Perinatal factors influencing infant feeding practices at birth: the Bedouin Infant Feeding Study

Summary. Bedouin Arab women delivering newborns at Soroka Medical Center, Israel, during 1 year were interviewed in hospital to determine the factors influencing infant feeding practices at birth. Eighty-six per cent breastfed, 11% breast and bottlefed, and 3% bottlefed at birth. Based on a multiple logistic regression analysis, the factors that significantly reduced the odds ratio (OR) of exclusive breastfeeding vs. breast and bottle feeding or bottle feeding at birth include: delivering during the high birth season (OR = 0.49); maternal recall of feeling unwell during pregnancy (OR = 0.59); delivering a low birthweight newborn (OR = 0.10); a newborn diagnosed with major malformations (OR = 0.30) or with major illnesses (OR = 0.32); and delivering by Cae-sarean section (OR = 0.09). In contrast, multiparae experienced an increased odds (OR = 1.67) of breastfeeding. Among primiparae, the factors that significantly reduced the odds of exclusive breastfeeding include: delivering during the high birth season (OR = 0.47); delivering a low birthweight newborn (OR = 0.12); and delivering by Caesarean section (OR = 0.18). Mothers of high-risk neonates and those who deliver by Caesarean section need to be educated about the benefits of exclusive breastfeeding. Young primiparae are a challenge and require qualitative and quantitative research into the reasons precluding exclusive breastfeeding.     

The Bedouin Infant Feeding Study: study design and factors influencing the duration of breast feeding

Summary. A longitudinal study of infant feeding practices, growth and morbidity among Bedouin Arab infants residing in the Negev, Israel, was conducted during a 3-year period (1981–1983). Follow-up samples were restricted to healthy newborns. The majority of newborns are breast fed at birth but, by 2 months, 50% are also introduced to a milk supplement. Based on the bivariate analysis using the logrank test to examine the factors associated with exclusive versus partial breast feeding during the first 6 months, those born during the wet cool months are exclusively breast fed longer than those born during the dry season. More traditional women, living in tents rather than houses or huts, exclusively breast feed for at least 6 months. In a multiple logistic regression model, parity, house type and birth season are independently associated with the odds of exclusively breast feeding for the first 6 months of life. Factors influencing the duration of any breast feeding for the first 18 months include: house type, place of residence, birthweight, and whether the infant was stunted at 6 months.     

The Bedouin Infant Feeding Study: study design and factors influencing the duration of breast feeding.

A longitudinal study of infant feeding practices, growth and morbidity among Bedouin Arab infants residing in the Negev, Israel, was conducted during a 3-year period (1981-1983). Follow-up samples were restricted to healthy newborns. The majority of newborns are breast fed at birth but, by 2 months, 50% are also introduced to a milk supplement. Based on the bivariate analysis using the logrank test to examine the factors associated with exclusive versus partial breast feeding during the first 6 months, those born during the wet cool months are exclusively breast fed longer than those born during the dry season. More traditional women, living in tents rather than houses or huts, exclusively breast feed for at least 6 months. In a multiple logistic regression model, parity, house type and birth season are independently associated with the odds of exclusively breast feeding for the first 6 months of life. Factors influencing the duration of any breast feeding for the first 18 months include: house type, place of residence, birthweight, and whether the infant was stunted at 6 months.     

Undernutrition among Bedouin Arab infants: the Bedouin Infant Feeding Study

Two hundred seventy-four healthy Bedouin Arab newborns in 1981 were followed for 18 mo to examine the relationship between infant-feeding practices and growth during planned social change. Although wasting was not prevalent, the prevalence rate of stunting (less than or equal to -2 SDs) increased from 12% to 19% to 32% at 6, 12, and 18 mo, respectively. After multiple-logistic-regression adjustment for covariates, the odds ratio (OR) of stunting at 6 mo was reduced among infants breast-fed only or fed with supplement compared with weaned infants. Infant-feeding practices were not associated with stunting in later infancy; however, those stunted at 6 mo had an OR of 13 of stunting at 12 mo and those stunted at 12 mo had an OR of 14 of stunting at 18 mo. In a multiple-linear-regression analysis, seasonality, duration of breast-feeding, hospitalized morbidity, and residual of height at 6 mo were negatively associated with daily average linear growth from 6 to 12 mo; these factors only explained 12% of the variation in daily linear growth.     

Factors influencing milk insufficiency and its long-term health effects: the Bedouin Infant Feeding Study.

