Interruption of breastfeeding by child death and pregnancy

Abstract

This paper estimates the mean monthly losses and proportionate interruptions of breastfeeding intervals due to child death and pregnancy. The paper uses a microanalytic model with stochastic risks for the basic processes of human reproduction. The model results show that a high proportion of women, depending upon mortality level and length of breastfeeding, have their breastfeeding interrupted by either child death or pregnancy. The results of this work suggest the need for caution in interpreting observed durations of breastfeeding. Child death and pregnancy causes bias in the reported length of breastfeeding, and this bias needs to be taken into account in statistical analysis.     

Birth spacing,breastfeeding, and early child mortality in a traditional Indian society: A hazards model analysis

Abstract

There are few studies of the interrelationships among breastfeeding, child spacing, and child mortality in traditional societies that incorporate extensive controls for social and demographic characteristics of the mother and child. In this paper, we investigate the impact of breastfeeding and the length of the preceding birth interval on early child mortality (defined as a death in the first two years of life) using data from a traditional society of India. Multivariate hazards models are used to analyze the data. Most prior analyses related the impact of breastfeeding duration to the duration of child survivability by taking breastfeeding as a fixed covariate. The present study has a methodological focus in the sense that breastfeeding information from retrospective survey data is treated as a time‐dependent covariate both as a status variate as well as a duration—with empirical findings compared across the two specifications. The effects of postpartum amenorrhoea and various other demographic and socioeconomic characteristics of mother and child are also studied. The results suggest that breastfeeding duration has a strong impact in reducing the relative risk of early child mortality; but it does not explain the effect of the length of the preceding birth interval on early child mortality.     

Correlates and implications of breast-feeding practices in Bas Zaire

A sample of 1871 women having a child under 3 years old in Bas Zaire was studied to determine the correlates of breastfeeding practices and to examine the interrelationships among breastfeeding, contraceptive practices and desire for pregnancy. The methods of analysis applied were life table analysis and its multivariate extensions. Most of the findings in this analysis are consistent with current literature on the correlates of the duration of breastfeeding. Maternal education, economic status, age, parity, urban residence, pregnancy, and sex of the index child were significantly related to the length of breastfeeding. Among non-pregnant women, current desire for pregnancy was also related to breastfeeding status when the length of time since birth of the last child was taken into consideration. Rural women were reportedly ready for another pregnancy sooner after the birth of their last child than were urban women. Breastfeeding appears to be the most important means of contraceptive protection in the study population. The effective traditional method of extended postpartum abstinence is not widely prevalent, particularly among the urban sample, and indeed seems to be on the decline. The data presented here also suggest that breastfeeding pratices are changing in this area of Africa where little economic development has occurred in the past 20 years. This research suggests that if current trends continue, fertility levels are likely to increase significantly. The findings also indicate that Bas Zairian mothers want to space their births and for this reason may be receptive to family planning programs that use appropriate strategies.     

Postpartum amenorrhoea in Ethiopia: The role of weaning,child death,and socioeconomic factors

Abstract

Using data from the 1990 National Family and Fertility Survey (NFFS) and employing discrete‐time hazards models, we examine the effect of weaning, child death, and socioeconomic factors on postpartum amenorrhoea in Ethiopia. The results show that 91 in every 100 mothers breastfed their child for at least 6 months. The median duration of breastfeeding stands at 18 months, and amenorrhoea lasts for a median duration of 12 months. Significant variations in breastfeeding and amenorrhoea duration are also observed among the different categories of breastfeeding women. The median duration of breastfeeding for lactating women is 24 months, 6 months for those who weaned, and 2 months for those whose child died. The median duration of postpartum amenorrhoea is 14 months for breastfeeding women, 12 months for those who weaned, and 6 months for those whose child died. Discrete‐time hazard models reveal that child death has the strongest effect on the resumption of menses. Net of other factors, the risk of returning to menses increased 3 times for mothers whose child died. The effect of child death, however, decreases over time. Weaning also has a significant positive effect; and, like child death, its effect diminishes as time passes. The study further shows significant differences in the risk of returning to postpartum menses by socioeconomic characteristics of the women, even though they are breastfeeding.     

