Breastfeeding In China Research Articles

Perinatal maternal factors influencing postpartum feeding practices at six weeks

ObjectiveDespite the World Health Organization’s recommendation of exclusive breastfeeding for the initial 6 months, breastfeeding rates decline within the first 6 weeks after delivery. This study aimed to (1) investigate the breastfeeding rate at 6 weeks postpartum and (2) explore the influence of perinatal factors on feeding patterns at 6 weeks postpartum.MethodA total of 635 participants were enrolled from February to August 2023 at outpatient clinics in three tertiary hospitals in Nantong City. Variables were collected through questionnaires during the third trimester of pregnancy, including demographic information, pregnancy stress, anxiety, depression, sleep, and resilience. At 6 weeks postpartum, information regarding feeding patterns, delivery and postpartum situations, postpartum stress, anxiety, depression, sleep, and resilience was gathered. Initial single-factor analyses were conducted using feeding pattern as the dependent variable, and variables with significance were chosen as independent variables. The disordered multi-classification logistic regression model was then established using the stepwise forward method.ResultsWithin the first 6 weeks, 35.28% (224/635) of postpartum women exclusively breastfed their infants. Factors influencing exclusive breastfeeding and formula feeding at 6 weeks postpartum included breast pain, sleep quality, mental resilience, difference between postpartum and late pregnancy anxiety, insufficient milk supply, and maternal herself caring for the infant (P < 0.05). Factors influencing the transition from exclusive to partial breastfeeding were insufficient milk supply and maternal herself caring for the infant (P < 0.05).ConclusionThe study reveals a relative low rate of exclusive breastfeeding in China’s first 6 weeks postpartum, along with a comparison of perinatal factors affecting three different feeding patterns. Our findings may contribute additional evidence to the association between perinatal factors and feeding patterns. This study guides healthcare professionals in developing strategies to promote exclusive breastfeeding and improve personalized counseling for exclusive breastfeeding and mental health.

The Current Status of Breastfeeding Knowledge and Its Influencing Factors in Nursing Undergraduates: A Cross-Sectional Study in China.

The aim of this study was to explore the breastfeeding knowledge of nursing undergraduates and the influencing factors. Human milk (HM) is one of the most effective nutritional supplies to improve early development and physical health, but the current status of breastfeeding in China is still not optimal. The breastfeeding knowledge of perinatal women influences their feeding beliefs and behavior. Nursing undergraduates, as core professionals who will care for perinatal women and provide feeding guidance in the future, can significantly affect feeding behavior of mothers and their babies, so their knowledge of breastfeeding may have a potential impact on breastfeeding in China. However, studies on breastfeeding knowledge among nursing undergraduates in China are limited. A convenience sampling method was conducted in four medical universities in China, and eligible nursing undergraduates were selected. An online survey was collected from 5 July 2022 to 5 August 2022. Categorical data were reported as number and percentage, while continuous data were reported as mean ± SD. Multivariate linear regression was used to evaluate the association between influencing factors and breastfeeding knowledge. The overall mean score of the 460 returned questionnaires was 43.991 out of 100. The pass rate of the questionnaire was only 23.04%. Nursing undergraduates had a relatively better grasp of the benefits of breastfeeding and related advice (correct rates: 67.83%). Birthplace, only child or not, the course in obstetrics and gynecological nursing, the course in pediatrics nursing, and placements in maternity or neonatology units were relevant factors for breastfeeding knowledge (p < 0.05). Nursing undergraduates showed unsatisfactory breastfeeding knowledge. It is urgent to raise the knowledge level of breastfeeding among nursing undergraduates. Medical colleges should optimally structure a curriculum of breastfeeding knowledge. Furthermore, it is also necessary to improve the public’s understanding of breastfeeding and the whole society’s attention to breastfeeding in China.

Content analysis of breast milk substitutes marketing on Chinese e‐commerce platforms

