Advice to use infant formula and free samples are common in both urban and rural areas in China: a cross-sectional survey.

OBJECTIVE: To examine the association between the place of residence and receiving free samples and advice to feed the baby with infant formula. DESIGN: A cross-sectional study. SETTING: The current study covered twelve counties/districts in China. PARTICIPANTS: 5112 mothers with infants aged 0-5·9 months. RESULTS: About 16 % of the mothers received free samples of infant formula. During pregnancy, this likelihood was higher among mothers in small and medium cities (OR: 1·96; 95 % CI 1·14, 3·38) and non-poor rural counties (OR: 4·65; 95 % CI 1·65, 13·14) compared with mothers in big cities. During the hospital stay, it was lower in big cities. After discharge, it was lower in poor rural counties (OR: 0·14; 95 % CI 0·05, 0·41). About 26 % of the mothers were advised to feed their infants with infant formula. The likelihood of receiving advice to feed the baby with infant formula from hospitals was lower in non-poor (OR: 0·37; 95 % CI 0·21, 0·66) and poor rural counties (OR: 0·35; 95 % CI 0·13, 0·91) than in big cities. Mothers in non-poor rural counties were less likely to receive advice from traditional mass media (OR: 0·17; 95 % CI 0·06, 0·48), while mothers in small and medium cities were more likely to receive advice from modern mass media (OR: 1·84; 95 % CI 1·20, 2·80) compared with mothers in big cities. CONCLUSIONS: The promotion strategy of infant formula varies from different places of residence in China. The study suggests the need to strengthen enforcement of relevant regulations, especially within health facilities and through modern mass media.

Volunteers' experiences of providing telephone-based breast-feeding peer support in the RUBY randomised controlled trial.

OBJECTIVE: The Ringing Up About Breastfeeding earlY (RUBY) randomised controlled trial (RCT) found that a telephone-based peer volunteer support intervention increased breast-feeding duration in a setting with high breast-feeding initiation. This sub-study of the RUBY RCT describes the motivation, preparation and experiences of volunteers who provided the peer support intervention. DESIGN: An online survey was completed by 154 (67 %) volunteers after ceasing volunteering. SETTING: Volunteers provided peer support to primiparous women (n 574) who birthed at one of three public hospitals in Melbourne, Australia, between February 2013 and December 2015. PARTICIPANTS: Volunteers (n 230) had themselves breastfed for at least 6 months and received 4 h of training for the role. RESULTS: The median number of mothers supported was two (range 1-11), and two-thirds of respondents supported at least one mother for 6 months. Volunteers were motivated by a strong desire to support new mothers to establish and continue breast-feeding. Most (93 %) considered the training session adequate. The majority (60 %) reported following the call schedule 'most of the time', but many commented that 'it depends on the mother'. Overall, 84 % of volunteers were satisfied with the role and reported that the experience was enjoyable (85 %) and worthwhile (90 %). Volunteers agreed that telephone support for breast-feeding was valued by women (88 %) and that the programme would be effective in helping women to breastfeed (93 %). CONCLUSIONS: These findings are important for those developing similar peer support programmes in which recruiting volunteers and developing training requirements are an integral and recurrent part of volunteer management.

Does cultural context make a difference to women's experiences of maternity care? A qualitative study comparing the perspectives of breast-feeding women of Bangladeshi origin and health practitioners.

BACKGROUND: Maternity services struggle to provide culturally appropriate care that meets the needs of women from diverse populations. Problems include simplistic understandings of ethnicity and the role of culture in women's lives, and stereotypes held by health practitioners. OBJECTIVE: To explore the extent to which cultural context makes a difference to experiences of breast-feeding support for women of Bangladeshi origin and to consider the implications for the provision of culturally appropriate care. METHODS: The study comprised individual interviews with 23 women of Bangladeshi origin and four health service managers, and focus group discussions with 28 health practitioners between February and December 2008. Participants were recruited from four localities in northern England. RESULTS: Women's rich descriptions of various facets of their identities were in contrast to practitioners' representations of women of Bangladeshi origin as homogenous. Practitioners did not recognize when the needs of women of Bangladeshi origin were similar to those of the majority white population, or where cultural context made a difference to their experiences of breast-feeding and breast-feeding support. Some practitioners used cultural stereotypes which, combined with organizational constraints, resulted in services not meeting many of the women's needs. CONCLUSIONS: Implications for education, policy and practice include the need for training of health practitioners to work with diverse populations, implementing evidence-based practice and providing an organizational context which supports practitioners to respond to diversity without using cultural stereotypes.

Barriers and Opportunities for Improved Exclusive Breast-Feeding Practices in Tanzania: Household Trials With Mothers and Fathers.

