Frequency and Determinants of Breastfeeding in Greece: A Prospective Cohort Study during the COVID-19 Pandemic

Breastfeeding is considered to be the cornerstone of child health. In Europe however, overall breastfeeding rates remain low. The present study aimed at estimating the frequency of breastfeeding in Greece during the COVID-19 pandemic period and comparing findings with the latest national study in order to identify a potential impact of the pandemic. Additionally, possible correlations of socio-cultural and demographic characteristics with breastfeeding indicators were investigated. This prospective cohort study included 847 women from five tertiary maternity hospitals, between January and December 2020. Data were collected by a structured questionnaire via interview during hospitalization and via telephone in the first, third and sixth month postpartum. Results showed that all breastfeeding indicators improved over the last three years. Full breastfeeding reached 7.2%, contrary to 0.78% of the latest national study at six months postpartum. Employment, marital status, educational level, mode of delivery, type of maternity hospital, body mass index before pregnancy, previous breastfeeding experience of the mother and infant’s birth weight correlated significantly with breastfeeding indicators at different time periods. The COVID-19 pandemic seems to have favorably influenced breastfeeding initiation and duration in Greece due to lockdowns, home confinement and teleworking.

Effects of the Experience of Breastfeeding-Friendly Practices and Breastfeeding Intention and Self-Efficacy on Breastfeeding Behavior: A Cohort Study in Taiwan

Background: Approximately 80% of births occurred in Baby-Friendly-accredited facilities in Taiwan, although the trend of exclusively breastfeeding infants until 6 months of age has stagnated in the last 10 years. To guide breastfeeding promotion interventions during postnatal stays and encourage mothers to continue breastfeeding for the first 6 months, the factors of breastfeeding behavior within 6 months post-delivery must be investigated. This study explored the relationships among breastfeeding intention, experience of breastfeeding-friendly practices, breastfeeding self-efficacy, and breastfeeding behavior at 4 and 6 months after childbirth.Methods: In this longitudinal cohort study, women who gave birth to healthy newborns at two Baby-Friendly hospitals in Taiwan and who were willing to breastfeed were recruited. Data were collected through a self-developed questionnaire measuring the experience of breastfeeding-friendly practices and through the Chinese version of the Breastfeeding Self-Efficacy Scale-Short Form during hospitalization and at 1, 2, 4, and 6 months after childbirth.Results: A total of 155 women completed the questionnaires 5 times within 6 months. The determinants of exclusive breastfeeding at 4 months and any breastfeeding at 6 months were longstanding breastfeeding intention during hospitalization, a high score for the experience of breastfeeding-friendly practices, and a high level of breastfeeding self-efficacy during that period. The in-hospital experience of breastfeeding-friendly practices did not predict breastfeeding behavior at 4 and 6 months. Breastfeeding intention (hazard ratio [HR] = 0.40–0.14) and in-hospital breastfeeding self-efficacy (HR = 0.98) were significant as in-hospital risk factors contributing to breastfeeding duration 6 months after childbirth.Conclusions: Longstanding breastfeeding intention, continuation of the experience of breastfeeding-friendly practices, and maintenance of a high level of breastfeeding self-efficacy were the determinants of breastfeeding at 4 and 6 months. Healthcare professionals in Taiwan must support breastfeeding-friendly practices and consider interactive interventions to promote continued breastfeeding at different stages during the first 6 months after childbirth based on the mother’s informed plan of breastfeeding and breastfeeding self-efficacy during their postnatal hospitalization.

Determinants of breastfeeding practice in Pujehun district, southern Sierra Leone: a mixed-method study