Breastfeeding behavior and infant survival with emphasis on reverse causation bias: some evidence from Nigeria

The possibility of selection bias in the estimation of the effects of breastfeeding on subsequent survival is implied by the clinical evidence that children who are healthier at birth are more likely to be breastfed than their less healthy counterparts who may be prone to difficulties in sustaining breastfeeding. This paper addresses an important problem in understanding the association of breastfeeding and child survival with regard to reverse causation. It utilizes data on the reported reason for weaning to assess the degree to which reverse causality may be responsible for observed associations. The analysis indicates that children who are weaned in the neonatal period because of illness or weakness to suckle, experience a much higher risk of dying than others. This is not mainly because of the cessation of breastfeeding, but because of the original factor, being their illness. Any biases imparted by an initial selection mechanism appear, therefore, to have influence on the effectiveness of breastfeeding behavior.     

Mental health, attachment and breastfeeding: implications for adopted children and their mothers

ABSTRACT : Breastfeeding an adopted child has previously been discussed as something that is nice to do but without potential for significant benefit. This paper reviews the evidence in physiological and behavioural research, that breastfeeding can play a significant role in developing the attachment relationship between child and mother. As illustrated in the case studies presented, in instances of adoption and particularly where the child has experienced abuse or neglect, the impact of breastfeeding can be considerable. Breastfeeding may assist attachment development via the provision of regular intimate interaction between mother and child; the calming, relaxing and analgesic impact of breastfeeding on children; and the stress relieving and maternal sensitivity promoting influence of breastfeeding on mothers. The impact of breastfeeding as observed in cases of adoption has applicability to all breastfeeding situations, but may be especially relevant to other at risk dyads, such as those families with a history of intergenerational relationship trauma; this deserves further investigation.     

Breastfeeding and child disability: A comparison of siblings from the United States

Little is known about whether breastfeeding may prevent disabilities throughout childhood. We evaluate the effects of breastfeeding on child disability using data from the National Survey of Family Growth merged to the National Health Interview Survey for a large nationally representative sample of children aged 1–18 years from the U.S. including over 3000 siblings who are discordant on breastfeeding status/duration. We focus on a mother fixed effect model that compares siblings in order to account for family-level unobservable confounders and employ multiple specifications including a dynamic model that accounts for disability status of the prior child. Breastfeeding the child for a longer duration is associated with a lower risk of child disability, by about 0.2 percentage-points per month of breastfeeding. This effect is only observed on the intensive margin among breastfed children, as any breastfeeding has no effect on the extensive margin. We conclude that very short breastfeeding durations are unlikely to have an effect on reducing disability risk.     

Focus: The Science of Stress: Can Maternal Prenatal Self-Reported and Physiological Distress Predict Postnatal Caregiving Practices?

Maternal prenatal distress is associated with child outcomes, including health, neurocognitive, and socio-emotional development. Knowledge on underlying mechanisms is limited, yet relevant for prevention and intervention. This study investigated whether maternal prenatal distress predicts specific caregiving practices that are known for their effects on child outcomes. Caregiving practices studied were maternal caregiving quality and the initiation and course of breastfeeding and room-sharing. We hypothesized that more maternal prenatal distress would be associated with altered caregiving practices. Participants were 174 healthy mother-child dyads. During the 37^th week of pregnancy maternal self-reported distress was assessed using questionnaires, and physiological stress by collecting saliva cortisol. Maternal caregiving quality was observed in postnatal week 5 during infant bathing. Weekly diaries on breastfeeding and daily diaries on room-sharing were completed during the first 6 postnatal months. In a regression analysis, no associations between maternal prenatal distress and caregiving quality were found. Multilevel analyses indicated that maternal prenatal evening cortisol was positively related to the initiation of breastfeeding and room-sharing. Replications are warranted, but these results suggest that breastfeeding and room-sharing initiation may be part of a mechanism underlying links between maternal prenatal physiological stress and child outcomes. As other prenatal cortisol markers and self-reported distress were not found to be related to the caregiving practices, it is likely that alternative mechanisms (co-)exist in explaining links between maternal prenatal distress and child outcomes. Future replication research including child outcomes and (other) potential mechanisms will inform prevention and intervention programs fostering healthy pregnancies and child development.     

Determinants of breastfeeding initiation among mothers in Sydney,Australia: findings from a birth cohort study

Background

Breastfeeding has short-term and long-term benefits for both the infant and the mother. The objective of this study was to identify the incidence of breastfeeding initiation among women in South Western Sydney, and the factors associated with the initiation of breastfeeding.

