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Tele-support in breastfeeding can be defined as any support provided by a service that connects health workers and/or lactation consultants with breastfeeding parents through video visits, although a telephone contact with the breastfeeding mother remains the first method of remote breastfeeding support. The tele-support in breastfeeding has increased significantly during the SARS-CoV2 pandemic worldwide and, given its effectiveness, may be maintained also after the pandemic. The Italian Society of Neonatology on the basis of: 1) two focus group studies on the tele-support in breastfeeding conducted in Italy with 11 Neonatal Intensive Care Unit nurses and 10 neonatologists, respectively, 2) a national survey on tele-support in breastfeeding addressing the Italian Neonatal Intensive Care Units, and 3) a review of the available experiences and literature, has provided a Position Statement, limitedly to the individual tele-support in breastfeeding. The Italian Society of Neonatology states that: 1) the tele-support in breastfeeding can be used when a consultation in person is not shortly available and may allow to select those situations that require an in-person visit; 2) the organization of a tele-support in breastfeeding session requires the use of a competent, dedicated healthcare staff (specifically trained and/or with adequate experience) and an appropriate methodology while preparing, running and concluding the support session. According to Italian Society of Neonatology the tele-support in breastfeeding may be an effective intervention to promote breastfeeding as a complementary method to the in-person assistance and should be possibly provided in an integrated manner by the Community Health Services and the Maternity Hospital. [ABSTRACT FROM AUTHOR]

Background: Between 2006 and 2016 the prevalence of overweight and obesity among children and adolescents aged 5–19 years in Peru increased from 22.7 to 27.0%. This investment case quantifies the economic impacts of childhood and adolescent overweight and obesity in Peru. It identifies and quantifies the potential impact of a set of new or expanded interventions that can strengthen current national efforts to prevent and reduce child and adolescent overweight and obesity. Methods: A deterministic Markov cohort model with a societal cost perspective estimated reductions in mortality and morbidity from implementing interventions to prevent and reduce child and adolescent overweight and obesity and the impact in savings in healthcare costs and gains in wages and productivity. Interventions identified through a review of published literature includes a school-based social marketing campaign, exclusive breastfeeding promotion and support, a healthy food and drink policy for school premises, and a 20% subsidy on fruits and vegetables for people living below the national poverty line. The return on investment (ROI) was calculated along with the estimated cost savings associated with the interventions. Analysis was conducted to test ROI sensitivity to changes in the key parameters and assumptions. Results: Between 2025 and 2092, the expected combined direct and indirect healthcare costs attributable to child and adolescent overweight and obesity in Peru are 210.6 billion USD. The direct healthcare costs are 1.8 billion USD, and the indirect costs are 208.8 billion USD. Expected savings for all interventions combined is 13.9 billion USD with a per-person savings of 12,089.8 USD. The expected ROI of the four interventions combined is 39.3 USD (30-years), 64.6 USD (50-years), and 164.1 USD (66-years) per one USD invested. Conclusions: The overweight and obesity epidemic among children and adolescents in Peru requires wide-ranging and expanded implementation of policies to achieve long-term reductions in prevalence. This study's findings show that the four priority interventions have high ROIs and can be used to guide policy to address the complex interplay of factors that contribute to the obesogenic environment. [ABSTRACT FROM AUTHOR]

Introduction: Breastfeeding challenges may be difficult to address within the constraints of a typical well-child visit. A team-based approach, including lactation consultants, can reduce physician workload, increase breastfeeding self-efficacy, and increase patient satisfaction. Continuity of care issues, including absent or delayed referrals, hinder patient access to skilled lactation support. Objectives: To examine the post-residency referral patterns of physicians to lactation consultants among physicians who did or did not participate in a brief outpatient lactation rotation at an academic lactation clinic during residency. Methods: A cross-sectional online survey of physicians who completed residency programs in pediatrics, family medicine, or medicine-pediatrics between 2013 and 2022 was conducted using REDCap; 46 valid responses were received. Results: Respondents who participated in a brief outpatient lactation rotation during residency refer patients to lactation consultants with significantly higher frequency than those who did not complete the rotation. Among those with lactation consultants in their geographic area, this relationship remained significant even when adjusting for residency type, gender, experience with an inpatient lactation consultant, and infant feeding attitudes using multiple linear regression. Conclusions: An outpatient lactation rotation during medical residency may increase the likelihood of referring to a lactation consultant in post-residency practice, which can improve breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Human milk feeding has generally been described using a heteronormative and cisnormative paradigm focusing on a mother and child dyad with the child nursing at the mother's breast and the father in a supportive role. However, there has been a paradigm shift that has emerged from the LGBTQI+ community that recognizes dynamic gender identities, gender roles, sexual orientations, and diverse family structures. Social workers can best provide support to people with dynamic and diverse gender roles and a variety of family structures. The purpose of this paper is to provide an overview of social work best practices, including de-sexed and gender-inclusive language, gender-affirming, and trauma-informed care in supporting lactation and infant feeding for LGBTQI+ families. This paper acknowledges and describes terminology that promotes equity and inclusivity in human milk feeding and provides examples of information and anticipatory guidance that social workers can use to protect, promote, and support human milk feeding in the LGBTQI+ community. [ABSTRACT FROM AUTHOR]

Limb-girdle muscular dystrophy (LGMD) poses unique challenges for women during pregnancy, necessitating comprehensive care and tailored management strategies. The present narrative review aims to examine the unique challenges and management strategies required for women with LGMD during pregnancy. With over 30 genetic subtypes identified and the potential for additional discoveries through advanced diagnostic techniques, preconception counseling plays a crucial role in informing prospective parents about reproductive risks and available options. Baseline assessments, including cardiac and pulmonary evaluations, are essential to guide antenatal care, alongside genetic testing for precise diagnosis and counseling. Optimizing maternal health through respiratory exercises, cardiac monitoring, and individualized exercise and nutrition plans is paramount to avoid potential complications. During pregnancy, close monitoring of maternal and fetal well-being is important, with collaborative care between obstetricians and specialists. An individualized approach to delivery mode considering factors such as muscle strength, pelvic size, and fetal presentation is crucial. While vaginal delivery has been proven to be possible, the need for an emergency cesarean delivery should always be kept in mind. Regional anesthesia is preferred, with proactive planning for potential respiratory support. Bupivacaine has been shown to be effective with epidural catheters that may be used for prolonged relief with opioids like morphine and fentanyl, while also evaluating the patients' respiratory function. Postpartum considerations include pain management, mobility support, breastfeeding assistance, and emotional support. Early mobilization and tailored physiotherapy regimens may promote optimal recovery, while comprehensive breastfeeding guidance is needed to address challenges related to muscle weakness. Access to mental health resources and support networks is essential to helping individuals cope with the emotional demands of parenthood alongside managing LGMD. By addressing the unique needs of pregnant individuals with LGMD, healthcare providers can optimize maternal and fetal outcomes while supporting individuals in their journey to parenthood. [ABSTRACT FROM AUTHOR]

Introduction: Early parenting services in Australia offer brief structured residential programs to address moderate to severe non‐psychotic mental health problems among women and unsettled infant/toddler behaviours. The aims were to (1) estimate the immediate and medium‐term impact of a five‐night psychoeducational residential early parenting program on postpartum depressive symptoms and (2) identify the factors associated with improvement or worsening of postpartum depressive symptoms after completing the program and six weeks post‐discharge. Methods: Audit of routinely collected medical record data from pre‐admission, pre‐discharge and post‐discharge assessments of a consecutive cohort of women admitted, with their infants/toddlers in a 15‐month period to Masada Private Hospital Early Parenting Centre. Data included structured questions assessing: demographic characteristics, access to family and social support, past and current mental health problems, reproductive and obstetric health, chronic health conditions, breastfeeding problems, coincidental major life events, health risk behaviours and infant/toddler feeding, sleeping and crying behaviours. Standardised instruments included the Partner Interaction after Birth Scale (PIBS), the MacLean Screening Instrument for Borderline Personality Disorder (MSI‐BPD), Modified Fatigue Assessment Scale (FAS) and selected items from the Karitane Parenting Confidence Scale. The primary outcomes were Edinburgh Postnatal Depression Scale scores at pre‐discharge and follow up assessments. Data were analysed using multinomial logistic regression models in which individual and psychosocial characteristics at pre‐admission were included as predictors of the likelihood of the changes of the outcomes from pre‐admission to pre‐discharge and follow up. Results: Complete data from 1220 of 1290 (95%) eligible women were available to assess pre‐admission to pre‐discharge and from 559 (45.8%) to assess pre‐discharge to six‐week follow‐up changes. The mean pre‐admission EPDS score was 11.7 (95% CI: 11.5; 12.0), pre‐discharge it was 7.1 (95% CI: 6.9; 7.4) and at six‐week follow up it was 5.7 (95% CI: 5.3; 6.1). We found that almost all women experienced a clinically meaningful and rapid improvement in depressive symptoms of at least this magnitude (reduction in mean EPDS scores of 4.6 points from pre‐admission to pre‐discharge (five nights) and a further reduction of 1.2 points pre‐discharge to follow up) (six weeks) and we identified an interpretable set of risk factors for symptoms that did not improve or worsened. The adverse outcomes were associated with having symptoms of borderline personality disorder, a partner experienced as lacking kindness and care, coincidental adverse events and having a child younger than six months. Conclusion: Residential early parenting programs, which take a psycho‐educational approach to strengthening caregiving skills, maximising agency, and reducing helplessness, have a rapid beneficial effect on women's postpartum depressive symptoms. These programs provide a valuable and effective component of comprehensive mental health services. Long‐term dialectical behaviour therapy is indicated for women with borderline personality disorder traits for whom early parenting programs alone are insufficient to improve depressive symptoms. [ABSTRACT FROM AUTHOR]

