Infant Feeding Decisions Research Articles

Early Infant Feeding Decisions in Low-Income Latinas

Breastfeeding rates remain low, especially among low-income minority women. The objective of this qualitative study was to assess barriers to breastfeeding and reasons for combination feeding among low-income Latina women and their families. Meetings were held with key informants to inform the sampling plan and develop questions for focus groups. Data were collected from eight qualitative focus groups with primiparous mothers postpartum, mothers breastfeeding at 4 to 6 months, mothers formula feeding at 4 to 6 months, grandmothers and fathers, and 29 individual interviews with formula- and combination-feeding mothers. Transcripts of focus groups and interviews were content coded and analyzed for thematic domains and then compared for concurrence and differences. Four main domains with 15 categories were identified: (a) Best of both: Mothers desire to ensure their babies get both the healthy aspects of breast milk and "vitamins" in formula. (b) Breastfeeding can be a struggle: Breastfeeding is natural but can be painful, embarrassing, and associated with breast changes and diet restrictions. (c) Not in Mother's Control: Mothers want to breastfeed, but things happen that cause them to discontinue breastfeeding. (d) Family and cultural beliefs: Relatives give messages about supplementation for babies who are crying or not chubby. Negative emotions are to be avoided so as to not affect mother's milk. Those counseling Latina mothers about infant feeding should discourage and/or limit early supplementation with formula, discuss the myth of "best of both," understand the fatalism involved in problem-solving breastfeeding issues, and enlist the altruism embedded in the family unit for support of the mother-infant pair.

A Longitudinal Qualitative Study of Infant-Feeding Decision Making and Practices among HIV-Positive Women in South Africa

This study examined the challenges that HIV-positive women face at different stages of early infant feeding using a longitudinal, qualitative design. The study explored factors influencing infant-feeding decision-making and behavior of HIV-positive mothers and identified characteristics of women and their environments that contributed to success in maintaining exclusivity of their infant feeding practices. The study was undertaken at 3 sites in South Africa. Participants consisted of a purposive sample of 27 women who had a positive HIV test result during antenatal care and were intending to either exclusively breast-feed or exclusively formula-feed their infants. Women were interviewed once antenatally and at 1, 4, 6, and 12 wk postpartum. Just under one-half of the women who initiated breast-feeding maintained exclusivity and over two-thirds of the women who initiated formula-feeding maintained exclusivity. Key characteristics of women who achieved success in exclusivity included the ability to resist pressure from the family to introduce other fluids and to recall key messages on mother-to-child transmission risks and mixed feeding. Among women who maintained exclusive breast-feeding, a strong belief in the benefits of breast-feeding and a supportive home environment was important. For women using formula milk, having resources such as electricity, a kettle, and flask made feeding at night easier. Support for infant feeding that extends beyond the antenatal period is important to enable mothers to cope with new challenges and pressures at critical times during the early postpartum period.

P3: Delaying the Introduction of Solid Food to Infants: A Six-Lesson Curriculum for Community Educators

Early introduction of solid foods, prior to the recommended 4-6 months of age, is a risk factor for later overweight. The goal of this project was to design and implement a nutrition education intervention for low-income mothers of infants under 4-6 months of age, with the aim of delaying the introduction of solids. ‘The Infant Feeding Study' (TIFS) was designed as a longitudinal, three-phase study. In Phase One, focus groups with mothers and health care providers were carried out to examine infant feeding practice and beliefs. These data informed the development of the TIFS intervention, Phase Two, which is presented here. The TIFS intervention, designed to be facilitated by paraprofessionals, consists of 6 lessons based on the transtheoretical model of change, a model of intentional behavior change and decision-making. The lessons are designed: a) to increase mothers' knowledge of infant development, feeding practices, and the consequences of early introduction of solids, and b) to increase mothers' abilities to take ownership of infant feeding decisions for their infants. Lesson content is based on current food and nutrition recommendations of the American Academy of Pediatrics. Topics include nutrition, responsive parenting, and effective consumer communication. Phase Three of the intervention will include pilot testing and refinement of the lessons. We hypothesize that mothers who participate in the lessons will be more efficacious in developing and following an age-appropriate feeding plan that is sensitive and responsive to their infants. This project was funded by Michigan Department of Community Health and Michigan State University.

