Smoking and caesarean deliveries: major negative predictors for breastfeeding in the mother–child cohort in Crete,Greece (Rhea study)

Although benefits of breastfeeding have been widely promoted and accepted, exclusive breastfeeding for the first 6 months of life is far from the norm in many countries. In a prospective mother–child cohort study in Crete, Greece (‘Rhea’ study), we assessed the frequency of breastfeeding and its socio‐demographic predictors. Information on breastfeeding was available for a period of 18 months post‐partum for a cohort of 1181 mothers and their 1208 infants. The frequency of exclusive and predominant breastfeeding in the first month post‐partum was 17.8% and 3.4%, respectively, with almost three‐quarters of women (73.6%) ceasing any breastfeeding after 4 months post‐partum. Women were less likely to initiate breastfeeding if they had a caesarean delivery (CD), whereas they were more likely to initiate breastfeeding if they had a higher education or gave birth to a private clinic. Among women breastfeeding, those who had a CD, were ex‐smokers or smokers during pregnancy had a statistically significant shorter duration of breastfeeding, whereas higher education and being on leave from work were associated with a longer duration of breastfeeding. Study findings suggest suboptimal levels of exclusive and any breastfeeding and difficulty maintaining longer breastfeeding duration. CD and smoking are common in Greece and are strong negative predictors for breastfeeding initiation and/or duration, necessitating targeting women at risk early in the prenatal period so as to have a meaningful increase of breastfeeding practices in future cohorts of mothers.     

The relationship between maternal smoking and breastfeeding duration after adjustment for maternal infant feeding intention

AIM: To investigate whether maternal smoking remains associated with decreased breastfeeding duration after adjustment for the mother's infant feeding intention. METHOD: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention at 32 wk of pregnancy: intention for the first week, intention for the rest of the first month and intention in months 2 to 4. Maternal smoking was defined as any smoking reported at any time during pregnancy. Data on initiation and duration of breastfeeding were based on the questionnaire at 6 mo postpartum, supplemented by data from the 15-mo questionnaire if necessary. RESULTS: Women who smoked during pregnancy had an adjusted odds ratio of 1.5 (95% CI: 1.3-1.7) of not breastfeeding at 6 mo compared to non-smokers (adjusting for maternal age, education and intention). Survival analysis of duration of breastfeeding in the first 6 mo postpartum found that women who intended to breastfeed for less than 1 mo were 78% more likely to stop at any given time than women planning to breastfeed for at least 4 mo, while smokers were 17% more likely to stop breastfeeding than non-smokers. CONCLUSION: Although women who smoke are less likely to breastfeed their infants than are non-smoking women, it appears that this is largely due to lower motivation to breastfeed rather than a physiological effect of smoking on their milk supply.     

Maternal cigarette smoking and breastfeeding duration

AIM: To examine the relationship between cigarette smoking and breastfeeding duration at 2 wk, 6 mo, and longer. METHODS: Design. A 12-mo longitudinal study. Setting. Two public maternity hospitals in the Perth metropolitan area (Western Australia). Subjects. Eligible mothers of healthy newborn infants. Interventions. Participants completed a self-administered baseline questionnaire while in hospital or shortly after discharge. All women regardless of their chosen infant feeding method were followed up by telephone interview at 4, 10, 16, 22, 32, 40 and 52 wk postpartum. Main outcome measures. Prevalence of breastfeeding at 2 wk, 2 wk to 6 mo and >6 mo in women who smoked during pregnancy, and breastfeeding duration. RESULTS: Women who smoked during pregnancy had a lower prevalence and shorter duration of breastfeeding than non-smoking mothers (28 vs 11 wk, 95% CI 8.3-13.7). This effect remained even after adjustment for age, education, income, father's smoking status, mother's country of birth, intended duration of breastfeeding >6 mo and birthweight (risk ratio 1.59, 95% CI 1.22-2.08). CONCLUSION: Women who smoke during pregnancy are at greater risk of not achieving national and international targets for breastfeeding. Encouraging smoking cessation in the antenatal setting is an area for considerable public health gain.     