Background: Psychosocial predictors of breastfeeding and changes in those factors during pregnancy, along with the relationship of those changes with both breastfeeding and smoke use and exposure, are not well explored. Research Aim: The aim of this study was to identify distinct trajectories of psychosocial determinants of breastfeeding and smoking in pregnant women. Methods: We used a longitudinal study design and data from a randomized controlled trial conducted among smoke-exposed pregnant women and their infants. Participants were recruited early in pregnancy and were surveyed at ≤ 16 and 32 weeks gestation, delivery, 3 and 6 months postpartum for breastfeeding intentions, initiation, continuation, and smoke use and exposure. Psychosocial variables associated with breastfeeding were measured at baseline and 32 weeks gestation using the Mitra index, a structured questionnaire that assesses barriers and facilitators of breastfeeding intentions. Latent class growth analysis was performed using Mitra scores to identify distinct subgroups of participants with different trajectories. Sociodemographic characteristics, breastfeeding, and tobacco smoke use and exposure were compared across classes. Results: Three or four trajectories were identified for each of the six Mitra scores. Trajectories for all Mitra scores were associated with breastfeeding intention and initiation. Overall, Mitra, knowledge, self-efficacy, social support, and time barrier classes all differed by tobacco smoke use or exposure. Conclusion: Trajectories of breastfeeding knowledge, self-efficacy, social support, and time to breastfeed/social barriers are associated with tobacco smoke use and exposure during pregnancy. Encouragement to breastfeed and to cease and avoid tobacco smoke should start early in pregnancy, focusing on these determinants to improve health outcomes. [ABSTRACT FROM AUTHOR]

Background: Human milk feeding rates in the United Kingdom are a public health concern. Changes to United Kingdom policy and practice are needed to improve lactation support. These should be informed by those with lived experience of human milk feeding and those who provide support. Research Aim: The aim of this study was to identify research, policy, and practice priorities for increasing human milk feeding rates using insights from a wide range of stakeholders. A secondary aim was to evaluate the influence of a World Café on individual attendees and their interactions within the organizations and communities of which they are a part. Methods: The research employed a participatory qualitative design, incorporating a cross-sectional survey and World Café discussions. World Café is a novel approach to engaging stakeholders in discussion, resulting in consensus-building and participatory-driven recommendations. A pre-event survey was completed by a self-selected sample of 67 participants; 37 of these (55%) took part in World Café discussions or an online focus group. World Café discussions and the online focus groups were recorded and transcribed verbatim. Following the World Café, 12 participants (32%) completed a post-event survey, and eight (22%) completed an additional follow-up survey at 2 months. Results: Priority policy and practice changes were identified, including enhancing education, the need for dedicated funding for human milk feeding support, the need to include family within support provision, and the need to change policy regarding media representations of infant feeding. In addition, World Café methodology proved valuable for facilitating networking and instigating changes in relation to support. Conclusion: World Café generated stakeholder agreed-on priorities for research and policy. Many of the recommendations from historical policy and guidance continue to be areas for further development. [ABSTRACT FROM AUTHOR]

Background: Peripartum cardiomyopathy (PPCM) is a form of heart failure occurring towards the end of pregnancy or in the months following delivery. Concerns regarding the role of prolactin (the polypeptide hormone responsible for lactation) driving the pathogenesis of PPCM have led experts to discourage patients from breastfeeding; however, limited clinical data exist. We sought to (1) determine whether lactation was associated with less cardiac recovery and (2) assess the counseling about breastfeeding given to patients at the time of their initial diagnosis. Methods: Patients diagnosed with PPCM from 1999 to 2019 were identified through detailed chart review and demographic characteristics, comorbidities, outcomes, and lactation status were collected. Cardiac recovery was defined as left ventricular ejection fraction (LVEF) 55% or higher. A survey about breastfeeding and patient experience was administered by mail. Patients were only included in this analysis if definitive information about lactation status was documented. Results: Of 220 patients with confirmed PPCM, lactation status was known definitively in 54 patients; of these, 18 (33%) had breastfed for at least 6 weeks and 36 (67%) did not breastfeed. There were no significant differences in the breastfeeding and non-breastfeeding groups related to baseline LVEF, age, race, gestational diabetes, smoking, hypertensive disorders of pregnancy, and medication treatments. Despite similar baseline LVEF at the time of diagnosis, there was no statistically significant difference in cardiac recovery based on lactation status. In a subset of patients with severe cardiac dysfunction at the time of diagnosis, there remained no significant differences in recovery based on lactation status. Of the 34 survey respondents, 62% were told not to breastfeed due to their diagnosis or concerns regarding safety of medications, and none were encouraged to breastfeed. Conclusion: In this retrospective cohort, lactation was not associated with lower rates of myocardial recovery. Importantly, a majority of patients had received counseling that they should not breastfeed. Future studies of the role of lactation in PPCM are needed in order to better understand the impact of breastfeeding and improve patient counseling. [ABSTRACT FROM AUTHOR]

Background: Despite the well-documented benefits of breastfeeding, many first-time mothers encounter challenges. This study compares the efficacy of traditional face-to-face breastfeeding education (FtFE) versus video-based breastfeeding education (VBE) on improving breastfeeding practices and self-efficacy among primiparous mothers. Methods: Using a sequential, quasi-experimental design, 70 primiparous mothers were enrolled from a State Hospital in Turkey and systematically divided into two groups: FtFE (n = 35) and VBE (n = 35). The study spanned from January to June 2023 and the assessments of statuses of breastfeeding self-efficacy and skilles was performed in two distinct phases for each group. In the first phase, mothers were administered the scale of breastfeeding self-efficacy short (BSES) to measure baseline breastfeeding self-efficacy and the scale of LATCH tool to assess baseline breastfeeding skills. Subsequently, the research groups received FtFE and VBE interventions. In the second phase, 2 weeks later, mothers were interviewed again, and the BSES scale was re-administered to evaluate changes in their breastfeeding self-efficacy levels. Results: The pre-test scores of BSES and LATCH tools of the FtFE and VBE groups were found similar (p > 0.05). The post-test score of BSES of the FtFE was significantly higher than that of the VBE group (p > 0.05). In the FtFE group, the post-test score of BSES was significantly higher compared to the pre-test score of BSES (p < 0.05). In the VBE group, the post-test score of BSES was higher compared to the pre-test score of BSES but this difference did not reached statistical significance (p > 0.05). Conclusion and recommendations: FtFE is more effective in informing mothers compared to VBE. However, VBE also positively affectes breastfeeding success. Further research is needed to explore the long-term impacts of these educational approaches on breastfeeding compliance. [ABSTRACT FROM AUTHOR]

Background: Psychosocial factors such as maternal stress in lactating women were shown to be related to an increased risk of infantile colic because the infants can be affected through breast milk. Therefore, domestic violence against lactating mothers can be effective on the infants' health. It is also demonstrated that domestic violence against women has increased following the COVID-19 pandemic and quarantine. Therefore, this study aims to assess the relationship between domestic violence against breastfeeding women during COVID-19 and the incidence of infantile colic. Methods: This was a case-control study that was conducted on 356 lactating mothers who attended Bentolhoda Hospital in Bojnoord-Iran from November 2021 to August 2022. The participants were exclusively breastfeeding mothers who were under 6 months infants. Mothers with and without infantile colic infants were considered the case and control groups, respectively. Two questionnaires were used for data collection including a demographic questionnaire, and a questionnaire to assess domestic violence against women during the quarantine period of Corona pandemic. The data was analyzed using SPSS-V22 and Pearson Spearman correlation and linear regression tests. Results: The results showed that women in the case group had a significantly higher score for "sexual violence and restraint" than women in the control group [0.59 ± 0.34 versus 0.62 ± 0.25 (Mean ± SD), respectively] (P < 0.05). The chance of infantile colic was higher among the infants of mothers who experienced domestic violence, but it was not statistically significant (OR = 1.236, P = 0.573). Significant relationships were found between the infantile colic and the history of abortion (OR = 1.430, P = 0.028) and cesarean section (OR = 1.723, P = 0.044). Conclusion: Domestic violence during pregnancy can potentially increase infant colic through breast milk. Although our findings need more investigation, it can be recommended to plan the direction of screening for domestic violence and providing the necessary care and counseling to the parents in perinatal care services to prevent infantile colic and improve the infant's health. [ABSTRACT FROM AUTHOR]

ABSTRACT Aim Design Sample Methods Results Conclusions To explore public health nurses' competence (namely knowledge, skills, and attitudes) in relation to long‐term breastfeeding and their experience of the need for additional training on the subject.The study design was quantitative, descriptive, and cross‐sectional.Public health nurses (n = 270).Data were collected with the Long‐Term Breastfeeding Competence Scale (LBCS) online survey. Data analysis was done with Spearman's correlation analysis and binary logistic regression analysis.Slightly more than half of the respondents had a good level of knowledge and skills. The majority had a baseline positive attitude toward long‐term breastfeeding, but the attitude became more negative as the age of the breastfed child increased. Better competence was associated with younger age, parenthood, an additional degree in midwifery, and breastfeeding specialist certification. Knowledge and skills, and attitudes revealed a high correlation: the higher the knowledge and skills level, the more positive attitudes. Respondents with better knowledge and skills experienced more often the need for additional training on the subject.This study addresses that public health nurses lack competence in relation to long‐term breastfeeding. This may compromise the quality of breastfeeding guidance for families in healthcare settings. [ABSTRACT FROM AUTHOR]