China has the largest and fastest‐growing breast milk substitutes (BMSs) market and a disproportionately low exclusive breastfeeding rate. Many BMS manufacturers have established Chinese e‐commerce stores. This marketing is of concern as it is likely to undermine breastfeeding. This study aimed to identify: (1) the marketing themes and strategies used to promote BMSs on the Chinese BMSs e‐commerce websites; (2) if and how digital BMSs marketing may deviate from the World Health Organization Code of Marketing of Breast Milk Substitutes (the Code) recommendations. Content analysis was conducted on the flagship websites of 10 BMSs companies on the Chinese e‐commerce platform “TMall” in July 2019. The main landing page (n = 10) of the flagship TMall website and the product description page (n = 113) of all individual formulas (Stages 1–3) within each company's TMall website were examined. The content was analysed and coded using an iterative thematic analysis approach. Emphasis on Premiumization and Science & Nutrition was the most commonly used marketing approaches. A total of 27.4% of the product description pages sampled used images of infants (<12 months), 33.6% made favourable comparisons of BMSs to breast milk, and only 34.5% included probreastfeeding statements. Marketing strategies were often inconsistent with the Code, and companies used “creative” ways to target mothers, often circumventing the Code recommendations. Unsubstantiated information was commonplace and of concern, because the e‐commerce platform provided easy opportunities for bulk purchases. National regulatory actions are urgently needed to monitor online BMS marketing and the undermining of breastfeeding in China.

Association of Breastfeeding for the First Six Months of Life and Autism Spectrum Disorders: A National Multi-Center Study in China.

Previous studies have shown that exclusive breastfeeding is associated with lower odds of having autism spectrum disorders (ASD) in children, but data are lacking in Asian countries, especially China. This cross-sectional study of seven cities in China collected data from August 2016 to March 2017 from 6049 toddlers aged 16–30 months and their parents who responded to questionnaires. The breastfeeding status was collected via questionnaires based on recommendations from the World Health Organization. The standard procedure for screening and diagnosis was applied to identify toddlers with ASD. Among the 6049 toddlers (3364 boys [55.6%]; mean [SD] age, 22.7 [4.1] months), 71 toddlers (1.2%) were identified as ASD. The prevalence of exclusive breastfeeding, partial breastfeeding, and not breastfeeding was 48.8%, 42.2%, and 9.1%, respectively. Compared to toddlers with exclusive breastfeeding, toddlers with partial breastfeeding or without breastfeeding had higher odds of having ASD (odd ratios [OR]: 1.55, 95% confidence interval [CI]: 0.90–2.74; OR: 2.34, 95% CI: 1.10–4.82). We did not find significant modification of demographic characteristics on the associations. The results remained robust in multiple sensitivity analyses. Toddlers without breastfeeding for the first six months of life had higher odds of having ASD, and our findings shed light on the necessity of strengthening public health efforts to increase exclusive breastfeeding in China.

Exclusive breastfeeding in rural Western China: does father\u2019s co-residence matter?

BackgroundChina suffers from a low exclusive breastfeeding rate. Though it has been proofed that paternal support benefits breastfeeding a lot, the correlation between father’s co-residence and exclusive breastfeeding in China remain undiscovered. This study is to provide population-based evidence for the association of paternal co-residence on exclusive breastfeeding in rural western China. We also attempt to detect how the process works by examining the correlation between the father’s co-residence and breastfeeding family support as well as maternal decision-making power.MethodsA cross-sectional study was conducted in 13 nationally-designated poverty-stricken counties in the Qinba Mountains area in 2019. Data on breastfeeding practices, the status of fathers co-residence, breastfeeding family support, and maternal decision-making power were collected via structured questionnaires from 452 caregivers-infant pairs. Multivariate regressions were conducted to explore the correlation between paternal co-residence and exclusive breastfeeding.ResultsThe exclusive breastfeeding (0–6 months) rate was 16% in rural western China. Fathers’ co-residence was associated with a lower exclusive breastfeeding rate (OR = 0.413, 95% CI = 0.227–0.750, P = 0.004) and the rate did not improve when the father was the secondary caregiver. Even ruling out support from grandmothers, the association was still negative. Paternal co-residence did not improve maternal perceived breastfeeding family support, neither practically nor emotionally (β =0.109, P = 0.105; β =0.011,P = 0.791, respectively) and it reduced maternal decision-making power (β = − 0.196, P = 0.007).ConclusionsFathers’ co-residence is negatively associated with the exclusive breastfeeding rates in rural western China. More skill-based practical and emotional strategies should be considered on father’s education to help them better involvement and show more respect to mothers’ decisions.

