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Einleitung: Im Jahr 2021 wurden in Österreich 86078 Kinder lebend geboren. Die Stillprävalenz liegt in Österreich in der ersten Lebenswoche bei 97,5% und sinkt im Laufe des ersten Lebensjahres. Die ausschließliche Stillrate in Österreich liegt in der ersten Lebenswoche bei 55,5%, nach sechs Monaten bei 1,9%. Die europäische WHO-Region hat mit 13% die niedrigste exklusive Stillrate weltweit. Das globale Ziel der WHO für 2025 ist es, die exklusive Stillrate auf mindestens 50% in den ersten sechs Lebensmonaten zu heben. Multivariate Analysen deuten drauf hin, dass folgende mögliche Einflussfaktoren für die Stilldauer in Österreich statistisch relevant sind: Alter, Bundesland, BMI der Mutter, Lebensstilfaktoren wie Rauchen und die Stillunterstützung. Von diesen Einflussfaktoren lassen sich einige in die Kategorie der soziokulturellen Faktoren einteilen. Ziel dieser Arbeit ist es, soziokulturelle stillbeeinflussende Faktoren anhand der interaktiven Theorie des Stillens zu beschreiben. Methode: Für diese Arbeit wurde eine systematische Literaturrecherche durchgeführt. Anschließend wurden die Studien nach Brandenburg, Panfil und Mayr beurteilt und die Studien nach dem Kodierparadigma von Strauss interpretiert. Ergebnisse: Insgesamt wurden 15 Studien für die Synthese eingeschlossen. Es konnte aufgezeigt werden, dass die Rückkehr zum Arbeitsplatz, das Selbstbewusstsein der Mutter und die negativen Emotionen bezüglich des Stillens die Mutterrolle beeinflussen. Selbstbewusstsein, Körperbewusstsein, Sexismus und negative Emotionen beeinflussen das Körperbild der stillenden Frau. Die Umgebung für das Stillen wird beschrieben für die Bereiche Öffentlichkeit, Arbeitsplatz, Geburtenstation und familiäres Umfeld. Die Legislation, die Arbeitsplatzrichtlinien, das Gesundheitspersonal, die Richtlinien für Selbsthilfegruppen, die Entsexualisierung der Brüste und die Sprache stellen die organisatorischen Systeme für den Schutz, die Förderung und die Unterstützung des Stillens dar. Diskussion: Die erarbeiteten Ergebnisse lassen sich auf Österreich nur schwer umlegen, da die eingeschlossenen Studien kaum Aspekte aus dem europäischen Raum beschreiben. Eine Forcierung von Forschungen im europäischen Raum ist notwendig. Eine breite quantitative Erhebung könnte die qualitative Forschung bestätigen. Introduction: In 2021, 86078 children were born alive in Austria. The breastfeeding prevalence in Austria is 97.5% in the first week of life and decreases over the course of the first year of life. The exclusive breastfeeding rate in Austria is 55.5% in the first week of life and 1.9% after six months. At 13%, the European WHO region has the lowest exclusive breastfeeding rate in the world. The WHO global goal for 2025 is to increase the exclusive breastfeeding rate to at least 50% in the first six months of life. Multivariate analyzes indicate that the following possible influencing factors for breastfeeding duration in Austria are statistically relevant: age, state, mother’s BMI, lifestyle factors such as smoking, and breastfeeding support. Some of these influencing factors fall into the category of sociocultural factors. The aim of this work is to describe sociocultural factors influencing breastfeeding using the interactive theory of breastfeeding. Method: A systematic literature search was carried out for this work. The studies were then assessed according to Brandenburg, Panfil and Mayr and the studies interpreted according to Strauss' coding paradigm. Results: A total of 15 studies were included for the synthesis. Returning to work, mother’s self-esteem and negative emotions related to breastfeeding have been shown to influence the mother’s role. Self-confidence, sexism, and negative emotions affect the breastfeeding woman’s body image. The space for breastfeeding is described for the public, workplace, maternity ward, and family environment. Legislation, workplace policies, health care providers, peer group policies, breast desexualization, and language represent the organizational systems for the protection, promotion, and support of breastfeeding. Discussion: The results obtained are difficult to extrapolate to Austria, since the included studies hardly describe aspects from the European area. A promotion of research in Europe is necessary. A broad quantitative survey could confirm the qualitative research.

Objectives Persistent disparities in breastfeeding rates among African American (AA) women compared to other population groups have motivated researchers to understand factors influencing breastfeeding choices using a variety of methods. Quantitative surveys are more commonly reported, however, qualitative work that amplifies voices of AA women is limited. Methods Participants were recruited from a randomized controlled feasibility trial focused on breastfeeding support for AA women in Detroit, MI. Thirteen women were enrolled in the qualitative portion of the study described here. Using the Socioecological model (SEM) as the theoretical foundation, semi-structured qualitative interviews were conducted to explore perceived facilitators and barriers to breastfeeding. Interviews were digitally recorded, transcribed, and analyzed using Theoretical thematic analysis. Results Women reported factors ranging from micro to macro SEM levels that discouraged or reinforced breastfeeding. Key challenges included breastfeeding-related discouragement issues, including factors that decreased confidence and led women to terminate breastfeeding (e.g., problems with latching, pumping, lack of comfort with breastfeeding in public, and work constraints). Facilitators included perceived mother and infant benefits, perseverance/commitment/self-motivation, pumping ability, and social support. Participant suggestions for expanding breastfeeding promotion and support included: (1) tangible, immediate, and proactive support; (2) positive non-judgmental support; (3) "milk supply" and "use of pump" education; and (4) self-motivation/willpower/perseverance. Conclusions for practice Despite the identification of common facilitators, findings reveal AA women face many obstacles to meeting breastfeeding recommendations. Collaborative discussions between women and healthcare providers focused on suggestions provided by AA women should be encouraged.

Background:The common feeding problems in infants with Cleft Palate (CP) and/or Cleft Lip and Palate (CLP) are the inability to suck and swallow breastmilk. Difficulties in feeding may compromise normal growth and disrupt the bonding process.Objective:To evaluate the treatment and breastfeeding rate in infants with CP and CLP.Methods:A retrospective study of infants with CP and CLP who were admitted to the postpartum ward between July 2017 and June 2019 was conducted. Demographic data, type of feeding, nursing activities, and duration of breastfeeding after discharge were collected.Results:A total of 35 infants were included in the study. Twenty-seven cases were non-syndromic complete CLP (77.2%). On admission only 15 infants (42.8%) received breastmilk and alternative feeding techniques were applied for 26 (74.3%) infants. Breastfeeding promotion and nursing care were provided to mothers and infants by an interdisciplinary team at the Craniofacial Center. The median Length of Stay (LOS) was 8 days (range 5-9 days) and infants born at the affiliated hospital (inborn) had a significantly shorter LOS compared to infants referred from other health centers (p=0.019). None of the inborn groups received infant formula. The breastfeeding rate in all groups was 100% at discharge. Exclusive breastfeeding rates at 2-, 4-, and 6-months follow-up were 82.8%, 42.8%, and 31.4%, respectively.Conclusion:Breastfeeding promotion, education, and nursing care from an interdisciplinary team resulted in an improved ability of mothers to breastfeed infants with CLP, particularly in non-syndromic CLP. The exclusive breastfeeding rate after 6-months in this study was higher than in previous studies.

Background The prevalence of exclusive breastfeeding (EBF) is suboptimal in China. There is limited evidence of effective interventions to increase EBF in China. Therefore, it is urgent to explore the potential factors that may be effective in promoting exclusive breastfeeding. Previous studies have mainly focused on socio-demographic factors and the Han ethnic group. This study explores more modifiable influencing factors of EBF in the Guangxi Zhuang Autonomous Region of China. Methods The cross-sectional data used in this study were collected to provide baseline information on EBF prevalence for a breastfeeding promotion project. A total of 494 mothers of infants aged 0–5 months were recruited from nine community health centres in Nanning, China, in October 2019. Data were collected through face-to-face interviews using structured questionnaires. Infant feeding was measured by 24-h recall. The Chinese version of the Breastfeeding Self-Efficacy Scale–Short Form was used to examine the maternal breastfeeding self-efficacy. Univariate and multivariate logistic regressions were used to examine the factors associated with EBF practices. Results In the present study, the prevalence of exclusive breastfeeding was 37.0%. Higher breastfeeding self-efficacy scores (adjusted odds ratio [AOR] 1.93; 95% confidence interval [CI] 1.25, 2.98), a college degree or above (AOR 2.15; 95% CI 1.24, 3.71), and early initiation of breastfeeding (AOR 2.06; 95% CI 1.29, 3.29) were positively associated with EBF practice. However, the preparation for infant formula before childbirth (AOR 0.30; 95% CI 0.17, 0.52) and premature birth (AOR 0.30; 95% CI 0.10, 0.87) were negatively associated with EBF practice. Conclusions Exclusive breastfeeding practice was suboptimal and associated with various factors in the study area. The prevalence of EBF was positively associated with higher breastfeeding self-efficacy, education level of mothers, and early initiation of breastfeeding, whereas premature birth and preparation for infant formula before childbirth were barriers to exclusive breastfeeding. Future intervention projects should target mothers with premature babies, lower levels of education, and breastfeeding self-efficacy. Breastfeeding-friendly practices, such as the early initiation of breastfeeding and regulations on breastmilk substitutes, should also be encouraged.