Delivery mode and breastfeeding outcomes among new mothers in Nicaragua

Breastfeeding has been shown to benefit infants and mothers. Women who have caesarean deliveries (C‐sections) are expected to be less likely to initiate and continue breastfeeding than those who have vaginal deliveries. Given the high rate of C‐sections in Nicaragua, the importance of breastfeeding, and the centrality of culture in choices about breastfeeding, this study sought to examine if mode of delivery relates with breastfeeding initiation and exclusivity in Nicaragua. Two hundred fifty mothers were surveyed about birth experiences and breastfeeding behaviour in 3 public clinics in León, Nicaragua, between June and August 2015. Logistic regression analyses were performed to examine the association of mode of delivery with initiation of breastfeeding within 1 hr of birth (early initiation) and exclusive breastfeeding for 6 months post‐partum. The rate of early initiation was 68.8% and that of exclusively breastfeeding for 6 months was 12.7%. Mode of delivery was not significantly associated with early initiation (p = .383) or exclusive breastfeeding (p = .518). Early initiation was negatively associated with prelacteal feeding, AOR = 0.30, 95% CI [0.16, 0.58]; p = .001. Mothers who had perceived their infants as large at birth were significantly less likely to exclusively breastfeed for 6 months, AOR (95%CI) = 0.25 (0.06–0.97); p = 0.046. Mode of delivery was not significantly associated with optimal breastfeeding initiation and exclusivity among mothers in Nicaragua. The 2 risk factors identified for delayed initiation of breastfeeding and lack of exclusive breastfeeding were prelacteal feeding and maternal perception of a large infant at birth, respectively.     

Maternity or parental leave and breastfeeding duration: Results from the ELFE cohort

Previous studies have shown a high level of noncompliance with recommendations on breastfeeding duration, especially in France. The objective was to describe the association between breastfeeding initiation and duration and the statutory duration of postnatal maternity leave, the gap between the end of legal maternity leave and the mother's return to work, and maternal working time during the first year post‐partum. Analyses were based on 8,009 infants from the French nationwide ELFE cohort. We assessed the association with breastfeeding initiation by using logistic regression and, among breastfeeding women, with categories of breastfeeding duration by using multinomial logistic regression. Among primiparous women, both postponing return to work for at least 3 weeks after statutory postnatal maternity leave (as compared with returning to work at the end of the statutory period) and working less than full‐time at 1 year post‐partum (as compared with full‐time) were related to higher prevalence of breastfeeding initiation. Among women giving birth to their first or second child, postponing the return to work until at least 15 weeks was related to a higher prevalence of long breastfeeding duration (at least 6 months) as compared with intermediate duration (3 to <6 months). Working part‐time was also positively related to breastfeeding duration. Among women giving birth to their third child or more, working characteristics were less strongly related to breastfeeding duration. These results support extending maternity leave or working time arrangements to encourage initiation and longer duration of breastfeeding.     

Breastfeeding practices in an area of high HIV prevalence in rural South Africa

Exclusive breastfeeding (EBF) from 0 to 6 mo of age is recommended by the World Health Organization as the optimal feeding method for infants, including infants of human immunodeficiency virus (HIV)-infected women from developing countries who choose to breastfeed. EBF may be associated with less risk of postnatal HIV transmission than mixed feeding, but is still uncommonly practised for reasons that are poorly understood. This study aimed to assess EBF rates and the impediments to EBF in a South African rural area of high HIV prevalence where most mothers are unaware of their status. In a longitudinal study, 130 women attending 3 clinics, chosen for their disparate socioeconomic characteristics, were interviewed at weekly postnatal intervals. Follow-up to 16 wk was completed on 119 infants. In an additional cross-sectional survey mothers of 445 infants, aged 0-12 mo, attending immunization clinics were interviewed. In the longitudinal study 46% of infants received non-breast-milk fluids or feeds within 48 h of birth; only 10% were exclusively breastfed for 6 wk and 6% for 16 wk. Supplements, most commonly formula milk, were introduced for perceived milk insufficiency. Feeding choices were mainly self-determined (43% of women), but health staff (22%) and grandmothers (16%) were cited as sources of advice. In the cross-sectional survey caregivers reported that 47% of infants aged 2 wk, 40% aged 6 wk and 33% aged 12 wk had been exclusively breastfed since birth. CONCLUSION: EBF is uncommon in this area in spite of a baby-friendly hospital initiative in the district. Strategies to promote exclusive breastfeeding in developing countries where HIV and infant feeding policies are being formulated must strongly address local perceptions on the need for supplements and sources of feeding advice.     