A multi-center longitudinal study on responsive breastfeeding in China from the perspective of health equity: research protocol

BackgroundSocio-economic inequities can strongly influence suboptimal infant feeding outcomes. Factors such as lack of knowledge about breastfeeding, low family income, low educational attainment, social and economic status, cultural norms and ethnicity may negatively affect success with offering breastfeeding following a responsive feeding approach (ie. responsive breastfeeding). Such inequities can indeed shorten breastfeeding duration, and negatively affect behavioral and cognitive infant outcomes. In China, there is a dearth of studies focusing on breastfeeding from the responsive and health equity perspective.ObjectiveThe aim of this article is to present a protocol of an ongoing longitudinal cohort study investigating factors associated with responsive breastfeeding behaviors, and the child’s behavioral and cognitive development from birth to12 months post-partum in five centers in China. The study seeks to identify breastfeeding barriers and facilitators from a health equity perspective.MethodsWe are enrolling 700 women and their singleton full term infants in Chongqing, Huizhou and Guangzhou urban and rural areas. The study questionnaires will be administrated within 72 h, 30 days, 3, 6, 9, and 12 months post-partum during the baby’s vaccination visits. We will investigate the difference between urban and rural areas sociodemographic characteristics, breastfeeding knowledge, attitudes and practice, postnatal depression, maternal emotion regulation and parenting stress, and anthropometric and cognitive development indicators of the infants at each time-point.ConclusionOur article illustrates how a cohort study can be designed to understand the barriers and facilitators of responsive breastfeeding taking equity principles into account to help promote infants’ growth and development in China.

WeChat-based intervention to support breastfeeding for Chinese mothers: protocol of a randomised controlled trial

BackgroundExclusive breastfeeding for the first 6 months of life is the optimal way to feed infants. However, recent studies suggest that exclusive breastfeeding rates in China remain low and are well below the recommended target. There has been evidence that a lack of awareness of, or exposure to, breastfeeding information is associated with poor breastfeeding practices. WeChat, the most widely used social networking platform in China, has shown some potential to promote health behaviours. We thus hypothesised that a breastfeeding intervention program delivered via WeChat would achieve at least a 10% increase in exclusive breastfeeding prevalence at 6 months compared to the control group.MethodsA two-arm, parallel, multicentre randomised controlled trial of 1000 pregnant women will be conducted at four maternity hospitals of Chengdu, China. Eligible women who consent to participate in the trial will be recruited at 28–30 weeks of gestation, and randomly allocated to either the intervention group (participants receive breastfeeding-related information from WeChat) or the control group (participants receive non-breastfeeding information from WeChat) using a central randomisation system on a 1:1 ratio at each participating site. The primary outcomes are exclusive breastfeeding rate and full breastfeeding rate at 6 months postpartum. All randomised participants will be included in the outcome analyses with missing data being imputed based on the best-case and worst-case scenarios. Multilevel mixed regression models will be used in the primary analyses to assess the effectiveness of intervention program on the breastfeeding rates.DiscussionThis trial uses the most widely used social media program as a means of delivering messages to mothers to increase exclusive breastfeeding in China. Increasing exclusive breastfeeding will contribute to meeting the health and environmental goals of the Sustainable Development Guidelines.Trial registration ClinicalTrials.gov, NCT04499404. Registered 5 August 2020—Retrospectively registered, https://clinicaltrials.gov/show/NCT04499404

Association between breastfeeding and types of obesity in children and adolescents

