Breastfeeding Initiation Research Articles

National Trends in Breastfeeding by Gestational Age Category

National breastfeeding (direct breastfeeding and/or provision of pumped breast milk) rates among preterm infants are unclear. We report rates of breastfeeding initiation and continuation at 12 weeks after birth by gestational age category from a nationally representative survey between 2009 to 2019. Breastfeeding rates were lowest among infants born late preterm compared with other gestational age categories.

Essential newborn care practices in selected public health facilities using observation of 2603 normal deliveries in Uttar Pradesh, India

IntroductionEssential newborn care (ENBC) practices are recommended for all births to improve neonatal survival. This paper aims to understand the facility-level variations and factors associated with the essential newborn care...

A community-based father education intervention on breastfeeding practice in Ethiopia: a quasi-experimental study.

Breastfeeding is the cornerstone of a newborn's nutrition, containing crucial nutritional components. While a substantial body of research focuses on mothers, there is limited understanding regarding effective strategies to engage fathers in promoting breastfeeding practices. Therefore, this quasi-experimental study investigated a community-based intervention to improve breastfeeding exclusivity and initiation rates by targeting fathers in breastfeeding education. This research was conducted in Dessie City in the Amhara region of Northeast Ethiopia from 5th October 2020 to 30th August 2021. Fathers and their wives were assigned individually to the intervention and control groups. Baseline data were gathered from selected Kebeles (Kebele: the lowest administrative level in Ethiopia) to identify couples seeking care through routine maternal and child health services. Fathers in the intervention area received breastfeeding education services at health facilities or home visits during antenatal, delivery, and postpartum periods. Trained midwives participated in giving breastfeeding education. In the control arm, they received routine counseling activities. Factors associated with early initiation and exclusive breastfeeding were analyzed using multivariable analysis among the two groups. The intervention involved 327 participants, 155 in the intervention arm and 172 in the control group. The multivariable analysis indicated that the community-based father health education intervention significantly influenced the early initiation of breastfeeding. Mothers in the intervention group were found to be nearly five times more likely to initiate breastfeeding within the first hour of their infants' lives (AOR: 4.85, 95% CI: 1.36-17.32). A significant positive impact was also found for exclusive breastfeeding (EBF) of infants at the 1st, 4th, and 6th months (AOR: 3.95, 95% CI: 1.09-14.27), (AOR: 5.47, 95%CI: 2.18-13.70), and (AOR: 1.70, 95% CI: 1.02-2.85) respectively. This study confirmed the positive effects of a community-based father education intervention on the rates of exclusive breastfeeding during the first, fourth, and sixth months, as well as the early initiation of breastfeeding. The government and healthcare workers should implement policies supporting father-inclusive breastfeeding initiatives such as creating awareness and the critical role fathers' play.

Determinants of infants and young children feeding practices among mothers living in Saudi Arabia: a cross-sectional study.

The WHO sets evidence-based guidelines for infant feeding. Adhering to the WHO guidelines ensures that infants receive the proper nutrition and thus is associated with healthy growth and development. To describe breastfeeding and complementary feeding practices (CFPs) for infants and young children and identify determinants of appropriate feeding practices. This cross-sectional study was performed via structured interviews with mothers living in Saudi Arabia's Eastern Province who had children aged 6-24 months. To evaluate their adherence to the recommended WHO practices, a scoring method was applied (0-9). 395 mothers were interviewed. The rate of breastfeeding within the first hour, and exclusively breastfeeding for six months was both 25%. Multivariate analysis showed that exclusive breastfeeding for at least six months was less likely in middle-income mothers were less likely to exclusively breastfeed for six months than high-income mothers (OR = 0.32; 95% CI: 0.18-0.57; p < 0.001). Mothers without domestic help were also less likely to exclusively breastfeed (OR = 3.0; p < 0.001), as were those not living with their husbands (OR = 2.1; p = 0.007). Multiparous mothers and those with higher education were more likely to breastfeed than high school graduates (OR = 2.3, p = 0.02; OR = 4.4, p = 0.015, respectively). Timely breastfeeding initiation within the first hour was more common in term infants than preterm infants (OR = 5.3; p = 0.033), and infants born through normal delivery were four times more likely to initiate breastfeeding early (OR = 4.0; p < 0.001). For CFPs, 42% of participants introduced solid food at six months. 55% of mothers reported poor CFPs, primarily due to inappropriate timing of solid food introduction, choking hazards, and delayed introduction of family meals. Good CFPs were positively associated with higher maternal education, increased income, and living with a husband. Partial compliance with WHO CFP standards need improvement. Interventions should raise awareness of factors leading to poor compliance and support early breastfeeding initiation and continuation. Low-income and less educated families appear to be most in need of support.

