Breastfeeding Perceptions and Decisions among Hispanic Participants in the Special Supplemental Nutrition Program for Women, Infants, and Children: A Qualitative Study.

The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) is a nutrition assistance program in the U.S. WIC served 2.5 million eligible Hispanic women, infants, and children under the age of five in 2021, which is WIC's largest racial/ethnic group. However, limited research has been conducted to understand Hispanic WIC participants' perceptions of WIC breastfeeding recommendations and their breastfeeding decisions. For this qualitative study, we interviewed 18 of these pregnant and postpartum WIC participants on their experiences and decision-making processes related to breastfeeding. Hispanic cultures and home country norms were identified as prominent influences on breastfeeding decisions, along with perceptions of WIC's breastfeeding support. These results can help the WIC program to refine its breastfeeding education to better meet the needs of Hispanic participants.

Research on Black Women and Breastfeeding: Assessing Publication Trends (1980-2020).

Background: Research on race/ethnicity and breastfeeding has consistently found lower rates for Black mothers compared with other U.S. women, due to various social, cultural, and historical factors. Aggregate analyses illuminate racial/ethnic differences, but they only provide partial insight into the factors contextualizing breastfeeding decisions and rates. We examined articles addressing Black women and breastfeeding (1980-2020) to assess publication trends. Materials and Methods: A targeted literature search in PubMed for research on Black women and breastfeeding (1980-2020). The search used nine different keyword combinations: ("breastfeeding" OR "lactation" OR "infant feeding,") AND ("rac*" OR "African American" OR "Black"). After removing duplicates, non-U.S. research, and irrelevant articles, 221 articles were reviewed. Articles were coded for year, type (quantitative, qualitative, mixed method, conceptual/literature review, commentary/editorial), and journal target audience (e.g., nursing). Results: More than 50% of all articles were published after 2013. The period of 2018-2020 accounts for 25% of all published articles. The research is also mostly quantitative (60.2%). Qualitative studies made up only 16.7% of articles. A few studies used mixed methods (5%). More than half of all qualitative studies were published after 2014. Conclusions: Research on Black women and breastfeeding has slowly increased since 1980, but much of the work has only been done post-2000. Research is also mostly quantitative analyses. Quantitative and qualitative methods rely on different research aims, styles, and objectives. To provide a fuller understanding of Black women's relationship to and experience of breastfeeding, we suggest that scholars cultivate a stronger focus on qualitative and mixed methods for future research.

Race/ethnicity-specific associations between breastfeeding information source and breastfeeding rates among U.S. women.

BACKGROUND: Despite evidence of the impact of breastfeeding information on breastfeeding rates, it is unknown if information sources and impact vary by race/ethnicity, thus this study assessed race/ethnicity-specific associations between breastfeeding information sources and breastfeeding. METHODS: We used data from the 2016-2019 Pregnancy Risk Assessment Monitoring System. Race/ethnicity-stratified multinomial logistic regression was used to estimate associations between information source (e.g., family/friends) and breastfeeding rates (0 weeks/none, < 10 weeks, or ≥ 10 weeks; < 10 weeks and ≥ 10 weeks = any breastfeeding). All analyses were weighted to be nationally representative. RESULTS: Among 5,945,018 women (weighted), 88% reported initiating breastfeeding (≥ 10 weeks = 70%). Information from family/friends (< 10 weeks: aORs = 1.58-2.14; ≥ 10 weeks: aORs = 1.63-2.64) and breastfeeding support groups (< 10 weeks: aORs = 1.31-1.76; ≥ 10 weeks: aORs = 1.42-2.77) were consistently associated with breastfeeding and duration across most racial/ethnic groups; effects were consistently smaller among Alaska Native, Black, and Hispanic women (vs White women). Over half of American Indian and one-quarter of Black women reported not breastfeeding/stopping breastfeeding due to return to school/work concerns. CONCLUSIONS: Associations between breastfeeding information source and breastfeeding rates vary across race/ethnicity. Culturally tailored breastfeeding information and support from family/friends and support groups could help reduce breastfeeding disparities. Additional measures are needed to address disparities related to concerns about return to work/school.

Mississippi CHAMPS: Decreasing Racial Inequities in Breastfeeding.