The health benefits of breastfeeding for mothers

Over the past thirty years much research and medical study has seen breastfeeding reconfirmed as the best option for the health of infants, so much so that it has influenced public health policies. As a result, research on the beneficial effects of breastfeeding on the health of mothers is somewhat limited. But information, which supports the view that there are significant positive health benefits for the breastfeeding mother, is growing. Most significant is information on breastfeeding's links to limiting the risks of various cancers, osteoporosis and diabetes. It is also found to be beneficial for uterine involution, weight loss, natural contraception and reducing stress. Yet, it is still the case in the UK that women are not opting to breastfeed in large enough numbers, or are breastfeeding for a very short time. Mothers need to be encouraged to breastfeed for their own health benefits as well as those of their child's. When making infant feeding decisions, women need to be well-informed about all aspects.

Breast-feeding, Bottle-feeding and Dr. Spock: The Shifting Context of Choice*

In today's environment, breast-feeding represents both a medical gold standard for infant feeding and a moral gold standard for mothering. The morally charged character of this discourse makes the notion of choice in infant feeding particularly problematic and fraught with difficulty. From an historical content analysis of selected editions from 1946 to 1998 of Dr. Spock's famous child-care manual, this paper explicates the process through which the breast versus bottle discourse has shifted over the last half-century, and how these shifts have shaped the context of choice within which mothers must make their infant-feeding decisions.

The Milk of Human Kindness: Environmental and Human Interactions in a WIC Clinic That Influence Infant-Feeding Decisions of Black Women

In this ethnographic study, the author explores the context of Black women's infant-feeding decisions in an urban WIC clinic. Data were obtained from 319 people (130 Black women enrolled in WIC [BWEW], 189 relatives and friends) with close follow-up of 11 primiparous key informants during pregnancy and the first year postpartum. The major findings include (a) the WIC clinic environment set a positive tone for service, (b) WIC employees treated the women with caring and respect, (c) BWEW believed that WIC was a source of support in time of need, and (d) WIC influenced infant-feeding decisions. The availability of free formula facilitated bottle feeding, but personalized breast-feeding promotion with trusting relationships with WIC providers encouraged breast-feeding decisions for almost half of the key informants.

Initiation and continuation of breastfeeding: theory of planned behaviour

This paper reports a study investigating new mothers' subjective norms in relation to both breast- and bottle-feeding. The influence of norms on women's infant feeding decisions and the relative influence of social referents at varying degrees of social distance were assessed. Increasing breastfeeding initiation and continuation rates is a key challenge for health educators. The perceived influence of other people's views (subjective norms), including the views of women's partners and health care professionals, is an important predictor of infant feeding behaviour. Semi-structured questionnaires were administered to 203 new mothers in central and northern Scotland and followed-up by postal questionnaire at 6 weeks. Infant feeding intentions, feeding behaviour at birth and follow-up, behavioural beliefs and subjective norms for both breastfeeding and bottle-feeding were assessed. The data were collected in 1998-1999. Subjective norms were important determinants of initiation and continuation of breastfeeding for breast- and bottlefeeders. Breastfeeders rated close social referents as more in favour of bottle-feeding and more against breastfeeding at follow-up, whereas bottlefeeders' ratings did not change. Partner's and nurses'/midwives' views were an important influence at baseline and follow-up. Breastfeeding 'continuers' perceived their partners as more pro-breastfeeding at 6 weeks. Discontinuers perceived more overall social pressure to bottle-feed. However, sampling limitations may have led to over-representation of the views of breastfeeders at baseline and follow-up. Nurses and midwives have a crucial role in communicating positive views on breastfeeding to new mothers at different time points. Future interventions to promote breastfeeding could adopt a broad social approach, encouraging positive norms for existing and potential mothers and fathers, families and people in general.

