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1.
Bull World Health Organ ; 98(6): 382-393, 2020 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-32514212

RESUMO

Objective: To develop a method to assess the cost of extending the duration of maternity leave for formally-employed women at the national level and apply it in Brazil, Ghana and Mexico. Methods: We adapted a World Bank costing method into a five-step method to estimate the costs of extending the length of maternity leave mandates. Our method used the unit cost of maternity leave based on working women's weekly wages; the number of additional weeks of maternity leave to be analysed for a given year; and the weighted population of women of reproductive and legal working age in a given country in that year. We weighted the population by the probability of having a baby that year among women in formal employment, according to individual characteristics. We applied nationally representative cross-sectional data from fertility, employment and population surveys to estimate the costs of maternity leave for mothers employed in the formal sector in Brazil, Ghana and Mexico for periods from 12 weeks up to 26 weeks, the WHO target for exclusive breastfeeding. Findings: We estimated that 640 742 women in Brazil, 33 869 in Ghana and 288 655 in Mexico would require formal maternity leave annually. The median weekly cost of extending maternity leave for formally working women was purchasing power parity international dollars (PPP$) 195.07 per woman in Brazil, PPP$ 109.68 in Ghana and PPP$ 168.83 in Mexico. Conclusion: Our costing method could facilitate evidence-based policy decisions across countries to improve maternity protection benefits and support breastfeeding.


Assuntos
Aleitamento Materno/economia , Licença Parental/economia , Mulheres Trabalhadoras , Brasil , Estudos Transversais , Feminino , Gana , Humanos , México , Modelos Econométricos , Fatores Socioeconômicos
2.
PLoS One ; 15(4): e0232316, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353021

RESUMO

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.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Modelos Estatísticos , Guias de Prática Clínica como Assunto , Adolescente , Adulto , Atitude Frente a Saúde , Aleitamento Materno/economia , Aleitamento Materno/etnologia , Cesárea/estatística & dados numéricos , Etiópia , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Cuidado Pós-Natal/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Educação Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos
3.
Arch Dis Child ; 105(2): 155-159, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31444210

RESUMO

OBJECTIVE: To provide the first estimate of the cost-effectiveness of financial incentive for breastfeeding intervention compared with usual care. DESIGN: Within-cluster ('ward'-level) randomised controlled trial cost-effectiveness analysis (trial registration number ISRCTN44898617). SETTING: Five local authority districts in the North of England. PARTICIPANTS: 5398 mother-infant dyads (intervention arm), 4612 mother-infant dyads (control arm). INTERVENTIONS: Offering a financial incentive (over a 6-month period) on breast feeding to women living in areas with low breastfeeding prevalence (<40% at 6-8 weeks). MAIN OUTCOME MEASURES: Babies breast fed (receiving breastmilk) at 6-8 weeks, and cost per additional baby breast fed. METHODS: Costs were compared with differences in area-level data on babies' breast fed in order to estimate a cost per additional baby breast fed and the quality-adjusted life year (QALY) gains required over the lifetime of babies to justify intervention cost. RESULTS: In the trial, the total cost of providing the intervention in 46 wards was £462 600, with an average cost per ward of £9989 and per baby of £91. At follow-up, area-level breastfeeding prevalence at 6-8 weeks was 31.7% (95% CI 29.4 to 34.0) in control areas and 37.9% (95% CI 35.0 to 40.8) in intervention areas. The adjusted difference between intervention and control was 5.7 percentage points (95% CI 2.7 to 8.6; p<0.001), resulting in 10 (95% CI 6 to 14) more additional babies breast fed in the intervention wards (39 vs 29). The cost per additional baby breast fed at 6-8 weeks was £974. At a cost per QALY threshold of £20 000 (recommended in England), an additional breastfed baby would need to show a QALY gain of 0.05 over their lifetime to justify the intervention cost. If decision makers are willing to pay £974 (or more) per additional baby breast fed at a QALY gain of 0.05, then this intervention could be cost-effective. Results were robust to sensitivity analyses. CONCLUSION: This study provides information to help inform public health guidance on breast feeding. To make the economic case unequivocal, evidence on the varied and long-term health benefits of breast feeding to both the baby and mother and the effectiveness of financial incentives for breastfeeding beyond 6-8 weeks is required.