Connaissances et pratiques de mères sénégalaises vivant en milieu rural ou suburbain sur l’alimentation de leurs enfants, de la naissance à l’âge de six mois

Breastfeeding practice is very common in Senegal. Indeed, it is the way nearly 100% of women feed their child. However, in 42% of cases, this practice is accompanied by early water administration (before sixth months). This is very often because of socio-cultural representations. Our work aimed to describe and analyze knowledge and practices of a sample of women on children feeding, from birth to six months of age.

Population and methods

It was a cross-sectional prospective study carried out from May 1st to June 30th, 2009. Qualitative data were recoded by face-to-face interviews with the mothers of six to 12 months old infants who frequented the two sites of the Institute of social and preventive paediatrics of the Cheikh Anta Diop university of Dakar (Senegal): the one being in the suburbs of Dakar (Pikine) and the other in a rural area (Khombole). Several topics were addressed: general knowledge on infants feeding, exclusive breastfeeding and the difficulties encountered in its practice, food introduced during exclusive breastfeeding and factors associated with their use.

Results

The study dealt with 44 mothers. The average time of first breastfeeding after birth was 6 ± 12 h (range: 1 to 72 h). The first food received by the newborn was the mother's milk for 64% of the mothers (n = 28). The 16 other mothers (36%) administered the “Tokental” (traditional drink for the newborn) before the first breastfeeding. Thirty-eight mothers held information about exclusive breastfeeding. Early breastfeeding was carried out by 22 mothers (50%). Exclusive breastfeeding up to six months was done by 29 mothers (66%). The reasons put forward by the 15 other mothers to choose another food are various. Among the factors influencing the practice of exclusive breastfeeding, the educational level of the mothers appeared, even if the difference were not statistically significant.

Conclusion

The practice of exclusive breastfeeding and early breastfeeding do not seem to be limited by knowledge but by sociocultural representations. Among the factors limiting the early breastfeeding, the most important seems to be the “Tokental”. To improve the practices on infants feeding, it would be important to reinforce information by healthcare professionals about newborn babies.     

Which mothers wean their babies prematurely from full breastfeeding? An Australian cohort study

Aim:  To identify the maternal and infant characteristics associated with an early transition from full breastfeeding to complementary or no breastfeeding during the first 2 months of life in a large, representative cohort of Australian infants.
Method:  Multinomial logistic modelling was performed on data for infants with complete breastfeeding and sociodemographic data (N = 4679) including maternal age, education, smoking, employment, pregnancy and birth outcomes.
Results:  Ninety-one percent of women initiated breastfeeding. Sixty-nine percent of infants were being fully breastfed at 1 month, and 59% were fully breastfed at 2 months. Maternal characteristics – age less than 25 years, smoking in pregnancy, early full-time postnatal employment and less educational attainment – were associated with early breastfeeding cessation. Infant factors – multiple birth, caesarean birth, infant or first birth – were associated with a transition to complementary breastfeeding in the first postnatal month.
Conclusion:  Breastfeeding duration is substantially affected by breastfeeding outcomes in the first postpartum month. The first month is an important window for evidence-based interventions to improve rates of full breastfeeding in groups of women identified as at risk of early breastfeeding cessation.     

Maternal employment and breastfeeding: results from the longitudinal study of Australian children

AIM: To investigate the effect of maternal postnatal employment on breastfeeding duration in Australia in the first 6 months after birth. METHOD: Secondary data analysis of the infant data (2004) from the Longitudinal Study of Australian Children (LSAC). Complete maternal and breastfeeding data were available for 3,697 infants. Multivariable logistic regression was used to investigate the effect of timing of resumption of maternal employment and maternal employment status on breastfeeding at 6 months postpartum after adjustment for maternal education, maternal age, maternal smoking during pregnancy and socioeconomic status of the child's area of residence. RESULTS: Fewer women employed full-time were breastfeeding their infants at 6 months (39%) than nonemployed women (56%). Participation in full-time employment before 6 months had a strong, negative effect on the likelihood of continuing breastfeeding for 6 months, adjusted OR = 0.35 (95%CI: 0.22-0.55). Compared to nonemployed women, fewer women in part-time employment were breastfeeding at 6 months (44%), adjusted OR = 0.49 (95% CI: 0.37-0.64). CONCLUSIONS: Results from this large representative cohort of Australian infants confirm that maternal employment in the first 6 months of life contributes to premature cessation of breastfeeding even when known risk factors for breastfeeding cessation are controlled for.     

