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

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          Abstract

          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.

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          Most cited references39

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          Predictors of breastfeeding duration: evidence from a cohort study.

          To report the duration of breastfeeding among a population of Australian women and to identify factors that are associated with the duration of full breastfeeding to 6 months and any breastfeeding to 12 months. Participants were 587 women who were recruited from 2 maternity hospitals in Perth and completed a baseline questionnaire just before or shortly after discharge from the hospital. Women were followed up by telephone interview at 4, 10, 16, 22, 32, 40, and 52 weeks postpartum. Data collected included sociodemographic, biomedical, hospital-related, and psychosocial factors associated with the initiation and the duration of breastfeeding. Cox's proportional hazards model was used to identify factors that were associated with the risk for discontinuing full breastfeeding before 6 months and any breastfeeding before 12 months. At 6 months of age, fewer than one half of infants were receiving any breast milk (45.9%), and only 12% were being fully breastfed. By 12 months, only 19.2% of infants were still receiving any breast milk. Breastfeeding duration was independently, positively associated with maternal infant feeding attitudes and negatively associated with breastfeeding difficulties in the first 4 weeks, maternal smoking, introduction of a pacifier, and early return to work. Relatively few women achieved the international recommendations for duration of full and overall breastfeeding. Women should receive anticipatory guidance while still in the hospital on how to prevent or manage common breastfeeding difficulties and should be discouraged from introducing a pacifier before 10 weeks, if at all. Improved maternity leave provisions and more flexible working conditions may help women to remain at home with their infants longer and/or to combine successfully breastfeeding with employment outside the home.
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            Australian dietary guidelines

            (2013)
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              A Western Australian survey of breastfeeding initiation, prevalence and early cessation patterns.

              This paper reports on current initiation and prevalence rates, in Western Australia, differentiating 'any' breastfeeding with 'exclusive' breastfeeding whilst exploring patterns and reasons for stopping breastfeeding. The results presented are part of a larger study examining women's perceptions of care and wellbeing in the early postnatal period. A cross sectional survey was used to examine infant feeding practices during the hospital stay and at 9 weeks post birth from Western Australian women with a registered live birth between February and June 2006. Data obtained from 2,669 women revealed a 93% (n = 2,472) initiation rate of any breastfeeding. More multiparous women (73.5%) were exclusively breastfeeding in hospital compared to primiparous women (65.2%), which decreased to 57.1 and 49.2%, respectively at 9 weeks. Of those who had ceased by 9 weeks, more multiparous women (71.1%) ceased before 3 weeks. Reasons cited for ceasing in order of frequency were insufficient milk supply, infant related reasons, pain and discomfort and emotional reasons. Younger maternal age, primiparous women, lower maternal education levels, offering a combination of breast milk and formula in hospital and caesarean birth were significant independent predictors of early cessation. Although initiation rates including "any" breast milk are meeting NHMRC dietary guidelines of 90%, the 60% target of exclusive breastfeeding is not being achieved for 3 months or in fact at 9 weeks. Targeted support for at risk groups such as younger, less well-educated, primiparous women must continue. Evidence based policies to protect breastfeeding must address the practice of offering formula to breastfed infants in hospital and the impact of increasing interventions such as caesarean births.
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                Author and article information

                Contributors
                a.arora@westernsydney.edu.au
                narendar.manohar@hotmail.com
                Andrew.Hayen@uts.edu.au
                Sameer.Bhole@sswahs.nsw.gov.au
                John.Eastwood@sswahs.nsw.gov.au
                steven-levy@uiowa.edu
                jane.scott@curtin.edu.au
                Journal
                Int Breastfeed J
                Int Breastfeed J
                International Breastfeeding Journal
                BioMed Central (London )
                1746-4358
                15 September 2017
                15 September 2017
                2017
                : 12
                : 39
                Affiliations
                [1 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, School of Science and Health, , Western Sydney University, ; Campbelltown Campus, Penrith, NSW Australia
                [2 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Discipline of Paediatrics and Child Health, , Sydney Medical School, ; Westmead, NSW Australia
                [3 ]ISNI 0000 0001 0753 1056, GRID grid.416088.3, Oral Health Service, , Sydney Local Health District and Sydney Dental Hospital, NSW Health, ; Surry Hills, Australia
                [4 ]GRID grid.429098.e, COHORTE Research Group, , Ingham Institute of Applied Medical Research, ; Liverpool, NSW Australia
                [5 ]ISNI 0000 0004 1936 7611, GRID grid.117476.2, Faculty of Health, , University of Technology Sydney, ; Ultimo, NSW Australia
                [6 ]ISNI 0000 0004 1936 834X, GRID grid.1013.3, Faculty of Dentistry, , The University of Sydney, ; Surry Hills, NSW Australia
                [7 ]Community Paediatrics, Sydney Local Health District, NSW Health, Croydon, Australia
                [8 ]ISNI 0000 0004 1936 8294, GRID grid.214572.7, Department of Preventive and Community Dentistry, , University of Iowa, ; Iowa City, USA
                [9 ]ISNI 0000 0004 0375 4078, GRID grid.1032.0, School of Public Health, Curtin University, ; Perth, WA Australia
                Article
                130
                10.1186/s13006-017-0130-0
                5602913
                28932255
                862c9a3c-c5bd-4b6a-a72d-5754bbef131d
                © The Author(s). 2017

                Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

                History
                : 7 May 2017
                : 7 September 2017
                Funding
                Funded by: FundRef http://dx.doi.org/10.13039/501100000925, National Health and Medical Research Council;
                Award ID: 1069861
                Award ID: 1033213
                Award ID: 1033213
                Award ID: 1134075
                Award Recipient :
                Funded by: FundRef http://dx.doi.org/10.13039/501100001776, University of Western Sydney;
                Funded by: FundRef http://dx.doi.org/10.13039/501100004799, Australian Dental Research Foundation;
                Funded by: FundRef http://dx.doi.org/10.13039/501100008810, NSW Ministry of Health;
                Funded by: Oral Health Foundation
                Categories
                Research
                Custom metadata
                © The Author(s) 2017

                Obstetrics & Gynecology
                breastfeeding,initiation,australia,sydney,cohort study
                Obstetrics & Gynecology
                breastfeeding, initiation, australia, sydney, cohort study

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