Objective: Breastfeeding is a cost-effective and evidence-based public health intervention for the control of childhood malnutrition and its consequences. Partners’ support and attitude towards breastfeeding is an important determinant of breastfeeding initiation, continuity, and outcome. This study assessed the perception of breastfeeding and its support among male students in Sagamu, Nigeria. Method: A cross-sectional study was carried out among 300 male undergraduate students in Sagamu, selected via systematic sampling. Data were collected with the aid of a structured, self-administered questionnaire and analyzed using SPSS 21.0, with results presented as frequencies and proportions. Result: The mean age of respondents was 20±3.5 years. All respondents felt it was important for women to breastfeed their infants; 42% of respondents felt breastfeeding interfered with work; 20% felt women should be entitled to paid maternity leave; 85% will support efforts to promote breastfeeding in public; 95% will encourage their partners to breastfeed while working outside the home; 92% will assist their breastfeeding partners with household chores. Conclusion: Respondents had a good perception of breastfeeding and were willing to support its practice at home, work, and in the community. Adequate engagement of men in nutrition education activities will be most effective in promoting and protecting breastfeeding.

Background: Exclusive breastfeeding provides numerous benefits to the health of infants, mothers, economics, and the environment. However, during the exclusive breastfeeding period, the mothers face many barriers. Objective: This study aimed to describe the perceived barrier of breastfeeding and compare its differences among mothers in Vietnam according to demographic and individual characteristics. Methods: A cross-sectional study was conducted among 246 women in Ho Chi Minh City, Vietnam. Data were derived from the original survey using a self-administered questionnaire asking about the barriers of breastfeeding in three aspects: maternal, infant, and socio-environment. Descriptive statistics, Independent t-test, and ANOVA were used to describe the mothers’ characteristics and the breastfeeding barriers. Results: The barrier from the infants was the most noticeable, followed by socio-environment and maternal barriers, respectively. Breastfeeding in public places (M = 2.93, SD = 0.92), baby’s illness (M = 2.74, SD = 0.99), and insufficient milk supply (M = 2.70, SD =0.99) were considered as major barriers to six-month exclusive breastfeeding among mothers in Ho Chi Minh City, Vietnam. Among the age groups, mothers who were more than 35 years old perceived had lower breastfeeding barriers than the younger mothers (F = 3.67, p = 0.03). Conclusion: The investigation of the barriers against exclusive breastfeeding practice can help nurses and midwives develop breastfeeding promotion programs to promote exclusive breastfeeding rate for women in Vietnam. Funding: This study was funded by the University of Medicine and Pharmacy at Ho Chi Minh City, Vietnam.

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

Background Exclusive breastfeeding (EBF) through six months of age has been scientifically validated as having a wide range of benefits, but remains infrequent in many countries. The WHO/UNICEF Baby-Friendly Hospital Initiative (BFHI) is one approach to improve EBF rates. Methods This study documents the implementation of BFHI at Clemenceau Medical Center (CMC), a private hospital in Lebanon, and analyzes data on EBF practices among CMC’s patients before, during, and after the implementation period. The process of launching the BFHI at CMC is discussed from the perspective of key stakeholders using the SQUIRE guidelines for reporting on quality improvement initiatives. As an objective measure of the program’s impact, 2,002 live births from July 2015 to February 2018 were included in an interrupted time series analysis measuring the rates of EBF at discharge prior to, during, and following the bundle of BFHI interventions. Results The steps necessary to bring CMC in line with the BFHI standards were implemented during the period between November 2015 and February 2016. These steps can be grouped into three phases: updates to hospital policies and infrastructure (Phase 1); changes to healthcare staff practices (Phase 2); and improvements in patient education (Phase 3). The baseline percentage of EBF was 2.4 % of all live births. Following the BFHI intervention, the observed monthly change in EBF in the “Follow-Up” period (i.e., the 24 months following Phases 1–3) was significantly increased relative to the baseline period (+ 2.0 % points per month, p = 0.006). Overall, the observed rate of EBF at hospital discharge increased from 2.4 to 49.0 % of all live births from the first to the final month of recorded data. Conclusions Meeting the BFHI standards is a complex process for a health facility, requiring changes to policies, practices, and infrastructure. Despite many challenges, the results of the interrupted time series analysis indicate that the BFHI reforms were successful in increasing the EBF rate among CMC’s patients and sustaining that rate over time. These results further support the importance of the hospital environment and health provider practices in breastfeeding promotion, ultimately improving the health, growth, and development of newborns.

Purpose Despite the health benefits of full breastfeeding for both infants and mothers, less than 50% of mothers in Germany practice this method for at least 4 months after childbirth. Because of the growing importance of health literacy to improve public health, we investigated the role of maternal health literacy in breastfeeding behavior. Methods We analyzed the data of 1172 mother–child dyads of the KUNO-Kids health study of the University Children’s and Maternity Hospital Regensburg. Maternal health literacy was assessed with the HLS-EU-Q47 questionnaire (sub-index health care) up to 48 h after childbirth. Outcome was analyzed 6 months after childbirth and categorized into full breastfeeding for less than 4 months or for at least 4 months. The association between breastfeeding and maternal health literacy was calculated with univariable and multivariable logistic regression analyses. Results 38.8% of mothers showed inadequate or limited health literacy. 75.9% of mothers had fully breastfed their child for at least 4 months. Univariable logistic regression analysis showed that health literacy and full breastfeeding for at least 4 months were not associated (OR = 0.995 [CI 0.977–1.015], p = 0.60). After adjusting for all potentially confounding variables with a significant association (p ≤ 0.05) on both health literacy and breastfeeding, the multivariable model showed no association between health literacy and breastfeeding (OR = 0.984 [CI 0.963–1.007], p = 0.170). Conclusion Surprisingly, we found no association between health literacy and breastfeeding behavior in our study. Therefore, future research with comparable measurements of health literacy and breastfeeding is required to validate this result and to identify reasons for early breastfeeding cessation.

Background Improper complementary feeding practices are common in India, thus leading to malnutrition. The objective was to compare complementary feeding practices of mothers with children aged between 6 months and 2 years before and after individualized nutritional counseling. Methods This before-and-after interventional study was carried out in a tertiary care teaching hospital between June 2018 and August 2018 on 30 mothers attending an immunization clinic. Feeding practices were assessed using interview techniques with the Breastfeeding Promotion Network of India Maharashtra checklist for Complementary Food Counseling (Diet Audit), and scoring was carried out. Baseline data included history of inclusion of items from food groups such as cereals; pulses; vitamins A, C, and D; vegetables/fruits; milk/dairy products; non-vegetarian items; and iron-rich foods; and consumption of baby feeds and junk foods. Individualized counseling was given to all study subjects, which lasted for 30–40 min. Models of various food items were shown to mothers. Feeding practices were reassessed after 4 weeks of one-to-one counseling. Results Feeding by mothers improved significantly in the form of items from the total number of groups from 4.3 (1.4) to 5.6 (1.3) after nutritional counseling (p: 0.001). Consumption of junk foods decreased significantly from 4.3 (2.8) to 2.6 (1.8; p: 0.001) and baby foods decreased from 0.8 (0.7) to 0.2 (0.4; p: 0.001). Conclusion Individualized nutritional counseling of mothers can improve complementary feeding practices and ensure food diversification.

BACKGROUND: The percentage of exclusive breastfeeding for infants 0–6 months in Aceh in 2019 was 55.24% and decreased compared to 2018, 60.84%. Exclusive breastfeeding in Aceh Province is still below the national figure. One of the efforts to increase the coverage of exclusive breastfeeding is the development of videos. The messages in the videos most influence the perception of who is breastfeeding. AIM: The aim of the study is video development to increase coverage of exclusive breastfeeding in Aceh Province, Indonesia. METHODS: This study uses the research and development research method. The research was conducted in the Darul Imarah district. The research subjects in this development research were breastfeeding mothers. Data collection was carried out using assessment sheets, observations, questionnaire sheets, process skills test sheets carried out by compiling tests/assessment instruments, selecting media, selecting formats, and preparing preliminary designs/designs. The development stage is carried out by expert validation and development trials. RESULTS: The results showed that researchers’ dissemination and implementation to breastfeeding mothers showed that 70% of babies received exclusive breastfeeding one month after seeing the video, and there were still 40% of babies who had received formula milk. The expert team’s assessment results showed that 73.3% still needed to match the Acehnese language with the players’ scenario. Overall, POMA video development effectively increases exclusive breastfeeding in Darul Imarah District, Aceh Besar District. The message presented in the video Poma Harapan can give confidence to the audience that exclusive breastfeeding coverage. CONCLUSION: POMA video development is effective in increasing exclusive breastfeeding in Darul Imarah District, Aceh Besar District.

