Bakgrund: Amning innehåller all näring ett spädbarn behöver och WHO rekommenderar helamning i sex månader och därefter amning i tillägg till annan kost. Amning medför flera positiva hälsoeffekter för mamma och barn och är även ett miljövänligt och ekonomiskt sätt att ge sitt barn mat. De flesta mammor har en önskan om att amma men många mammor slutar att amma innan barnet är sex månader. Detta skulle kunna minska med rätt stöd. Syfte: Syftet med studien var att undersöka om och var föräldrar får kunskap och stöd gällande amning/uppfödning före och efter barnets födelse samt vilket stöd de önskar. Metod: Kvantitativ metod med deskriptiv ansats valdes för att besvara studiens syfte. En tvärsnittsstudie genomfördes. En enkät utformad som ett frågeformulär med slutna och öppna frågor delades ut till föräldrar som var med vid barnets åttamånaderskontroll på BVC genom ett konsekutivt urval. Totalt 124 föräldrar inkluderades. Data från de slutna frågorna analyserades med deskriptiv statistik. De öppna frågorna analyserades med kvalitativ innehållsanalys. Resultat: De flesta föräldrar (92%) hade tänkt att deras barn skulle helammas från början men endast 37,1 procent av föräldrarna hade tänkt att helamma de första sex månaderna. Det var 29,8 procent av föräldrarna som uppgav att de hade fått helt tillräcklig kunskap om amning före eller under graviditeten. Det var vanligast att denna kunskap hade inhämtats från barnmorskemottagning (59,7%) och därefter från internet (43,5%). De flesta föräldrar (79%) tänkte att de kunde vända sig till BVC med amningsfrågor efter att barnet var fött. Det var från BVC som de flesta (58,1%) föräldrarna fick stöd med amning/uppfödning när barnet var nyfött. Det var även fortsättningsvis BVC som de flesta föräldrarna (54%) fick stöd från när barnet var äldre än fyra veckor. Föräldrarna var nöjda med det stöd som gavs när vårdpersonal var tillgänglig, tydlig, ingav trygghet och upplevdes ha hög kompetens. De var inte nöjda när något av det brast eller när vårdpersonal gav motsägelsefulla råd. Föräldrarna önskade mer praktisk hjälp vid både amning och flaskmatning samt mer förberedande information under graviditeten. Slutsats: Alla föräldrar får inte den information de själva anser att de behöver gällande amning/uppfödning under graviditeten. Mer stöd och utbildning bör ges under denna tid. Barnmorskemottagning och internet är viktiga informationskällor och därför bör lämpliga hemsidor rekommenderas av barnmorskan. Det stöd som föräldrarna får efter barnets födelse kommer främst från BVC men också från andra delar av vårdkedjan, speciellt under de första veckorna. Det stöd och den information som ges bör vara samstämmig genom hela vårdkedjan och bör utgå från ett personcentrerat perspektiv, vara evidensbaserad samt inte vara dömande. / Background: Breastmilk contains all the nutrients an infant need. WHO recommends exclusive breastfeeding for six months and then in addition to other foods. Breastfeeding has several positive health effects for both mother and child and is also an environmentally friendly and economical way to feed a child. Most mothers want to breastfeed but many mothers quit before the baby is six months old. This could be avoided with the right support. Aim: The aim of this study was to investigate if and from where parents get knowledge and support regarding breastfeeding/nourishing before and after the child is born and what support they want. Method: Quantitative method with descriptive approach was chosen to answer the aim of this study. A cross-sectional study was conducted. A survey designed as a questionnaire with closed and open questions was distributed to parents who participated in the child's eight-month check up on the child health services through a consecutive sample. A total of 124 parents were included. Data from the closed questions were analyzed with descriptive statistics. The open questions were analyzed with qualitative content analysis. Result: Most of the parents (92%) had thought their child would breastfeed exclusively from the beginning but only 37,1 percent of the parents had planned to exclusively breastfeed for the first six months. It was 29,8 percent of the parents who stated that they had received sufficient knowledge of breastfeeding before or during pregnancy. Most commonly this knowledge had been obtained from maternal health care (59,7%) followed by the internet (43,5%). Most parents (79%) thought that they could turn to the child health services with breastfeeding issues after the child was born. It was from the child health services most (58,1%) parents received support with breastfeeding/nourishing when the child was newborn. It was also from the child health services that most parents (54%) received support when the child was older than four weeks. The parents were satisfied with the support when healthcare professionals were available, provided clear advice and security and were experienced highly competent. They were not satisfied when this failed or when healthcare professionals gave contradictory advice. The parents wanted more practical help in both breastfeeding and bottle feeding and more preparatory information during pregnancy. Conclusion: All parents do not get the information they think they need regarding breastfeeding/nourishing during pregnancy. More support and education should be provided during this time. Maternal healthcare and the internet are important sources of information and therefore suitable websites should be recommended by the midwife. The support that the parents receive after the birth of the child comes mainly from the child health services but also from other parts of the chain of care, especially during the first few weeks. The support and information provided should be consistent throughout the chain of care and should be based on a person-centered perspective, be evidence-based and not be judgmental.

