Measuring exclusive breastfeeding social support: Scale development and validation in Uganda

The World Health Organization recommends exclusive breastfeeding (EBF) for 6 months and continued breastfeeding for at least 2 years. Social support has been widely recognized to influence breastfeeding practices. However, existing scales do not measure exclusive breastfeeding social support (EBFSS), rather they assess social support for any breastfeeding. Further, they are tailored towards high‐income settings. Therefore, our objectives were to develop and validate a tool to measure EBFSS in low‐income settings. To develop the scale, local and international breastfeeding experts were consulted on modifications to the Hughes' Breastfeeding Social Support Scale. It was then implemented in an observational cohort in Gulu, Uganda, at 1 (n = 238) and 3 (n = 237) months post‐partum (NCT02925429). We performed polychoric and polyserial correlations to remove redundant items and exploratory factor analysis at 1 month post‐partum to determine the latent factor structure of EBFSS. We further applied confirmatory factor analysis to assess dimensionality of the scale at 3 months post‐partum. We then conducted tests of predictive, convergent, and discriminant validity against EBF, self‐efficacy, general social support, and depression. The modification of the Hughes' scale resulted in 18 items, which were reduced to 16 after examining variances and factor loadings. Three dimensions of support emerged: Instrumental, Emotional, and Informational, with alpha coefficients of 0.79, 0.85, and 0.83, respectively. Predictive, convergent, and discriminant validity of the resultant EBFSS scale was supported. The EBFSS scale is valid and reliable for measuring EBFSS in northern Uganda and may be of use in other low‐income settings to assess determinants of EBF.     

The impact of peer support training on mothers' attitudes towards and knowledge of breastfeeding

While the benefits of breastfeeding are well established, few Scottish women exclusively breastfeed, as recommended nationally and internationally. Breastfeeding peer support can help mothers to breastfeed for longer, but the training peer supporters receive is variable and few studies have measured the effectiveness of peer supporter training. This study aimed to compare mothers' attitudes towards and knowledge of breastfeeding before and after undertaking Breastfeeding Network (BfN) peer supporter training. This study used a quasi‐experimental design to investigate levels of breastfeeding knowledge and attitudes in 28 women, immediately before and after the BfN peer supporter (Helper) training programme. Data were collected using the Infant Feeding Questionnaire. Mothers had high baseline scores for attitude (88.8%) and knowledge (76.4%). After training 78% of mothers improved their attitude scores. The mean difference in attitude scores was 4.9%, which was statistically significant (t = 4.44, P < 0.001). Ninety‐six per cent of mothers had increased their knowledge scores. The mean difference in knowledge scores was 10.4%, which was statistically significant (t = 6.25, P < 0.001). This study provides evidence that the BfN's accredited peer support training can improve both breastfeeding knowledge and attitudes of breastfeeding mothers. Peer supporters who have undertaken this training are therefore suitably qualified to provide mothers with the support and information required to make informed choices in breastfeeding and to contribute to effective support and promotion of breastfeeding as suggested in the National Institute for Health and Clinical Excellence guideline on maternal and infant nutrition (PH11) and Scottish Government's Maternal and Infant Nutrition: A Framework for Action (2011).     

Stress,social support,and racial differences: Dominant drivers of exclusive breastfeeding

Exclusive breastfeeding is recommended for 6 months; however, many childbearing people wean their infants before 6 months. Psychosocial factors such as stress, social support and race are significant determinants of breastfeeding; however, few studies have longitudinally explored the effect of perceived stress and various forms of social support on exclusive breastfeeding. We used quantitative methodologies to examine exclusive breastfeeding, perceived stress and social support among 251 participants from the Postpartum Mothers Mobile Study. Participants between 18 and 44 years were recruited during pregnancy (irrespective of parity) and completed surveys in real-time via Ecological Momentary Assessment up to 12 months postpartum from December 2017 to August 2021. We measured perceived stress with the adapted Perceived Stress Scale and perceived social support with the Multi-dimensional Social Support Scale. Received social support was measured using a single question on breastfeeding support. We conducted a mixed-effects logistic regression to determine the effect of stress, race and social support on exclusive breastfeeding over 6 months. We examined the moderation effect of perceived social support and breastfeeding support in the relationship between perceived stress and exclusive breastfeeding. Black, compared with White, participants were less likely to breastfeed exclusively for 6 months. Participants who reported higher perceived stress were less likely to breastfeed exclusively for 6 months. Perceived social support moderated the relationship between perceived stress and exclusive breastfeeding (odds ratio: 0.01, 95% confidence interval: 0.001–0.072). However, breastfeeding support directly increased the likelihood of exclusive breastfeeding over 6 months. Perceived stress is negatively associated with exclusive breastfeeding. Birthing people who intend to breastfeed may benefit from perinatal support programs that include components to buffer stress.     