Mississippi CHAMPS addressed racial inequities in breastfeeding by implementing community and hospital-based practice changes in accordance with the BFHI and by parallel community work.

Assessment of breastfeeding techniques in Enugu, South-East Nigeria.

Background: Good breastfeeding technique is important in ensuring adequate milk delivery and preventing breastfeeding problems. Exclusive breastfeeding rate is quite low, and requisite skills regarding proper positioning and attachment of an infant while breastfeeding appears lacking among mothers in Nigeria. This study was undertaken to assess breastfeeding techniques of mothers attending the well-child clinics of two tertiary hospitals in southeast Nigeria. Materials and Methods: This cross-sectional descriptive study of 396 mother and child pairs who attend the well child clinics of two tertiary hospitals in Enugu (Enugu state University Teaching Hospital and University of Nigeria Teaching Hospital) between September 2018 and February 2019. An interviewer administered, well-structured pro forma was used to collect data while mothers were observed closely as they breastfed and scored using the World Health Organization criteria. Data were analyzed using SPSS version 22. Results: Most of the mothers studied (357; 90.2%) attended ante-natal care, and 365 (92.2%) of the deliveries were assisted by a health worker. Only 194 (49%) of mothers practiced good breastfeeding techniques. Maternal age (20-30 years) (P < 0.001, odds ratio [OR] 0.464), attendance to antenatal clinic (P < 0.001; OR 8.336), health education and demonstration on breastfeeding techniques before and after delivery (P = 0.001) and maternal level of education (χ2 = 13.173, P = 0.001) but not parity (P = 0.386; OR 1.192) were significantly associated with good breastfeeding techniques. Conclusion: There are suboptimal breastfeeding techniques among mothers. Increased awareness creation and regular demonstration of breastfeeding techniques are needed.

RésuméContexte: Une bonne technique d'allaitement est importante pour assurer une livraison adéquate du lait et prévenir les problèmes d'allaitement. Exclusive le taux d'allaitement est assez faible, et les compétences requises en ce qui concerne le positionnement et l'attachement appropriés d'un nourrisson pendant l'allaitement semblent manqué chez les mères au Nigéria. Cette étude a été entreprise pour évaluer les techniques d'allaitement des mères qui fréquentent les cliniques hôpitaux tertiaires dans le sud-est du Nigeria. Matériaux et méthodes: Cette étude descriptive transversale de 396 couples de mères et d'enfants assister aux cliniques pour enfants de deux hôpitaux tertiaires à Enugu (Hôpital universitaire d'Enseignement de l'Université d'Enugu et Université du Nigeria Enseignement hôpital) entre septembre 2018 et février 2019. Un intervieweur administré, bien structuré pro forma a été utilisé pour recueillir des données les mères ont été observées de près au fur et à mesure qu'elles allaitaient et scorelaient selon les critères de l'Organisation mondiale de la santé. Les données ont été analysées à l'aide du SPSS version 22. Résultats: La plupart des mères étudiées (357; 90,2 %) soins prénatals, et 365 (92,2 %) des livraisons ont été assistées par un travailleur de la santé. Seulement 194 (49%) des mères pratiquaient de bonnes techniques d'allaitement. Âge maternel (20­30 ans) (P 0,001, rapport de cotes [OR] 0.464), présence à la clinique prénatale (P 0,001; OU 8.336), éducation à la santé et démonstration sur les techniques d'allaitement avant et après (P = 0,001) et le niveau d'éducation maternel (2 = 13,173, P = 0,001) mais pas la parité (P = 0,386; OR 1.192) ont été significativement associés avec de bonnes techniques d'allaitement. Conclusion: Il existe des techniques d'allaitement sous-optimales chez les mères. Création accrue de sensibilisation et une démonstration régulière des techniques d'allaitement sont nécessaires.

Racial and Ethnic Disparities in Breastfeeding Initiation ─ United States, 2019.