Background The continuity of maternal depressive symptoms throughout the perinatal period and breastfeeding problems have adverse influences on breastfeeding. Research aim To compare the feeding patterns and breastfeeding experiences, maternal health and mental health, and breastfeeding self-efficacy between women with depressive symptoms who participated in a prenatal individualized mixed management intervention and those who received usual care. Methods Chinese primigravida ( N = 182) with an Edinburgh Postnatal Depression Scale score ≥ 9 in late pregnancy (≥ 28 weeks and < 35 weeks) were randomly assigned to the intervention group ( n = 84) or the control group ( n = 84). Intervention group participants received four sessions of individualized mixed management combining psycho-education and breastfeeding education. Breastfeeding self-efficacy, feeding patterns, maternal depression, and health status were evaluated in both groups. Results Significant differences were noted between the groups in breastfeeding self-efficacy at 42 days postpartum ( p < .05) and feeding patterns at 3 months and 6 months postpartum ( p < .05). Repeated measures analysis of variance showed significant differences in the EPDS scores between groups at three postpartum time points ( p < .05). The intervention group had significantly lower postpartum depression as diagnosed by the MINI ( p < .05). Conclusions A prenatal individualized mixed management intervention holds promise as an effective prevention and health promotion program addressing breastfeeding outcomes and maternal mental health. This RCT was registered (ChiCTR-IOR-17013761) with Chinese Clinical Trial Registry, http://www.chictr.org.cn/enIndex.aspx on 12/7/2017.

Non-communicable diseases are already acknowledged as a double burden, and now childhood obesity is putting extra strain on our health system. The current paper aimed to analyze the ongoing health and related programmes/policies in India, and we discussed the existing opportunities in the programmes to address the issue of childhood obesity in India. We searched the "MEDLINE," "PsycINFO," "Scopus," "Web of Science," and "Google Scholar" databases using the following keywords: ("overweight") and ("obesity"), ("childhood obesity"), ("nutritional programmes in India"), ("Health policies in India"), ("malnourished children in India") in combination with each other and in truncated form. All the relevant articles and policy documents (MOHFW, INDIA) available in the public domain were included to support the argument for this narrative review. We found that we have programme gaps like guidelines issues by Food Safety Standards Authority of India to tackle childhood obesity and it has not been strictly implemented due to multiple reasons. School health programme has an opportunity to address the issue of childhood obesity, but at the ground level the outcomes are not very promising. The National Nutrition Mission have only focussed on undernutrition and anemia problem, ignoring the overweight/childhood obesity. Primary care physicians are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. National Programme for prevention & Control of Cancer, Diabetes, Cardiovascular Diseases & stroke is dealing with health promotion and prevention, early diagnosis, and management of all ages, except children. Diet provided in Integrated Child Development Scheme is calculated based on calories, not by the quality which is a concern to us. The breastfeeding promotion programme named Mothers Absolute Affection programme has not been implemented with letter and spirit. Other than health programmes, we assume that Ministry of Urban Planning, Foreign Direct Investment policy, Advertisement Council of India and many more sector/policy/programme are indirectly responsible for the increasing burden of childhood obesity in India. Lack of awareness and wrong perception also responsible for the development of childhood obesity. We have multiple National Health Programmes and Policies to address the childhood malnutrition, but are focussing the undernutrition component only, ignoring overnutrition problem in the children, which is emerging as quadruple burden to our health system. Appropriate actions and inclusion of suggestions provided in this study for the improvement of the programmes at the practical level needs to be considered by the policy makers to halt the ever-rising trend of childhood obesity and primary care physicians should play a leadership role.

We explored paternal roles in timely breastfeeding initiation and exclusive breastfeeding practices in Jakarta using a mixed-methods approach in sequence of focus group discussions (FGDs – phase 1) and a quantitative survey (phase 2). The study population was parents with infants aged below 6 months. Data on paternal roles, maternal attributes, and breastfeeding practices were collected from 43 purposively selected parents in phase 1 and 536 couples in phase 2. FGDs provided insights to finalize the questionnaire for the survey. Nine paternal roles were identified: 1-accompanying the mother during antenatal and postnatal visits, 2-suggesting places for health checkups and delivery, 3-seeking information about child nutrition, 4-accompanying the mother during delivery, 5-facilitating psychological support of the mother, 6-childcare involvement, 7-engagement in childcare discussions, 8-involvement in decisions about infant feeding mode, and 9-enthusiasm for fatherhood. Roles 3 (aOR=1.65; 95%CI=1.07 to 2.54) and 9 (1.59; 1.04-2.44) were positively associated with timely initiation of breastfeeding. Role 8 was positively associated with exclusive breastfeeding (1.69; 1.10-2.60), but roles 2 (0.49; 0.32-0.76) and 5 (0.97; 0.41-0.64) were negatively associated with exclusive breastfeeding. Fathers played roles in breastfeeding practices under study. Fathers need a tailored breastfeeding promotion to stimulate necessary support for breastfeeding mothers. Keywords: initiation of breastfeeding, exclusive breastfeeding, fathers, mixed-methods approach, Indonesia

Background Global health policy recommends exclusive breastfeeding until infants are 6 months. Little is known about the cost-effectiveness of breastfeeding promotion strategies. This paper presents a systematic search and narrative review of economic evaluations of strategies to support or promote breastfeeding. The aim of the review is to bring together current knowledge to guide researchers and commissioners towards potentially cost-effective strategies to promote or support breastfeeding. Methods Searches were conducted of electronic databases, including MEDLINE and Scopus, for economic evaluations relevant to breastfeeding, published up to August 2019. Records were screened against pre-specified inclusion/exclusion criteria and quality was assessed using a published checklist. Costs reported in included studies underwent currency conversion and inflation to a single year and currency so that they could be compared. The review protocol was registered on the PROSPERO register of literature reviews (ID, CRD42019141721). Results There were 212 non-duplicate citations. Four were included in the review, which generally indicated that interventions were cost-effective. Two studies reported that breastfeeding promotion for low-birth weight babies in critical care is associated with lower costs and greater health benefits than usual care and so is likely to be cost-effective. Peer-support for breastfeeding was associated with longer duration of exclusivity with costs ranging from £19–£107 per additional month (two studies). Conclusions There is limited published evidence on the cost-effectiveness of strategies to promote breastfeeding, although the quality of the current evidence is reasonably high. Future studies should integrate evaluations of the effectiveness of strategies with economic analyses.

Background: Inappropriate practice of exclusive breastfeeding (EBF) is still a major problem worldwide.Objective: To identify exclusive breastfeeding practice and its associated factors among children aged 6-23 months in Woldia Town.Methods: A Community based cross-sectional study was carried out.Interviewer-administered questionnaire was utilized to collect the data. The questionnaire was adapted from the 2016 Ethiopia Demographic and Health Survey. Hosmer-Lemeshowmodel was fitted at a P-value of 0.91. Finally, Variables having P-Value

Many studies correlate lower health literacy with poorer health outcomes and inferior provider-patient communication. Little is known about how impaired health literacy among women receiving prenatal care at inner city public hospitals may impact reproductive health behaviors and outcomes. The objective of this study was to assess health literacy among postpartum women receiving care at a public tertiary care center and to explore the association of impaired health literacy with prenatal care attendance and postpartum outcomes. Written consent was obtained before completing the 7-item REALM-SF study tool to assess health literacy. A score of zero to three indicated low health literacy, four to six moderately low health literacy, and seven adequate health literacy. Patients completed a 25-item demographic questionnaire, and medical outcomes were obtained via this questionnaire and chart review. Descriptive statistics were generated, and bivariate and multivariate analyses evaluated the association between REALM-SF score and study outcomes. We recruited 300 adult English-speaking postpartum women and 293 were included in the final analysis. The majority of participants (53.9%) experienced impaired health literacy (score zero to six). Most respondents completed high school or higher education (77.1%), 17.8% had no prenatal care, and 83.6% reported that this pregnancy was unplanned. After adjusting for age, race, and education, women in the lowest health literacy group were less likely to indicate a plan to exclusively breastfeed (aRR = 0.54, p = 0.03). Impaired health literacy affects a majority of our patients and is associated with reproductive health outcomes, including exclusive breastfeeding. Health care providers should attempt to overcome differences in health literacy through strong breastfeeding promotion. Verbal and written patient education materials should be tailored to the needs of patients with impaired health literacy.

Background: Mothers of preterm infants face significant challenges to breastfeeding. The theory of planned behavior (TPB) is a well-known framework comprising three domains (attitudes, perceived control, and social norms), which has been used to conceptualize the array of factors that influence health-related behaviors and develop interventions to promote behaviors. Aim: We used the TPB framework to determine the array of factors that contribute to breastfeeding among mothers of preterm infants. Materials and Methods: Using qualitative research methods, we conducted in-depth, semistructured interviews with mothers regarding their experiences feeding their preterm infants according to TPB domains. We developed themes based on an iterative process of review of transcripts and conducted interviews until thematic saturation was reached. Results: We interviewed 23 mothers in 3 states 2 to 6 months after hospital discharge; 22 mothers initiated milk production and 6 were breastfeeding at the time of the interview. Factors that were positive and negative toward breastfeeding were present for all three TPB domains. Regarding attitudes, mothers felt that breastfeeding was a way to bond, that breast milk was healthy and protective, and that breast milk alone was insufficient for a growing preterm infant. Regarding perceived control, mothers felt empowered to breastfeed due to encouragement from hospital staff, friends, and family, and had difficulty overcoming their infant's immature oral feeding skills, competing responsibilities, and perceived infant preference for bottle feeding. Regarding social norms, mothers reported support for and against breastfeeding among hospital and Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) providers, family, friends, and the media. Conclusion: Interventional studies geared toward breastfeeding promotion among mothers of preterm infants may focus on addressing barriers to direct breastfeeding during the neonatal intensive care unit and early post-discharge time periods.

