International Breastfeeding Journal最新文献

Background: Context-specific breastfeeding research has significantly improved infant health outcomes in many low-resource settings. Afghanistan, which has one of the world's highest under-five mortality rates, similarly stands to gain from evidence-based infant and young child feeding (IYCF) interventions. Optimal breastfeeding practices - early initiation, exclusive breastfeeding, and continued breastfeeding - are proven to reduce child mortality and improve child health. Yet Afghanistan lacks robust data on breastfeeding behaviors and determinants; decades of conflict and limited research capacity have left critical evidence gaps, hindering the development of effective, tailored IYCF policies and programs.

Breastfeeding research gaps and priorities in afghanistan: To address these gaps, this commentary presents a theory of change framework that links identified research needs to feasible studies, trackable indicators, and policy impact. The theory of change outlines key assumptions and risk mitigation strategies to guide a sequenced, policy-relevant research program. Based on the identified gaps, six priority research areas are highlighted: (1) assessing mothers' IYCF knowledge and communication channels to inform education campaigns; (2) exploring cultural and religious influences on feeding practices (e.g., rationales for prelacteal feeding); (3) evaluating and adapting proven breastfeeding support interventions (peer support groups, mobile health) for the Afghan context; (4) investigating emerging challenges to optimal breastfeeding (formula marketing, bottle-feeding trends, workplace barriers); (5) strengthening health system and community support for breastfeeding (enhancing healthcare provider training, counseling services, and enforcement of maternity protection policies); and (6) piloting the feasibility of donor human milk banking in select provinces. Collectively, these studies should aim to generate actionable evidence and measurable outcomes to drive improvements in breastfeeding policy and practice.

Conclusion: Achieving this research agenda will require investment in local research capacity and strong political commitment. Key recommendations include establishing a multi-stakeholder Breastfeeding Research Working Group under the Ministry of Public Health (MoPH), securing dedicated funding for breastfeeding research in national health programs, and fostering cross-sector partnerships to ensure that new evidence is translated into policy and practice. By aligning research efforts with national priorities, Afghanistan can harness breastfeeding's lifesaving benefits to improve child survival and well-being.

Background: Exclusive breastfeeding is essential for optimal infant nutrition and health, yet many mothers experience concerns about insufficient milk supply. This study investigated the effects of a ginger-spiced millet-soya drink (Zim-So drink), selected for its rich content of phytoestrogens and cultural use as a galactagogue and breastfeeding education on breast milk volumes and prolactin levels to enhance breastfeeding experiences among postpartum mothers in Tamale, Northern Ghana.

Method: A randomized-controlled intervention study was conducted, with 75 participants randomly assigned to three groups: Zim-So drink (n = 25), breastfeeding education (n = 25), or control (n = 25). The sample size was determined using G-Power to detect a moderate-to-large effect (Cohen's d = 0.8) with 80% power and α = 0.05. Blinding was not feasible due to the type of intervention, but standardized procedures minimized observer bias. Breast milk volume was measured using a manual breast pump and standardized logging; serum prolactin levels were assessed using ELISA at baseline, Day 7, and Day 14. Statistical analysis was conducted using Analysis of Variance (ANOVA) followed by Tukey's post hoc test to determine significant differences among samples.

Results: The study found no significant baseline differences among groups, confirming their comparability. By Day 7 and Day 14, both the Zim-So drink and breastfeeding education groups showed significant improvements in breast milk volume and prolactin levels compared to the control. The Zim-So drink group demonstrated the largest effect size, with mean breast milk volume increasing by 24.9 mL (95% CI, 22.1-27.7) and prolactin levels by 25.0 ng/mL (95% CI, 22.0-28.0) at Day 14 compared to the control (p < 0.001), indicating a stronger and sustained impact on lactation outcomes.

Conclusion: This study highlights the importance of dietary and educational interventions in enhancing lactation. The Zim-So drink, formulated with culturally familiar and bioactive-rich ingredients, emerges as an effective, acceptable, and affordable galactagogue for breastfeeding mothers. These findings indicate that integrating traditional dietary supplementation with structured breastfeeding education within maternal healthcare systems offers a practical and cost-effective approach to enhancing breastfeeding outcomes, particularly in resource-limited settings.

