Breastfeeding,
how...
Mothers'
weaning decisions
Simondon
KB, Costes R, Delaunay V, Diallo A, Simondon F. Children's
height, health and appetite influence mothers' weaning
decisions in rural Senegal. Int J Epidemiol 2001;30:476-81
In Senegal,
the habit of postponing weaning of stunted children
very likely explains why breastfed children have lower
height-for-age than weaned children. This is the conclusion
of a study on maternal reasons for early and late weaning.
A cohort of 485 children was investigated with interviews
at the ages of 18-28 and 23-33 months. Two-thirds of
mothers of breastfed children under 2 years stated that
they would wean at the age of 2, while for breastfed
children aged 2 years a 'tall and strong' child was
the most prevalent rule. The main reasons for weaning
prior to 2 years were that the child ate well from the
family plate (60%), that the child was 'tall and strong'
(46%), and maternal pregnancy (35%). The main reasons
for weaning later than 2 years were a 'little, weak'
child (33%), food shortage (25%), illness of the child
(24%), and refusal of family food (14%). Children breastfed
above the age of 2 because they were 'small and weak',
had lower mean height-for-age and a greater prevalence
of stunting than children breastfed late for other reasons.
Adherence
to infant feeding recommendations
MVaahtera
M, Kulmala T, Hietanen A, Ndekha M, Cullinan T, Salin
ML, Ashorn P. Breastfeeding and complementary feeding
practices in rural Malawi. Acta Paediatr 2001;90:328-32
Education
and family planning may improve adherence to infant
feeding recommendations and reduce the incidence of
early childhood malnutrition. This is shown by a study
on a cohort of 720 newborn babies in Malawi. Monthly
interviews of the main guardians indicated that breastfeeding
was universal for 18 months. As most babies were given
water or other supplements soon after birth, the EBF
rates were only 19%, 8%, 2% and 0% at ages 1, 2, 3 and
4 months, respectively. Complementary foods and family
foods were introduced at median ages of 2.5 and 6.3
months, i.e. much earlier than recommended. Better adherence
to national recommendations was associated with smaller
number of children in the family, increased maternal
education and some other socio-economic or environmental
variables.
Infant
feeding practices in Tanzania
Agnarsson
I, Mpello A, Gunnlaugsson G, Hofvander Y, Greiner T.
Infant feeding practices during the first six months
of life in a rural area in Tanzania. East Afr Med
J 2001;78:9-13
The recommendation
to exclusively breastfeed is still not followed everywhere.
To assess beliefs, knowledge and practices affecting
EBF, a house-to-house survey was conducted on 107 Tanzanian
mothers with infants less than 7 months. 64% were put
to the breast within 2 to 11 hours. Prelacteal feeds
were given to about 25% of infants. The type of prelacteal
fluid given was mainly glucose water in hospital and
plain water with home deliveries. 46% of the mothers
discarded colostrum. The median duration of EBF was
about 2 months, and of full breastfeeding, about 4 months.
The average duration of EBF, though far below recommended
levels, is higher than is found in most studies in Africa
and Tanzania. This may be due to the efforts of hospital
staff that had received special training on breastfeeding
in recent years.
…
and Brazil
Marques NM,
Lira PIC, Lima MC, da Silva NL, Batista Filho M, Huttly
SRA, Ashworth A. Breastfeeding and early weaning
practices in northeast Brazil: a longitudinal study.
Pediatrics 2001;108:e66
In Brazil,
breastfeeding is nowadays common, but EBF is still rare
and of short duration. This study tries to identify
risk factors that may be used to develop interventions.
In four small towns of northeast Brazil, 364 mothers
were interviewed at delivery to ascertain home support,
antenatal care, delivery room practices, and their intentions
regarding breastfeeding, pacifiers, and introduction
of water, teas, and other milk. Thereafter, daily information
about feeding practices was collected at twice-weekly
home visits from 0 to 12 months of age. Almost 100%
of mothers breastfed their infant, but few intended
to breastfeed exclusively, and in the first week, 80%
gave water/tea and 56% used a pacifier. The median duration
of EBF was 0 days, and the median age for starting other
milk was 24 days. The median duration of breastfeeding
was 65 days for mothers who started other milk within
1 month and 165 days for other mothers. After adjustment
for confounding variables, the main factors associated
with introduction of other milk within 1 month were
pacifier use in the first week, intention to start other
milk in the first month, giving water/tea in the first
week, and leaving the maternity ward before breastfeeding
was started.