The dissertation includes two projects. The first one studies the product market segmentation and output collusion within substitutes; the second one examines the effects of WIC program and peers on breastfeeding activities. In Chapter I, we extend the differentiated product model, first developed by Bowley (1924), by relaxing the assumption that each firm produces only one differentiated product. By doing so, we are able to analyze the potential for collusive market segmentation in a two stage decision framework, first in product space and second in output. We find that when firms cannot coordinate on output, the required discount factor that supports collusive market segmentation is strictly decreasing in product substitutability and is greater than partial output and full collusion. Overall we find that output collusion alone is easier to sustain than collusive product market segmentation. In Chapter II, we first use duration analysis techniques to estimate the effects of WIC participation on breastfeeding activities using a nationwide data. Income ineligible participants are excluded from the sample. The models with and without peer effects variables are both estimated. We find that the prenatal WIC participation status does not have significant effect on breastfeeding activities. Peer effects have significant positive effects on both partial and exclusive breastfeeding durations but not on breastfeeding initiation. The magnitude of the peer effects on each individual is different and depends on the individual’s propensity to breastfeed. The results on peer effects based on the full sample are consistent with the findings from restricted sample. Knowing more than five peers who breastfed increases the probability of initiating by 3.7% and the likelihood of breastfeeding at months 3 and 6 by more than 15%. It also increases the partial and exclusive breastfeeding durations by 9 and 3 weeks, respectively. The results suggest the presence of a social multiplier in breastfeeding. Any exogenous change in breastfeeding behavior due to policy interventions would result in an even greater change due to the bidirectional influences within peer groups. Peer effects play a more important role for breastfeeding duration than initiation.

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Background: Breastfeeding amongst HIV-infected and HIV-exposed mother-infant dyads is a wide-ranging and persistent field in which more investigation is needed. The literature widely recognizes the multifactorial and syndemic nature of HIV and infant feeding, specifically pertaining to maternal and other breastfeeding-associated risks. Findings differed regarding breastfeeding and general developmental outcomes amongst HIV-exposed and HIV-infected infants when compared with HIV-unexposed infants. Evidence, however, suggests slight neurodevelopmental differences in HIV-exposed infants when compared with HIV-unexposed infants, suggesting possible feeding differences. Recent literature also indicated a lack of knowledge among allied health care staff regarding evidence-based counselling content to be provided to mothers concerning single option feeding, breastfeeding outcomes and risks in HIV-affected mother-infant dyads in South Africa. Owing to these varied findings related to HIV-affected mother-infant dyads, synthesising of knowledge regarding HIV, infant breastfeeding outcomes and associated risk factors is warranted. Objective: To critically appraise recent literature regarding breastfeeding outcomes and associated risks in HIV-infected and HIV-exposed infants using the PRISMA-P statement guidelines. Method: Five electronic databases were systematically searched to obtain English publications from the last ten years pertaining to breastfeeding outcomes and associated risks of HIV-infected and HIV-exposed infants and children. Grey literature sources were also included. Data were extracted according to various data items and were synthesised using thematic synthesis. Results: Of the initial 7151 sources identified, 42 articles were deemed eligible for final inclusion. The final selection included 19 cohort studies and two expert committee reports, classified as grey literature. The remaining 21 studies compromised of case-control, cross-sectional, and randomized controlled trial studies. The following themes were identified from the review objectives: breastfeeding outcomes, breastfeeding risk factors, infant growth and developmental outcomes and barriers and facilitators to feeding decisions. Most studies focused on HIV-exposed infants’ growth and developmental outcomes. Exclusive breastfeeding was confirmed to have the best outcomes for all infants, regardless of their HIV status, which in turn supports national and international policies. The most prevalent factors that made it difficult for mothers to breastfeeding were maternal factors affecting decision-making for breastfeeding, followed by biological risk factors. Conclusion: Knowledge regarding breastfeeding outcomes in HIV-exposed and HIV-infected infants remains lacking and further research is necessary. This review emphasised that the majority of HIV-affected mother-infant dyads reside in sub-Saharan Africa, illustrating that health professionals, especially those in sub-Saharan Africa (SSA), have to look beyond their traditional assessment and management focuses to include the factors that can impact successful exclusive breastfeeding. Addressing both infants’ needs and maternal HIV-related needs and risks on macro, meso, and microsystem levels is necessary. / Dissertation (MA (Speech-Language Pathology))--University of Pretoria, 2021. / Speech-Language Pathology and Audiology / MA (Speech-Language Pathology) / Unrestricted

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No description available.

Abstract available in the Annals of Behavioral Medicine.

