Low Rates Of Exclusive Breastfeeding Research Articles

How social and commercial determinants influence exclusive breastfeeding in the Philippines

Abstract Background The World Health Organization recommends exclusive breastfeeding (EBF) for the first six months after delivery. However, the EBF rate in the Philippines is only 29%. Existing literature suggests that the influence of infant formula marketing (IFM), communication channels, and traditional health beliefs are possible contributors to low EBF rates, but rare studies have been conducted in low-resource settings. Methods: To bridge the gap, 15 barangays in Palawan were selected; 97 interviews were conducted with lactating mothers (LM), health workers (HW), traditional healers, infant formula sellers, and community leaders (CL) to represent different perspectives. The results were coded and analyzed inductively. Results LM received EBF information through multiple resources. Poverty, lacking breast milk (BM), EBF education, and health benefits (HB) to infants are top contributors to EBF while maternal employment and no BM are top barriers to EBF. Elders, traditional health beliefs (THB), and the influence of COVID-19 can influence EBF in both directions. LM emphasized more on poverty and elders to EBF while HW and CL emphasized the role of EBF education and HB. Urban LM tend to have more regular EBF education, use pumps when going out, and are more influenced by IFM. LM in remote areas tend to have more THB, have more BM substitutes, and share BM. Social classes, locations, Indigeneity, migration, and poverty are intersectioned to influence EBF. Conclusions Multiple social and commercial determinants influenced EBF. LM is facing more challenges to EBF under globalization and capitalism. Remote LM are less benefited from new technologies and policies to promote EBF. Different stakeholders have echo chambers to perceive the determinants of EBF. To improve health equity and EBF, the situations of marginalized people in remote areas should be more considered in policy making. Community building should also be considered differently to assist in EBF. Key messages • The project focuses on social and commercial determinants of exclusive breastfeeding with people in extreme poverty. • The project includes plenty of Indigenous breastfeeding behavior that are underreported.

Breastfeeding Practices in the Twin Town of India - A Cross-Sectional Study.

The global rise in twinning rates poses health challenges due to increased risks for infants and mothers. Despite the benefits, breastfeeding rates among multiples are low, with exclusive breastfeeding (EBF) particularly scarce compared to singletons. Our study focuses on the mothers of twins in a unique population in Kodinhi village, Kerala, India, known for its high twinning rates, which aims to contribute to existing knowledge of breastfeeding practices and perspectives in a high twinning environment and offer valuable insights to promote optimal breastfeeding among mothers of twins. A retrospective cross-sectional survey was adopted. Seventy-five mothers with twins under 3 years of age from Kodinhi and neighboring areas were interviewed face to face using structured validated tools. Data collection focused on quantitative data supplemented by narrative descriptions. Most women delivered preterm (57.3%), operative delivery (58.7%), and had a late initiation of breastfeeding (32.9% within 24 hours). Colostrum feed was common (86.7%). The EBF rate was 4%, with 47.9% initiating nonexclusive breastfeeding before 3 months, and most of the twins (46.6%) were breastfed for 1-2 years. Fatigue (69.9%) and low milk supply (38.7%) were chief concerns. While 16.4% of mothers opted for a tandem breastfeeding technique, many preferred consecutive feeding as tandem was challenging. Mothers in Kodinhi demonstrated commendable efforts in breastfeeding twins; despite the low rate of EBF, breastfeeding extended to 1-2 years. Evidence-based interventions and personalized support, primarily focusing on maternal perspectives of milk insufficiency, fatigue and breastfeeding techniques, are crucial for sustaining optimal breastfeeding practices among mothers of twins.

Women with Gestational Diabetes Mellitus Have Greater Formula Supplementation in the Hospital and at Home Despite Intention to Exclusively Breastfeed.