Assuntos
Aleitamento Materno/economia , Análise Custo-Benefício , Motivação , Análise por Conglomerados , Inglaterra , Humanos , Lactente , Recém-Nascido , Estudos Prospectivos
4.
Am J Perinatol ; 37(1): 1-7, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31370065

RESUMO

OBJECTIVE: Our cost-effectiveness analysis investigated rooming-in versus not rooming-in to determine optimal management of neonates with neonatal opioid withdrawal (NOW). STUDY DESIGN: A decision-analytic model was constructed using TreeAge to compare rooming-in versus not rooming-in in a theoretical cohort of 23,200 newborns, the estimated annual number affected by NOW in the United States. Additional considerations included the effect of breast milk versus formula milk in evaluating the need for pharmacotherapy. Primary outcomes were needed for pharmacotherapy and neurodevelopment. We assumed a societal perspective in evaluating costs and maternal-neonatal quality-adjusted life years (QALYs) using a willingness-to-pay threshold of $100,000/QALY. Model inputs were derived from literature and varied in sensitivity analyses. RESULTS: Rooming-in resulted in fewer neonates requiring pharmacotherapy when compared with not rooming-in. The rooming-in group had more neonates with intact/mild neurodevelopmental impairment and fewer cases of moderate to severe impairment. Rooming-in resulted in cost savings of $509,652,728 and 12,333 additional QALYs per annual cohort. When the risk ratio of need for pharmacotherapy in rooming-in was varied across a clinically plausible range, rooming-in remained the cost-effective strategy. CONCLUSION: Maternal rooming-in with newborns affected by NOW leads to reduced costs and increased effectiveness. Management strategies should optimize nonpharmacological interventions as first-line treatment.


Assuntos
Aleitamento Materno/economia , Análise Custo-Benefício , Técnicas de Apoio para a Decisão , Síndrome de Abstinência Neonatal/economia , Berçários Hospitalares/economia , Alojamento Conjunto/economia , Estudos de Coortes , Redução de Custos , Feminino , Humanos , Incidência , Recém-Nascido , Modelos Econômicos , Síndrome de Abstinência Neonatal/epidemiologia , Anos de Vida Ajustados por Qualidade de Vida , Estados Unidos/epidemiologia
5.
Br J Nutr ; 122(s1): S16-S21, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31638500

RESUMO

The aim of this study was to assess the economic benefits of improved cognitive development related to being breast-fed. Breast-feeding rates were assessed in the Avon Longitudinal Study of Parents and Children. Educational attainment was assessed at age 16 years with higher attainment defined as gaining five General Certificate of Secondary Education (GCSE) passes at a high grade. The economic benefit of being breast-fed was calculated in a decision model using a child's educational attainment and the corresponding expected value of average income in later life. There was a positive association between being breast-fed and achieving higher educational attainment, which remained significant, after adjustment for possible confounders: being breast-fed <6 months yielded an OR of 1·30 (95 % CI 1·13, 1·51) and for ≥6 months yielded an OR of 1·72 (95 % CI 1·46, 2·05), compared with never breast-fed children. On the basis of UK income statistics, the present value of lifetime gross income was calculated to be £67 500 higher for children achieving 5 high-grade GCSE passes compared with not achieving this. Therefore, the economic benefit of being breast-fed <6 months would be £4208 and that for ≥6 months would be £8799/child. The model shows that the increased educational attainment associated with being breast-fed has a positive economic benefit for society, even from small improvements in breast-feeding rates. Within a total UK birth cohort of 800 000/year an increase by 1 % in breast-feeding rates would be worth >£33·6 million over the working life of the cohort. Therefore, breast-feeding promotion is likely to be highly cost-effective and policymakers should take this into consideration.