ABSTRACT Background Methods Results Discussion Community doulas are perinatal health workers who provide peer education, resource navigation, and support during pregnancy, childbirth, and the postpartum period. Evidence suggests that doulas improve the experience of care, reduce cesarean birth, and improve breastfeeding outcomes. However, people with low incomes cannot access affordable community doula support in most states due to lack of insurance reimbursement. To determine the affordability of Medicaid reimbursement for doula services, there is a need to fill a gap in research that employs real‐world data and a return‐on‐investment (ROI) analysis approach.We conducted a ROI analysis from the healthcare perspective of an enhanced community doula intervention, Best Beginnings for Babies (BBB). Healthcare and program cost data were collected alongside clinical outcomes from a randomized controlled trial of routine maternity care at Boston Medical Center with and without BBB. ROI was calculated as the net healthcare savings divided by the investment costs. Post‐COVID‐19 program costing estimates were also performed.Average healthcare costs per patient were $18,969 for the BBB group compared with $20,121 for routine care, a savings of $1,152. BBB program costs were an average of $971 per person. There was an 18% ROI. Lower costs for the birth hospitalization and NICU stays accounted for the largest areas of savings. Per‐person program costs using proposed MassHealth fees produced a positive return on investment, although 2023 hospital doula program wages and salaries did not.The BBB‐enhanced community doula program was cost‐saving to payers and increased access to doula support for low‐income people. Even with post‐COVID‐19 increases in program costs, analysis demonstrated doula support was still financially feasible. This study should reassure budget‐conscious Medicaid payers that doula services are affordable. [ABSTRACT FROM AUTHOR]

Breastfeeding practices require improvement. We performed a systematic review of randomised controlled trials (RCTs) and analytic observational studies to assess effects of mobile applications (apps) aiming to support and promote breastfeeding targeting pregnant women, mothers of infants or their partners, on breastfeeding outcomes. We searched MEDLINE, EMBASE, Cochrane CENTRAL and Association of Computing Machinery Digital Library from 1 July 2008 to 29 November 2022, with lack of coverage of the most recent period before publication date being a limitation of this review. We performed meta‐analyses of findings from RCTs on primary outcomes, namely early breastfeeding initiation, exclusive and any breastfeeding rates. Joanna Briggs Institute tools were used for risk of bias assessment. Six RCTs, one quasi‐experimental and two cohort studies, mainly from high‐income countries, were included. Most studies focused on maternal app usage starting from pregnancy. One study targeted fathers as app‐users. Population characteristics, such as parity or delivery mode, apps scope of content and applied active components varied between studies. Main methodological limitations of studies were baseline differences between groups and lack of blinding. Compared to controls, app usage tended to increase the odds of exclusive breastfeeding. This nonsignificant effect was most pronounced at 1–1.5 months (n = 1294, odds ratio 1.45 (95% Confidence Interval, CI 0.83, 2.54), with considerable heterogeneity between studies [I2 77%]), but less so at 3 and 6 months post‐partum. The odds of early breastfeeding initiation, any breastfeeding at all time points were similar among groups. However, two cohort studies reported increased odds of exclusive and/or any breastfeeding at different time points. In conclusion, evidence is insufficient to show sustained beneficial effects of breastfeeding promotion and support through mobile apps on breastfeeding rates. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is a powerful public health intervention that produces long-term health benefits. However, in high-income countries such as Denmark, breastfeeding rates are suboptimal and unequally distributed across socio-economic positions. The 'Breastfeeding – a good start together' intervention, to promote longer duration of exclusive breastfeeding and reduce social inequity, was implemented in a cluster-randomised trial during 2022–2023 across 21 municipalities in two Danish regions. A process evaluation was conducted to assess the implementation, mechanisms of impact, and possible contextual factors affecting the intervention. Methods: The study was guided by the Medical Research Council's guidance for conducting process evaluations and employed a mixed-methods approach in a convergence design. Quantitative data: contextual mapping survey (n = 20), health visitor survey (n = 284), health visitor records from 20 clusters and intervention website statistics. Qualitative data: dialogue meetings (n = 7), focus groups (n = 3) and interviews (n = 8). Results: Overall, the intervention was delivered as planned to intended recipients, with few exceptions. Health visitors responded positively to the intervention, noting that it fitted well within their usual practice and enhanced families' chances of breastfeeding. Mothers expressed having received the intervention with few exceptions, and reacted positively to the intervention. Although health visitors were concerned about the potential stigmatisation of mothers receiving the intensified intervention, none of the interviewed mothers felt stigmatised. Contextual factors impacting the intervention implementation and mechanisms included staff and management turnover, project infrastructure and mothers' context, such as resources, social networks and previous experiences. The overall fidelity of the intervention delivery was high. Conclusions: Health visitors and families responded well to the intervention. Interventions aimed at enabling health care providers to deliver simplified and structured breastfeeding support, in alignment with support provided in other sectors of the health care system, may increase breastfeeding rates and reduce social inequity in breastfeeding, even in international contexts. Trial registration: Clinical Trials: NCT05311631. First posted April 5, 2022. [ABSTRACT FROM AUTHOR]

Objectives: The purpose of this study was to examine the relationship between maternal work and infant feeding practices and explore the moderating impact of parental stress. Methods: Prospective data on categorical hours worked and infant feeding practices were collected at 3 and 6 months postpartum in a prospective prenatal cohort of 95 women. Chi-square tests were used to compare change in proportion of exclusive breastfeeding from birth to 6 months and maternal work status. Results: Rates of exclusive breastfeeding significantly decreased from birth to 6 months, while the percent of mothers working outside of the home significantly increased from 3 to 6 months. At 6 months, mothers who worked full time pumped significantly more than their non-working counterparts. Multivariate logistic regression models were used to test the prediction of exclusive breastfeeding by maternal work, including sociodemographic covariates, and the moderating impact of parental stress. Results indicated that maternal education, paternal education, and maternal work significantly predicted exclusive breastfeeding at 6 months. Full time work (OR = 0.09, 95% CI = 0.01, 0.62) was associated with a decreased odds of exclusive breastfeeding. Additionally, higher maternal (OR = 1.44, 95% CI = 1.05, 1.97) and paternal (OR = 1.28, 95% CI = 1.00, 1.66) education was associated with an increased odds of exclusive breastfeeding. Maternal stress did not predict exclusive breastfeeding, nor did it have a moderating effect on the relationship between maternal work and breastfeeding. Conclusions for Practice: Future studies should investigate maternal work in more diverse birthing populations to better understand how families can incorporate breastfeeding as a primary infant feeding practice. Significance Statement: Maternal employment may be an impediment to exclusive breastfeeding. The majority of studies dichotomize employment, and far fewer measure number of hours worked per week. Findings of the current study add to the small literature on overtime work. Moreover, this study examines the practice of pumping breastmilk in relation to these work categories. Ultimately, our findings suggest that there is opportunity for future interventions to capitalize on breastfeeding education, policies to support both time for infant feeding at work or while working from home, and better options for pumping and storage of breastmilk in the workplace. [ABSTRACT FROM AUTHOR]

Background: The exclusive breastfeeding condition in China is not optimism now. Maternal breastfeeding self-efficacy stands as a pivotal factor influencing exclusive breastfeeding. Interestingly, studies have suggested that father support breastfeeding self-efficacy is a pivotal mediator in infant breastfeeding. Thus, the current research aimed to investigate the association between father support breastfeeding self-efficacy and exclusive breastfeeding at six weeks postpartum, and the influencing factors of father support breastfeeding self-efficacy. Methods: This research was structured as a multi-centre cross-sectional study, involving 328 fathers, whose partners were six weeks postpartum, and recruited from two public hospitals in Southeast China. Self-designed demographic questionnaires, namely, Father Support Breastfeeding Self-Efficacy Scale-Short Form, Breastfeeding Knowledge Questionnaire, Positive Affect Scale and the 14-item Fatigue Scale, were applied. Descriptive statistics, Chi-square test, logistic regression univariate analysis and multiple linear regression were used to analyse data. Results: Results indicate a significant difference between the infant feeding methods at six weeks postpartum and fathers with different levels of support breastfeeding self-efficacy (p < 0.05). Particularly, father support breastfeeding self-efficacy positively affected exclusive breastfeeding at six weeks postpartum after adjusting all the demographic characteristics of fathers (OR: 2.407; 95% CI: 1.017–4.121). Moreover, results show that the significant influencing factors of father support breastfeeding self-efficacy include breastfeeding knowledge, fatigue, positive affect, successfully experienced helping mothers to breastfeed, spousal relationships and companionship time. Conclusions: High-level father support breastfeeding self-efficacy effectively increased exclusive breastfeeding rate at six weeks postpartum. To enhance the exclusive breastfeeding rate, nurses or midwives can endeavour to design educational programmes or take supportive interventions customised for fathers, such as enhancing their breastfeeding knowledge education, reducing fatigue and mobilising positive emotions, thereby bolstering paternal self-efficacy in breastfeeding. [ABSTRACT FROM AUTHOR]