Breastfeeding is the optimal source of nutrition for most infants (1). Although breastfeeding rates in the United States have increased during the past decade, racial/ethnic disparities persist (2). Breastfeeding surveillance typically focuses on disparities at the national level, because small sample sizes limit examination of disparities at the state or territorial level. However, birth certificate data allow for assessment of breastfeeding initiation among nearly all newborn infants in the United States both nationally and at the state and territorial levels. To describe breastfeeding initiation by maternal race/ethnicity,* CDC analyzed 2019 National Vital Statistics System (NVSS) birth certificate data for 3,129,646 births from 48 of the 50 states (all except California and Michigan†), the District of Columbia (DC), and three U.S. territories (Guam, Northern Mariana Islands, and Puerto Rico). The prevalence of breastfeeding initiation was 84.1% overall and varied by maternal race/ethnicity, ranging from 90.3% among infants of Asian mothers to 73.6% among infants of Black mothers, a difference of 16.7 percentage points. Across states, the magnitude of disparity between the highest and lowest breastfeeding rates by racial/ethnic groups varied, ranging from 6.6 percentage points in Vermont to 37.6 percentage points in North Dakota, as did the specific racial/ethnic groups with the highest and lowest rates. These state/territory-specific data highlight the variation that exists in breastfeeding disparities across the United States and can help public health practitioners and health departments identify groups on which to focus efforts. Targeting breastfeeding promotion programs on populations with lower breastfeeding rates might help reduce racial/ethnic disparities in breastfeeding initiation and improve infant nutrition and health.

Enhancing Patient-Provider Breastfeeding Conversations: Breastfeeding Intention and Prenatal Breastfeeding Self-Efficacy among a Sample of Pregnant Women.

OBJECTIVES: The purpose of this study was to investigate and identify which sociodemographic factors may be associated with breastfeeding intention and breastfeeding self-efficacy among pregnant women. METHODS: Pregnant women at a medical center in Alabama completed a cross-sectional survey. The Prenatal Rating of Efficacy in Preparation to Breastfeed Scale (PREP to BF) was used to assess prenatal breastfeeding self-efficacy. A valid 3-item breastfeeding intention scale and the Fetal Health Locus of Control Scale also were used. Nonparametric tests were used to assess differences in breastfeeding intention, locus of control subscales, and PREP to BF scores by history with breastfeeding, planned mode of delivery, and sociodemographic factors. RESULTS: The participants in the final analysis (N = 124) had a mean prenatal breastfeeding self-efficacy score of 299.5 (±92.33), with a range of 0 to 390. Significantly lower scores related to intention and PREP to BF were found among Black women (P ≤ 0.05), those with a high school education or less (P ≤ 0.019), single women (P ≤ 0.028), and those who had no breastfeeding experience (P ≤ 0.035). CONCLUSIONS: Identifying pregnant women with low breastfeeding self-efficacy and intention and recognizing the effects of social and cultural influences on breastfeeding are vital. Healthcare providers can engage in meaningful dialog to address ways to increase social support, communication, goal-setting skills, and overcoming mental and emotional barriers.

Breastfeeding and emerging motherhood identity: An interpretative phenomenological analysis of first time Chinese Australian mothers' breastfeeding experiences.

BACKGROUND: Chinese Australian mothers are more likely than the general Australian mothers to introduce formula in the first month of age. A better understanding of the context of formula introduction in the early weeks of birth can provide a deeper insight into how Chinese Australian mothers can be supported to continue exclusive breastfeeding. METHODS: An interpretative phenomenological analysis approach was used to examine the lived breastfeeding experiences of 11 first time Chinese mothers in Australia. The experiences of those who breastfed exclusively were compared to those who introduced formula in the first month after birth. FINDINGS: An overarching theme across all participants' narratives was the meaning ascribed to breastfeeding in their emerging motherhood identity. Breastfeeding could be a pragmatic and a socially desirable method to nourish an infant but lacking personal identification to the mother. These mothers were more vulnerable to the early introduction of formula, especially when the support environment was lacking. Maternal identity conflict was common and negatively impacted exclusive breastfeeding and mothers' mental health. In contrast, mothers who identified closely with breastfeeding showed greater persistence and enjoyment in breastfeeding and were more likely to continue breastfeeding exclusively. Health professionals were perceived to have an important influence in strengthening maternal breastfeeding motivation and self-efficacy. CONCLUSION: Breastfeeding support to Chinese Australian mothers needs to consider how breastfeeding can be better integrated with their motherhood identity. Health professionals are well-positioned to facilitate this process through a better understanding of mothers' cultural and social contexts around breastfeeding.