Centering community-based maternal and child nutrition services in Bangladesh’s rural primary healthcare: what has potential to scale

IntroductionThe extensive network of community health workers in rural Bangladesh has the potential to deliver maternal and child nutrition services, while promoting linkages with healthcare facilities. A strategy for strengthening community-based nutrition services was developed and tested.MethodsThe three-phased strategy included review of existing community-based systems, co-designing service package with multi-sector government representatives, and testing implementation feasibility. Integrated health and nutrition service delivery, supportive supervision, and increased accountability of local government were core components of the service package being implemented in selected geographies since March 2023. The assessment followed a mixed-method design with household survey of 1,166 pregnant women, mothers of children under-6 months and 6–23 months, and observations of 965 service delivery points along with qualitative study.ResultsA higher proportion of children received growth monitoring and promotion (GMP) services through expanded program on immunization (EPI) sessions, with better compliance to service delivery protocol in intervention areas compared with controls. Maternal nutrition services of gestational weight gain monitoring and distribution of supplements were better available in intervention areas. However, minimum dietary diversity among pregnant women (69% intervention, 72% control), early initiation of breastfeeding (55% intervention, 51% control), and complementary feeding practices were comparable in intervention and control areas. Nutrition services were successfully integrated in supervision which earlier covered EPI and family planning. The local government contributed to strengthening nutrition services but at a small scale.DiscussionThere is potential to scale-up GMP services through EPI and merging antenatal clinics with GMP and EPI such that all maternal and childcare services are available at the same place and same time. A coordinated investment and oversight from multiple national government departments is needed. At district and sub-district levels, scale-up requires joint annual planning of nutrition and EPI services, strengthened management of nutrition services, bridging health worker vacancies, introducing volunteers in sites with high EPI case load, capacity building, and supportive supervision. Replacement of multiple health and nutrition records with a single mother and child health and nutrition card is also feasible. However, behavior change interventions through home visits and courtyard meetings need more testing before recommending scale-up.

Antenatal care and breastfeeding practices in Sub-Saharan Africa: an analysis of demographic and health surveys

BackgroundThe World Health Organization (WHO) recommends immediate breastfeeding (within the first hour after birth) and exclusive breastfeeding (for the first six months of life), particularly in low-resource settings such as sub-Saharan Africa. In 2016, WHO updated its antenatal care (ANC) guidelines, recommending at least eight (8+) ANC contacts during pregnancy to improve maternal and child health outcomes. This study investigates i) trends in breastfeeding practices across sub-Saharan Africa following the rollout of the revised WHO 2016 ANC policy and ii) the relationship between ANC uptake and exclusive or early breastfeeding.MethodsWe performed a secondary analysis of Demographic and Health Survey data from 19 countries, from 2018-2023. Key variables included exclusive breastfeeding, early initiation of breastfeeding (within one hour of birth), and the number of ANC contacts (categorized into 0-3, 4-7, and 8 + visits) among mothers with a live birth in the six months preceding the survey.ResultsExclusive breastfeeding rates ranged from 19% in Gabon to 81% in Rwanda (median = 53%), while early initiation of breastfeeding ranged from 32% in Senegal to 85% in Rwanda (median = 60%). The percentage of women with 8 + ANC contacts ranged from 0.3% in Rwanda to 39% in Ghana (median = 4%). Women with 8 + ANC contacts did not show increased odds of early initiation (aOR: 0.94; 95% CI: 0.84, 1.05) or exclusive breastfeeding (aOR: 0.85; 95% CI: 0.76, 0.94) compared to women with 4-7 contacts.DiscussionThese findings reveal low rates of 8 + ANC contacts against a backdrop of suboptimal breastfeeding practices across sub-Saharan Africa. Furthermore, the results suggest limited additional benefits of 8 + ANC contacts over 4-7 contacts in promoting immediate and exclusive breastfeeding, as recommended by the WHO 2016 ANC policy. Urgent efforts are needed to promote ANC uptake and improve the quality of ANC contacts through behavior change interventions and complementary health service delivery. Sub-national, national, and global stakeholders should prioritize these interventions.