The benefits,challenges and impacts of accessing social media group support for breastfeeding: A systematic review

Breastfeeding support is a key component in meeting the public health responsibility of increasing breastfeeding rates, with access to individualised, convenient and linked support across services central to improved outcomes. With the rise of new technology and the COVID‐19 pandemic, social media (SM) support for breastfeeding has become increasingly popular and it is important to understand how and why mothers access such support, and from whom, to optimise services and to meet mothers’ needs. Increasing research is building on women''s use and experience of SM for breastfeeding, although there is a paucity of UK data. This systematic review aimed to understand the impacts of SM support for breastfeeding, including benefits and challenges, to establish the evidence for wider provision within maternity services. The search was limited to studies published in English and focused on the self‐directed use of social media groups for breastfeeding (defined as platforms that facilitate group support via interactivity, allowing for user‐generated content and subsequent responses). Of 327 papers retrieved, 13 studies were included for review. The six themes identified were: breastfeeding context, including factors impacting women''s decision making; the relational impact of belonging to an online community; increased self‐efficacy; critiques of SM; the nature and types of support commonly sought and received; and breastfeeding duration as an outcome. The findings confirm that mothers value SM groups for community support, which normalises breastfeeding and provides the support they attribute to improved outcomes, and highlight that UK research focused on provision linked to wider services is needed.     

Prevalence of breast-feeding and its correlates in Ho Chi Minh City, Vietnam

BACKGROUND: The health benefits of breast-feeding are widely acknowledged and breast-feeding is crucial for the survival of the infants in developing countries. The present study aims to elucidate the prevalence of breast-feeding and the possible risk factors affecting the breast-feeding of infants at the age of 3 months in Ho Chi Minh City, Vietnam after the World Health Organization and the United Nations Children's Fund launched "the Baby-Friendly Hospital" Initiative in 1989. METHODS: A cross-sectional study was conducted in the urban areas of Ho Chi Minh City, Vietnam in February, 2000. Two hundred and sixty mother-infant pairs were conveniently recruited in three child health centers in Ho Chi Minh City. Mothers of infants aged 6-12 months were interviewed and completed a well-structured questionnaire regarding the feeding types of the infant, the maternal knowledge, attitudes and behaviors related to breast-feeding. RESULTS: The results indicated that although about 86.4% newborns in the maternity wards and 88.5% infants at 3 months were at least partially fed with breast milk, the prevalence of breast-feeding were 57.4 and 53.1%, respectively. About 47.5% newborns were fed with breast milk in the first feeding. The multivariate logistic regression analysis shows that the risk factors for the introduction of breast milk substitutes at 3 months of age were maternal antenatal plan of mixed or artificial feeding (odds ratio (OR) = 6.59, 95% confidence interval (CI): 3.18-13.64, P < 0.001) and the supplement of breast milk substitutes in the maternity ward (OR = 4.30, 95% CI: 2.10-8.77, P < 0.001). Higher maternal education levels were beneficial to the continuation of breast-feeding. About 18.5% mothers had attended antenatal breast-feeding education. Most of the mothers (94.1%) and families (95.4%) indicated supportive attitudes to breast-feeding. CONCLUSION: The prevalence of breast-feeding was relatively low in Ho Chi Minh City, Vietnam. The antenatal education in breast-feeding needs to be improved and the implementation of the "Baby-Friendly Hospital" policy needs to be strengthened.     

Fetal growth: relationship with maternal anthropometery,hemoglobin and serum albumin status

Three hundred fortyone primiparous mothers in the age group of 20 to 28 yr were subjected to anthropometery (weight, height and head circumference), hemoglobin and serum albumin estimations. Their offsprings were weighed at birth and birth weight was studied in relation to these maternal variables. The means for birth weight increased with increase in maternal weight, height, head circumference, hemoglobin and serum albumin levels. The subgroups of maternal weight, height and hemoglobin explained almost equal per cent variation in birth weight. Subgroups of gestation explained maximum per cent variation in birth weight. High degree of correlation (p<0.001) persisted between birth weight and maternal weight, height, head circumference and hemoglobin levels even after controlling gestation. The partial correlation coefficient value(r) between birth weight and serum albumin levels fell down considerably when gestation was controlled (p<0.05). Orthogonal polynomial equations were derived between birth weight(y) and maternal variables using coefficients of determination (R²) value of suitable degree.     