Background: Women with gestational diabetes mellitus (GDM) have lower rates of exclusive breastfeeding compared with women without diabetes. Objectives: To assess associations between GDM and breastfeeding intentions and attitudes, formula supplementation, reasons for formula supplementation, and knowledge of type 2 diabetes mellitus (T2DM) risk reduction associated with breastfeeding among U.S. mothers. Design/Methods: Participants completed an online survey assessing infant feeding knowledge, attitudes, and practices; demographics; and pregnancy-related medical history. Multivariable logistic regression was used to estimate adjusted odds ratios for formula supplementation in the hospital and at home. Results: Of 871 respondents, a smaller proportion of women with GDM compared with women without diabetes intended to exclusively breastfeed. There were no differences between groups in attitudes toward public breastfeeding, attitudes toward breastfeeding beyond infancy, or actual duration of any breastfeeding. Approximately one in four participants believed that breastfeeding mothers may be less likely to develop T2DM, regardless of GDM status. Among those who intended to exclusively breastfeed, GDM was associated with higher odds of formula supplementation in the hospital (adjusted odds ratio [OR] 1.75, 95% confidence interval [CI] 0.97-3.18) and at home (adjusted OR 2.02, 95% CI 1.05-3.89). "Medical reasons," which was reported as an important reason for formula supplementation, was reported more frequently by women with GDM. Conclusions: Women with GDM who intended to exclusively breastfeed had higher odds of in-hospital and at-home formula supplementation, cited medical reasons as a main reason for formula supplementation more often, and were largely unaware of T2DM risk reduction associated with breastfeeding.

Gastrointestinal Symptoms in Autism Spectrum Disorder: A Case-Control Study.

Background and objectives This study aimed to explore the frequency of gastrointestinal (GI) symptoms and associated risk factors among children with autism spectrum disorder (ASD). Methods This was a retrospective case-control study including children aged 2-14 years diagnosed with ASD by the Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 criteria and the assessment card in the ASD center at King Salman Armed Forces Hospital. Data were obtained using a self-developed questionnaire that included demographic features, nutritional and behavioral characteristics, and GI symptoms in the previous six months. The control group consisted of typically developing (TD) children matched to the ASD group for age and gender. Syndromic autism with defined somatic abnormalities and recognized genetic causes (e.g., fragile X syndrome, tuberous sclerosis) were excluded Results A total of 146 ASD children and 114 normal children were included. No significant demographic differences were found between the groups. The ASD group had a higher frequency of low income and a significantly lower rate of exclusive breastfeeding in the first six months. GI symptoms, specifically constipation, abdominal gases and distension, diarrhea, undigested food particles in stool, and mouth ulcers, were significantly more frequent in the ASD group. Weight abnormalities (both increase and decrease) were also more common. Family history of ASD was significantly more in ASD children with GI symptoms while low maternal education was more in those without. Conclusion This study reveals a high prevalence of GI symptoms in ASD children. Family history of ASD and maternal education may influence the GI symptoms reported in ASD children.

Perinatal maternal factors influencing postpartum feeding practices at six weeks

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

Infant Feeding Pattern during the First Six Months of Age among Primipara Mothers

The exclusive breastfeeding (EBF) rates are low globally and in Saudi Arabia. This study aimed to identify the type of infant feeding practiced during the first six months of age and determine if there is an association between demographic characteristics and the type of breastfeeding. A descriptive cross-sectional survey was conducted on 401 primipara mothers who attended 15 primary health care centers (PHCCs)by using a self-administered questionnaire. Only 17.2% of infants were exclusively breastfed, and 65.8% were given mixed feeding in the first six months of life. The breastfeeding rate declined from 99.8% in the first month to 76.3% by six months, with a corresponding increase in the use of formula milk, plain water and dates from 31.7%, 24.9%, and 24.7% in the first month to 53.1%. 49.1%, and 32.7% in the six months, respectively. Mothers also used herbs, lump sugar, glucose water and honey every month. A chi-square test reveals no association between the demographic characteristics and type of breastfeeding (EBF, predominant breastfeeding and mixed feeding). The primipara mothers had low EBF rates indicating the need to provide culture-specific education, support and counselling.

