International Breastfeeding Journal最新文献

Background: Lactation Consultants (LC) at Health Sciences Centre (HSC) and St Boniface General Hospitals (SBGH) supported the lactation of 2/3 of Manitoba newborns since 1994. The LC program in HSC was discontinued in 2018. Its impact on infant feeding in the province remains unclear.

Methods: To assess the influence of the LC program cessation on the feeding of newborns in postpartum wards via a retrospective administrative database cohort.

Results: A total of 126,285 infants were delivered in all Manitoban hospitals during 2014-2021 [First Nations (FN): 21%, all others: 79%, urban: 55%, rural: 41% and remote: 4%]. The rates of breastfeeding were lower and formula feeding were higher in FN and all other newborns after the program cessation (2018-2021) compared to that during 2014-2017 (p < 0.01). The intensity of the changes in infant feeding among FN or remote-living newborns during 2018-2021 were 2-threefold greater than that among all others or urban/rural-living newborns delivered in HSC (p < 0.01). In contrast, infant feeding status stayed stable for those delivered at SBGH where the LC program did not withdraw. The cessation of LC program decreased adjusted odds ratio (aOR) for exclusive breastfeeding in FN infants (aOR 0.93, 95% CI: 0.88-0.98) and urban-living infants (aOR 0.96, 95% CI: 0.94-0.98), but not in all others, rural- or remote-living infants. Increased odds for formula feeding was detected in FN and all other infants living in various regions in the province during 2018-2021 compared to that during 2014-2017 (p < 0.05).

Conclusion: The findings suggest that the discontinuation of LC program decreased breastfeeding and increased formula feeding, and the unfavorable changes in infant feeding was most profound among FN and remote-living infants.

Background: Breastfeeding counseling is a proven strategy to protect and promote breastfeeding, as evidenced by numerous studies. However, there is limited research on its application during the dyad's stay in rooming-in and its impact on the duration of exclusive breastfeeding. This study aims to evaluate the effectiveness of individualized counseling during the dyad's rooming-in period and its role in maintaining exclusive breastfeeding until the sixth month of life, compared to standard care.

Methods: This randomized, multicenter, parallel, and open clinical trial was conducted at two Brazilian university hospitals. A total of 102 primiparous women, who had conditions and intentions favorable to breastfeeding, were enrolled between December 2023 and April 2024. Following hospital discharge, participants were followed up via telephone until the child reached six months of age, with the study concluding in October 2024. Participants were randomly assigned to one of two groups. The intervention group received two to four breastfeeding counseling sessions during their hospital stay, while the control group received standard institutional care. Both groups were provided with educational materials on the benefits of breastfeeding and information on where to seek help if complications arose. During the telephone follow-ups, outcomes were measured without any additional interventions. The primary outcome measured was the exclusive breastfeeding rate since birth to the sixth month.

Results: A total of 97 breastfeeding women completed the follow-up, forming the sample for analysis. Compared to the control group, women who received counseling were more likely to maintain exclusive breastfeeding at the fourth month (27/48 (56.2%) vs. 15/50 (30.0%), Prevalence Ratio = 1.88 (Confidence Interval 95% 1.15, 3.07) and the sixth month of the child's life (27/47 (57.4%) vs. 12/50 (24.0%), Prevalence Ratio = 2.40 (Confidence Interval 95% 1.38, 4.16).

Conclusion: Breastfeeding counseling during the dyad's stay in rooming-in was effective in maintaining exclusive breastfeeding until the child's sixth month of life.

Trial registration: UTN: U1111-1284-3559 / RBR-4w9v5rq (2023-03-20).

Background: Exclusive (EBF) and continued breastfeeding (CBF) as defined by the World Health Organization are the optimal feeding practices. Perinatal Mental Health Conditions (PMHCs) such as anxiety and depression may influence breastfeeding practices. We aimed to examine if maternal postpartum anxiety and depression symptoms, individually and combined (comorbid), influence EBF and CBF practices.

Methods: A cross-sectional survey was conducted between November 2022 and March 2023 with 326 mothers of children 0-23 months old, all residing in Clark County, Nevada, USA. Descriptive, bivariate, and multivariable logistic regression analyses were conducted to examine the association between self-reported postpartum anxiety and depression symptoms and EBF and CBF in the 24 h prior to the survey.

