Research confirms that breastfeeding disparities persist and that lactation consultants play a key role in reducing them. However, there continues to be a limited availability of International Board Certified Lactation Consultants (IBCLCs) in the US with racial minorities in particular facing persistent barriers in the certification process. Through semi-structured interviews with 36 IBCLCs across the US, this study takes a systematic look at breastfeeding disparities through the lens of the IBCLC. Specifically, this study addresses barriers to certification and employment discrimination faced by IBCLCs of color, race-based discrimination against patients, and the ways in which IBCLCs work to both medicalize and demedicalize breastfeeding. Each of these areas can impact breastfeeding equity, and each help to reveal the ways in which race, class, gender and medicine shape views and practices related to lactation and motherhood. Cost and the increasingly university-focused approach of the IBCLC certification process are found to be significant barrier for participants. Race-based discrimination during the certification process and in the workplace is also an ongoing and persistent reality that affects participant’s relationships with patients and coworkers and their ability to secure workplace resources and to advance in their careers. IBCLCs report instances of race-based discrimination against patients such as unequal care provided to patients of color and overt racist remarks said in front of or behind patient’s backs. Finally IBCLCs are found to demedicalize breastfeeding, but they often lack the authority to change breastfeeding policies. They also engage in other work that medicalizes breastfeeding and perpetuate the idea that mothers are anxiety-prone patients in need of professional intervention.

A violência por parceiro íntimo (VPI), durante a fase gravídico-puerperal da mulher, pode ter consequências sérias e desastrosas tanto para a saúde das mulheres como para seus conceptos/neonatos. Algumas dificuldades das mães, durante o aleitamento materno, podem estar relacionadas, direta ou indiretamente, à atitude de agressão por parte do parceiro, independente de ocorrer antes, durante e/ou depois da gestação. Este estudo teve como objetivo analisar a prática da amamentação entre mulheres em situação de VPI, durante a gestação atual, usuárias de um serviço de pré-natal da rede pública quanto à duração do aleitamento materno exclusivo (AME), ao nível de autoeficácia materna para amamentar e aos fatores relacionados ao início, estabelecimento da amamentação e desmame precoce. Trata-se de um estudo quantitativo e descritivo-exploratório, desenvolvido no CRSM-MATER, situado em Ribeirão Preto - SP, com aprovação da Comissão de Ética em Pesquisa com Seres Humanos, nº 1421/2011. Os dados foram coletados no período de maio de 2012 a maio de 2013. As mulheres participantes do estudo foram recrutadas a partir de um inquérito sobre prevalência de VPI na gestação, aplicado no pré-natal para 358 gestantes, além de dados sociodemográficos e ginecológicos. Na internação, as informações sobre variáveis obstétricas, neonatais e de amamentação foram coletadas no prontuário. Com 30 dias de pós-parto, as mulheres foram acompanhadas no domicílio, quando foi aplicado o Instrumento Breastfeeding Self-Efficacy Scale (BSES), e com 70 dias após o parto, por contato telefônico, para obter informações sobre a amamentação. Os dados foram analisados pelo programa estatístico SAS ® 9.0, com análise fundamentada na estatística descritiva, utilizando-se o Teste Exato de Fisher, t-Student e Análise de Variância. Verificamos que 17,59% das participantes relataram algum tipo de VPI, durante a gestação atual, sendo 94% por violência psicológica, 42%, física e 2%, sexual. A média de idade foi de 24,5 anos e de estudo, 8,94 anos, renda familiar média de 2,61 salários-mínimos. Na alta hospitalar, 88% dos bebês estavam em AME, reduzindo para 55,32% e 40% com 30 e 70 dias após o parto, respectivamente. A média de duração do AME foi de 19,08 dias. E 54% das mulheres apresentaram alta autoeficácia na amamentação. Não houve associação do nível de autoeficácia na amamentação e da duração do AME com o tipo de VPI, na gestação atual. Verificamos associação da duração do AME com o nível de autoeficácia na amamentação com 30 e 70 dias, após o parto. Dentre os fatores relacionados ao início, estabelecimento da amamentação e desmame precoce, observamos associação estatisticamente significativa do nível de autoeficácia na amamentação com o Apgar de 1º minuto, a presença de intercorrências com o recém-nascido (RN) e a separação da mãe durante a internação. Concluímos que a análise da autoeficácia na amamentação entre mulheres em situação de VPI, na gestação atual, possibilitou identificar fatores relacionados à amamentação que podem ter influências negativas e positivas sobre o início e estabelecimento da amamentação, bem como para o desmame precoce. A BSES é um instrumento que pode ser usado tanto em pesquisas como no planejamento de uma assistência mais efetiva / Intimate Partner Violence (IPV) during the pregnancy-puerperal phase can have serious and disastrous consequences for women and their neonates. Some difficulties for mothers during breastfeeding, may be related directly or indirectly to the act of aggression by the partner before, during or after gestation. This study\'s objective is to analyze breastfeeding in the IPV situation during current gestation among users of a prenatal service from the public health care in relation to the