PERCEIVED INSUFFICIENT MILK AS A BARRIER TO OPTIMAL INFANT FEEDING: EXAMPLES FROM BOLIVIA

In its recently adopted Global Strategy on Infant and Young Child Feeding, the World Health Assembly called for urgent action in addressing the barriers to optimal feeding practices. This paper examines mothers' concerns about milk insufficiency as a major contributor to suboptimal infant feeding decisions, using survey data from peri-urban areas of two Bolivian cities. Mothers in the lowland modernizing city of Santa Cruz were more likely than mothers in the highland traditional city of Cochabamba to express concern about insufficient milk, and also less likely to feed their infants according to international recommendations. Furthermore, perceived milk insufficiency was particularly common among mothers of infants younger than 6 months of age -- an age at which infants are particularly vulnerable to the adverse effects of breast-feeding cessation and complementary feeding initiation. The paper concludes with policy, programme and research recommendations to address the critical problem of perceived insufficient breast milk.

Korean university students’ knowledge and attitudes toward breastfeeding: A questionnaire survey

Infant feeding decisions depend on knowledge and attitudes toward breastfeeding. The purpose of this study was to explore Korean university students’ knowledge and attitudes toward breastfeeding by gender and major. This was a cross-sectional comparative study among 341 university students. The instrument was a modified self-administered breastfeeding knowledge and attitudes questionnaire. Female students were slightly more knowledgeable and had somewhat more positive attitudes compared to male students. Students in health-related fields showed more knowledge than students in other disciplines, but their attitudes did not differ in majority. A significant correlation was found between the students’ knowledge and their attitudes.

Sociocultural influences on infant feeding decisions among HIV-infected women in rural Kwa-Zulu Natal, South Africa.

The promotion of exclusive breastfeeding for 6 months, followed by rapid transition to alternative food sources may be an important public health approach to the reduction of mother-to-child transmission of HIV through breastmilk. The basic ethical principle of 'informed choice' requires that HIV positive women are provided with adequate information about their options. However, information is only one factor that affects their decisions. The objective of this ethnographic study was to identify sociocultural influences on infant feeding decisions in the context of a large cohort study designed to assess the impact of a breastfeeding counselling and support strategy to promote exclusive breastfeeding on postnatal transmission of HIV in African women. Following an initial period of exploratory interviewing, ethnographic techniques were used to interview 22 HIV positive women about their views on infant feeding and health. Interviews were tape-recorded, transcribed and analysed with a text analysis program. Five themes of influences on feeding decisions emerged: (1) social stigma of HIV infection; (2) maternal age and family influences on feeding practices; (3) economic circumstances; (4) beliefs about HIV transmission through breastmilk; and (5) beliefs about the quality of breastmilk compared to formula. The study highlights the role of cultural, social, economic and psychological factors that affect HIV positive women's infant feeding decisions and behaviour.

Infant-feeding beliefs and experiences of Black women enrolled in WIC in the New York metropolitan area.

In this ethnographic inquiry, the author explored infant-feeding beliefs and experiences of Black women enrolled in WIC (BWEW) in a New York metropolitan inner city. The study was conducted over an 18-month period and included 319 people (130 BWEW, 116 children, 20 grandmothers, 17 fathers, 11 friends, and 25 other relatives). From this group of BWEW, the author interviewed and observed 11 primiparous key informants during pregnancy and the first year postpartum to see how infant-feeding decisions fit into the context of their everyday lives. The major themes that emerged from analysis include (a) formula-feeding experiences were the norm for most BWEW, (b) life experiences of BWEW included a preponderance of loss and stress, and (c) infant-feeding beliefs of BWEW reflected responses to life experiences. These findings could be used to provide culturally sensitive care for BWEW.

Experiences of infant‐feeding decision‐making among urban economically disadvantaged pregnant adolescents