Methods

Child and Family Health Nurses recruited mother-infant dyads (n = 1035) to the Healthy Smiles Healthy Kids birth study in South Western Sydney, an ethnically and socio-economically diverse area, at the first post-natal home visit. A sample of 935 women completed a structured, interviewer-administered questionnaire at 8 weeks. Multivariate logistic regression analysis was used to identify those factors independently associated with the initiation of breastfeeding.

Results

In total, 92% of women (n = 860) commenced breastfeeding in hospital. Women who completed a university degree were more likely to initiate breastfeeding compared to those who did not complete high school (AOR = 7.16, 95% CI 2.73, 18.79). Vietnamese women had lower odds of breastfeeding initiation compared to Australian born women (AOR = 0.34. 95% CI 0.13, 0.87). Women who had more than one child were less likely to breastfeed than those who had one child (AOR = 0.38, 95% CI 0.19, 0.79). Women who gave birth via a caesarean section were less likely to breastfeed their baby compared to those who had a vaginal delivery (AOR = 0.27, 95% CI 0.14, 0.52). Women who drank alcohol during pregnancy had 72% lower odds to breastfeed compared to those who did not drink alcohol during pregnancy (AOR = 0.28, 95% CI 0.11, 0.71). Women who reported that their partner preferred breastfeeding were more likely to initiate breastfeeding (AOR = 11.77, 95% CI 5.73, 24.15) and women who had chosen to breastfeed before pregnancy had more than 2.5 times the odds of breastfeeding their baby compared to those women who made their decision either during pregnancy or after labour (AOR = 2.80, 95% CI 1.31, 5.97).

Conclusions

Women with lower levels of education, who consume alcohol during pregnancy, have more than one child, and make infant feeding decision after becoming pregnant, and those born in Vietnam should be targeted when implementing breastfeeding promotion programs. Further, women who deliver by caesarean section require additional breastfeeding support post-delivery and it is important to include fathers in breastfeeding related decisions and encourage them to participate in antenatal programs.

     

Breastfeeding knowledge,attitude and practice among school teachers in Abha female educational district,southwestern Saudi Arabia

ABSTRACT: BACKGROUND: Inadequate knowledge, or inappropriate practice, of breastfeeding may lead to undesirable consequences. The aim of this study was to assess breastfeeding knowledge, attitude and practice (KAP) among female teachers in the Abha Female Educational District and identify factors that may affect breastfeeding practice in the study population. METHODS: A cross-sectional study using a self-administered questionnaire was conducted among school teachers in Abha Female Educational District during the months of April to June, 2011. Breastfeeding KAP of participants who had at least one child aged five years or younger at the time of the study were assessed using a self-administered questionnaire, based on their experience with the last child. RESULTS: A total of 384 women made up of 246 (61.1%) primary-, 89 (23.2%) intermediate- and 49 (12.8%) high-school teachers participated in the study. One hundred and nineteen participants (31%) started breastfeeding their children within one hour of delivery, while exclusive breastfeeding for 6 months was reported only by 32 (8.3%) participants. Insufficient breast milk and work related problems were the main reasons given by 169 (44%) and 148 (38.5%) of participants, respectively, for stopping breastfeeding before two years. Only 33 participants (8.6%) had attended classes related to breastfeeding. However, 261 participants (68%) indicated the willingness to attend such classes, if available, in future pregnancies. CONCLUSIONS: This study revealed that breast milk insufficiency and adverse work related issues were the main reasons for a very low rate of exclusive breastfeeding among female school teachers in Abha female educational district, Saudi Arabia. A very low rate of attending classes addressing the breastfeeding issues during pregnancy, and an alarming finding of a high percentage of babies receiving readymade liquid formula while still in hospital, were also brought out by the present study. Such findings, if addressed comprehensively by health care providers and decision-makers, will lead to the improvement of breastfeeding practices in the study community.     