Objectives: To describe preventive, diagnostic and therapeutic strategies regarding necrotising enterocolitis in Spain and to identify the strengths, areas of further improvement, and future research lines. Methods: Two questionnaires on the management of preterm infants less than 32 weeks, at risk of, or with diagnosed necrotising enterocolitis, were distributed among selected representatives of the surgeons and neonatologists of the Spanish Neonatal Network (SEN1500) participant hospitals with a Paediatric Surgery Department. Results: Percentage of response was 77.1% of contacted surgeons and 88.6% of neonatologists. There is a written protocol on the diagnosis and medical management of necrotising enterocolitis in 52% of the hospitals, and as regards surgical treatment in 33%. There is wide access to donor bank milk and to staff dedicated to breastfeeding promotion (87%). On the contrary, only 52% of the centres perform delayed cord clamping, and probiotics are used in just 23%. The use of abdominal ultrasound is increasing. There are no large differences as regards duration of antibiotic use and bowel rest, whereas there was as regards antibiotic selection, surgical indication, and type of intervention. Conclusions: As regards prevention, delayed cord clamping and extended access to donor milk are two possible aspects of further improvement. The observed discrepancies noted in diagnostic and therapeutic aspects are common in precisely the areas where evidence in the literature is weakest. Resumen: Objetivo: Describir la prevención, diagnóstico y tratamiento de la enterocolitis necrosante en hospitales españoles e identificar puntos fuertes, áreas de mejora y líneas de investigación pendientes. Métodos: Se realizaron 2 encuestas sobre manejo de pacientes en riesgo o diagnóstico de enterocolitis necrosante en recién nacidos pretérmino menores de 32 semanas, distribuidas entre representantes de los cirujanos pediátricos y neonatólogos de los centros participantes en la red española SEN 1500 con Servicio de Cirugía Pediátrica. Resultados: El porcentaje de respuestas fue del 77.1% y del 88.6% entre los cirujanos y neonatólogos contactados, respectivamente. El 52% de los hospitales dispone de un protocolo de diagnóstico y manejo médico de la enterocolitis y el 33% uno sobre tratamiento quirúrgico. El acceso a leche de banco y disponer de personal dedicado a la promoción de la lactancia materna es común (87%), por el contrario, la ligadura tardía de cordón solo se realiza en el 52% de los centros y en un 23% se administran probióticos. La ecografía abdominal está cada vez más extendida. No hay grandes diferencias en cuanto a la duración de los antibióticos y del reposo intestinal, pero si en cuanto a los antibióticos seleccionados, la indicación quirúrgica y el tipo de intervención. Conclusiones: La implementación de la ligadura tardía de cordón y la extensión del acceso a leche de banco son áreas de mejora en el aspecto preventivo. En cuanto al diagnóstico y tratamiento existe una gran división que afecta precisamente a las áreas donde la evidencia en la literatura es menor.

Problem In Bhutan, exclusive breastfeeding is not routinely practised according to the World Health Organisation recommendation, thereby placing infants and women at increased risk of morbidity and mortality. Background Research indicates that support from midwives is positively associated with longer breastfeeding duration. Previously, no studies had been conducted in Bhutan to explore midwives’ perceptions of the barriers to the promotion of exclusive breastfeeding. Aim To explore midwives’ perceptions of the barriers to promoting exclusive breastfeeding among Bhutanese women. Methods A qualitative exploratory descriptive study design was used, involving individual semi-structured audio-recorded interviews. The Framework approach was utilised for data analysis. Findings Five themes emerged from a total of 26 interviews. The themes were: ‘cultural and traditional practices’, ‘women’s return to work’, ‘midwives’ advice in response to breastfeeding problems’, ‘shortage of staff in a busy maternity service’ and ‘lack of professional development about breastfeeding’. Discussion Midwives reported that upholding Bhutanese cultural and traditional practices by women and their families was a powerful barrier to the promotion of exclusive breastfeeding. Midwives experienced difficulty in promoting exclusive breastfeeding among women in the immediate postnatal period during women’s short hospital stay. A shortage of midwives, coupled with a lack of professional development about breastfeeding promotion and support, were additional barriers to the promotion of exclusive breastfeeding. Conclusion The study findings highlight the need for continuing professional development of midwives in relation to exclusive breastfeeding. Additionally, a review of the midwifery workforce model is recommended, to ensure midwives have time to provide women with breastfeeding support.

Margaret Isabirye Kyenkya (photo) grew up in Uganda with five bothers and six sisters. Her Bachelor of Arts was in Social Work and Social Administration (Makerere University, Uganda), and was followed by a Masters in Sociology, (Nairobi University), and a Certificate in Mother and Child Health (International Child Health Institute, London). Her PhD focused on Hospital Administration inspired by the WHO/UNICEF Baby Friendly Hospital Initiative. She has worked as a researcher, the founder of Non-Governmental Organizations, a Senior United Nations Officer (New York Headquarters and several regions), a Manager in the United States Agency for International Development-funded National Health and Nutrition Projects, and a governmental Health and Nutrition Adviser. A certified trainer in a number of health and nutrition areas, a breastfeeding counselor, and a retired La Leche League Leader, Dr. Kyenkya has significantly influenced the course of lactation support and promotion globally. She stated, “My most precious and valued occupation is that of a mother [of five] and grandmother [of eight].” Dr. Kyenkya currently lives in Atlanta, Georgia, in the United States. (This interview was conducted in-person and transcribed verbatim. It has been edited for ease of readability. MK refers to Margaret Kyenkya; KM refers to Kathleen Marinelli.)

Background: The understanding of what mothers think about breastfeeding helps in developing successful breastfeeding promotion programs. This study aims to assess the maternal knowledge, attitude, and practice about the complementary feeding for infants aged 6-12 months. Methods: A cross-sectional study designed to interview 219 mothers with children between 6-12 months. Data was collected between 1st March and 30th April 2019 from ten maternal and child health clinics (MCHCs) in Anbar Province, Iraq. SPSS version 16.0 was recruited to analyze the data. Descriptive and inferential statistics such as Chi-square used to present data with the significance level set at less than 0.05. Results: The mean age of respondents was 27.76 ± 6.3 years, and 31% were at the primary school level. Two third (66.82%) of the surveyed mothers exclusively used breastfeeding to feed their infants. Most women (84.09%) have the correct knowledge about the best time to start complementary food. The vast majority of women (93.64%) refused to give vitamins to children even with signs of malnutrition. Conclusion: Although exclusive breastfeeding is common among mothers of the western region in Iraq, there is still a considerable percentage depend on the mixture of breastfeeding and bottle feeding. The positive impact of the family and society on mothers was evident. However, more attention should be given to improve knowledge, attitude, and practice through qualified healthcare providers.

Background: As part of Nigeria’s effort to attain the targets of the 1990 Innocenti Declaration, the Baby-Friendly Hospital Initiative (BFHI) was launched in 1991. The 2005 Innocenti Declaration reiterated the need for the Initiative by asking governments to “revitalize” it and maintain “the Global Criteria as the minimum requirement for all facilities”. The Nigerian government adopted the Initiative and in response to the national directive for tertiary health facilities to become Baby Friendly, the University of Port Harcourt Teaching Hospital (UPTH) established its BFHI Committee in 1992, with a multi-departmental and multi-disciplinary membership. Although the Baby Friendly Hospitals designated following this directive have largely not been reassessed, the BFHI Committee of the UPTH has remained active, implementing relevant activities at the facility and within and outside Rivers State. Aims: To share experiences with sustaining BFHI activities without adequate support in a tertiary health facility with a goal to stimulating commitment to the establishment and sustenance of similar committees in similar health facilities. Place and Duration of Study: University of Port Harcourt Teaching Hospital, Nigeria; 27 years. Methodology: From the inception of the Committee, an administrative structure comprising of the Steering Committee and its Chairman, the Coordinator and Secretary was set up. Information on the activities of the Committee was extracted from the reports of activities, Minutes of Meetings and other publications of the Committee. These were analysed for presentation. Results: Established in 1992 to drive the hospital’s mandate to become Baby Friendly, the Committee has sustained the efforts to promote, protect and support breastfeeding through capacity development, provision of technical support to Departments and facilities, promotion of research and support of the implementation of the Ten Steps to Successful Breastfeeding, the International Code of Marketing of Breast milk Substitutes, HIV and Infant Feeding Counselling, Facility Based Management of Severe Acute Malnutrition and others. Some of the achievements of the Committee during the period 1992-2019 are: Sustained implementation of activities in support of the Ten Steps to Successful Breastfeeding (operating the Crèche, Mother’s Room, Nutrition Clinic and Breastfeeding Room in the Special Care Baby Unit, Nutrition education and the distribution of Information, Education and Communication materials on breastfeeding and the Code). Celebration of the World Breastfeeding Week and mobilization of stakeholders to celebrate the Week since 1997. Awareness creation on the Code for improved compliance within and outside Rivers State Integration of breastfeeding education into the curricula of health workers The Conduct of the 2015 World Breastfeeding Trends Initiative Assessment in Nigeria Challenges: include changes in leadership with some leaders not showing commitment to the mandate of the Committee; Lack of funds, lack of dedicated staff for breastfeeding promotion in the hospital and pressure from infant food industries. Conclusion: Successful and continued implementation of the Baby Friendly Hospital Initiative with its expansion to the BFH Community Initiative will contribute to improved breastfeeding practices and therefore the attainment of the global nutrition targets. While mitigating the challenges to effective implementation of the Committee’s activities, tertiary health facilities should reposition themselves to promote, protect and support the initiative for the realization of relevant global nutrition targets.

