Donor human milk practice in Indonesia: a media content analysis.

Introduction: Donor human milk (DHM) is recommended as the second-best alternative form of supplementation when a mother is unable to breastfeed directly. However, little is known about the experience of mothers and families in the communities regarding accessing and donating expressed breastmilk in Indonesia. This study aimed to identify the experience related to donor human milk in the society in Indonesia. Method: A search was conducted through six main online news portals. The keywords used included "donor human milk," "expressed breastmilk," and "wet nursing" in the Indonesian language, Bahasa Indonesia. A total of 107 articles were found, but only 20 articles were included for analysis using a qualitative media content analysis approach. Results: In the study, the following five themes were identified: (1) the whys and wherefores of donor human milk, (2) national and religious-based regulations, (3) recommendations from authorized organizations, healthcare professionals, and Islamic scholars, (4) the negative impact from the lack of national regulations, and (5) contradictory feelings among mothers. Conclusion: With the lack of detailed information on how to access or donate expressed human milk and the absence of a human milk bank in place, informal human milk sharing is inevitably occurring in the community. This has also raised concerns among authorized organizations, healthcare professionals, and Islamic scholars. Consequently, mothers, both donors and recipients, experienced negative impacts, which included contradictory feelings. Engaging with Islamic scholars and healthcare professionals to develop clear guidelines and regulations to enable mothers' and families' access and/or make contributions to DHM in a safe and accountable way is critical to prevent further problems from occurring in Indonesian society.

A Comprehensive Assessment of the Environmental Impact of Different Infant Feeding Types: The Observational Study GREEN MOTHER.

AIM(S): To observe and compare the environmental impacts of different types of infant feeding, considering the use of formula, infant feeding accessories, potentially increased maternal dietary intake during breastfeeding (BF) and food consumption habits. DESIGN: An observational cross-sectional multicentre study conducted in the Barcelona Metropolitan Area of the Catalan Institute of Health. METHODS: Data were collected from 419 postpartum women on infant feeding type (formula milk and accessories), maternal dietary intake (24-h register) and food consumption habits from November 2022 to April 2023. The environmental impacts (climate change (CC), water consumption and water scarcity) of the infant feeding types and maternal diet were calculated using the IPCC, ReCiPE and AWARE indicators, respectively. The differences in impacts were calculated by Kruskal-Wallis test. RESULTS: Significant differences for the three environmental impacts were observed. The CC impact of formula milk and feeding accessories was 0.01 kg CO2eq for exclusive BF, 1.55 kg CO2eq for mixed feeding and 4.98 kg CO2eq for formula feeding. While BF mothers consumed an extra 238 kcal, no significant differences were found related to maternal diet across feeding types. CONCLUSION: Exclusive BF was the most sustainable type of infant feeding, considering formula and infant feeding accessories. In our study, the difference between the impacts of BF and non-BF mothers' diet was insignificant. IMPLICATIONS FOR THE PROFESSION AND/OR PATIENT CARE: Offer informative and educational support for midwives and other healthcare professionals on BF and a healthy, sustainable diet to transfer this knowledge to the general public. IMPACT: Raise the general public's awareness about BF and a healthy, sustainable diet. To reduce environmental impacts through behavioural changes. REPORTING METHOD: STROBE. PATIENT OR PUBLIC CONTRIBUTION: Patients of the Catalan Health Service reviewed the content of the data collection tools. TRIAL REGISTRATION: (for the whole GREEN MOTHER project): NCT05729581 (https://clinicaltrials.gov).

Breastfeeding disparities and recommended strategies to end them in New York.

