Search

Objectives: Interest in expanding access to the birth center model is growing. The purpose of this research is to describe birth center staffing models and business characteristics and explore relationships to perinatal outcomes. Methods: This descriptive analysis includes a convenience sample of all 84 birth center sites that participated in the AABC Site Survey and AABC Perinatal Data Registry between 2012 and 2020. Selected independent variables include staffing model (CNM/CM or CPM/LM), legal entity status, birth volume/year, and hours of midwifery call/week. Perinatal outcomes include rates of induction of labor, cesarean birth, exclusive breastfeeding, birthweight in pounds, low APGAR scores, and neonatal intensive care admission. Results: The birth center model of care is demonstrated to be safe and effective, across a variety of staffing and business models. Outcomes for both CNM/CM and CPM/LM models of care exceed national benchmarks for perinatal quality with low induction, cesarean, NICU admission, and high rates of breastfeeding. Within the sample of medically low‐risk multiparas, variations in clinical outcomes were correlated with business characteristics of the birth center, specifically annual birth volume. Increased induction of labor and cesarean birth, with decreased success breastfeeding, were present within practices characterized as high volume (>200 births/year). The research demonstrates decreased access to the birth center model of care for Black and Hispanic populations. Conclusions for Practice: Between 2012 and 2020, 84 birth centers across the United States engaged in 90,580 episodes of perinatal care. Continued policy development is necessary to provide risk‐appropriate care for populations of healthy, medically low‐risk consumers. [ABSTRACT FROM AUTHOR]

Summary: Background: The complex multifactorial nature of childhood obesity makes community interventions difficult to evaluate using traditional approaches; innovative methods are needed. Objective: To evaluate the impact of various interventions targeting childhood obesity‐related behaviours, and classified as using a micro‐level (e.g., home visitation programs) or macro‐level (e.g., business practices) strategy, on obesity among children enrolled in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC). Methods: We simulated a population of 1500 children enrolled in WIC, with specific diet, physical activity, breastfeeding behaviours and body mass index z‐scores (BMIz), following them from age 2 to 5 years. Results: Combined interventions targeting breastfeeding appeared to be moderately effective, reducing BMIz by 0.03 (95% CI −005, −0.01). Two strategy‐specific interventions, home visitation programs and business practices targeting obesity‐related behaviours, appeared to be moderately effective at reducing BMIz by 0.04 (95% CI −0.06, −0.02) and 0.02 (95% CI −0.04, 0.00), respectively. Contrary to expectation, combining all micro and macro interventions appeared to have no impact or moderately increased the proportion of obesity/overweight among children. Conclusion: Interventions targeting breastfeeding behaviour were most effective when both micro and macro strategies were implemented. Interventions targeting obesity‐related behaviours in general were effective for two strategies, home visitation and business practices. [ABSTRACT FROM AUTHOR]

Background: Exclusive breastfeeding (EBF) for six months is recommended as one of the most important ways to support child health and survival, particularly during the COVID-19 pandemic. However, breastfeeding women encountered several obstacles during the pandemic. The purpose of this study was to conduct a survey to document breastfeeding practices, EBF rates and associated factors with six month exclusive breastfeeding during the second wave of the coronavirus outbreak in Thailand. Methods: A mixed-methods design that included a cross-sectional survey (n = 390) and semi-structured in-depth interviews (n = 15) was carried out between August and November 2021. Participants were women aged ≥ 15 years who had given birth within 6–12 months before data collection and delivered in three public hospitals in the top three provinces with the most severe COVID-19 outbreaks. Results: The median duration of EBF was four months (interquartile range, IQR: 1–6 months) and 37.4% of women exclusively breastfed for six months. From binary logistic regression models, several personal factors were associated with exclusive breastfeeding for six months including being a housewife (AOR 2.848; 95% CI 1.512, 5.367), perceived sufficiency of family income (AOR 2.502; 95% CI 1.362, 4.594), working from home/business (AOR 2.071; 95% CI 1.074, 3.995), breastfeeding intention (AOR 1.162; 95% CI 1.116, 1.210), and maternal age (AOR 0.932; 95% CI 0.882, 0.986). From qualitative interviews, women who were able to exclusively breastfed during the outbreak explained five themes that were a protective shield; I have to save money, I could spend all my time with my baby and breastfeed, spousal support is valuable, and opportunity to avoid the obstructed beliefs about exclusive breastfeeding. Conclusions: Mothers with higher socioeconomic status and who were unemployed/worked from home and had support structures in place were able to successfully EBF during the COVID-19 outbreak. Healthcare providers can better support breastfeeding if they provide informational support and allow family members to participate in breastfeeding programs, especially spouses who provided key emotional and tangible support during pandemic. [ABSTRACT FROM AUTHOR]