Background Infants, young children, and their mothers are vulnerable in humanitarian emergencies. The health benefits of optimal breastfeeding practices in emergency settings have been demonstrated by many researchers. Infant and Young Children Feeding in Emergency guidelines illustrate a series of interventions to protect, promote, and support breastfeeding, but unfortunately, these recommendations are still scarcely applied. Research Aims (1) To review the literature describing the effectiveness of breastfeeding protection, promotion, and support interventions in humanitarian emergency contexts; (2) to describe the influence of interventions on breastfeeding initiation, exclusivity, and duration; and (3) to evaluate relevant mother and infant/child outcomes available in the literature. Methods PubMed, CINAHL, Cochrane Library, Psychology Database, JSTOR, Web of Science, EMBASE, and Ovid were searched for articles that examined breastfeeding protection, promotion, or support interventions and the resulting outcomes without any time limits ( N = 10). Articles that did not include the interventions and related outcomes were excluded ( n = 1,391). Results Improved breastfeeding outcomes were reported in four (40%) papers, and three (30%) highlighted a behavioral change in infant and young child feeding practices following the implementation of the interventions. Increased knowledge about appropriate infant and young child feeding practices among mothers and humanitarian/health staff was reported in eight (80%) papers. However, outcomes were sometimes only generically reported, and some of the included papers had a low strength of evidence. Conclusion In the literature, there is a great dearth of studies evaluating the influence of interventions aimed at improving breastfeeding in emergency settings. More evidence is urgently needed to encourage and implement optimal breastfeeding practices.

Background In China, the prevalence of exclusive breastfeeding at 6 months was only 20.8%. In promoting breastfeeding for newborns, a number of strategies have been initiated by Chinese government. These actions facilitated a high breastfeeding initiation of 77 to 99.9% in different regions. However, the exclusive breastfeeding rates remained low at 6 months resulting from a high rate of perceived insufficient breast milk and complementary feeding during the early days after childbirth. The aim of this study was to understand the experiences of women in Shenzhen with regard to breastfeeding in the first 6 weeks after giving birth, to identify the facilitators and barriers impacting their breastfeeding decisions and to identify their perceived support needs that might facilitate breastfeeding in the future. Methods This was a qualitative exploratory study. Data were collected in November 2018 through semi-structured, face-to-face, in-depth interviews. A purposive sample of early postpartum women was recruited from a postpartum clinic of a tertiary maternal hospital in Shenzhen, China. The dataset was analysed using inductive content analysis. Results A total of 22women were interviewed within the first 6 weeks after delivery. Three themes related to breastfeeding were identified from the transcribed interviews: “breastfeeding facilitators,” “breastfeeding barriers,” and “recommendations for breastfeeding promotion.” Conclusions Women experienced both joy and suffering in their journey of breastfeeding. Insufficient knowledge of breastfeeding, discomfort, intergenerational disagreements regarding nutritional supplements, and a lack of professional support contributed to difficulties and the threat of discontinuation. A supportive environment for breastfeeding is crucial for women’s decision on exclusive breastfeeding and the psychological wellbeing of breastfeeding women. Interventions that target to promote exclusive breastfeeding should include both new mothers and significant family members. Future studies could test the effectiveness of breastfeeding training for home visit nurses to promote exclusive breastfeeding in the early postpartum.

Background The Special Supplemental Nutrition Program for Women, Infants and Children (WIC) changed the food packages provided to its participants in 2009, to better align them with the Dietary Guidelines for Americans. Previous research found that the 2009 WIC food package change was associated with reduced obesity risk, particularly among breastfed infants but also among those who were never breastfed. The objective of this study was to determine if the new child food package introduced in 2009, including more produce and whole grains for 1–4-year old children, was associated with healthier growth trajectories and reduced obesity risk at age 4 years among children who were exclusively formula fed during infancy. Methods Administrative data on WIC-participating children in Los Angeles County, 2003–2016, were used (N = 74,871), including repeated measures of weight and length (or height); child’s age, gender, and race/ethnicity; maternal education and language; and family poverty. Gender-stratified spline mixed models were used to examine weight-for-height z-score (WHZ) growth trajectories from 0 to 4 years and Poisson regression models were used to assess obesity (BMI-for-age > 95th percentile) at age 4. The main independent variable was duration of receipt (dose) of the new child package, categorized as 0, > 0 to Results WHZ growth trajectories were similar for children across new child package dose groups. Boys and girls who were fully formula fed during infancy but received the new child food package for 4 years had a 7% (RR = 0.93; 95%CI = 0.89–0.98) and a 6% (RR = 0.94; 95%CI = 0.89–0.99) lower obesity risk, respectively, compared to children who received the new child food package for 0 years. There were no differences in obesity risk for children receiving child package vs. 0 years. Conclusions Providing healthy foods during childhood to children who were exclusively formula fed as infants was associated with modest improvements in obesity outcomes. While breastfeeding promotion should still be prioritized among WIC participants, providing healthy foods during childhood may provide health benefits to formula fed children, who comprise a sizeable proportion of children served by WIC.

Indiana University-Purdue University Indianapolis (IUPUI), Despite clinical recommendations, only 25.8% of infants in the United States are exclusively breastfed at 6 months of age. Breastfeeding policies and communication campaigns exist to support exclusive breastfeeding, and women who use formula report facing stigma and feeling like a failure. Narratives can be used to discern how individuals make sense of experiences related to health, and narrative theorizing in health communication provides a framework of problematics used to explain how individuals construct stories that reveal the tensions between continuity and disruption and creativity and constraint. Individual experiences are often influenced by master narratives such as “Breast is best,” which are phrases that shape our understanding of the world. Because of the negative impact of using formula on maternal well-being, the purpose of this research was to use a narrative framework to analyze the stories of women who used formula in relation to the master narrative of breast is best. Building off of pilot interviews with 22 mothers, semi-structured interviews were conducted with 20 women who had used formula within the first 6 months after giving birth and had an infant no older than 12 months at the time of the interview. Qualitative analysis revealed that women perceived formula as shameful and costly. Conversely, they viewed breastfeeding as biologically superior, better for bonding, and a way to enact good motherhood. Current messaging about breastfeeding, particularly for women who intend to breastfeed, may have unintended negative effects when women face a disruption to their breastfeeding journey. In addition, women viewed breastfeeding and formula feeding as in relation to and in opposition to one another, reducing the perceived acceptability of behaviors such as combination feeding. Despite constraints in the master narrative regarding acceptable infant feeding practices, women demonstrated creativity in their individual stories and found formula feeding enabled more equitable parenting and preserved mental health. Practical implications include that organizations promoting exclusive breastfeeding in the United States should move away from framing breastfeeding as an all-or-nothing choice and develop tailored and value-neutral messaging recognizing breastfeeding as a complex psychosocial and biological process.

Vecmāte Veselības aprūpe Midwifery Health Care Pasaules Veselības organizācija (turpmāk tekstā PVO) iesaka ekskluzīvu zīdīšanu (turpmāk tekstā EZ) bērna pirmajos sešos dzīves mēnešos, savukārt, kombinējot mātes pienu ar citu uzturu, turpināt zīdīšanu līdz divu gadu vecumam vai ilgāk (WHO, 2021). Starp PVO reģioniem Eiropas reģionā ir viszemākie EZ rādītāji sešu mēnešu vecumā - aptuveni 25% (Theurich et al., 2019). Zīdīšanas ilguma rādītāji Latvijā pēdējos gados bijuši līdzīgi, un tie bija krietni zemāki par PVO ieteikumiem. Vairākos pētījumos un pārskatos tika secināts, ka vecmātēm vai citām atbalsta personām atbalstot sievietes zīdīšanas laikā, EZ ilgums un kopējais zīdīšanas ilgums palielinājās, kā arī tas ietekmēja agrīnu zīdīšanas pārtraukšanu (McFadden, 2017 ; Forster et al., 2019). Pētījuma mērķis bija noskaidrot sieviešu apmierinātību par vecmāšu sniegto atbalstu zīdīšanas veicināšanā (turpmāk - VSAZV), zīdīšanas uzsākšanā, EZ un kopējā zīdīšanas periodā. Darba uzdevumi bija noskaidrot sieviešu apmierinātību par VSAZV, noskaidrot zīdīšanas uzsākšanu un ilgumu izlases sievietēm un izvērtēt, vai pastāv saistība starp sieviešu apmierinātību par VSAZV un zīdīšanas uzsākšanu, EZ un kopējo zīdīšanas ilgumu. Tika veikts neeksperimentāls šķērsgriezuma korelācijas pētījums. Pētījumā piedalījās 523 pirms diviem līdz trim gadiem Latvijā dzemdējušas sievietes. Rezultāti: No 523 sievietēm aprūpi no vecmātēm pēcdzemdību periodā saņēma 220 sievietes stacionārā un 12 sievietes mājas vizīšu laikā. Mediānie sieviešu apmierinātības vērtējumi par VSAZV bija vidēji augsti un augsti. Zīdīt savu bērnu uzsāka 99,0% (n=518) resondentu, bet 1% respondentu (n=5) zīdīšanu neuzsāka. EZ mediānais periods bija 130,00 dienas, kopējais mediānais zīdīšanas periods bija 12,00 mēneši. Autores izvirzīta hipotēze apstiprinājās daļēji. Netika atrasta statistiski nozīmīga asociācija starp sieviešu apmierinātību par VSAZV un zīdīšanas uzsākšanu. Tika pierādīta statistiski nozīmīga vāja pozitīva korelācija starp EZ, kopējo zīdīšanas periodu un četriem aspektiem vecmātes sniegtā atbalsta zīdīšanas veicināšanā pēcdzemdību perioda stacionārā: aprūpes personāla empātija, atsaucība un ieinteresētība, saprotoša attieksme, sievietei nepieciešamā individuālā atbalsta sniegšana un papildu vizīšu piedāvāšana (p