Objective To explore the association between breastfeeding and the type of obesity in children and adolescents, and to provide a theoretical basis for the identification and intervention of influential factors of different types of childhood obesity. Methods Using stratified cluster sampling method, 93 primary and secondary schools in 7 provinces and cities in China were selected for physical examination and questionnaire surveys. Totally, 30 437 primary and middle school students aged 7-17, with completed information, were selected. A multivariable Logistic regression model was used to analyze the association between breastfeeding and different types of obesity. Results The breastfeeding rate of students was 69.8%. The rates of general obesity, simple abdominal obesity, and combined obesity in the breastfeeding group were 7.1%, 3.9%, and 18.7%, the non-breastfeeding group were 7.0%, 4.7%, and 19.5%. The differences were statistically significant (χ 2 = 14.04, P <0.01). Univariate analysis found that breastfeeding significantly reduced the risk of simple abdominal obesity in children and adolescents ( OR = 0.81, 95% CI = 0.72-0.92, P <0.01) with normal (BMI non-overweight and obesity and waist <P 90 ) as control group. After adjustment, breastfeeding could still significantly reduce the risk of simple abdominal obesity ( OR = 0.76, 95% CI = 0.67-0.86, P <0.01), and combined obesity ( OR = 0.93, 95% CI = 0.87-0.99, P <0.05). Conclusion Breastfeeding is a protective factor for children with simple abdominal obesity and combined obesity, and the rate of breastfeeding in China should be further improved. 【摘要】 目的 探讨母乳喂养与儿童青少年肥胖类型的关联, 为儿童期不同类型肥胖影响因素的识别和干预提供理论基 础。 方法 采用分层整群抽样方法, 在中国 7 个省市抽取 93 所中小学校学生进行体格检査和问卷调査, 选择母乳喂养等 资料完整的 30 437 名 7〜17 岁中小学生作为研究对象。采用无序多分类Logistic回归模型分析母乳喂养与儿童青少年肥 胖类型的关联。 结果 研究对象母乳喂养率为69.8%。母乳喂养组一般性肥胖、单纯腹型肥胖和复合型肥胖发生率依次 为 7.1%, 3.9% 和 18.7%, 非母乳喂养组为 7.0%, 4.7%和19.5%, 差异有统计学意义 (χ 2 = 14.04, P <0.01)。单因素分析发现, 以正常组 (体质量指数非超重肥胖且腰围< P 90 )为对照, 母乳喂养可降低单纯腹型肥胖的风险 ( OR = 0.81, 95% CI =0.72〜 0.92, P <0.01)。在多因素调整后, 母乳喂养仍可降低单纯腹型肥胖的风险 ( OR = 0.76,95% CI = 0.67~0.86, P <0.01), 并可降 低复合型肥胖的风险 ( OR = 0.93,95% CI =0.87~0.99, P <0.05)。 结论 母乳喂养是儿童青少年单纯腹型肥胖和复合型肥胖 的保护因素, 应进一步提髙中国母乳喂养率。

Breastfeeding in China: A Review of Changes in the Past Decade.

This review summarizes breastfeeding rates in China reported during the decade 2007–2018, a decade on from our previous review published in 2007. Compared with the studies undertaken before 2007 in China, recent studies are more likely to report breastfeeding rates using longer periods of observation, enabling rates to be summarized to six and 12 months postpartum in this review. There appears to have been a modest increase in breastfeeding in China. The mean duration of “any breastfeeding” was 10 months (9 to 11 months in the majority of cities), an increase compared with the previous review in which the mean of “any breastfeeding” duration was 8 months (7 to 9 months in the majority of cities). Using data from cohort studies, the proportion of infants being breastfed at 4 months increased from 78% in the earlier decade to 83% more recently. A second baby is usually breastfed for longer than the first, considering both “any” and “exclusive breastfeeding”. China is a huge country and there is considerable diversity in culture, level of economic development, education and breastfeeding rates in different areas of China, but our review suggests that there has been some improvement in the “any breastfeeding” rate in the most recent decade.

Promoting breastfeeding in Chinese women undergoing cesarean section based on the health belief model: A randomized controlled trial.

Background:The high rate of cesarean section is an important factor affecting breastfeeding in China. To improve the nation's current situation of breastfeeding, promoting breastfeeding in women undergoing cesarean section is essential.Objective:To explore the effects of health belief model-based interventions on breastfeeding knowledge, breastfeeding behaviors, and breastfeeding satisfaction of Chinese cesarean women.Methods:A total of 346 cesarean section women were enrolled in the randomized controlled trial conducted at a center in Chengdu, China, between July 1, 2018 and August 31, 2018. While the control group (n = 173) received conventional breastfeeding guidance only, the intervention group (n = 173) received additional interventions based on the health belief model. Questionnaires were distributed to assess breastfeeding knowledge, breastfeeding behavior, and breastfeeding satisfaction at discharge, 42 days postpartum, and 4 months postpartum, respectively.Results:At discharge from hospital, the breastfeeding knowledge score of the intervention group was higher than that of the control group (Z = −11.753, P < .001). The exclusive breastfeeding rates in the intervention group at the time of discharge, 42 days postpartum, and 4 months postpartum were 67.3%, 60.7%, and 52.9%, respectively, while those of the control group were 41.2%, 41.6%, and 40.4%, respectively. The differences were statistically significant (χ2 = 23.353, P < .001; χ2 = 11.853, P < .001; χ2 = 4.805, P = .03). The breastfeeding satisfaction of the intervention group was also higher than the control group at the time of discharge, 42 days postpartum and 4 months postpartum (t = 4.955, P < .001; t = 3.051, P = .002; Z = −3.801, P < .001).Conclusion:The health belief model-based interventions can effectively increase breastfeeding knowledge for Chinese cesarean women and improve their breastfeeding behaviors and breastfeeding satisfaction within 4 months after delivery.Clinical Trial Registration:ChiCTR1900026006 <http://www.chictr.org.cn/usercenter.aspx>