Breast-feeding in Bangladesh

In this paper the duration of breastfeeding is examined in relation to demographic and socioeconomic characteristics of women and households. 98% of Bangladesh mothers breastfeed their children from birth. In data from the Bangladesh Fertility Survey conducted in 1975-1976 on 4998 live births, the mean duration of breastfeeding was 27.3 months. Duration of breastfeeding was positively related with the age of women. Female children were breastfed for periods about 5 months shorter than male children. Children born to urban mothers were breastfed for shorter durations than children born to rural mothers of all age groups. The duration of breastfeeding decreased with the increase of education of the mother. Promotion of breastfeeding should be a primary responsibility of family planning clinics. Further decline in the duration of breastfeeding would increase levels of fertility and infant and child mortality.     

Regression analysis of "current status" life tables on duration of breastfeeding in Sri Lanka

Provided that women report the dates of their children's births with reasonable accuracy, it is possible to derive good estimates of the duration of breastfeeding from women's breastfeeding status at the time of the interview. This paper illustrates the application of conventional regression techniques to the analysis of breastfeeding rates derived in this manner. Construction of current status rates is explained and a comparison between open interval, closed interval, and current status breastfeeding life tables is presented, indicating the extent of bias to which tables of the former types are open. Birth-weighted rates are used for WFS data from Sri Lanka; the variables entered into the regression equation include parity, educational level, residence, work experience since marriage and use of contraception since the birth. Contraception is not found to influence net breastfeeding rates in the 1st interval (1-16 months), although it is about as prevalent as in later intervals. The positive coefficients at intervals beyond the 1st also imply that contraceptive use is not a substitute for lactation in Sri Lanka or not a predominant one. Lifetime urban residence is associated with short durations of breastfeeding, and being an urban migrant is associated with intermediate durations relative to those of rural women. The effects of residence on breastfeeding are especially pronounced in the 1st interval. By parity as by contraception, differences in breastfeeding rates are not significant at short durations but become so with time as lower parity women reach pregnancy. Patterns by age are similar, but less sharp. Middle school attendance and work at home are both strongly associated with with lactation behavior, the former negatively and the latter to about an equal degree positively. Working outside the home seems not to influence breastfeeding to any great extent. In the multiple attribute regressions, middle schooling depresses breastfeeding durations about as strongly as lifetime urban residence relative to women who are rural and uneducated. Being at parity 5 or above or working at home almost as sharply increases durations. The use of contraception has slightly smaller positive effects. The patterns suggest that as Sri Lankan women become increasingly well educated and urban, and as family sizes decline, durations of breastfeeding will decline. Equally important however, even among better educated urban wives, breastfeeding continues longer than is typical of western countries.     

Dysphoric milk ejection reflex: A case report

Background

Breastfeeding and complementary feeding practices have profound implications for the maternal and child health status of a society. Feeding practices in Pakistan are suboptimal, leading to adverse outcomes on child health. In Pakistan, the Maternal, Neonatal and Child Health (MNCH) Program, in collaboration with several international organizations, including WHO and UNICEF, is working to improve these feeding practices in the country. The aim of this paper is to evaluate the effectiveness of these programs.

Methods

Estimates on the various indicators for infant and young child feeding proposed by WHO were analyzed in light of the Pakistan Demographic and Health Surveys (1990-91 and 2006-07) and several other national studies conducted since 1995.

Results

Nearly half the core and optional indicators have improved over the years, though modestly; the others have demonstrated no statistically significant improvement over the years. Of the five indicators required in the WHO tool for the assessment of infant and young child feeding, introduction of complementary foods, bottle-feeding, and early initiation of breastfeeding, stand in the poor category, while exclusive breastfeeding and duration of breastfeeding fall in the fair category, suggesting an overall poor status.

Conclusions

There is considerable scope to improve breastfeeding and complementary feeding in Pakistan. Further programs should focus on improving the following indicators that have shown no significant development: early initiation of breastfeeding, exclusive breastfeeding under six months, continued breastfeeding at two years, age appropriate feeding, and bottle feeding. Effective implementation of interventions that are known to improve breastfeeding practices is imperative, as is further research to yield data that can lead future endeavors.     

