The study objective was to identify demographic, medical, and health behavior factors that predict breastfeeding initiation in a rural population with low breastfeeding rates. Participants were 2323 women who experienced consecutive deliveries at 2 hospitals, with data obtained through detailed chart review. Only half the women initiated breastfeeding, which was significantly associated with higher levels of education, private insurance, nonsmoking and non-drug-using status, and primiparity, after controlling for confounders. Follow-up analyses revealed that smoking status was the strongest predictor of failure to breastfeed, with nonsmokers nearly twice as likely to breastfeed as smokers and with those who had smoked a pack per day or more the least likely to breastfeed. Findings reveal many factors placing women at risk for not breastfeeding and suggest that intervention efforts should encourage a combination of smoking cessation and breastfeeding while emphasizing that breastfeeding is not contraindicated even if the mother continues to smoke.

Vital statistics data were statistically analyzed to determine who is breastfeeding in central Kentucky and if factors differ between those in a WIC and non-WIC population. The sample consisted of 479 postpartum women aged 18-44 in central Kentucky. Participants in the study were analyzed as a whole, then divided by their participation in the WIC program (n=304) or non-participation in the WIC program (n=175). Variables recorded in the vital statistics form were analyzed. These variables included age, education level, marital status, and ethnicity of the mother, household income status, and gender, gestational age, and birth weight of the infant. In the population studied, education level, ethnicity, marital status, household income status, and gestational age of the infant were significantly different between mothers who initiated breastfeeding and those who did not. In the WIC population, mothers were more likely to initiate breastfeeding if they were of non-white ethnicity or if the infant was born at greater than 37 weeks gestation; whereas, in the non-WIC population, mothers were more likely to initiate breastfeeding if they had some college or a college degree or if they were not enrolled in Medicaid. WIC participants were significantly less likely to initiate breastfeeding than non-WIC participants.

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.

Magister Scientiae (Nutrition Management) - MSc(NM) / Despite evidence-based proof on the benefits of breastfeeding, little progress has been made globally to improve breastfeeding rates (The Lancet, 2016), including in South Africa. Despite many attempts to improve breastfeeding rates worldwide, women are still choosing to stop breastfeeding or avoid it due to various factors (The Lancet, 2016). Aim: To explore the factors influencing the exclusive breastfeeding rate within the first 14 weeks postpartum with mothers in the Khayelitsha Eastern Substructure.

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Kvinnans amning har många olika hälsofördelar både för den nya mamman men också för hennes nyfödda. Amning har ett antal olika hälsofördelar, till exempel utvecklingen av barnets immunsystem och tarmflora. Genom kvinnans amning främjas deras första kopplings- och interaktionsfas mellan modern och det nyfödda och därmed en större möjlighet till framgångsrik amning. / The woman's breastfeeding has many different health benefits both for the new mother but also for her newborn. Breastfeeding has a number of different health benefits, such as the development of the baby's immune system and intestinal flora, for example. Through the woman's breastfeeding, their first connection and interaction phase between the mother and the newborn is promoted and thus a greater opportunity for successful breastfeeding.

Background: Breastfeeding confers health and social benefits on both mother and baby and is thus a key global public health priority, with exclusive breastfeeding for the first six months recommended. A variety of factors can influence a woman’s decision to initiate breastfeeding but a short duration of breastfeeding appears to be common in developed countries. In the UK, promotion of breastfeeding has been government policy since 1974 and gradually the incidence has increased. In Scotland in 2010 the incidence was 74% but by one week 17% of women had given up. A minority of women find that their babies attach easily at birth and more than half report problems at this time. The prevalence of exclusive breastfeeding falls sharply in the first few weeks and the introduction of formula is associated with a shorter duration. It is therefore crucial to understand what happens at this time to enable women to continue breastfeeding effectively. Study Aim: To use Social Cognitive Theory (SCT) to explore and help explain the expectations, knowledge and experiences of women and midwives with regard to breastfeeding initiation. Methods: A systematic review of qualitative studies synthesised using thematic analysis and SCT was conducted and afforded insight into what had been known before and highlighted further aspects that needed to be explored with a qualitative study. The qualitative study was comprised of five focus groups with ten antenatal women, eight postnatal women and eighteen midwives. Photographs included in a leaflet “Feeding cues at birth”, and the chart of “Feeding cues after the first few hours” were developed and used as focussing exercises during the focus groups and interviews. The focus groups and interviews were recorded, transcribed and analysed using a hybrid process of inductive and deductive thematic analysis which integrated data driven codes with theory driven codes based on SCT. Results: Twenty one studies were included in the systematic review and identified clear differences in the experiences of women when breastfeeding was going well as compared to when it was going wrong at the start. There were also differences in the midwives’ knowledge, experience and confidence when breastfeeding was going well in contrast to when it was going wrong. The synthesis did not identify any qualitative studies relevant to initiation which explored skin contact, instinctive behaviour or strategies to resolve failure to attach in the first few days after birth, from the perspectives of mothers and midwives. These topics were therefore explored in detail in the qualitative study. Few mothers recruited to my study experienced instinctive behaviour and successful attachment (in SCT enactive behaviour) at birth. The majority of mothers did not experience attachment at birth and struggled to persist and maintain their motivation to enable breastfeeding initiation in an unfamiliar environment. Midwives’ social expectations and environmental circumstances made women centred care difficult. Midwives considered that sleepy babies who were unable to feed were normal, but women were unprepared for this, compounding the difficulties in initiating breastfeeding. The triangulation of the findings from the systematic review and the qualitative study provide a more complete picture of contributory factors to understanding of difficulties in breastfeeding initiation. Conclusion: It is recognised that behaviour interacts with emotions, perceived abilities and the environment, as in triadic reciprocal causation, which affects peoples’ decisions, experiences and abilities to enable the successful initiation of breastfeeding. Social Cognitive Theory could be used as a framework to develop strategies and materials to enhance women’s confidence both antenatally and in the postnatal period. In a minority of women, breastfeeding goes well and is more likely when the baby is an active participant and the midwife a knowledgeable and confident supporter. This is not the case for the majority of women and babies or their midwives. There is a need to consider strategies to develop appropriate skills and environmental changes that would in turn lead to changes in behaviour and successful interventions. More emphasis should be made clinically on facilitating instinctive behaviour. The current position where babies’ sleepy behaviour is considered normal in this particular environment could be challenged. Social Cognitive Theory could be utilised in research to develop strategies to increase women’s and midwives’ confidence specifically in initiation.