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Breastfeeding rates vary considerably among high-income countries who are members of the Organization for Economic Co-operation and Development (OECD). In the 1960's, breastfeeding outcomes, both initiation of breastfeeding and breastfeeding duration, were at an all-time low. Over the past half century, breastfeeding outcomes have increased among all OECD countries, but at very different rates. This dissertation examines both the policy-level and public health-level initiatives that have affected the differential growth of breastfeeding rates among 18 high-income, OECD countries. Using a combination of multiple regression, fuzzy-set qualitative comparative analysis, and small-n methods, I find that countries in the broad Scandinavian welfare regime have combined policy support for women's reproductive and productive labor, along with a strong female representation in government to facilitate positive breastfeeding outcomes. I find that countries who have a strong commitment to the World Health Organization's Baby-Friendly Hospital Initiative have higher breastfeeding initiation rates than countries who do not have a high percentage of hospitals following the WHO protocol. This dissertation adds to the broader understanding of how welfare state policies and public health initiatives operate in tandem to support positive breastfeeding outcomes among high-income countries.

There is some evidence suggesting that the rate of breastfeeding initiation is lower among particular ethnic or cultural groups who have immigrated to Canada and South Asian women comprise one of these groups. Given the evidence that breastfeeding is important in promoting infant health and maternal health, it is important to understand factors that influence breastfeeding initiation among South Asian immigrant women. This descriptive exploratory study investigated the following research question: What are South Asian women's perceptions about the social, socio-economic, personal and acculturation factors that influence their initiation of breastfeeding? The study explored factors that could influence the initiation of breastfeeding among primiparous South Asian immigrant women who have immigrated to Canada. It was informed in part by the conceptual framework used by Kong and Lee (2004), whose study investigated factors that influenced 252 first-time mothers in their decision-making about whether or not to breastfeed. A convenience sample of 15 subjects was interviewed using a semi-structured interview guide with 10 questions. Data were transcribed and analyzed using inductive constant comparative analysis. The following themes emerged: the representation of breastfeeding, vicarious learning about breastfeeding, family influences, spiritual connection, breaking with tradition, resisting the moral mandate, deferring to medical authority, transition to work and cultural mores. With respect to the findings, implications are discussed for nursing research, theory and education.

Internationellt sett är amningsfrekvensen i dagens Sverige hög, men har minskat något senaste åren. Studier visar att inställningen till amning är positiv, men att kvinnor upplever svårigheter i samband med amning samt en brist på information och stöd. Syftet med fördjupningsarbetet var att belysa gravida kvinnors tankar om amning, amningsinformation och stöd. Studien genomfördes med kvalitativ ansats, där data samlades in genom fokusgruppsintervjuer med 18 gravida kvinnor hösten 2012. Data bearbetades med innehållsanalys. Analysen gav ett övergripande tema; Balans mellan förväntningar och svårigheter. Fem kategorier framkom; Att vara medveten om amningens fördelar, Att vara medveten om svårigheter med amning, Att planera för sin kommande amning, Att påverkas av sin omgivning och Att ha förväntningar på stöd inför kommande amning. Resultatet visade att gravida kvinnor var medvetna om amningens fördelar och svårigheter, omgivningen påverkade deras tankar och kvinnorna ansåg ofta att amningen ”löser sig naturligt”. Tydligast framkom kvinnors känsla av bristande kunskap om amningsproblem och en önskan att få amningsinformation sent i graviditet. Amningsinformation som ges under graviditet bör vara varierad, innehållsrik och förbereda föräldrarna på att amning kan vara påfrestande. Det är viktigt att involvera partnern i information och förberedelser för amning.   Nyckelord: amning, graviditet, amningsstöd, amningsinformation, amningsproblem / Internationally, the frequency of breastfeeding in today`s Sweden is high, but has declined somewhat in recent years. Studies showed that attitudes to breastfeeding were positive, but the difficulties associated with breastfeeding and lack of information and support also emerged. The aim of this master essay was to examine pregnant women`s thoughts about breastfeeding, breastfeeding information and support. The study was conducted with a qualitative approach and, data was collected through focus group interviews with 18 pregnant women in autumn 2012. Data was analysed with a qualitative content analysis. The analysis yielded an overall theme; Balance between individual expectations and difficulties. Five categories emerged; Being aware of breastfeeding benefits, Being aware of the difficulties of breastfeeding, To plan for their next lactation, To be influenced by their surroundings and To have expectations of support for the next lactation. The result showed that pregnant women were aware of breastfeeding benefits and difficulties, that environment affected their thoughts, and that the women often felt that breastfeeding “dissolves naturally”, The results revealed most clearly women`s perceived lack of knowledge about breastfeeding problems and a desire to get breastfeeding information late in the pregnancy. Breastfeeding information given during pregnancy should be varied and, extensive and prepare parents that breastfeeding can be stressful. It is important to involve the partner in information and preparation for breastfeeding.