Learned social hopelessness: the role of explanatory style in predicting social support during adolescence

Background: Almost no research has examined the impact of explanatory style on social adjustment. We hypothesised that adolescents with a pessimistic style would be less likely to develop and maintain social support networks. Methods: Seven hundred and nineteen students (351 males and 366 females; 2 unknown; M_AGE = 12.28, SD = .49) completed an anonymous survey in Grades 7 through 10. Explanatory style was assessed in Grades 7 and 9, sadness was assessed in Grades 7 through 10, and quantity and quality of social support was assessed in Grades 8, 9, and 10. Results: Structural equation modelling was used to conduct cross‐lagged panel analyses of the four waves of data. Pessimistic explanatory style predicted lower levels of social support, and lower social support from the family predicted higher levels of pessimistic explanatory style. Additional analyses suggested that the effects could not be explained by sadness or by assuming that pessimistic adolescents where less liked by their peers. Conclusions: Pessimistic adolescents feel unable to influence their social worlds in positive ways and consequently may not take actions to develop and maintain social support networks.     

Hospital breastfeeding support and exclusive breastfeeding by maternal prepregnancy body mass index

Overweight and obese mothers in the United States have disproportionately lower rates of exclusive breastfeeding than mothers of normal weight. The Ten Steps to Successful Breastfeeding (Ten Steps), a series of evidence‐based practices designed to support breastfeeding initiation, duration, and exclusivity, demonstrate effectiveness at the population level. It is unknown, however, whether they are consistently provided to women across all maternal body mass index (BMI) categories. We sought to determine whether pre‐pregnancy BMI is associated with the implementation and effectiveness of the Ten Steps. We used data from Listening to Mothers III, a cross‐sectional survey administered to a sample of mothers who delivered in U.S. hospitals between July 2011 and June 2012. Measures of the Ten Steps were based on maternal self‐report on Listening to Mothers III. Our analytic sample was limited to mothers of term infants intending to breastfeed (N = 1,506, weighted). We conducted chi‐square testing and constructed weighted multivariable logistic regression models to account for potential confounders. Results suggest that two practices (i.e., holding their babies skin‐to‐skin for the first time and being encouraged to breastfeed on demand) were more strongly associated with exclusive breastfeeding among mothers with obesity than other mothers. Additionally, mothers with obesity reported holding babies skin‐to‐skin significantly less often than other mothers. Thus, interventions aimed at helping mothers with obesity to hold their babies skin‐to‐skin in the first hour and teaching them to breastfeed on demand have the potential to decrease the breastfeeding disparities in this population.     

Perinatal care and breastfeeding education during the COVID-19 pandemic: Perspectives from Kenyan mothers and healthcare workers

The impact of the COVID-19 pandemic on breastfeeding (BF) practices in low- and middle-income countries (LMICs) is not well understood. Modifications in BF guidelines and delivery platforms for breastfeeding education during the COVID-19 pandemic are hypothesised to have affected BF practices. We aimed to understand the experiences with perinatal care, BF education and practice among Kenyan mothers who delivered infants during the COVID-19 pandemic. We conducted in-depth key informant interviews with 45 mothers who delivered infants between March 2020 and December 2021, and 26 health care workers (HCW) from four health facilities in Naivasha, Kenya. While mothers noted that HCWs provided quality care and BF counselling, individual BF counselling was cited to be less frequent than before the pandemic due to altered conditions in health facilities and COVID-19 safety protocols. Mothers stated that some HCW messages emphasised the immunologic importance of BF. However, knowledge among mothers about the safety of BF in the context of COVID-19 was limited, with few participants reporting specific counselling or educational materials on topics such as COVID-19 transmission through human milk and the safety of nursing during a COVID-19 infection. Mothers described COVID-19-related income loss and lack of support from family and friends as the major challenge to practising exclusive breastfeeding (EBF) as they wished or planned. COVID-19 restrictions limited or prevented mothers’ access to familial support at facilities and at home, causing them stress and fatigue. In some cases, mothers reported job loss, time spent seeking new means of employment and food insecurity as causes for milk insufficiency, which contributed to mixed feeding before 6 months. The COVID-19 pandemic created changes to the perinatal experience for mothers. While messages about the importance of practising EBF were provided, altered HCW education delivery methods, reduced social support and food insecurity limit EBF practices for mothers in this context.     