Objective: To identify the most used social networks and the most consumed contents by women seeking support and further understanding of breastfeeding/breast milk. Data source: An integrative literature review was performed using the Psychology & Behavioral Sciences Collection, MEDLINE Complete, CINAHL Complete, MedicLatina, Academic Search Complete and ERIC databases. The search was conducted in April, 2020. The inclusion criteria were: publications in Portuguese, English or Spanish with several keywords, such as “Breastfeeding”, “Social Networking”, “Social Media”, “Breastfeeding Promotion”, in the title and in the abstract, with the combination of the Boolean operators “AND” and “OR”, in original articles of primary source, which were available in full text and were published between 2015 and 2020. Data synthesis: Out of the 93 articles that were first examined, 10 were used in the descriptive summary. Studies from the United States, Sweden, New Zealand, Brazil, Australia, Indonesia, and Switzerland were included in the review. Women were found to use several social networks, which is facilitated by an easy access to the Internet and to its content through several electronic resources, often using more than one device simultaneously. Most issues were universally recognized as some of the most common reasons for interrupting breastfeeding. Conclusions: The analyzed studies show that women seek to clarify their doubts outside the traditional health services’ environment, using Facebook, apps, websites, online videos, podcasts and e-mail. We stress the importance of these support groups for promoting breastfeeding and the need for health professionals to introduce themselves in social networks to reach mothers.

[EN] Background: Even if women have intention to breastfeed, they do not always achieve a successful breastfeeding. Aim: This study aims to analyse factors affecting breastfeeding prevalence among mothers that intended to breastfeed. Methods: This is a prospective observational study involving 401 pregnant women that intended to breastfeed (asked at the 20th week). Breastfeeding prevalence was evaluated in reference to health-related, socio-cultural factors and healthcare professionals' interventions at 1 month, 6 months and 12 months after birth. Data were analysed using descriptive statistical methods, bivariate logistic regression and multivariate logistic regression modelling. Results: Independent factors negatively affecting breastfeeding prevalence related to mothers' and newborns' health parameters and birth characteristics included smoking during pregnancy, anaemia and use of analgesia during labour. Regarding sociocultural parameters, being an immigrant, higher education level, intention to breastfeed before pregnancy, comfort with public breastfeeding and bedsharing were positively linked to breastfeeding, while teat or pacifier use in the first week was negatively linked. Regarding healthcare professionals' practices, mother and father/partner antenatal education course attendance and exclusive breastfeeding at the hospital were positively associated with breastfeeding. Conclusion: Breastfeeding is a very complex phenomenon affected by multiple and diverse variables. Physiological factors only affect the short term (1st month), while middle and long term BF affecting variables are mainly identical and include mostly socio-cultural factors and also BF related practices, especially in the first days after birth. These data should help to develop more effective breastfeeding promotion strategies. Funding GGTM has received the grant OSIBB18/024 from BIOEF (Fundacion Vasca de Innovacion e Investigacion Sanitarias) . Open Access funding provided by University of Basque Country.

Objectives: Breastfeeding support rooms are low-cost interventions that may prolong breastfeeding and improve work performance. Thus, we sought to understand the experiences and perceptions of working women who use breastfeeding support rooms and the potential contribution to sustainable development goals.Methods: Descriptive and exploratory research was conducted through convenience sampling of women working in companies with breastfeeding support rooms in the state of Paraná, Brazil. A semi-structured questionnaire was applied through interviews and online self-completion.Results: Fifty-three women between 28 and 41 years old participated in the study. In addition, 88.7% had graduated from college, and 96% were married. From the women's experiences and perceptions, we identified that breastfeeding support rooms contribute to prolonged breastfeeding, improve physical and emotional well-being, allow women to exercise their professional activities comfortably, contribute to women's professional appreciation for the excellent relationship between employees and employers.Conclusion: In this novel study, we demonstrate how, from a female point of view, breastfeeding support rooms can contribute to 8 of the 17 sustainable development goals and should therefore be encouraged and promoted.

Background Because breastfeeding offers short- and long- term health benefits to mothers and children, breastfeeding promotion and support is a public health priority. Evidence shows that SARS-CoV-2 is not likely to be transmitted via breastmilk. Moreover, antibodies against SARS-CoV-2 are thought to be contained in breastmilk of mothers with history of COVID-19 infection or vaccination. WHO recommends direct breastfeeding as the preferred infant feeding option during the COVID-19 pandemic, even among women with COVID-19; but conflicting practices have been adopted, which could widen existing inequities in breastfeeding. This study aims to describe how information about breastfeeding was communicated in Mexican media during the pandemic and assess Mexican adults’ beliefs regarding breastfeeding among mothers infected with COVID-19. Methods We conducted a retrospective content analysis of media coverage on breastfeeding in Mexico between March 1 and September 24, 2020, excluding advertisements. For the content analysis, we performed both a sentiment analysis and an analysis based on strengths, weaknesses, opportunities, and threats (SWOT) for breastfeeding promotion. Additionally, we conducted a descriptive analysis of nationally representative data on adults’ beliefs about breastfeeding from the July 2020 round of the ENCOVID-19 survey in Mexico and stratified the results by gender, age, and socioeconomic status. Results A total of 1014 publications on breastfeeding were identified on the internet and television and in newspapers and magazines. Most information was published during World Breastfeeding Week, celebrated in August. The sentiment analysis showed that 57.2% of all information was classified as positive. The SWOT analysis indicated that most information focused on current actions, messages, policies, or programs that enable breastfeeding (i.e., strengths) or those not currently in place but that may enable breastfeeding (i.e., opportunities) for breastfeeding promotion. However, ENCOVID-19 survey results showed that 67.3% of adults living in households with children under 3 years of age believe that mothers with COVID-19 should not breastfeed, and 19.8% do not know whether these mothers should breastfeed. These beliefs showed differences both by gender and by socioeconomic status. Conclusions While the Mexican government endorsed the recommendation on breastfeeding during the COVID-19 pandemic, communication was sporadic, inconstant and unequal across types of media. There was a widespread notion that mothers with COVID-19 should not breastfeed and due to differences on beliefs by socioeconomic status, health inequities could be exacerbated by increasing the risk of poorer breastfeeding practices and preventing vulnerable groups from reaping the short and long-term benefits of breastfeeding.

Background In Los Angeles County (LAC), disparities in breastfeeding rates vary by race and region. Black persons are more affected by social and environmental factors than other racial/ethnic groups, leading to lower breast/chestfeeding rates. This study aims to evaluate the community’s knowledge, perceptions, experiences, barriers, and solutions before and after an educational film about Black persons who are breast/chestfeeding. Methods Participant responses were collected anonymously through an online survey (via QR code) pre-and post-viewing a film with open- and closed-ended questions. There were 15 pre-screening questions and 24 post-screening questions discussed with a team of community experts. Questions included four main areas related to breast/chestfeeding: current/past experiences, support, awareness of laws, and solutions. Central tendency, variance, and paired differences were calculated from evaluation responses. Results There were 185 participants who completed the pre-screening evaluation and 57 participants who completed the post-screening evaluation. Racial/ethnic differences were found for stated reasons for attendance, and perceptions of breastfeeding being challenging after viewing the video. On a five-point Likert scale (1 = very relevant, 5 = not relevant), most participants felt the video was relevant (median response = “2-relevant”; IQR = “3-neutral”; “1-very relevant”), learned something new (81.4%) and knew how to access breast/chestfeeding support after viewing the video (93.2%). Conclusions Current media is a way to alter perceptions and opinions, and provides information. Additionally, it can be a way of increasing awareness of issues that Black breast/chestfeeding persons encounter. Strategic marketing efforts for future film screenings may increase attendance of those that can gain insight into breast/chestfeeding support (youth/young adults and males). Supportive breast/chestfeeding environments can also be a reality with readily accessible, unified, and encouraging personal and professional networks.