Assuntos
Aleitamento Materno/economia , Cognição/fisiologia , Escolaridade , Renda/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Análise Custo-Benefício/estatística & dados numéricos , Feminino , Humanos , Lactente , Fenômenos Fisiológicos da Nutrição do Lactente/fisiologia , Recém-Nascido , Estudos Longitudinais , Masculino , Reino Unido
6.
Health Place ; 59: 102125, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31400646

RESUMO

This paper compares experiences of breastfeeding outside the home for women living in low-income and high-income neighborhoods of the same city. Our findings are based on an analysis of 22 interviews with breastfeeding mothers (11 in each of two study areas) undertaken in Bristol, UK in 2017. We extend existing scholarship by showing how experiences of breastfeeding vary not only at the regional level but between local areas of the same city, and outline how our findings can inform policy. We advance literature on maternal bodies by exploring how local "landscapes" of breastfeeding emerge as mothers encounter and negotiate different socio-material landscapes and locally-differentiated norms about "appropriate" maternal embodiment. We argue that these variegated interactions can lead to different orientations to space and forms of spatial practice on the part of breastfeeding mothers, as well as different kinds of maternal identities.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Aleitamento Materno/economia , Inglaterra , Feminino , Humanos , Entrevistas como Assunto , Mães/psicologia , Mães/estatística & dados numéricos , Pobreza/psicologia , Pobreza/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Fatores Socioeconômicos
8.
Health Policy Plan ; 34(6): 407-417, 2019 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-31236559

RESUMO

Evidence shows that breastfeeding has many health, human capital and future economic benefits for young children, their mothers and countries. The new Cost of Not Breastfeeding tool, based on open access data, was developed to help policy-makers and advocates have information on the estimated human and economic costs of not breastfeeding at the country, regional and global levels. The results of the analysis using the tool show that 595 379 childhood deaths (6 to 59 months) from diarrhoea and pneumonia each year can be attributed to not breastfeeding according to global recommendations from WHO and UNICEF. It also estimates that 974 956 cases of childhood obesity can be attributed to not breastfeeding according to recommendations each year. For women, breastfeeding is estimated to have the potential to prevent 98 243 deaths from breast and ovarian cancers as well as type II diabetes each year. This level of avoidable morbidity and mortality translates into global health system treatment costs of US$1.1 billion annually. The economic losses of premature child and women's mortality are estimated to equal US$53.7 billion in future lost earnings each year. The largest component of economic losses, however, is the cognitive losses, which are estimated to equal US$285.4 billion annually. Aggregating these costs, the total global economic losses are estimated to be US$341.3 billion, or 0.70% of global gross national income. While the aim of the tool is to capture the majority of the costs, the estimates are likely to be conservative since economic costs of increased household caregiving time (mainly borne by women), and treatment costs related to other diseases attributable to not breastfeeding according to recommendations are not included in the analysis. This study illustrates the substantial costs of not breastfeeding, and potential economic benefits that could be generated by government and development partners' investments in scaling up effective breastfeeding promotion and support strategies.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/tendências , Análise Custo-Benefício , Saúde Global , Feminino , Humanos , Lactente , Mortalidade Infantil/tendências , Serviços de Saúde Materno-Infantil , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 98(23): e15841, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31169687

