Background: The government in Taiwan has promoted breastfeeding in recent years yet, exclusive initiation rates and continuation of breastfeeding remain low. Maternal attitudes have been found to be better predictors of infant feeding method during the postpartum period than socio-demographic factors. Understanding maternal attitudes related to infant feeding in Taiwan will support the development of better targeted, more effective health promotion programs aimed at increasing breastfeeding rates. Objectives: To examine maternal attitudes toward breastfeeding and the relationship of these factors to breastfeeding duration at six weeks postpartum. The Iowa Infant Feeding Attitude Scale (IIFAS) was translated into Chinese for this study; a secondary aim of the study was to assess the psychometric properties of the translated tool. Design: A prospective longitudinal study. Setting: A public hospital in Taichung City, Taiwan. Participants: Using convenience sample. 140 in-hospital breastfeeding mothers were recruited in the hospital setting to complete the IIFAS. A total of 120 (86%) completed 3 week follow-up interview and of those who continued to breastfeed 102 women (100%) were contacted at 6 weeks and completed the study protocol. Methods: Following a systematic translation procedure, mothers completed IIFAS questionnaire in the hospital. Then, participating women were contacted by telephone at three weeks and six weeks postpartum to obtain information regarding infant feeding status and duration. Results: Maternal breastfeeding attitudes were the only predictive factor of the breastfeeding duration (p=0.05). The Cronbach’s alpha for internal consistency was 0.73. In-hospital IIFAS scores significantly predicted infant feeding methods at six weeks postpartum. 72.9% (n=102) of the mothers were breastfeeding their infants, of which 37 mothers (26.4%) were exclusively breastfeeding, 65 mothers (46.4%) were partially breastfeeding at three weeks postpartum. These102 breastfeeding mothers were continued to be followed through six weeks postpartum. 62.1% (n=87) were still breastfeeding their infants, of which 34 mothers (24.3%) were exclusively breastfeeding and 53 mothers (37.9%) were partially breastfeeding at six weeks postpartum. Insufficient milk supply was the reason most often given for discontinuing breastfeeding. Conclusions: Maternal attitudes were related to breastfeeding duration. This study provides evidence that the translated version of the IIFAS is a valid and reliable tool to assess breastfeeding attitudes among Taiwanese mothers in the population tested. Breastfeeding rates showed that the low rates of exclusive breastfeeding. Health professionals might use this tool to identify mothers at increase risk for not continuing with exclusive breastfeeding and intervention strategies need to be developed to improve rates of successful exclusive breastfeeding.

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Yes / Breastfeeding is important to infant health and survival in sub-Saharan Africa. To promote breastfeeding effectively, understanding of psychological factors associated with infant feeding choices is required. This study investigated breastfeeding attitudes and health locus of control (HLoC) in a Nigerian community sample. Men and women (N=400) (71% female; mean age 34.2 years/ range 18–86 years) were recruited through community groups in Nigeria. Self-report survey by questionnaire measured breastfeeding attitudes using the Iowa Infant Feeding Attitude Scale (IIFAS) and health locus of control using the Multidimensional Health Locus of Control Scale (MHLoCs). IIFAS scores (mean=57.7; sd=7.8) became less favourable with increasing age (p=0.02). Men had higher IIFAS scores (mean=58.6; sd=7.6) than women (mean=56.6; sd=8.0) indicating more favourable attitudes toward breastfeeding (p=0.02). Women scored higher than men on external chance HLoC (ECHLoC) (p=0.003) and external powerful others HLoC (EPHLoC) (p=0.02). Increasing age was associated with higher scores on ECHLoC (p<0.01) and EPHLoC (p<0.01). Multiple linear regression analysis was significant (p<0.001) and explained 7.8% of variance in breastfeeding attitude. Lower IIFAS scores, reflecting more negative attitudes to breastfeeding, were associated with higher ECHLoC (p<0.01) and EPOHLoC (p<0.05). Higher IIFAS scores, reflecting more positive attitudes to breastfeeding, were associated with greater IHLoC (p<0.01). Neither age nor gender were associated with IIFAS scores in the final model. This implies a need to explore health locus of control when promoting positive attitudes to breastfeeding and supporting families in breastfeeding advocacy.

Exclusive breastfeeding and holistic maternity care are strategic to improving maternal and infant health outcomes in Nigeria. This thesis aimed at informing policies and interventions to promote breastfeeding and to improve Nigerian mother’s experiences in antenatal and intrapartum care. The study in this research focused upon psychological dynamics underlying societal culture around maternity and breastfeeding. Using quantitative method, attitudes toward breastfeeding and health orientation were surveyed in 400 Nigerian men and women using the Iowa Infant Feeding Attitude Scale (IIFAS) and the Multidimensional Health Locus of Control Scale (MHLoC). There were more positive attitudes toward breastfeeding in males, participants in the 20-29-year-old age category, and in those who identified as single. Higher internal HLoC was associated with more positive attitudes to breastfeeding and higher EHLoC scores were associated with more negative attitudes to formula feeding. The second study explored the experience of pregnancy and childbirth in Nigerian women. Qualitative interviews with 12 women implied that Nigerian women perceive pregnancy and childbirth as a multidimensional experience comprising physiological and psychological elements and also as risky. Control mechanisms that reflected internal HLoC included choosing multiple antenatal care sources to obtain holistic care, adopting new technology in bridging perceived communication gaps with health care providers and adopting physical and mental strategies in controlling the somatic and sensory changes that accompany pregnancy. Pregnancy and childbirth were viewed through an external HLoC lens as spiritual, and reflected in an entrenched belief in the intervention of deity to mitigate pain and risk associated with childbirth. These results have implications for practice, intervention and policy to promote breastfeeding at the societal level and improve maternity services for the current and next child-bearing generation.