Neonatal indicator data in Tanzania District Health Information System: evaluation of availability and quality of selected newborn indicators, 2015-2022

BackgroundThe Every Newborn Action Plan (ENAP) indicators are essential in monitoring neonatal healthcare coverage and quality. The District Health Information System (DHIS2), an open-source platform in over 80 countries, supports health data collection and analysis, enabling progress tracking at national and subnational levels. This study evaluates the availability and quality of maternal and newborn health indicators, explicitly focusing on ENAP indicators within Tanzania’s DHIS2.MethodsUsing the EN-MINI tool, we assessed data availability for 20 ENAP indicators by analysing their numerators and denominators in Tanzania’s DHIS2 (2015–2022) across all healthcare levels. World Health Organization’s (WHO) data quality framework was adapted to examine four dimensions: (a) availability of indicators, (b) completeness of indicator reporting, (c) internal consistency of related indicators, and (d) indicator plausibility by comparing DHIS2 data with population-based Demographic and Health Survey (DHS) data.ResultsOf the 20 ENAP indicators, 14 were available in Tanzania’s DHIS2, with definitions, numerators and denominators aligned with WHO standards. Between 2015 and 2022, the number of facilities reporting at least one delivery annually increased by 19% from 5,898 to 7,016. During this period, 75% to 97% of facilities consistently reported data on skilled attendance at birth and early breastfeeding initiation. In contrast, 4% to 54% of facilities reported on maternal and newborn outcomes, including complications such as stillbirths and maternal mortality. Internal consistency was high (> 94%). However, neonatal mortality rates reported in DHIS2 were lower than those reported in Tanzania DHS for similar periods, even after a 20% adjustment to account for home births.ConclusionTanzania’s DHIS2 captures many ENAP indicators; however, notable variability in data quality persists, with substantial data gaps related to maternal and newborn outcomes and complications. To address these challenges, it is crucial to strengthen routine data review, implement robust quality checks, enhance validation processes, provide targeted training, deliver constructive feedback, and conduct supportive supervision. Placing greater emphasis on using DHIS2 data to monitor progress will help identify gaps and drive improvements in data quality, ultimately supporting better maternal and newborn health outcomes.

Informational Sources About Breastfeeding Associated with Breastfeeding Initiation: Insights into Racial Disparities.

Background: Breastfeeding provides essential nutrition and disease protection for infants while reducing the risk of type 2 diabetes and breast cancer in mothers. Despite these benefits, significant racial and ethnic disparities exist in breastfeeding initiation, particularly among Black women. This study examines racial differences in the receipt of breastfeeding information from varying sources and their association with breastfeeding initiation. Methods: Data were obtained from the Phase 8 Core Pregnancy Risk Assessment Monitoring System for 2016-2020 (n = 163,724). The analysis focused on comparing the likelihood of breastfeeding initiation (yes/no) across racial groups and the impact of receiving breastfeeding information from varying clinical (mother's doctor/nurse/baby's doctor, etc.) and social sources (support group/family/friends, etc.). Univariate and multivariable analysis was conducted in SAS 9.4. Results: Black women consistently exhibited lower odds of breastfeeding initiation compared with other racial groups, across all informational sources. The study found that while information from both clinical and social sources increased breastfeeding initiation overall, Black women remained less likely to initiate breastfeeding than White women (p < 0.0001). Conclusion: Systemic barriers, including racism and bias in health care, contribute to the racial disparities in breastfeeding initiation. Culturally tailored interventions and improved health care provider training are necessary to address these gaps. Future efforts should aim to bridge the divide between clinical and social breastfeeding information sources to improve breastfeeding rates among minority women.

Neighborhood Socioeconomic Status and Breastfeeding Initiation and Duration Among Primiparous Black Women.

Background: Social determinants of health account for racial inequities in breastfeeding rates in the United States. There is a gap in the role of neighborhood socioeconomic status (NSES) as it relates to breastfeeding disparities. Methods: Using longitudinal data from the Black Women's Health Study, we assessed associations of NSES with breastfeeding initiation and duration in a cohort of primiparous U.S. Black women. We also explored associations within strata of important economic indicators, including education, occupation, and marital status. Results: Breastfeeding initiation (n = 2,705) increased with NSES quartile, from 75.2% in the lowest quartile to 88.3% in the highest quartile (p < 0.0001). Compared with women living in the highest NSES quartile, those in the lowest quartile had a 41% (odds ratio: 0.59 [95% confidence interval: 0.43, 0.81]) decreased odds of initiating breastfeeding. For breastfeeding duration (n = 2,172), women residing in NSES quartiles 1-3 were significantly less likely (p < 0.0001) to breastfeed (44.4%) for 6+ months compared with those living in the highest quartile (62.8%). Adjusted relative risks for those in quartiles 1-3 compared with 4 (highest) were 0.63 (0.45, 0.87), 0.50 (0.37, 0.68), and 0.64 (0.47, 0.86), respectively (p = 0.0001). There was no statistically significant evidence of effect modification by education, occupation, marital status, and region (Pinteraction = >0.05). Conclusion: Living in a lower NSES environment was associated with reduced breastfeeding initiation and duration compared with a higher NSES environment. Research is needed to understand the mechanisms by which neighborhood-level factors influence breastfeeding initiation and duration for Black women in the United States.

