Breastfeeding Intention Research Articles

Workplace support and breastfeeding duration: The mediating effect of breastfeeding intention and self-efficacy.

Given the large proportion of mothers in the United States work force, understanding the implications of workplace support on breastfeeding outcomes is an important public health priority. The current study investigates if (a) workplace support directly influences the working mothers' breastfeeding intention, self-efficacy, and duration, and (b) workplace support indirectly influences breastfeeding duration through the mediating effect of breastfeeding intention and self-efficacy. Data from the longitudinal Infant Feeding Practices Survey II were analyzed. The main predictor variable, workplace support, was based on a Likert scale from "not at all supportive" to "very supportive." Both mediators, exclusive breastfeeding intention and self-efficacy, were dichotomized (yes; no) while the study outcome, breastfeeding duration, was continuous. Structural equation modeling was used to obtain direct and indirect effects of breastfeeding intention and confidence in attaining breastfeeding goals. After adjusting for confounders, there was a statistically significant direct effect between self-efficacy, breastfeeding intention, and breastfeeding duration. A statistically significant indirect effect of workplace support on breastfeeding duration through self-efficacy in attaining breastfeeding goals was also observed. The mediation ratios of the indirect effects showed that self-efficacy in attaining breastfeeding goals accounted for 40.8% (P-value=0.032) of the total effect; however, all other mediation ratios did not show statistical significance. Self-efficacy is an important predictor for breastfeeding duration. Workplaces may help bolster women's self-efficacy by providing environments that are supportive to breastfeeding working mothers. Future research is needed to identify breastfeeding policies that boost self-efficacy.

Acculturation and Breastfeeding Among Hispanic American Women: A Systematic Review

Introduction Hispanic immigrants are more likely to breastfeed than are Hispanics born in the US, in part due to their acculturation. This paper aims to systematically review the existing literature on the association between acculturation and Hispanics' breastfeeding behaviors. Methods The systematic search used major databases such as Medline and PubMed, and it followed the PRISMA checklist. The scientific quality of the studies was rated using the Quality Assessment Tool for Quantitative Studies. Results We identified 1943 potential citations, of which 18 studies met the eligibility criteria. Overall, while 13 studies suggested that high-acculturated Hispanics were less likely to breastfeed compared with low-acculturated, five studies did not find significant evidence of such an association. Moreover, 12 studies used a static measure or a linear scale, which is not optimal; only three studies utilized bi/multidimensional scales to assess acculturation. Intention to breastfeed was examined in six studies, but the results were inconsistent. Breastfeeding initiation was examined in 11 studies, and two out of eight studies that examined breastfeeding duration, specifically analyzed exclusive breastfeeding at 6months. Discussion Our results agree with the general hypothesis that higher acculturation is inversely related to breastfeeding rates, independently of income. Researchers used different methodologies to study acculturation and breastfeeding practices, limiting our ability to reach more detailed conclusions. Owing to the lack of a standard methodology for measuring acculturation, future studies should utilize bi/multidimensional scales when studying breastfeeding, in particular, in relation to breastfeeding intention and exclusive breastfeeding at 6months; preferably according to Hispanic subgroups.

The best of intentions: Prenatal breastfeeding intentions and infant health

Health organizations recommend that mothers exclusively breastfeed infants for the first six months of life. The current study contributes to a growing body of research that examines whether the purported benefits of breastfeeding are causal. We systematically evaluated the role of an expectant mother’s prenatal breastfeeding intentions, which reflect not only demographic characteristics, but also knowledge, attitudes, and social norms about infant feeding, and therefore serve as a proxy for positive maternal selection into breastfeeding. We used the Infant Feeding Practices Study (IFPS) II (n = 1008) to examine a heretofore overlooked group of mothers—those who intended to breastfeed but did not actually breastfeed. Results suggest that mothers who intended to breastfeed had infants with fewer ear infections and respiratory syncytial viruses, and used fewer antibiotics in the first year of life compared to infants whose mothers did not intend to breastfeed, irrespective of whether they actually breastfed. Because breastfeeding intention is a confounding characteristic that proxies for positive maternal selection and does not represent a causal mechanism for infant health, we further examined how mothers who intended to breastfeed differed from mothers who did not intend to breastfeed. Results suggest that mothers who intended to breastfeed had more knowledge about potential food contaminants and consulted more sources of information about nutrition and diet than mothers who did not intend to breastfeed. Taken together, our results underscore the need for new policy interventions aimed at improving infant health.