Predictors of breastfeeding non‐initiation in the NICU

This study compared predictors of breastfeeding non‐initiation between infants who were and were not admitted to the NICU so that interventions can target high‐risk mothers whose infants desperately need breastmilk. This was a population‐based retrospective cohort study of singleton Ohio live births using birth certificates, 2006–2015. In babies who were and were not admitted to the NICU, a multivariable logistic regression model assessed the association between breastfeeding non‐initiation and predictors relating to the mother, neonate, and labour and delivery events while adjusting for covariables. Of 1,463,506 births, 76,855 infants were admitted to the NICU (5.8% of study population), and breastfeeding was not initiated in 39.4% of them, compared with 31.5% of infants in the newborn nursery, p < 0.001. Apart from abnormal newborn conditions, smoking during pregnancy was the most significant risk factor for not breastfeeding in the NICU (RR 1.91 [95% CI 1.82–2.02]) and newborn nursery (RR 2.10 [95% CI 2.08–2.13]), followed by socioeconomic factors and multiparity. Limited prenatal visits (≤5) were a significantly higher risk factor in the NICU (RR 1.41 [95% CI 1.34–1.49]) than in the newborn nursery (RR 1.24 [95% CI 1.22–1.26]). Intentional home birth and use of infertility treatment were associated with breastfeeding initiation. The rate of breastfeeding initiation is lower in infants admitted to the NICU than those who are not, especially among mothers with limited prenatal care. Interventions should target mothers who smoke because they are least likely to breastfeed, and their babies, who are prone to serious health conditions, could especially benefit from breastmilk.     

Maternal obesity and initiation and duration of breastfeeding: data from the longitudinal study of Australian children

The aim of this paper is to investigate whether the lower rate of breastfeeding at 6 months by overweight and obese mothers is primarily due to these women giving up breastfeeding in the first week postpartum using a cross-sectional population survey. The sample is children from the infant cohort (about 12 months of age) of Wave 1 (2004) of the Longitudinal Study of Australian Children for whom breastfeeding and maternal information were available ( n  = 3075). Definitions used: normal-weight body mass index (BMI, kg/m²) 20 to <25, overweight BMI 25 to <30, obese BMI ≥30. Breastfeeding initiation was 95.1% for normal-weight women, 92.8% for overweight women and 87.1% for obese women. At 6 months, 64% of normal-weight women were breastfeeding, compared with 54% of overweight and 44% of obese women. On multivariate analysis, for women who initiated breastfeeding, overweight women had an odds ratio (OR) of 1.52 [95% confidence interval (CI) 1.02, 2.28] and obese women had an OR of 2.54 (95% CI 1.70, 3.79) of stopping breastfeeding by 1 week compared with normal-weight women (adjusted for maternal age, education, smoking, level of socio-economic disadvantage, caesarean birth, admission to special care nursery). For women who breastfed for at least 1 week, overweight women had an adjusted OR of 1.26 (1.04, 1.53) and obese women had an adjusted OR of 1.38 (1.10, 1.73) of ceasing to breastfeed before 6 months, compared with normal-weight women. In conclusion, among overweight/obese women who initiate breastfeeding, higher rates of cessation of breastfeeding in both the immediate postpartum period and in the first 6 months contribute to the shorter duration.     