Edukasi Dan Pendampingan Ibu Nifas Dalam Pemberian ASI Eksklusif Di RSUD Padjonga Daeng Ngalle Takalar

Low rates of exclusive breastfeeding pose a threat to children's growth and development, affecting the quality of human resources. The majority of breastfeeding mothers discontinue breastfeeding within a few weeks postpartum due to perceived insufficient breast milk and dissatisfaction of the infant during breastfeeding. The objective of this community service activity is to enhance the knowledge, attitudes, and behaviors of postpartum mothers regarding breastfeeding their infants. The methods employed included lectures and question-and-answer sessions with mothers. This activity took place in the Postnatal Care Room of Padjonga Daeng Ngalle Hospital, Takalar Regency, on March 20, 2024, with the participation of six postpartum mothers. The results of education and support provided to postpartum mothers on exclusive breastfeeding using leaflets and flip charts showed that prior to the intervention, only 2 mothers (33.33%) had good knowledge, and after the education and support, this number increased to 5 mothers (83.33%) in the post-intervention test. Therefore, through education and support, motivation and behavioral changes in exclusive breastfeeding practices among postpartum mothers can be enhanced

Family support is the strongest predictor that influences mother’s self-efficacy level on complementary feedings practices among toddlers in Tengger tribe

PurposeThe low rate of exclusive breastfeeding and the early introduction of complementary feeding are among the causes of nutritional problems in children. The national coverage of exclusive breastfeeding in 2019 was 67.7%, surpassing the target of the 2019 Strategic Plan, which was 50%. However, there are still several practices of early and inappropriate complementary feeding (32.3%) that can be contributing factors to malnutrition problems in children. The purpose of this study was to determine the factors that influence mother’s self-efficacy levels regarding complementary feeding practices among toddlers in the Tengger tribe.Design/methodology/approachThe study conducted was an observational study with a cross-sectional design. It focused on mothers with children aged 6–24 months in Wonokitri village, East Java. Data was collected using a structured questionnaire and information from the local health center. The analysis involved univariate and bivariate analysis using the chi-square test.FindingsMost mothers were aged 20–34 years (78.9%), had a good level of knowledge (61.4%), the last education level of fathers and mothers was high school (47.4%; 54.4%), parents work as farmers (86.0%; 61.4%), Hinduism (98.2%), family income is less than the minimum wage (78.9%), and mothers receive good family support (73.7%). Most toddlers were boys (56.1%), aged 13–24 months (68.4%), and the second child (66.7%). Family support was the only factor that was significantly related to a mother’s self-efficacy in complementary breastfeeding practices (p-value = 0.042).Research limitations/implicationsIt is hoped that more families and health workers will support mothers in giving food to their babies based on the guidelines.Originality/valueThis paper collects evidence from indigenous people of the Tengger tribe.

SOCIO-CULTURAL DETERMINANTS OF EXCLUSIVE BREASTFEEDING AND INFANT FEEDING PRACTICES IN NIGER

Background&#x0D; Niger has one of the lowest exclusive breastfeeding (EBF) rates in the world. Prelacteal feeding practices may contribute to low EBF rates, but research on the barriers related to EBF in Niger is limited.&#x0D; Objective&#x0D; The purpose of this study was to identify socio-cultural determinants for, and barriers to, EBF during an infant’s first 6 months through maternal perspectives in Niamey, the capital of Niger.&#x0D; Methods&#x0D; Participants were mothers with children aged 0 to 24 months in Niamey, Niger. Participants completed an interview including a 20-item questionnaire on socio-demographics, breastfeeding support and knowledge, a short food security survey, and a 24-hour diet recall. Infant anthropometric data (height, weight, upper arm circumference) was collected from patient records.&#x0D; Results&#x0D; All participants (n=31) breastfed and a majority of the mothers were planning to breastfeed until the child reached 18 months old. No mother among the participants practiced EBF for the recommended 6 months because of the common practice of prelacteal feeding, where solid or liquid foods were introduced before 6 months of age. Most participants stated that they were instructed on how to feed their child by a close relative such as their mother or sister, while health professionals rarely gave such instructions.&#x0D; Conclusions&#x0D; Exclusive breastfeeding is not a common practice among mothers in Niamey. Even though many breastfeed their infant for a relatively long duration, the participants disclosed that they often feed their infants solid and liquid foods before they reach the recommended age for complementary feeding, and sometimes within 48 hours after birth. Study results may inform the development of breastfeeding education components in clinics where mothers attend pre and postnatal consultations.