Educational intervention about breastfeeding among secondary school students

PurposeBreastfeeding education in the school setting offers the opportunity to improve knowledge base and positively influence beliefs and intentions for students. The purpose of this paper is to analyze the effect of short education program among secondary school students on breastfeeding knowledge and intentions.Design/methodology/approachTotal of 106 female and 155 male students from four different high schools in Bjelovar were given online questionnaire about intentions to breastfeed and test of knowledge about breastfeeding, both before and shortly after education. The effect of education and school on breastfeeding intentions and knowledge was examined using mixed design ANOVA. Univariate tests were used to examine relation of several independent variables to breastfeeding intention and knowledge scores before and after education.FindingsResults showed statistically significant effect of education on both intentions and knowledge, whereas the effect of school was significant only for intentions. Students show more positive intentions and better knowledge about breastfeeding after education than before education.Research limitations/implicationsThis paper does not entail validation of breastfeeding questionnaire and knowledge test. Due to comprehensiveness and report length, study on validity and reliability of measures is the subject of another paper.Practical implicationsThe authors hope that results of the study will influence professional public in Croatia and encourage it to support implementation of breastfeeding education in curriculum.Originality/valueThis paper offers the first national intervention data in relation to breastfeeding intentions and knowledge among secondary school students. It provides an evidence for necessity of implementation of well-structured education module in regular curriculum of secondary education in Croatia.

Does the Degree of Acculturation Influence Breastfeeding Intention and Start or the Frequency of Early Weaning? Results of a Prospective Observational Study.

Objectives Recent breastfeeding studies from immigration countries have found that acculturation factors influence breastfeeding behaviour in women with a migration background. To date, there has been no systematic investigation for Germany. Therefore, we study whether and how the degree of acculturation within a population of migrant women influences the start, time and duration of breastfeeding. Patient Population and Methodology Pregnant women who were admitted to one of the three participating maternity clinics in Berlin for the birth of their child in the one-year study period were surveyed (including sociodemographic details, data on migration/acculturation). These women were interviewed again two or three days post partum (including start of breastfeeding, planned breastfeeding duration, reasons for not breastfeeding). In a subgroup, a telephone interview took place 6 months post partum about the actual breastfeeding duration, contraceptive behaviour post partum and availing of midwife services following delivery. Breastfeeding behaviour was analysed using multivariate regression models, among other things. Results The prepartum survey included 7100 women, 6884 women were contacted in the postnatal wards, and the subgroup six months after delivery comprised 605 women. No acculturation-related differences were found in the start of breastfeeding. In the adjusted model, a medium and higher degree of acculturation diminished the chance of planning a long breastfeeding period. More acculturated women show a greater risk of weaning within the first six months than less acculturated women. Conclusion The degree of acculturation has relevant significance for some aspects of breastfeeding behaviour in women with a migration background. This should be considered both in breastfeeding promotion programmes and in further national breastfeeding studies.

Agreement between Future Parents on Infant Feeding Intentions and Its Association with Breastfeeding Duration: Results from the Growing Up in New Zealand Cohort Study.

Maternal intentions are believed to have the strongest influence on infant feeding. However, what has rarely been studied, are the associations of maternal and partner intentions, and the influence these factors have on infant feeding. Our objective was to describe breastfeeding intentions of pregnant women and their partners, agreement about these intentions, and whether this agreement is associated with breastfeeding initiation and duration. This study was completed within the Growing Up in New Zealand study. Agreement between mothers and partners on intended initial infant feeding method was fair (κ = 0.21, 95% confidence interval (CI) 0.17–0.25) as was intended breastfeeding duration (κ = 0.25, 95% CI 0.22–0.28). Infants whose parents agreed antenatally on breastfeeding only were more likely to have been breastfed for >6 months, after adjustment for maternal (odds ratio (OR) = 6.3, 95% CI 3.9–10.2) and partner demographics (OR = 5.7, 95% CI 3.6–9.2). Likewise, infants whose parents agreed antenatally to breastfeed for >6 months were more likely to have been breastfed for >6 months, after adjustment for maternal (OR = 4.9, 95% CI 3.9–6.2) and partner demographics (OR = 5.0, 95% CI 4.0–6.3). Interventions that promote breastfeeding to both mothers and partners which enable parents to reach agreement about intended feeding methods have the potential to increase both breastfeeding initiation and duration.