Review of online breastfeeding information for Aboriginal and Torres Strait Islander women.

BACKGROUND: Breastfeeding provides the healthiest start to life, but breastfeeding rates amongst Aboriginal and Torres Strait Islanders is lower than non-Indigenous women. AIM: To assess the accuracy, quality and appropriate presentation of online breastfeeding information for Aboriginal and Torres Strait Islander women in Australia. METHODS: An online search conducted in Google, Bing and Yahoo search engines to identify any breastfeeding websites that provided information for Aboriginal and Torres Strait Islander women. Relevant websites were evaluated against: a) National Health and Medical Research Council clinical guidelines, b) the quality of health information on the Internet by using DISCERN instrument, and c) appropriate key design features for Aboriginal and Torres Strait Islander women. RESULTS: The search located 348 sites with 31 being eligible for inclusion. Websites from governmental organizations had the highest accuracy while YouTube videos had the lowest accuracy. Three quarters (74%, n=23) of sites incorporated the national clinical guidelines adequately, and most of the sites (77.8%, n=24) were considered high quality. Only 23% (n=7) of sites had sufficient key design features appropriate for Aboriginal and Torres Strait Islander women. Four websites were considered exemplary for their accuracy, quality and cultural appropriateness of information for Aboriginal and Torres Strait Islander women. CONCLUSION: Some websites are tailored to provide breastfeeding information and support to Aboriginal and Torres Strait Islander women. However, only a few contain culturally appropriate key design features. Further participatory action research is required to design online platforms for women from different cultural backgrounds that take into account cultural principles, beliefs and values.

Navigating infant feeding supports after migration: Perspectives of Arabic and Chinese mothers and health professionals in Australia.

Optimal feeding practices can establish lifelong, transgenerational and global health benefits. Migration and cultural factors impact infant feeding practices and the support mothers receive for optimal infant feeding. This qualitative study explored support for infant feeding among Arabic and Chinese speaking migrant mothers in Australia. Semi-structured focus groups were conducted in language with 24 Arabic and 22 Chinese-Mandarin speaking migrant mothers with children under five years of age. Individual interviews were conducted in English with 20 health professionals working with Arabic or Chinese speaking migrant families. Data were thematically analysed using the framework method. Traditional family networks and trusted bi-cultural doctors were influential infant feeding supports for mothers. Health professionals perceived maternal and child health services to be poorly understood, and some mothers who accessed services felt they were not always culturally sensitive. Mothers sought additional information and support through online sources and peers. Both mothers and health professionals recognised the challenges of managing conflicting infant feeding advice and seeking best-practice support. The findings of this study highlight opportunities for health professionals to better support migrant mothers' infant feeding practices, for example through engaging families and working with doctors. There is a need for greater cultural sensitivity within maternal and child health services and culturally relevant programs to support healthy infant feeding practices among migrant communities.

Racial and socioeconomic disparities in breast milk feedings in US neonatal intensive care units.

Very low birth weight (VLBW; <1500 g birth weight) infants are substantially more likely to be born to black than to non-black mothers, predisposing them to potentially preventable morbidities that increase the risk for costly lifelong health problems. Mothers' own milk (MOM) may be considered the ultimate "personalized medicine" since milk composition and bioactive components vary among mothers and multiple milk constituents provide specific protection based on shared exposures between mother and infant. MOM feedings reduce the risks and associated costs of prematurity-associated morbidities, with the greatest reduction afforded by MOM through to NICU discharge. Although black and non-black mothers have similar lactation goals and initiation rates, black VLBW infants are half as likely to receive MOM at NICU discharge in the United States. Black mothers are significantly more likely to be low-income, single heads of household and have more children in the home, increasing the burden of MOM provision. Although rarely considered, the out-of-pocket and opportunity costs associated with providing MOM for VLBW infants are especially onerous for black mothers. When MOM is not available, the NICU assumes the costs of inferior substitutes for MOM, contributing further to disparate outcomes. Novel strategies to mitigate these disparities are urgently needed. IMPACT: Mother's own milk exemplifies personalized medicine through its unique biologic activity. Hospital factors and social determinants of health are associated with mother's own milk feedings for very low-birth-weight infants in the neonatal intensive care unit. Notably, out-of-pocket and opportunity costs associated with providing mother's own milk are borne by mothers. Conceptualizing mother's own milk feedings as an integral part of NICU care requires consideration of who bears the costs of MOM provision-the mother or the NICU?

