Abstract
B
To describe women's breastfeeding practices and to identify the factors associated with breastfeeding cessation (before 6 months) in China, we conducted a cross-sectional survey in the center of China (Beijing) and the east–south areas (Nanjing in Jiangsu Province and HeFei in Anhui Province), which have similar economic status as big cities. The questionnaire, with a participation information sheet, was distributed by researchers to mothers from December 2011 to June 2012 in the community clinics. After finishing the questionnaire by herself, the mother gave it back, and then the researcher interviewed her to collect more information about feeding practices. In total, 151 mothers completed the questionnaires and returned them, representing a response rate of 93.78%.
Only 25.2 percent of women (n=38) reported they breastfed exclusively when the baby was 6 months old. Thirty-six percent of babies (n=55) were breastfed within 1 hour of birth. Forty-three percent of babies were bottle-fed before their first breastfeeding (n=65). The average number of breastfeeding per day while the babies were in the hospital was 5.93 (SD 3.19; range, 0–14), and after they were discharged it was 7.19 times per day (SD 3.33; range, 0–20). Thirty-nine women (25.8%) reported that the most difficult time of maintaining exclusive breastfeeding was during the first 3 days after delivery, followed by the baby being 6 months old (n=21, 13.2%) and 4 months old (n=20, 13.2%).
Associations were found between exclusive breastfeeding rates and occupation status, baby's first sucking time, and number of baby's sucking times per day when back home (Table 1).
CI, confidence interval.
The findings of this study show that the rate of exclusive breastfeeding 6 months after childbirth among Chinese mothers was only 25.2%, and among the 113 women who gave the baby mixed feeding, the main reasons explored in this study were a perceived inadequate supply of milk (n=81, 71.7%) and the mother returning to work (n=19, 16.8%). Our findings suggest the most difficult time of maintaining exclusive breastfeeding was 0–3 days after delivery, followed by 6 month and 4 months after birth. The main problems women encountered when they breastfed were “do not know how to determine whether breastmilk was enough” (n=63, 41.7%), “breast tenderness/chapped” (n=47, 31.1%), and “the baby cannot fully latch onto the mother's nipples” (n=18, 11.9%). These findings are useful for those working in supporting mothers to breastfeed exclusively, particularly in relation to the approaches mothers implemented to overcome issues that they faced.
In this study, only 36.4% of babies (n=55) had initiated breastfeeding within 1 hour of birth, and 43.0% of babies had a bottle feeding before their first breastfeeding (n=65). These data indicate that there is much that should be done in the maternity ward to promote breastfeeding, such as early skin-to-skin contact between the mother and newborn, rooming-in, and not providing free formula samples for mothers. 2
According to the result of multivariate analysis, the times of sucking when the baby and mother went back home played an important role in exclusive breastfeeding practice. Ideally, the newborn should be nursed eight to 12 times per day during the first month. In this study, however, more than 50% of mothers breastfed their baby less than eight times per day. Therefore, caregivers should pay attention to this situation, which would be improved by education of mothers and their families.
Another important finding from this study was that the delivery mode did not impact breastfeeding initiation or success. This result differs from some other studies, which have suggested an association between cesarean delivery and lower rates of breastfeeding. 3 Evidence to support a link between the delivery mode and breastfeeding success is inconclusive. The question of whether cesarean birth influences breastfeeding is increasingly important, as cesarean birth now accounts for 46% of all deliveries in China, 4 and in this study the rate was 56%.
These study results imply that specific education aimed at new mothers should be carried out. Community healthcare providers should play a more important role in this issue, and family support should be encouraged by the health worker. Universal strategies to encourage initiation and longer duration of breastfeeding need to be established and implemented to achieve the World Health Organization recommendations.