Previous studies failed to report benefits of prolonged breast feeding on nutritional status. A nationally representative sample of 1411 children from Sri Lanka (1987) was used to compare breast feeders versus non breast feeders, as well as duration of breast feeding, through multivariate analyses for height-for-age, weight-for-age and weight-for-height z-scores. Analyses of interaction showed prolonged breast feeding to be advantageous among children of working mothers, and children from households using an unimproved water supply. For example, children 35 months of age, breast fed for 24 versus 8 months were 0.9 centimetres (95% confidence interval; +0.0, 1.8) taller if mothers worked and 420 grams (140, 690) heavier if households used an unimproved water supply. Among uneducated mothers breast fed children were 1.3 cm (2.2, 3.3) shorter than non breast fed children. Prolonged breast feeding should be encouraged as it is advantageous for the nutritional status of certain subgroups of children older than 12 months of age.

The aims of this research were to examine the effects of infant feeding method on sleep development across the first twelve months of life, and to determine whether there are differences in sleep development between infants who are exclusively breastfed and those who are not. The participants were 52 infants and their parents. Parents completed sleep diaries for six consecutive nights once a month, for 12 months starting at one month of age, recording infant and parent sleep-related behaviours. It was predicted that infants who were breastfed for a longer period would have higher instances of night waking, would take longer to achieve the three criteria for sleeping through the night, and would have higher Composite Sleep Scores (Richman, 1981) than their non-breastfed counterparts. There was an unexpected high rate of breastfeeding in the sample of infants across the first 12 months. The breastfed infants displayed less night waking than their mixed or bottle-fed counterparts before three months of age, but more night waking after three months for the remainder of the study. They also took longer to reach each of the three sleeping through the night criteria. However, two subsets appeared within the breastfeeding group - those infants who experienced consolidated sleep earlier than six months of age, and those who did not. This finding demonstrated that breastfed infants are capable of sleeping through the night from an early age, contrary to what previous literature suggests.

Bakgrund: Hälsofördelarna med amning är välkända, och sedan 1992 försöker svenska sjukhus arbeta efter internationella amningsrekommendationer. Trots detta framkommer brister i vården och amningsstatistiken i Sverige sjunker. Syfte: Syftet med denna studie var att undersöka amningsdurationen hos förstföderskor, om den kunde associeras med vården de fått i samband med barnets födelse och första levnadsdygn, samt med mammornas skattning av amningsstöd vid amningsstart. Metod: Designen var en longitudinell kvantitativ tvärsnittsstudie och urvalet var icke slumpmässigt konsekutivt. I samband med utskrivning från BB, tillfrågades 63 mammor om att delta i en enkätstudie med frågor gällande vården de fått i relation till amning och 52 mammor besvarade enkäten. Efter nio till tolv månader blev de uppringda för en kortare uppföljning och 50 mammor valde att delta. Resultat: Medianen för durationen av exklusiv amning var tre månader och tre veckor och medianen för durationen av partiell amning var åtta månader. Amningsstödet på BB skattades högre vid det första mättillfället, men det påvisades inte ha något samband med amningsdurationen. Faktorer i vården såsom; hudnära vård, amning inom två timmar eller handgriplig amningshjälp, bidrog inte till någon skillnad i amningsduration. Däremot påverkades amningsdurationen negativt hos de barn som fått tillmatning på BB, med en kortare exklusiv amningsduration som följd, och de som fötts med kejsarsnitt, med kortare amningsduration såväl exklusivt som partiellt. Slutsats: Medianen för durationen av exklusiv amning var tre månader och tre veckor och medianen för durationen av partiell amning var åtta månader.  Faktorer i vården som inverkade negativt på amningsdurationen var tillmatning på BB samt att barnet fötts med kejsarsnitt. Däremot fanns ingen association mellan amningsduration och amningsstöd, hudnära vård, amning inom två timmar eller handgriplig hjälp. / Background: The health benefits of breastfeeding are well known and since 1992, Swedish hospitals aim to provide care according to international guidelines of breastfeeding support. Despite this, there are inadequacies in the care provided, and the frequency of breastfeeding in Sweden is statistically decreasing. Aim: The aim of this study was to investigate the duration of breastfeeding among primiparas, if the duration was associated with the provided care and with how the mothers valued the help and support they received at the initiation of breastfeeding. Method: A quantitative longitudinal with consecutive sample was conducted. At discharge from hospital, 63 mothers were asked if they wanted to participate in a survey about breastfeeding and the related care, and 52 mothers filled in the questionnaire. After nine to twelve months the participants were contacted by phone for a short follow-up, and 50 mothers chose to participate. Results: The median duration of exclusive breastfeeding was three months and three weeks and the median duration of partial breastfeeding was eight months. The evaluation of the breastfeeding support was higher at the first data collection but did not appear to correlate with the duration of breastfeeding. Of the investigated factors; skin-to-skin contact immediately after birth, breastfeeding within two hours after birth and hands-on support, none of them led to differences in breastfeeding duration. Breastfeeding duration was adversely affected if the infant was given formula at the maternity ward and if the infant was born by Caesarean section. Feeding by infant formula led to a shorter duration of exclusive breastfeeding and birth by Caesarean section led to a shorter duration of both exclusive and partial breastfeeding. Conclusion: The median duration of exclusive breastfeeding was three months and three weeks and the median duration of partial breastfeeding was eight months. The infant being given formula at the maternity ward, and being born by Caesarean section were factors that adversely affected the duration of breastfeeding. However, there was no association between breastfeeding duration and; perceived breastfeeding support, skin-to-skin-care, breastfeeding within two hours or hands-on support.