duration of the exclusive breastfeeding (EBF), the level of maternal self-efficacy to breastfeed, and breastfeeding factors related to its initiation, establishment, and early weaning. The present study is quantitative and descriptive-exploratory, developed at CRSM-MATER, situated in Ribeirão Preto, Sao Paulo, with the approval of the Ethics Committee on Human Research, no. 1421/2011. The data were collected from May 2012 to May 2013. The participating women (n=358) were recruited from an inquiry about the prevalence of IPV during their gestation, applied in pre-natal. Socio-demographic and gynecological data were also considered. At admission, information about obstetric variations, neonatal and breast-feeding were collected. In the 30th day from postpartum, the Breastfeeding Self- Efficacy Scale (BSES) instrument was applied in person in the home. Within 70 days postpartum, information about breast-feeding was obtained via telephone. The data were analyzed in using SAS® version 9.0 statistical software, with an analysis grounded in descriptive statisticz, utilizing the Fisher\'s exact test, Student\'s t-test and Variance Analysis. The average age was 24.5 years and 8.94 studying years, average family income was 2.61 minimum wage. It was verified that 17.59% of the participants reported some kind of IPV during gestation, with 94% of these cases reporting psychological, 42% physical and 2% sexual violence. At hospital discharge, 88% of neonates were in EBF, reduced to 55.32% and 40% at 30 and 70 days postpartum, respectively. The average duration of EBF was 19.08 days. 54% of the women presented high self-efficacy in breast-feeding. There was no association between the kind of IPV in the current gestation with the level of self-efficacy in breast-feeding or with the duration of EBF. There was however, an association between the duration of the EBF and the level of self-efficacy in breast-feeding at 30 and 70 days postpartum. Among breast-feeding characteristics, there were significant associations between the level of self-efficacy in breast-feeding with the Apgar of 1st minute, neonatal complications and maternal separation during hospitalization. We conclude that self-efficacy in breastfeeding among women in situations of IPV during gestation can influence breastfeeding beginning, breastfeeding establishment and early weaning. The present study establishes the utility of the BSES as a research instrument in this context, which may help guide the development of strategies for more effective assistance

Despite the burgeoning literature documenting the effects of breast-feeding on cognition and educational attainment over the past several decades, there remains important gaps in our knowledge regarding whether this relationship is dictated by sociodemographic factors. The current investigations, which examined the literature on the effects of breast-feeding on cognition and educational attainment in children, adolescents, and older adults addressed these gaps. Chapter 2 was an up-to-date global systematic review of population studies in individuals ≤ 25 years and ≥ 25 years of age. Results indicate that the majority of published studies conducted by researchers demonstrated a positive relationship between the effect of breast-feeding on cognitive outcomes and educational attainment. Additionally, findings highlighted the importance of possible confounders and how adjusting for them can change the relationship between breast-feeding and cognition and educational attainment. Chapter 3 investigated the breast-feeding-cognition/educational attainment relationship across race, as well as whether mother-child stimulation might mediate this relationship. The National Longitudinal Study of Adolescent to Adult Health (Add Health) was used to examine the effect of being breast-fed or not, and duration on cognitive outcomes and grade point average (GPA). Results indicate that individuals who were breast-fed had slightly higher GPAs and performance on both a vocabulary test and a number recall test compared to adolescents who were not breast-fed. There was an effect for race, but no interaction between race and breast-feeding. Mother-child stimulation had a limited effect on the relationship between breast-feeding and cognitive outcomes and GPA. Chapter 4 explored whether the effect observed in adolescence persists into older adulthood. The Reasons for Geographic and Racial Differences in Stroke (REGARDS) Cohort was used to examine this relationship in adults age ≥ 45 years. The covariates included sex of adolescent, race (Black or White), maternal education, paternal education, maternal smoking history, number of other children mother has, resident location (urban/not-urban), and a financial adversity index. This was a composite score consisting of yes or no responses to (1) do you have health insurance, (2) have you been employed within the past 12 months, (3) are you on public assistance, and (4) do you have enough money to pay your bills? Results show that self-report history of being breast-fed did not current predict performance on cognitive tests. Additionally, neither race nor sex moderated this relationship between breast-feeding and cognition. Overall, evidence from the review and two studies highlight the important of assessing the effect of breast-feeding on cognition and educational attainment in populations with varying confounding factors, however, while some of the results are inconsistent with our hypothesis, replication is clearly essential to further explore the possible underlying mechanism.