Effectiveness of breastfeeding interventions delivered to fathers in low- and middle-income countries: A systematic review.

Adequate support for lactating mothers is crucial to improve the rates of early initiation, exclusive, and continued breastfeeding. Maternal breastfeeding intention and ongoing breastfeeding duration are strongly predicted by their partners' breastfeeding beliefs. Partner support has a significant effect on improving rates of any and exclusive breastfeeding, when compared with professional support, particularly in low-income populations. This systematic review investigates the effectiveness of breastfeeding interventions targeting fathers in low- and middle-income countries (LMIC). A systematic literature search was undertaken on Medline (EBSCOhost), PsycInfo, CINAHL, and Scopus databases and via manual searching. Inclusion criteria were experimental or quasiexperimental designs targeting fathers from LMIC, which measured either breastfeeding initiation, breastfeeding exclusivity, or duration of breastfeeding as the main outcomes. No time restriction was put in place, and all articles were published in English. The quality of selected papers was assessed using the Joanna Briggs Institute tool. A total of 8 articles were included from 6 interventions: 2 quasiexperimental and 4 randomized control trials. All interventions involved breastfeeding education targeting fathers; 2 were given only to fathers, and 4 delivered to both fathers and mothers. Among these interventions, 2 measured both early initiation and exclusive breastfeeding; one exclusive breastfeeding only; one exclusive breastfeeding, knowledge, and attitudes; one exclusive breastfeeding and knowledge; and one breastfeeding, continued breastfeeding, and awareness. Across all interventions, breastfeeding education showed significant improvement in breastfeeding outcomes in the intervention compared with the control groups. In summary, breastfeeding education interventions targeting fathers in LMIC are effective in improving early initiation of breastfeeding, exclusive breastfeeding, and continued breastfeeding. Thus, breastfeeding promotion should consider the education and involvement of fathers in the intervention.

Development and Validation of a Questionnaire on Breastfeeding Intentions, Attitudes and Knowledge of a Sample of Croatian Secondary-School Students.

Background: Validating a questionnaire/instrument before proceeding to the field for data collection is important. Methods: An 18-item breastfeeding intention, 39-item attitude and 44-item knowledge questionnaire was validated in a Croatian sample of secondary-school students (N = 277). Results: For the intentions, principal component analysis (PCA) yielded a four-factor solution with 8 items explaining 68.3% of the total variance. Cronbach’s alpha (0.71) indicated satisfactory internal consistency. For the attitudes, PCA showed a seven-factor structure with 33 items explaining 58.41% of total variance. Cronbach’s alpha (0.87) indicated good internal consistency. There were 13 knowledge questions that were retained after item analysis, showing good internal consistency (KR20 = 0.83). In terms of criterion validity, the questionnaire differentiated between students who received breastfeeding education compared to students who were not educated in breastfeeding. Correlations between intentions and attitudes (r = 0.49), intentions and knowledge (r = 0.29), and attitudes and knowledge (r = 0.38) confirmed concurrent validity. Conclusions: The final instrument is reliable and valid for data collection on breastfeeding. Therefore, the instrument is recommended for evaluation of breastfeeding education programs aimed at upper-grade elementary and secondary school students.