Results: The prevalence of EBF among infants under 6 months old and CBF among children 6-23 months old was 36.3% (n = 41) and 52.1% (n = 111), respectively. After adjusting for maternal socio-demographic, perinatal, and infant/child characteristics, decreased odds of EBF were associated with the presence of postpartum depressive symptoms (AOR 0.13; 95% CI 0.03,0.55) and the comorbid presence of postpartum anxiety and depression symptoms (AOR 0.16; 95% CI 0.04,0.66). Similarly, decreased odds of CBF were associated with the presence of postpartum anxiety symptoms (AOR 0.36; 95% CI 0.16,0.82).

Conclusion: Postpartum anxiety and depression symptoms decreased the odds of breastfeeding practices among mothers of children under two years old in Clark County, Nevada. However, the relationship may be bidirectional or inverse, requiring further research to clarify. Culturally appropriate interventions to reduce postpartum anxiety and depression are essential to improve breastfeeding practices.

Background: Despite the health benefits of breastfeeding only 57% of infants were exclusively breastfed at 4 months postpartum in Germany in 2017-2019. Due to the gap between the actual exclusive breastfeeding (EBF) rates and recommendations, we aimed at investigating further factors influencing breastfeeding duration.

Methods: This prospective observational study conducted in Berlin, Germany from 11/2022-05/2024 implemented a mixed-methods design with concurrent triangulation. We present quantitative results here. First-time mothers were surveyed at birth and 2, 6 and 12 months postpartum. Breastfeeding status was assessed by asking "How are you currently feeding your child?" and, if anything other than EBF (defined as supply of breastmilk without liquids or solids) was indicated, "I breastfed exclusively until [date]". Maternal perception was assessed by asking "How comfortable do you currently feel with breastfeeding/feeding your child?", with comfort referring to well-being/statisfaction/feeling good (German = wohlfühlen). Obstetric and newborn characteristics were collected from recruiting hospital's health records: an anthroposophic baby-friendly certified hospital (a-BF), a baby-friendly certified hospital (BF) and a university hospital not certified as baby-friendly (non-BF). Data were analysed descriptively and through multivariate analysis.

Results: Most of the 326 participating mothers had initiated breastfeeding in the delivery room (94.7%). Mothers reported EBF for a median duration of 5.7 months, with 76.6% achieving ≥ 4 months. High levels of maternal comfort with breastfeeding 2 months postpartum were significantly associated with an EBF duration ≥ 4 months (aOR 7.25, CI 95% 2.11, 24.9). An intended EBF duration of 4-7 months (aOR 4.08, CI 95% 0.29, 57.77), higher breastfeeding comfort shortly after birth (aOR 1.79, CI 95% 0.49, 6.59), delivery in the a-BF clinic (aOR 1.59, CI 95% 0.41, 6.14) and high satisfaction regarding breastfeeding support in the hospital (aOR 1.39, CI 95% 0.41, 4.70) increased likeliness of EBF ≥ 4 months.

Conclusion: Our results emphasize the pivotal role of the mother's comfort in the breastfeeding process and it's impact on breastfeeding duration. Strategies to enhace maternal comfort therefore need to be specifically included in maternal care. To explore key aspects of maternal comfort qualitative interviews will address the individual experiences in the breastfeeding journey and identify parent-centred strategies for sustainable breastfeeding.

Background: Breastfeeding is recommended for optimal infant outcomes. Breastfeeding rates are thought to be suboptimal, but actual rates are not known in the United Arab Emirates (UAE). While there have been various studies about breastfeeding, there is no systematic review or meta-analysis in the UAE which has synthesized available evidence about breastfeeding rates and practices. The primary objectives of this study were to estimate breastfeeding rates, identify factors influencing breastfeeding, and explore breastfeeding practices among women in the United Arab Emirates (UAE).

Methods: A systematic review and meta-analysis of relevant published peer-reviewed literature in six relevant electronic databases from 2013 to 1 August 2023. When statistical pooling was not possible, results were synthesized narratively.

