The effect of a breastfeeding education program on lactational amenorrhea in the Philippines

A study was conducted in two communities in the rural Philippines to determine whether breastfeeding mothers could intensify their nursing enough to increase the period of lactational amenorrhea. Women in one community were exposed to a breastfeeding education program before the birth and during lactation, while women in the other community served as a comparison group. Increased breastfeeding was observed in the group that received breastfeeding education, beginning in the sixth month postpartum. Bottle use began earlier and was more common in the comparison group, but the introduction of solid foods at five to six months was similar. No difference in the duration of postpartum amenorrhea (a proxy for the duration of infertility) was observed between the groups.     

哺乳期闭经的影响因素分析

利用世界卫生组织课题“健康教育对哺乳和避孕行为的影响—上海市产后妇女哺乳和避孕行为队列研究”的调查资料,分析了不同因素对哺乳期闭经的影响。多元COX回归分析结果发现市区(黄浦区和普陀区)对象中闭经时间短,月经初潮年龄小的妇女闭经时间也短。按时喂养、每昼夜喂奶次数少、哺乳时间短的对象闭经时间短。哺乳期闭经时间的长短因受多种因素的影响(尤其是哺乳的情况),在作为一种避孕方法使用时应注意其避孕效率。     

农村育龄妇女分娩方式与健康状况的关系研究

目的:了解浙江省农村育龄妇女分娩方式与健康状况的关系,提高母婴健康水平。方法:采用分层整群抽样法调查2000～2010年浙江省6个样本村的522例农村育龄妇女的分娩方式和育龄妇女及儿童的健康状况。结果:剖宫产术的母亲两周患病率高于自然分娩者,产后恢复和总体健康状况较自然分娩者差,差异均有统计学意义;剖宫产术的儿童总体健康状况较自然分娩者差,住院率高于自然分娩者。剖宫产的纯母乳喂养率和泌乳量均低于自然分娩者。结论:通过相关部门和整个社会的共同努力,大力提倡自然分娩,最大限度地减少非必须剖宫产术,降低剖宫产率,保障母婴的整体健康水平。     

Lactation and fertility.

During the last decade there have been many reports indicating a decline in breast feeding practices in the urban areas of developing countries. This decline might have adverse effects on maternal and child health. A study of 1079 urban hospital attending women was undertaken to evaluate their breast feeding practices. Prolonged (mean duration of lactation 19.8 months) and successful lactation (failure of lactation occurred in only 3.5%) was common among this group. But a trend toward shorter duration of breast feeding was found among educationally and economically better off segment. There was very good correlation between mean duration of lactation, lactational amenorrhea, and interpregnancy interval. Therefore, it is possible that decrease in duration of lactation might result in shorter interpregnancy interval. The duration of lactation appeared to be "fixed" for each individual irrespective of age and parity. This in turn resulted in "fixed" duration of lactational amenorrhea and interpregnancy interval under conditions of unhindered lactation and uncontrolled fertility. Conception during lactational amenorrhea was low (7.7%) but once periods were reestablished lactation offered very little protection against conception.     

Nutritional status and dietary intake of lactating Yoruba mothers in Nigeria

A study was conducted into the nutritional status and dietary intake of 100 lactating Yoruba mothers in Nigeria. The group included 75 rural and 25 urban women, all from lower socioeconomic groups. All the mothers had given birth to singleton babies and fully breast fed their infants. Energy inadequacy ranged between 82-83% while protein inadequacy varied from 78-91%. Urban women were lower in both categories. Compared to the recommended allowance, the mean daily intake of iron, thiamin and calcium was found to be adequate and the intake of vitamin A was high. Mean energy, protein, riboflavin, and ascorbic acid intakes were inadequate. Results generally agree with those from other developing countries. The mothers were generally healthy and the weights of their infants were found to be satisfactory. Most of the mothers were maintaining a satisfactory lactation performance. The contribution of supplemental food for the infants was judged insignificant.     