Maternal knowledge of infant feeding guidelines and label reading behaviours in a population of new mothers in San Francisco, California

The objective of this study was to evaluate the relationship between maternal nutrition knowledge and maternal socio-demographics including participation in the Special Supplemental Women, Infants and Children's (WIC) Program. A cross-sectional study of new mothers at two San Francisco hospitals was conducted using some of the American Academy of Pediatrics' guidelines in a structured questionnaire to assess maternal nutritional knowledge. Maternal nutritional attitudes towards product nutrient labels were also assessed in a questionnaire format. Logistic regression models were used to evaluate the odds of having high maternal nutrition knowledge and of infrequently reading nutrition labels. In multivariate logistic regression models, higher maternal nutrition knowledge (defined as answering all four nutrition questions correctly) was associated with higher income levels defined as ≥$25 000/year, odds ratio (OR) 10.03 95% confidence interval (CI) (1.51–66.74), and in linear models, higher nutritional knowledge was associated with having more children ( P  < 0.01), a higher income ( P  = 0.01) and not being a WIC participant ( P  < 0.01). Mothers with higher incomes were also more likely to read product nutritional labels OR 4.24, 95% CI (1.24–14.51), compared with mothers with lower incomes as were mothers with higher education levels OR 3.32, 95% CI (1.28–8.63). In San Francisco, lower income mothers are at greatest risk for low maternal nutrition knowledge and not reading product nutritional labels. Higher household income was independently associated with increased maternal nutrition knowledge and likelihood of reading nutritional labels. More comprehensive interventions need to target low-income mothers including current WIC participants to help close the nutritional advantages gap conferred by income and education.     

Peer and teacher ratings of third- and fourth-grade children's social behavior as a function of early maternal employment

BACKGROUND: One of the more controversial issues related to maternal employment in the United States concerns the timing of entry into the workforce and its effect on children, particularly during the first year of the child's life. Some studies show deleterious effects on children, such as increases in aggression and noncompliance, while others document few negative and even positive effects of early employment. METHODS: This study examined the long-term effects of maternal employment during the child's first year of life on the social behavior of 171 third- and fourth-grade children in two-parent families. The moderating effects of child gender and social class were investigated. The extent to which stability in alternative care arrangements statistically explained links between early maternal employment and child outcomes was tested. RESULTS: After controlling for child gender, and maternal ethnicity, social class, and current employment status, third- and fourth-grade children whose mothers were employed during their first year of life evinced more acting out and less frustration tolerance and were nominated more often by peers for 'hitting' and 'being mean' than children whose mothers were not employed. There was some evidence that these associations were moderated by child gender and social class: boys, but not girls, whose mothers were employed during the first year were subsequently rated by teachers as acting out more than other children, and were also more likely to be nominated by peers for hitting. Higher nominations for hitting were only found in the working class. Finally, there was partial evidence that the number of alternative child-care arrangements during the first year accounted for the links between early maternal employment and subsequent child outcomes. CONCLUSIONS: These results are congruent with extant research that posits a risk of early employment on socioemotional development, but show that this risk is partially attributable to child-care instability.     

Maternal stress, social support and preschool children's intelligence

BACKGROUND: Despite some research suggesting maternal stress may be associated with cognitive impairment in preschool children, there has been little direct investigation of the association between maternal stress, social support and children's intelligence. AIM: To determine whether maternal stress and social support during pregnancy and during the child's early years of life are associated with the intelligence test performance of preschool children. STUDY DESIGN: Five hundred and fifty European mothers and children enrolled in the Auckland Birthweight Collaborative Study at birth were interviewed when the child was 3 1/2 years of age. SUBJECTS: All children were full term gestation and approximately half the sample were small for gestational age at birth (SGA = birthweight < or = 10th percentile). OUTCOME MEASURE: The cognitive ability of children aged 3 1/2 years was assessed using the Stanford Binet Intelligence Scale 4th Edition. RESULTS: In the total sample, maternal stress and lack of social support during pregnancy were significantly associated with lower intelligence test scores of children. In the group of SGA children, maternal stress post pregnancy was significantly associated with lower intelligence test scores in children. There is evidence that for some children the presence of good social support for mothers may reduce the negative effects of maternal stress on children's cognitive development. CONCLUSION: Maternal stress and lack of social support appear to be associated with lower intelligence test scores of preschool children. Social support may attenuate some of the negative effects of maternal stress on intelligence in children born small for gestational age.     

Emotion regulation in preschoolers: the roles of behavioral inhibition, maternal affective behavior, and maternal depression

Background:  This study examined preschoolers' emotion regulation (ER) strategies and the association with temperament, maternal interactive style, and maternal history of childhood-onset depression (COD).
Methods:  Participants were 62 children and their mothers, 37 of whom had mothers with COD. Children's ER was assessed using a disappointment paradigm; temperament assessment also was laboratory-based.
Results:  Maternal COD was inversely related to offspring's active ER and positive mood. Among children of COD mothers, behavioral inhibition was associated with passive regulation and sadness, and maternal positivity toward these children was associated with child active ER and positive mood.
Conclusion:  Behavioral inhibition may place children of COD mothers at risk for developing maladaptive ways of regulating negative emotion, whereas mothers' positivity may serve as a protective factor for them.     