Assessment of the Baby-Friendly Hospital Initiative showed suboptimal knowledge and a low exclusive breastfeeding rate in Ogun State, Nigeria.

Implementing the Baby-Friendly Hospital Initiative (BFHI) programme has been fraught with challenges globally. The study aimed to assess the implementation of the BFHI and breastfeeding practices in healthcare facilities in Ogun State, Nigeria. It was a questionnaire-based cross-sectional study carried out between August and October 2019 among 100 healthcare workers and 110 mothers from health facilities in Ijebu-Ode Local Government Area of Ogun State, Nigeria. Nearly two-thirds (61.0%) of the healthcare workers were community health workers while the others were nurses. Less than a quarter (23.8%) of the healthcare workers had ever attended breastfeeding educational programmes since they started working. About half of the healthcare workers had good knowledge, attitude and practice of BFHI. Nurses had a significantly better practice of BFHI than community health workers. Understaffing was a major limitation to the implementation of BFHI. The mothers had an exclusive breastfeeding rate of 47%. The knowledge, attitude, and practice of BFHI were suboptimal and the exclusive breastfeeding rate among the mothers was low. There is a need to improve staff strength, training and re-training of staff, as well as regular monitoring and evaluation of healthcare facilities on the implementation of BFHI.

PERSPECTIVES OF TRADITIONAL MARKET WOMEN ON EXCLUSIVE BREASTFEEDING IN THE WORKING AREA OF DELI TUA HEALTH CENTER WORK AREA YEAR 2023

Abstract&#x0D; One of the fundamental steps toward a healthy and productive life is breastfeeding, which is in line with the Sustainable Development Goals (SDGs) or Sustainable Development Goals 2030 (Bennett et al., 2020). Low rates of exclusive breastfeeding lead to various infant health problems. The North Sumatra Provincial Government has recorded 299 cases of infant mortality until July 2021. Records from the Ministry of Health of the Republic of Indonesia, as many as 31.36% of 37.94% of children are sick, because they do not receive exclusive breastfeeding. The prevalence of stunting in Indonesia is currently at 27.67%. The low coverage of exclusive breastfeeding is influenced by various obstacles to optimal breastfeeding, one of the biggest obstacles is working women, especially those who work in the informal sector. The purpose of this study was to determine "The perspective of women informal workers in exclusive breastfeeding in the working area of the Deli Tua Health Center. This research is a qualitative study with a descriptive phenomenological approach. The participants in this study were mothers of traditional market traders as many as 7 participants who were obtained using nonprobality sampling technique with purposive sampling type. The instrument used in this research is an interview guide. In collecting data, this study used the in-depth interview method to collect data. The location of this research is Deli Tua Tax in the working area of the Deli Tua Health Center. The results of the research conducted obtained the results of a description of the factors that influence the perspective of traditional market trader mothers in exclusive breastfeeding, namely knowledge, work, husband support and socio-culture.

Evaluating an Association Between Prenatal Smoking Behavior and Exclusive Breastfeeding: A Population-Based Study

Background: Prenatal smoking is consistently associated with adverse breastfeeding outcomes. We aimed to evaluate the association of smoking cessation or continuation during pregnancy with exclusive breastfeeding in a representative sample of the general Canadian population. Methods: We used the pooled sample of 9860 females with pregnancy experience of last under-five child from the Canadian Community Health Surveys 2015-2018 public use microdata file. We categorized self-reported prenatal smoking status as continuing, quitting, or no smoking. We evaluated the association between exclusive breastfeeding for 6 months or more with prenatal smoking status using multivariable logistic regression, adjusted for socio-demographic variables. Results: With the pooled prevalence of 33.2% (95% CI 31.7, 34.8), 34.4% (95% CI 32.8, 36.1) of non-smokers, 25.7% (95% CI 20.2, 32.2) of those who quit and 15.7% (95% CI 10.8, 22.2) of those who continued smoking reported exclusive breastfeeding for 6 months or more. Continuing smoking had lower odds of exclusive breastfeeding (aOR .47; 95% CI 0.30,0.75) but quitting smoking had no difference (aOR .78;95% CI 0.56,1.08) when compared to non-smokers. Conclusion: Continuing smoking during pregnancy was associated with lower rates of exclusive breastfeeding of infants for 6 months or more. Smoking cessation interventions during prenatal visits may improve exclusive breastfeeding rates.