Background:Aim:Methods:Results:Conclusion:Breastfeeding is widely acknowledged as the optimal method of infant feeding. However, the percentage of South African mothers who exclusively breastfeed remains alarmingly low. Healthcare workers (HCWs) are pivotal in promoting breastfeeding; however, a deficiency in their knowledge, negative attitudes, and unfavourable practices can impede the promotion and support of breastfeeding.To assess the knowledge, attitudes, and support practices related to breastfeeding promotion of HCWs in the Motheo district, Free State province, compared with the 2016 WHO Guideline updates on HIV and infant feeding and 2018 Mother-Baby Friendly initiative guidelines.A quantitative analytical cross-sectional study involving paediatricians, obstetricians, general practitioners (GPs), and midwives was conducted using a self-administered questionnaire.Over half of the HCWs (59%) were able to define exclusive breastfeeding (EBF), with a significant majority of GPs (76.1%) and midwives (78.6%) recommending EBF up to six months, compared with only 10% of paediatricians and 25% of obstetricians (p < 0.001). Some 11.1% of the total group of HCWs reported that breastfeeding is contraindicated for HIV-infected mothers, while 15.4% were unsure of the recommendation for breastfeeding among HIV-infected mothers. A higher proportion of midwives, compared with other HCWs, felt highly confident in providing breastfeeding advice (p < 0.001). Additionally, more than half (56%) of HCWs had not completed the 20-hour WHO Lactation Management Training, and 55% believed their prior breastfeeding training was not sufficient to support and educate breastfeeding mothers.Regular breastfeeding training of HCWs on the latest breastfeeding guidelines is necessary to equip HCWs with the knowledge and competence to successfully promote, protect, and support breastfeeding. [ABSTRACT FROM AUTHOR]

Context Combining or supplementing breastfeeding with formula feeding, also called mixed milk feeding (MMF), is a common infant feeding practice. However, there is no well-established MMF evidence-base for informing and guiding parents. A better understanding of the reasons why mothers practice MMF may facilitate identification of efficient strategies for supporting exclusive breastfeeding, and/or opportunities to prolong breastfeeding, at least partially. Objective An updated systematic literature review was undertaken with the primary aim of gaining a deeper understanding of the reasons why mothers choose MMF. Data Sources Six databases were searched for relevant articles published in English from January 2012 to January 2022. Data Extraction Two reviewers independently performed the screenings and data extraction, and any differences were resolved by a third reviewer. Data from 138 articles were included, 90 of which contained data on MMF reasons/drivers, and 60 contained data on infant age and/or maternal demographic factors associated with MMF. Data Analysis A total of 13 different unique MMF drivers/reasons were identified and categorized according to whether the drivers/reasons related to perceived choice, necessity, or pressure. Risk of bias was evaluated using the Quality Assessment Tool of Diverse Studies and the JBI Systematic Reviews tool. Several different terms were used to describe and classify MMF across the studies. The most commonly reported reasons for MMF were related to a perception of necessity (39% of drivers, eg, concerns about infant's hunger/perceived breast milk insufficiency or breastfeeding difficulties), followed by drivers associated with perceived choice (34%; eg, having more flexibility) and perceived pressure (25%; eg, returning to work or healthcare professionals' advice). This was particularly true for infants aged 3 months or younger. Conclusion The key global drivers for MMF and their distribution across infant age and regions were identified and described, providing opportunities for the provision of optimal breastfeeding support. A unified definition of MMF is needed in order to enable more comparable and standardized research. Systematic Review Registration PROSPERO registration no. CRD42022304253. [ABSTRACT FROM AUTHOR]

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Different initiatives have been implemented along with the results from and recommendations of multiple international meetings to improve breastfeeding. The most common interventions to improve breastfeeding are education and counseling. Although studies are reporting that breastfeeding education and counseling programs improve breastfeeding results, the lack of breastfeeding rates to reach the targeted levels suggests that there is a requirement for a different approach. In addition to these results, a paradigm shift in education and counseling, which are the most frequently used methods to improve breastfeeding, is necessary. Hence, the philosophy of HypnoBreastfeeding has emerged. This study addresses the origin and development of HypnoBreastfeeding philosophy, its concepts, and the correlations between the concepts and the relevant philosophical claims. [ABSTRACT FROM AUTHOR]

Background: Understanding the timing of food introduction in infants is essential for promoting optimal complementary feeding practices. However, existing studies often rely on cross-sectional data, limiting the ability to capture age-specific patterns. We aimed to describe food introduction during the first year of life by identifying patterns related to age at food introduction and associated factors in a cohort of Brazilian infants. Methods: Data were collected through standardized questionnaires administered to mothers via face-to-face interviews during the infant's first month of life and at 3, 6, 9, and 12 months of age. Additionally, two telephone interviews were conducted at 2 and 4 months of age. Information regarding food intake was assessed using a list of 48 foods, with two key aspects recorded: whether the food was introduced (yes/no) and the age at introduction. To define food introduction patterns, we employed k-means cluster analysis. Hierarchical Poisson multiple regression was employed to examine the associations between sociodemographic, biological, and healthcare factors and patterns of food introduction. Results: Three distinct patterns were identified and named according to their main characteristics: Pattern 1 – "Low Infant Formula and Timely CF Introduction"; Pattern 2 – "High Infant Formula and Early CF Introduction"; and Pattern 3 – "High Infant Formula and Later Ultra-processed Food Introduction". Breastfeeding at six months showed a positive association with Pattern 1 (PR = 1.40; 95% CI = 1.10–1.80), while bottle use at four months was negatively associated with Pattern 1 (PR = 0.68; 95% CI = 0.53–0.87). No variables studied exhibited an association with Pattern 2. For Pattern 3, higher prevalences were observed among children whose mothers were aged < 20 years (PR = 1.54; 95% CI = 1.13–2.01) or > 34 years (PR = 1.42; 95% CI = 1.04–1.93). Not receiving guidance on the recommended duration of breastfeeding and complementary feeding during prenatal care was associated with a higher prevalence of children in this pattern (PR = 1.35; 95% CI = 1.01–1.80). Conclusions: We identified three distinct patterns of age at food introduction in the study population, although none perfectly aligned with Brazilian or WHO dietary recommendations. These findings underscore the need for targeted interventions to promote timely and healthy complementary feeding practices in Brazilian infants. [ABSTRACT FROM AUTHOR]

Background: The International Code of Marketing of Breast-milk Substitutes, or 'the Code,' sets standards to regulate marketing of commercial milk formula (CMF) to protect breastfeeding. World Health Organization member states are advised to legislate the Code into national law, but understanding of its implementation outcomes is limited. This systematic review aimed to examine implementation outcomes in countries implementing the Code as national law. Methods: We systematically searched five academic databases in September 2022 for articles published in English from 1982 to 2022. We double-screened titles/abstracts and then full texts for eligible articles reporting implementation outcomes of the Code in 144 eligible countries. We used the Mixed Methods Appraisal Tool for quality assessment and synthesized data thematically. We applied the Proctor et al. framework to guide synthesis of implementation outcomes, organizing our findings according to its taxonomy. Results: We included 60 eligible articles of the 12,075 screened, spanning 28 countries. Fifty-seven articles focused on legal compliance, 5 on acceptability, and 1 on feasibility. Compliance was assessed across multiple sources, including mothers, health workers, media, points of sale, and product labels. Maternal exposure to CMF promotion remained widespread, with reports of mothers receiving free samples and coupons, and encountering media advertisements. Compliance of health workers varied across countries, with many reporting contact with CMF companies despite legal prohibitions. Public hospitals generally showed better adherence to the national law than private ones. While implementing the Code as national law effectively regulated the promotion of CMF for infants aged 0–12 months in public settings and in the media, it remains insufficient in addressing the promotion of unregulated products like growing-up milk, which are often marketed through emerging strategies such as cross-promotion and digital advertising. Point-of-sales compliance was inconsistent, with many countries reporting non-compliant price-related promotions. Conclusion: To enhance legal compliance, robust monitoring and reporting systems are necessary. Utilizing technology-assisted solutions for monitoring compliance can be an option for countries with limited human resources. Adequate training for health workers and communication strategies targeting shop managers about national law are also essential in enhancing their acceptability and compliance. [ABSTRACT FROM AUTHOR]

Background: Returning to work is a barrier to breastfeeding. Although the Department of Labour Protection and Welfare (DLPW) in Thailand encourages employers to initiate a breastfeeding corner – a designated area where mothers can express their breastmilk privately and comfortably – in their workplace to support lactating employees, little is known about what kind of support mothers would like to continue breastfeeding after returning to work. This research aimed to explore mothers' needs and wishes for breastfeeding support in the workplace. Methods: This qualitative study used focus group discussions to collect data from female employees who had a child aged 6 − 24 months in factories that had initiated a breastfeeding corner between 1 October 2021 and 30 September 2022. The focus group discussions were held between June and July 2023. We employed semi-structured questions relating to breastfeeding support in their workplaces (e.g., a breastfeeding corner, lactation break, providing information or knowledge), baby food marketing in workplaces, and recommendations to improve breastfeeding support for working mothers. We applied thematic analysis to analyse the data. Results: Nineteen mothers from five factories located in Bangkok and surrounding provinces participated in the study. All participating factories had a breastfeeding corner in a first aid room, and no lactation breaks were given. Therefore, lactating employees spent time during their breaks pumping breastmilk. Furthermore, the lactating employees did not acquire any information or education about breastfeeding from the workplace during pregnancy or after delivery but rather obtained this from health system services and digital platforms. They also received support from family, health professionals, and colleagues when they returned to work after giving birth. Lactating employees would like employers to provide specific lactation breaks. They also wanted credible information or knowledge about breastfeeding to be provided during pregnancy and after giving birth, together with other social support. Conclusions: The Department of Labour Protection and Welfare, the Department of Health, and the Thai Breastfeeding Centre Foundation could collaborate with other relevant organisations to support employers in establishing breastfeeding support in their workplace. [ABSTRACT FROM AUTHOR]