Differences in the infant-feeding practices in Urban and Rural Nigeria

This study compared the infant-feeding methods of 378 urban mothers and 356 rural mothers. We collected information by means of a questionnaire. The weights of infants were taken by means of an Avery scale and milk intake was assessed by the test-weighing method. The results showed that all mothers breastfed their children and introduced milk formula or other milks at some stage. All urban mothers had stopped breastfeeding by 12 months, but 27.5% of rural mothers breastfed 1 year or more. A majority of the mothers (87.1% rural and 78.6% urban) reported that they stopped breastfeeding when they thought the child was old enough to stop. And although urban and rural mothers said they started weaning their children for similar reasons, 33.9% of urban mothers weaned their babies within the first 9 months of life compared to 6.7% in the rural area. Urban infants were heavier within the period surveyed. This article includes recommendations for increasing the duration of breastfeeding and improving availability of weaning foods.     

Maternal Visceral Adiposity by Consistency of Lactation

The purpose of this study was to examine the assocation between lactation and maternal visceral adiposity among US women who were on average 7 years postpartum. This cross-sectional analysis included 89 women who gave birth between 1997 and 2002, who did not have preeclampsia, prepregnancy hypertension or prepregnancy diabetes, and enrolled in The Women and Infant Study of Healthy Hearts (WISH). Computed tomography was used to assess abdominal adiposity. History of lactation was self-reported. Visceral adiposity was greater by 36.96 cm² (95% CI: 20.92,53.01) among mothers who never breastfed than mothers who breastfed for ≥3 months after every birth, even after adjustment for age, parity, years since last birth, site, socioeconomic, lifestyle, psychological, and family history variables, early adult BMI, and current BMI. Similarly, in fully adjusted models, mothers who breastfed any of their children for less than 3 months had 20.38 cm² (95% CI: 2.70, 38.06) greater visceral adiposity than mothers who consistently breastfed all their children for 3 or more months. This study found that 7 years postpartum visceral fat depots are significantly greater among mothers who lactated for less than 3 months after the birth of each of their children. These results provide a potential physiologic basis for prior findings that women who do not consistently breastfeed are at an increased risk of diabetes, cardiovascular disease, and the metabolic syndrome.     

Lactation and pregnancy in Iran. I. Social and economic aspects

Adequacy of lactation was assessed in Teheran women of low (LSE) and lower-middle (MSE) socioeconomic status in the third month postpartum, as part of a study linking nutrition, hormonal status, and lactation. Methods of assessment of nutritional adequacy are discussed. Characteristics of the socioeconomic groups, infant mortality, food beliefs related to lactation, and supplemental feeding practices are described. Of the LSE mothers 15 to 30% and of the MSE mothers 40 to 55% had a fully adequate milk supply in the third month. Substitutes used and affordable by the LSE were nutritionally inadequate. LSE mothers were traditional in their food beliefs. MSE mothers demonstrate the influence of scientific nutrition knowledge. The low percentage of lactation adequacy even in the MSE indicates that other social or health factors associated with urban living conditions may be just as important as economic and nutritional factors in lactation failure.     

Infant feeding in Nigeria: A case study of practices in Ile-Ife community

Infant feeding practices and nutritional status of one hundred and ten infants in urban and rural areas of lle-lfe were investigated. Questionnaires were administered with the nursing mothers as respondents. Information was obtained on breastfeeding pattern, feeding of milk and non-milk supplements, and also health and medical history of the infants. Anthropometric measurements were also conducted on the infants aged between 0-2 years.

Analysis of the data showed that all nursing mothers breastfed their babies within the first three days up to an average of 12 months of life after which milk and non-milk supplements were introduced. Urban mothers were found to introduce milk supplements at an earlier age of life than their rural counterparts with urban infants being better nourished.     

Factors influencing duration of breast feeding among low-income women

Forty low-income breast feeding primiparous women were interviewed to determine whether family member and peer attitudes toward breast feeding and available postpartum support were associated with continued or early termination of breast feeding. Mean breast feeding duration equalled 20.5 weeks (range, 1 to 52 weeks). When an outside source of assistance (a doula) was available during the first 2 weeks postpartum, mean duration was 23.4 weeks compared with 12.3 weeks when a doula was unavailable (p less than .05). Breast feeding duration was independent of the doula's attitude regarding breast feeding. Duration of breast feeding was significantly longer for breast feeding women who participated in the USDA Special Supplemental Program for Women, Infants, and Children (WIC) than for those who did not participate. All of the women claimed to like breast feeding; 93% of the husbands or boyfriends, 83% of the women's mothers, and 81% of the women's best friends had positive attitudes toward breast feeding. The more breast feeding friends the woman had, the longer she breast fed (r = .32, p less than .05). Termination of breast feeding was not due to perceived negative attitudes of family members and peers regarding breast feeding.     