Objective: The objective of this study was to identify strategies to address breastfeeding disparities across New York in the United States. Methods: Data were collected from August-December 2021 using a qualitative research design that included 45 key informant interviews and 253 online questionnaires. Results: Ninety-six percent of participants lived in or represented New York, and four percent were national experts. Participants discussed the factors contributing to breastfeeding disparities across the social ecological continuum. They identified New York subgroups most likely to report lower rates of breastfeeding initiation and/or continuation, including: certain racial and ethnic groups; individuals working in certain employment sectors or living in specific geographic areas; people with disabilities; and the lesbian, gay, bisexual, transgender, queer, intersex, asexual and more (LGBTQIA+) community. Recommendations included addressing social and commercial determinants of health and modifying the healthcare and workplace sectors with an emphasis on policy changes. Conclusions: The findings from this study emphasize the need to address systemic and structural factors impacting breastfeeding disparities. This article makes a novel contribution by providing recommendations that can be implemented collectively across relevant settings to address breastfeeding disparities in a state with one of the largest and most diverse populations.

Breastfeeding During COVID-19 Stay-at-Home Orders: Implications for Future Maternal Work Policies and Health Equity.

OBJECTIVES: This study aimed to explore the impact of the COVID-19 pandemic and associated stay-at-home orders on the breastfeeding experiences of U.S. people a identify facilitators and barriers to breastfeeding during this period, and to assess the effects of maternal stress and misinformation on breastfeeding practices. METHODS: U.S. women with infants were selected through purposive and convenience sampling. An online survey, distributed during summer 2020, measured changes in infant feeding practices, maternal stress levels, use of lactation support resources, and the influence of misinformation on feeding decisions. Quantitative data were analyzed using descriptive statistics, and qualitative responses underwent thematic analysis. RESULTS: Our sample (n = 1,861) revealed that 34% of U.S. women realized the pandemic affected their feeding practices, 544 women provided qualitative data. Major themes from qualitative analysis included ease of breastfeeding at home, bonding, increased breastfeeding duration, and challenges like limited access to lactation support. Logistic regressions highlighted demographic influences on breastfeeding practices, with no significant effects found related to the child's age or women's income on changes in feeding practices. CONCLUSIONS FOR PRACTICE: The COVID-19 pandemic substantially impacted breastfeeding experiences of U.S. women, yielding insights for future policy and healthcare practices. The findings underscore the potential benefits of telehealth lactation support services and flexible remote work environments for breastfeeding people. Clear and scientifically-grounded communication regarding breastfeeding, mental health support, and policy development, are essential to promote equitable and flexible work and maternity leave options for breastfeeding people especially during global health crises.

Development of the Baby Behaviors when Satiated (BABES) Behavioral Coding Scheme.

Current infant feeding recommendations promote responsive feeding, wherein caregivers respond to infants' cues to determine feeding pace and duration, to support infant self-regulation and healthier weight outcomes. A central tenet of responsive feeding is that infants will effectively signal hunger, receptiveness to feeding, needs to disengage from feeding, and satiation, yet there is a lack of research available to support this assumption. Rather, previous research illustrates substantial variability exists for the extent to which infants exhibit behavioral cues during feeding and that many mothers feel their infants do not clearly communicate satiation, suggesting certain caregivers need tailored support to understand their infants' needs during feeding interactions. As a first step toward addressing this research gap, we developed the Baby Behaviors when Satiated (BABES) coding scheme, a comprehensive tool that assesses infants' disengagement/satiation behaviors and mothers' responses to infant behaviors and feeding practices during mother-infant feeding interactions. The BABES was applied to 876 videos of bottle-feeding interactions from a prospective, longitudinal study of dyads observed when infants were 1, 2, 4, 6, 9, and 12 months old. Coders achieved moderate to strong inter-rater reliability and descriptive analyses illustrated that the percentages of infants and mothers exhibiting different behaviors at each age were consistent with developmental trends noted in previous research. Application of this tool within future research holds the potential to create rich datasets allowing for description of intra- and inter-individual variability in infant and mother behaviors and how infants' and mothers' behaviors co-develop across the first year.

Enhancing Surgical Outcomes: Presurgical Nasoalveolar Molding for Unilateral Cleft Lip, Alveolus, and Palate in Infants-A Progressive Clinical Report.