A violência por parceiro íntimo (VPI), durante a fase gravídico-puerperal da mulher, pode ter consequências sérias e desastrosas tanto para a saúde das mulheres como para seus conceptos/neonatos. Algumas dificuldades das mães, durante o aleitamento materno, podem estar relacionadas, direta ou indiretamente, à atitude de agressão por parte do parceiro, independente de ocorrer antes, durante e/ou depois da gestação. Este estudo teve como objetivo analisar a prática da amamentação entre mulheres em situação de VPI, durante a gestação atual, usuárias de um serviço de pré-natal da rede pública quanto à duração do aleitamento materno exclusivo (AME), ao nível de autoeficácia materna para amamentar e aos fatores relacionados ao início, estabelecimento da amamentação e desmame precoce. Trata-se de um estudo quantitativo e descritivo-exploratório, desenvolvido no CRSM-MATER, situado em Ribeirão Preto - SP, com aprovação da Comissão de Ética em Pesquisa com Seres Humanos, nº 1421/2011. Os dados foram coletados no período de maio de 2012 a maio de 2013. As mulheres participantes do estudo foram recrutadas a partir de um inquérito sobre prevalência de VPI na gestação, aplicado no pré-natal para 358 gestantes, além de dados sociodemográficos e ginecológicos. Na internação, as informações sobre variáveis obstétricas, neonatais e de amamentação foram coletadas no prontuário. Com 30 dias de pós-parto, as mulheres foram acompanhadas no domicílio, quando foi aplicado o Instrumento Breastfeeding Self-Efficacy Scale (BSES), e com 70 dias após o parto, por contato telefônico, para obter informações sobre a amamentação. Os dados foram analisados pelo programa estatístico SAS ® 9.0, com análise fundamentada na estatística descritiva, utilizando-se o Teste Exato de Fisher, t-Student e Análise de Variância. Verificamos que 17,59% das participantes relataram algum tipo de VPI, durante a gestação atual, sendo 94% por violência psicológica, 42%, física e 2%, sexual. A média de idade foi de 24,5 anos e de estudo, 8,94 anos, renda familiar média de 2,61 salários-mínimos. Na alta hospitalar, 88% dos bebês estavam em AME, reduzindo para 55,32% e 40% com 30 e 70 dias após o parto, respectivamente. A média de duração do AME foi de 19,08 dias. E 54% das mulheres apresentaram alta autoeficácia na amamentação. Não houve associação do nível de autoeficácia na amamentação e da duração do AME com o tipo de VPI, na gestação atual. Verificamos associação da duração do AME com o nível de autoeficácia na amamentação com 30 e 70 dias, após o parto. Dentre os fatores relacionados ao início, estabelecimento da amamentação e desmame precoce, observamos associação estatisticamente significativa do nível de autoeficácia na amamentação com o Apgar de 1º minuto, a presença de intercorrências com o recém-nascido (RN) e a separação da mãe durante a internação. Concluímos que a análise da autoeficácia na amamentação entre mulheres em situação de VPI, na gestação atual, possibilitou identificar fatores relacionados à amamentação que podem ter influências negativas e positivas sobre o início e estabelecimento da amamentação, bem como para o desmame precoce. A BSES é um instrumento que pode ser usado tanto em pesquisas como no planejamento de uma assistência mais efetiva / Intimate Partner Violence (IPV) during the pregnancy-puerperal phase can have serious and disastrous consequences for women and their neonates. Some difficulties for mothers during breastfeeding, may be related directly or indirectly to the act of aggression by the partner before, during or after gestation. This study\'s objective is to analyze breastfeeding in the IPV situation during current gestation among users of a prenatal service from the public health care in relation to the duration of the exclusive breastfeeding (EBF), the level of maternal self-efficacy to breastfeed, and breastfeeding factors related to its initiation, establishment, and early weaning. The present study is quantitative and descriptive-exploratory, developed at CRSM-MATER, situated in Ribeirão Preto, Sao Paulo, with the approval of the Ethics Committee on Human Research, no. 1421/2011. The data were collected from May 2012 to May 2013. The participating women (n=358) were recruited from an inquiry about