INTRODUCTION: Father support has recently been associated with increasing breastfeeding rates, but there is limited research on how the American father’s perspective of breastfeeding rates affect those rates. AIM: The aim of this study was to investigate the perspective American fathers have on breastfeeding and understand if it contributed to mothers’ decisions to initiate and continue exclusive breastfeeding for at least six months. METHODS: This study analyzed 10 semi-structured in-depth interviews conducted with both fathers and mothers of ever-breastfeed infants at least six months of age. Interviews were transcribed verbatim and openly coded to identify common themes, and then analyzed using principles of grounded theory. RESULTS: Results suggested that mothers were often the lead decision makers in the decision to breastfeed based on her prepartum knowledge of breastfeeding and its benefits. Many fathers had no prepartum perspective of breastfeeding, though they were not opposed to it. Those fathers who had prepartum opinions about breastfeeding traced their beliefs about breastfeeding to their families’ cultures or traditions. DISCUSSION: Data suggested that among this population of 30 – 44 year old educated, heterosexual married couples breastfeeding was common, but the recent increasing rates may not necessarily be influenced by the American father's perspective of breastfeeding.

The overall objective of this thesis is to investigate factors that influence the utilization of maternal services, infant feeding and postpartum contraception practices in rural Vietnam. Field studies were carried out in a rural district of Thanh Hoa, a province located in North Central Vietnam. Willingness-to-pay for maternal preferences was measured in a sample of 200 postpartum and 196 pregnant women, as well as 196 men using the payment card technique. An association was found between satisfaction with the quality of maternal services and willingness-to-pay. There were no significant differences in willingness-to-pay values between prenatal and postpartum groups, and between male and female subjects. The feasibility, reliability and validity of a 20-item scale for measuring perceived quality of maternal services provided at commune health centres, were examined based on a sample of 200 postpartum and 196 pregnant women. The instrument was found to have good inter-rater reliability and internal consistency. Maternal status of clients (prenatal vs. postnatal) was found to influence the perceived quality of maternal services. Determinants of the utilization of maternal services at the primary health care level were investigated in a sample of 200 postpartum women together with sixteen focus group discussions and 16 in-depth interviews. The results showed that client-perceived quality of services and socio-cultural, and economic factors, rather than geographical access, could affect the utilization of maternal services. Factors affecting infant feeding practices were measured in a longitudinal study of 463 women at weeks one, 16 and 24 postpartum. Within the first week after delivery, the initiation and exclusive breastfeeding rates were relatively high at 98.3% and 83.6% respectively, but the premature introduction of complementary food was a great concern. / Exclusive breastfeeding dropped from 83.6% at week one to 43.6% at week 16, and by week 24, no infant was exclusively breastfed. Home-cooked solid food was introduced by 4.8%, 40.9% and 74.3% at weeks one, 16 and 24, respectively. Logistic regression analysis showed that, together with socio-cultural determinants, factors related to the mother, such as education level and occupation, and infant related factors could influence the initiation and exclusive breastfeeding within six months postpartum. The practice of contraceptive use within six months postpartum was also examined in a prospective study of 463 postpartum women. The proportion of contraceptive users at weeks 16 and 24 were 17.4% and 43.4% respectively. At week 24, of contraceptive users, 57.3% used IUD, 25.1% used condom, and 13.6% used traditional methods. Logistic regression analysis found age, sufficient knowledge on contraceptives and husband/partner opinion can significantly affect the contraception decision. The results of the study indicated that good physical access does not necessarily increase the utilization of maternal services due to institutional, environment and individual barriers. Client-perceived quality of services, socio-cultural and economic factors are important determinants of the utilization of maternal services. In view of the observed low rates of exclusive breastfeeding and contraception, there is a risk of unwanted pregnancy for women within six months postpartum. To improve maternal and child health status, health workers need to be trained in terms of inter-personal communication and counselling skills, and be appropriately supervised by district health authorities. Mobilizing the participation of the community and family, especially men to share the workload with women, would play a crucial role in the improvement of childbirth, contraception and breastfeeding practice.