This case report describes the successful application of presurgical nasoalveolar molding (PNAM) in the treatment of a neonate with Veau's class III cleft lip and palate of the left side. PNAM, a noninvasive method, effectively reduced the cleft deformity (from 10 mm pretreatment to 1 mm post-NAM), improved nasal esthetics, and minimized the need for extensive surgical interventions and better surgical outcomes. The treatment involved precise impression procedures, custom-made appliances, and weekly modifications to achieve optimal results. The comprehensive approach resulted in favorable esthetic outcomes, reduced scar formation, and improved lip symmetry, demonstrating the potential of PNAM as a valuable adjunctive therapy in cleft lip and palate management. How to cite this article: Yadav L, Mattu N, Yadav N, et al. Enhancing Surgical Outcomes: Presurgical Nasoalveolar Molding for Unilateral Cleft Lip, Alveolus, and Palate in Infants-A Progressive Clinical Report. Int J Clin Pediatr Dent 2024;17(8):951-954.

Infant feeding knowledge among women living with HIV and their interaction with healthcare providers in a high-income setting: a longitudinal mixed methods study.

BACKGROUND: Recent changes in the infant feeding guidelines for women living with HIV from high-income countries recommend a more supportive approach focusing on shared decision-making. Limited information is available on the infant feeding knowledge of women living with HIV and how healthcare providers engage with them in this context. This multicenter, longitudinal, mixed methods study aims to get a comprehensive and nuanced understanding of infant feeding knowledge among women living with HIV of Nordic and non-Nordic origin living in Nordic countries, and their interaction with healthcare providers regarding infant feeding planning. METHODS: Pregnant women living with HIV in Denmark, Finland, and Sweden were recruited in 2019-2020. The Positive Attitudes Concerning Infant Feeding (PACIFY) questionnaire was completed in the 3rd trimester (T1), three (T2), and six (T3) months postpartum. Women who completed the quantitative survey were also invited to participate in qualitative semi-structured interviews at T1 and T3. Results from the survey and interviews were brought together through merging to assess for concordance, complementarity, expansion, or discordance between the datasets and to draw meta-inferences. RESULTS: In total, 44 women living with HIV completed the survey, of whom 31 also participated in the interviews. The merged analyses identified two overarching domains: Knowledge about breastfeeding in the U = U era and Communications with healthcare providers. The women expressed confusion about breastfeeding in the context of undetectable equals untransmittable (U = U). Women of Nordic origin were more unsure about whether breastfeeding was possible in the context of U = U than women of non-Nordic origin. Increased postpartum monitoring with monthly testing of the mother was not seen as a barrier to breastfeeding, but concerns were found regarding infant testing and infant ART exposure. Infant feeding discussions with healthcare providers were welcome but could also question whether breastfeeding was feasible, and many participants highlighted a need for more information. CONCLUSIONS: Healthcare providers caring for women living with HIV must have up-to-date knowledge of HIV transmission risks during breastfeeding and engage in shared decision-making to optimally support infant feeding choices.

Exploring the relationship between child temperament, maternal psychiatric symptoms, family environment and infant feeding.

OBJECTIVES: Infant temperament is assumed to be primarily innate. However, newer research suggests that maternal affection impacts ratings of temperament and environmental factors, including feeding method, can also influence infant temperament. This study investigates child temperament and its relationships with maternal psychiatric symptoms, environmental variables and feeding method longitudinally in a cohort of children followed from 6 to 72 months. Differences in temperament by feeding group are also investigated. We hypothesized that maternal psychiatric symptoms, environmental stressors, and impaired family dynamics would have negative impact on child temperament, whereas breastfeeding would have a positive impact on child temperament. METHOD: Mothers' ratings of child's temperament, own psychiatric symptomatology, environmental stresses and family cohesion were obtained in 504 mother-infant dyads via rating scales completed by mothers. Infants were breastfeed (BF), fed soy-based infant formula (SF) or dairy-based infant formula (MF). Linear mixed effect models investigated the relationship of variables on child's temperament while controlling for significant covariates and repeated measurements. RESULTS: Mothers in this study did not endorse clinical-level psychiatric symptomatology; however, when adjusted for significant covariates, higher psychiatric symptomatology significantly correlated with environmental stressors, impaired family dynamics and elevations in temperament ratings of infants' adaptability and mood. There were no lasting differences for temperament between feeding groups. However, some significant transient increases in rhythmicity and adaptability were found between SF and BF children. CONCLUSION: Positive relationships between family environment stressors and maternal psychiatric ratings were found. Transient differences were found in child temperament based upon feeding method.

