeding duration and infant health. As it is not possible to randomize mothers to breastfeeding or formula feeding, the study randomized hospitals and their associated clinics to a breastfeeding promotion intervention or no intervention and followed the infants of breastfeeding mothers for1 year. The primary outcome was the rate of infant infections. The article reviews the most important components of the study, its strengths and weaknesses, and the implications for practice and presents a related clinical case at the end.