Breastfeeding, Antidepressants, and Depression in the Mercy Pregnancy and Emotional Well-Being Study

Depression is consistently shown to predict lower rates of breastfeeding. In a handful of studies, breastfeeding has predicted lower depression symptoms. However, studies demonstrating the latter are limited in their measurement of both depression and breastfeeding and have not followed participants from pregnancy across the postpartum period. The primary aim of this study was to describe breastfeeding intentions and behaviors for the first 12 months postpartum among nonmedicated depressed, antidepressant-exposed, and control participants. The secondary aim was to examine group differences in the association between depressive symptoms and breastfeeding duration up to 12 months postpartum. First-trimester women ( N = 212) were recruited into a prospective longitudinal study. Depressive disorders at baseline were diagnosed using the Structured Clinical Interview for DSM-IV Axis I Disorders, and depressive symptoms were measured at the first and second trimesters and 6 and 12 months postpartum using the Edinburgh Postnatal Depression Scale. Breastfeeding duration, support from family and employers, and perceptions of participants' experience were measured. Depressed women and antidepressant-exposed women reported a trend toward lower rates of intention, initiation, and duration, but this did not reach statistical significance. There was a statistically significant difference on depressive symptoms for women taking antidepressants during pregnancy, compared with controls, when they continued to breastfeed for 12 months postpartum. This study did not find a strong association between depression or antidepressant use and intention to breastfeed, partner breastfeeding support, or initiation or duration of breastfeeding. However, for women who took antidepressants, there was evidence that breastfeeding for 12 months was associated with lower depressive symptoms.

Exclusive Breastfeeding Intention among Pregnant Mothers

AbstractExclusive breastfeeding intention is a mother’s intention to provide her baby only breast milk since the infant was born until at the age of 6 months. Intention in prenatal period is the direct affirmation of exclusive breastfeeding. This study aimed to find out the most dominant factor related to exclusive breastfeeding intention among pregnant women at a mother and child hospital in South Tangerang. A cross-sectional study design was conducted primarily. The samples were 143 pregnant women on their third semester pregnancy selected by purposive sampling. Intention was measured by the Infant Feeding Intention scale questionnaire. Meanwhile, attitude, subjective norms, and perceived behavioral control were measured by the modified Breastfeeding Attrition Prediction Tool questionnaire. Data were analyzed using the multivariate logistic regression analysis. It was 61.5% mother had strong exclusive breastfeeding intention. Perceived behavioral control dominantly influenced the exclusive breastfeeding intention (p value = 0.007; Odds Ratio 3.030; 95% CI = (1.361-6.746)). The other factors influencing intention were attitude, exposure to exclusive breastfeeding from social media, health workers’ support, previous breastfeeding experienceand mothers’ occupation. A mother with high perceived behavioral control has three times more likely to have ‘high exclusive breastfeeding intention’ than those having the low ones.AbstrakIntensi pemberian ASI eksklusif adalah intensi ibu untuk memberikan hanya ASI pada bayinya sejak dilahirkan hingga berusia enam bulan. Intensi pada periode prenatal merupakan penentu langsung pemberian ASI eksklusif. Penelitian ini bertujuan mengetahui faktor paling dominan berhubungan dengan intensi pemberian ASI eksklusif pada ibu hamil di sebuah rumah sakit ibu dan anak di Kota Tangerang Selatan. Penelitian dengan desain studi potong lintang dilakukan secara primer. Sampel berjumlah 143 ibu hamil trimester ketiga dipilih secara purposive sampling. Intensi pemberian ASI eksklusif diukur menggunakan kuesioner the Infant Feeding Intentions scale. Sedangkan sikap, norma subjektif dan persepsi kontrol perilaku dinilai menggunakan modifikasi kuesioner Breastfeeding Attrition Prediction Tool. Data dianalisis menggunakan analisis regresi logistik ganda. Sebanyak 61,5% ibu memiliki intensi kuat memberikan ASI eksklusif. Persepsi kontrol perilaku paling dominan berhubungan dengan intensi pemberian ASI eksklusif, (p=0,007; Odds Ratio 3,030; 95% CI (1,361-6,746). Faktor lainnya yang berhubungan dengan intensi adalah sikap, keterpaparan ibu terhadap ASI eksklusif dari media sosial, dukungan tenaga kesehatan, pengalaman menyusui sebelumnya, dan pekerjaan ibu dengan persepsi kontrol perilaku tinggi berpeluang tiga kali lebih besar memiliki ‘intensi tinggi’ untuk memberikan ASI eksklusif dibandingkan ibu berpersepsi kontrol perilaku rendah.