The effectiveness of using a WeChat account to improve exclusive breastfeeding in Huzhu County Qinghai Province, China: protocol for a randomized control trial

BackgroundAn exclusive breastfeeding rate in the first 6 months of life of at least 50% is one of the six World Health Organization global nutrition targets for 2025. However, the exclusive breastfeeding rate in China is quite low and decreasing which makes it urgent to explore effective ways to reverse the current downward trend. As mobile technologies have rapidly developed, mobile communication apps such as WeChat (one of the largest social networking platforms in China) are well accepted and have the potential to improve health behaviors in a convenient way. The current paper describes the study protocol of a WeChat intervention that aims to promote breastfeeding in rural areas in China.MethodsThe study is designed as a randomized controlled trial in rural Qinghai Province, China. Women who are 14–36 weeks pregnant will be randomized to routine antenatal and postnatal care, or routine care plus the WeChat breastfeeding education. pregnant women with a severe disease and complications of pregnancy or HIV-1 will be excluded. Breastfeeding knowledge and promotion information will be delivered to the intervention group through a WeChat official account from 3 months pregnancy to 6 months postpartum. The outcome assessments are conducted at baseline through face-to-face interviews, and at one week, 1 month, 3 months and 6 months postpartum by telephone interviews. The primary outcome is difference in the exclusive breastfeeding rate at 1 month, 3 months, and 6 months postpartum between the intervention group and the control group. Secondary outcomes include the overall duration of any and exclusive breastfeeding across the first 6 months postpartum; mothers’ knowledge of breastfeeding; the proportion of early initiation of breastfeeding; and the timing of the introduction of solid food to infants. Intention-to-treat-analysis will be used. Survival analysis will be used to compare the overall duration of any and exclusive breastfeeding between groups.DiscussionThis study is the first effort to promote exclusive breastfeeding through WeChat in China. Our results will provide scientific evidence for the effect of health education through WeChat on breastfeeding. Thereby this may offer a comprehensive intervention to promote exclusive breastfeeding in China and other settings.Trial registrationChinese Clinical Trial Registry –ChiCTR1800017364. Registered 26 July 2018. http://www.chictr.org.cn/showproj.aspx?proj=29325

The Patterns and Social Determinants of Breastfeeding in 12 Selected Regions in China: A Population-Based Cross-Sectional Study.

With rapid industrialization and urbanization, there is a growing need for women to enter the workforce, and affluent people are drawn to the infant formula market. The breastfeeding rates in China are below the optimal level. Large scale quantitative research studying breastfeeding practices after 2015 in China are lacking. We aimed to (1) explore the latest patterns and (2) identify the determinants of breastfeeding in China. The study was a population-based, cross-sectional survey. A multi-stage sampling technique was adopted for the selection of participants. We recruited 10,408 mothers with children under 12 months old, in 12 regions of China, and conducted a questionnaire survey about breastfeeding patterns. The associations between social and biophysical determinants and breastfeeding outcomes were analyzed using a logistic regression model. The exclusive breastfeeding rate was 29.32% (n = 3,052) decreasing from 32.71% (n = 3,404) to 15.83% (n = 1,648) among children aged 0-5 months. Cesarean section had a negative association with early breastfeeding initiation (OR = .33, 95% CI [.30, .36]), exclusive breastfeeding (OR = .78, 95% CI [.69, .89]), and predominant breastfeeding (OR = .73, 95% CI [.65, .83]). Compared to participants with an annual household income lower than 40,000 Yuan ($5,817 USD), those with over 100,000 Yuan ($14,542 USD) had an OR of .78 (95% CI [.67, .90]) in exclusive breastfeeding. Compared with illiterate and unemployed groups, middle/high school education and a current work status, respectively, were associated with a lower likelihood of exclusive breastfeeding (OR = .73, 95% CI [.63, .84]; OR = .58, 95% CI [.37, .89]). The prevalence of breastfeeding in 12 selected regions in China was low and interventions focusing on the targeted population should be strengthened.

China should take more measures to raise its breastfeeding rate.

