Low Rates Of Exclusive Breastfeeding Research Articles

International Perspectives

Meeting the commitment to reach the Millennium Developmental Goal of reducing infant mortality rate to less than 30 in India is only possible through improved neonatal survival. The formidable hurdles that contribute to the high neonatal mortality include domiciliary births aided by unskilled birth attendants, low exclusive breastfeeding rates, high burden of low-birthweight infants, poor care-seeking practices for sick children (with female infants receiving less care), and high cost of care for sick newborns compared with family incomes. Creating models of community and domiciliary newborn care and establishing low-cost newborn care units at district health facilities have reduced neonatal mortality significantly. Taking these experiments to scale appears to be the road map for India to reduce its burden of neonatal deaths.

A Barrier to Exclusive Breastfeeding for WIC Enrollees: Limited Use of Exclusive Breastfeeding Food Package for Mothers

In the first 2 weeks of life, most breastfeeding mother-infant dyads in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) receive infant formula from WIC, instead of a larger food package designed for exclusively breastfeeding mothers. This study was designed to explore reasons for high rates of formula supplementation of breastfeeding newborns enrolled in WIC and the limited use of the WIC expanded food package. We conducted in-depth interviews with 29 mothers who either partially or exclusively breastfed for at least 2 months. Interviews were transcribed verbatim, analyzed, coded, and organized into 10 themes. Participants view the WIC program in a contradictory manner. They see it as highly supportive of breastfeeding, but also as a promoter of infant formula. The expanded food package for mothers is not valued, but free supplemental formula is highly valued. Misinformation about breastfeeding pervades the healthcare system, and exclusive breastfeeding is not promoted as an important health goal. Lack of access to breast pumps, the unacceptability of pumping in the workplace, and difficulties with nursing in public all contribute to formula supplementation. The healthcare system, the WIC program, and demands of daily life all contribute to low rates of exclusive breastfeeding in the WIC program. The available expanded food package for mothers who are exclusively breastfeeding is both disliked and underutilized, while free supplemental formula is rarely discouraged.

Mainstreaming interventions in the health sector to address maternal and child undernutrition

Mainstreaming interventions in the health sector to address maternal and child undernutrition

Breastfeeding and Infant Illness in Low-Income, Minority Women: A Prospective Cohort Study of the Dose-Response Relationship

The authors' objective was to determine whether cumulative weekly breastfeeding duration by 13 weeks was associated with infant otitis media, respiratory and gastrointestinal illness, and total illness visits up to 12 months. The authors performed a secondary analysis of data from a randomized clinical trial of low-income, primarily Hispanic and Black women enrolled from 2 medical center affiliated clinics. "Breastfeeding sensitive" (BFS) outpatient and emergency room (ER) visit data for the above illnesses were obtained for 255 mother/infant dyads. Outcome measures were unadjusted and adjusted rates of outpatient and ER visits with sick and BFS diagnoses. The authors found no significant associations between breastfeeding intensity and infant visits for otitis media, respiratory and gastrointestinal illness, or total illness visits. In this low-income, multiethnic sample, breastfeeding intensity was not associated with infant health service use, in contrast to other evidence-based reports. Low exclusive breastfeeding rates and lack of coverage for health visits may be reasons for this finding.

Paucity of Evidence-Based Research on How to Achieve the Healthy People 2010 Goal of Exclusive Breastfeeding

To the Editor .— The evidence base for the public health import of exclusive, prolonged breastfeeding continues to expand, as shown in the article “Breastfeeding and Hospitalization for Diarrheal and Respiratory Infection in the United Kingdom Millennium Cohort Study,”1 which comes on the heels of the new Healthy People 2010 (HP2010) exclusive breastfeeding goals2 (objective 16 now reflects exclusive breastfeeding at 16–19 d and e as objectives approved for HP2010). Achieving the new HP2010 goals will require substantial effort, given dismally low rates of exclusive breastfeeding in the United States. Several years ago, Pediatrics published an analysis of federal research funding that depicted an incongruity between national priorities for breastfeeding on the one hand and research aimed at achieving Healthy People 2000 (HP2000) breastfeeding goals on the other hand.3 By the mid-2000s this incongruity had grown starker, even as the new HP2010 targets justifiably raise the bar for this public health objective. The revised HP2010 breastfeeding objectives adopted in December 2006 set targets for 60% of women …

Randomized controlled trial of a prenatal and postnatal lactation consultant intervention on infant health care use.