Investigation of Human Milk as a Biological System in a Multicenter Mother-Infant Cohort: Protocol Design and Cohort Profile of the Phoenix Study.

Breastfeeding and human milk are the gold standard for infant feeding. Studying human milk with a systems biology approach in a large longitudinal cohort is needed to understand its complexity and health implications. The Phoenix study is a multicenter cohort study focusing on the interactions of maternal characteristics, human milk composition, infant feeding practices, and health outcomes of Chinese mothers and infants. A total of 779 mother-infant dyads were recruited from November 2021 to September 2022, and 769 mother-infant dyads were enrolled in the study. Scheduled home visits took place at 1, 4, 6, and 12 months postpartum, and 696 dyads (90.5% participants) completed the 12-month visit. At each visit, maternal and infant anthropometry was assessed. Questionnaires were administered to collect longitudinal information on maternal characteristics and lifestyle, infant feeding, and health. Digital diaries were used to record maternal dietary intake, infant feeding, and stool character. Human milk, maternal feces, infant feces, and infant saliva were collected. An external pharmaceutical-level quality assurance approach was implied to ensure the trial quality. Multi-omics techniques (including glycomics, lipidomics, proteomics, and microbiomics) and machine learning algorithms were integrated into the sample and data analysis. The protocol design of the Phoenix study provides a framework for prospective cohort studies of mother-infant dyads and will provide insights into the complex dynamics of human milk and its interplay with maternal and infant health outcomes in the Chinese population.

Common Feeding Practices Used by Chinese Caregivers of 6-10-Month-Old Infants: A Behavioral Observation Study in Shaanxi Province.

OBJECTIVE: To explore the feeding practices and feeding environment of Chinese families with 6-10-month-old infants. DESIGN: One day of caregiver-recorded feeding occasions. SETTING: Homes in Shaanxi, China. PARTICIPANTS: Families recruited using convenience sampling. VARIABLES MEASURED: Videos were coded for feeding practice frequency and acceptance rate, feeding environment, and responsiveness to infant fullness cues and eating pace. ANALYSIS: Wilcoxon rank sum tests examined the differences in feeding practice use based on caregiver type, infant sex, and infant weight status. RESULTS: Twenty-eight families provided videos for coding. The most commonly observed feeding practices were opening the mouth, giving instructions, and interfering with the child's actions. Prompts to eat were accepted 86.9% of the time. Overweight infants' caregivers used significantly more coercive prompts to eat than did caregivers of healthy-weight infants (P < 0.05). Mothers used more autonomy-supportive prompts to eat than did fathers (P < 0.05). Early, active, and late infant fullness cues were captured in 25.6%, 34.8%, and 8.5% of videos, respectively. 53.6% of caregivers fed at the right pace, whereas 14.5% and 31.9% fed too slow or too fast, respectively. Approximately 5.5% of videos had a screen on, and 33.5% of videos included at least 1 other distraction during the meal. CONCLUSIONS AND IMPLICATIONS: Differences in feeding practices among caregivers suggest that targeted advice may further improve feeding practices. Improving the caregiver's ability to identify satiety cues and respond to infant eating speed may also reduce the risk of overfeeding.

Human immunodeficiency virus exposed child feeding and maternal enriching factors.