Results: Twelve studies were included. Pooled data from five studies (n = 2009) indicated that 62% of women initiated breastfeeding within the first hour after birth (95% CI 0.45, 0.78; I² 98.3%). At three months, pooled data from three studies (n = 851) showed that 73% of these women were breastfeeding (95% CI 0.42, 0.96; I² 98.7%). At six months, the rate of exclusive breastfeeding, based on pooled data from three studies (n = 1121), was 29.5% (95% CI 0.14, 0.477, I² 97.5%). Significant heterogeneity was observed, suggesting that the results should be interpreted with caution. Three key themes emerged from the analysis of 12 studies: (1) balancing supportive factors with traditional practices, (2) the role of health service provision in breastfeeding, and (3) the influence of socioeconomic factors.

Conclusion: This review highlights the importance of integrating cultural competence into healthcare strategies to better support breastfeeding mothers. Additionally, a national infant feeding survey is recommended to address the existing knowledge gaps in the UAE.

Background: Including fathers as breastfeeding facilitators and providing qualified breastfeeding counselling from healthcare professionals are key factors that increase breastfeeding outcomes. It is essential to explore how healthcare professionals can effectively support fathers in navigating their roles and addressing the challenges they encounter to promote breastfeeding. We aimed to explore fathers' experiences of being in a breastfeeding family with a particular focus on their interactions with midwives and public health nurses during breastfeeding counselling. The purpose was to gain deeper insights into the phenomenon of breastfeeding counselling from the father's perspective to develop knowledge that can better help fathers support breastfeeding mothers.

Methods: A qualitative content analysis with a phenomenological hermeneutic approach was employed using individual interviews with ten fathers in Norway between January and October 2022. The study adhered to the COREQ Checklist for reporting.

Results: The meaning of fathers` experiences of being in a breastfeeding family and receiving breastfeeding counselling was formulated into three interrelated themes: being a caregiver and breastfeeding facilitator, meaning to be prepared for the father's role and supporting mother and child; being part of a breastfeeding family which means being included or excluded in breastfeeding counselling, desire to nurture parent-child bonds and develop resilience as a couple. Managing everyday life means making their own decisions, and competent breastfeeding counsellors provide security and trust, while inadequate counselling leaves fathers feeling trapped in a chaotic situation.

Conclusions: To enable fathers to fulfil their roles as caregivers and breastfeeding facilitators, healthcare professionals should actively encourage their participation and involvement in breastfeeding counselling and discussions regarding breastfeeding. Additionally, to help fathers navigate daily life confidently, healthcare professionals must offer qualified breastfeeding counselling, be aware of their needs and provide appropriate support. Empowering fathers to support breastfeeding may contribute to promoting breastfeeding, closer relationships and better health for the family.

Background: Sales of commercial milk formula products (CMF) are rising rapidly. This study analysed key economic and environmental impacts CMF feeding in Indonesia, which are often overlooked in policy discussions despite their relevance.

Methods: We assessed the economic and environmental impacts of CMF in Indonesia in 2020 using the Mothers' Milk Tool (MMT), the Green Feeding Tool (GFT) and the Cost of Not Breastfeeding Tool (CONBF). We compared the estimated values from these tools with calculations based on Euromonitor data on CMF retail sales in Indonesia.

Results: In 2020, according to the MMT, women in Indonesia produced around 455 million litres of breastmilk for infants aged < 6 months, which had an estimated monetary value of US$45.5 billion. The MMT and GFT shows substantial economic losses from displacement of breastfeeding in Indonesia; 62-96 million litres of breastmilk were lost in 2020 compared to the biologically feasible potential. The GFT tool calculates a carbon footprint of 215-274 million kg of CO₂ eq. and a water footprint of 93,037 million litres. The CONBF estimates that the annual cost to families of purchasing CMF for infants aged < 24 months was US$598.6 million. By comparison, Euromonitor retail sales data suggests that in 2020, the retail value of sales of CMF products targeting the age group 0-36 months was around US$2.25 billion. Euromonitor also reports 27,200 tonnes of CMF products targeting infants < 6 months were sold in Indonesia in 2020. We calculate a carbon footprint from these sales of 299-381 million kg CO2 eq. and a water footprint of 129,064 million litres, higher than the GFT estimate.