Breastfeeding in China: A Review of Changes in the Past Decade.

This review summarizes breastfeeding rates in China reported during the decade 2007-2018, a decade on from our previous review published in 2007. Compared with the studies undertaken before 2007 in China, recent studies are more likely to report breastfeeding rates using longer periods of observation, enabling rates to be summarized to six and 12 months postpartum in this review. There appears to have been a modest increase in breastfeeding in China. The mean duration of "any breastfeeding" was 10 months (9 to 11 months in the majority of cities), an increase compared with the previous review in which the mean of "any breastfeeding" duration was 8 months (7 to 9 months in the majority of cities). Using data from cohort studies, the proportion of infants being breastfed at 4 months increased from 78% in the earlier decade to 83% more recently. A second baby is usually breastfed for longer than the first, considering both "any" and "exclusive breastfeeding". China is a huge country and there is considerable diversity in culture, level of economic development, education and breastfeeding rates in different areas of China, but our review suggests that there has been some improvement in the "any breastfeeding" rate in the most recent decade.

Pre-lacteal feeding practices and associated factors among mothers of children aged less than 12 months in Jinka Town, South Ethiopia, 2018/19.

BACKGROUND: Pre-lacteal feeding is one of the major harmful practices being faced while feeding the newborns. Although it affects child health, little is known about the extent of the problem and its contributing factors in the study area. Therefore, this study aimed to figure the prevalence of pre-lacteal feeding practices and associated factors among mothers of children aged less than 12 months in Jinka Town. METHODS: A community-based cross-sectional study was conducted at Jinka Town from March 1 to 30, 2019. A total of 430 mothers, having children less than 12 months of age, were selected by systematic sampling technique. The data were collected by using pretested and interviewer- administered structured questionnaires. The data were entered using epidata 4.2.1 and exported to SPSS version 23 for analysis. Adjusted odds ratios, 95% confidence intervals and p-values were reported. RESULTS: The prevalence of pre-lacteal feeding practice was 12.6% [95% CI (9.5-15.7)]. Having no maternal education [AOR = 4.82(95%CI 1.60-14.24)], colostrum avoidance [AOR = 4.09(95% CI 1.62-7.67)], lack of breast feeding counseling [AOR: = 2.51(95% CI 1.20-5.25)], home delivery [AOR = 3.34 (95% CI 1.52-7.33)], lack of knowledge about risks of pre-lacteal feeding [AOR = 2.86 (95% CI 1.30-6.29] and poor knowledge on breast feeding practices [AOR = 3.63(95% CI 1.62-8.11)] were factors associated with pre-lacteal feeding practices. CONCLUSION: Pre-lacteal feeding practice among mothers of children aged less than 12 months in Jinka town was found to be higher than the national prevalence. Illiterate, colostrum avoidance, lack of breastfeeding counseling, home delivery, lack of knowledge on the risk of pre-lacteal feeding, and poor knowledge on breastfeeding practice were factors associated with pre-lacteal feeding practices.

Enabling Breastfeeding to Support Lifelong Health for Mother and Child.

The health benefits of breastfeeding are well documented, and more than 80% of US women initiate breastfeeding; however, mothers in the United States face substantial challenges in meeting their personal breastfeeding goals, with approximately 60% weaning earlier than they had intended. In addition, there are significant racial/ethnic inequities in infant-feeding behaviors, and these inequities are a major public health concern. Enabling women to meet their breastfeeding goals is a public health priority. Infant feeding should be addressed as a modifiable health behavior, rather than a lifestyle choice.

Informal Milk Sharing for the Hospitalized at-Risk Infant in the Ultra-Orthodox-Haredi Jewish Community in the United States.