Globally, each year 1.3 million neonates acquire human immunodeficiency virus during pregnancy, labour, and breastfeeding time. Replacing breastfeeding with recommended safe infant feeding practices significantly reduces the risk of transmission, nearly eliminating it. This study aimed to assess Human immunodeficiency virus exposed child feeding among 314 mothers with infants under 24 months old. Participants were selected using a systematic random sampling technique, and data were collected through a semi-structured questionnaire. Bivariable and multivariable logistic regression analyses employed to identify determinants for safe infant feeding. During interviews, the mean age of women was 32.35 years (standard deviation±4.5), and infants were 10.8(±3.951) months. The overall safe infant feeding was 67.2% (95% CI: 61.7, 72.9), with a mean knowledge score. By the study's end, 9 infants (2.89%) were confirmed to be infected with virus based on dried blood sample test. Maternal promoting factors for safe infant practice included infant age 25-35 years (adjusted odd ratio (aOR) =2.9) completing high school education (adjusted odd ratio = 9.2), having a good knowledge score for infant feeding (adjusted odd ratio = 8.2), and urban residency (adjusted odd ratio = 2.2). On the other hand, being married made it 83% less likely for safe infant feeding practices (adjusted odd ratio = 0.17) compared to those never in a union. Two in three mothers practiced safe infant feeding for their HIV-exposed infants, with a mean knowledge score of 70.3%. Therefore, healthcare providers give accurate information and counselling services to make informed decisions about infant safe feeding.

"Figure it out or starve": The Impact of an Infant-Formula Shortage on Prenatal Infant Feeding Intentions.

OBJECTIVES: Beginning in February 2022, the United States faced an infant formula shortage that severely impacted access and affordability. Little is known about how this shortage impacted infant feeding intentions among expectant mothers. Our study sought to determine the impact of the formula shortage on prenatal feeding intentions and to understand expectant mothers' feelings and perceived stress related to the shortage. METHODS: This cross-sectional, exploratory, observational study of pregnant women (n = 57) residing in New York City utilized a self-administered online survey in May-July 2022. RESULTS: The results indicate that ten (17.5%) respondents changed their feeding intentions during the infant formula shortage for months 0-3 or 3-6 of infancy to include more breastfeeding than originally intended. These mothers also reported significantly higher stress levels related to the shortage than their non-changing peers. CONCLUSIONS FOR PRACTICE: Our results suggest that the formula shortage influenced feeding intentions among a subset of surveyed expectant mothers. The stress associated with the shortage influenced prenatal feeding intentions to include more breastfeeding than intended prior to the shortage. Prenatal healthcare providers should consider the availability of infant formula as one of myriad factors that influence infant feeding intentions, and that the stress associated with whether infant formula is readily available may influence these intentions as well.

Socioeconomic Moderators of the Association Between Delayed Breastfeeding Initiation and Place of Delivery: Cross-Sectional Study.

BACKGROUND: Breastfeeding is a crucial and irreplaceable method of feeding infants. Despite the well-established advantages of early breastfeeding initiation, its progress remains constrained. Over half of Indian mothers witness delayed breastfeeding initiation. Various factors have been implicated to influence breastfeeding initiation, with institutional deliveries emerging as a crucial factor among them. OBJECTIVE: We tested the hypothesized association between institutional delivery and initiation delays and identified how various socioeconomic variables moderate (weaken, strengthen, or reverse) the association between breastfeeding initiation delays and place of delivery. METHODS: This cross-sectional study analyses data of 106,569 breastfeeding mothers from the NFHS-5 (National Family Health Survey, 2019-21). Missing data were managed by using a complete case analysis approach. The outcome variable was the timing of breastfeeding initiation for the most recent child, with the place of delivery being the explanatory variable. Socioeconomic factors including age, education level, marital status, place of residence, and wealth index were considered moderating variables. Logistic regression-based moderation analysis explored how these variables influence the relationship between breastfeeding initiation delays and place of delivery. Separate binary logistic regression models analyzed the effect of each moderating variable. Statistical analysis was conducted using IBM SPSS Statistics 26. RESULTS: The highest occurrence of delayed breastfeeding initiation was observed among mothers aged ≥36 years (58.3%), lacking formal education (60.9%), belonging to lower wealth groups (58.1%), residing in rural areas (57.4%), and having home births (64.1%). Results confirmed the primary hypothesis that institutional delivery significantly and negatively affects delayed breastfeeding initiation (odds ratio [OR] 0.705, 95% CI 0.676-0.735, P<.001). Age as a moderating variable significantly affected this association (adjusted OR [aOR] 0.757, 95% CI 0.696-1.307, P=.02 for the 15-25 age group). Notably, education level (aOR 0.616, 95% CI 0.429-1.930, P=.005 for no education and aOR 0.510, 95% CI 0.429-1.772, P=.04 for primary education) and poor wealth index (aOR 0.672, 95% CI 0.528-1.432, P=.004) as moderating factors significantly strengthened the negative effect of institutional delivery on delayed initiation. Poor mothers and those without education or a lower level of education (primary) when delivering the child at the health institution further reduced the chances of witnessing delayed initiation. CONCLUSIONS: Institutional delivery significantly lowers the likelihood of delayed breastfeeding initiation, and this negative effect is significantly strengthened when uneducated women or lesser-educated women and those with lower wealth deliver their children at the institutional facilities, underscoring the significance of these moderating factors. Developing strategies targeting these socioeconomic moderating factors is crucial. Tailored awareness programs crafted to address the needs of uneducated mothers from economically disadvantaged backgrounds can enhance coverage. Outreach initiatives aimed at promoting health care service use during pregnancy and delivery, as well as raising awareness about breastfeeding practices, are warranted for the adoption and implementation of early breastfeeding initiation.