The Long Term Economic Impact of Severe Obstetric Complications for Women and Their Children in Burkina Faso

This study investigates the long term economic impact of severe obstetric complications for women and their children in Burkina Faso, focusing on measures of food security, expenditures and related quality of life measures. It uses a hospital based cohort, first visited in 2004/2005 and followed up four years later. This cohort of 1014 women consisted of two main groups of comparison: 677 women who had an uncomplicated delivery and 337 women who experienced a severe obstetric complication which would have almost certainly caused death had they not received hospital care (labelled a “near miss” event). To analyze the impact of such near miss events as well as the possible interaction with the pregnancy outcome, we compared household and individual level indicators between women without a near miss event and women with a near miss event who either had a live birth, a perinatal death or an early pregnancy loss. We used propensity score matching to remove initial selection bias. Although we found limited effects for the whole group of near miss women, the results indicated negative impacts: a) for near miss women with a live birth, on child development and education, on relatively expensive food consumption and on women’s quality of life; b) for near miss women with perinatal death, on relatively expensive foods consumption and children’s education and c) for near miss women who had an early pregnancy loss, on overall food security. Our results showed that severe obstetric complications have long lasting consequences for different groups of women and their children and highlighted the need for carefully targeted interventions.     

A note on the determinants of breastfeeding durations in an African country

This paper utilizes data from the 1977-78 Kenya Fertility Survey, 1 component of the World Fertility Survey, to analyze the determinants of breastfeeding durations for women 15 to 50 years old who had their last-but-1 live birth between 3 and 15 years prior to the interview. Comparisons are made with the findings fro m the World Fertility Surveys in 8 other developing countries in Asia and Latin America. Findings indicate that literacy, urban residence, secondary school education, and modern employment reduce the duration of breastfeeding in Kenya. In addition, the subgroups of women who appear to be curtailing breastfeeding are growing in proportional size or are composed of women may be innovators or leaders. A continuation of this pattern into the future may increase levels of infant morbidity and mortality and, in the absence of increased modern contraceptive practice, may increase the societal level of fertility. The death of the infant curtails the period of breastfeeding. Although there is a pronounced preference for male children in Kenya, this preference does not lead to differential durations of breastfeeding by sex of child. About 10% of Kenyan women used contraception in the last closed interval. Parity and age explain less than 1% of the variation in duration of breastfeeding in Kenya. Kenyan women are among the least likely to have attended secondary school, to have worked since marriage, and to have used modern contraception. The most traditional groups of Kenyan women, those who are Muslim or who are in polygamous unions, breastfeed for the longest durations. The Kenya Fertility Survey suggests that the subgroup of women with some secondary school education is growing considerably. Kikuyu women may be regarded as innovators in many respects. In addition to having shorter breastfeeding durations, they are the least likely to be in polygamous unions or to want more children, and they are the most likely to be using contraception.     

The effects of breastfeeding and birth spacing on infant and early childhood mortality in Ethiopia

Research conducted in developing countries clearly demonstrates the positive effects of breastfeeding and widely spaced births on infant survival. The evidence is less clear as to whether these beneficial effects extend into early childhood, and under what conditions. In this paper we examine the effects of breastfeeding and birth spacing on neonatal, post-neonatal, and early childhood mortality in Ethiopia using data from the 1990 National Family and Fertility Survey. Our results provide clear evidence that the increased mortality risks associated with closely-spaced births continue beyond the first year of life into early childhood. Competition between siblings for food and maternal attention is the most probable explanation for this finding. We also find that breastfeeding beyond the second year of life is associated with higher mortality. Given that delayed weaning in Ethiopia is a common response to food shortages, we interpret this finding as further evidence of the negative consequences of resource deprivation for child survival.     

A stochastic model for survival of early prostate cancer with adjustments for leadtime, length bias, and over-detection

To compare the survival between screen-detected and clinically detected cancers, we applied a series of non-homogeneous stochastic processes to deal with leadtime, length bias, and over-detection by using full information on detection modes obtained from the Finnish randomized controlled trial for prostate cancer screening. The results show after 9-year follow-up the hazard ratio of prostate cancer death for screen-detected cases against clinically detected cases increased from 0.24 (95% CI: 0.16-0.35) without correction for these biases, to 0.76 after correction for leadtime and length biases, and finally to 1.03 (95% CI: 0.79-1.33) for a further adjustment for over-detection. Adjustment for leadtime and length bias but no over-detection led to a 24% reduction in prostate cancer death as a result of prostate-specific antigen test. The further calibration of over-detection indicates no gain in survival of screen-detected prostate cancers (excluding over-detected case as stayer considered in the mover-stayer model) as compared with the control group in the absence of screening that is considered as the mover. However, whether the model assumption on over-detection is robust should be validated with other data sets and longer follow-up.     