A growing number of studies show that breastfeeding is the best source of nutrition for infants and young children and one of the most effective measures to ensure the healthy growth and development of children. However, a study from the China Development Research Fund found that the rate of exclusive breastfeeding among Chinese infants within six months of birth is only 29%, a rate that is lower than that in other countries and regions of the world. Other data provided by the World Bank shows that the rate of exclusive breastfeeding in China declined from 1998 to 2013 and that it increased slightly by 2018, but it was still lower than the global average. Compared to other Asian countries, the exclusive breastfeeding rate in China is also low. Establishing a sound breastfeeding support system and creating a breastfeeding environment with full support for mothers of infants is a way to effectively improve the state of breastfeeding in China, to ensure the healthy growth of children, and to achieve the goals of Healthy China 2030.

Socioeconomic status and breastfeeding in China: an analysis of data from a longitudinal nationwide household survey

BackgroundSocioeconomic status is an important factor affecting the initiation and cessation of breastfeeding. However, limited evidence exists regarding the association between socioeconomic status and breastfeeding behavior in China on a national level. This study aims to investigate the relationship between socioeconomic status and the initiation and duration of breastfeeding in China.MethodsData were collected from the China Family Panel Studies, a longitudinal nationwide household survey. A total of 2938 infants born between 2010 and 2014 were included in the study. The logistic regression model was used to investigate the relationship between socioeconomic status and the initiation of breastfeeding. Meanwhile, the Cox proportional hazards model was used to investigate the relationship between socioeconomic status and the risk of breastfeeding cessation.ResultsOverall, 90.5% of infants were breastfed, while the average duration of breastfeeding was 8.66 months in China. The breastfeeding continuance rate at 12 months declined sharply, to 30.1%. The study’s findings also indicate that socioeconomic status did not significantly affect breastfeeding initiation. However, infants whose mothers had a high school or higher education and who scored 33–58 on the International Socio-Economic Index of Occupational Status (ISEI) were more likely to experience breastfeeding cessation, as were infants whose fathers had an ISEI score of 59–90.ConclusionsEfforts to promote breastfeeding practices should be conducted comprehensively to target mothers with a high school or higher education, mothers with a medium occupational status, and fathers with a high occupational status.

Breastfeeding duration of different age groups and its associated factors among Chinese women: a cross-sectional study

BackgroundThe current situation of breastfeeding in China has been discussed in many articles, and a declining trend of breastfeeding duration has been confirmed. The associations between various socioeconomic, reproductive factors and breastfeeding duration have been discussed as well. However, there remains a lack of evidence on breastfeeding duration amongst different age groups.MethodsData was extracted from the baseline of a large cohort study: a sample of 300,000 adult women born in the 1930s’ through 1970s’ from 10 geographically distinct regions was obtained. The breastfeeding duration was assumed by breastfeeding duration of the first child. Different age groups were categorized by 10-year age groups, and they were born in 1930–1938, 1939–1948, 1949–1958, 1959–1968, and 1969–1974. Multivariable linear regression was used to evaluate the associations between breastfeeding duration and sociodemographic, and reproductive factors (i.e.: different age groups, education, household size, use of oral contraceptive pills, age at menarche, and age at first birth).ResultsThe mean breastfeeding duration (Standard Deviation) of women born in 1930–1938, 1939–1948, 1949–1958, 1959–1968, and 1969–1974 were 15.4 (9.2), 14.8 (8.2), 14.7 (8.9), 12.8 (7.2), 13.1 (7.2) months, respectively. Younger age groups, higher levels of education, and use of oral contraceptive pills were negatively associated with breastfeeding duration. In particular, the negative association with higher levels of education (for urban regions: βmiddle school = − 1.3, βhigh school & above = − 1.6; for rural regions: βmiddle school = − 0.6, βhigh school & above = − 1.2; all p < 0.0001) was found significant in both rural and urban areas, household size (β = − 0.1, p < 0.0001) and age at first birth (β = − 0.2, p < 0.0001) were negatively associated with breastfeeding duration only in urban areas, but were all positively associated with breastfeeding duration in rural areas.ConclusionsThis research demonstrated that, among Chinese women, younger age groups and higher levels of education were negatively associated with breastfeeding duration. Considering the declining trend of breastfeeding duration in China, healthcare providers need to continue advocating for breastfeeding practices. We also call for collaboration with various sectors and concerned groups to actions that promote breastfeeding-friendly environment and measures.