RESUMO

OBJECTIVE: The aim of the study was to determine whether exclusive breastfeeding or exclusive formula feeding is more cost-effective when a Canadian mother with HIV is adherent to antiretroviral therapy and has full virologic suppression. DESIGN: Current Canadian guidelines recommend that mothers with HIV practice exclusive formula feeding. This contradicts the updated World Health Organization (WHO) guidelines which recommend that mothers with HIV should breastfeed for ≥12 months while receiving support for antiretroviral therapy adherence. Due to the economic and health risks and benefits associated with each modality, there remains expert disagreement on whether the WHO recommendations should be adopted in high-income countries. METHODS: A microsimulation model was developed to estimate lifetime costs and effectiveness (i.e., infant's quality-adjusted life years) of a hypothetical group of 1,000,000 initially healthy, HIV-negative infants, if the mother with HIV was on antiretroviral therapy with full virologic suppression and either exclusive breastfeeding or exclusive formula feeding. The model was developed from the economic perspective of the Ontario Ministry of Health, taking into account direct costs associated with infant feeding modality as well as related indirect costs born out of the child's lifetime health outcomes. Uncertainties related to model parameters were evaluated using one-way and probabilistic sensitivity analyses. RESULTS: In comparison to exclusive formula feeding, exclusive breastfeeding was the dominant feeding modality (i.e., less costly and more effective) yielding cost-savings of $13,812 per additional quality-adjusted life year gained. Neither one-way nor probabilistic sensitivity analyses altered the conclusions. CONCLUSIONS: Despite the risk of HIV transmission, exclusive breastfeeding was more cost-effective than exclusive formula feeding. These findings merit review of current infant feeding guidelines for mothers with HIV living in high-income countries.


Assuntos
Antirretrovirais/uso terapêutico , Aleitamento Materno/economia , Fórmulas Infantis/economia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Mães , Resposta Viral Sustentada , Antirretrovirais/administração & dosagem , Canadá , Simulação por Computador , Análise Custo-Benefício , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Lactente , Recém-Nascido , Metanálise como Assunto , Modelos Econométricos , Gravidez , Complicações Infecciosas na Gravidez/tratamento farmacológico , Anos de Vida Ajustados por Qualidade de Vida , Literatura de Revisão como Assunto
10.
Int Breastfeed J ; 14: 19, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31086559

RESUMO

Background: The current situation of breastfeeding in China has been discussed in many articles, and a declining trend of breastfeeding duration has been confirmed. The associations between various socioeconomic, reproductive factors and breastfeeding duration have been discussed as well. However, there remains a lack of evidence on breastfeeding duration amongst different age groups. Methods: Data was extracted from the baseline of a large cohort study: a sample of 300,000 adult women born in the 1930s' through 1970s' from 10 geographically distinct regions was obtained. The breastfeeding duration was assumed by breastfeeding duration of the first child. Different age groups were categorized by 10-year age groups, and they were born in 1930-1938, 1939-1948, 1949-1958, 1959-1968, and 1969-1974. Multivariable linear regression was used to evaluate the associations between breastfeeding duration and sociodemographic, and reproductive factors (i.e.: different age groups, education, household size, use of oral contraceptive pills, age at menarche, and age at first birth). Results: The mean breastfeeding duration (Standard Deviation) of women born in 1930-1938, 1939-1948, 1949-1958, 1959-1968, and 1969-1974 were 15.4 (9.2), 14.8 (8.2), 14.7 (8.9), 12.8 (7.2), 13.1 (7.2) months, respectively. Younger age groups, higher levels of education, and use of oral contraceptive pills were negatively associated with breastfeeding duration. In particular, the negative association with higher levels of education (for urban regions: ßmiddle school = - 1.3, ßhigh school & above = - 1.6; for rural regions: ßmiddle school = - 0.6, ßhigh school & above = - 1.2; all p < 0.0001) was found significant in both rural and urban areas, household size (ß = - 0.1, p < 0.0001) and age at first birth (ß = - 0.2, p < 0.0001) were negatively associated with breastfeeding duration only in urban areas, but were all positively associated with breastfeeding duration in rural areas. Conclusions: This research demonstrated that, among Chinese women, younger age groups and higher levels of education were negatively associated with breastfeeding duration. Considering the declining trend of breastfeeding duration in China, healthcare providers need to continue advocating for breastfeeding practices. We also call for collaboration with various sectors and concerned groups to actions that promote breastfeeding-friendly environment and measures.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Adulto , Fatores Etários , Idoso , Aleitamento Materno/economia , China , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo , População Urbana/estatística & dados numéricos
11.
BMC Pediatr ; 19(1): 167, 2019 05 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133000