Introduction. Breast cancer is currently the most frequently detected cancer in women and the primary cause of cancer‐related deaths globally. The incidence of breast cancer has significantly increased in countries across sub‐Saharan Africa, counting Ethiopia. There are multiple determinants of breast cancer, a few of these can be changeable whereas others are not. Evidence suggests that breastfeeding, which is a changeable determinant, reduces breast cancer risk. However, there is a lack of evidence specifically linking the duration of breastfeeding to breast cancer risk. To date, no study has been conducted on the association between the duration of breastfeeding and the likelihood of breast cancer among Ethiopian women. Objective. The aim of this study was to evaluate the relationship between breastfeeding duration and breast cancer risk in Ethiopian mothers who had breastfed, taking into account other significant determinants. Methods. A hospital‐based case‐control study was carried out in Bahir Dar, Ethiopia, involving 203 women (70 cases and 133 controls). Face‐to‐face interviews were performed using a standardized, validated questionnaire that assessed various sociodemographic, reproductive, lifestyle, and dietary characteristics. Differences between cases and controls were evaluated using the chi‐square test. The associations among factors were examined through bivariate and multivariable binary logistic regression, with results presented as odds ratios and 95% confidence intervals. Results. The multivariable investigation revealed that an inverse relationship between breastfeeding duration and breast cancer risk. Mothers who breastfed for a longer period had a 93% lower risk of breast cancer (AOR = 0.07; 95% CI: 0.021–0.21) compared to those who breastfed for a shorter duration. Younger mothers had a 95% lower likelihood of developing breast cancer (AOR = 0.05; 95% CI: 0.003–0.91) than older mothers. Additionally, mothers with sedentary behaviour were 10.53 times more likely to develop breast cancer (AOR = 10.53; 95% CI: 5.21–21.36) than those who were moderately or highly active. Mothers who experienced chest therapy were 6.43 times more likely to develop breast cancer (AOR = 6.43; 95% CI: 3.20–13.90) compared to those who had not. Conclusions. Interventions such as breastfeeding counselling and promoting the recommended duration of breastfeeding are crucial in minimizing the risk of breast cancer. Enhancing physical activity should also be viewed as a vital approach for lowering breast cancer risk. Additionally, healthcare professionals need to limit exposure to chest radiation therapy to reduce the likelihood of breast cancer. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic contact restrictions considerably changed maternal visiting contacts during the time in which breastfeeding is initiated. We wanted to know how maternity ward staff and mothers rated the conditions of starting breastfeeding under contact restrictions. Methods: In the Breastfeeding in North Rhine-Westphalia (SINA) study, Germany, 2021/22, chief physicians as well as ward staff from 41 (out of 131) maternity hospitals (82 members of the healthcare sector in total) were surveyed by telephone concerning structural and practical conditions for breastfeeding support before and during the pandemic; 192 (out of 426 eligible) mothers answered an online-questionnaire about their breastfeeding experiences at 2 weeks and 2 months after birth. Results: In almost all of the hospitals, visits were restricted due to the pandemic, with the exception of the primary support person. After more than one year of pandemic experience, the ward staff were convinced that the restrictions were mostly positive for the mothers (97.6%) and for the ward staff themselves (78.0%). A total of 80.5% of the ward staff would maintain the restrictions beyond the pandemic. The mothers themselves mostly rated the restrictions in the hospital as being just right; moreover, many mothers voluntarily maintained the restrictions at home, at least in part. Conclusions: The unprecedented visiting restrictions in hospitals during the pandemic were like an "experiment" born out of necessity. Restricting visiting arrangements may be an underestimated beneficial component for the development of the mother-infant dyad in perinatal breastfeeding care, particularly in healthcare systems where almost all births occur in the maternity hospital. Trial registration: German Clinical Trials Register (DRKS) (DRKS00027975). [ABSTRACT FROM AUTHOR]

Background: The benefits of exclusive breastfeeding (EBF) have been universally documented, with evidence of positive impacts on a child's optimal growth, development, and survival. However, EBF practices in Nepal have fluctuated and declined over the last 25 years. In addition to the individual factors of mothers and infants, EBF practices are affected by multiple community-level factors. Understanding these factors is essential for designing breastfeeding promotion programs to improve child nutritional status in Nepal. This study investigated the individual- and community-level determinants of EBF practices among young infants aged 0–5 months in Nepal. Method: We used the dataset from the Nepal Demographic and Health Survey 2022. Information on EBF in the past 24 h was available for 540 infants aged 0–5 months. A multilevel mixed-effect logistic regression was used to identify individual- and community-level factors associated with EBF among infants aged 0–5 months in Nepal. Results: The 24-hour prevalence of EBF among infants aged 0–5 months was 57.46% (95% confidence interval (CI): 52.18, 62.57). The infant's age was inversely associated with EBF prevalence at the individual level. Compared with infants aged < 1 month, infants aged three months (adjusted odds ratio (AOR): 0.14, 95% CI: 0.05, 0.40), four months (AOR: 0.11, 95% CI: 0.04, 0.28), and five months (AOR: 0.07, 95% CI: 0.03, 0.20) were less likely to receive EBF. At the community level, community-level variables such as ≥ 4 ANC visits coverage, maternal employment status, and poverty level were generated by aggregating the individual characteristics in a cluster and were categorized using quartiles into low ("< 25%"), moderate (25–75%), and high (≥ 75%). Mothers from communities with moderate ≥ 4 ANC visits (AOR: 3.30, 95% CI: 1.65, 6.57) and high ≥ 4 ANC visits (AOR: 2.70, 95% CI: 1.40, 5.22) coverage had higher odds of EBF practices than did those from communities with low ≥ 4 ANC visits coverage. Similarly, communities with moderate (AOR: 2.67, 95% CI: 1.34, 5.30) and high (AOR: 2.34, 95% CI: 1.10, 4.99) levels of maternal employment status and moderate levels of poverty (AOR: 2.20, 95% CI: 1.13, 4.28) were associated with a higher likelihood of EBF practices. Subnational level variation was evident, with infants in Lumbini province having lower odds of EBF (AOR: 0.32, 95% CI: 0.13, 0.77) relative to Koshi province. Approximately 9% of the variation in EBF practices was observed among mothers while mapping across clusters in this study. Conclusion: Various individual- and community-level factors influence the uptake of EBF in Nepal, underscoring the need to improve the approaches and strategies of EBF programs. This study highlighted the significant association of community-level factors (≥ 4 ANC visits coverage, poverty level, and maternal employment status) with EBF among infants under 6 months. It revealed approximately 9% variability in EBF across clusters. Future efforts to promote EBF should focus on older infants and communities with low poverty levels and low coverage of recommended ≥ 4 ANC visits. Furthermore, context-specific adaptation of such efforts might be required considering the variation observed between the communities in the present study. [ABSTRACT FROM AUTHOR]

Background: The exclusive breastfeeding rates is low in some countries. Low breastfeeding rates results in higher healthcare expenses and adverse health outcomes for individuals and society. Co-parenting is effective in promoting breastfeeding as it involves shared responsibility and collaboration between parents in raising children. However, the current breastfeeding co-parenting intervention programs exhibits significant variations in components, timing, and duration across studies. An evidence-based breastfeeding co-parenting intervention program is essential for enhancing breastfeeding-related outcomes. Objective: To develop an evidence-based breastfeeding co-parenting intervention program for healthcare providers to guide parents with primiparas on breastfeeding. Method: To form an initial version of the intervention program, a systematic literature review was conducted to consolidate information on current intervention programs. Two rounds of Delphi method were followed to gather expert comments for the program modification to establish the formal version. Results: Fourteen articles published between 1995 and 2022 were screened. Details of these researches, including starting and ending time, duration and specific contents, were integrated to developed the initial program. Then, six experts completed the two rounds consultation with a positive coefficient of 85.71%, coefficient judgment basis of 0.93, familiarity coefficient of 0.87, authority coefficient of 0.90 and the Kendall's W of 0.62. Finally, an evidence-based breastfeeding co-parenting intervention program was constructed in this study, consisting of breastfeeding co-parenting courses, individual counselling and a father's support group. Conclusion: This research developed a breastfeeding co-parenting intervention program for healthcare providers to guide primiparous parents to improve breastfeeding rates. Through a systematic literature review and Delphi method with good reliability, the program integrates breastfeeding courses, individual counseling, and a father's support group. Future research will focus on evaluating its impact and scalability to benefit maternal and infant health globally. Trial registration: ChiCTR.org.cn (ChiCTR2300069648). Registration date: 2023-03-22. [ABSTRACT FROM AUTHOR]

