Abstract
BackgroundBreast milk is the best source of essential nutrients and bioactive components for infants under 6 months. However, little is known about what affects breastfeeding intentions and practices of Chinese mothers. With measures of individual, setting, and sociocultural factors, this study examined determinants of exclusive breastfeeding in the first 6 months of infancy in China.MethodsData were obtained from a national cross-sectional survey in China in 2018 that included 5237 infants under 6 months with available measurements of breastfeeding. A 24-h reported food recall method was applied to assess breastfeeding and complementary food intake in the past 24 h. Potential breastfeeding determinants categorized into six aspects were measured: (1) infant health, (2) maternal sociodemographic characteristics, (3) maternal health, (4) breastfeeding support from family, friends, and workplace, (5) social support for breastfeeding, and (6) maternal breastfeeding experiences and knowledge. Reasons for non-commencement or early cessation of breastfeeding were evaluated for non-breastfed infants. For breastfed infants, multivariate logistic regression was used to explore the determinants of exclusive breastfeeding.ResultsAbout 30 % (29.5%) of infants under 6 months were exclusively breastfed; 2.3% (2.3%) had never been breastfed and 3.2% had ceased breastfeeding. No breast milk (60.7%), maternal illness (13.9%), and infant illness (13.1%) were the top three reasons for non-commencement of breastfeeding. Insufficient breast milk was the reason given for ceasing breastfeeding early by almost two thirds of caregivers who had stopped breastfeeding. The following factors were associated with exclusive breastfeeding: maternal higher education, formal employment with ≥6 months of paid maternity leave, support of the husband and best friends for breastfeeding, a breastfeeding-supportive society, and better breastfeeding knowledge and experiences (a previous successful breastfeeding experience ≥6 months and early initiation of breastfeeding). Maternal age of ≥40 years, caesarean delivery, and infant disease history were associated with non-exclusive breastfeeding.ConclusionsThe exclusive breastfeeding rate is still very low in China. Multidimensional barriers contribute to this situation. A comprehensive intervention framework is needed to increase optimal breastfeeding and achieve substantial public health gains.
Highlights
Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months
Using data from a recent cross-sectional survey, this study aimed to explore determinants associated with maternal practices of exclusive breastfeeding in China
Among 5237 infants included, around two thirds of them were in cities, 50.0% were boys and those in each month age group accounted for 15.6 –18.2% of all surveyed infants (Table 1). 86.1% of the mothers were of Han ethnic group and 13.9% were of ethnic minorities. 15.5% of the mothers were 35 years old or older and 39.4% had a college or higher school education
Summary
Breast milk is the best source of essential nutrients and bioactive components for infants under 6 months. The 2012 World Health Assembly (WHA) set one of the global nutrition target as increasing the exclusive breastfeeding rates up to 50% by 2025 [6]. The exclusive breastfeeding rate measured by a 24-h diet recall increased from 24.9% in 1993 to 35.7% in 2013 globally; the corresponding rates were 47% in low-income countries, 39% in lower-middle-income countries, and 37% in uppermiddle-income countries [4]. The Under-5 Child Nutrition and Health Surveillance System shows that the prevalence of exclusive breastfeeding measured by diet recall of the previous 24 h increased from 16.14% in 2013 to 34.90% in 2018 in China, with an annual percent of change of 14.90% [8]
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