No description available.

There is some evidence suggesting that the rate of breastfeeding initiation is lower among particular ethnic or cultural groups who have immigrated to Canada and South Asian women comprise one of these groups. Given the evidence that breastfeeding is important in promoting infant health and maternal health, it is important to understand factors that influence breastfeeding initiation among South Asian immigrant women. This descriptive exploratory study investigated the following research question: What are South Asian women's perceptions about the social, socio-economic, personal and acculturation factors that influence their initiation of breastfeeding? The study explored factors that could influence the initiation of breastfeeding among primiparous South Asian immigrant women who have immigrated to Canada. It was informed in part by the conceptual framework used by Kong and Lee (2004), whose study investigated factors that influenced 252 first-time mothers in their decision-making about whether or not to breastfeed. A convenience sample of 15 subjects was interviewed using a semi-structured interview guide with 10 questions. Data were transcribed and analyzed using inductive constant comparative analysis. The following themes emerged: the representation of breastfeeding, vicarious learning about breastfeeding, family influences, spiritual connection, breaking with tradition, resisting the moral mandate, deferring to medical authority, transition to work and cultural mores. With respect to the findings, implications are discussed for nursing research, theory and education.

Introduction: Breast milk is the best way to feed all infants. It results in better nutrition for the infant and to reduced rates of chronic disease later in childhood and adulthood. Breastfed babies have lower rates of infectious diseases and will not be exposed to contaminated infant formula, such as the recent experience with melamine in China. The WHO Expert Consultation on Infant Feeding recommended exclusive breastfeeding for six months, with the introduction of complementary foods and continued breastfeeding thereafter. It was also recommended by the WHO that breastfeeding continue beyond six months for up to two years and beyond. Breastmilk can provide the majority of nutrients for the first 12 months of life. Complementary foods were given in the second half year gradually. / However with the rapid economic development, the traditional home based obstetric system in China has changed. Following the change in women’s living styles, traditional infant feeding perceptions and practices have changed. Women now have high rates of returning to work after delivering a baby, especially in the urban areas, and more infants are being given infant formula and other substitutes for breastfeeding. Zhejiang Province is the one of fastest developing economic regions located in the mid Eastern coast of China. The breastfeeding rate has dropped rapidly since the 1970’s. This has significant implications for the child health in this region. A longitudinal study of breastfeeding was needed to provide the data necessary to implement a comprehensive health promotion program. Efforts are needed to promote breastfeeding, which should be one of the highest health promotion priorities. / The aim of this study was to document the prevalence and duration of breastfeeding and exclusive breastfeeding in city, suburban and rural areas in Zhejiang Province; analyze the factors determining the initiation and the duration of breastfeeding; document mothers’ knowledge about the benefits of breastfeeding; identify the prevalence of problems associated with breastfeeding and constraints to exclusive breastfeeding up to six months of life; document the prevalence of prelacteal feeds and finally to describe differences in breastfeeding between city, suburb and rural area. / Method: In order to achieve these objectives a longitudinal cohort study was undertaken of infant feeding practices in three locations in Zhejiang Province which represent city and suburban and rural areas. Mothers who delivered babies during 2004 and 2005 were randomly selected from the obstetric wards while in hospital and invited to voluntarily participate in the study. The mothers were interviewed in hospital and after discharge, were contacted by telephone three more times at 1, 3 and 6 months. The few mothers who could not be reached by telephone were interviewed during the