Breastfeeding following bariatric surgery among obese women with and without diabetes mellitus.

Information on exclusive breastfeeding (BF) and BF initiation following bariatric surgery (BS) among obese women with diabetes mellitus (DM) and without DM (non-DM) is limited. Retrospective cohort study. Obesity was defined by BMI (kg/m2) as grade 1 (30-34.9), grade 2 (35-39.9) or grade 3 (≥40). The 65 women in the DM group (40 women with gestational, 19 with Type 2 and 6 with Type 1) was similar to 84 with no-DM in BS type: Roux-en-Y (51 vs 55%), sleeve gastrectomy (32 vs 35%), laparoscopic gastric banding (17 vs 7%) and gastro-duodenal anastomosis (0 vs 4%). Women with DM were older (35 vs 33y), of advanced age (54 vs 27%), with higher prevalence of grade 3 obesity (66 vs 46%), chronic hypertension (31 vs 10%), delivery of late-preterm infants (23 vs 10%) and neonatal hypoglycemia (25 vs 12%). Although infant feeding intention was similar: BF (66 vs 79%), partial BF (9 vs 7%) or formula (25 vs 14%), at discharge women with DM had lower exclusive BF (29 vs 41%) and BF initiation rates (68 vs 76%) than those with no-DM. Women with grade 3 obesity (52% were DM) differed from those with grades 1-2 (34% were DM) in exclusive BF (27 vs 52%), and BF initiation rates (66 vs 86%). After BS, women with DM, especially those with grade 3 obesity, had higher rates of chronic hypertension and preeclampsia and lower rates of exclusive BF and BF initiation than those who had DM but had less severe obesity.

Examining the Role of Women, Infant, and Children in Black Women Breastfeeding Duration and Exclusivity: A Systematic Review.

Background: African American women continue to experience low rates of breastfeeding initiation as well as low rates of exclusive breastfeeding for 6 months. Research has indicated that there are several social determinants that impact breastfeeding rates, but there is a dearth of literature that allows African American women to give voice to their experiences. In addition, research has shown women, infant, and children (WIC) participants to have lower breastfeeding rates than non-WIC eligible women. Research Aim/Question: The aim of this systematic review was to examine the relationship between WIC program participation and breastfeeding initiation and duration among non-Hispanic African American/Black women. Methods: The approach for this review used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Four online databases, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library, MEDLINE, and SCOPUS, were used to search for peer-reviewed articles and grey literature. Results: Two hundred eighteen articles were retrieved through the database search and underwent initial screening, yielding 59 potential eligible articles. Full-text articles were further reviewed and 11 met the inclusion criteria and were included in this systematic review. Conclusions: Included studies show mixed results regarding the association between WIC participation and breastfeeding initiation, but there is a general negative association between WIC participation and breastfeeding duration, especially among Black women.

Analysis on the current situation of twin breastfeeding and its influencing factors.