Colostrum avoidance and associated factors among postnatal mothers in health facilities in Addis Ababa, Ethiopia: a mixed method study

BackgroundColostrum is the first form of milk produced immediately following the delivery of a newborn. It is highly nutritious and contains antibodies to protect the newborn against disease and crucial for the newborn’s health Despite its benefits, some mothers avoid giving colostrum to their newborns.ObjectiveThis study aims to assess the prevalence and factors associated with colostrum avoidance among postnatal mothers in Addis Ababa, Ethiopia.MethodsA health facility-based mixed-methods of study design was conducted. Both quantitative and qualitative data were collected using pretested questionnaires and key informant interview question guides, respectively.Quantitative data were collected through structured interviews and analyzed using descriptive statistics such as frequencies, means, and standard deviations were performed. Binary logistic regression analysis was employed to assess the associated factors of colostrum avoidance among postnatal mothers at health facilities in study area.Qualitative data were gathered via in-depth interviews and analyzed thematically.ResultsThe prevalence of colostrum avoidance was 8.94% (95% CI: 5.9–10.9). Multivariable analysis revealed significant predictors of colostrum avoidance: lack of counseling about colostrum benefits (AOR = 5.802, 95% CI: 2.467–13.647), cesarean delivery (AOR = 3.420, 95% CI: 1.411–8.288), poor maternal knowledge about colostrum (AOR = 13.111, 95% CI: 5.462–31.468), and late initiation of breastfeeding (AOR = 3.330, 95% CI: 1.242–8.926). Qualitative findings echoed these results, with cultural beliefs and misconceptions about colostrum contributing to its avoidance.ConclusionThe study highlights a significant prevalence of colostrum avoidance among postnatal mothers in Addis Ababa. Key predictors include inadequate counseling, cesarean delivery, poor knowledge about colostrum, and delayed breastfeeding initiation. Interventions aimed at improving maternal education and breastfeeding practices are essential to reduce colostrum avoidance.

Infant and young child feeding practice status and its determinants in UAE: results from the MISC cohort

BackgroundTo evaluate breastfeeding and complementary feeding practices and their determinants among infants and young children in the United Arab Emirates using the 2021 WHO/UNICEF IYCF guidelines.MethodsThe Mother and Infant Study Cohort (MISC), is a prospective study of mothers recruited in their third gestational trimester and followed with their infants up to 18 months of age (n = 167). Data were collected at 3rd trimester, delivery, 2, 6, 12, and 18 months postpartum via questionnaires, review of medical records, anthropometric measurements, and 24-hour dietary recalls of the child’s intake at 6, 12, and 18 months. Descriptive statistics and multiple logistic regressions were used to report on feeding practices and their determinants.ResultsEver breastfeeding, Early initiation of breastfeeding, and exclusive breastfeeding under 6 months were reported by 84.3%, 99.4%, and 32.9% of participants, respectively. Of children, 96.4% consumed solid foods at 6–8 months; 68.7% and 44.7% continued to be breastfed at 12 and 18 months, respectively. Despite improvement with age; several complementary feeding indicators remained suboptimal at 18 months: Minimum Dietary Diversity: 40.4%, Minimum Meal Frequency: 56.7%, Minimum Acceptable Diet: 23.1%, Sugar-Sweetened Beverages, 26.9%, Zero Vegetables and Fruits: 28.8%, Unhealthy Food Consumption: 65.4%. After adjustment, multiparous mothers had higher odds of exclusive breastfeeding, whereas pregnancy complications were associated with lower odds of exclusive breastfeeding. Continued breastfeeding at 18 months was associated with older age among mothers and lower income. Among the factors associated with complementary feeding indicators were higher physical activity and Minimum Dietary Diversity. While Gestational Diabetes Mellitus, Sugar-Sweetened Beverages, and higher education were associated with lower odds of Zero Vegetables and Fruits, and a higher income was associated with lower Unhealthy Food Consumption.ConclusionsThis study reported good rates of Early initiation of breastfeeding and ever-breastfeeding, yet suboptimal exclusive breastfeeding and complementary feeding. The identified risk factors for inappropriate practices could be used to guide nutrition interventions and public health programs in the United Arab Emirates.