RESUMO

BACKGROUND: Socioeconomic status is an important factor affecting the initiation and cessation of breastfeeding. However, limited evidence exists regarding the association between socioeconomic status and breastfeeding behavior in China on a national level. This study aims to investigate the relationship between socioeconomic status and the initiation and duration of breastfeeding in China. METHODS: Data were collected from the China Family Panel Studies, a longitudinal nationwide household survey. A total of 2938 infants born between 2010 and 2014 were included in the study. The logistic regression model was used to investigate the relationship between socioeconomic status and the initiation of breastfeeding. Meanwhile, the Cox proportional hazards model was used to investigate the relationship between socioeconomic status and the risk of breastfeeding cessation. RESULTS: Overall, 90.5% of infants were breastfed, while the average duration of breastfeeding was 8.66 months in China. The breastfeeding continuance rate at 12 months declined sharply, to 30.1%. The study's findings also indicate that socioeconomic status did not significantly affect breastfeeding initiation. However, infants whose mothers had a high school or higher education and who scored 33-58 on the International Socio-Economic Index of Occupational Status (ISEI) were more likely to experience breastfeeding cessation, as were infants whose fathers had an ISEI score of 59-90. CONCLUSIONS: Efforts to promote breastfeeding practices should be conducted comprehensively to target mothers with a high school or higher education, mothers with a medium occupational status, and fathers with a high occupational status.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Classe Social , Aleitamento Materno/economia , Pai , Feminino , Humanos , Lactente , Modelos Logísticos , Estudos Longitudinais , Masculino , Mães , Fatores Socioeconômicos , Inquéritos e Questionários
12.
Breastfeed Med ; 14(6): 424-431, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31084434

RESUMO

Background: Breastfeeding rates among low-income children participating in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) lag behind national rates. In Los Angeles County (LAC), recent efforts have been made to increase the number of Baby-Friendly designated hospitals. This study examines changes in Baby-Friendly hospital practices, breastfeeding outcomes, and their relationships with Baby-Friendly hospital status among WIC-enrolled children in LAC. Methods: Cross-sectional data from the triennial LAC WIC Survey (2008 through 2017) were analyzed (n = 6,449) to examine changes in Baby-Friendly hospital practices over time, and differences in breastfeeding outcomes by specific Baby-Friendly hospital practices. Multivariate logistic regression was used to evaluate the relationship between the number of Baby-Friendly hospital practices that mothers met and any and exclusive breastfeeding outcomes. Results: In 2017, mothers surveyed were more likely to engage in Baby-Friendly hospital practices compared with 2008. Any and exclusive breastfeeding outcomes at 1 and 3 months significantly increased since 2014, and breastfed infants were more likely to have mothers who participated in Baby-Friendly hospital practices. The more Baby-Friendly hospital practices mothers met, the better the breastfeeding outcomes. However, there is room for improvement in the uptake of Baby-Friendly hospital practices in Baby-Friendly hospitals. Conclusion: Effort is needed to ensure Baby-Friendly hospitals have support to continuously comply with all steps to maintain Baby-Friendly designation, and non-Baby-Friendly hospitals have support to incorporate these practices into hospital protocols.