The aim of this paper is to report a pilot study of influencing factors in disadvantaged urban pregnant adolescents' decision-making about infant-feeding choices. Research related to decision-making among adolescents indicates that attitudinal, social, perceived control, and commitment factors are influential in choosing and initiating breast- or bottle-feeding. However, there is a need for further description of decision-making processes in disadvantaged teenagers before intervention research is done. Focus group interviews with the Theory of Planned Behavior guiding the questioning were used with 14 pregnant adolescents between 18 and 39 weeks of gestation and between the ages of 14 and 18 in two obstetric clinics in Midwestern USA urban teaching hospitals. The majority of adolescents were African-American and primiparae. The experiences of infant-feeding decision-making among pregnant adolescents were captured by two major themes: benefits vs. barriers of breastfeeding and bottle-feeding, and independent choice vs. social influences. A common thread in these themes was ambivalence and uncertainty. The adolescents had both positive and negative attitudes toward methods, with many expressing their desire to combine breast- and bottle-feeding. Many reported the health benefits of breastfeeding, yet identified barriers of pain, public exposure, and the complexity of breastfeeding. They viewed bottle-feeding as automatic and simple, allowing freedom to leave the infant with others. Although adolescents were adamant that choice of feeding method was their independent decision, social and family influences were evident. Consistent with the Theory of Planned Behaviour and other research, attitudes, perceived social influences, and perceived control factors were influential to adolescents when choosing infant feeding methods. The findings suggest that adolescents need education on decision-making, and are being used to fine-tune the interventions of a randomized clinical trial to investigate promoting and supporting breastfeeding among adolescent mothers.

Differences in the factors influencing the infant-feeding decision between adolescents and adult women

Differences in the factors influencing the infant-feeding decision between adolescents and adult women

Health promotion: partners’ perceptions of breastfeeding

Breastfeeding is recognized as the most appropriate method of infant feeding (UNICEF, 1999a), yet past research suggests that it declines during the early postpartum period (Foster et al, 1995). More importantly, recent studies have suggested that partners may influence breastfeeding decisions (Jackson, 2000) so their roles significantly reinforce more recent findings (Hamlyn et al, 2002). This small qualitative study explores partners' perceptions of breastfeeding, the extent of influence on breastfeeding decisions, and how health promotion can contribute to the uptake of breastfeeding. In this article, an open-ended, in-depth guide was used during the interviewing of eight male participants. The findings were analysed using thematic analysis. The findings indicate that partners have significant influence on a mother's infant-feeding decisions by their use of language, and that partners are greatly influenced by their perceptions of gender.

Infant feeding practices of HIV-infected and uninfected women in Zimbabwe.

We surveyed infant feeding knowledge, attitudes, and practices in Zimbabwe to determine whether knowledge of HIV seropositivity influences infant feeding behavior. Questionnaires were administered to 97 women 1 and 4 weeks postpartum and prospective data on infant feeding practices were collected. Participants were pregnant women who consented to a HIV test. A total of 116 women participated of whom 99 women underwent voluntary HIV counseling and testing (VCT); 17 women agreed to blinded HIV testing but did not opt for VCT. The responses to questionnaires on infant feeding practices of HIV-positive and HIV-negative women who knew and did not know their HIV status at day 1 and week 4 postpartum were compared. We found that HIV-positive women who did not learn their status breastfed their infants less, introduced supplementary foods sooner, and planned to wean their babies earlier compared to other women (p = 0.005, p = NS, p= 0.02). HIV-positive women (30/97) more frequently reported a prior history of infant death and AIDS-related symptoms compared to HIV-negative women. We conclude that HIV-positive women who did not know their status made incorrect decisions with respect to infant feeding. These women may have suspected themselves to be HIV-positive and consequently underfed their infants or because these women were more symptomatic may have been less likely to breastfeed; decreased intake may increase the risk for malnutrition. Knowledge of HIV status may influence infant feeding decisions and reveal an urgent need to address infant feeding practices of pregnant women in Zimbabwe.

What is the problem with breast-feeding? A qualitative analysis of infant feeding perceptions.

Breast-feeding rates are low in Northern Ireland (NI) compared with other regions of Europe. The aim of this study has therefore been to define and explore factors determining infant feeding decisions with a view to the planning of future research and intervention needs. Participants were approached at convenience from the throughput of women attending a large teaching hospital antenatal clinic to take part in focus group discussion. Dominant themes indicated that the main barriers to breast-feeding are restricted freedom and independence associated with family issues, return to work, societal embarrassment and perceived social isolation. The dialogue suggested that breast-feeding leads to inability to carry out everyday activities and social exclusion. Incompatible social norms make it difficult for mothers to breast-feed successfully. This implies that future promotional efforts should take a societal approach.

Thai nurses' beliefs about breastfeeding and postpartum practices.