Mothers' Concerns for Personal Safety and Privacy While Breastfeeding: An Unexplored Phenomenon.

Preliminary qualitative research in upstate NY shows new mothers are worried about safety while breastfeeding. Little is known regarding prevalence of these concerns and their effect on breastfeeding outcomes. (1) Determine frequency of breastfeeding safety and privacy concerns; (2) Explore their association with breastfeeding outcomes. Mothers were surveyed immediately and 1-month postpartum about breastfeeding goals; both surveys addressed privacy and safety concerns at home, work, and in public. Outcome data included breastfeeding intent, exclusivity, and duration. Breastfeeding/non-breastfeeding mothers were compared using Chi-square and multivariate analyses. A total of 279 women enrolled. Of these 82.8% initiated breastfeeding; at 1-month 72% provided any breast milk, and 44% were exclusively breastfeeding. About 99% felt safe breastfeeding at home; 25% reported privacy concerns; and 5% felt "vulnerable or unsafe" while breastfeeding. At 1-month, 49% agreed there was a safe place to breastfeed/express milk at work (20% unsure). Non-breastfeeding mothers expressed more safety concerns outside home/at work: 18% breastfeeding versus 28% non-breastfeeding outside home; 27% breastfeeding versus 40% non-breastfeeding at work. Nearly 54% who reported feeling vulnerable/unsafe with breastfeeding initiated breastfeeding, compared with 86% not reporting this concern (p = 0.008). Fewer women initiating breastfeeding reported vulnerability/safety (3% breastfeeding versus 14% non-breastfeeding, p = 0.008) or privacy (22% breastfeeding versus 40% non-breastfeeding, p = 0.19) concerns. Associations held after controlling for age, race, parity, insurance, geography, and marital-status. Significant associations between initiation, privacy, and safety concerns did not extend to duration or exclusivity. Many breastfeeding women reported safety and privacy concerns, especially outside the home and at work, which may influence breastfeeding initiation. Further study may identify methods to address these issues, potentially increasing breastfeeding rates.

The Influence of Breastfeeding Self-Efficacy and Breastfeeding Intention on Breastfeeding Behavior in Postpartum Women

World Health Organization (WHO) guidelines recommend that infants should be breastfed for six month after childbirth. The average duration of breastfeeding in Taiwan still falls short of this sixth-month timeline. In order to improve the duration of breastfeeding, it is crucial to understand the factors that affect related behavior. To explore the effects of breastfeeding self-efficacy and breastfeeding intention among exclusive-breastfeeding women during the initial six months after childbirth and to verify the reliability and validity of the infant feeding intentions scale (Chinese version). Purposive sampling was used to select and enroll a total of 167 breastfeeding women from a southern metropolitan medical-teaching hospital. Data were collected using a structured questionnaire and phone interviews. Data were analyzed using SPSS 18.0, LISREL8.7, and S-Plus package software to obtain scores for the independent-sample t test, Pearson's product-moment correlation coefficient, one-way analysis of variance, survival analysis, and reliability and validity. Breastfeeding self-efficacy scores ranged from 14 to 70, with a mean score of 44.80 (±11.56). Infant feeding intention scores ranged from 14 to 70, with a mean score of 12.20 (±3.14). Additionally, 29.9% of the participants breastfed exclusively for the entire six months after childbirth. Breastfeeding self-efficacy and breastfeeding intention were positively correlated (r = .45, p < .001). Education level, occupation, and breastfeeding intention were each identified as factors that significantly influenced the success of exclusive breastfeeding during the initial six months after childbirth. Breastfeeding self-efficacy and breastfeeding intention are correlated with breastfeeding behavior. Based on findings, medical staff should target promotion and education regarding the importance of breastfeeding particularly toward women who have lower levels of education, who are employed, and who express low initial intention to breastfeed.