Barriers and drivers to exclusive breastfeeding in Kyrgyzstan: a qualitative study with mothers and health workers

BackgroundThe WHO/UNICEF global nutrition target for exclusive breastfeeding for six months is at least 70% of infants by 2030. However, global prevalence rates are 48% with variations between countries and within regions. Kyrgyzstan has consistently high early breastfeeding initiation rates, yet exclusive breastfeeding for six months is 46%. This qualitative study addressed two research questions: (1) What are the barriers and drivers for mothers to exclusive breastfeeding in the first six months? (2) What are the barriers and drivers for health workers in primary care facilities to supporting exclusive breastfeeding in the first six months?MethodsThe study took place from April to June 2023 in five sites (mix of urban and rural). Ten focus group discussions with 40 primary care health workers and 20 in-depth interviews with mothers of a child currently aged 6–12 months who initiated breastfeeding with this child were conducted. Mothers were purposively selected to represent four groups of infant feeding practices in the first six months: (1) exclusive breastfeeding, (2) breastfeeding alongside other fluids/solids, (3) breastfeeding alongside infant formula, (4) breastfeeding followed by switching to formula only. The Capability-Opportunity-Motivation-Behaviour (COM-B) model was the underpinning theoretical framework. Data were analysed using the Framework approach.ResultsThe study uncovered important misperceptions amongst mothers who were not exclusively breastfeeding (groups 2–4). These existed alongside a perceived inability to resolve physical challenges of breastfeeding and social pressure to supplement breastmilk with fluids/solids or formula. Half of all mothers felt uncomfortable breastfeeding in public. Health workers were recommending and supporting women with exclusive breastfeeding during multiple antenatal and postnatal interactions during the initial six months. They were knowledgeable and motivated to do this. Moreover, they felt well supported with training, resources, and legislation with just a few mentioning workplace time or space challenges. Very few doctors appeared to currently be meeting with formula industry representatives.ConclusionsThis theory-informed qualitative study focusing on mother and health worker perspectives provided important insights into the individual and contextual barriers and drivers to exclusive breastfeeding for the first six months in Kyrgyzstan. These insights have informed recommendations for tailored interventions for both groups.

The effect of Baby-Friendly Hospital Initiative compliance on the association between mode of birth and breastfeeding initiation in Sri Lanka

BackgroundIn Sri Lanka, there is some evidence that the likelihood of breastfeeding initiation varies by exposure to Baby-Friendly Hospital Initiative [BFHI]-compliant care and mode of birth. Globally, there is some evidence that exposure to mother-baby skin-to-skin contact (BFHI Step 4) is lower in caesarean section births. Therefore, we aimed to determine how breastfeeding initiation varies by mode of birth in Sri Lanka, and the extent to which women’s exposure to BFHI practices explains any associations found.MethodsA cross-sectional survey was conducted with women with a live baby across four government hospitals in Sri Lanka. Quantitative data were collected through participant interviews and extraction from medical records. Associations between BFHI practices, breastfeeding initiation, mode of birth, and women’s characteristics were assessed using binary logistic regression analysis applied in mediation and moderated mediation models.ResultsWomen who received care compliant with Steps 4 and 6 of BFHI, regardless of their mode of birth, were more likely to initiate breastfeeding within the first hour after birth. BFHI Step 4 partially and completely mediated the effect of planned caesarean section and emergency caesarean section, respectively, on breastfeeding initiation within one hour of birth. Further, exposure to BFHI Step 6 partially mediated the effect of emergency caesarean section on breastfeeding initiation within one hour of birth. Women’s age, pre-pregnancy BMI, parity status, and ethnic group significantly influenced the relationship between planned or emergency caesarean section, exposure to Step 4 or Step 6 of BFHI, and breastfeeding initiation within one hour of birth. Specifically, being primiparous strengthened the likelihood that having a planned caesarean section decreased women’s exposure to BFHI Step 4; and having a pre-pregnancy BMI of 23–27.49 kg/m2 weakened the likelihood that planned caesarean section decreased exposure to BFHI Step 4.ConclusionsImproving compliance with mother-baby skin-to-skin contact (BFHI Step 4) and no supplementation (BFHI Step 6) is critical for Sri Lankan health services to support all women to establish breastfeeding initiation within one hour of birth, as these practices attenuate the negative effect of caesarean section on breastfeeding initiation.

Population attributable fractions for modifiable risk factors of neonatal, infant, and under-five mortality in 48 low- and middle-income countries.