Cultural beliefs are important determinants of health care behaviours. Nurses have an important influence on infant feeding decisions and maternal postpartum care, but little is known about the extent to which their practice is influenced by traditional beliefs and/or recent innovations driven by evidence-based research. The aim of this study was to investigate Thai nurses' traditional beliefs about breastfeeding and related postpartum care, and their impact on nursing practice. A survey of 372 nurses working in hospitals and health services in Ubon Ratchathani, Thailand was undertaken. Questionnaire items were developed from a review of the literature and exploratory interviews with Thai women. Descriptive statistics were used to represent the incidence of particular beliefs and behaviours. Chi-square analyses were conducted to determine relationships between demographic characteristics and traditional beliefs and practices. There were discrepancies between nurses' beliefs and contemporary evidence-based practices. Many nurses supported traditional Thai postpartum practices such as food restrictions and encouraging hot baths. Some traditional beliefs supported by nurses may be detrimental to women and babies such as "lying by fire", discarding of colostrum, and giving boiled water to neonates. Only half the nurses reported that they encouraged mothers to breastfeed immediately following birth. The study was undertaken in the North-East of Thailand, where the population is known to have strong belief systems. Reliability and content validity of the tool would be enhanced through replication studies and qualitative investigations of other breastfeeding issues. There is a need for professional development strategies such as peer review and mentoring to address inadequate knowledge and outdated practices of some health professionals, as well as continuity of care models to assess quality care outcomes that are culturally appropriate.

Infant Feeding Practices of HIV-Positive Mothers in India

Exclusive breast-feeding is widely accepted and advocated in India; however, clinicians are now faced with advising women infected with human immunodeficiency virus (HIV) about the risks and benefits of other infant feeding options. This study assessed factors that influence the infant feeding decisions of HIV-infected mothers in Pune, India. From December 2000 to April 2002, HIV-positive (HIV(+)) pregnant women (n = 101) from a government hospital antenatal clinic were interviewed prepartum about infant feeding intention, feeding practice immediately postpartum and feeding after a minimum of 2 wk postpartum. Of the HIV(+) sample, the last 39 were interviewed more intensively to examine factors affecting feeding decision making. We found that an equal number of HIV(+) women intended to breast-feed (44%) or give top milk (44%) (diluted animal milk). Women who chose to top feed were also more likely to disclose their HIV status to family members. Mixed feeding occurred frequently in our sample (29%); however, for the majority of those (74%), it lasted only 3 d postpartum. The hospital counselor had an important role in assisting women in their intended feeding choice as well as actual practice. The time immediately after delivery was noted as critical for recounseling about infant feeding and further support of the woman's decision, thus lowering the risk of mixed feeding. Lack of funds, poor hygienic conditions and risk of social repercussions were more commonly noted as reasons to breast-feed. Top milk, the alternative for breast-milk used in this population, however, must be investigated further to assess its nutritional value and safety before it can be endorsed widely for infants of HIV(+) women.

The effects of infant feeding decisions on infant growth.

To determine the effects of feeding decisions on infant growth in the first 6 months of life. Growth measurements were collected twice during the first 6 months of infancy as part of a larger investigation of infant feeding practices (N = 52). Infants who received solid foods before the age of 4 to 6 months weighed less than those who received solid foods after 4 to 6 months. There were no differences in growth measurements between formula-fed and breast-fed infants, although breast-fed infants weighed more at birth. Emphasize the importance of feeding breast milk (preferably) or formula only for the first 6 months. Advise parents to withhold fruit juices until the infant is at least 6 months old.

Intrinsic and extrinsic motivation and intention to breast-feed.

To examine the feasibility of using the cognitive evaluation theory to examine pregnant women's intention to breast-feed. A questionnaire designed to measure intrinsic and extrinsic motivation was administered to 228 pregnant women. Results provide evidence for reliability and validity of the revised instrument in this population. A factor analysis suggests the instrument measures 2 types of intrinsic motivation, one type of extrinsic motivation, and motivation related to the baby. The instrument distinguished differences in motivation between women who intend to breast-feed and those who intend to formula feed. This study helps elucidate motivational factors involved in infant-feeding decisions.