Further decline of breast-feeding.

In a personal survey, by structured interview, we have investigated some of the factors which led 100 healthy mothers (63 primiparae) to decide to breast-feed their healthy babies, and 100 comparable mothers (43 primiparae) to decide to bottle-feed. Past experience (either personal or that of their family and friends) was of considerable but not overriding importance, and the decisions were apparently made surprisingly early in most cases. But much more effective educational approaches are needed, perhaps starting in the schools, and concentrated in the antenatal clinic, to allow mothers to reach the right decision for themselves and their babies. The reasons for early cessation of breast-feeding were also investigated, and suggested that those mothers opting for breast-feeding need better technical information and support.     

Increasing prevalence of breast-feeding.

Two studies were performed to gauge the prevalence of and attitudes towards breast-feeding. Mothers delivered in one month in 1975 and in one month in 1977 were sent a questionnaire one month later to determine whether they were breast-feeding their babies; those that were received a second questionnaire at three months. The prevalence of breast-feeding increased significantly between 1975 and 1977, and in both periods primiparas were more likely to breast-feed than multiparas. A survey of mothers'' intentions to breast-feed showed that there were no significant racial differences, but that 82% of women in social classes I and II intended to breast-feed compared with 54% in classes IV and V. These results show that, although the level of breast-feeding was high in 1975, a campaign directed at mothers, doctors, midwives, and health visitors did increase the prevalence of breast-feeding.     

Cancer in a Montreal suburb: the investigation of a nonepidemic.

In response to an alarming newspaper report of 34 cases of cancer in Chomedey, a suburb of Montreal, an epidemiologic survey was undertaken to determine the incidence of cancer in selected Montreal census tracts during the period 1975-79. Cases of cancer, were ascertained from the Quebec Tumour Registry, then age-standardized incidence ratios (SIRs) were calculated, the expected incidence being based on provincial age-specific rates and 1976 populations. The SIRs were significantly lower for males living in the implicated area (P less than 0.01) and were within expected limits for female residents. Further analysis revealed neither an elevated frequency of any particular tumour type nor a clustering of cases in this area. Following additional ascertainment of cases through the examination of hospital records, the SIRs were recalculated. No significant differences were found between those of the implicated area and those of the most demographically comparable census tract. Finally, an independent inquiry failed to uncover any actual or potential sources of environmental carcinogens.     

Prevalence and duration of breast-feeding in Manitoba.

The rate of breast-feeding in the first 3 months post partum was studied in a group of 456 mothers. At 3 months 58% had been or still were breast-feeding their infants. The mothers who breast-fed were older, had a higher level of education, had a higher socioeconomic status, and were more likely to live on farms or in small towns, to have attended prenatal education classes and to have previously breast-feds. There were no significant differences between the method of feeding and the sex or birthweight of the infant, the maternal weight/height ratio or the participation of the father in the prenatal education classes. At 1 month 45% of the infants, at 2 months 35% and at 3 months 28% were being breast-fed. Public programs to promote breast-feeding as normal, beneficial and satisfying to both mother and infant are necessary so that more mothers will attempt to breast-feed their infants. Support for continuance of breast-feeding is needed in the hospital as well as in the home and the community.     

Prevalence of iron deficiency among Chinese children aged 6 to 36 months in Montreal.

Screening for iron deficiency was undertaken among a group of Chinese children aged 6 to 36 months to determine the prevalence of the condition and its association with infant feeding. Of the 346 children studied, 12.1% were found to be iron deficient. The overall prevalence rate of thalassemia minor was 6.7%. Among the 166 children aged 6 to 12 months, more of those who were breast-fed for at least 2 months than of those who were bottle-fed were iron deficient (27.0% v. 7.0%; p less than 0.001). This difference persisted after controlling for the effect of iron-fortified formula. No such difference was found among those older than 12 months. The observed prevalence of iron deficiency was closer to the rate reported for black children than to that reported for white children in the United States. The findings stress the importance of conducting further studies of iron deficiency among Chinese subpopulations in North America.     

