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      Breastfeeding in China: a review

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          Abstract

          This review aims to describe changes in breastfeeding and summarise the breastfeeding rates, duration and reasons of discontinuing 'any breastfeeding' or 'exclusive breastfeeding' in P.R. China. Breastfeeding rates in China fell during the 1970s when the use of breast milk substitutes became widespread, and reached the lowest point in the 1980s. As a result many efforts were introduced to promote breastfeeding. The breastfeeding rate in China started to increase in the 1990s, and since the mid-1990s 'any breastfeeding' rates in the majority of cities and provinces, including minority areas, have been above 80% at four months. But most cities and provinces did not reach the national target of 'exclusive breastfeeding' of 80%. The 'exclusive breastfeeding' rates in minority areas were relatively lower than comparable inland provinces. The mean duration of 'any breastfeeding' in the majority of cities or provinces was between seven and nine months. The common reasons for ceasing breastfeeding, or introducing water or other infant food before four months, were perceived breast milk insufficiency, mother going to work, maternal and child illness and breast problems. Incorrect traditional perceptions have a strong adverse influence on 'exclusive breastfeeding' in less developed areas or rural areas. China is a huge country, geographically and in population size, and there is considerable ethnic diversity. Therefore breastfeeding rates in different parts of China can vary considerably.

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          Most cited references86

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          Effect of breastfeeding on infant and child mortality due to infectious diseases in less developed countries: a pooled analysis. WHO Collaborative Study Team on the Role of Breastfeeding on the Prevention of Infant Mortality.

          (2000)
          The debate on breastfeeding in areas of high HIV prevalence has led to the development of simulation models that attempt to assess the risks and benefits associated with breastfeeding. An essential element of these simulations is the extent to which breastfeeding protects against infant and child mortality; however, few studies are available on this topic. We did a pooled analysis of studies that assessed the effect of not breastfeeding on the risk of death due to infectious diseases. Studies were identified through consultations with experts in international health, and from a MEDLINE search for 1980-98. Using meta-analytical techniques, we assessed the protective effect of breastfeeding according to the age and sex of the infant, the cause of death, and the educational status of the mother. We identified eight studies, data from six of which were available (from Brazil, The Gambia, Ghana, Pakistan, the Philippines, and Senegal). These studies provided information on 1223 deaths of children under two years of age. In the African studies, virtually all babies were breastfed well into the second year of life, making it impossible to include them in the analyses of infant mortality. On the basis of the other three studies, protection provided by breastmilk declined steadily with age during infancy (pooled odds ratios: 5.8 [95% CI 3.4-9.8] for infants <2 months of age, 4.1 [2.7-6.4] for 2-3-month-olds, 2.6 [1.6-3.9] for 4-5-month-olds, 1.8 [1.2-2.8] for 6-8-month-olds, and 1.4 [0.8-2.6] for 9-11-month-olds). In the first 6 months of life, protection against diarrhoea was substantially greater (odds ratio 6.1 [4.1-9.0]) than against deaths due to acute respiratory infections (2.4 [1.6-3.5]). However, for infants aged 6-11 months, similar levels of protection were observed (1.9 [1.2-3.1] and 2.5 [1.4-4.6], respectively). For second-year deaths, the pooled odds ratios from five studies ranged between 1.6 and 2.1. Protection was highest when maternal education was low. These results may help shape policy decisions about feeding choices in the face of the HIV epidemic. Of particular relevance is the need to account for declining levels of protection with age in infancy, the continued protection afforded during the second year of life, and the question of the safety of breastmilk substitutes in families of low socioeconomic status.
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            Factors associated with breastfeeding at discharge and duration of breastfeeding.

            To identify determinants of the initiation and duration of breastfeeding amongst Australian women. A prospective cohort study of 556 women in Perth, Western Australia and 503 women from the Darling Downs area, Queensland, Australia. Breastfeeding at discharge was most strongly associated with perceived paternal support of breastfeeding with an adjusted odds ratio of 9.13 (95% CI 4.83-17.26), using multivariate logistic regression analysis. Duration of breastfeeding was most strongly associated with the length of time a mother intended to breastfeed with an adjusted relative risk of 4.18 (95% CI 2.81-6.22) for > or = 4 months relative to < 4 months. Interventions which aim to increase the length of time a woman intends to breastfeed, and which highlight the role of the father in successful breastfeeding, are recommended to help achieve recommended targets for breastfeeding initiation and duration.
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              Breastfeeding: reasons for starting, reasons for stopping and problems along the way.

              The objective of this study was to describe the problems experienced by mothers when breastfeeding and the impact that these problems have on breastfeeding duration. A cohort of 556 mothers who birthed in Perth, Western Australia were recruited to study their infant feeding practices. The mothers were interviewed in hospital and again at 2, 6, 10, 14, 18 and 24 weeks postpartum, or until they ceased to breastfeed. The results showed that most mothers were not prepared to experience any difficulties or problems with breastfeeding. Twelve percent of the mothers left hospital without having attempted to breastfeed. The most common reasons given for infant-formula-feeding related to previous problems with breastfeeding, the ability of husbands to assist with feeding and perceived ease of bottle-feeding. While in hospital 83% of breastfeeding women stated that they had experienced one or more problems related to breastfeeding. Two weeks after leaving hospital 29% of breastfeeding mothers were experiencing problems and the prevalence of problems continued to decline, reaching 13% at six months. In this study the most common reason cited by mothers for stopping breastfeeding before the baby was two weeks old, was that their baby was unsettled, a behaviour often interpreted by mothers as indicating an insufficient milk supply. Levels of anxiety over milk supply reached 23% in the early stages of breastfeeding, and a number of mothers were still experiencing anxiety through to six months. Anxiety over the sufficiency of breastmilk supply was the most serious problem, in that it often resulted in the cessation of breastfeeding Most mothers experience some problems during breastfeeding, especially in the early stages. Proper advice and management is required to ensure that the problems do not lead to cessation of breastfeeding.
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                Author and article information

                Journal
                Int Breastfeed J
                International Breastfeeding Journal
                BioMed Central
                1746-4358
                2009
                16 June 2009
                : 4
                : 6
                Affiliations
                [1 ]Medical College of Shihezi University; Xinjiang, PR China, 832002
                [2 ]Women's Hospital, Zhejiang University, PR China, 310006
                [3 ]School of Public Health and Curtin Health Innovation Research Institute, Curtin University of Technology, WA, Australia, 6845
                [4 ]Tongji Medical College, Huazhong University of Science and Technology, PR China, 430013
                Article
                1746-4358-4-6
                10.1186/1746-4358-4-6
                2706212
                19531253
                0d6ce174-3a13-4a3e-8a14-c132f5af7877
                Copyright © 2009 Xu et al; licensee BioMed Central Ltd.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution License ( http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

                History
                : 31 July 2008
                : 16 June 2009
                Categories
                Review

                Obstetrics & Gynecology
                Obstetrics & Gynecology

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