Background: On 6 February 2023, an Mw 7.8 earthquake struck southern and central Türkiye and north-western Syria, affecting the lives of 4.6 and 2.5 million children, respectively. In such crises, infants who are dependent on commercial milk formula (CMF) face increased vulnerability to diseases and malnutrition as safe preparation of CMF becomes difficult and sometimes impossible. The Operational Guidance on Infant and Young Child Feeding in Emergencies (OG-IFE) provides guidance on protecting and supporting recommended infant and young child feeding and minimizing the risks that come with CMF feeding. In addition, the International Code of Marketing of Breastmilk Substitutes (the Code) ensures adequate nutrition for infants by protecting and promoting breastfeeding and ensuring the proper usage of CMF. This study aims to document violations of the Code and the OG-IFE during the earthquake relief efforts to help strengthen infant and young child feeding emergency responses and inform future disaster relief policies. Methods: Data was collected from 6 February to 10 March 2023 through Internet sources. Social media, news websites, and the Emergency Nutrition Network forum were used for data collection. Turkish content was translated into English for analysis, with a focus on donation-related information and Code violations related to baby food and infant feeding. Results: A total of 40 reports on CMF, complementary food, and feeding equipment donations were collected. Three main types of violations of the OG-IFE and the Code were identified, with the majority of them being incidences of individuals, humanitarian organizations, and government agencies seeking or accepting donations. Infant formula companies continued to violate the Code by donating large quantities of CMF and feeding equipment to the Turkish Red Crescent, government agencies, and disaster relief infant and young child feeding (IYCF) coordination authorities. Conclusions: These incidents reflected a systematic violation of the Code and non-compliance with the OG-IFE. Globally accepted IYCF standards and recommendations were not consistently followed due to fragmented early responses. There is a critical need to step up efforts to ensure appropriate and safe IYCF practice protecting and supporting breastfed and non-breastfed infants in emergencies. [ABSTRACT FROM AUTHOR]

Background: Parents can engage in several behaviours with regard to early childhood allergy prevention (ECAP). These can be related to diet of mother/child and the modification of the home environment; not all of them are justified by current evidence. Previous studies showed that parental health literacy (HL) is related to favourable health behaviours directed at the child. This study aimed to investigate the causal effect of mothers' HL on ECAP behaviours and to test different moderators of this effect. Methods: One thousand six hundred sixty-two mothers participating in the KUNO-Kids health study in the area of Regensburg, Germany were surveyed on HL (assessed via the health care scale of the Health Literacy Survey-EU questionnaire, HLS-EU-Q47) and ECAP behaviours implemented during pregnancy and the child's first year of life. Patterns in ECAP behaviours were identified by latent class analysis. Multinomial regression modelling was performed with HL as exposure, ECAP as outcome variable, allergy risk, parental competence and bonding, anxiety and depression as moderators as well as potentially confounding variables. Results: We identified three classes of ECAP behaviours (class 1: „breastfeeding " N = 871; class 2: „allergen-avoidance " N = 490; class 3: „mixed behaviours " N = 301). In univariable as well as fully adjusted regression models, compared to class 1, class 2 was negatively, and class 3 was not associated with HL. None of the tested moderating variables altered the association between HL and ECAP significantly. Conclusions: We found an effect of mothers' HL on ECAP behaviours: lower HL of mothers increased allergen-avoiding behaviour directed at their child, while decreasing the chance of exclusive breastfeeding. Improving HL could contribute to the implementation of recommended ECAP behaviours in families, especially to the reduction of allergen-avoiding behaviours. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding self-efficacy is a woman's self-belief and confidence in her perceived ability to breastfeed. This modifiable determinant is strongly associated with breastfeeding initiation, exclusivity, and duration. It is unclear how important the timing of breastfeeding self-efficacy measurement and interventions are. The prenatal period appears underexplored in the literature and yet a prenatal focus provides increased opportunity for breastfeeding self-efficacy enhancement and further potential improvement in breastfeeding outcomes. This scoping review aims to synthesise the evidence on prenatal breastfeeding self-efficacy, describing for the first time the theoretical frameworks, measurement tools, and interventions used in the prenatal period. Methods: 8 databases were searched using the PCC framework (Problem: breastfeeding, Concept: self-efficacy, Context: prenatal period). From 4,667 citations and 156 additional sources identified through grey literature and snowballing, data were extracted from 184 studies and 2 guidance documents. All were summarised descriptively and narratively. Results: Just over half (57%) of included studies stated their theoretical underpinning, with Bandura's Self-Efficacy Theory / Dennis' Breastfeeding Self-Efficacy Framework predominant. Only half of intervention studies incorporated theory in their design. More intervention studies were undertaken in the past decade than previously, but the level of theoretical underpinning has not improved. Prenatal interventions incorporating theory-led design and using components addressing the breadth of theory, more frequently reported improving breastfeeding self-efficacy and breastfeeding outcomes than those not theory-led. Intervention components used less frequently were vicarious or kinaesthetic learning (52.5%) and involvement of social circle support (26%). The Breastfeeding Self-Efficacy Scales were the most common measurement tool, despite being designed for postpartum use. Overall, issues were identified with the late prenatal timing of breastfeeding self-efficacy investigation and the design, content and phraseology of measurements and interventions used in the prenatal period. Conclusion: This review provides novel insights for consideration in the design and conduct of breastfeeding self-efficacy studies in the prenatal period. Future research should aim to be theory-led, commence earlier in pregnancy, and embed the breadth of self-efficacy theory into the design of interventions and measurement tools. This would provide more robust data on prenatal breastfeeding self-efficacy's role in impacting breastfeeding outcomes. [ABSTRACT FROM AUTHOR]

Objective: Self-efficacy is important in supporting breastfeeding behaviors and enhancing breastfeeding practices. This study aimed to explore research trends, identify knowledge gaps, and provide a comprehensive overview of breastfeeding self-efficacy. Materials and Methods: Data were retrieved from the Scopus online database on March 20, 2024, encompassing articles published in English between 2000 and 2023. The search strategy focused on articles containing the keywords “self-efficacy,” “breastfeeding,” and “mother.” VOSviewer version 1.6.19 was then used to map the data and visually identify research clusters. Results: The analysis yielded a significant increase in breastfeeding self-efficacy research over the past 2 decades. The United States led in publication numbers (117 documents), while Canada dominated citations (2792 citations). Furthermore, the analysis identified 8 critical themes in 8 different clusters, encompassing various aspects of breastfeeding, including determinants, behaviors, interventions, and mental health considerations during lactation, and employed research methodologies. One crucial gap identified in this study pertains to low breastfeeding social support. This includes a lack of support from peer groups, social networks, and social media platforms. Addressing this gap can be a valuable reference point for developing future interventions to bolster breastfeeding self-efficacy. Conclusion: Bibliometric analysis contributes to exploring research trends, identifying knowledge gaps, and providing a comprehensive overview of breastfeeding self-efficacy. [ABSTRACT FROM AUTHOR]

Background: While an abundance of evidence exists regarding infectious outcomes in children as they relate to the short-term benefits of breastfeeding, there is limited evidence related to similar impacts beyond one year and after breastfeeding has stopped. Specifically, little is known about the long-term benefits of breastfeeding for acute health outcomes after infancy, particularly in Nigeria. Methods: The Nigeria Demographic and Health Survey data was used in this study. We utilized data (n = 5391) on children who had stopped breastfeeding for at least 12 months before the survey. Breastfeeding duration was categorized into 1–6 months, 7–12 months, 13–18 months, 18–24 months, and > 24 months. Any recent incident of acute respiratory illness in children was operationalized using the responses to related questions (recent incidents of fever, cough, running nose, and short, rapid, or difficulty breathing in children). Adjusted logistic regression was used to estimate odds ratios, and statistical significance was determined at p ≤ 0.05. Results: Post-infancy and after breastfeeding had stopped, the odds of recent acute respiratory illness were significantly less (AOR = 0.37, 95% CI [0.15–0.79], p = 0.04) in children breastfed for 19–24 months compared to those breastfed for 1–6 months. No significant association was found between the other durations and ARI post-infancy (p > 0.05). Conclusions: These findings indicate that breastfeeding for up to 24 months has a long-term protective effect from an acute health condition that contributes to the high under-five mortality rates recorded for decades in Nigeria specifically, and more broadly, in sub-Saharan Africa. [ABSTRACT FROM AUTHOR]

Increasing scholarly attention has been paid to the reproductive injustices experienced by Indigenous women. However, the breastfeeding experiences of Indigenous women have infrequently been explored. This study uses a qualitative description research approach to explore the breastfeeding experiences of Indigenous women members of a non-federally recognized tribe in the Gulf South. Key themes included: 1) Shifting generational practices; 2) Lack of institutional resources; 3) Inadequate support from healthcare providers; and 4) Institutional and community supports for breastfeeding. These findings highlight the need for increased institutional and community support, and breastfeeding education, so that Indigenous women can reach their breastfeeding goals. [ABSTRACT FROM AUTHOR]