Background: Breast milk is widely recognized as the optimal source of infant nutrition, with the World Health Organization recommending exclusive breastfeeding for the first six months. However, breastfeeding rates remain suboptimal worldwide and in Taiwan. The six-month exclusive breastfeeding rate in Taiwan, defined as the percentage of infants aged six months who received only breast milk and no other foods or liquids in the previous 24 h, declined from 46.2% in 2018 to 37.9% in 2020. One barrier to continued breastfeeding is the discomfort or hesitation some mothers feel when breastfeeding in public. While qualitative research has indicated that conservative values may inhibit public breastfeeding, few quantitative studies have examined the simultaneous influence of traditionality and modernity. This study investigates how traditionality and modernity affect public breastfeeding behavior in Taiwan, using the Theory of Planned Behavior (TPB) as a framework.

Methods: A cross-sectional online survey was conducted from 4 to 15 March 2024, recruiting 358 Taiwanese mothers with prior breastfeeding experience via social media. Validated instruments measured traditionality, modernity, TPB constructs (attitudes, subjective norms, perceived behavioral control, and intention), and frequency of public breastfeeding. Data were analyzed using descriptive statistics, bivariate correlations, and structural equation modeling.

Results: Traditionality was negatively associated with attitudes (β = -0.30), perceived control (β = -0.11), intention (β = -0.14), and public breastfeeding behavior (β = -0.14). Modernity indirectly promoted public breastfeeding through positive links with attitudes (β = 0.12), subjective norms (β = 0.23), and perceived control (β = 0.26). Intention strongly predicted behavior (β = 0.60). The model explained 42% of the variance (CFI = 0.99, SRMR = 0.05).

Conclusions: The study confirms that traditionality may hinder public breastfeeding, while modernity enhances it by shaping attitudes, norms, and control beliefs. These findings have important implications for public health policy and practice. Since traditionality and modernity influence behavior through distinct psychological pathways, interventions should be culturally tailored. For mothers with high traditionality, mobilizing family and community support may reinforce positive norms. For those with strong modern values, strategies should focus on autonomy, self-efficacy, and informed decision-making to support breastfeeding in public spaces.

Background: Early initiation of breastfeeding, defined as breastfeeding within one hour of birth, is a critical indicator of optimal infant feeding practices with substantial health benefits for mothers and infants. Early initiation of breastfeeding rates in Thailand has declined over the past decade, necessitating an investigation into the underlying determinants. Therefore, this study aimed to identify trends in early initiation of breastfeeding prevalence and examine associated factors using national survey data from Thailand.

Methods: This study analysed secondary data from four rounds of the Thailand Multiple Indicator Cluster Survey (MICS4-7), conducted in 2012 (MICS4), 2015-2015 (MICS5), 2019 (MICS6), and 2022 (MICS7), including 13,063 mothers of children under 6 months. Logistic regression analysis was used to evaluate the association between geographic, socioeconomic, and maternal factors with early initiation of breastfeeding. Statistical significance was determined at 95% confidence and p-value < 0.05, and all analysis was conducted using STATA 17.

Results: Early initiation of breastfeeding prevalence declined from 54.9% in 2012 to 43.1% in 2022. Vaginal delivery increased adjusted odds by 2.1 times (95%CI 1.59, 2.85) while non-skin-to-skin contact reduced early initiation of breastfeeding likelihood by 57% (AOR 0.43, 95%CI 0.33, 0.57). Geographic disparities emerged, with almost all regions showing higher early initiation of breastfeeding rates than Bangkok: North (AOR 2.65, 95%CI 1.49, 4.72), Northeast (AOR 2.55, 95%CI 1.49, 4.35), and South (AOR 3.26, 95%CI 1.92, 5.52). Socioeconomic status and urban or rural residence showed inconsistent associations across survey rounds.

Conclusions: Early initiation of breastfeeding prevalence in Thailand remains low and is off track to meet the 2030 global target of 70%. Interventions to promote vaginal delivery and ensure immediate skin-to-skin contact in all births are critical. Regional variations highlight the importance of culturally tailored strategies to support breastfeeding practices. These findings provide critical evidence for policy development to improve maternal and child health outcomes in Thailand.

Objective: This study aimed to compare the characteristics and experiences of women with measured low and normal 24 h milk production.