the prevalence of IPV during their gestation, applied in pre-natal. Socio-demographic and gynecological data were also considered. At admission, information about obstetric variations, neonatal and breast-feeding were collected. In the 30th day from postpartum, the Breastfeeding Self- Efficacy Scale (BSES) instrument was applied in person in the home. Within 70 days postpartum, information about breast-feeding was obtained via telephone. The data were analyzed in using SAS® version 9.0 statistical software, with an analysis grounded in descriptive statisticz, utilizing the Fisher\'s exact test, Student\'s t-test and Variance Analysis. The average age was 24.5 years and 8.94 studying years, average family income was 2.61 minimum wage. It was verified that 17.59% of the participants reported some kind of IPV during gestation, with 94% of these cases reporting psychological, 42% physical and 2% sexual violence. At hospital discharge, 88% of neonates were in EBF, reduced to 55.32% and 40% at 30 and 70 days postpartum, respectively. The average duration of EBF was 19.08 days. 54% of the women presented high self-efficacy in breast-feeding. There was no association between the kind of IPV in the current gestation with the level of self-efficacy in breast-feeding or with the duration of EBF. There was however, an association between the duration of the EBF and the level of self-efficacy in breast-feeding at 30 and 70 days postpartum. Among breast-feeding characteristics, there were significant associations between the level of self-efficacy in breast-feeding with the Apgar of 1st minute, neonatal complications and maternal separation during hospitalization. We conclude that self-efficacy in breastfeeding among women in situations of IPV during gestation can influence breastfeeding beginning, breastfeeding establishment and early weaning. The present study establishes the utility of the BSES as a research instrument in this context, which may help guide the development of strategies for more effective assistance

Thesis (MPH.) -- University of Limpopo, 2019 / Introduction: Exclusive breastfeeding for six months, with introduction of appropriate complimentary feeding at six months, continuing to 2 years and beyond comes highly recommended. Although breastfeeding rates have improved in South Africa, the prevalence still remains lower than the Rome target of 50%, supporting investigation into factors that influence infant feeding practices. Aim: The aim of this study was to describe infant feeding practices and to determine the factors influencing infant feeding practices of mothers and care givers of infants in the Polokwane Municipality - Limpopo Province. Methods: A cross-sectional health facility-based quantitative and descriptive survey was conducted using a validated-structured questionnaire. Interviews only were conducted to gather quantitative data. The questionnaires were administered to the mothers, one mother at a time. Chi–square tests were used to determine the relationship between selected variables, where p<0.05 was set as level of significance. Results: A total of 146 mothers participated in the study. All were biological mothers of infants. Ninety-four percent of the mothers initiated breastfeeding, however, at the time of data collection 8% of mothers had stopped. Of those who had stopped breastfeeding, 5% stopped earlier than one month after initiation. Thirty-nine percent of mothers breastfed exclusively, while 61% practiced mix feeding. A positive association between breast feeding practices and age of the mother (p<0.036) was observed. The reasons mothers reported for stopping breastfeeding were: mother was ill (45.4%) and going back to school or work (27.3%). Reasons for not breastfeeding were cited as: medical condition, not enough milk and infant refusal to breastfeed at 33.3%. Health workers are the main source of HIV information (77%). Mothers believe that HIV-positive women should breastfeed their infants (57%). Conclusion: breastfeeding initiation is well practiced. Exclusive breastfeeding during the first six months is rarely practiced. Infant formula and solid foods were introduced at an early age. Young mothers tend to stop exclusive breastfeeding compared to older mothers.