This population-based retrospective cohort study describes breastfeeding patterns and identifies the determinants of longer exclusive breastfeeding among 4,533 mother-infants pairs in two regions of Nova Scotia, Canada between 2006 and 2009. Multivariate logistic and proportional hazard regression analyses were used to model breastfeeding practices. While 64.1% (95% CI=62.7-65.5) of mothers initiated breastfeeding, only 10.4% (9.5-11.4) of mothers exclusively breastfed for the recommended six months; 21% (19.7-22.3) of mothers continued to breastfeed at six months, but not exclusively. Six risk factors are independently associated with poorer breastfeeding practices: lower maternal education, no partner, higher pre-pregnancy body mass index, smoking during pregnancy, no breast contact between dyads within one hour of birth, and no intention of breastfeeding. Rates of exclusive breastfeeding remain lower in these districts than elsewhere in Canada. Understanding determinants of longer exclusive breastfeeding is critical to assist policy makers and health care providers in better supporting mothers and newborns.

Master of Public Health - MPH / Evidence on the benefits of breastfeeding for child survival, growth and development is published extensively. Breastfeeding is an "unequalled" way of providing ideal food to infants and young children to promote good health, growth, development and to attainment of their full potential. Despite initiatives and programmes to promote uptake of exclusive breastfeeding, this practice remains sub-optimal in Zimbabwe. This study explored factors that influence breastfeeding decisions and practices based on mothers' own breastfeeding experiences. Methodology: This study employed a phenomenological research design. Information collected from mothers using in-depth interviews was triangulated with that from key informants. Interviews were audio-tape recorded and transcribed verbatim in Ndebele and then translated to English. Thematic analysis was used to compare various accounts from study participants to identify similar and related themes. Findings: Mothers could not differentiate exclusive breastfeeding from predominant and partial breastfeeding. Barriers to exclusive breastfeeding were: (i) Poor understanding of exclusive breastfeeding and its benefits; (ii) Use of herbal infusions; (iii) Practice of giving babies water; (iv) Perceived insufficient breastmilk production; (v) Myths and misconceptions; (vi) Breast conditions; (vii) Tradition (viii) the HIV epidemic; and (ix) Employment. Enabling factors were: (i) Adequate food for the lactating mother; (ii) Family support; (iii) Support from husband; and (iv) Knowledge of the benefits of exclusive breastfeeding.

This study explored the factors which affect the feeding and weaning practices of Emirati mothers as well as the experiences and perceptions which influence their breastfeeding decisions. It used both quantitative and qualitative methods to examine Emirati mothers’ understanding of infant feeding and to identify the factors which appeared to have a relevant effect and locate them in their cultural context. n the survey, a convenientce sample of 593 mothers with infants aged up to 2 years was interviewed face to face in the maternal and child healthcare centers in Al Ain, Dubai and Abu Dhabi. The interview was based on a pretested structured questionnaire. The results of multiple logistic analysis showed that the time of initiation of the first breastfeed was significantly associated with the infant’s birth weight (OR=2.007; P<0.023), parity (OR=2.139; P<0.001) and rooming in (OR=21.70; P<0.001). As for the feeding patterns, the results of the multiple logistic analysis revealed that rooming in (OR=4.485; P<0.001), feeding on demand (OR=2.290; P<0.005) and feeding more frequently at night (P<0.001) emerged as significant factors associated with exclusive or almost exclusive breastfeeding practices. The duration of breastfeeding rate was significantly influenced by many variables. Concerning the duration of lactational amenorrhea, the, the multiple logistic analysis showed that mother's age, breastfeeding duration and the early introduction of formula milk and solid food emerged as significant variables. Among the 593 infants in the study, 24.1% were predominantly breastfed,25% of the infants were exclusively breastfed, and 49.4% were almost exclusively breastfed since birth. Fifteen Emirati mothers from each city were interviewed about their breastfeeding practices, beliefs and perceptions. The following themes emerged: the influence of others, the sources of information, infants’ behavior, knowledge of and attitudes towards current WHO recommendations and mothers’ perception of the benefits of breastfeeding. Health promotions and healthcare facilities failed to deliver the message of the importance of exclusive breastfeeding. Grandmothers and mothers-in-law appeared to influence the mother's breastfeeding practices. In conclusion, there is a need for a national community-based breastfeeding intervention programme for the promoting exclusive breastfeeding practices as part of a primary public health strategy.