Factors associated with breastfeeding intent among mothers of newborn babies in Da Nang, Viet Nam

BackgroundBreastfeeding is recognized as the single most cost-effective intervention to reduce child morbidity and mortality. However, few studies have explored perceived barriers to breastfeeding and factors associated with breastfeeding intent among mothers of newborn babies in Viet Nam. We conducted a study to assess breastfeeding initiation rates, intent to breastfeed exclusively for 6 months or more and perceived barriers to breastfeed among mothers of newborn babies in Da Nang, Viet Nam.MethodsWe conducted a cross-sectional questionnaire survey of mothers in the postnatal wards of Da Nang Hospital for Women and Children in central Viet Nam from 10 February 2017 to 24 February 2017, following implementation of the World Health Organization (WHO) Essential Newborn Care (ENC) package.ResultsOf 286 mothers surveyed, 259 (90.6%) initiated breastfeeding; 203/258 (78.7%) within 1 hour (h) of birth. Most (207, 72.4%) mothers indicated intent to breastfeed exclusively for 6 months or more, but this was lower among mothers of preterm babies (82.2% versus 20.0%, p < 0.001) and those without post-secondary school education (74.8% versus 55.6%, p = 0.02). Amongst mothers struggling to establish breastfeeding, 18/27 (66.7%) had a Cesarean section. Planned non-exclusive breastfeeding was mostly (39, 60.9%) motivated by mothers’ concern that their milk supply would be insufficient for their baby’s growth requirements. Most mothers had good knowledge about the benefits of breastfeeding and indicated strong decision autonomy.ConclusionsWe documented high rates of early breastfeeding establishment and intent to breastfeed exclusively for 6 months or more. This probably reflects high levels of maternal education and successful implementation of the WHO ENC package. Mothers of premature babies may benefit from additional support.

BREASTFEEDING INTENTION AND KNOWLEDGE IN SECONDARY-SCHOOL STUDENTS.

SUMMARY – Breast milk makes the world healthier and better. Deaths and suffering of thousands of children and mothers each year could be prevented through universal breastfeeding, along with enormous economic savings. The aim of this study was to examine the knowledge of breastfeeding and intention to breastfeed in third-year secondary school students from various high schools and to make a conclusion on the unique and structured education program on breastfeeding in secondary schools. A total of 252 third-year secondary school students from 4 high schools in Bjelovar, Kutina and Pakrac completed an online questionnaire on the knowledge and intention to breastfeed. The results were presented by descriptive statistics methods. Kruskal-Wallis test was conducted for intention scale and χ2-test for questions about knowledge. Logistic regression was used to predict probabilities of a response. The results showed the responses of students from individual schools to be statistically significantly different in some questions of knowledge and some items of intention of breastfeeding. Insufficient breastfeeding information in schools does not provide a basis to third-year secondary school students to make an informed decision about breastfeeding in adulthood. We propose development and use of a unique structured educational program on breastfeeding for secondary school students.

Factors Influencing Engagement and Behavioral Determinants of Infant Feeding in an mHealth Program: Qualitative Evaluation of the Growing Healthy Program.

BackgroundInfant feeding practices, including breastfeeding and optimal formula feeding practices, can play a role in the prevention of childhood obesity. The ubiquity of smartphone ownership among women of childbearing age provides important opportunities for the delivery of low-cost, broad reach parenting interventions delivered by mobile phone (mHealth or mobile health interventions). Little is known about how parents engage with mHealth programs targeting infant feeding and how such programs might influence infant feeding practices.ObjectiveThe objectives of this study were to explore participant views on (1) factors influencing engagement with the Growing healthy program, an mHealth program targeting healthy infant feeding practices from birth to 9 months of age, and (2) the ways in which the program influenced behavioral determinants of capability, opportunity, and motivation for breastfeeding and optimal formula feeding behaviors.MethodsSemistructured, telephone interviews were conducted with a purposeful sample (n=24) of mothers participating in the Growing healthy program. Interviews explored participants’ views about engagement with the program and its features, and the ways the program influenced determinants of infant feeding behaviors related to breastfeeding and optimal formula feeding. The interview schedule was informed by the Capability, Opportunity, Motivation, and Behavior (COM-B) model.ResultsParticipants reported that engagement fluctuated depending on need and the degree to which the program was perceived to fit with existing parenting beliefs and values. Participants identified that the credibility of the program source, the user friendly interface, and tailoring of content and push notifications to baby’s age and key transition points promoted engagement, whereas technical glitches were reported to reduce engagement. Participants discussed that the program increased confidence in feeding decisions. For breastfeeding mothers, this was achieved by helping them to overcome doubts about breast milk supply, whereas mothers using formula reported feeling more confident to feed to hunger and satiety cues rather than encouraging infants to finish the bottle. Participants discussed that the program provided around-the-clock, readily accessible, nonjudgmental information and support on infant feeding and helped to reinforce information received by health professionals or encouraged them to seek additional help if needed. Participants reflected that their plans for feeding were typically made before joining the program, limiting the potential for the program to influence this aspect of motivation. Rather, the program provided emotional reassurance to continue with current feeding plans.ConclusionsOur findings suggest that engagement with the program was influenced by an interplay between the program features and needs of the user. Participants reported that the program enhanced confidence in feeding decisions by providing a 24/7 accessible, expert, nonjudgmental support for infant feeding that complemented health professional advice. It is likely that interventions need to commence during pregnancy to maximize the impact on breastfeeding intentions and plans.