Relationship between Infant Feeding and the Microbiome: Implications for Allergies and Food Intolerances.

Childhood is a critical period for immune system development, which is greatly influenced by the gut microbiome. Likewise, a number of factors affect the gut microbiome composition and diversity, including breastfeeding, formula feeding, and solid foods introduction. In this regard, several studies have previously demonstrated that breastfeeding promotes a favorable microbiome. In contrast, formula feeding and the early incorporation of certain solid foods may adversely affect microbiome development. Additionally, there is increasing evidence that disruptions in the early microbiome can lead to allergic conditions and food intolerances. Thus, developing strategies to promote optimal infant nutrition requires an understanding of the relationship between infant nutrition and long-term health. The present review aims to examine the relationship between infant feeding practices and the microbiome, as well as its implications on allergies and food intolerances in infants. Moreover, this study synthesizes existing evidence on how different eating habits influence the microbiome. It highlights their implications for the prevention of allergies and food intolerances. In conclusion, introducing allergenic solid foods before six months, alongside breastfeeding, may significantly reduce allergies and food intolerances risks, being also associated with variations in gut microbiome and related complications.

A Comparison of Infant Feeding Practices in South Asian-Born Mothers and Australian-Born Mothers Living in Australia.

South Asian infants and children have a higher predisposition to central adiposity, increasing their risk of metabolic diseases in childhood. Infant feeding practices are a key factor in reducing the risk of obesity in children. The current study aimed to compare infant feeding practices of South Asian-born mothers to Australin-born mothers. The 2010 Australian National Infant Feeding Survey data were used to compare infant feeding practices between South Asian-born mothers and Australian-born mothers with children aged up to 2 years. Chi-square and t-tests were conducted, as well as regression models, with adjustment for covariates, to assess individual infant feeding practices between the two groups. A total of 298 South Asian-born mothers and 294 Australian-born mothers were included. The age at which a child stopped receiving breast milk was lower among Australian-born mothers (3 months) compared with South Asian-born mothers (5 months, p < 0.001). A greater proportion of South Asian-born mothers reported that solids were introduced at or after 6 months of age compared to Australian-born mothers (86% vs. 69%, p < 0.001, respectively). South Asian-born mothers were engaging in some health-promoting infant feeding practices compared to Australian-born mothers; however, they were not meeting the infant feeding guidelines for exclusive breastfeeding and the introduction of solids. Further research is needed to better understand factors influencing infant feeding practices in South Asian-born immigrant mothers in Australia to determine whether culturally tailored interventions are needed to help these women achieve optimal feeding practices for their infants.

Maternal Work and Infant Feeding Practices in the First 6 Months.