Assuntos
Aleitamento Materno/tendências , Assistência Alimentar , Promoção da Saúde/tendências , Hospitais/tendências , Cuidado Pós-Natal/tendências , Pobreza , Aleitamento Materno/economia , Pré-Escolar , Estudos Transversais , Feminino , Promoção da Saúde/métodos , Disparidades nos Níveis de Saúde , Inquéritos Epidemiológicos , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Los Angeles , Masculino , Avaliação de Resultados em Cuidados de Saúde , Cuidado Pós-Natal/métodos
13.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088893

RESUMO

BACKGROUND AND OBJECTIVES: Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines. METHODS: We performed purposive sampling of low-income Hispanic mothers (n = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached. RESULTS: Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies. CONCLUSIONS: Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.


Assuntos
Aleitamento Materno/economia , Abastecimento de Alimentos/economia , Hispano-Americanos , Mães , Obesidade Pediátrica/economia , Pobreza/economia , Adulto , Aleitamento Materno/tendências , Pré-Escolar , Feminino , Hospitais Públicos/economia , Hospitais Públicos/tendências , Humanos , Lactente , Masculino , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Pobreza/tendências , Gravidez
14.
Breastfeed Med ; 14(6): 375-381, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30994371

RESUMO

Background: Most women in the United States do not meet their breastfeeding goals, and low-income women breastfeed at lower rates than the general population. While risk factors for early cessation have been documented, specific reasons for discontinuing among this population are less understood. We examined reasons for cessation among low-income mothers to inform the development of targeted strategies to address breastfeeding disparities. Materials and Methods: We performed a secondary data analysis using prospective data collected during a randomized intervention trial of Special Supplemental Nutrition Program for Women, Infants, and Children (WIC)-eligible women interviewed in the third trimester and at 1, 3, and 6 months postpartum. We included the 221 women who initiated breastfeeding and stopped by 6 months. Women's reasons for discontinuing breastfeeding were grouped by thematic category and compared by time of breastfeeding cessation. Results: The most common reasons reported overall for breastfeeding cessation were concerns about breast milk supply and latch difficulty. Some reasons differed significantly by time of cessation. Latch difficulty was reported most often by women who breastfed for 1 month or less; supply concerns increased with increasing breastfeeding duration. Returning to work/school was uncommonly reported for those who stopped by 1 month, but more frequently reported in those with later cessation. Conclusions: We found that low-income women reported similar reasons for early breastfeeding cessation as have been reported for other populations of women. These results underscore the need for appropriately timed, culturally sensitive interventions to reduce disparities in duration of breastfeeding, specifically to address latch difficulty in the first few weeks and supply concerns as infants grow.


Assuntos
Aleitamento Materno/psicologia , Comportamentos Relacionados com a Saúde , Disparidades nos Níveis de Saúde , Pobreza/psicologia , Adulto , Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Estudos Longitudinais , Estudos Prospectivos , Apoio Social , Estados Unidos
15.
Am J Med ; 132(8): 912-920, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-30853481

RESUMO

Breastfeeding seems to be a low-cost intervention that provides both short- and long-term health benefits for the breastfeeding woman. Interventions to support breastfeeding can increase its rate, exclusivity, and duration. Internists often have a longitudinal relationship with their patients and can be important partners with obstetricians and pediatricians in advocating for breastfeeding. To play their unique and critical role in breastfeeding promotion, internists need to be knowledgeable about breastfeeding and its maternal health benefits. In this paper, we review the short- and long-term maternal health benefits of breastfeeding. We also discuss special considerations in the care of breastfeeding women for the internist.


Assuntos
Aleitamento Materno/tendências , Medicina Interna/educação , Aleitamento Materno/economia , Aleitamento Materno/métodos , Humanos , Medicina Interna/métodos , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Leite Humano/metabolismo , Leite Humano/microbiologia
16.
Int Breastfeed J ; 14: 10, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30792751