Background: Baby-Friendly Hospitals (BFH) in the United States (U.S.) are associated with higher breastfeeding initiation rates. Breastfeeding is associated with a myriad of favorable health outcomes for both mother and child. However, few studies have examined the impact of breastfeeding support resources, like BFH, on breastfeeding initiation among minority groups. The objective of this study is to evaluate the association between birth at a BFH and the breastfeeding initiation in Florida. Methods: A retrospective exploratory analysis of BFH and birth certificate data (n=3,321,022) from 2004-2022 from Florida was conducted. A logistic regression model was fit to examine the main and interaction effects of race/ethnicity and birth at a BFH on breastfeeding initiation. Time was included as a sequential variable to adjust for temporal effects. Covariates known to impact breastfeeding initiation rates, including maternal education and prenatal care utilization, were included in multivariate analyses. Results: Of births at a BFH, 89% of mothers initiated breastfeeding. Comparatively, of the births at a non-BFH, 84% of mothers initiated breastfeeding. Giving birth at a BFH increased the odds of breastfeeding initiation by at least 42% (OR = 1.42, CI: 1.38-1.45, p <0.001, Hispanic White mothers) in unadjusted models and 10% (OR = 1.10, CI: 1.03-1.17, p = 0.004, other non-Hispanic mothers) in adjusted models. However, BFH may have differential effects by maternal race and ethnicity. In the multivariate model adjusting for relevant covariates, non-Hispanic Black mothers who gave birth at a BFH were 27% less likely to initiate breastfeeding compared to mothers that gave birth at a non-BFH (OR = 0.73, CI: 0.61- 0.88, p < 0.001; interaction term for BFH*maternal race/ethnicity). Similar trends were observed for Hispanic Black, Hispanic White, and other non-Hispanic mothers. Conclusions: Giving birth at a BFH is associated with greater odds of breastfeeding initiation. However, when considering the race and ethnicity of mothers, these odds significantly decline, indicating a need to further explore the barriers that may preclude non-Hispanic Black and Hispanic moms from receiving the same benefits of BFH. Significance: What We Already Know: Despite the known benefits, breastfeeding rates in the U.S. remain below optimal levels, especially among racial and ethnic minority populations. Initiatives like the Baby-Friendly Hospital Initiative (BFH) have been shown to improve breastfeeding initiation and exclusivity rates, but racial and ethnic disparities persist. What This Study Adds: This study finds that while BFH hospitals are associated with increased breastfeeding initiation overall, minority mothers—particularly non-Hispanic Black mothers—experience lower breastfeeding initiation rates compared to their non-Hispanic White counterparts, even at BFH hospitals. The study highlights the need for culturally competent and racially conscious breastfeeding support to close the breastfeeding gap and improve health outcomes for minority populations. [ABSTRACT FROM AUTHOR]

Aim: To explore what Internet‐based breastfeeding peer support offers to breastfeeding parents. Design: Integrative review. Data Sources and Review Methods: A systematic literature search was conducted in March 2024 using the following electronic databases: CINAHL, The Cochrane Library, PubMed/MEDLINE and PsycINFO. Database searches yielded 717 results. Two researchers removed the duplicates (n = 256) and screened the remaining titles (n = 461), abstracts (n = 197) and full texts (n = 60) independently. Eventually, 19 studies were included in the review. The chosen studies had qualitative (n = 11), quantitative (n = 6), or mixed methods designs (n = 2) and were published between 2015 and 2024. Qualitative content analysis was conducted. Results: The main categories were supplying support that is responsive to the needs of parents and belonging to a breastfeeding community. The parents looked for and received breastfeeding support, advice, information, emotional support, reassurance and access to shared experiences from various online breastfeeding peer support groups. The support groups helped them in their breastfeeding decisions, thus making a difference in their breastfeeding experience. The support groups created breastfeeding communities for these parents and they were able to bond with others, feel like they belonged and share experiences. Additionally, these breastfeeding communities helped to normalize various breastfeeding practices. Conclusion: Breastfeeding peer support groups can offer parents the support and guidance they seek and a sense that they are part of a breastfeeding community. However, it is vital these groups are efficiently moderated to ensure the advice parents receive is evidence‐based and the support is encouraging. Impact: These findings show that well‐moderated online breastfeeding peer support can offer parents high‐quality support. It is essential for health care professionals to be aware of the various options available in order to recommend high‐quality support groups for breastfeeding parents. Reporting Method: PRISMA. Patient or Public Contribution: This was an integrative review therefore no patient or public contribution was necessary. [ABSTRACT FROM AUTHOR]

Aim: To evaluate the outcomes of a low‐cost hospital‐grade breast pump hire program for women experiencing financial hardship with infants in neonatal intensive care. Design: A multi‐method evaluation including data audits and surveys. Methods: Twenty‐four electric breast pumps were purchased and rented to mothers at a cost of $1/day. To be eligible, mothers needed to have given birth to an infant <32 weeks and/or <1500 g and self‐identified as experiencing financial hardship. Data were collected by (1) a retrospective audit to evaluate infant feeding and clinical outcomes at hospital discharge; (2) prospective telephone surveys to evaluate women's satisfaction with the program; and (3) analysis of the breast pump register to determine any loss or damages. Results: Twenty‐four mothers of 26 infants participated in the program. More than half of the infants were exclusively breastmilk fed at hospital discharge, and more than three‐quarters were fed a combination of breastmilk and formula. Women who intended to formula feed were supported to provide breastmilk to their infants in the first few weeks of life. Most participants were highly satisfied with the program. Women reported that accessibility to a hospital‐grade breast pump improved their ability to provide expressed breastmilk to their infants. Most participants were 'extremely satisfied' with the performance of the breast pump. One‐quarter of the women reported that they would have exclusively formula‐fed if they did not have access to the breast pump hire program. The audit of the equipment register showed no reported technical issues, loss or damages. Conclusion: The findings suggested that the low‐cost breast pump hire program supported equitable care, increasing women's ability to provide expressed breastmilk for their infants. Impact: Providing access to low‐cost hospital‐grade breast pumps to mothers of vulnerable infants is likely to prevent poor infant clinical outcomes and improve women's care satisfaction. Public or Patient Contribution: Nil. [ABSTRACT FROM AUTHOR]

Breastfeeding (BF) is associated with improved maternal and infant health outcomes. However, underserved populations have limited access to lactation support. Our urban pediatric primary care practice partnered with WIC to integrate a BF peer counselor (BFPC) into newborn visits. To study the association of BF duration with (1) BFPC integration, (2) initial infant feeding methods (IFM). This is a retrospective cohort study of patients receiving BFPC support matched with those that did not based on race, ethnicity, and insurance. IFM were compared using chi-square. BF duration was compared using a t-test. These variables were compared across IFM using ANOVA. A cohort of 111 infant-mother dyads received BFPC support and 222 dyads did not (7/09/2019–4/25/2022). There was no significant difference in feeding methods between these groups. Compared to infants whose IFM was exclusive BF, fewer infants who initially used formula or both formula and breastmilk were exclusively BF at 2-month (55.8%, 8.2%, 10.9%), 4-month (54.8%, 6.3%, 14.5%), and 6-month visits (54.8%, 4.3%, 14.1%) (p < 0.001). There was a significant association between IFM and duration of any and exclusive BF (Formula only: 1 week; BF and Formula: 3 weeks; Exclusive BF: 14 weeks; p < 0.001). A significant association was found between IFM and duration of BF. Early formula introduction was negatively associated with BF duration. The prenatal period may therefore be optimal for initiating BF support. Although there was no association between BFPC and BF duration, additional benefits of this intervention should be explored. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion This study estimated the healthcare cost savings for the government due to the prevention of gastroenteritis (GE) infections and lower respiratory tract infections (LRTI) in the first year of life, attributed to an increase in the exclusive breastfeeding rate at 4 months in Hong Kong.The model used the best available data inputs, with uncertainty considered using probabilistic sensitivity analysis. We additionally assessed the impact of neonatal jaundice (NNJ) on the economic benefits of increasing exclusive breastfeeding rates.During 2010–2019, five admissions for GE and three admissions for LRTI per 1000 births would have been prevented in the first year of life if the exclusive breastfeeding rate at 4 months increased from the actual levels (~15–30%) to 50%, resulting in annual healthcare cost savings of USD1.05 (95% CI 1.03–1.07) million/year. The cost saving would reach USD1.89 (95% CI 1.86–1.92) million/year if the exclusive breastfeeding rate at 4 months increase to 70%. However, if higher NNJ admissions during 7–90 days related to more exclusive breastfeeding are considered, the cost saving would reduce by 60%.Our findings can guide policymakers in allocating budget and resources for breastfeeding promotion in Hong Kong. The prevention of unnecessary NNJ admissions would maximise the economic benefits of exclusive breastfeeding at 4 months. [ABSTRACT FROM AUTHOR]

Background: Improving the quality of breastfeeding counselling delivered by primary care providers can improve breastfeeding outcomes and ultimately reduce mortality and morbidity of children and mothers. Accurate data on coverage and quality of primary care breastfeeding counselling is essential for monitoring progress; however, global and national indicators are limited. To help address this gap, this study validated indicators of receipt and quality of breastfeeding counselling during routine consultations for infant care at seven primary health facilities across Kosovo. Methods: Mothers' reports of breastfeeding counselling received during routine consultations for their infants (0–12 months of age) were collected by exit interview in 2019 and 2021 (n = 609). Responses were compared against direct observation of their consultation using a structured checklist (reference standard) by a trained third-party observer at the primary care facility. We assessed 13 indicators; ten were related to the receipt and content of breastfeeding counselling, and three were specific to the provider's interpersonal skills. We calculated sensitivity, specificity, and area under the receiver operating curve (AUC) to determine individual-level reporting accuracy. Results: Ten indicators had an agreement rate above 70% and seven indicators had high overall individual-level validity (AUC ≥ 0.7). High prevalence indicators recorded high sensitivity and low specificity, and the inverse for low prevalence indicators. More subjective indicators were less reliable, e.g., mothers over-reported the prevalence of all three indicators related to providers' interpersonal skills. Conclusions: This study offers evidence on breastfeeding counselling quality by validating maternal reports of whether a provider discussed breastfeeding, the clinical content of that counselling, and how it was delivered. It is also situated in a primary care setting within a fragile state of which there is limited evidence. We observed that mothers reported accurately when asked directly to recall breastfeeding counselling services received. However, there is a need to further validate subjective questions about interpersonal skills and other measures for the 'experience of care' quality dimension. [ABSTRACT FROM AUTHOR]