Background Breastfeeding is associated with a lower risk of subsequent overweight or obesity, but it is uncertain whether this is a causal relation because most studies have not adequately reduced risk of bias due to confounding. Objectives The aim of this review was to examine whether 1) ever compared with never consuming human milk and 2) different durations of human milk consumption among infants fed human milk are related to later risk of overweight or obesity, with emphasis on sibling-pair and intervention studies. Methods The 2020 Dietary Guidelines Advisory Committee, together with the Nutrition Evidence Systematic Review team, conducted a systematic review of articles relevant to healthy full-term infants in countries with a high or very high level of human development. We searched PubMed, Embase, Cochrane, and CINAHL; dual-screened the results using predetermined criteria; extracted data from and assessed the risk of bias for each included study; qualitatively synthesized the evidence; developed conclusion statements; and graded the strength of the evidence. Results The review included 42 articles, including 6 cohorts with sibling-pair analyses and 1 randomized controlled trial of a breastfeeding promotion intervention. Moderate evidence suggested that ever, compared with never, consuming human milk is associated with a lower risk of overweight and obesity at ages 2 y and older, particularly if the duration of human milk consumption is >6 mo. However, residual confounding cannot be ruled out. Evidence was insufficient to determine the relation between the duration of any human milk consumption, among infants fed human milk, and overweight and/or obesity at age 2 y and older. Conclusions Further research, using strong study designs, is needed to disentangle the complex relation between infant feeding practices and the risk of subsequent overweight or obesity, as well as the biological and behavioral mechanisms if the relation is causal.

IntroductionBreastfeeding is one of the most effective ways to ensure infant health and survival. Inadequate breastfeeding practices, and knowledge among adolescent mothers have led to unprecedented infant and child morbidity and mortality. Given, the high global prevalence of adolescent mothers it is imperative to understand how the knowledge of breastfeeding practices operates among adolescent girls across different socio-economic settings.Materials & methodsData was carried out from Understanding the Lives of Adolescents and Young Adults (UDAYA) survey, conducted in 2015–16. Descriptive statistics along with bivariate analysis was done to examine the preliminary results. For analysing the association between the binary outcome variable and other explanatory variables, binary logistic regression method was used. The explanatory variables were educational status of the respondent, media exposure, working status, ever pregnant status (only for married adolescent girls), sex and age of the household head, educational status of the head of the household, caste, religion, wealth index, residence and states.ResultsAbout 42%, 50%, and 42% of married adolescent girls had knowledge of immediate breastfeeding, yellowish milk, and exclusive breastfeeding respectively. The odds of knowledge about immediate breastfeeding [married-AOR: 1.57; CI: 1.09–2.28 and unmarried-AOR: 1.30; CI: 1.08–1.55], yellowish milk feeding [married-AOR: 2.09; CI: 1.46–3.01 and unmarried-AOR: 1.39; CI: 1.17–1.66], and exclusive breastfeeding [married-AOR: 1.74; CI: 1.2–2.52 and unmarried-AOR: 1.46; CI: 1.22–1.76] were significantly more among adolescent girls aged 19 years old compared to 15 years old girls. Adolescent married and unmarried girls with 10 & above years of schooling were 1.82 times [AOR: 1.82; CI: 1.52–2.18] and 2.69 times [AOR: 2.69; CI: 2.08–3.47] more likely to have knowledge about immediate breastfeeding, 1.74 times [AOR: 1.74; CI: 1.45–2.09] and 2.10 times [AOR: 2.10; CI: 1.68–2.62] more likely to have knowledge about yellowish milk feeding, and 3.13 times [AOR: 3.13; CI: 2.6–3.78] and 3.87 times [AOR: 3.87; CI: 2.95–5.08] more likely to have knowledge about exclusive breastfeeding respectively than girls with no schooling.ConclusionBreastfeeding practices and interpersonal counselling from elders in the household should be encouraged. Ongoing breastfeeding promotion programs of the government should promote high education of adolescent girls. Mass media interventions should be encouraged.

Background In South Africa, breastfeeding promotion is a national health priority. Regular perinatal home visits by community health workers (CHWs) have helped promote exclusive breastfeeding (EBF) in underresourced settings. Innovative, digital approaches including mobile video content have also shown promise, especially as access to mobile technology increases among CHWs. We measured the effects of an animated, mobile video series, the Philani MObile Video Intervention for Exclusive breastfeeding (MOVIE), delivered by a cadre of CHWs (“mentor mothers”). Methods and findings We conducted a stratified, cluster-randomized controlled trial from November 2018 to March 2020 in Khayelitsha, South Africa. The trial was conducted in collaboration with the Philani Maternal Child Health and Nutrition Trust, a nongovernmental community health organization. We quantified the effect of the MOVIE intervention on EBF at 1 and 5 months (primary outcomes), and on other infant feeding practices and maternal knowledge (secondary outcomes). We randomized 1,502 pregnant women in 84 clusters 1:1 to 2 study arms. Participants’ median age was 26 years, 36.9% had completed secondary school, and 18.3% were employed. Mentor mothers in the video intervention arm provided standard-of-care counseling plus the MOVIE intervention; mentor mothers in the control arm provided standard of care only. Within the causal impact evaluation, we nested a mixed-methods performance evaluation measuring mentor mothers’ time use and eliciting their subjective experiences through in-depth interviews. At both points of follow-up, we observed no statistically significant differences between the video intervention and the control arm with regard to EBF rates and other infant feeding practices [EBF in the last 24 hours at 1 month: RR 0.93 (95% CI 0.86 to 1.01, P = 0.091); EBF in the last 24 hours at 5 months: RR 0.90 (95% CI 0.77 to 1.04, P = 0.152)]. We observed a small, but significant improvement in maternal knowledge at the 1-month follow-up, but not at the 5-month follow-up. The interpretation of the results from this causal impact evaluation changes when we consider the results of the nested mixed-methods performance evaluation. The mean time spent per home visit was similar across study arms, but the intervention group spent approximately 40% of their visit time viewing videos. The absence of difference in effects on primary and secondary endpoints implies that, for the same time investment, the video intervention was as effective as face-to-face counseling with a mentor mother. The videos were also highly valued by mentor mothers and participants. Study limitations include a high loss to follow-up at 5 months after premature termination of the trial due to the COVID-19 pandemic and changes in mentor mother service demarcations. Conclusions This trial measured the effect of a video-based, mobile health (mHealth) intervention, delivered by CHWs during home visits in an underresourced setting. The videos replaced about two-fifths of CHWs’ direct engagement time with participants in the intervention arm. The similar outcomes in the 2 study arms thus suggest that the videos were as effective as face-to-face counselling, when CHWs used them to replace a portion of that counselling. Where CHWs are scarce, mHealth video interventions could be a feasible and practical solution, supporting the delivery and scaling of community health promotion services. Trial registration The study and its outcomes were registered at clinicaltrials.gov (#NCT03688217) on September 27, 2018., Maya Adam and colleagues study a video intervention, delivered by community health workers, to promote breastfeeding in South Africa., Author summary Why was this study done? Perinatal home visits from trained community health workers (CHWs) have shown promise for increasing the prevalence of exclusive breastfeeding, a national health priority in South Africa. Video-based, mobile health interventions, incorporating narratives and entertainment–education (E–E), have demonstrated potential for engaging community members and improving health knowledge. Few studies have measured the effect of integrating health promotion videos into CHW workflows in underresourced settings. What did the researchers do and find? We developed a mobile, video breastfeeding intervention to be delivered by CHWs (“mentor mothers”) employed by an established community health program during their home visits with 1,502 pregnant participants. We randomized mentor mothers 1:1 to intervention and control arm. All participants served by the same mentor mother either received or did not receive the intervention. In addition to the causal impact evaluation using a randomized controlled trial, we performed a mixed-methods performance evaluation measuring mentor mothers’ time use and gaining insights into mentor mothers’ subjective experiences with the intervention through in-depth interviews. The randomized controlled trial showed no difference in effects between the intervention and control arms. The performance evaluation results showed that mentor mothers in the intervention arm spent approximately 40% of their visit time viewing videos with their participants. What do these findings mean? Instead of serving as a complement to the standard of care, mentor mothers in the video intervention group used it to replace two-fifths of their face-to-face counseling time with participants. The absence of difference between infant feeding outcomes in the 2 study arms implies that the video intervention was as effective as face-to-face counseling, when the CHWs used it to replace a portion of that counselling. Used in addition to face-to-face engagement, video interventions could boost the health promotion efforts of CHWs, and, where CHWs are not available or extremely scarce, mobile video health interventions could become an increasingly feasible and practical solution for the delivery and scaling of community health promotion services. Future research should explore alternative delivery channels for mobile video E–E health interventions and measure, across channels, the potential for these interventions to (a) increase access to health promotion in underresourced communities; (b) support existing CHW programs; and (c) improve health behaviors and outcomes.

The World Health Organization recommends that women exclusively breastfeed until their babies are 6 months old and continue to breastfeed while introducing complementary foods. A meta‐aggregation methodology was used to systematically review and synthesise the qualitative studies on factors influencing breastfeeding practices of healthy Chinese women in Greater China. English and Chinese databases were searched to identify peer‐reviewed qualitative studies (published 2008–2019). Relevant data were extracted, and key themes related to factors influencing breastfeeding practices were identified. Of 7587 articles identified, 22 qualitative studies met inclusion criteria for the review, 10 of which were published in Chinese. A total of 87 themes were extracted from all included studies and classified into 9 subcategories: government enactment of policies, implementation of policies in workplaces, social expectations, social support, medical and health services, services with Chinese characteristics, breastfeeding and pumping facilities, maternal perceptions of breastfeeding and self‐efficacy to breastfeed. The nine subcategories were then grouped into four categories. Potential effect associations among these influence factors of breastfeeding practices emerged from categories and subcategories. Family members' influence on breastfeeding motivation and self‐efficacy suggest a potential benefit of breastfeeding promotion interventions targeting the whole family. The role of primary care should be fully exploited in breastfeeding promotion, including both prenatal education and post‐partum visits. Standardising the training and qualifications of maternity matrons (yuesao) and folk breastfeeding specialists (cuirushi) can promote evidence‐based approaches to facilitating breastfeeding during the confinement period. Increased availability of breastfeeding and pumping facilities in the workplace would facilitate continuing breastfeeding after returning to work.