Purpose Breastfeeding rates in Northeast Tennessee are much lower than national rates and the Healthy People 2020 targets. The purpose of this research was to develop and evaluate a high school breastfeeding education intervention. Methods Literature review and interviews with regional stakeholders informed development of an educational intervention for high school students aimed at increasing breastfeeding rates in this southern Appalachian region. An interactive educational game was developed based on the Theory of Planned Behavior (TPB) to provide age-appropriate information about breastfeeding. Health science classes from two regional high schools participated. Prior to the game, the students were given a 35-question pre-survey to assess knowledge, attitudes, subjective norms, perceived behavioral control, and intentions, the tenets of the TPB. Education was delivered during a single class session and included information about related health careers. A post-survey was given two weeks after the educational intervention and compared to the pre-test results using t-tests and Cohen’s d to assess changes in mean summary scores of measures of the TPB tenets. Results Surveys were completed by 107 students (75% female, 68% freshman/sophomores). Intention to breastfeed in the future significantly increased from 47.6% to 66.3% following the intervention. Measures of knowledge, attitudes, and perceptions of subjective norms related to breastfeeding were all significantly improved after the intervention. Levels of breastfeeding knowledge were low at baseline and demonstrated the largest improvement of all of the TPB tenets following the intervention (Cohen’s d = 1.6). Results were not found to vary significantly based on gender or grade level. Conclusion Breastfeeding education is not common in middle and high schools and published research evaluating the effects of breastfeeding education in schools is limited. While this study did not assess the impact of the intervention on breastfeeding rates, the changes observed suggest that an educational intervention based on the TPB may have the potential to increase the breastfeeding rates in the future. Limitations of the study include only having one session of education and a short follow-up period of only two weeks.

Thesis (MPH. ) --University of Limpopo, 2014 / The aim of this study was to determine the knowledge and practices of mothers with regard to exclusive breastfeeding in the Mahwelereng Local Area of the Waterberg District, Limpopo Province. A quantitative study was conducted by using a researcher-administered structured questionnaire at six clinics in the Mahwelereng Local Area. A simple random sampling method was used to select the hundred and seventy five mothers who had babies of less than six months old from whom data was collected. Data was analysed with the assistance of the statistician by using the SPSS software program. Data is presented applying descriptive and inferential statistics. Less than half (74; 42.3%) of the responding mothers were practising exclusive breastfeeding despite the fact that 137 (78.3%) of them were given information about exclusive breastfeeding. There is an association between knowledge of exclusive breastfeeding (Chi-Square= 14.039; Sig=0.000 p<0.05) and exclusive breastfeeding practice. There is no association between exclusive breastfeeding practice and HIV status (Chi-Square=2.444; Sig=0.118; p>0.05). Challenges that mothers faced in relation to practising exclusive breastfeeding were work-related, school-related, health-related, pressure from family to mix-feed, and a lack of knowledge. However, 42.9% of the respondents indicated that they did not have any challenges with regard to the practice of breastfeeding. It was, therefore, recommended that one-on-one counselling about exclusive breastfeeding needs to be intensified and maternity leave should be extended to six months. The majority of respondents showed adequate knowledge of what exclusive breastfeeding was because they were counselled about breastfeeding although they were not practising it. Key words: Exclusive breastfeeding, mothers, knowledge, practices, mix-feeding.