Conclusions: Breastfeeding's economic importance to Indonesia far exceeds the retail value of CMF sales. Displacing breastfeeding carries high but largely undocumented economic and environmental costs. Losses are greater when measured as a food resource than as health costs, lost lives, or cognitive decline. Environmental impacts based on sales data are higher than those from survey data. Our findings and the discrepancies between tools reveal a critical gap in national statistics and highlight the need to recognise breast milk as an economically valuable, healthy, and sustainable national resource in Indonesia.

Background: Exclusive breastfeeding is a crucial public health intervention with significant benefits for infants and maternal health. In Sierra Leone, despite national efforts to promote exclusive breastfeeding, prevalence remains suboptimal. Understanding the factors influencing exclusive breastfeeding practices among children aged 0-5 months is essential for developing effective interventions to increase exclusive breastfeeding rates. This study examined the sociodemographic, and healthcare-related factors associated with exclusive breastfeeding in Sierra Leone.

Methods: Data from the 2019 Sierra Leone Demographic and Health Survey was used for the study. A mixed-effect multilevel binary logistic regression models was fitted to examine the factors associated with exclusive breastfeeding in Sierra Leone. The results were presented as adjusted odds ratios (aOR) with a 95% confidence interval (CI) and intra-cluster correlation coefficients.

Results: The prevalence of exclusive breastfeeding among children aged 0-5 months was 54.1% (95% CI 50.2, 57.9) in Sierra Leone. Children aged 2-3 months (aOR 0.30; 95% CI: 0.20, 0.45) and 4-5 months (aOR 0.08; 95% CI: 0.05, 0.13) had lower odds of exclusive breastfeeding than those aged 0-1 months. Children of mothers with a history of skilled birth attendance (aOR 0.55; 95% CI: 0.32, 0.96) had lower odds of exclusive breastfeeding than those without skilled birth attendance. Children of mothers in rural areas (aOR 1.62; 95% CI: 1.03, 2.55) had higher odds for exclusive breastfeeding than those in urban areas.

Conclusion: The findings suggest a need for targeted interventions to improve exclusive breastfeeding rates, particularly for infants aged 2-5 months, where the odds are significantly lower. There is also a critical need to enhance postnatal care and education for mothers, especially those with skilled birth attendance, to ensure they receive adequate support for breastfeeding practices. Furthermore, leveraging the strengths observed in rural areas could inform community-based strategies that promote exclusive breastfeeding, highlighting the importance of culturally sensitive approaches that address the unique challenges faced by urban mothers.

Background: Saudi Arabia hosts more than 150 charitable institutions dedicated to vulnerable groups, such as orphan care associations that provide orphaned children with food, clothing, housing, and other care until they reach adulthood. The Al-Wedad Society for Orphan Care (ASOC) in Saudi Arabi operates a wet nursing program in which Saudi mothers breastfeed orphans in their care under specific conditions and circumstances. The program is intended to not only help the orphans survive and receive the psychological and nutritional benefits of breastfeeding but also establish kinship between the child and the members of the family providing the wet nursing and so support children's emotional wellbeing and belonging.

Methods: The ASOC wet nursing program was explored using two methods: content analysis of existing sources, such as documents and archival records, and in-depth interviews with ASOC full-time administrations and professional practitioners (n = 9). Data collection took approximately five months (January 2022 to May 2022).

Results: The study reveals the positive values of wet-nursing as beneficial for both orphans and volunteer wet nurses. The results illustrate that the wet-nursing program has undertaken steps to ensure health and safety requirements of participants. The program elaborates many positives. First, after completing the breastfeeding program, the child becomes a relative of the whole family not only breastfed mother. Second, the breastfeeding could be a solution for many abandoned children dealing with a loss of identity as it gives them a sense of belonging to a family and community. Third, the child feels more secure and confident to interact normally with family members of the opposite sex especially upon reaching adolescence. They can communicate freely with fellow family members with fewer constraints, a greater sense of belonging, and less stigmatization than would otherwise be the case.

Conclusion: This ASOC wet nursing program has been successful in supporting the breastfeeding and legal belonging via milk kinship of children in alternative care families but challenges remain. More research is needed on the impact of programs such as the ASOC wet nursing program on children, alternative caregiving families and societies.