Efficacy of Chinese herbal medicine Zengru Gao to promote breastfeeding: a multicenter randomized controlled trial

BackgroundBreastfeeding is recommended worldwide but not fully practiced. The first week after childbirth is regarded as a critical period for increasing breast milk production. The aim of the study was to investigate whether Chinese herbal medicine Zengru Gao would result in more women breastfeeding in the first week after childbirth.MethodsA multicenter randomized controlled trial was conducted of 588 mothers considering breastfeeding in China. Among the mothers of the intervention group, the intervention included Chinese herbal medicine Zengru Gao; among those of the control group, it did not. Primary outcomes were the percentages of fully and partially breastfeeding mothers. Secondary outcome was baby’s daily formula intake.ResultsAt 3 d and 7 d after delivery, significant differences were found in favour of Zengru Gao group on the percentage of full/ partial breastfeeding (Z = − 3.0037, p = 0.0027). At day 7, the percentage of full/ partial breastfeeding of the active group increased to 71.48%/20.70% versus 58.67%/30.26% in the control group, the differences remained significant (Z = − 3.0037, p = 0.0027). No statistically significant differences were detected on primary measures at 1 d. While intake of formula differed between groups at 1 d and 3 d, this difference did not achieve statistical significance, but this difference was apparent by 7 d (55.45 ± 115.39 ml/day vs 90.66 ± 153.89 ml/day).ConclusionIn conclusion, Chinese Herbal medicine Zengru Gao enhanced breastfeeding success during one week postpartum. The approach is acceptable to participants and merits further evaluation.Trial registrationChiCTR-IPR-15007376, December 11, 2015.

Socioeconomic status and breastfeeding in China: an analysis of data from a longitudinal nationwide household survey

BackgroundThe benefits of breastfeeding, to infant and mother, are supported by a comprehensive body of evidence. However, in China, only a small proportion of women achieve the breastfeeding recommendation from WHO. Previous studies in high-income countries have found a positive association between socioeconomic status and initiation and duration of breastfeeding. This association might differ between societies and be affected by rapid social and economic development, such as has occurred in China over the past decade. The purpose of this study was to investigate the role of socioeconomic status on breastfeeding initiation and duration in China. MethodsIn this analysis we used data from the China Family Panel Studies (CFPS), funded by the 985 Program of Peking University and undertaken by the Institute of Social Science Survey of Peking University. CFPS is a nationally representative and longitudinal household survey that has been collecting individual, family, and community information annually in China since 2010. CFPS has surveyed 15 000 selected households in 25 provinces or directly governed municipalities. Our analysis included all surveyed children who were born between 2010 and 2014, and excluded children with missing breastfeeding information. We obtained data for initiation of breastfeeding (ie, breastfed or non-breastfed), and duration of breastfeeding time, expressed in months. Socioeconomic status was measured using household income per capita, parental years of education, and parental occupational status. We used Kaplan-Meier time-to-event analysis to compare duration of breastfeeding according to socioeconomic status variables, a logistic regression model to analyse the association between socioeconomic status and initiation of breastfeeding, and a Cox proportional hazards model to analyse breastfeeding duration and socioeconomic status. Sex of infant, birthweight of infant, birthplace, nationality, type of residence, age of parents, residential region, marriage status of mother, parity of mother, and birth year were adjusted for in the logistic and Cox model. CFPS was undertaken according to the guidelines laid down in the Declaration of Helsinki and all procedures involving human participants were approved by the ethics committee of Peking University. Written informed consent was obtained from all participants. FindingsOur sample consisted of 2938 children. 2658 (90%) infants had ever breast-fed, and the mean duration of breastfeeding was 8·66 months (SD 6·15). After adjusting for potential confounders, we found that socioeconomic status variables were not significant predictors for breastfeeding initiation, but that low birthweight babies were less likely to be breastfed than normal weight babies (odds ratio 0·272, 95% CI 0·18–0·42; p<0·0001). As for breastfeeding duration, mothers with a high school or higher education were more likely to breastfeed for longer than those with a middle school or lower education (hazard ratio [HR] 1·15, 95% CI 1·02–1·29; p=0·021), as were infants with fathers with the highest occupation level versus those with fathers with the lowest occupation level (HR 1·29, 95% CI 1·04–1·59, p=0·019). Mother's occupation had an inverted U-shaped relationship with breastfeeding duration (HRs for low, high, and highest occupation level vs lowest occupation level were 1·17 [95% CI 1·02–1·33], p=0·023; 1·29 [1·08–1·54], p=0·005; and 1·11 [0·87–1·42], p=0·408, respectively). InterpretationThe finding that socioeconomic status in China was not a predictor of breastfeeding initiation is different from that reported in high-income countries. Comprehensive efforts to promote breastfeeding practices should be targeted towards women who are less well educated, and those in both the lowest and highest occupation levels, because we found that these variables were associated with shorter breastfeeding duration. FundingSichuan University (skqx201401 and 2015SCU04A19).