The process of human milk donation and sharing for the promotion of infant health is a phenomenon of interest as it directly affects children's health and well-being. Although its prevalence is currently unknown, informal sharing of human milk is occurring across the United States. The U.S. Food and Drug Administration recommends against informal sharing of human milk. However, the Ultra-Orthodox (Haredi) Orthodox Jewish population, who strictly observes Jewish laws and often consults with rabbis before making medical decisions, is known to donate and obtain milk through informal sharing. The objective of this study was to explore the lived experience of informal donation from the perspective of Ultra-Orthodox mothers from the Northeastern region of the United States who engaged in milk sharing to support hospitalized at-risk infants. Women were interviewed by an Orthodox Jewish member of the team, using a semistructured interview guide. Informal milk sharing was regarded as a positive empowering experience. Themes which illuminate the phenomena of milk sharing include faith, mistrust of the medical establishment, a strong reliance on social connectedness, and importance of sacred cultural traditions. Health care providers need to be aware of these specific needs to provide culturally sensitive care for safer milk sharing practices in cloistered and faith-based communities.

Predictors of optimal breastfeeding practices in Worabe town, Silte zone, South Ethiopia.

BACKGROUND: Studies in sub-Saharan Africa indicated the overall prevalence of optimal breast feeding ranged between a lowest of 17.63% in East Africa and a highest of 46.37% in West Africa. It's estimated that 823,000 deaths of children could be prevented every year through optimal breastfeeding practices. However optimal breastfeeding practices is low in most setting of Ethiopia. Therefore, this study aimed to assess optimal breastfeeding practices and associated factors in Worabe town. METHOD: A community-based analytical cross-sectional study was conducted from April 15th-25th, 2018. A systematic sampling technique was applied on 347 sampled mothers who had children greater than or equal to 2 years old. The data was entered into EpiData (version 3.1) and subsequently exported to SPSS Statistics (version 22) for analysis. Descriptive statistics were used for presenting summary data using tables and graph. Bivariate and multi variable logistic regression analysis to identify were used to identify associated factors. The statistical significance was declared at P<0.05. RESULT: Optimal breastfeeding was exhibited by 42.1% of mothers. Government employees (AOR = 8.0; 95% CI: 1.7, 36.4), families with a household income of 1,500-3,000 Ethiopian birr (AOR = 4.6; 95% CI: 1.0, 20.1), individuals knowledgeable about optimal breastfeeding practices (AOR: 5.5 95% CI: 1.6, 18.1), individuals counselled about breastfeeding practices during postnatal follow-ups (AOR = 4.940, 95% CI: 1.313, 10.195), and individuals that had a caesarean section delivery (AOR = 4.2, 95% CI: 1.2, 14.1) had a higher chance of practicing optimal breastfeeding. However, mothers who did not attend or have access to antenatal care follow-ups (AOR = 0.1, 95% CI: 0.04, 0.5) were less likely to practice optimal breastfeeding. CONCLUSIONS: Less than half of mothers breastfed their children optimally. Factors that influenced this included knowledge of optimal breastfeeding practices, total household income, the woman's occupation, access to breastfeeding counselling during postnatal care follow-ups, access to antenatal care follow-ups, and mode of delivery. It is strongly recommended that optimal breastfeeding awareness programs through health education be done in collaboration with health extension workers, and zonal health offices.

A Qualitative Exploration of the Determinants of Exclusive Breastfeeding (EBF) Practices in Wajir County, Kenya.