The significance of early breastfeeding experiences on breastfeeding self‐efficacy one week postpartum

Many new mothers do not reach their breastfeeding goals. Breastfeeding self‐efficacy is a modifiable determinant influenced by prior and new breastfeeding experiences. More knowledge about factors associated with early breastfeeding experiences and breastfeeding self‐efficacy would allow us to qualify breastfeeding counselling and increase breastfeeding duration. This study aimed to identify prevalence and factors associated with early negative breastfeeding experience, low breastfeeding self‐efficacy in the first week postpartum, and drop in self‐efficacy from late pregnancy to early postpartum period. A prospective longitudinal study was performed in Denmark from 2013 to 2014, including 2, 804 mothers. Results showed that 1 week postpartum almost 10% of mothers had negative breastfeeding experiences, 36% had low breastfeeding self‐efficacy, and 26% drop in self‐efficacy from pregnancy. Negative breastfeeding experiences were significantly associated with epidural analgesia, interrupted skin‐to‐skin contact immediately postpartum, short previous breastfeeding duration, and lacking social support. Low breastfeeding self‐efficacy was associated with low breastfeeding intention, short previous breastfeeding duration, and negative breastfeeding experiences in the first week postpartum. Finally, significant associations of drop in breastfeeding self‐efficacy from late pregnancy were no or short education, early negative breastfeeding experiences, prior short breastfeeding duration, and low general breastfeeding self‐efficacy in pregnancy. Negative breastfeeding experiences in the first week postpartum is crucial for maternal breastfeeding self‐efficacy 1 week following birth. It is important to identify and support mothers at risk of negative breastfeeding experiences in the first week following birth and address factors that might increase the probability of early successful breastfeeding experiences.     

Relationship between prenatal infant feeding intention and initiation and duration of breastfeeding: a cohort study

AIM: To report the relationship between maternal prenatal intention to breastfeed and the actual initiation and duration of breastfeeding. METHODS: Pregnant women resident within Avon, UK, expected to give birth between 1 April 1991 and 31 December 1992 were recruited in a longitudinal cohort study. Main outcome measures included maternal infant feeding intention (breastfeed, breast and bottle feed, bottle feed, or uncertain) at 32 wk of pregnancy: intention in the first week, intention for the rest of the first month and intention in months 2 to 4; initiation and duration of breastfeeding up to six months. RESULTS: Data were available on 10,548 women. Prenatal intention to breastfeed had an influence on both initiation and duration of breastfeeding. Of the women intending to bottle feed from birth, only 3.4% initiated breastfeeding compared with 96.6% of women planning to breastfeed for at least four months. At six months postpartum, the mean duration of breastfeeding for women intending to breastfeed for at least five months was 4.4 mo (95% CI 4.3, 4.4), compared with 2.5 mo (95% CI 2.4, 2.6) for women with a prenatal intention to breastfeed for only one month. Logistic regression, using intended duration as the only explanatory variable, correctly predicted 91.4% of breastfeeding initiation and 72.2% of infant feeding at six months. CONCLUSIONS: This large population-based study confirms the strength of the relationship between maternal prenatal intention to breastfeed and both breastfeeding initiation and duration. Maternal intention was a stronger predictor than the standard demographic factors combined. This should be taken into account in future research, and trials should be undertaken to establish whether interventions could alter maternal intention and thereby increase rates of breastfeeding initiation and duration.     

Factors influencing breastfeeding duration: a survey in a Turkish population

Breastfeeding provides perfect nutrition for infants and is a source of many health benefits for both mother and baby. To obtain the maximum beneficial effects of breast milk, it is necessary to prolong the breastfeeding duration. In this study, we investigated the factors influencing the duration of breastfeeding. We conducted a 32-question survey of mothers with children aged 2–4 years, who presented to our medical school's pediatric outpatient clinics. The questionnaire solicited information on demographics and breastfeeding attitudes. We found correlations between total duration of breastfeeding and the time the mother and baby spent together (sharing a room to sleep at night) and the father's engagement in breastfeeding. Breastfeeding duration inversely correlated with maternal employment. Total duration of breastfeeding did not correlate with breastfeeding education by health personnel, the mother's education level, the gender of the child, regular prenatal care visits, the use of a pacifier, the interval between birth and the onset of breastfeeding, gestational age, method of delivery, or the birth weight of the infant. Conclusion: Our findings suggest several strategies to increase the duration of breastfeeding, including educating fathers along with mothers, supporting a shared bedroom until the child is 2 years of age, and promoting measures that allow mothers to be with their children during working hours.     