Identifying the modifiable risk factors for childhood mortality using population-attributable fractions (PAFs) estimates can inform public health planning and resource allocation in low- and middle-income countries (LMICs). We estimated PAFs for key population-level modifiable risk factors of neonatal, infant, and under-five mortality in LMICs. We used the most recent Demographic and Health Survey data sets (2010-22) from 48 LMICs, encompassing 35 sub-Saharan African countries and 13 countries from South and Southeast Asia (n = 506 989). We used generalised linear latent mixed models to compute odds ratios (ORs), and we calculated the PAFs adjusted for commonality using ORs and prevalence estimates for key modifiable risk factors. The highest PAFs of neonatal mortality were attributed to delayed initiation of breastfeeding (>1 hour of birth) (PAF = 23.9; 95% confidence interval (CI) = 23.1, 24.8), uncleaned cooking fuel (PAF = 6.2; 95% CI = 6.4, 7.8), infrequent antenatal care (ANC) visits (PAF = 4.3; 95% CI = 3.3, 5.9), maternal lack of formal education (PAF = 3.9; 95% CI = 2.7, 5.3), and mother's lacking two doses of tetanus injections (PAF = 3.0; 95% CI = 1.9, 3.9). These five modifiable risk factors contributed to 41.4% (95% CI = 35.6, 47.0) of neonatal deaths in the 48 LMICs. Similarly, a combination of these five risk factors contributed to 40.5% of infant deaths. Further, delayed initiation of breastfeeding (PAF = 15.8; 95% CI = 15.2, 16.2), unclean cooking fuel (PAF = 9.6; 95% CI = 8.4, 10.7), mothers lacking formal education (PAF = 7.9; 95% CI = 7.0, 8.9), infrequent ANC visits (PAF = 4.0; 95% CI = 3.3, 4.7), and poor toilet facilities (PAF = 3.4; 95% CI = 2.6, 4.3) were attributed to 40.8% (95% CI = 36.4, 45.2) of under-five deaths. Given the current global economic climate, policymakers should prioritise these modifiable risk factors. Key recommendations include ensuring that women enter pregnancy in optimal health, prioritising the presence of skilled newborn attendants for timely and proper breastfeeding initiation, and enhancing home-based care during the postnatal period and beyond.

Effectiveness of a technical support program with women's self-help groups in catalyzing health and nutrition behaviors in Bihar-a multicomponent analysis.

Bihar Rural Livelihoods Promotion Society launched the JEEViKA program in 2007 to improve livelihoods through the Self-Help Group (SHG) platform. Women's SHGs have shown members' health improvements by promoting awareness, practices and access to services. This study investigates whether Health & Nutrition (HN) interventions delivered by JEEViKA Technical Support Program (JTSP) via SHG platforms could improve maternal and newborn health and nutritional behaviors in rural Bihar. Annual Household Survey and Married Women of Reproductive Age (MWRA) studies of Bihar Technical Support Unit were used to analyze the effectiveness of JTSP on HN behaviors for mother and their infants in Bihar during 2016-21. Descriptive analysis followed by multivariable (binary and multinomial) logistic regressions were conducted to determine the distribution of and associations between various individual/community and programmatic exposures and outcomes of interest. During 2016-2021, in Bihar, statewide increase (32 to 47%) in SHG membership across all population strata and expansion of HN layering of JTSP from 101 to 349 blocks corroborated with improvements in Maternal-Newborn-Child Health & Nutrition (MNCHN) indicators in JTSP blocks and SHG members. Substantial increase was observed in ≥3ANC visit (9% points), institutional delivery (10%), skin-to-skin-care (17%), dry cord-care (23%), early initiation of breastfeeding (19%) & complementary feeding (9%). Adjusting for socio-demographic factors and Front-Line Workers' (FLWs') advice/counseling, multivariable logistic regression revealed that SHG member in JTSP blocks delivering post-intervention (2021) were more likely (vs 2016) to practice: ≥3ANC visits (Adjusted Odds Ratio: aOR = 1.48, p < 0.0001), institutional delivery (aOR = 1.71, p < 0.0001), skin-to-skin care (aOR = 3.16, p < 0.0001) and dry cord-care (aOR = 2.64, p < 0.0001), early initiation of breastfeeding (aOR = 1.61, p < 0.0001), complementary feeding (aOR6-8 months = 1.48, p < 0.0001) and minimum dietary diversity (aOR6-8 months = 1.24). Better mobility, decision making, economic independence and overall empowerment were also evident among SHG member MWRA as opposed to non-members after both phases. The results highlight successful HN integration in JEEViKA by JTSP, demonstrating its effectiveness in integrating with State Rural Livelihoods Mission community platforms. JTSP showcases collaboration within a government system and emphasizes systematic introduction and strengthening at multiple levels. This integration has enabled JEEViKA systems to self-sustain its own HN implementation processes, paving the way for cross-sectoral comprehensive delivery mechanisms for social development.