Women who breastfeed have frequently reported milk insufficiency as the reason for introducing the bottle, but no one has addressed its potential long-term health effects. This paper described the factors associated with milk insufficiency versus another reason for introducing the bottle and its potential health effects based on an analysis of a prospective cohort study of 1005 Bedouin Arab women who delivered healthy newborns in 1981 and 1982. By two months postpartum, 72% introduced the infant to the bottle with 72% reporting milk insufficiency as the reason for introducing the bottle. The percentage of milk insufficiency declined with increasing age of the infant. Based on multiple logistic regression analyses, birth season was statistically significantly associated with the odds ratio (OR) of milk insufficiency versus another reason for introducing the bottle during the first two months. Women who delivered in the spring-summer had an increased OR = 1.65 of reported milk insufficiency compared with those who delivered during the rest of the year. Parity was directly related to the OR = 1.04 of milk insufficiency (but just missed significance) during one to two months and was statistically significantly associated with the OR = 1.12 of reported milk insufficiency during 3-18 months. The rates of stunting after the infant was introduced to the bottle and the duration of breastfeeding did not differ by reason for introducing the bottle. Thus the high frequency of reported milk insufficiency was not associated with adverse health effects.     

Infant feeding practices and socio-demographic factors in Ottawa-Carleton

Parents of 320 infants 6-18 months of age were interviewed to determine infant feeding practices and socio-demographic factors contributing to parental choices. 76% of women breastfed initially. Social class was directly related to the incidence of breastfeeding. 50% of the women who started breastfeeding continued to do so at 6 months, a figure which is higher than that previously reported in Canada. Although social class was a major determinant in parents' choice of infant feeding, cultural factors were also very important. A higher proportion of mothers who spoke languages other than English or French in the home (including mainly Polish, Italian, Spanish, and East Indian) breastfed their infants than did mothers who spoke French, even though more of them were in the lowest socio-economic group. The reason for the relatively low incidence of breastfeeding by Francophone mothers is unclear.     

Factors influencing infant feeding practices of mothers in Vancouver.

This study describes factors influencing infant feeding choices of 434 mothers with 9-month-old infants in Vancouver. Consistent with Social Cognitive Theory, both internal personal and socio-environmental factors influence infant feeding choices. Mothers attributed the choice to breastfeed primarily to personal choice, whereas the choice to formula feed was attributed to socio-environmental factors. Among mothers who breastfed < 3 months, the choice to wean was primarily attributed to concern for baby's nutrition; compared to returning to work, concern about milk supply and concern for baby's nutrition among those who breastfed > or = 3 to < 6 months; and returning to work and personal choice among those who breastfed > or = 6 months. Among Caucasian mothers, the choice to wean was primarily attributed to returning to work, compared to concern for baby's nutrition among non-Caucasian mothers. Initiatives to facilitate further advances in breastfeeding promotion could address three areas: 1) prenatal intentions, 2) early postpartum concerns, and 3) later issues surrounding returning to work and infant nutrition.     

Infant feeding practices of the Igbo,Nigeria

The pattern of infant feeding and attitudes of the mothers towards breast feeding, morbidity and mortality of a sample of the Nigerian Igbo tribe was studied. The result showed that:

• Ninety‐four percent of all mothers breast fed their infants for at least six months. The duration was longer among the non‐educated than the educated mothers.

• The size of the family decreased with increases in educational attainment. Eighty percent of the mothers gave their babies supplementary food between 3–7 months of age. A special weaning diet was used by 49 percent of the educated mothers and 27 percent of the non‐educated mothers.

• Twenty percent of the children has at least one attack of diarrhoea before the age of six months. One out of every eleven children was admitted at least once to the hospital before the end of six months.

The prevalence of diarrhoea, malnutrition and possibly death could be attributed to a number of factors. These include: the introduction of supplementary food too early in unsanitary conditions, the ignorance of the mothers of what the weaning diet should constitute, the large number of children in the family, and the unhiegienic environment.     

Studying the infant feeding intentions of pregnant women experiencing material deprivation: Methodology of the Looking at Infant Feeding Today (LIFT) study

The Looking at Infant Feeding Today (LIFT) study examined the factors underlying the infant feeding choices of first-time mothers in the Leeds and Bradford areas of England experiencing material hardship, with a view to informing interventions aimed at increasing breastfeeding uptake amongst this group. This short report describes the novel methodology used to obtain data from a sample of pregnant women who are traditionally ‘hard-to-reach’ in deprived areas. This involved the use of trusted individuals such as midwives and multilingual health workers. A total of 449 women were approached; 441 (91.5%) agreed to participate and 303 returned completed questionnaires. Whilst 285 participants self-completed, 18 opted for interviewer assistance provided by a trained multilingual health worker. Feeding method up to 10 days after birth was obtained from the hospital records of 248 women (82.4% of eligible returns), and self-reported feeding method at six weeks was obtained from 273 women (90.7% of eligible returns). The study succeeded in obtaining data from a relatively deprived and hard-to-reach sample, with adequate numbers of participants in the subgroups of interest (teenage, left full time education age 16 or younger, household receiving income support or job seekers allowance, Asian or African-Caribbean).     