Background: Breastfeeding is widely recognised as the ideal approach for improving child survival and feeding new-born babies and young infants. The World Health Organisation (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life with timely introduction of complementary foods at 6 months and continued breastfeeding for up to two years and beyond. The feeding practices of mothers are widely influenced by different factors which may be embedded within different contexts of life. Aim: This study explored the infant feeding practices of mothers and/or caregivers of infants below the age of 6 months. Method: This cross sectional study was conducted in four provinces in South Africa. In total, 40 health facilities were randomly selected in the four provinces and visited including metropolitan and non-metropolitan health facilities over the geographical area of the provinces. Fixed structured interviews were conducted and data on the feeding practices of mothers were collected using a questionnaire which had both open and closed-ended questions. Qualitative data were coded under different themes. The sample size comprised of mothers and/or caregivers of babies aged 6 months and below. A 24-hour recall was completed for all infants. Dietary intake and diversity were assessed using the FAO dietary diversity list consisting of 12 different food groups. Descriptive statistics, crosstabs and Pearson chi-square tests were used. Results: A total of 580 mothers/caregivers of infants below the age of 6 months were interviewed. Ninety-five % (n=551) were biological mothers. A total of 490 (85%) were breastfeeding at the time of the interviews. Ninety % had initiated breastfeeding during the first hour after delivery. At the time of the study, 12% (n=4) of the women were practising exclusive breastfeeding (EBF) for the recommended 6 months. Sixteen % (n=90) were not breastfeeding at the time the interviews were conducted. More than two thirds (64%) had exclusively breastfed their infants but stopped at the time of the interviews and 36% (n=32) did not breastfeed their babies at all. Twelve % (n=4) of the mothers stopped breastfeeding from as early as one month. The most cited reasons by the participants for breastfeeding cessation were the need to return to work or school. Reasons for not breastfeeding at all included the mothers HIV status, poor health and insufficient milk production. Forty-one % (n=239) of the mothers believed that breastfeeding contains adequate nutrients for the child and 5.7% (33) did not know why breastfeeding is important. Nearly half (49%) were giving infant feeding formula. Seventy % (n=220) of the women were giving either infant feeding formula or other liquids in addition to breast milk. The most stated reason for giving other liquids or foods was the belief that breast milk was not enough for the infant. Almost two thirds (56%) of the mothers gave their infants fortified infant feeding formula. Only one infant (0.2%) met the minimum standard of dietary diversity. Complementary food was introduced from as early as one month, and 73% of the women reported that their infants were receiving dietary supplements. Conclusion: Breastfeeding still remains a universal practice in the country. Sustained exclusive breastfeeding is still a cause of concern and 6 month EBF rates remain very low. Both mothers and caregivers had sound understanding of the importance of breastfeeding. Early initiation of complementary foods is still a norm and wide problem in the country. The dietary diversity of complementary diets given to babies was nutritionally inadequate. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Background: Breastfeeding is widely recognised as the ideal approach for improving child survival and feeding new-born babies and young infants. The World Health Organisation (WHO) recommends exclusive breastfeeding (EBF) for the first 6 months of life with timely introduction of complementary foods at 6 months and continued breastfeeding for up to two years and beyond. The feeding practices of mothers are widely influenced by different factors which may be embedded within different contexts of life. Aim: This study explored the infant feeding practices of mothers and/or caregivers of infants below the age of 6 months. Method: This cross sectional study was conducted in four provinces in South Africa. In total, 40 health facilities were randomly selected in the four provinces and visited including metropolitan and non-metropolitan health facilities over the geographical area of the provinces. Fixed structured interviews were conducted and data on the feeding practices of mothers were collected using a questionnaire which had both open and closed-ended questions. Qualitative data were coded under different themes. The sample size comprised of mothers and/or caregivers of babies aged 6 months and below. A 24-hour recall was completed for all infants. Dietary intake and diversity were assessed using the FAO dietary diversity list consisting of 12 