Social support, peer victimisation, and somatic complaints: A mediational analysis

Aim:   This study investigated the associations among social support, peer victimisation and somatic problems in children and adolescents. Specifically, we tested a model that posited a mediational role of peer victimisation on the association between low social support and somatic symptoms in three age groups.
Methods:   A total of 1570 Italian children and adolescents aged 9 to 15 years participated in this study during Winter 2006. Students completed self-report measures of perceived social support, somatic complaints and peer victimisation. A series of regression analyses were used to test the hypothesised mediational model.
Results:   Age differences emerged for somatic complaints and peer victimisation, with primary school children reporting more somatic problems and victimisation experiences than older participants. Three series of regression analyses, performed separately for the three age groups, confirmed the mediational model. Low levels of social support received by peers were associated with more reported somatic complaints and more peer victimisation. When victimisation was entered as the mediator variable in the last regression equation, the association between social support and somatic problems was non-significant.
Conclusions:   In our sample, social support was negatively associated with somatic complaints. In all age groups, this association was completely mediated by peer victimisation experiences. These findings may suggest the importance of using targeted screening and interventions to address peer victimisation and its negative consequences on children's and adolescents' health.     

The relationship of maternal iodine status and neonatal thyrotropin concentration: a study in Southern Thailand

Iodine deficiency disorder (IDD) is a global health problem. Previous studies in Southern Thailand have shown that the prevalence of goiter in schoolchildren is 3-5%, indicating that Southern Thailand is an iodine sufficient area. We conducted a study in pregnant women to determine their iodine status and whether there was an association between maternal urinary iodine excretion (UIE) and the neonatal thyrotropin (TSH) concentration. We recruited 244 pregnant women attending the antenatal clinic at Songklanagarind Hospital. Their mean age was 28.5 +/- 5.3 years (range 15-42) with a mean gestation age of 9.4 +/- 2.7 weeks (range 6-15). Ten ml urine was collected for UIE measurement. All women were delivered at Songklanagarind Hospital. The mean gestational age at delivery was 38.2 +/- 2.1 weeks (range 28-41). The median maternal UIE was 139.5 microg/l with 78 (32%) women having UIE below 100 microg/l. The median TSH of the infants was 4.14 mIU/l (range 0.30-17.89) with 88 (36.1%) of infants having TSH concentration above 5 mIU/l. Logistic regression analysis revealed that the odds ratio of pregnant women with UIE below 100 microg/l giving birth to infants with neonatal TSH above 5 mIU/l was 2.04 (95% confidence interval 1.17-3.66, p = 0.012). In conclusion, our findings demonstrate that 32% of pregnant women have UIE below 100 microg/l, and that UIE below 100 microg/l in pregnant women is associated with neonatal TSH concentration above 5 mIU/l. These findings suggest that iodine deficiency is prevalent in pregnant women in Southern Thailand.     

Breastfeeding peer supporters and a community support group: evaluating their effectiveness

Peer support for breastfeeding mothers has often been promoted as a way of increasing rates in communities with low breastfeeding prevalence, where there are few breastfeeding role models and a bottle-feeding culture predominates. This study evaluated the effectiveness of a peer support initiative, which trained peer supporters who then set up a support group, in an area of social and economic deprivation in South Bristol, UK. The effects of training on 6 local women were explored; the combined effect of peer support and the group on breastfeeding prevalence assessed; and mothers' views on what they had gained from the breastfeeding support group reported. Focus groups were held with the peer supporters, who also completed questionnaires before and after their training. Questionnaires were sent to all mothers (35) who attended the support group over the first 5 months to ascertain their views. Breastfeeding rates were extracted from routinely collected sources for both the local area and the wider Bristol population (excluding the peer support area). The initial training increased the peer supporters' knowledge about breastfeeding and their confidence in talking to and supporting mothers. The number of mothers attending the breastfeeding support group increased from 3 per week in May to 10 per week by September 2001. Mothers who attended the group particularly appreciated being able to talk about breastfeeding and getting consistent breastfeeding advice. Breastfeeding rates in the area for 12-months before and after the start of the peer support initiative showed a significant increase at 8 weeks (7%), which was higher than the overall increase in the wider Bristol area (3%). This evaluation suggests that peer supporters combined with a breastfeeding support group are an effective way of increasing breastfeeding prevalence in areas of low continuation.