RESUMO

Background: In India, though breastfeeding is universally practiced, exclusive breastfeeding (EBF) rates in urban informal settlements are low; and health programs face several challenges in promoting EBF. In this study, ensconced in one program area of a non-government organization, we focused on "positive deviant"- mothers who were able to practice EBF for six months and attempted to delineate factors that shaped their EBF practices. Typically, qualitative research from Lower and Middle Income countries on EBF has focused on understanding why women do not practice EBF; the converse perspective taken in this study has been less explored. Methods: We employed the positive deviance approach which contends that important programmatic learnings can be attained from persons who adopt positive behaviours. We conducted twenty-five diverse, purposively sampled case-studies of "positive deviant" mothers from two urban informal settlements in Mumbai; and analysed these using a framework approach. The results were summarised using a socioecological framework (consisting of individual, interpersonal, organizational and environment levels). Results: We found that mothers typically construed EBF as not giving breastmilk substitutes. Giving the infant minor supplements (water, honey) was not considered a violation of the EBF practice. The main themes that emerged as influencers of EBF included: at individual level, perceptions of having adequate milk; at interpersonal level, having role models who practiced EBF and having family support; at organizational level, advice from health workers (which was purported to play a secondary role); and at environmental level, financial constraints that limited access to supplements. One important finding was that women who practiced EBF could not always do it optimally; we encountered several instances of "poor EBF" practices, where mothers had breastfed infants inconsistently, allowing for long gaps between feeds, and had continued EBF even after six months. Conclusions: There is an urgent need for health programs to clarify the meaning of EBF and counsel against "poor EBF" practices. Messages received by women from immediate family on EBF were powerful and families play an important role in the actualization of optimal EBF practices. Hence, it is imperative to counsel entire families on EBF rather than women alone.


Assuntos
Aleitamento Materno/psicologia , Leite Humano/metabolismo , Adolescente , Adulto , Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde , Humanos , Índia , Mães/psicologia , Percepção , Pesquisa Qualitativa , Adulto Jovem
17.
J Hum Lact ; 35(2): 340-348, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30508488

RESUMO

BACKGROUND: Breastfeeding provides health benefits for women and newborns. However, few studies have explored how these health benefits translate into economic savings. RESEARCH AIM: This study aimed to estimate the healthcare costs savings generated by exclusive breastfeeding for healthy newborns. METHODS: We designed a longitudinal two-group observational study that included healthy women and newborns ( N = 236) in Toledo, Spain. Over the first 6-months of the infants' lives, we reviewed their clinical histories to determine their consumption of healthcare resources and the type of nutrition provided. The sample was categorized into two groups: exclusive breastfeeding ( n = 46) and non-exclusive breastfeeding for 6 months ( n = 190). Two-part regression models were applied to determine whether there were differences in healthcare costs between the groups. RESULTS: The average age of the women was 32 ( SD: 5.3). The average birth weight of the newborns was 3.3 kg. ( SD: 0.38). At 6 months, 19.5% ( n = 46) of the women breastfed exclusively, 28.4% ( n = 67) combined breastfeeding with formula, and 45.8% ( n = 108) used formula only. Healthcare costs during follow-up reached €785.58 (44% for specialized care, 42% for primary care, 9.8% for medical emergencies, 3% for medications and approximately 1% for medical tests). The statistical analysis estimated a lower healthcare cost of between €454.40 and €503.50 for exclusively breastfed newborns. CONCLUSION: Breastfeeding generated savings in healthcare costs; therefore, it could be a cost-efficient option compared with alternatives. Researchers who evaluate the efficiency of strategies that promote breastfeeding can contribute to the sustainability of health services.


Assuntos
Aleitamento Materno/estatística & dados numéricos , Custos de Cuidados de Saúde/estatística & dados numéricos , Fórmulas Infantis/economia , Fórmulas Infantis/estatística & dados numéricos , Adulto , Aleitamento Materno/economia , Feminino , Promoção da Saúde/organização & administração , Humanos , Recém-Nascido , Estudos Longitudinais , Fatores Socioeconômicos , Espanha , Adulto Jovem
18.
Matern Child Nutr ; 15(2): e12745, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30381867