different food groups. Descriptive statistics, crosstabs and Pearson chi-square tests were used. Results: A total of 580 mothers/caregivers of infants below the age of 6 months were interviewed. Ninety-five % (n=551) were biological mothers. A total of 490 (85%) were breastfeeding at the time of the interviews. Ninety % had initiated breastfeeding during the first hour after delivery. At the time of the study, 12% (n=4) of the women were practising exclusive breastfeeding (EBF) for the recommended 6 months. Sixteen % (n=90) were not breastfeeding at the time the interviews were conducted. More than two thirds (64%) had exclusively breastfed their infants but stopped at the time of the interviews and 36% (n=32) did not breastfeed their babies at all. Twelve % (n=4) of the mothers stopped breastfeeding from as early as one month. The most cited reasons by the participants for breastfeeding cessation were the need to return to work or school. Reasons for not breastfeeding at all included the mothers HIV status, poor health and insufficient milk production. Forty-one % (n=239) of the mothers believed that breastfeeding contains adequate nutrients for the child and 5.7% (33) did not know why breastfeeding is important. Nearly half (49%) were giving infant feeding formula. Seventy % (n=220) of the women were giving either infant feeding formula or other liquids in addition to breast milk. The most stated reason for giving other liquids or foods was the belief that breast milk was not enough for the infant. Almost two thirds (56%) of the mothers gave their infants fortified infant feeding formula. Only one infant (0.2%) met the minimum standard of dietary diversity. Complementary food was introduced from as early as one month, and 73% of the women reported that their infants were receiving dietary supplements. Conclusion: Breastfeeding still remains a universal practice in the country. Sustained exclusive breastfeeding is still a cause of concern and 6 month EBF rates remain very low. Both mothers and caregivers had sound understanding of the importance of breastfeeding. Early initiation of complementary foods is still a norm and wide problem in the country. The dietary diversity of complementary diets given to babies was nutritionally inadequate. / MSc (Nutrition), North-West University, Potchefstroom Campus, 2015

Examining Exclusive Breastfeeding Practice in Indonesia, and its Association to Maternal Socio-demographic Determinants, to Inform Intervention Efforts Aimed at Reducing Infant Mortality Introduction Exclusive breastfeeding, the gold standard of infant feeding practices, has been identified as the single most effective strategy to improve child survival. However, this recommendation is not highly practiced in Indonesia, while Indonesia’s infant and under five mortality is still high. Interventions to promote, protect, and support breastfeeding practice are critical public health needs in Indonesia. Aim The current study examined socio-demographic factors associated with exclusive breastfeeding practice in Indonesia: whether maternal age, level of education, occupation status, wealth index, and region of residence, as well as breastfeeding initiation are associated with exclusive breastfeeding practice in Indonesia for mothers having infants up to age five months. Methods This study analyzed 1695 women having infant aged 0-5 month old data from the 2012 Indonesia Demographic Health Survey. Chi-square test was used for preliminary analysis and logistic regression analyses were used to primary analysis by using SAS 9.4 program. Results Exclusive breastfeeding practice in Indonesia was low (36.1%). Mothers aged 30-39 years old were more likely to exclusively breastfeed compare to mothers under 20 years old (OR=1.56, 95% CI 1.04-2.35). Mothers with high education level had higher odds to exclusively breastfeed compare to low education mothers. Unemployed mother were more likely to exclusively breastfeed than working mothers (OR=1.65, 95% CI 1.28-2.13). Mothers coming from richer wealth index were less likely to exclusively breastfeed compare to mothers having poorest wealth index (OR= 0.49, 95% CI 95% 0.34-0.72). Those who initiated breastfeeding early had increased odds to exclusively breastfeed than mothers who delayed breastfeeding initiation (OR=1.47 95% CI 1.19-1.83). Finally, mothers who lived in Eastern Indonesia were more likely to exclusively breastfeed compare to mothers who lived in Sumatera and Kalimantan (OR=1.82, 95% CI 1.30-2.55). Conclusion This study found characteristics of Indonesian mothers who were more likely to exclusively breastfeed compared to the reference group: aged 30-39 years old, high education level, unemployed, richer wealth index, and those who live in Eastern Indonesia; as well as, mother who initiate breastfeeding early. Having tailored strategies and interventions to targeted at-risk populations may increase the likelihood of exclusive breastfeeding practices, and ultimately, decreasing infant mortality rates in Indonesia.