Predictors
of premature cessation of breastfeeding
Berra S,
Rajmil L, Passamonte R, Fernandez E, Sabulsky J. Premature
cessation of breastfeeding in infants: development and
evaluation of a predictive model in two Argentinian
cohorts: the CLACYD study, 1993-1999. Acta Paediatr
2001;90:544-51
To identify
factors that are predictors of early weaning is certainly
helpful for programme planners. The following may be
predictors of premature (prior to 6 months) cessation
of breastfeeding: mother breastfed less than 6 months,
breastfeeding of previous child for less than 6 months,
the condition of the firstborn child, the first mother-child
contact occurring after 90 minutes of life, and having
an unplanned pregnancy. This is the result of a study
on two cohorts of newborn infants with a birthweight
of 2000 g or more, a total of 700 babies, recruited
in 1993 and 1995 during hospital admittance for childbirth
in Cordoba, Argentina.
Promotion
of breastfeeding in the Gambia
Semega-Janneh
IJ. et al. Promoting breastfeeding in rural Gambia:
combining traditional and modern knowledge. Health
Policy Plan 2001;16:199-205
In rural
Gambia, delayed initiation of breastfeeding, prelacteal
feeding and failure to practice EBF are widespread.
In this study, quantitative methods were used to identify
current infant feeding practices in twelve rural communities.
Qualitative data further indicated that current beliefs
and practices were strongly influenced by traditional
beliefs and practices. Elders, both women and men, including
husbands, kept these very much alive. The results also
showed an unexpected support for bottle feeding from
both male and female elders who considered it part of
the modernisation process. A strategy for promoting
early initiation of breastfeeding, use of colostrum
and EBF for 6 months should therefore incorporate traditional
beliefs and practices into modern messages on optimal
breastfeeding. Traditional beliefs and practices in
the study setting that could be used in this way include
knowledge from the population's acquaintance with the
newborns of their livestock. It also includes the traditional
practice of mothers taking their very young children
with them when going to work in the fields.
Unplanned
pregnancies and prolonged breastfeeding
Chinebuah
B, Perez-Escamilla R. Unplanned pregnancies are associated
with less likelihood of prolonged breastfeeding among
primiparous women in Ghana. J Nutr 2001;131:1247-9
If a pregnancy
is unplanned, we should expect the mother to breastfeed
less, but only if she is primiparous. This is shown
by a study that examined the association between pregnancy
intentions and the likelihood of breastfeeding, to determine
whether parity modifies it. The analysis was based on
last-born children, aged 13-36 months, of women participating
in the 1993 Demographic and Health Survey in Ghana.
Primiparous women with planned pregnancies had a significantly
greater median duration of breastfeeding than their
counterparts whose pregnancies were unintended (21.1
vs. 18.5 months). Among multiparous women, median breastfeeding
duration was similar in both groups (21.5 vs. 21 months).
Lack
of social support for breastfeeding
McIntyre
E, Hiller JE, Turnbull D. Attitudes towards infant
feeding among adults in a low socioeconomic community:
what social support is there for breastfeeding?
Breastfeed Rev 2001;9:13-24
To examine
infant feeding attitudes and experiences of mothers,
fathers and grandmothers, as well as the general community,
this study undertook an analysis of the role of social
support in influencing breastfeeding in a low socioeconomic
area in South Australia. A random telephone survey of
over 3,400 adults indicated that there was little support
for breastfeeding compared to bottle feeding, with similar
barriers to breastfeeding found in all target groups
as well as in the general community. These barriers
included breastfeeding in public, the convenience of
bottle feeding, maternal discomfort of breastfeeding,
fathers' involvement with feeding, and the mother's
need to have had some previous experience related to
breastfeeding. Strategies promoting and supporting breastfeeding
should address these issues and should be directed at
the community in general rather than at specific groups.
Prepared
by the Geneva Infant Feeding Association (GIFA),
a member of the International Baby Food Action Network
(IBFAN)
Editors:
Marina Ferreira Rea, Adriano Cattaneo. Bob Peck revised
and edited the text.
Copies
of Breastfeeding Briefs sent upon request to GIFA, Avenue
de la Paix 11, 1202 Geneva, Switzerland,
Fax: +41-22-798 44 43, or to UNICEF country offices.
Available
also in French, Spanish, Portuguese and Arabic.
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