Methods: We analysed data from a nested case-control study of 136 participants who measured their 24 h milk production within 1-6 months of birth and completed an online survey of lactation risk factors and experiences within 2 years of birth. The study was conducted between January 2020 and March 2024. 24 h milk production, calculated as the sum of all pre-post breastfeed and expression weights, was classified as low (< 600 mL) or normal milk production (≥ 600 mL). The prevalence of anatomical, endocrine/metabolic, pregnancy, birth complications and postpartum lactation risk factors was reported. Further, the experiences of participants that reported low milk production were described.

Results: Low milk production was measured in 39 out of 136 participants (29%). Breast hypoplasia was more prevalent in this group (low milk production 13%; normal milk production 3%; p = 0.03). Of those with measured low milk production 21% perceived production was normal. In participants with measured normal production 28% had perceived low production. Formula use was more common among those with low milk production, and their infants had significantly lower weight-for-age z-scores despite similar birth weights. Qualitative data reflected the stress and effort expended in trying to increase milk production, and 10/26 (39%) rated lactation consultant support as most helpful in managing their milk production.

Conclusions: Low milk production is a multifactorial and common concern, affecting nearly one in three breastfeeding women. While some contributing risk factors such as breast hypoplasia were identified, over half of the affected participants had not received an explanation from their healthcare provider. This underscores that low milk production is not always fully explainable or treatable, and highlights the need for personalized supportand further research to improve clinical assessment and effective management.

Background: A comprehensive understanding of women lived experiences is crucial for developing effective strategies to support breastfeeding at both individual and systemic levels. In this context, this study aimed to explore the social representations of breastfeeding among Uruguayan mothers and grandmothers through a structural approach.

Methods: A total of 154 women, 77 mothers and 77 grandmothers, biologically related, were recruited from eight public health centers in Montevideo, Uruguay, between June and August 2022. Participants completed a free word association task using the stimuli "breastfeeding" and "exclusive breastfeeding." Interviews were conducted by trained researchers via telephone, and participants were asked to provide 3-5 associations per term. Responses were analyzed using structural analysis with openEvoc software to identify core and peripheral elements of the social representations.

Results: "Love" emerged as the central element in the social representations of both breastfeeding and exclusive breastfeeding for mothers and grandmothers, highlighting the emotional and symbolic importance of breastfeeding across generations. Among mothers, representations were emotionally rich and experientially grounded, with frequent references to "baby," "affection," "attachment," and health-related benefits. Mothers also acknowledged challenges such as "pain" and "tiredness." In contrast, grandmothers' representations were more heterogeneous and less detailed, especially for exclusive breastfeeding, which lacked a clear structure. Grandmothers frequently used normative or moral terms such as "correct," "essential," and "nutrition," and showed limited familiarity with exclusive breastfeeding as a defined concept. Health-related benefits were present in peripheral areas for both groups, while references to the mother's well-being were largely absent.

Conclusions: The findings highlight intergenerational continuity in the emotional anchoring of breastfeeding but reveal differences in knowledge and cognitive engagement, particularly concerning exclusive breastfeeding. While mothers integrate biomedical and experiential dimensions, grandmothers rely more on traditional values. These results underscore the need for generationally tailored communication strategies that acknowledge emotional and practical experiences and actively involve grandmothers in breastfeeding promotion efforts to strengthen intergenerational support for optimal breastfeeding practices.

Background: Global uptake of the Baby Friendly Hospital Initiative (BFHI) and Ten Steps to Successful Breastfeeding (Ten Steps) is low, and sustainability is a challenge. Although both programs are backed by strong evidence and international endorsement, their integration into national health systems has been inconsistent and often lacks institutional prioritization. This study aimed to analyze challenges to implementation of the BFHI and Ten Steps programs in Australia and Indonesia.

Methods: We used the Non-adoption, Scale-up, Spread and Sustainability (NASSS) framework and categorized the relative complexity of implementing the program into each setting.

Results: Most BFHI/Ten Steps implementation domains were categorized as complicated or complex, and the policy level, organizational and community settings for the intervention overlapped for most domains. Despite the cultural and health systems differences between Australia and Indonesia, both environments present challenges and also unique opportunities for the uptake and scale up of BFHI/Ten Steps with the right support and adaptation. Importantly, the complexity was not only technical but also institutional, with implementation often relying on individual champions rather than systemic support.