RESUMO

Improving breastfeeding outcomes is a global priority; however, in the United Kingdom, continuation of breastfeeding remains low. Growing empirical evidence suggests a free breast pump service might be an acceptable and feasible incentive intervention to improve breastfeeding outcomes and reduce heath inequalities. To inform intervention development, we conducted an online survey with women recruited via social media using snowball sampling. Data were analysed descriptively (closed questions) with qualitative thematic analysis (free text). The survey was completed by 666 women, most of whom had recently breastfed and used a breast pump. Participants agreed that free pump hire (rental/loan; 567 women; 85.1%) or a free pump to keep (408; 61.3%) should be provided. Free text comments provided by 408 women (free pump) and 309 women (free hire) highlighted potential benefits: helping women to continue breastfeeding; express milk; overcome difficulties; and pump choice. Concerns are possible effect on breast milk supply, reduced breastfeeding, pumps replacing good support for breastfeeding, and pump hire hygiene. Personal and societal costs are important issues. Some suggested a pump service should be for low-income mothers, those with feeding difficulties or sick/preterm infants. A one-size service would not suit all and vouchers were proposed. Some suggested fees and deposits to prevent waste. To our knowledge, this is the first study reporting views about the acceptability of providing a free breast pump hire service. Mothers support and wish to have a say in breast pump service development. Future evaluations should address impact on feeding outcomes, professional support, hygiene for hired pumps, and costs.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Leite Humano , Mães/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto , Feminino , Humanos , Pessoa de Meia-Idade , Reino Unido , Adulto Jovem
19.
Breastfeed Med ; 13(8): 532-534, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335485

RESUMO

In recent years, there has been renewed attention to the central role that clinicians and healthcare institutions can play to support women in initiating and sustaining breastfeeding through the first year of their infant's life. There has been, however, considerably less focus on how to support the breastfeeding needs of new mothers who return to work, particularly those who go back shortly after the birth of their infant. While many women intend to continue breastfeeding when they go back to work, about one-third report breastfeeding as a major challenge. For many women, the lack of paid family leave, limited flexibility with their work hours, and workplaces that offer few accommodations can make it especially hard for them to sustain breastfeeding. The Affordable Care Act (ACA) included many provisions that strengthened coverage for pregnant women and new mothers. In addition to coverage improvements, The ACA amended the Fair Labor Standards Act to require employers with 50 or more workers to provide reasonable break time and a private space that is not a bathroom for expressing milk. For women who breastfeed or who must express milk while they work, having health insurance benefits and Medicaid policies that cover the costs of lactation supplies and support services can make a difference in the decision to continue to provide their infants with breast milk through the first year of their lives and ultimately improve both maternal and infant outcomes in the long run.


Assuntos
Aleitamento Materno/economia , Política de Saúde , Cobertura do Seguro , Mulheres Trabalhadoras , Local de Trabalho/legislação & jurisprudência , Feminino , Humanos , Medicaid/economia , Patient Protection and Affordable Care Act/economia , Apoio Social , Estados Unidos
20.
Breastfeed Med ; 13(8): 544-548, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30335490

RESUMO

Breastfeeding rates in the United States continue to rise, but still fall short of goals for both initiation and continuation. Many different maternal demographic characteristics have been identified as risk factors for not breastfeeding, but the literature remains inconsistent. National and even state-level data may not reflect patterns seen at the local level. Clinicians and breastfeeding advocates should be aware of the general trends, but should more importantly become familiar with the predominant risk patterns in their local area and populations. This presentation for the Breastfeeding Summit reports on our findings regarding the influence of race and economic status on breastfeeding behavior among women in inner city Philadelphia, and makes a case for advocates and clinicians to explore these trends in their own, local populations.


Assuntos
Aleitamento Materno/economia , Aleitamento Materno/etnologia , Status Econômico/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Aleitamento Materno/estatística & dados numéricos , Feminino , Humanos , Philadelphia , Fatores de Risco , Meio Social
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