THE RELATIONSHIP OF EARLY BREASTFEEDING INITIATION (IMD) TO POST PARTUM UTERINE INVOLUTION IN THE INDEPENDENT PRACTICE OF MIDWIVES (PMB) MARIYAH ULFAH EAST JAKARTA

Early breastfeeding initiation (IMD) is one of the factors that influence uterine involution. IMD can stimulate and release hormones, including the hormone oxytocin, which functions in addition to stimulating contraction of breast smooth muscles, also causes contraction and retraction of uterine muscles. This will compress the blood vessels resulting in reduced blood supply to the uterus. In women who choose to breastfeed their babies, the baby's suction will stimulate the release of oxytocin and help the uterus return to its normal shape. This study aims to determine the relationship of Early Breastfeeding Initiation (IMD) to uterine involution in post partum at PMB Mariyah Ulfah East Jakarta which was conducted in May-August 2024. The type of research used in this study is quantitative research. This study used a Cross Sectional approach. The sample technique used in this study was total sampling of 30 people. The research instruments used were metline and observation sheet. The results of this study identified that there was a difference in TFU reduction in mothers who did , Early initiation of breastfeeding (IMD) and those who did not do IMD, so there was a relationship between Early Breastfeeding Initiation (IMD) to Uterine Involution during the nifaas period at PMB Mariyah Ulfah East Jakarta, where the p-value = 0.006 (0.006 &lt;0.05)

Factors Affecting Early Initiation of Breastfeeding Among Women Delivered in a Tertiary Care Hospital

Objective: To determine the proportion of early initiation of breastfeeding among women delivered in a tertiary care hospital before discharge and to identify factors affecting itMethodology: This cross-sectional analytical study was conducted in the Department of Obstetrics and Gynecology, Holy Family Hospital, Rawalpindi from Sep 2022 to Feb 2023. In the study, data were collected from 380 women through a structured questionnaire about the feeding practices and different factors affecting it after taking ethical approval and consent. Data were analyzed by using SPSS version 26.The Chi-square test was used to evaluate the association of the independent variables with the early initiation of breastfeeding. Binary logistic regression analysis was employed to identify the factors independently associated with early initiation of breastfeeding. A p- value of &lt;0.05 was considered significant.Results: Early initiation of breastfeeding was found in only 12.6 % of women. Out of the remaining, 41% started breastfeeding within 2-12 hours. The most common reason for delayed breastfeeding was neonatal NICU admission (29%), followed by postoperative pain (28.6%) and perceived inadequate milk quantity (24.2%). On the Chi-square test, factors having significant association with EIBF are the mode of delivery (p=0.000), availability of guidance by family members or health care representatives (p=&lt;0.001), parity (p-value=0.024) and sex of the baby (p=0.044). On binary logistic regression analysis, factors that were significantly associated with early initiation of breastfeeding, were the mode of delivery, parity and availability of help or guidance by family members or health care representatives (p&lt;0.05).Conclusion: Early initiation of breastfeeding practices can be increased by antenatal counseling and training of mothers, limiting neonatal NICU admission by uniform protocols and training of health care workers.

Prevalence of and factors associated with formula feeding among mothers with infants 0-6 months of age in Ethiopia: a systematic review and meta-analysis.

Inconsistent results have been reported regarding the prevalence of and factors associated with formula feeding in Ethiopia. This study aimed to determine the pooled prevalence of and factors associated with formula feeding among mothers with infants 0-6 months of age in Ethiopia. A comprehensive systematic search was conducted across 3 databases (PubMed, EMBASE, and ScienceDirect) and the Google Scholar search engine to identify relevant studies published up to April 2, 2024. After assessing the quality of each study using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies, data were independently extracted by 2 authors using pre-designed forms in an Excel spreadsheet. Any disagreements were resolved through discussion and consultation with additional authors. Statistical heterogeneity across studies was assessed using the I2 statistic. A random-effects meta-analysis was used to pool the proportions, due to high heterogeneity, while a fixed-effect meta-analysis was used to pool associated factors with low heterogeneity. A sensitivity analysis was performed to assess the potential impact of outlier studies on the overall estimates. Five studies, with a combined sample size of 2344 participants, were included. The pooled prevalence of formula feeding was 34.0% (95% CI: 23.0%, 44.0%). Factors significantly associated with formula feeding included cesarean delivery (POR [pooled odds ratio] = 4.72, 95% CI: 3.32, 6.71) compared with vaginal delivery, a positive attitude toward formula feeding (POR = 2.26, 95% CI: 1.45, 3.53) compared with a negative attitude, initiation of breastfeeding more than 1 hour after delivery (POR = 2.27, 95% CI: 1.25, 4.13) compared with initiation within 1 hour, and receiving information about formula feeding from friends or family (POR = 2.47, 95% CI: 1.46, 4.20) compared with receiving information from health-care professionals. The prevalence of formula feeding in Ethiopia is significant. Cesarean delivery, a positive attitude toward formula feeding, late initiation of breastfeeding, and receiving formula feeding-related information from friends and family were positively associated with formula feeding. Given these findings, the authors recommend that public health interventions in Ethiopia target these key determinants to decrease the high prevalence of formula feeding practices observed in the country. Strategies addressing factors such as promoting vaginal delivery, improving attitudes toward breastfeeding, encouraging early breastfeeding initiation, and limiting the influence of social networks on formula-feeding decisions may be beneficial.