OBJECTIVES: The purpose of this study was to examine the relationship between maternal work and infant feeding practices and explore the moderating impact of parental stress. METHODS: Prospective data on categorical hours worked and infant feeding practices were collected at 3 and 6 months postpartum in a prospective prenatal cohort of 95 women. Chi-square tests were used to compare change in proportion of exclusive breastfeeding from birth to 6 months and maternal work status. RESULTS: Rates of exclusive breastfeeding significantly decreased from birth to 6 months, while the percent of mothers working outside of the home significantly increased from 3 to 6 months. At 6 months, mothers who worked full time pumped significantly more than their non-working counterparts. Multivariate logistic regression models were used to test the prediction of exclusive breastfeeding by maternal work, including sociodemographic covariates, and the moderating impact of parental stress. Results indicated that maternal education, paternal education, and maternal work significantly predicted exclusive breastfeeding at 6 months. Full time work (OR = 0.09, 95% CI = 0.01, 0.62) was associated with a decreased odds of exclusive breastfeeding. Additionally, higher maternal (OR = 1.44, 95% CI = 1.05, 1.97) and paternal (OR = 1.28, 95% CI = 1.00, 1.66) education was associated with an increased odds of exclusive breastfeeding. Maternal stress did not predict exclusive breastfeeding, nor did it have a moderating effect on the relationship between maternal work and breastfeeding. CONCLUSIONS FOR PRACTICE: Future studies should investigate maternal work in more diverse birthing populations to better understand how families can incorporate breastfeeding as a primary infant feeding practice.

Infant feeding for women with an eating disorder: An interpretative phenomenological analysis.

Mothers with eating disorders can face additional challenges with infant feeding, and there is evidence they are likely to cease breastfeeding earlier than intended. However, there is little research exploring this. The present study used interpretative phenomenological analysis to explore the lived experience of infant feeding for mothers suffering from or recovering from an eating disorder. Semistructured interviews were conducted with six women-five who had breastfed and one who formula-fed. The women experienced two incompatible worlds-motherhood and an eating disorder. Tensions were sometimes resolved by reducing eating disordered behaviour alongside immersion in motherhood. Two participants did not find infant feeding particularly important for their journey into motherhood. Four recounted a positive shift in their relationship to their body through breastfeeding and felt their embodied experience of mothering provided a route out of eating disordered behaviour. However, doubts about their mothering and infant feeding capabilities could be amplified by feeling mistrusted by others and by the relative silence around eating disorders within maternity care services. Respectful dialogue with health care professionals was particularly valued where this occurred. Although long-term outcomes for the participants are unknown, the study suggests women with a history of eating disorders can form successful breastfeeding relationships and may be motivated to engage in collaborative risk assessment. However, they need support in managing emotional challenges. Training around eating disorders for maternity care professionals is likely to be useful for enhancing confidence in engaging mothers proactively to share concerns about eating, weight and body shape.

How women living with HIV in the UK manage infant-feeding decisions and vertical transmission risk - a qualitative study.

BACKGROUND: The World Health Organization (WHO) recommends that women with HIV breastfeed for a minimum of one year. In contrast, across high-income countries, HIV and infant-feeding guidelines recommend exclusive formula feeding if parents want to avoid all risk of postpartum transmission. However, recently these guidelines (including in the United Kingdom (UK)) increasingly state that individuals with HIV should be supported to breast/chest feed if they meet certain criteria; such as an undetectable maternal HIV viral load and consent to additional clinical monitoring. Between 600 and 800 pregnancies are reported annually in women with HIV in the UK, with low rates of vertical transmission (0.22%). Informed infant-feeding decision-making requires clinical support. Currently, little research addresses how individuals with HIV in high-income countries navigate infant-feeding decisions with their clinical teams and familial and social networks, and the resources needed to reach an informed decision. METHODS: Semi-structured remote interviews were conducted between April 2021 - January 2022 with UK-based individuals with a confirmed HIV diagnosis who were pregnant or one-year postpartum. Using purposive sampling, pregnant and postpartum participants were recruited through NHS HIV clinics, community-based organisations and snowballing. Data were analysed thematically and organised using NVivo 12. RESULTS: Of the 36 cisgender women interviewed, 28 were postpartum. The majority were of Black African descent (n = 22) and born outside the UK. The majority of postpartum women had chosen to formula feed. Women's decision-making regarding infant-feeding was determined by (1) information and support; (2) practicalities of implementing medical guidance; (3) social implications of infant-feeding decisions. CONCLUSION: The evolution of UK HIV and infant-feeding guidelines are not reflected in the experiences of women living with HIV. Clinicians' emphasis on reducing the risk of vertical transmission, without adequately considering personal, social and financial concerns, prevents women from making fully informed infant-feeding decisions. For some, seeking advice beyond their immediate clinical team was key to feeling empowered in their decision. The significant informational and support need among women with HIV around their infant-feeding options must be addressed. Furthermore, training for and communication by healthcare professionals supporting women with HIV is essential if women are to make fully informed decisions.