Background It is well established that exclusive breastfeeding can play a critical role in reducing child morbidity and mortality. Limited research has been done thus far on the practice and perceptions of breastfeeding in Sierra Leone, where more than 10 % of children die before the age of five. This study aimed to gain understanding into and explore both matters in order to develop recommendations for effective strategies to promote breastfeeding practice in Pujehun District, Southern Sierra Leone. Methods This exploratory mixed-method study included a cross-sectional survey of 194 mothers, semi-structured interviews and focus group discussions. Logistic regression analysis was used calculated odds ratios of factors associated with primarily breastfeeding practice, defined as ‘Children under six months of age who are fed with breast milk only and children older than six months of age that were exclusively breastfed up to six months’, based on recall from birth. Exclusive breastfeeding rate was based on breastfeeding practice 24 h prior to the survey. Qualitative data was analysed through a deductive approach, using a pre-determined framework on determinants of breastfeeding. Results This study revealed an exclusive breastfeeding rate of 62.8% (95% CI 53.9, 71.7); dropping from 74% in the 0–1-month age group to 33% in the 4–5 months group. Triangulation of qualitative and quantitative data revealed enabling factors for primarily breastfeeding practice included mothers receiving support during their first breastfeed, pregnant women being provided with information on the benefits of the practice, counselling by nurses, support from husbands, and women’s awareness of how their friends and family members fed their own babies. The main barriers were a lack of encouragement by husbands, women’s perception that their infants’ stools were abnormal or that they were not producing enough breast milk. Conclusions Although the exclusive breastfeeding may have risen over recent years, a gap remains compared to World Health Organization recommendations. According to the breastfeeding determinants identified in this study, promotion of counselling by a nurse, encouragement of husbands’ support, and improve knowledge of mothers on breastfeeding are recommended to be incorporated in the design of future health programs.

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.

Determinants of Breastfeeding Among Mexican Women with Higher Education Working in a Private University

Objectives To examine breastfeeding practices and to identify determinants of breastfeeding duration among Mexican women with high levels of education working in a university. We hypothesized that having a C-section delivery, giving birth at a private hospital, receiving free infant formula at the hospital and/or supplementing breastmilk with other liquids soon after giving birth would be negatively associated with breastfeeding duration. Methods Retrospective, cross-sectional study on mothers 18–50 years of age who worked at a private university in Mexico City (N = 150). We performed descriptive analyses and ran linear regression models to identify determinants of any and exclusive breastfeeding duration for the women's youngest offspring. Results Mean breastfeeding duration was 7.6 months and the mean exclusive breastfeeding duration was 1.81 months. Nearly 60% of the women in the sample had a C-section; almost 70% gave birth at private hospitals; 50% reported to have fed their baby with liquids other than breastmilk within the first three days of their baby´s life; and almost 25% of the women were offered free infant formula at the hospital where their child was born. Findings from the regression models that controlled for sociodemographic characteristics suggest that giving birth at a private vs. a public hospital was significantly associated with 1 month less of exclusive breastfeeding (95% CI: −2.11, 0.10, P < 0.1). Similarly, being offered free infant formula at the hospital was marginally associated with 1.59 months less of exclusive breastfeeding (95% CI: −3.2, 0.02, P < 0.1). Conclusions Breastfeeding outcomes among this group of women are suboptimal. Our findings underscore the need to improve breastfeeding protection, promotion and support in maternity hospitals through adherence to the Ten Steps promoted by the Baby Friendly Hospital Initiative. Funding Sources Universidad Iberoamericana.

Determinants of breastfeeding practices in Ecuador: implications for localized applications of breastfeeding promotion and policies

Background Best practices in breastfeeding are often not followed in spite of appropriate levels of knowledge and positive attitudes regarding the many benefits of human milk. For a variety of reasons, particular, women do not initiate breastfeeding, suspend breastfeeding early, or initiate complementary feeding earlier than recommended. This paper analyzes breastfeeding patterns in three settings in Ecuador: a suburban parish near Quito, the nation’s capital, urban and rural parts of a province in the Amazonian lowlands, and the province of Galapagos. Methods We analyse data produced by surveys conducted in the three locations, each of which included mothers of infants between 0 and 24 months of age. The surveys collected demographic information and data based on breastfeeding indicators established by WHO. Results Significant differences were found in breastfeeding practices, particularly between the suburban parish near Quito and Galapagos, on one hand, and urban and rural parts of the Amazonian province, on the other. Conclusions Differences among population segments reflect specific opportunities and barriers to practices related to promoting optimal infant health and nutrition. Consequently, regional or local conditions that often are not apparent in national-level data should orient policies and promotion activities in specific populations.