Infant milk feeding practices in the Netherlands and associated factors

AIM: The aim of the study was to describe infant feeding practices and associated factors, and to explore mothers' main reasons for starting and stopping breastfeeding. METHODS: We performed a national inquiry into milk feeding practices among 9133 Dutch infants aged < 7 mo by means of a questionnaire. RESULTS: 78% of mothers initiated breastfeeding. At 1 and 4 mo, respectively, 51 and 25% of infants were fed primarily on human milk; after 6 mo, only 15% of mothers still provided human milk as the only source of milk feeding. During the whole 6-mo period, another 11 to 18% was fed on both breast and formula milk. Women initiating breastfeeding were more likely to be higher educated, have a higher-educated partner, be non-smokers, have a full-time job, and be primiparous. In addition, breastfeeding initiation rate was higher for women born outside the Netherlands. Longer duration of breastfeeding was mostly found amongst higher-educated, non-smoking women. The odds for continuation of breastfeeding after 4 mo increased when mothers' working hours did not exceed 16 h/wk. Infant delivery at home was associated with a higher initiation rate as well as longer duration of breastfeeding compared to hospital delivery. Infants born after 38 wk of gestation, with a birthweight of 3500 g had higher odds to be breastfed for a longer period. CONCLUSION: Only a minority of Dutch infants is breastfed for 6 mo. Maternal and infant characteristics are important predictors of breastfeeding initiation and duration.     

Breastfeeding after return to work: An Australian national workplace survey

Breastfeeding initiation rates in Australia are high but duration rates fall well below the World Health Organization targets. Return to work is a known factor impacting 6 months exclusive breastfeeding and continuation into the infants second year of life. Work related factors can influence a woman's confidence in maintaining breastmilk supply after return to employment and determine whether she meets her personal breastfeeding goals. This cross-sectional online survey is the first Australian study to explore women's experience of maintaining breastfeeding after return to work, in all work sectors. Results revealed variations across work sectors reflected in worker autonomy and confidence in speaking up about breastfeeding rights. Women who had autonomy or flexibility in planning their workday were more likely to be confident in maintaining breastmilk supply. The main predictors for milk supply confidence and meeting personal breastfeeding goals included having: a suitable place to express milk; confidence in speaking out about rights; a formal return-to-work plan; a supportive workplace; and returning to work after the period of exclusive breastfeeding. This study reveals that supportive workplace environments can lead to increased confidence in maintaining milk supply, extending durations of breastfeeding. Women who are confident in their rights to express breastmilk, or breastfeed at work, are more likely to meet their own breastfeeding goals. Education, and awareness raising, on the rights of breastfeeding women in the workplace, is a gender equity imperative that can improve experiences for breastfeeding women, and, increase manager and co-worker knowledge for creating enabling workplace environments for breastfeeding employees.     

Postnatal peer counselling on exclusive breastfeeding of low-birthweight infants: a randomized, controlled trial

AIM: Exclusive breastfeeding increases survival and optimizes growth of low-birthweight (LBW) infants. If supported, mothers can overcome the unique difficulties associated with breastfeeding from birth to 6 mo. We tested the efficacy of postnatal peer counselling among first-time mothers that aimed to increase exclusive breastfeeding of term LBW infants. METHODS: In a Manila hospital, 204 mothers were randomized into three groups. Two intervention groups receiving home-based counselling visits, one by counsellors trained in breastfeeding counselling (n=68), the other by counsellors trained in general childcare (n=67), were compared with a control group of mothers (n=69) who did not receive counselling. RESULTS: Eighty-eight per cent of the participating pairs completed the trial. At 6 mo, 44% of the breastfeeding counselled mothers, 7% childcare-counselled mothers and none of the mothers in the control group were exclusively breastfeeding. More mothers in the breastfeeding counselled group than in the other groups were still breastfeeding at 6 mo. Twenty-four infants who were exclusively breastfed for 6 mo did not have any diarrhoea. All groups had improved mean weight-for-age Z-scores at 6 mo. CONCLUSION: This study has provided fundamental evidence of successful intervention to achieve 6 mo of exclusive breastfeeding among term LBW infants. By improving health outcomes, enhanced breastfeeding offers a distinct possibility of disrupting the intergenerational cycle of undernourished women giving birth to LBW infants.     