Emergency response and preparedness among Polish human milk banks: a comparison of the COVID-19 pandemic and the 2022 Ukrainian refugee crisis.

Introduction: In recent years, Poland has faced two major emergencies: the COVID-19 pandemic, a global-scale public health emergency in 2020, and the outbreak of a full-scale war in Ukraine, which forced over 9 million Ukrainians-mostly women and children-to flee from their country through the Polish-Ukrainian border in 2022. Methods: In 2020 and 2022, we conducted two online questionnaires with human milk bank personnel to assess the impact of these emergencies on the human milk banking sector and its preparedness to face them. All 16 human milk bank entities operating in Poland were contacted and invited to participate in the study. For the first questionnaire, which was distributed in 2020, we obtained a 100% response rate. For the second questionnaire, the response rate was 88%, i.e., 14 out of 16 human milk banks completed the questionnaire. We compared these two emergencies in terms of the extent to which the potential of the Polish human milk bank network was exploited to support vulnerable infants who were not breastfed. Results and discussion: Our findings indicate that recommendations to provide donor human milk to infants separated from their mothers during the COVID-19 pandemic were never fully implemented. Meanwhile, during the refugee crisis, national legislation allowing equal access to public healthcare for Ukrainian citizens were rapidly implemented, enabling a more effective response by human milk banks to support vulnerable infants. However, no specific measures were introduced to support refugees outside the standard criteria for donor human milk provision. Our results highlight the limited response from the sector during emergencies and the underutilization of the potential of a nationwide network of professional human milk banks. Drawing on Polish experiences, we emphasize the importance of having procedures and legal regulations regarding human milk banking in place even in non-crisis settings, which would facilitate a rapid emergency response. We also emphasize the need to include the implementation of emergency procedures in building a strong and resilient human milk banking system.

Infant feeding knowledge, attitudes and practices of HIV-positive breastfeeding mothers.

Background: Assessment of infant feeding knowledge, attitudes and practices of human immunodeficiency virus (HIV)-positive breastfeeding mothers may determine compliance with the chosen feeding method. Aim: The study assessed knowledge, attitudes and practices on infant feeding among HIV-positive breastfeeding mothers. Setting: The study was conducted at five clinics in the Chief Albert Luthuli sub-district of Mpumalanga, South Africa. Methods: A descriptive cross-sectional study with a convenient sample of 155 HIV-positive breastfeeding mothers. Results: More than half of the participants (54.8%) were knowledgeable of exclusive breastfeeding in general. However, less than half were knowledgeable of exclusive breastfeeding in the context of HIV (46.5%), mixed feeding (28.4%) and replacement feeding (49.0%). Most participants (85.8%) reported that they were advised to exclusively breastfeed for 6 months, 61.3% intended to exclusively breastfeed for 6 months, and 29% intended to stop breastfeeding at 6 months. Most participants (64.5%) intended to introduce solids at 6 months, and for participants who intended to introduce solids before 6 months, 37.7% did not believe that exclusive breastfeeding was sufficient for the baby. Conclusion: Although most participants were knowledgeable about exclusive breastfeeding, there were misconceptions that required attention such as the lack of knowledge on exclusive breastfeeding in the context of HIV, mixed feeding and replacement feeding. Exclusive breastfeeding for 6 months was the most emphasised infant feeding practice. Contribution: This study builds on existing literature on infant feeding knowledge, attitudes and practices and provides a basis for interventions for improved exclusive breastfeeding rates.