In response to suboptimal breastfeeding rates, North Dakota added a provision to SB 2344 (public indecency legislation) creating an Infant Friendly business designation for employers providing specified lactation accommodations to employees. However, there has been no evaluation of this designation to determine effectiveness. The purpose of this article is to examine the impact of the Infant Friendly business designation in North Dakota on breastfeeding continuation rates within the context of the social ecological model (SEM). Between November 2016 and March 2017, an 85-item online questionnaire, designed using the SEM, was distributed to working women across the state using various sampling methods. T tests, analysis of variance, and regression were used to analyze results. Designated (intervention) and nondesignated (control) businesses were targeted. There was no statistically significant difference in breastfeeding duration between designated and nondesignated businesses. There was a 2-month difference in duration between continually designated businesses and those with lapsing designations. Twenty-eight percent of the women working for Infant Friendly businesses were aware that their businesses were designated, indicating a lack of awareness regarding the designation. The designation is a starting point for worksite breastfeeding support. A policy promotion plan based on the SEM targeting individual awareness and employee education may improve the designation's effectiveness. [ABSTRACT FROM AUTHOR]

Abstract The increase in female labor force participation (FLFP) in the paid labor market since the mid-1900s is one of the most pronounced family transitions and increasingly a global phenomenon. While this may improve income and bargaining power of the women, it may also increase stress and decrease time with children. Using the Chitwan Valley Family Study in Nepal, we explore the consequences of this transition for children's health by combining newly collected data on child health outcomes, quarterly data on women's employment, and data on households and neighborhoods. Regression models were used to estimate the relationship between FLFP and child health, exploring both the type (wage, salary, or own business) and timing of work across the child's first five years for 860 children born to 793 mothers. After adjusting for a robust set of individual, household, and community factors, FLFP is associated with worse child health. We find evidence this is largely due to wage labor, the more common but "lower quality" and lower paying type of work women do. Measures of current work are generally inadequate at capturing this negative relationship. Breastfeeding may be an important piece of this story as mothers that worked during the first six months of a child's life were less likely to exclusively breastfeed during this period. Recognizing the challenges faced by working mothers in LMICs and paying attention to the quality of work will be critical as more women enter the workforce. Highlights • Maternal employment is associated with worse child health outcomes in rural Nepal. • Wage labor, the most common but low-skilled labor, drives this association. • Earnings are positively related to child health. • Women are unlikely to earn enough from wage labor to offset their time away. • Work timing in relation to child age conditions the relationship with child health. [ABSTRACT FROM AUTHOR]

In order to assess the prevalence of point‐of‐sale promotions of infant and young child feeding products in Phnom Penh, Cambodia; Kathmandu Valley, Nepal; Dakar Department, Senegal; and Dar es Salaam, Tanzania, approximately 30 retail stores per site, 121 in total, were visited. Promotional activity for breastmilk substitutes (BMS) and commercially produced complementary foods in each site were recorded. Point‐of‐sale promotion of BMS occurred in approximately one‐third of sampled stores in Phnom Penh and Dakar Department but in 3.2% and 6.7% of stores in Kathmandu Valley and Dar es Salaam, respectively. Promotion of commercially produced complementary foods was highly prevalent in Dakar Department with half of stores having at least one promotion, while promotions for these products occurred in 10% or less of stores in the other three sites. While promotion of BMS in stores is legal in Senegal, it is prohibited in Cambodia without prior permission of the Ministry of Health/Ministry of Information and prohibited in both Nepal and Tanzania. Strengthening legislation in Senegal and enforcing regulations in Cambodia could help to prevent such promotion that can negatively affect breastfeeding practices. Key messagesEven in countries such as Cambodia, Nepal and Tanzania where point‐of‐sale promotion is restricted, promotions of BMS were observed (in nearly one‐third of stores in Phnom Penh and less than 10% in Dar es Salaam and Kathmandu).Limited promotion of commercially produced complementary foods was evident (less than 10% of stores had a promotion for such foods), except in Dakar Department, where promotions were found in half of stores.Efforts are needed to strengthen monitoring, regulation and enforcement of restrictions on the promotion of BMS.Manufacturers and distributors should take responsibility for compliance with national regulations and global policies pertaining to the promotion of breastmilk substitutes. [ABSTRACT FROM AUTHOR]