<p>The aim of this study was to examine four women’s experiences of and attitudes towards breastfeeding. In order to achieve this end, the four women were interviewed individually. Breastfeeding is a controversial subject, which is also mirrored by the women and the different advice and recommendation that they meet. Consequently, each woman has to take a stand for what she thinks is suitable regarding her individual situation. Moreover, breastfeeding is embedded in complex historical, political and cultural systems. This becomes obvious in the contemporary principle of breastfeeding on demand, according to which breastfeeding is adapted to the child’s needs. Thus, a majority of the interviewees have difficulties with combining breastfeeding on demand with ideas of gender equality. Due to breastfeeding on demand, the women must also breastfeed in public. In those situations, the women are keen on breastfeeding as discretely as possible.</p><p> </p> / <p>Syftet med den här uppsatsen är att undersöka fyra kvinnors erfarenheter av och attityder till amning. Av den anledningen blev de fyra kvinnorna individuellt intervjuade. Amning är ett kontroversiellt ämne, som också speglades av kvinnorna och de råd och rekommendationer de möter. Konsekvensen av detta är att varje kvinna måste ta ställning till vad som passar deras individuella situation. Dessutom, amning är inbäddat i ett komplext historiskt, politiskt och kulturellt system. Detta blir tydligt genom den rådande fria amningsprincipen, som innebär att amningen är anpassad efter barnets behov. Majoriteten av kvinnorna har därför svårigheter med att kombinera fri amning med idéer om jämlikhet. På grund av fri amning, måste kvinnorna ibland amma offentligt. I de situationerna är kvinnorna måna om att amma så diskret som möjligt.</p>

Rekommendationerna är att spädbarn helammas i sex månader utan tillskott av annan föda. Trots att hälsoeffekterna för både mor och barn är välkända, har amningsprevalensen sjunkit i Sverige de sista åren. Syftet med denna studie var att undersöka om förstagångsmammor ammade så länge de tänkt sig, vilka orsaker som bidrog till att de slutade helamma respektive delamma och hur deras upplevelse av amningsstöd varit med speciellt fokus på barnhälsovården (BHV). En enkät skickades till 65 förstagångsmammor, vilket resulterade i 35 svar. Resultatet visade att knappt hälften av de mammor som svarade på enkäten hade avslutat sin amning tidigare än vad de tänkt sig. Hälften av de mammor som hade velat amma längre hade uppgett orsaker som kunde relateras till brist på stöd.  Resultatet visade även att många mammor söker stöd från det egna sociala nätverket och att stöd från mödrahälsovården (MHV) och förlossning/BB är viktigt för hur amningsstarten blir. BHV:s stöd är betydelsefullt när amningen ska etableras och upprätthållas vilket påverkar amningstidens längd. Det finns ett behov av fortsatt utbildning för vårdpersonal och amningsstödjare, gällande betydelsen av amning och bröstmjölk för att ge efterfrågat stöd till mammor som vill amma sina barn. / The health benefits of breastfeeding are well documented and guidelines for infant feeding have supported exclusive breastfeeding during the first 6 months. The breastfeeding prevalence has decreased in Sweden during the last ten years. The aim with this study was to find out if primaparous mothers could breastfeed as long as they had planned to do, reasons for stopping breastfeeding and how the mothers had perceived breastfeeding support, especially the support from the child health care. A questionnaire was sent out to 65 primiparous women and 35 mothers participated in the study. Almost half of the mothers had stopped breastfeeding earlier than they wanted to do. The result showed that many mothers looked for support in their own social network. The support from antenatal care, delivery and maternity ward, child health care was important in initiating breastfeeding as well as to maintain breastfeeding. There is a need of more education in breastfeeding and breast milk to health professionals and breastfeeding supporters to be able to support those mothers who want to breastfeed their babies.

In this thesis, I examine the experiences of breastfeeding mothers who chose to give birth with Certified Professional Midwives at a free-standing birth center, and the factors that influence their known high rates of breastfeeding initiation and duration. Using grounded theory and data collected from participant observation, semi-structured interviews, and an open-ended survey, I describe the functioning of the birth center and the breastfeeding explanatory models of the birth center staff as well as how the birth center's model of care affects client-participant's experiences of breastfeeding in community that rejects medicalized models of birth and breastfeeding. Findings interpreted from a biocultural perspective reveal how women utilize previously constructed breastfeeding convictions to navigate support and difficulties in a way that allows 92% of client-participants to report overall happiness about their breastfeeding experiences. There was, however, a small subset of women who were disappointed in their breastfeeding experience. Recommendations include changes in care practice to further support breastfeeding women in this community. / Graduation date: 2013