BACKGROUND: Effective promotion of exclusive breast-feeding (EBF) is needed to improve child nutrition and survival. OBJECTIVE: We explored barriers and facilitators to EBF in rural Tanzania and assessed parents' willingness and ability to try specific recommended EBF practices plus strategies for men to support breast-feeding. METHODS: We conducted Trials of Improved Practices in 36 households with infants <6 months. Fathers participated in focus group discussions on ways to support breast-feeding. Fathers and mothers were individually interviewed 2 and 3 times, respectively, about their willingness to try and experience with selected new practices. We analyzed data thematically. RESULTS: Common barriers to EBF were (1) use of gripe water and traditional medicines for perceived symptoms of infantile distress; (2) mothers' workloads and time away from infants, limiting availability for EBF; and (3) water given for perceived thirst. Although several mothers expressed concerns about breast-milk insufficiency, few were giving other foods. After counseling, most mothers reported breast-feeding more optimally. Some reported improved breast-milk supply. Fathers saw their roles as providing food to mothers to ensure sufficient breast-milk and encouraging new practices. Dominant gender roles and work away from home were barriers even if fathers were willing to help with household chores. Fathers mostly provided emotional support or encouraged others to help with chores. CONCLUSION: Exclusive breast-feeding promotion needs to address concerns about infantile distress and help parents develop effective soothing techniques while avoiding nonprescribed medicines. Engaging men in EBF interventions could help change social norms and facilitate men's involvement in improving breast-feeding practices.

Childcare workers' experiences of supporting exclusive breastfeeding in Kuala Muda District, Malaysia: a qualitative study.

BACKGROUND: The role of childcare workers at registered nurseries in supporting exclusive breastfeeding practice is important, as many newborn babies are placed in nurseries during working hours. To increase exclusive breastfeeding rates among working mothers, understanding childcare workers' experiences and needs relating to supporting these mothers is crucial. This study aimed to explore childcare workers' experiences of supporting breastfeeding at registered nurseries. METHODS: We used a qualitative design to conduct in-depth, semi-structured interviews with ten childcare workers at seven registered nursery centres in Kuala Muda District, Malaysia. Attitudes towards exclusive breastfeeding practice, experiences of breastfeeding training and information, and experiences supporting exclusive breastfeeding at the nursery were explored. Participants were asked to suggest improvements for exclusive breastfeeding practice at their nursery. All interviews were audio recorded, transcribed verbatim, and translated before analysis. RESULTS: All participants demonstrated a positive attitude in supporting and promoting exclusive breastfeeding practice, mainly centred on the advantages of breastfeeding. Various supports have been found such as labelling bottled breastmilk, allowing the mother to come to the nursery during breaks, and providing reading materials. However, several issues emerged that include parents' choice on infant feeding practice, insufficient content on breastfeeding topics during training, and adherence to the (not recommended) practice of bottle feeding expressed breastmilk. Recommendations to enhance breastfeeding were also suggested by participants. CONCLUSION: Childcare workers may serve as another potential resource for sustaining exclusive breastfeeding at registered nurseries.

'Oh no, no, no, we haven׳t got time to be doing that': Challenges encountered introducing a breast-feeding support intervention on a postnatal ward.

OBJECTIVE: to identify elements in the environment of a postnatal ward which impacted on the introduction of a breast-feeding support intervention. DESIGN: a concurrent, realist evaluation including practice observations and semi-structured interviews. SETTING: a typical British maternity ward. PARTICIPANTS: five midwives and two maternity support workers were observed. Seven midwives and three maternity support workers were interviewed. Informed consent was obtained from all participants. Ethical approval was granted by the relevant authorities. FINDINGS: a high level of non-compliance with the intervention was driven by a lack of time and staff, and the ward staffs׳ lack of control of the organisation of their time and space. This was compounded by a propensity towards task orientation, workload reduction and resistance to change - all of which supported the existing medical approach to care. Limited support for the intervention was underpinned by staff willingness to reconsider their views and a widespread frustration with current ways of working. KEY CONCLUSIONS: this small, local study suggests that the environment and working conditions on a typical British postnatal ward present significant barriers to the introduction of breast-feeding support interventions requiring a relational approach to care. IMPLICATIONS FOR PRACTICE: midwives and maternity support workers need to be able to control their time and space, and feel able to provide the relational care they perceive that women need, before breast-feeding support interventions can be successfully implemented in practice. Frustration with current ways of working, and a willingness to consider other approaches, could be harnessed to initiate change that would benefit health professionals and the women and families in their care. However, without appropriate leadership or facilitation for change, this could alternatively encourage learned helplessness and passive resistance.

Developing a workplace breast feeding support model for employed lactating mothers.

Resuming work is often considered an obstacle for continued breast feeding. The objectives of this participatory action research study were to develop a breast feeding support model in the workplace and to compare breast feeding rates before and after implementation of the breast feeding support campaign. Twenty-four women participated before the implementation of the breast feeding support campaign, whereas 31 women participated after the campaign. Data were collected by interviewing employed women about their breast feeding practices within six months post partum. Additional data were collected through interviews with the workplace administrator and head of work sections as well as observation of the breast feeding support campaigns. Qualitative data were analysed using thematic analysis, whereas quantitative data were analysed using descriptive statistics and χ(2) test. The workplace breast feeding support model was developed based on the concept of Mother-Friendly Workplace Initiatives by the World Alliance for Breastfeeding Action (WABA) and the Thai government׳s promotion of a workplace breast feeding corner. Within this model, a committee for breast feeding support was created for working with the research team to develop breast feeding activities and media for breast feeding education and breast feeding support campaigns in the workplace. Breast feeding rates at six months after implementation of the breast feeding support campaign were significantly higher than rates before, both for exclusive breast feeding and any breast feeding at levels .004 and .033, respectively. These results suggest that breast feeding should be encouraged in every workplace depending on context. Individual advice and help for employed mothers should be provided from pregnancy through weaning in the postpartum period.