Impact of Prenatal Care Utilization on Infant Care Practices in Nepal: a National Representative Cross-sectional Survey

This study aimed to examine the utilization of prenatal care and its association with infant care practices using a nationally representative sample of Nepalese mothers and children. The study data was based on the 2006 Nepal Demographic and Health Survey which comprised of women age 15–49 years old who had delivered within three years prior to the survey (N?=?4,136). A multilevel logistic regression model was fitted to assess the influence of prenatal care utilization on several indicators of infant care. Neonatal mortality is still high in Nepal (46 per 1,000 live births). After taking into account several maternal and child characteristics, children of mothers with no prenatal care were at increased risk of neonatal death (OR = 2.03, 95 % CI = 1.28–3.23). Compared to women with no prenatal care, those with more than three visits were more likely to immunize their children (OR = 2.66, 95 % CI = 2.10–3.36) and more likely to initiate breastfeeding within 1 h after birth (OR = 1.25, 95 % CI = 1.02–1.54). Having skilled attendants at prenatal care and at birth was also associated with better infant care practices. Conclusion:Neonatal mortality is still high in Nepal. Adequate prenatal care utilization may represent a key preventative strategy, which, in the present study, was associated with improvement in neonatal mortality, higher likelihood of having immunization, and initiation of breastfeeding within 1 h after birth. Public health awareness programs and interventions are needed in Nepal to increase the utilization of prenatal care as well as delivery assisted by skilled attendants.     

Maternal employment during the early postpartum period: effects on initiation and continuation of breast-feeding

This study sought to determine whether and to what extent maternal employment in the early post-partum period is associated with the initiation and continuation of breast-feeding in a heterogeneous, urban population. A panel of women were interviewed twice during the first 3 months postpartum. In analyses adjusted for maternal demographic characteristics, there was no association between planning to be employed within the first 6 months postpartum and initiation of breast-feeding. However, actually being employed was significantly associated with cessation of breast-feeding as early as 2 or 3 months postpartum, even after adjustment for maternal demographic variables. Less than one half of mothers who were employed were still breast-feeding at the second postpartum interview, whereas two thirds of those who were not employed were still breast-feeding. Among employed mothers, working no more than 20 hours per week appeared to be protective for continued breast-feeding.     

Monitoring breastfeeding rates in Italy: national surveys 1995 and 1999

AIM: To assess and compare the rates of initiation and duration of breastfeeding in Italy in 1995 and 1999, and to examine the adherence to the ten steps to successful breastfeeding recommended by WHO. METHODS: Two cohorts of mothers who delivered healthy infants in November 1995 (n = 1601) or November 1999 (n = 2450) were interviewed by telephone within 4 wk of delivery and when their infant were 3, 6, 9 and 12 mo of age. Type of breastfeeding was classified according to the WHO definitions. Adherence to the WHO ten steps was evaluated as experienced by the mothers. RESULTS: Initiation and duration of breastfeeding increased during the 1995-1999 period (p < 0.0001). The rate of breastfeeding at birth, at discharge and when the infants were 3, 6, 9 and 12 mo of age was 85%, 83%, 42%, 19%, 10% and 4%, in 1995 and 91%, 89%, 66%, 47%, 25% and 12% in 1999. The rate of exclusive breastfeeding was higher in 1999 than 1995 at birth (39% vs 30%, p < 0.0001) and at discharge (77% vs 70%, p < 0.0001), but overall no longer duration was observed in 1999. At 4 and 6 mo of age the rate of exclusive breastfeeding was 25% and 8% in 1995 and 31% and 5% in 1999. The adherence to each WHO step was higher in 1999 than in 1995 (p < 0.05) but concomitant adherence was low (<3%). CONCLUSION: Although an increase in initiation and duration of breastfeeding occurred in Italy during the 1995-1999 period, the duration of breastfeeding and exclusive breastfeeding is currently unsatisfactory, as is adherence to the ten steps specified by WHO. Promotion of breastfeeding and education and improvement in adherence to the WHO recommendations are still needed in Italy.