Health organizations around the world, from international bodies of government to local advocacy groups, are pushing the benefits of breastfeeding. While this is commendable, no study has ever been completed to assess on a regional scale the available policy options and their effectiveness at producing increased breastfeeding rates. It is my contention that five key factors influence the effectiveness of breastfeeding policies in Europe; Acceptance of public breastfeeding, maternity resource commitment, legal protection of breastfeeding in public and business space, a united voice in favor of breastfeeding, and limitations to formula advertisements in hospitals on media outlets. These five factors influence how successfully mothers navigate public and private space as they choose to breastfeed their children. In my effort to assess the contextual factors and policies that create an environment conducive to long term breastfeeding rates I am also interested in discovering a set of factors that do not increase the economic vulnerability of women. The emperical analysis derived from data from the WomanStats Database found that a combination of five conditions; social acceptance of public breastfeeding, maternal resource commitment, legal protection of breastfeeding, united voice in favor of breastfeeding, and laws regulating the sale of formula were all necessary in order to produce higher breastfeeding rates in Europe. The data also shows that when countries pursue these five factors female income disparity is not negatively impacted.

Breastfeeding (BF) reduces maternal and infant risk for the development of a variety of short and long-term health outcomes. Appalachia faces several health disparities, with infants at increased risk for poor birth outcomes. The purpose of this study was to explore postpartum patients’ (PP) infant feeding experiences (IFE) and examine perceived barriers to BF among PPs and international board-certified lactation consultants (IBCLC) in Northeast Tennessee, located in Appalachia. PPs and IBCLCS were recruited using convenience and snowball sampling, respectively. Fourteen semi-structured interviews were conducted, 7 PPs and 7 IBCLCs. Interviews were conducted in-person or via Zoom and were recorded, transcribed, and de-identified. PPs were asked about their IFEs and barriers to BF, while IBCLCs were asked about perceived barriers to BF for their patient population. Rapid qualitative analysis was conducted with two coders, both summarizing the first interview for each participant type. Summaries were compared to ensure consistency and subsequent interviews were coded by a single coder. Summaries were used to identify high-level themes related to barriers to BF for each participant type. All analysis was conducted in Microsoft Excel, and the study was approved by the ETSU Institutional Review Board. High-level themes for PP IFEs included stressful experiences and the positive impacts of IBCLCs. Stressful experience sub-themes included latch and supply issues, pump and syringe feeding, PP and infant health complications, lack of hospital support, and expectations for supplementing. Barriers to BF for PPs incorporated physiological (latch and milk supply sub-themes) and environmental barriers (employment and family support sub-themes). High-level themes for IBCLCs perceived barriers to BF included PPs having access to too much information, perceptions and expectations of BF, cultural barriers, lack of support and prenatal education, physiological barriers, and maternal comorbidities. Overlap between PPs stressful IFEs and IBCLCs perceived barriers to BF included themes related to BF expectations, lack of support, physiological barriers, and comorbidities. Similarly, overlap between PPs and IBCLCs perceived barriers to BF included physiological and environmental factors. IBCLCs mentioned additional barriers such as access to too much information and lack of prenatal BF education, while these themes were not identified in PP interviews. A future focus for BF support includes discussions with clinicians after delivery about any physiologic barriers that PPs may face and informing providers on how to both avoid and treat these barriers as they arise to alleviate stress. Connection to BF support in the community before and after delivery could improve the chances that mothers receive help in addressing these issues as they arise. Furthermore, including family members in these discussions may help build family and overall social support.

Breastfeeding offers significant benefits to the breastfed infant as well as the breastfeeding woman. The World Health Organization now recommends exclusive breastfeeding until six months, followed by supplementation and continued breastfeeding to two years or more. Around the world, public health programs endeavour to promote breastfeeding through educational programs. In Brazil, such programming is widespread, and yet less than 30% of women in São Paulo breastfeeding exclusively even to four months post-partum. This study uses a qualitative-quantitative bio-experiential approach to explore the way that stressful experiences and circumstances in the lives of low-income women from the Eastern Zone of São Paulo, Brazil, influence their decision to wean or supplement their infant before 12 weeks post-partum. Sixty-five first-time mothers participated in a 12-week longitudinal study of life stressors and breastfeeding practice. Participants were asked to complete one pre-partum and six post-partum interviews. Narrative and biological data were collected from each participant at each interview. Statistical analysis revealed that among these participants the breastfeeding hormone oxytocin did not mediate breastfeeding duration. Oxytocin appeared to act as a biomarker of stressful experience, while Epstein-Barr Virus antibody titre, a commonly used biological measure of psychosocial stress, did not. Unplanned pregnancy, older age and higher mean oxytocin level were statistically associated with weaned outcome at 12 weeks. Unplanned pregnancy, older age, higher mean oxytocin level, higher mean satisfaction score regarding financial situation and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of any breastfeeding. Unplanned pregnancy, older age and lower mean satisfaction score regarding interpersonal factors were associated with decreased duration of exclusive breastfeeding. Ethnographic analysis revealed that the effect of unplanned pregnancy may be connected to the discourse of the self-sacrificial, child-centric “good mother.” Exclusive breastfeeding was seen as a hallmark of this idealised maternal type. Single women with unplanned pregnancies expressed a great deal of ambivalence towards their own maternity and toward the somewhat unobtainable good mother ideal, especially with relation to the physical and psychological challenges breastfeeding. Women’s ambivalence appeared to influence their decisions to supplement or wean their infants by or before 12 weeks post-partum.