Thesis (PhD (Interdisciplinary Health Sciences. Human Nutrition))--Stellenbosch University, 2008. / Objectives: To determine the impact of facility-based semi-intensive and home-based intensive counseling strategies to improve exclusive breastfeeding rates and to identify factors associated with exclusive breastfeeding. Methods: This was a randomized trial in which villages in the Kibera slum, Nairobi Kenya were assigned to two intervention groups and a control group. Study participants from among 34-36 week pregnant, HIV-negative women, attending antenatal clinic at Lang’ata health centre, were assigned to study groups and followed up in their homes until 6 months postpartum. Experimental group 1, the Home-Based Intensive Counseling Group (HBICG)] received 7 counseling sessions; 1 prenatally and 6 postnatally. Experimental group 2, the Facility-Based Semi-Intensive Counseling Group (FBSICG) received 1 counseling session prenatally. The control group (Control Group) received irregularly provided health education by health personnel. Information on infant feeding practices, using a validated 24-hour recall questionnaire was collected monthly at participant homes; observations were conducted on a random 10% sub-sample to verify the reported information. Qualitative data from focus group discussions provided information on the rationale for feeding choices. Information on infant morbidity and weight measurements were taken on a monthly basis. Results: At six months, exclusive breastfeeding rate was 23.6% in HBICG; 9.2% in FBSICG; and 5.6% in CG. Mothers from HBICG had a 4.2 increased likelihood to exclusively breastfeed compared to those in the CG (RR=4.20; 95% CI; 1.66-10.64; p=0.002). Cumulative exclusive breastfeeding rate for 6 months was 3.2% in the CG; and 6.9% and 15.6% in the FBSICG and HBICG respectively (p<0.00001). Mothers from HBICG had a 3.4 increased likelihood to practice exclusive breastfeeding for 6 months compared to those in CG (RR=3.4; 95% CI: 1-34-8.80; p=0.010). Exclusive breastfeeding rates in FBSICG were insignificantly higher than those in the CG. The median duration of exclusive breastfeeding was one month in both the CG and FBSICG and three months in the HBICG. The predictors of exclusive breastfeeding were non-giving of post-lacteal feeds; planned long breastfeeding duration; living in smaller households; non-ownership of telephones and televisions; absence of breast health problems; and correct knowledge of breastfeeding duration. The major hindrances to exclusive breastfeeding were: inadequate knowledge of exclusive breastfeeding; cultural perceptions about infant feeding; and absence of mother from home for long periods. The prevalence of acute respiratory infections and diarrhoea were significantly lower among exclusively breastfed infants than those non-exclusively breastfed. The prevalence of underweight was significantly lower among the exclusively breastfed infants than those non-exclusively breastfed at one month (p=0.006) and three months (p=0.005). Conclusions: It is feasible to promote and sustain exclusive breastfeeding for six months in low socioeconomic conditions, using the home-based intensive counseling strategy. Breastfeeding promotion programmes should adopt strategies to allow for wider dissemination of information, targeting both mothers and the community at large, as this study showed family members were major decision-makers in the choice of infant feeding practices. Hospital-based breastfeeding education should offer detailed information on a consistent basis. Breastfeeding promotion messages should be re-packaged to address cultural perceptions in infant feeding practices.

Breastfeeding confers immunological, physiological and psychological benefits for the infant and mother as well as social and economic benefits to the nation. The United States Department of Health and Human Servcies (HHS), Healthy People 2020 has established national objectives for the initiation and duration of breastfeeding at 82% initiation, 61% at six months and 34% at one year. In addition, they have set goals for exclusive breastfeeding at 3 months to be 46% and 25% at 6 months of infant's age. Currently breastfeeding initiation is at the highest recorded level of 76.9%, yet significant disparities exist (CDC, 2012). The purpose of this study was to examine the association of acculturation and self-efficacy on breastfeeding behavior of a sample of Hispanic women. Initially the plan was to focus on women from Mexican, Cuban and Puerto Rican countries of origin. However recruitiment goals for only the Mexican population were reached. Two valid and reliable bidimensional instruments were used in addition to collecting contextual information to foster a more comprehensive understanding of the acculturation process. The roles of self-efficacy and social support and their relationship with acculturation measures and breastfeeding behavior was explored. The Non-Hispanic domain subscale of the Bidimensional Acculturation Scale scores were significantly different for those breastfeeding compared to those formula feeding, indicating higher levels of Non-Hispanic domain acculturation associated with not breastfeeding. Acculturation and self efficacy (general and parental) were not found to be related. Breastfeeding outcomes and parental self-efficacy were found to have a significant negative correlation, a finding that was in an unexpected direction, with higher parental self-efficacy associated with decreased breastfeeding intensity. Mixed feeding or Las Dos, is a common finding among Hispanic women especially for the Mexican origin community and exclusivity may not have been perceived as higher value then mixed feeding or formula feeding (Bunik et al., 2006). Rates for exclusive breastfeeding at three months are 33% for both the US as well as for Hispanic/Latino ethnicity (National Immunization Survey, 2007). At six weeks the practice of exclusively breastfeeding (not giving formula) was 17% and this is about half of the 46% goal set for exclusive breastfeeding at three months by (HHS) Healthy People 2020. Of those that were exclusively breastfeeding in the hospital only three were still exclusively breastfeeding at the six week follow up call. This presents a unique opportunity in which targeting Hispanic mothers after discharge may assist in increasing further the rates of exclusive breastfeeding and recommendations are provided.