Studies have found that exclusive breastfeeding can not only promote the growth and development of infants, but also increase the emotional communication between mothers and infants, and reduce the incidence of maternal breast diseases. To analysis the current situation and influencing factors of breastfeeding twins. A total of 420 twin mothers delivered in our hospital from January 2019 to December 2022 were selected to investigate the situation of breastfeeding within 6 months after delivery. An electronic questionnaire was conducted, and clinical information were collected. Univariate analysis and multivariate logistic regression analysis were applied to analyze the factors influencing exclusive breastfeeding. The rate of exclusive breastfeeding was 21.90%; in the exclusive breastfeeding group, the age <35 years old, bachelor degree or above, rural areas, no nipple depression or flat, no breast distension, no postpartum depression, adequate breast milk, participation in health education during pregnancy, husband support for breastfeeding, no infant feeding difficulties, infant diarrhea, lactose intolerance and return to milk were 96.74%, 53.26%, 65.22%, 80.43%, 76.09%, 80.43%, 73.91%, 63.04%, 69.57%, 71.74%, 65.22%, 70.65%, and 66.30%, respectively. It was significantly higher than that in the non-exclusive breastfeeding group (P < .05). The score of Edinburgh Postpartum Depression Scale (EPDS) was (8.08 ± 1.03) in the exclusive breastfeeding group, which was significantly lower than that in the non-exclusive breastfeeding group (P < .001), while the score of Perceived Social Support Scale (PSSS) was (67.32 ± 9.92), which was significantly higher than that in the non-exclusive breastfeeding one(P < .001). Logistic regression analysis showed that age, education level, nipple depression or flat, breast tenderness, postpartum depression, breast milk volume, health education training during pregnancy, husband support for breastfeeding, PSSS score, infant diarrhea, lactose intolerance, and delectation were the influencing factors of exclusive breastfeeding (P < .001). Our findings suggest that various factors were associated with a low rate of exclusive breastfeeding in twin births, such as age, educational level, and social support. Corresponding measures should be formulated for intervention to promote exclusive breastfeeding.

Exclusive Breastfeeding at Discharge in Regional New South Wales, Australia: The Role of Antenatal Care (2011-2020).

Increasing the number of infants exclusively breastfeeding on discharge from the hospital after birth is a key goal of breastfeeding policy in New South Wales (NSW), Australia. Despite consistent efforts, exclusive breastfeeding on discharge rates have declined over the past decade. Using pooled data from the New South Wales Perinatal Data Collection from 2011 to 2020, we examined the association between antenatal care (ANC) and exclusive breastfeeding at discharge from birth admission outcomes for mother-baby dyads in Southern New South Wales Local Health District (SNSWLHD). Our study confirmed that exclusive breastfeeding rates in SNSWLHD have declined over the past decade, providing local evidence to support action. Late entry to ANC and a failure to attend the recommended number of ANC visits were important predictors of a lower rate of exclusive breastfeeding on discharge. Improving accessibility to ANC visits for rural and regional mothers has potential to positively impact breastfeeding rates in SNSWLHD. We suggest that wider implementation of caseload midwifery models may have a positive impact on breastfeeding outcomes in the region for all mother-baby dyads, but particularly for Aboriginal mothers and infants, younger mothers and mothers experiencing disadvantage.

Breastfeeding Practices and Associated Factors among Immigrant Muslim Arab Women Living in a Metropolitan Area of the Southwest of United States.

Muslim Arab immigrants are a fast-growing, under-studied, and underserved minority population in the United States. Little is known about breastfeeding practices in this population. The objective of this study was to describe infant feeding practices and factors associated with these practices among immigrant Muslim Arab women. A nonexperimental-one group, cross-sectional, descriptive, prospective design was used to identify infant feeding practices among immigrant Muslim Arab women. A convenience sample of one hundred sixteen immigrant Muslim Arab women with at least one child five years or younger was recruited from a large metropolitan area in the Southwestern region. Participants completed the social ecological model of health promotion self-reported questionnaire. Descriptive statistics were performed to identify infant feeding practices and logistic regression was used to identify factors associated with these practices. Immigrant Muslim Arab mothers demonstrate high breastfeeding initiation rates (99.2%) and lengthy breastfeeding duration (M = 11.86, SD = 8.04), but low rates of exclusive breastfeeding at six months (21.6%). The most frequent reasons for early termination of breastfeeding were perceived insufficient milk (44.4%), child was still hungry after breastfeeding (37.5%), and the belief that the child was old enough to stop breastfeeding (32.9%). Development of educational interventions are needed to improve breastfeeding exclusivity and raise women's awareness of the importance of exclusive breastfeeding. Healthcare providers should help women gain confidence in their ability to produce enough milk to successfully continue breastfeeding.