The application of autogenic training in counseling center for mother and child in order to promote breastfeeding

The aim of this study was to investigate whether mothers with newborn children, the usage of autogenic training with advice on breastfeeding effect on: the decision and the duration of breastfeeding, increase maternal confidence and support. It was assumed that the above result in a higher percentage of mothers who exclusively breastfed baby during the first six months of child's life. The survey was conducted in the Association "For a healthy and happy childhood"-Counseling center for mother and child, in Bjelovar in 2010. The Counseling center was attended by 100 nursing mothers with children aged up to two months. They randomly went to the study or control group. Mothers of both groups were advised to successful breastfeeding. Study group has practiced autogenic training until the child's age of six months. In parallel, by using psychotherapeutic interview and specific questionnaires we collected data on the somatic, psychological and social situation of the mother, discovered mother's mental changes (anxiety, depression) that were treated. The results at the end of the study confirm the initial expected benefits from the application of autogenic training. Mothers of the study group were significantly more emotionally balanced with a higher self-esteem. Autogenous training with the advices for successful breastfeeding conducted in this counseling center contributed in significantly higher rate of breastfeeding children up to six months of life, improved mental and physical health of mother and child and their peculiar relationship.     

Bushman birth spacing: Direct tests of some simple predictions

Blurton Jones and Sibly (1978) developed a model of costs (weight of food and baby carried while foraging) of !Kung women's reproduction under ecological-economic constraints that were described by Lee (1972). Predictions are drawn from this model and tested on Howell's (1979) data from reproductive histories of 172 individual women.Women were rated on a scale of dependence on bush or cattlepost foods. The ratings were compared with what is known about the places at which the women gave birth to their children. Agreement was good and the population was divided into two groups for study: 65 women most dependent on bush foods and 70 women substantially dependent on agricultural produce. Thirty-seven women of uncertain or intermediate status were omitted.As predicted by the model, among the women who were dependent on bush foods: (1) first interbirth intervals (IBI) were shorter than were later IBI; (2) the survivorship of children in first IBIs was not strongly related to length of IBI, with shorter IBI giving as good survivorship as longer IBI; (3) IBIs lengthen as the number of surviving children increases, until the fourth child; (4) after the fourth child IBIs do not differ significantly although they tend to be shorter (contrary to the prediction, a null hypothesis whose statistical support is consequently poor); (5) for IBIs after the first IBI, mortality increased markedly as IBI decreased; (6) mortality was even more closely related to backloads entailed by each IBI, as calculated by Blurton Jones and Sibly (1978); (7) mortality was less closely related to backloads calculated from an alternative version of the model from which weight of food was excluded; (8) as reported by Howell (1979), a new pregnancy followed rapidly after the death of the preceeding child but (9) as predicted, a new pregnancy did not follow so fast after the death of older children; (10) for the cattlepost women IBIs were shorter than for women dependent mainly on bush foods; and (11) there was no significant relationship between IBI and mortality for the cattlepost women, and mortality at short IBI was lower than in bush women.The assumption that the benefit accruing from more births will be balanced against the costs (costs to survivorship assumed to result from the work entailed by caring for each child) was successful in giving many predictions confirmed by the data. The significance and limitations of this “optimization” study are discussed.     

Developmental Predictors of Inattention-Hyperactivity from Pregnancy to Early Childhood

ObjectiveThe objective of the study was to characterize the developmental sequence of pre- and postnatal risk factors for inattention-hyperactivity symptoms in preschoolers.ResultsA low family socioeconomic status before pregnancy was the main environmental risk factor for inattention-hyperactivity symptoms at 3 years, and its effect occurred via two pathways. The first was a risk pathway, where lower SES was associated with higher maternal depression and anxiety during pregnancy; then to higher maternal and child distress and dysregulation in infancy; and in turn to higher levels of inattention-hyperactivity at 3 years. The second was a protective pathway, where higher SES was associated with longer duration of breastfeeding during infancy; then to better child neurodevelopmental status in toddlerhood; and in turn to lower levels of inattention-hyperactivity at 3 years.DiscussionThis study identified psychosocial factors at several developmental periods that represent potential targets for preventing the emergence of inattention-hyperactivity symptoms in early childhood.