Socioeconomic inequality in birth weight and gestational age in Denmark 1996–2007: Using a family-based approach to explore alternative explanations

A large body of literature has reported associations between socioeconomic position and adverse pregnancy outcomes even in affluent egalitarian welfare states. This study explored the nature of this relationship by examining women who changed socioeconomic position between pregnancies and women who were siblings but were different in terms of socioeconomic position. Data consisted of 471,215 live born singletons born in Denmark 1997–2007 with at least one sibling or one first cousin. We examined parental educational attainment and household income in relation to preterm birth and small for gestational age using Cox regression. Household income was only weakly related to these outcomes. Paternal education was strongly associated with the outcomes only in the cohort analyses. Maternal education was inversely associated with preterm birth only in the cohort analyses, where the least educated women had the highest risk. Maternal education was inversely associated with the risk of small for gestational age in cohort analyses, attenuated between mothers who were siblings, and not present between children who were siblings. For example, the hazard ratio of preterm birth of women with a college/university degree when compared to women with only mandatory education was 0.64 (95% confidence interval: 0.60–0.67) in the cohort analysis, 0.90 (0.78–1.04) between mothers who were siblings, and 1.01 (0.82–1.24) between children who were siblings. The corresponding hazard ratios of small for gestational age were 0.54 (0.52–0.56), 0.72 (0.63–0.83), and 1.02 (0.84–1.24). This suggests that the associations were partly explained by factors shared between mothers who are siblings. In conclusion, the early life circumstances of mothers appear to be important in understanding the association between education, preterm birth and small for gestational age.     

Lactational amenorrhea as a method of family planning in Egypt

Because of the potential importance of the lactational amenorrhea method (LAM) as a family-planning option in Egypt, we analyzed data from the 1995 Egyptian Demographic and Health Survey (EDHS) to study breastfeeding practices, use of contraception, reproductive history and sociodemographic factors for 5504 mothers with children under 3 years. According to the EDHS data, about 80% of Egyptian women breastfed for at least 6 months, and 40% breastfed for 15-18 months. Over half of breastfeeding mothers used no additional contraception. Thirty-six percent of mothers breastfeeding children younger than 6 months who reported using no additional contraception were exclusively breastfeeding and amenorrheic, but only 4% reported relying on breastfeeding for family planning. We also held eight focus group discussions with breastfeeding mothers from urban and rural Upper and Lower Egypt on their use of contraceptive methods, breastfeeding, lactational amenorrhea and LAM. Participants showed strong recognition of the contraceptive effects of breastfeeding but differed widely in their understanding of lactational infecundability and knowledge of LAM as a method. These results suggest that LAM would be widely acceptable to Egyptian women, but that an educational program about the method is needed.     

Prolonged lactation contributes to depletion of maternal energy reserves in Filipino women.

This paper identifies determinants of women's postpartum weight and weight change in a large group of Filipino women followed for 24 mo. Longitudinal, multivariate models focused on the effects of lactation, while controlling for energy intake, energy expenditure, reproductive history and seasonality. Lactation was found to have a significant negative effect on weight of urban women. The negative effects of lactation increased with the intensity and duration of breast-feeding. Among rural women negative effects of lactation on weight were observed only after 10-14 mo. Models of net postpartum weight change (from 2 to 24 mo) among nonpregnant women confirmed an important role for lactation. The likelihood of weight loss was significantly increased by lactation of more than 12-mo duration, by greater maternal age and by low dietary energy intake. The effects of lactation on maternal energy reserves can be mitigated substantially be increasing maternal dietary energy intakes.     