Psychometric Assessment and Precision Remodeling of the Iowa Infant Feeding Attitude Scale to Improve Clinical Use and Efficacy Among Prenatal Women in Canada.

The 17-item Iowa Infant Feeding Attitude Scale (IIFAS) has been widely used to assess maternal attitudes toward infant feeding and to predict breastfeeding intention. The IIFAS has been validated among prenatal women located in Newfoundland and Labrador in Canada, although its length may prove challenging to complete in a clinical setting. Research aim: The authors aimed to reduce the number of items from the original 17-item IIFAS scale while maintaining reliability and validity. A nonexperimental cross-sectional design was used among 1,283 women in their third trimester residing in Newfoundland and Labrador. Data were collected from August 2011 to June 2016. An exploratory factor analysis using principal component analysis was performed to explore the underlying structure of the IIFAS. The internal consistency of both the 17-item and reduced version was assessed using Cronbach's alpha and item-total correlation. The area under the curve and linear regression model were used to assess predictive validity of intention to breastfeed. Our findings revealed that a 13-item IIFAS (Cronbach's α = .870) had relatively similar internal consistency to the original IIFAS (Cronbach's α = .868). Three themes were extracted from the factor analysis, resulting in the removal of four items. The reduced scale demonstrated an excellent ability to predict breastfeeding intention (area under the curve = 0.914). The reduced 13-item version of the IIFAS is a psychometrically sound instrument that maintains its accuracy and validity when measuring maternal feeding attitudes during pregnancy and can be more time efficient in clinical settings compared with the 17-item IIFAS.

Changes in mothers' intended duration of breastfeeding from the prenatal to neonatal periods.

Although previous studies suggest that the intentions of mothers to breastfeed during pregnancy strongly predict actual breastfeeding practice, no studies have examined the changes in the intentions of mothers to breastfeed from the prenatal to neonatal periods. The purpose of this study was to examine changes in intended breastfeeding duration from the prenatal to neonatal periods, their association with actual duration, and predictors for shortened duration. The Infant Feeding Practices Study II was a longitudinal study of mothers in the United States. Changes to intended breastfeeding duration were calculated as the difference from prenatal to neonatal reports (months); we compared this change to actual breastfeeding duration. By using multivariable logistic regression, we identified maternal characteristics associated with a shortened breastfeeding intention. Of 1780 women, 43.7% had no change to intended breastfeeding duration, 35.0% had a shorter intended duration, and 21.3% had a longer intended duration. Mothers with shortened intended duration also had shorter actual duration (P<.001). Women of Hispanic ethnicity, with a prepregnancy body mass index of ≥30kg/m2 , who were primiparous and who smoked prenatally had increased odds of shortening their breastfeeding intention from prenatal to neonatal reports. A maternal age of ≥35years was associated with decreased odds of shortened breastfeeding intention. Approximately one in three women shorten their intended breastfeeding duration during the early postpartum period, which negatively affects the actual duration of their breastfeeding. Women may need additional support during the early postpartum period to meet their prenatal breastfeeding intentions.

Contraception and Breastfeeding at 4 Months Postpartum Among Women Intending to Breastfeed.