Extending lactational amenorrhoea in Manila: a successful breast-feeding education programme.

An experimental breast-feeding education programme conducted at the Philippine General Hospital in Manila demonstrated that women could be motivated to improve their breast-feeding practices and lengthen their period of lactational amenorrhoea in comparison to a control group. Mothers who participated in the programme breast-fed their babies more frequently, delayed the introduction of regular supplements, used fewer bottles and pacifiers and maintained night feeding longer than mothers who were not exposed to the positive breast-feeding messages. The programme was successful in lengthening the period of amenorrhoea among women with elementary, high school, or technical school education, but not among college-educated women. Different educational approaches may be necessary for women of different education levels.     

An evaluation of a national breast-feeding promotion programme in Honduras

A significant increase occurred in the initiation and duration of breast-feeding among Honduran women between 1981 and 1987. Changes in population characteristics (e.g. level of education of women) would be expected to lead to a decrease in breast-feeding at each infant age, but these were offset by behavioural changes that led to an increase in the likelihood of initiation and continuation of breast-feeding. An exploration of relevant factors suggests that the PROALMA breast-feeding promotion programme has had a profound effect on the breast-feeding behaviour of Honduran mothers.     

Influence of cultural and environmental factors on breast-feeding.

A study was undertaken at hôpital Sainte-Justine, Montreal, to determine the factors that influence the choice of feeding method for infants and the duration of breast-feeding. The factors that most clearly distinguished the mothers who breast-fed were lifestyle, education and conditioning to the parental role; those who nursed successfully for a long time were well motivated, well educated, supported by their family, especially the husband, and the La Leche League, and were of an economic status such that it was not necessary for them to return to work soon after delivery. Although the breast-fed babies were more fussy, they were healthier and received fewer drugs.     

HIV infection among women undergoing abortion in Montreal.

OBJECTIVE: To determine the seroprevalence and correlates of HIV infection in a subpopulation of women of childbearing age in Montreal. DESIGN: Anonymous unlinked seroprevalence study. SETTING: Pregnancy termination unit in a teaching hospital in Montreal. PARTICIPANTS: Women presenting for abortion from July 1989 to June 1993 who resided in Quebec and were not known to have HIV infection; 12,017 (99.6%) of 12,068 eligible women were included in the study. INTERVENTION: HIV antibody testing of serum left over from samples obtained for routine Rh typing; the same algorithm as for serodiagnostic testing, namely enzyme immunoassay (EIA) followed by confirmatory testing of repeatedly EIA-reactive samples, was used. OUTCOME MEASURES: HIV serostatus by age, marital status, region of residence (metropolitan Montreal versus other), country of birth and number of living children. RESULTS: Most (84.7%) of the subjects resided in metropolitan Montreal. The median age was 27.0 (range 13 to 50) years. The serum samples of 22 women were confirmed to be HIV positive, for an overall seroprevalence rate of 1.8 per 1000 (95% confidence interval 1.1 to 2.8). The seroprevalence rate did not vary significantly by age, marital status, region of residence or study year. However, it was strongly correlated with country of birth: Canada 0.16, Haiti 23.5, HIV-endemic countries other than Haiti 5.3 and non-HIV-endemic countries other than Canada 0.0 per 1000. The seroprevalence rate among women born in Haiti was 147 times higher than that among women born in Canada (p < 0.0001). Of the women born in Haiti the rate was 3.0 times greater among those who immigrated to Canada in 1985 or later than among those who immigrated earlier (p = 0.047). CONCLUSIONS: The results of this study indicate that the HIV seroprevalence rate among women in Montreal is strongly associated with country of birth, women born in HIV-endemic countries, especially Haiti, having the highest rate. These results will help in the development of policies regarding HIV antibody testing and prevention of HIV transmission in Quebec.