Racial and socioeconomic disparities in breastfeeding--United States, 2004

The American Academy of Pediatrics recommends breastfeeding for at least the first year of life, and beyond for as long as mutually desired by mother and child. Not breastfeeding is associated with increased health risks for children, including otitis media, respiratory tract infections, diarrhea, and necrotizing enterocolitis. In addition, breastfeeding duration is inversely associated with risk for childhood overweight. Breastfeeding also is associated with health benefits for mothers, including reduced risk for ovarian cancer and premenopausal breast cancer. Breastfeeding rates differ substantially by race, socioeconomic level, and other demographic factors. For example, among children born during 1982-1993, non-Hispanic black children were less likely than non-Hispanic white children to be breastfed at birth and at age 6 months, even when comparisons were among children in the same socioeconomic or other demographic subgroup. To obtain current estimates of racial and economic disparities in breastfeeding among U.S. children, CDC analyzed data from the 2004 National Immunization Survey (NIS). This report describes the results of that analysis, which indicated that 71.5% of non-Hispanic white children were ever breastfed compared with 50.1% of non-Hispanic black children. Among those ever breastfed, 53.9% of non-Hispanic white and 43.2% of non-Hispanic black children continued breastfeeding until at least age 6 months. Disparities between black and white children existed within most socioeconomic subgroups studied. Public health programs should continue to promote breastfeeding initiation and increase support of breastfeeding continuation, especially among subgroups with the lowest rates (i.e., black, poor, and young mothers; mothers with less than a high school education; and mothers residing in rural areas).     

New IPPF statement on breastfeeding,fertility and post-partum contraception

The International Planned Parenthood Federation International Medical Advisory Panel drew up the following statement in November, 1989. Breastfeeding is good for the infant. Antibodies passed to it from the mother protect it from infection. Patterns of breastfeeding are changing. Therefore, the risk of pregnancy is increased. Postpartum amenorrhea plays a major role in natural fertility regulation. Studies from around the world show a positive correlation between the length of breastfeeding and the length of lactational amenorrhea. Amenorrhea lasts longer in those who breastfeed more often at night and during the day. There is controversy over the effect of nutrition on postpartum infertility. Pregnancy and the puerperium are a good time for counseling on maternal nutrition, child spacing, breastfeeding, and contraceptive methods. Counseling nursing mothers about potential fertility during lactation should be based on local information. All women should be advised to fully breastfeed. Family planning programs should cooperate with maternity services in providing counseling and education for postpartum women who need contraception, for providing referral services, for producing educational resources, and in training health personnel. Postpartum contraception should be included in the training of traditional birth attendants. Women who do not breastfeed can select any contraceptive method. Mothers who nurse must not hurt success of lactation or the infant's health. Nonhormonal contraception should be the 1st choice for lactating women. IUDs do not harm infant growth or lactation. Postpartum insertions are appropriate, though care must be taken. Female sterilization can be conveniently done at this time. Barrier methods are reliable when used regularly. The failure rate should be lower when used after delivery. Progestagen-only contraception consists of progestagen-only pills, injectables, and Norplant. These do not affect quality and quantity of breast milk or length of lactation. They are suitable for those who do not wish nonhormonal methods. There are possible consequences, however, of the transfer of the steroid to breast milk. Hormonal methods should not be used earlier than 6 weeks postpartum. High and low dose oral contraceptives adversely affect the quality and quantity of breast milk. They also reduce duration of lactation. They should be withheld until 6 weeks after delivery, or until the infant is weaned--whichever comes first. The efficacy or periodic abstinence in nursing women requires further analysis.     

Health and Well-Being of Childbearing Women in Rural and Urban Contexts

As part of the national focus on women's health issues, it is important to identify those health-related characteristics of rural women that distinguish them from women living in urban settings. The aim of this study was to compare rural and urban childbearing women on socioeconomic characteristics, perceived stress, health-related practices, illness symptoms, parenting confidence, and body weight. One hundred sixty-five midwestern women responded to a health survey sent to them six months after childbirth. Rural women were younger and less educationally and economically advantaged compared to urban women. Before adjusting for these differences, rural women were less self-actualized, more interpersonally isolated, and reported less healthy nutrition than urban women. These differences disappeared when socioeconomic differences were adjusted. Rural and urban mothers did not differ in most other areas, including perceived stress, parenting confidence, and body weight. Compared to national norms, the perceived stress levels of both rural and urban mothers were significantly higher than a probability sample of U.S. women. Findings support the role of socioeconomic factors as contributing to risk of poor health promotion among rural childbearing women.     

Lactation amenorrhea in Saudi women.