scheduled routine immunisation clinics at their local MCH clinic. On each of these follow up occasions they were interviewed using a structured questionnaire to obtain details of infant feeding practices. A total of 1520 mothers were recruited in 4 hospitals located in city, suburb and rural areas. Almost all mothers (98%) agreed to participate. All data analyses were carried out using the Statistical Package for Social Science (SPSS), release 14.0 (SPSS Inc., Chicago, IL, USA). Descriptive techniques and survival analysis were used to document breastfeeding rates and duration. Cox regression analysis was undertaken to explore factors affecting breastfeeding. / Results: Of the total 1520 mothers were recruited into the study, 628 were from the city, 347 from the suburb and 535 from the rural area. Breastfeeding initiation rates were high in all three locations. Initially more than 95% of the mothers began breastfeeding, but only 50.3% babies averagely in three locations were being exclusively breastfed at discharge. The number of infants being exclusively breastfed prior to discharge was relatively low. Exclusive breastfeeding before discharge was positively related to delivery method, the first feed given to the baby, mother’s place of residence, mother’s age, mothers’ education level and family income. / ‘Any breastfeeding’ rates at discharge and at 1, 3 and 6 months were 96.9%, 96.0%, 89.7% and 76.7% respectively. ‘Exclusive breastfeeding’ rates at discharge, and at 1, 3, 6 months were 50.3%, 55.1%, 45.8% and 3.9% respectively. The average duration of ‘exclusive breastfeeding’ was 44.7 days (95% CI, 41.6-47.9). / Overall about half of mothers gave the babies prelacteal feeds before commencing breastfeeding. This situation was more common in city, compared with the suburban and rural mothers. The prelacteal feeding rates were 62.0%, 36.6% and 39.0% in city, suburb and rural area respectively. / The breastfeeding rates differed by location between the city, suburb and rural areas. ‘Any breastfeeding’ rates in the city, suburb and rural area at discharge were 96.5 %, 96.8 % and 97.4 % respectively, the ‘exclusive breastfeeding’ rates in city, suburb and rural area at discharge were 38.0%, 63.4 % and 61.0 % respectively. The rates of exclusive breastfeeding at six months were only 0.2%, 0.5 % and 7.2 % respectively, well below the Chinese and WHO targets. / The risk factors related to cessation of ‘any breastfeeding’ were ‘mother’s age’, ‘the time the decision to breastfeed was made’, ‘whether the infant was admitted to special care nursery’, ‘mother’s return to work within 6 months’, ‘the early feeding of water and /or other complementary foods, and location of mother’s usual residence. Factors negatively associated with ‘exclusive breastfeeding’ duration were early return to work and to place of residence, with the mothers living in the rural area exclusively breastfeeding for longer. / Delivery method was an important influence on breastfeeding. In this study the highest caesarean section rate was in the city (76%), with a similar rate in the suburbs (74%) and the lowest in the rural area (53%). Mothers who had a caesarean section were less likely to be exclusively breastfeeding on discharge (35.8% in city, 59.6% in the suburbs) compared to vaginal delivery where the rates were 45% and 74.4% respectively. The adjusted odds ratio for exclusive breastfeeding in caesarean section deliveries in the city and suburban mothers was 0.64 (95% CI 0.46, 0.88). / Conclusion: The study has descried the initiation and duration of breastfeeding (to six months) of babies in the different areas of Zhejiang Province. Separate information is provided on the prevalence of ‘any breastfeeding’ and ‘exclusive breastfeeding'. The factors that are associated with the initiation and duration of breastfeeding in Zhejiang Province are documented. Health promotion programs are needed to change some traditional inappropriate breastfeeding perceptions and to promote ‘exclusive breastfeeding’ in the first six months of life in Zhejiang. Education should be given and regulations should be introduced restricting hospital staff from recommending prelacteal and supplementary feeds unless warranted for medical reasons. The research also shows that there would be a benefit to breastfeeding if delivery and lactation leave were extended to six months and if the incidence of caesarean section could be reduced to levels more consistent with WHO expected levels.