To estimate the association between postpartum contraception and breastfeeding among women intending to breastfeed. We analyzed data from the Infant Feeding Practices Study II, a prospective cohort study of U.S. mothers (2005-2007). Among 1,349 women with prenatal intention to breastfeed at least 4 months who reported contraception use 3 months postpartum, we used multivariable logistic regression to estimate odds and predicted probabilities of breastfeeding by contraceptive category. We considered prenatal breastfeeding intention, age, race, education, income, marital status, region, depressive symptoms, parity, and timing of return to work as potential confounders, using standard statistical methods to determine model covariates. At 3 months postpartum, contraception was reported as follows: 720 (53%) nonhormonal contraceptives (NHCs), 256 (19%) combined hormonal contraceptives (CHCs), 217 (16%) progestin-only pills (POPs), 92 (7%) intrauterine devices, and 64 (5%) depot medroxyprogesterone acetate. Compared with NHCs, adjusted odds ratio (aOR) for any breastfeeding at 4 months postpartum among women using POPs was 3.15 (95% confidence interval [CI] 1.42-7.02), and for women using CHCs aOR was 0.17 (95% CI 0.10-0.29). For women using NHCs, predicted probability of any breastfeeding at 4 months postpartum was 90% (95% CI 85-94); it was 97% (95% CI 92-99) among those using POPs and 61% (95% CI 46-74) among those using CHCs. In a cohort of women intending to breastfeed at least 4 months, women using POPs were most likely, and women using CHCs were least likely, to achieve their breastfeeding intentions.

Factors affecting breastfeeding adherence among Chinese mothers: A multicenter study.

Breastfeeding is beneficial for both infant and mother, but discontinuation of breastfeeding is very common.To investigate maternal breastfeeding intention and the rate of breastfeeding based on the theory of reasoned action, and analyze the predominant factors associated with breastfeeding and breastfeeding problems.This observational study was conducted in 3 hospitals. Three researchers recruited women at 3 time points in the hospitals: initial documentation of pregnancy at the outpatient department, prenatal admission, and postpartum discharge. SPSS version 21 was used for statistical analyses. Significance was set at P < .05. In the multivariate analysis, binary logistic regression was used and odds ratios (ORs) with 95% confidence intervals (CI) were calculated.We recruited 1260 women, with 420 pregnant women at each time point. 55.1% of the infants were exclusively breastfed, 40.6% were mixed fed, and 4.3% were formula fed when discharged from hospital. A total of 53.8% of the mothers declared having breastfeeding problems. The multivariate analysis showed that nonsuccessful breastfeeding was associated with neonatal birth length, food intake before breastfeeding, infrequent sucking, the intention of breastfeeding, understanding level of the benefits of breastfeeding and that breastfeeding problems were related with the understanding level of the benefits of breastfeeding, neonatal birth length, normal vaginal delivery, breast size, the experience of breastfeeding, use of pacifier and the needs of family member's support in breastfeeding.Most mothers who intended to practice exclusive breastfeeding initially chose to add formula and had breastfeeding problems when discharged from hospital. Successful breastfeeding depends on antenatal and postnatal breastfeeding education and on support provided by healthcare professionals.

The Association Between Pregnancy Intention and Breastfeeding.

Although breastfeeding is associated with proven benefits to both mother and child, there are many factors that influence a mother's decision to breastfeed. Pregnancy intentionality at the time of conception is associated with postpartum maternal behavior including breastfeeding. Research aim: We sought to understand how maternal and paternal pregnancy intentions were associated with breastfeeding initiation and duration in a nationally representative sample. We used a cross-sectional, retrospective study of the CDC National Survey of Family Growth data to examine the link between pregnancy intentionality and breastfeeding initiation and duration among women ages 15 to 44 years. We found that whereas the mother's intention to have a child was a factor in how long she breastfed, the paternal intention to have a child predicted whether the mother breastfed at all. Additionally, Hispanic mothers were most likely to breastfeed and breastfed the longest of any other group. Age and education were also positive predictors of ever breastfeeding. Understanding the father's and mother's attitudes toward the pregnancy and influence on breastfeeding intention is important for intervention planning.