BACKGROUND: The World Health Organization recommends exclusive breastfeeding for the first six months of life. A qualitative study was conducted to assess the factors that influence the practice of exclusive breastfeeding amongst mothers attending Wajir County Hospital, Kenya. METHOD: This study was part of a cross-sectional study to compare the exclusive breastfeeding rates amongst primiparous and multiparous mothers with infants under 6 months old attending Wajir County Hospital. Focus group discussions and key informant interviews were conducted to collect information on exclusive breastfeeding and related factors. Four focus group discussions were conducted with mothers who exclusively breastfed and the same number with mothers who did not exclusively breastfeed their babies. Key informant interviews were conducted with nine healthcare providers. The data were transcribed, and a content analysis identified common themes and inferences. RESULTS: The exclusive breastfeeding rate among the mothers in the larger study was 45.5%. There was no disparity between the practice of exclusive breastfeeding between primiparous and multiparous mothers. Despite the high knowledge and positive attitudes towards exclusive breastfeeding of most mothers, the practice of exclusive breastfeeding was unsatisfactory. The major hindrances identified were cultural barriers propagated by mothers-in-law and traditional birth attendants; the belief that babies cannot live without water; and a few unsupportive health workers. The uptake of exclusive breastfeeding was enhanced by Islamic teaching on breastfeeding, education from a few supportive healthcare providers; support from husbands; and positive deviance among some lactating mothers who practiced exclusive breastfeeding. CONCLUSIONS: Deeply rooted cultural factors were the major hindrance to the practice of exclusive breastfeeding. Most of the mothers did not practice exclusive breastfeeding, despite the majority being knowledgeable and having positive attitudes towards the practice. The influence of mother-in-law's and traditional birth assistants were major barriers. Strengthening the Community Health Strategy through training traditional birth attendants on Infant Young Child Nutrition practices, designing mechanisms linking traditional birth assistants to existing health facilities for support, and capacity building and monitoring is critical in promoting exclusive breastfeeding. Behavior change and communication through multiple channels within the community should be utilized to maximize promotion of exclusive breastfeeding among all stakeholders.

Historical Antecedents of Breastfeeding for African American Women: from the Pre-Colonial Period to the Mid-Twentieth Century.

INTRODUCTION: African American women have much lower breastfeeding rates than other racial and ethnic groups in the USA. While researchers are beginning to explore contemporary factors contributing to this inequality, much less research has been devoted to the historical conditions that have contributed to these disparities. AIM: The aim of this paper was to describe the social, economic, and political factors that have influenced African American breastfeeding behavior in the USA from the colonial era through the mid-twentieth century. METHODS: A thematic analysis was conducted across multiple databases and sources. A social history framework, which focuses on the experiences of ordinary people and events, was used to identify and integrate themes found within the reviewed literature. RESULTS: Three themes emerged: (1) Labor forces and other socio-cultural factors affected feeding practices and communal caregiving; (2) history of supplementation; and (3) influence of medicalization of birth and mobility on infant feeding in the twentieth century. These themes illustrate how African American women's ability to breastfeed has been significantly constrained throughout the U.S. HISTORY: Supplementation with non-human milk substitutes and communal caregiving helped African American women navigate infant rearing under adverse socioeconomic circumstances. CONCLUSIONS: Social, political, and economic factors have contributed significantly to African American women's ability to breastfeed throughout the U.S. HISTORY: Understanding the influences of historical antecedents on breastfeeding decisions over time may be key to finding effective interventions that might increase breastfeeding rates within this population.

Breastfeeding Initiation, Duration, and Supplementation Among Mexican-Origin Women in Texas.

BACKGROUND: Mexican-origin women breastfeed at similar rates as white women in the United States, yet they usually breastfeed for less time. In our study, we seek to identify differences in Mexican-origin women's breastfeeding intentions, initiation, continuation, and supplementation across nativity and country-of-education groups. METHODS: The data are from a prospective cohort study of postpartum women ages 18 to 44 recruited from 8 Texas hospitals. We included 1235 Mexican-origin women who were born and educated in either Texas or Mexico. Women were interviewed at delivery and at 3, 6, 12, 18, and 24 months post partum. Breastfeeding intentions and initiation were reported at baseline, continuation was collected at each interview, and weeks until supplementation was assessed for both solids and formula. Women were classified into 3 categories: born and educated in Mexico, born and educated in the United States, and born in Mexico and educated in the United States. RESULTS: Breastfeeding initiation and continuation varied by nativity and country of birth, although all women reported similar breastfeeding intentions. Women born and educated in Mexico initiated and continued breastfeeding in higher proportions than women born and educated in the United States. Mexican-born and US-educated women formed an intermediate group. Early supplementation with formula and solid foods was similar across groups, and early supplementation with formula negatively impacted duration across all groups. CONCLUSIONS: Nativity and country of education are important predictors of breastfeeding and should be assessed in pediatric and postpartum settings to tailor breastfeeding support. Support is especially warranted among US-born women, and additional educational interventions should be developed to forestall early supplementation with formula across all acculturation groups.