Colostrum feeding practice and associated factors among mothers who come for postnatal care to Asella referral and teaching hospital, Arsi Zone, South-East Ethiopia.

Every day throughout the world more than 4,000 infants and young children die because colostrum feeding was not initiated within an hour of birth as recommended by the World Health Organization (WHO)/United Nations Children's Fund. Even though breastfeeding is common in Ethiopia, the widespread belief that colostrum feeding causes morbidity and mortality among neonates still exists. To assess the colostrum feeding practice and It's associated factors among mothers who come for Post-natal care at Asella Referral and Teaching Hospital, Asella Town, Southeast Ethiopia from November 20, 2023, to January 25, 2024. This study employed an institutional-based cross-sectional study among 301 surveyed postnatal care mothers from November 20, 2023, to January 25, 2024. Systematic random sampling was employed to select study participants. A pretest was performed to check the reliability and clarity of the study questionnaires. The tool to examine the practice of colostrum feeding and related aspects was modified from earlier studies. The collected data were input into Epi Info version 7.2.5.0 and exported to SPSS version 26 for analysis. Bivariate and multivariable logistic regression analyses were used to identify variables associated with the practice of colostrum feeding. The variables with significant association were identified based on p-value < 0.05. In this study, 301 study participants took part, with a 99% response rate. The mean age of mothers was found to be 27.13 ± 5.46. This study's overall prevalence of practice was 57.8% (95% CI, 52.2-63.35). Being Urban residence (AOR = 4.05, 95%CI: 2.18-7.52), health education counseling (AOR = 4.31, 95%CI: 1.27-10.73), and favorable attitude toward colostrum milk (AOR = 6.64, 95% CI: 3.61-12.2) were factors significantly associated with colostrum feeding practice. In comparison to WHO recommendations, the study area had a low rate of colostrum feeding practice. Additionally, this study also identified factors associated with maternal colostrum feeding practice level such as urban residence, counseling on timely initiation of breastfeeding during antenatal care, and good maternal attitude toward colostrum feeding. Therefore, Health education dissemination should be given to postnatal mothers regarding the importance of colostrum feeding.

Breastfeeding patterns among parturients with diabetes: A secondary analysis of the MOMPOD randomized clinical trial

AbstractIntroductionInsulin resistance is associated with decreased milk supply in lactating people. Metformin is hypothesized to increase breast milk production by decreasing insulin resistance, suggesting use may increase breastfeeding success. We aimed to determine the association between metformin use during pregnancy and breastfeeding initiation and continuation.MethodsThis was a secondary analysis of the MOMPOD randomized controlled trial of metformin versus placebo in addition to insulin therapy among pregnant people with type 2 diabetes and early diabetes. We included parturients who delivered a living neonate, received at least one dose of study drug or placebo, endorsed an intention to breastfeed, and completed a breastfeeding survey. Breastfeeding intentions and breastfeeding outcomes were collected utilizing a breastfeeding questionnaire at 24–30 weeks and 30 days postpartum, respectively. The primary outcome was breastfeeding at 30 days postpartum defined by exclusive or partial breastfeeding. Secondary outcomes included immediate breastfeeding defined as any breastfeeding during the postpartum hospital admission until at least postpartum day 3, onset of lactogenesis (days), breast and bra size, and breastfeeding challenges. Baseline characteristics and outcomes were compared using chi‐square, t‐test, or Wilcoxon tests, as appropriate.ResultsAmong the 794 women randomized and receiving either placebo or metformin in the primary trial, 378 (47.6%) met inclusion criteria with 194 (51.3%) in metformin and 184 (48.7%) in placebo groups. There were no significant differences in baseline characteristics. Immediate breastfeeding was comparable between groups (91.1% vs. 88.9%, p = 0.53) and there was no difference in onset of lactogenesis. Breastfeeding rates were lower among all parturients 30 days postpartum and there was no difference between metformin and placebo groups (76.0% vs. 66.7%, p = 0.11). Also, there were no differences in partial or exclusive breastfeeding, breast cup or bra size, or breastfeeding challenges.ConclusionOur data suggest no association between metformin use and breastfeeding patterns in those with type 2 or early diabetes in pregnancy. Antepartum metformin should not be recommended solely to improve breastfeeding success.