Conclusions: Systems that require and motivate compliance to the WHO Code (Step 1) and optimize healthcare professionals' (HCP) lactation support capacity (Step 2) are crucial, and need to be regulated and coordinated from the national level. To achieve optimal support for initiating and establishing breastfeeding, governments, facilities, and relevant HCPs must support birth models that ensure women receive continuity of care and adequate time with skilled midwives, who in turn are educated in ways that are free from commercial influence (Step 1). These policy and clinical level steps can reduce the misalignment of costs and benefits of BFHI and Ten Steps implementation. Strengthening institutional commitment and embedding BFHI into national quality frameworks may further enhance sustainability and scale-up. A coordinated, system-wide approach is essential to ensure these evidence-based practices become standard in maternal and newborn care.

Objective: This study aimed to elucidate healthcare professionals' (HCPs) evaluations of a breastfeeding training program that incorporated diverse professions along the care continuum.

Methods: The breastfeeding training program was conducted over a full day during 2018-2019. To enable as many HCPs as possible to participate, the program was offered om twelve different dates. Approximately 25 HCPs took part on each occasion. Both qualitative and quantitative data was gathered on each occasion. The cohort comprised 238 HCPs, including midwives, registered nurses, specialist registered nurses, assistant nurses, physicians, and psychologists, all actively engaged in clinical practice at delivery/maternity wards or child healthcare centers. HCPs completed questionnaires featuring both closed and open-ended queries at the commencement and conclusion of the training program. Additionally, participants collaborated in small groups to propose improvements within the care continuum.

Results: Following the training program, HCPs reported a perceived increase in their interest in breastfeeding and noted the acquisition of novel tools for breastfeeding support. Noteworthy aspects of the training program, as identified by participants, included group discussions, the structure of the training session, inspiration for breastfeeding support, newfound knowledge regarding breastfeeding, and the utility of provided parental materials.

Conclusion: The breastfeeding training program was beneficial across various HCP roles. The training program served to augment participants' interest in breastfeeding and equipped them with resources to bolster ongoing breastfeeding support efforts. Facilitating HCP attendance at such training sessions and fostering commitment to breastfeeding promotion emerge as crucial imperatives.

Trial registration: Detailed information about the program and its implementation is available in the trial registered in the ISRCTN Registry: https://doi.org/10.1186/ISRCTN91972905 .

Background: Early initiation of breastfeeding, defined as placing a newborn to the breast within the first hour of birth, is vital for improving neonatal survival, strengthening the mother-child bond, and ensuring the delivery of essential nutrients and antibodies. This study examines progress and socioeconomic inequalities in the early initiation of breastfeeding among women in Sierra Leone from 2008 to 2019.

Methods: We used data from the three rounds of the Sierra Leone Demographic and Health Survey conducted in 2008, 2013, and 2019. We used the Health Equity Assessment Toolkit developed by the World Health Organisation to calculate the inequality measures among women 15-49 years, which include simple difference (D), ratio (R), population attributable risk (PAR), and population attributable fraction (PAF). The inequality assessment was conducted based on six stratifiers: age, economic status, level of education, place of residence, sex of the child, and sub-national region.

Results: In Sierra Leone, the early initiation of breastfeeding rate increased from 48.7% in 2008 to 75.2% in 2019. Higher rates of early initiation of breastfeeding were observed among mothers (15-19 years), women from the lowest wealth quintile, those without formal education, and those residing in rural areas. However, regional inequalities persisted, with the Eastern region showing the lowest rates. The inequality (D) in age increased from - 0.2 in 2008 to -1.6 in 2019. The economic status disparity increased from - 8.7% in 2008 to -18.4% in 2019. Inequality for education decreased from - 10.6 in 2008 to -4.7 in 2019. The increase in place of residence inequality was from -2.6% in 2008 to -13.4% in 2019. For the sex of the child, the disparity increased from - 1.5% to -3.6% in 2019. Regional disparity increased from 19.7 in 2008 to 28.6 in 2019. PAR also rose from 8.9 to 11.1 percentage points.

Conclusion: Early initiation of breastfeeding has shown substantial improvement in Sierra Leone, highlighting the effectiveness of recent public health interventions. However, inequalities accross economic status, level of education, sex of the child, and sub-national region still persist. To sustain these gains and ensure equitable progress, continued policy attention and targeted strategies are essential to address persistent socio-economic and regional inequalities disparities.