To determine whether infants of women randomized to a prenatal and postpartum lactation support intervention incur fewer otitis media-, respiratory tract-, or gastrointestinal-related visits than controls. Randomized, unmasked controlled trial recruiting women from prenatal care settings. Breastfeeding sensitive (BFS) illness visits for otitis media or respiratory tract or gastrointestinal complaints were obtained up to 12 months. Two urban community health centers. Analytic sample of 338 low-income, primarily Hispanic and/or black mother-infant dyads (n = 163 for the intervention group and n = 175 for the control group). Study lactation consultants attempted 2 prenatal meetings, 1 postpartum hospital and/or home visit, and telephone calls as needed. Controls received the standard of care. Combined outpatient and emergency department visits with illness and BFS illness diagnoses. There was a significant interaction between treatment and Medicaid; among those not receiving Medicaid, the number of otitis media visits was higher among controls (P</=.03). Visits for any illness and BFS, gastrointestinal, or respiratory tract illnesses did not differ by treatment group. Intervention group infants received more breast milk than controls, but exclusive breastfeeding rates remained low and did not differ between groups at any point. Only the number of otitis media visits was reduced, in a subset of the intervention group. The intervention did not reduce visits for respiratory tract or gastrointestinal illness. Limited intervention contact and low exclusive breastfeeding rates may have attenuated intervention effects. Future interventions designed to yield markedly increased breastfeeding rates may show greater effects in low-income multiethnic samples. Health coverage for visits may moderate intervention effects.

Counter-Response

This paper summarizes findings from a formative research study conducted in Haiti to develop a behavior change communication (BCC) strategy to improve infant and child feeding practices and to reduce childhood malnutrition. It describes the methodology used and the tools developed to facilitate decisionmaking and effective use of formative research for program planning. The study is part of a larger research project carried out by the International Food Policy Research Institute (IFPRI) and Cornell University in collaboration with World Vision-Haiti, a private voluntary organization responsible for the implementation of integrated health and nutrition programs that include food donations. The study used formative research methods that included individual and group interviews, food-rating exercises, and participatory recipe trials. The aims of the study were to (1) study current infant and young child feeding practices in the Central Plateau of Haiti, (2) identify individual, household, and community factors that may facilitate or constrain adoption of recommended behaviors, and (3) use the information from the formative research to prioritize behaviors and design an effective BCC strategy. The study revealed some nonoptimal infant and young child feeding practices in this part of rural Haiti, such as low rates of exclusive breastfeeding, early introduction of nutrient-poor gruels, and the scarcity of nutrient-dense foods such as animal products in the diet. A number of constraints were also identified that may limit the ability of families to engage in optimal feeding practices. These include the early resumption of work outside the home by women, which is driven by economic necessity and results in frequent and sometimes long separations of the mother from her young infant. The lack of time to prepare special complementary foods for the child, the perception that 12month-old infants are ready to consume the family diet, and the low availability of micronutrient-rich foods (animal-source foods in particular) are additional constraints on poor families to achieving optimal child feeding practices.

Racial and ethnic disparities in breastfeeding among United States infants: Third National Health and Nutrition Examination Survey, 1988-1994.

The studies suggesting that blacks are less likely to initiate and maintain breastfeeding than whites in the United States are limited either by the representativeness of the sample or by the ambiguousness of attribution of racial and ethnic disparities to generally poor socioeconomic status among blacks. The purpose of this study was to examine racial and ethnic disparities in breastfeeding rates among U.S. infants using national representative data. We analyzed breastfeeding data reported by parents of children ages 12 to 71 months at the time of interview from the Third National Health and Nutrition Examination Survey (1988-1994). Breastfeeding data were stratified by both race and ethnicity, and by a series of sociodemographic and health-related characteristics. The proportion of children ever breastfed was 60 percent among non-Hispanic whites, 26 percent among non-Hispanic blacks, and 54 percent among Mexican Americans. By 6 months postpartum, the proportion still breastfed decreased to 27, 9, and 23 percent, correspondently. Blacks also had a significantly lower rate of exclusive breastfeeding at 4 months than whites (14%). In addition, the differentials in breastfeeding rates between high and low socioeconomic classes were most substantial among blacks. Blacks had consistent lower breastfeeding rates than whites regardless of their sociodemographic status. The large differentials between high and low socioeconomic classes among blacks suggest that socioeconomic status has a bigger impact on breastfeeding practices among blacks. Therefore, blacks, particularly those who are poor or less educated, need to be targeted for promotion, protection, and support of breastfeeding.