Family-Centered Breastfeeding Education to Promote Primiparas' Exclusive Breastfeeding in China.

Few breastfeeding education programs focus on primiparas and the importance of family members on exclusive breastfeeding in China. Research aim: This study aimed to explore the influence of a family-centered breastfeeding education program in promoting exclusive breastfeeding up to 6 months postpartum and to improve women's attitude and knowledge, family members' knowledge, and family support. This was a two-group quasi-experimental design with multiple comparisons. Participants ( N = 59) were randomized to either the intervention ( n = 29) or the control ( n = 30) group. The intervention group received two prenatal breastfeeding education lectures that included important family members, three home visits, eight telephone calls, text or video/audio support, and quality online resources during lactation. The control group received in-hospital care and follow-up by community nurses after discharge. Compared with the control group, the intervention group was more likely to exclusively breastfeed in the first 6 months, odds ratio = 0.44, 95% confidence interval [0.20, 0.98]. The mean knowledge level of the intervention group improved more across time ( p < .05) and was higher than the control group ( p < .05). Perceived family support within the intervention group was significantly higher than the control group from 1 to 6 months ( p < .05). The breastfeeding education program is an effective strategy to promote exclusive breastfeeding in China.

Prevalence of Breastfeeding: Findings from the First Health Service Household Interview in Hunan Province, China.

Background: With the development of economy and urbanization, methods of child-feeding have significantly changed in China over the past three decades. However, little is known about breastfeeding in China since 2009. This study aims to update information on the prevalence of breastfeeding in China. Methods: Data were obtained from the first Health Service Household Interview Survey of Hunan Province, China. Of 24,282 respondents, 1659 were aged five years or younger. We ran multivariable logistic regression to examine the impact of urban/rural setting, gender, age and household income per capita on the use of breastfeeding. Results: A total of 79.4% of children aged 5 years or younger had been breastfed at some point and 44.9% been breastfed exclusively in the first 6 months of life. After controlling for setting urban/rural setting, gender and child age, children from households with average family income were more likely to be breastfed than those from households with the lowest family income (adjusted odds ratio: 2.28). Children from households with higher and the highest family income were less likely to be exclusively breastfed in the first 6 months of life compared to those from households with the lowest family income (adjusted odds ratio: 0.51 and 0.68, respectively). Conclusions: It is encouraging that the prevalence of exclusive breastfeeding for infants in the first 6 months of life in Hunan Province, China is approaching the goal of 50% proposed by the World Health Organization (WHO). Nevertheless, more efforts are needed to further promote exclusive breastfeeding in the first 6 months after birth.

Breastfeeding rates in China: a cross-sectional survey and estimate of benefits of improvement

BackgroundBreastfeeding is the gold standard for infant and young child feeding. Increased rates of breastfeeding could reduce morbidity and mortality for both children and mothers. In addition, breastfed children could have better cognitive development, persisting through later life. However, quantitative data are scarce on the effect of improved breastfeeding rates in China. The objectives of this study were to assess current breastfeeding rates and to analyse the potential effect of improved breastfeeding rates in China. MethodsA national representative survey (Chinese Nutrition and Health Surveillance) of children ages 6 years was done in 2013. Stratified multistage cluster sampling was used to select study patricipants. WHO infant and young feeding indicators were used to assess breastfeeding practice. Lives Saved Tool (version 5·441) was used to estimate death prevented with improved breastfeeding practice. The survey was approved by the National Institute for Nutrition and Health, Chinese Center for Disease Control and Prevention Medical Ethnical Committee. All caregivers signed the consent form. Findings14 539 children aged 2 years and younger (0–730 days) were studied from 55 counties in 30 provinces in China. The weighted prevalence for ever breastfed was 79·6%; 20·8% were exclusively breastfed at 6 months, 11·5% were breastfed at 1 year of age, and 6·9% were breastfed at 2 years of age. The median duration of breastfeeding was 8·63 months. Assuming an increase to 50% exclusively breastfed infants at 6 months, the Lives Saved Tool predicted 19 323 (11 266–22 530) fewer deaths and a reduction in mortality of 5% (from 10·7 per 1000 to 10·17 per 1000) among children under 5 years of age. InterpretationThe rates of breastfeeding in China are low. Improved breastfeeding rates could be substantially reduce mortality in children aged 5 years and younger in China. FundingChinese Central Government