STUDY OBJECTIVE--The study aimed to investigate some aspects of breast feeding, namely-lactation amenorrhea, the average interval between pregnancies, and the extent of knowledge that an average Saudi woman has about breast feeding. DESIGN--This was a cross sectional study in which a pretested questionnaire was used to collect the information. SETTING--The study was conducted in the Taif area between January and April of 1990. Seventy nine primary health care centres participated. PARTICIPANTS--Altogether 1019 of 2400 women contacted who agreed to participate and met the criteria were studied. Eligible subjects were defined as Saudi women, between 16 and 40 years old, who came with their infants for vaccination, and had delivered between one week and 12 months previously. Each mother had at least one other child. MEASUREMENT AND MAIN RESULT--At birth, the percentage of infants who were initially breast fed was 98% but within three days of delivery over two thirds (68.9%) of the mothers gave other supplementary liquids to their infants. At the time of interview more than half (55.1%) of mothers had lactation amenorrhea. The mean (SD) lactation amenorrhea period and birth interval were 5.95 (5) and 26.8 (14.1) months, respectively. Mothers obtained information on breast feeding mainly from their doctors and television. Within families, husbands had the primary role in encouraging their wives to breast feed, followed by the mother and then by the mother in law. It was found that a high percentage (94.2%) of women had breast fed their previous child. CONCLUSION--The lack of adequate information on breast feeding and the short interval between births are local problems which should be considered by the health authorities.     

A study of breastfeeding and the return of menses and pregnancy in Karachi, Pakistan

A longitudinal study of breastfeeding women was conducted to determine whether breastfeeding frequency is associated with the length of postpartum amenorrhea. The data are also conducive to testing the guidelines of the "Bellagio Consensus" (i.e., that there is no more than a 2% chance of pregnancy during breastfeeding in the first six months postpartum in the absence of vaginal bleeding and regular supplements). Twenty-eight breastfeeding women were followed-up weekly in Karachi, Pakistan. The frequency of breastfeeding was found to be a poor correlate of the duration of amenorrhea. Thirty-six percent of the women became pregnant during the study. However, all were having menses and/or giving regular supplements before the estimated date of conception, consistent with the Bellagio Consensus. In countries such as Pakistan, where contraceptive use is low, active promotion is needed to prevent the further decline of breastfeeding in order to retain its contraceptive as well as other maternal and child health benefits.     

Successful sustained lactation following postpartum tubal ligation

This study was undertaken to see whether tubal ligation performed within days postpartum, and associated with a delay in the initiation of breastfeeding, exerts a disruptive influence on successfully establishing lactation among the rural population of northern Thailand. Lactational performance of 12 rural northern Thai mothers was not affected by the delay in reunion of mothers with their babies as a result of postpartum tubal sterilization procedure when compared with a group of 8 other healthy mothers and babies. The volume of breast milk transferred, frequency of breastfeeding and the total feeding time spent on the breast were similar on days 15, 45, 90, 180 and 360 postpartum. This finding suggests that the pattern of intense breastfeeding activity as practiced by this group of mothers has a stronger influence on prolonged and successful lactation than early contact in the immediate postpartum period.     

The effects of vitamin C, vitamin B6, and vitamin B12 supplementation on the breast milk and maternal status of well-nourished women.

The effects of vitamin supplements and/or diet on the levels of vitamin C, vitamin B6, and vitamin B12 in milk and blood of lactating women were determined. At the end of gestation, subjects were divided into two lactation groups: supplemented (10 subjects) and nonsupplemented (seven subjects). Milk samples were collected from 5 to 7 days and 43 to 45 days postpartum. Fasting blood samples were drawn at 8 and 46 days postpartum for vitamin C, B6, and B12 status measurements. Dietary records of all foods consumed by the subject were kept for 4 days at 1 and 6 weeks postpartum. The vitamin B6 level in breast milk of the unsupplemented group of mothers was significantly lower (P less than 0.05) than the supplemented group of women at 5 to 7 days postpartum. Vitamin B12 concentration in milk of nonsupplemented mothers at 43 to 45 days postpartum was significantly lower (P less than 0.05) than the supplemented group of women at 43 to 45 days postpartum. None of the milk values or the maternal blood levels measured in the women was less than published norms for vitamin C, vitamin B6, and vitamin B12.