How and Where the Birth Delivery Taking Place Matter towards the Success of Exclusive Breastfeeding

Background: Breast milk is the best nutrition for babies. The coverage of exclusive breastfeeding in Indonesia in 2017 was still low. However, there are many factors that contribute to low rates of exclusive breastfeeding including socio-cultural factors, factors related to the health system, market, environment, and knowledge. Recent studies have shown that there was a relationship between the place and type of delivery with exclusive breastfeeding. Objectives: This study aimed to analyze the correlation between the place and type of delivery with the success of exclusive breastfeeding practice in Indonesia among mothers of infants 0-6 months.Methods: This study was a secondary data analysis using data from the results of the 2017 Indonesia Demographic and Health Survey (IDHS), conducted in 34 provinces in Indonesia with a total sample of 1810 infants aged 0-6 months. The dependent variable was the exclusive breastfeeding. Independent variables were mother’s age, mother’s level of education, parity, place of delivery, and type of delivery. Data collection was carried out for all variables by interviewing using a reproductive woman questionnaire. Data were analyzed using chi square test.Results: The results showed that 48.2% of mothers gave exclusive breastfeeding. The results of the bivariate analysis showed that the variables of place of delivery (p-value=0.045), type of delivery (p-value&lt;0.001), and mother’s age (p-value=0.048) were related to the practice of exclusive breastfeeding.Conclusions: The conclusion of this study was the factors that affecting exclusive breastfeeding in were place of delivery, type of delivery, and mother’s age.Keywords: exclusive breastfeeding, place of delivery, type of delivery, early life nutrition

Dukungan Suami, Orang Tua, dan Mertua dalam Pemberian ASI Ekslusif di Kota Tasikmalaya

Low breastfeeding is a problem that must be faced together because it can affect children's lives in the future. The lack of exclusive breastfeeding can interfere with child growth and development. Based on several studies in Indonesia, one of the factors that influence the low rate of exclusive breastfeeding is the lack of family support. Exclusive breastfeeding in West Java province in 2018 reached 57.97%. This number is still below the national target (65.16%). Based on the information from the Tasikmalaya City Health Office, the coverage of exclusive breastfeeding in Tasikmalaya City in 2018 reached 69.00%, but has not reached the target. The purpose of this study was to determine the support of husbands, parents, and in-laws in exclusive breastfeeding. This study used a qualitative method of focus group discussions (FGD). This method presented a direct relationship between the researcher and the person providing the information, making it possible to gain insight into the attitudes, motivations and behavior of the target towards the support and barriers to exclusive breastfeeding. There were four informants in this study. The results of this study indicated that the factors that support the success of exclusive breastfeeding in this study were the wishes of the baby's own mother, support from her husband, the baby's grandmother, and health workers who assisted in childbirth.

Impact of Donor Human Milk in an Urban NICU Population.

The American Academy of Pediatrics recommends the use of donor human milk in infants when mother's own milk is not available. Our objective was to analyze whether the use of donor human milk in preterm, very-low-birth-weight (VLBW, &lt;1500 g) infants affected the rates of necrotizing enterocolitis, duration of parenteral nutrition (PN), growth, culture-positive sepsis, length of hospital stay, and mortality in an urban NICU population with low exclusive breast-feeding rates. A retrospective cohort study was conducted comparing two 2-year epochs of VLBW neonates before and after the introduction of donor breast milk in our neonatal intensive care unit (NICU). With the introduction of donor human milk, there was a significant reduction in the rate of necrotizing enterocolitis (NEC) (5% vs. 13%; p = 0.04) and less severe NEC as defined by Stage III based on the Modified Bell Staging Criteria (10% to 3%; p = 0.04). In the donor milk era, there was earlier initiation of enteral feeding (2.69 days vs. 3.84; p = 0.006) and a more rapid return to birthweight (9.5 days. 10.9 days; p = 0.006). In this study, a change in practice to the use of donor breast milk in a population with low rates of human milk provision was associated with earlier initiation of enteral feeding, faster return to birth weight, and a reduced incidence of NEC.