Infant feeding practices: the case of Hmong women in Australia

I discuss infant feeding beliefs and practices among Hmong women in Melbourne, focusing particularly on changed patterns that have occurred since their settlement in Australia. Traditionally, Hmong women breastfeed their newborn infants. Most women can breastfeed successfully in their homeland. However, since their settlement in a new country, some women have changed to bottlefeeding. Reasons given include the need to study English and seek employment, the availability of infant formula, insufficient milk, and their concern about the health and well-being of the infants. Hmong women either choose breast- or bottlefeeding based on what they think is best for their babies; their clear intention is to have children who will be healthy and thrive. Understanding of women's beliefs and practices relating to feeding is essential in creating a breastfeeding campaign. More importantly, the information will assist health professionals to support mothers in their choice of a feeding method, whether it be breast or bottle.     

Infant feeding practices in Ottawa-Carleton: the introduction of solid foods

Infant feeding guidelines regarding the introduction of solid foods are generally not well known in Canada. The guidelines recommend that solid foods be introduced between four to six months of age, depending on the developmental readiness of the infant. In order to understand the underlying factors and patterns which contribute to the introduction of solid foods in infants, data were analyzed from three cross-sectional surveys of parents of six-month-old infants from the Ottawa-Carleton region (n = 373, 1988; n = 330, 1992; n = 338, 1996) conducted by the Ottawa-Carleton Health Department. Multivariable analysis showed that mothers who: did not breastfeed, were younger, had lower education, smoked or had partners that smoked, and lacked support after birth, were more likely to introduce solid foods before four months of age. These data support the need for nutrition education programs to increase adherence to the new Nutrition for Healthy Term Infants guidelines.     

What did your baby eat yesterday?: Social factors and infant feeding practices

This paper presents data on the feeding of 354 young childrenin the Midlands and the South of England in 1987–9. Thedata were collected by means of a postal questionnaire completedby mothers. Considerable geographical and social variation ininfant feeding practices is shown to exist. Social factors significantlyrelated to diet are household income, housing tenure and quality,the presence of other children in the household, household amenities,mothers' feelings of control, and partners' domestic help. Theimplications of these findings for current policy guidelinesconcerning parental feeding of young children are explored,as are the ways in which they contribute to the debate aboutthe merits of personal health education versus those of attendingto environmental and material constraints on the promotion ofthe public health.     

Infant feeding: a review of breast- and formula-feeding practices

The large scale use of cows' milk for infant feeding is a comparatively recent development. The trends in artificial formula and breast-feeding practices are reviewed by comparing the recommendations in infant feeding practices from the 1974, 1980 and 1988 DHSS Present Day Practices in Infant Feeding Reports.     

Traditional infant feeding practices: Right or wrong?

Infant feeding practices, breastmilk and food intake and post-natal growth in Madura, East Java, Indonesia and Machakos, Kenya are described. Breastfeeding is commonly practised. Additional foods are introduced the first week post-partum in Madura and at age 2-3 months in Machakos. Growth started to falter at 2-3 months in Madura but was acceptable during the first 6 months in Machakos. It was felt that apart from breastfeeding and morbidity, other factors pertaining to mother's perceptions about what infants should eat and her possibility to make suitable weaning foods, should be considered to understand the background of growth faltering.     

A review of infant feeding practices at a regional cystic fibrosis unit

We have reviewed the outcome and feeding of the 28 cystic fibrosis (CF) infants diagnosed at St James's University Hospital, Leeds, during 15 years between 1974–1988. During this period most infants were fed on either standard formula milk feeds or a lower fat, higher protein mix (CF milk). It was the practice to prescribe pancreatic enzymes from the diagnosis of CF, wean the infant on to solids between 2 and 3 months of age and provide extra calorie supplements if infants were not thriving adequately. The mean weight at birth (s.d.) was 3.33 (0.45) kg and at 12 months was 9.56 (1.21) kg. It is concluded that CF infants provided with adequate energy intake and appropriate pancreatic enzymes should thrive satisfactorily.