OBJECTIVES: The implementation of the “10 Step” programme of WHO/UNICEF for breastfeeding promotion (BFP) in maternity hospitals is considered as a key for long-term breastfeeding success of mothers worldwide. The objective of this work was to determine whether this expectation also holds true for Germany. METHODS: The nationwide SuSe II study (2017–19) is a combination of a cross-sectional survey in maternity hospitals and a prospective follow-up of mother-infant pairs (0.5, 2, 4, 6, 12 months postpartum (pp)) recruited in the participating hospitals. All German maternity hospitals were invited to complete an online questionnaire assessing BFP based on the 10 Steps. Mothers reported if they were breastfeeding and if the infant received any other fluid or food. Relevant factors for exclusive breastfeeding (EBF) during the first 4 months pp were determined in 5 multivariable models with variable selection through backward elimination according to the likelihood ratio. RESULTS: One hundred and three hospitals (15% out of 692) recruited 929 mothers (33% of eligible mothers) who had tried to breastfeed, with a compliance of about 90%. During hospital stay, 74% of mothers exclusively breastfed, 77% at discharge, 74% 2 weeks, 70% 2 months and 58% 4 months pp. Hospitals had implemented between 2 and 10 Steps (median 7). Until 4 months pp, the rate of EBF was higher, if mothers had given birth in hospitals with a high BFP (≥9 Steps) compared to medium (6–8 Steps) or low promotion (≤5 Steps). Even after adjusting for potential confounders, high BFP compared to medium and low promotion significantly increased the modeled odds of mothers for EBF during hospital stay (p = 0.000), at discharge (p = 0.005) and 2 months pp (p = 0.002). Maternal breastfeeding experience and absence of a pacifier significantly increased the modeled odds of mothers for EBF at all 5 time points pp. CONCLUSIONS: Implementation of at least 9 of the 10 Steps for BFP in hospitals was related to mothers' breastfeeding success in the first 2 months. It is noteworthy that this association was found even at the high level of BFP in hospitals and the high initial breastfeeding rates in the SuSe II study. FUNDING SOURCES: Funding: Federal Ministry of Food and Agriculture Client: German Society for Nutrition.

Health benefits associated with breastfeeding are supported by extensive research. Measurements of breastfeeding success in clinical and research settings have focused on maximizing adherence to population-level health recommendations for infant feeding (compliance). Concordance, a new adjunct measure of breastfeeding success, uses a comparison between the parent's intended feeding method and the actual feeding method to better assess whether the person's goals for infant feeding have been met. This measure uses a modified patient-centered outcomes research question to evaluate success in a person-centered framework and is congruent with patient-centered individualized care and shared decision making. Use of concordance as an adjunct success metric in evaluation of interventions and clinical programs will provide an opportunity to approach breastfeeding promotion holistically and incorporate the parent's desired outcome(s) as central to that success.

Background: Breastfeeding promotion and support are not universally accepted in the United States as a strategy to reduce infant mortality. We investigated associations between breastfeedi...

Background Although the reasons for discontinued breastfeeding are multifactorial, an unsupportive work environment is consistently reported as a barrier to continued breastfeeding. In the United States, several state breastfeeding advocates have taken a distinctive approach to promote worksite lactation support by developing statewide recognition initiatives aimed at incentivizing employers to support breastfeeding employees by offering public recognition for the worksites’ efforts. Research aim To identify and describe statewide worksite lactation support recognition initiatives in the United States. Methods Between May 2016 and June 2017, semi-structured phone interviews were conducted with breastfeeding experts in each U.S. state ( N = 60 participants) for this cross-sectional study. Experts in states with a recognition initiative were asked about the background, structure, and requirements of the initiative. Results Twenty-six states had a current initiative, and some had requirements for providing a private space ( n = 19; 73%) and time ( n = 18; 69%) for employees to express human milk, as well as a written worksite lactation support policy ( n = 10; 38%). Conclusions This was the first study in which researchers systematically identified ongoing worksite lactation support recognition initiatives in the United States. The results of this work also served to highlight both the similarities and the variety between initiatives. Future researchers should aim to determine the components of an initiative that increase employer support and, in turn, breastfeeding rates.

Background The World Health Organization (WHO) and the United Kingdom Committee for UNICEF recommend that secondary schools include infant feeding education in the curriculum. However, little attention has been given to the study of educators’ views and practices regarding infant feeding education. Aims The aims of this research were to (1) explore North Carolina Family and Consumer Sciences teachers’ attitudes towards infant feeding education in secondary schools and (2) describe North Carolina Family and Consumer Sciences teachers’ infant feeding education practices. Methods Researchers conducted interviews ( N = 19) and a survey ( N = 137) using a sequential mixed methods design. The constant comparative method was used to analyze interview transcripts. Subsequently, a 33-item survey was developed to assess teachers’ attitudes and practices, and this survey was tested for validity and reliability. Results The majority of participants supported including infant feeding ( n = 119, 86.9%) and breastfeeding ( n = 116, 84.7%) education in high school. Approximately half of the participants supported including infant feeding ( n = 71, 51.9%) and breastfeeding ( n = 64, 46.7%) education in middle school. Participants reported that they taught infant feeding at both levels; topics taught included complementary foods, patterns of infant feeding, and the safe preparation of infant formula. Breastfeeding content was covered primarily in the high school Parenting and Child Development course. Conclusions North Carolina Family and Consumer Sciences teachers have positive attitudes towards teaching about breastfeeding at the secondary school level. Content about infant nutrition and breastfeeding is currently included in courses that cover child development and human nutrition.

Evidence for the health benefits of breastfeeding is well substantiated but breastfeeding uptake and duration remains low worldwide. Individual level breastfeeding promotion programmes are behavioural interventions, targeting malleable social-psychological processes to change behaviour. This systematic review aimed to investigate whether such interventions are effective at improving breastfeeding initiation, duration and exclusivity, and breastfeeding support. A three-stage search strategy identified eligible articles from six databases. Nine controlled-clinical trials and 11 quasi-experimental trials were included. Random-effects meta-analyses identified significant improvements in rates of breastfeeding initiation (N = 2,213; OR = 2.32, 95% CI [1.33, 4.03], p = .003; I2 = 0%, p = .966) and suggested improved exclusive breastfeeding rates up to six months postpartum (N = 3,671; OR = 1.84, 95% CI [1.38, 2.45], p

PURPOSE The Centers for Disease Control and Prevention identified rural mothers as a priority population for targeted breastfeeding promotion programs. In Georgia, breastfeeding rates lag behind the national ones. This study examines rural-urban differences and trends over time in breastfeeding initiation and continuation (breastfeeding for at least 8 weeks) among women with a live birth from 2004 to 2013 in Georgia. METHODS This observational study is based on the Pregnancy Risk Assessment Monitoring System data. The National Center for Health Statistics urban-rural continuum codes were used to operationalize mother's county of residence. Prevalence of breastfeeding was estimated from the logistic regression models, unadjusted and adjusted for sociodemographic and health-related characteristics. FINDINGS In both unadjusted and adjusted analyses, significantly fewer rural (60.2%, 95% CI: 57.5-62.9 and 64.5%, 95% CI: 61.3-67.6, respectively) than urban (74.9%, 95% CI: 73.4-76.4 and 72.9%, 95% CI: 71.1-74.6, respectively) mothers initiated breastfeeding (P

Background: Numerous efforts to promote breastfeeding resulted in a steady increase in the rates of breastfeeding initiation and duration. Increasing numbers of breastfeeding interventions are focused on breastfeeding maintenance and exclusivity and based on behavioral theories. Few studies critically analyzed the use of theories in breastfeeding intervention development and evaluation. Research aim: The aim of this critical review was to examine the existing literature about breastfeeding intervention, and investigate the role of theory in its development, implementation, and evaluation to provide future directions and implications for breastfeeding interventions. Methods: This critical review examined the existing breastfeeding intervention studies that used self-efficacy theories (SE), theory of planned behavior (TPB), and social cognitive theory (SCT) and were published during the past decade. Using five databases, studies in which researchers explicitly applied these three theories to frame the intervention were selected. Studies were critically reviewed for fidelity to theory in intervention design, delivery, and evaluation. Results: Eighteen studies were reviewed: nine SE-, five TPB-, and four SCT-based. Most interventions were focused on building mothers’ breastfeeding self-efficacy to improve breastfeeding exclusivity and duration. To achieve this goal, researchers who developed SE-based interventions used individual approaches, whereas other researchers who based studies on TPB incorporated social and environmental changes. SE-based studies were more likely to include theory-based instruments, but TPB- and SCT-based studies demonstrated less consistent choices of measurement. Researchers in most studies did not test the relationships between the proposed theoretical constructs and breastfeeding outcomes as guided by theories. Inconsistent outcomes resulted among the studies due to variations in study follow-ups. Conclusion: Sound applications of single or multiple theories demonstrate a great potential to help practitioners and researchers develop effective breastfeeding interventions and evaluate true impacts on positive breastfeeding outcomes.