Background: This paper outlines a pilot of a new memory aide for breastfeeding conducted in the Northeast of England and North Cumbria between April and August 2023. The United Kingdom has some of the lowest rates of breastfeeding, particularly in the Northeast of England, and as such more needs to be done to support mothers to breastfeed for as long as they would like to. Good support from health professionals can be effective in influencing decisions to breastfeed as well as helping to ensure initiation and continuation of breastfeeding but there is evidence to suggest that professionals and students do not always feel adequately trained and it is here, where memory aides may have value. Methods: Key breastfeeding practitioners and educators were brought together to select one of two memory aides for principles of attachment for effective breastfeeding. The selected memory aide, LATCHS, was piloted with 57 participants with a key role in promotion and support of breastfeeding in the Northeast of England and North Cumbria. Results: Participants conveyed mixed views about the proposed memory aide with more experienced staff reporting more favourable opinions than student midwives and early years practitioners. Experienced staff felt the new memory aide would complement an early memory aide, CHINS, which focused on principles of positioning. Discussion: Findings of the pilot indicate there is a role for a mnemonic to help practitioners understand, recall, and retain theory around attachment for effective breastfeeding and that memory aides can play an important role in complementing existing approaches to education and practice. The participants felt the proposed memory aide had some limitations and suggested important ways for it to be improved, particularly in adding an E to reflect the expecting wording. This produced the final memory aide: LATCHES. Conclusion: Using data from the pilot, the memory aide was refined, and the final version LATCHES agreed for wider dissemination. Future research is needed to understand the value of LATCHES on the wider breastfeeding workforce and whether any future improvements can be made to enhance its utility. [ABSTRACT FROM AUTHOR]

Background: Following a decline in perinatal HIV transmission from 20% to 10% between 2010 and 2017 in Kenya, rates have since plateaued with an estimated 8% transmission rate in 2021. Between October 2016 and September 2021, Family AIDS Care & Education Services (FACES) supported HIV care and treatment services across 61 facilities in Kisumu County, Kenya with an emphasis on service strengthening for pregnant and postpartum women living with HIV to reduce perinatal HIV transmission. This included rigorous implementation of national HIV guidelines and implementation of 3 locally adapted evidence-based interventions targeted to the unique needs of women and their infants. We examined whether these person-centered program enhancements were associated with changes in perinatal HIV transmission at FACES-supported sites over time. Methods and findings: We conducted a repeated cross-sectional study of annually aggregated routinely collected documentation of perinatal HIV transmission risk through the end of breastfeeding at FACES-supported facilities between October 2016 and September 2021. Data included 12,599 women living with HIV with baseline antenatal care metrics, and, a separate data set of 11,879 mother–infant pairs who were followed from birth through the end of breastfeeding (overlapping with those in antenatal care 2 years prior). FACES implemented 3 interventions for pregnant and postpartum women living with HIV in 2019: (1) high-risk clinics; (2) case management; and (3) a mobile app to support treatment engagement. Our primary outcome was infant HIV acquisition by the end of breastfeeding (18 to 24 months). We compared infant HIV acquisition risk in the final year of the FACES program (2021) to the year before intervention scale-up and following implementation of the "Treat All" policy (2018). Mother–infant pair loss to follow-up was a secondary outcome. Program data were aggregated by year and site, thus in multivariable regression, we adjusted for site-level characteristics, including facility type, urban versus rural, number of women with HIV in antenatal care each year, and the proportion among them under 25 years of age. Between October 2016 and September 2021, 81,172 pregnant women received HIV testing at the initiation of antenatal care, among whom 12,599 (15.5%) were living with HIV, with little variation in HIV prevalence over time. The risk of infant HIV acquisition by 24 months of age declined from 4.9% (101/2,072) in 2018 to 2.2% (48/2,156) in 2021 (adjusted risk difference −2.6% [95% confidence interval (CI): −3.7, −1.6]; p < 0.001). Loss to follow-up declined from 9.9% (253/2,556) in 2018 to 2.5% (59/2,393) in 2021 (risk difference −7.5% [95% CI: −8.8, −6.2]; p < 0.001). During the same period, UNAIDS estimated rates of perinatal transmission in the broader Nyanza region and in Kenya as a whole did not decline. The main limitation of this study is that we lacked a comparable control group. Conclusions: These findings suggest that implementation of person-centered interventions was associated with significant declines in perinatal HIV transmission and loss to follow-up of pregnant and postpartum women. Francesca Akoth Odhiambo and colleagues examined whether person-centered interventions were associated with changes in perinatal HIV transmission at FACES-supported sites in Kisumu County, Kenya. Author summary: Why was this study done?: Globally and in Kenya, ongoing perinatal HIV transmission persists at unacceptable rates despite the availability of highly effective treatment to prevent infant HIV acquisition. In the era of "Treat All," limited programmatic exist that describe perinatal transmission through to the end of breastfeeding for mother–infant pairs in routine healthcare settings. The Family AIDS Care & Education Services (FACES) program aimed to eliminate perinatal HIV transmission via person-centered interventions to support vulnerable women in Kisumu Kenya. What did the researchers do and find?: We used programmatic data from FACES to assess whether implementation of person-centered interventions for pregnant and postpartum women living with HIV was associated with reduced perinatal transmission and improved engagement in care between October 2016 through September 2021 in Kisumu County Kenya. We found that both 24-month perinatal transmission and loss to follow-up declined over the 5-year period when similar declines were not observed in the wider Nyanza region that encompasses Kisumu County. What do these findings mean?: These findings suggest that person-centered services have the potential to meaningfully improve clinical outcomes for pregnant and postpartum women living with HIV and to reduce perinatal HIV transmission. The use of routine healthcare data enhances the generalizability of our findings to other high maternal HIV prevalence settings. The main limitation of this study is the lack of a similar control group that did not receive these interventions. Thus, the trends we observed could be due to factors not associated with the interventions. [ABSTRACT FROM AUTHOR]

Objective: Pregnancy care can improve maternal pregnancy outcomes. Cluster nursing, an evidence-based, patient-centered model, enhances pregnancy care, can provide patients with high-quality nursing services, has been widely used in clinical practice in recent years. However, most previous studies evaluated cluster nursing program only for a single clinical scenario. In this study, we developed and implemented a antenatal cluster care program for various prenatal issues faced by puerpera to analyze its application effect. Methods: This is a historical before and after control study. 89 expectant mothers who had their prenatal information files registered in the outpatient department of a grade III, level A hospital from June 2020 to September 2021 were finally enrolled in observation group, and received prenatal cluster management. Another set of 89 expectant mothers from January 2019 to December 2019 were included in the control group and received traditional routine prenatal management. The effect of cluster nursing management on maternal delivery and postpartum rehabilitation was evaluated and compared between the two groups. Results: Compared with the control group, the observation group had a significantly higher natural delivery rate, better neonatal prognosis, higher rates of exclusive breastfeeding, lower incidence of postpartum complications, shorter postpartum hospital stay, better postpartum health status, and higher satisfaction with nursing services. Compared with before intervention, the SAS and SDS scores of the observation group showed significant improvement after intervention. Conclusion: Antenatal cluster care is beneficial to improve maternal and neonatal outcomes, and can have positive effects on natural pregnancy and breastfeeding, while improving the multimedia health education ability of medical care and emphasizing the importance of social support. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Impact What Problem Did the Study Address? What Were the Main Findings? Where and on Whom Will the Research Have an Impact? Reporting Method Patient or Public Contribution To explore the factors influencing help‐seeking behaviours amongst mothers with low socioeconomic status at pregnancy, 1 month postpartum and 3 months postpartum.A prospective cohort study was conducted from September 2022 to August 2023. A total of 209 mothers aged 21 years and above, with low socioeconomic status and irrespective of parity, were recruited from a local hospital using convenience sampling. Self‐administered questionnaires were used to collect data at (1) third trimester of pregnancy, (2) 1 month postpartum and (3) 3 months postpartum. Multiple regression analysis was used to identify significant factors influencing help‐seeking behaviour at 3 months postpartum. Sub‐analyses were conducted between primiparous mothers and multiparous mothers. General linear model repeated measures were used to identify longitudinal trends in outcomes of help‐seeking behaviour.Help‐seeking behaviour at pregnancy and 1 month postpartum, sources of social support at 3 months postpartum, birth order of the child, attendance of antenatal classes, paternal involvement in feeding and changing diapers and mode of delivery significantly predicted mothers' help‐seeking behaviour at 3 months postpartum. Amongst primiparous mothers, help‐seeking behaviour at pregnancy at 1 month, social support at 3 months postpartum, employment in part‐time jobs and exclusively breastfeeding their infant were significant factors in influencing their help‐seeking behaviours at 3 months postpartum. For multiparous mothers, help‐seeking behaviour at pregnancy and 1 month postpartum, number of hours of antenatal class attended, Malay ethnicity, educational background, parental satisfaction at 3 months postpartum and infant bonding at both time points were significant factors influencing their help‐seeking behaviours at 3 months postpartum.Primiparous mothers with low socioeconomic status who underwent caesarean section exhibited less help‐seeking behaviours. Attendance of antenatal classes and greater paternal involvement in infant care encouraged mothers with low socioeconomic status to help‐seeking behaviours. A tailored approach is needed to support mothers with low socioeconomic status by providing additional support in improving the accessibility of antenatal classes and involving fathers in infant care. Mothers with low socioeconomic status tend to exhibit lower help‐seeking behaviours due to limited support and access to care services. First‐time mothers who underwent caesarean section, did not attend antenatal classes, and had husbands uninvolved in feeding and diaper changing were significantly less likely to seek help in the third month postpartum. One and 3 months postpartum are crucial time points when mothers with low socioeconomic status could benefit from additional support. Hospitals should explore online informational resources, forums, teleconsultations and virtual antenatal classes as possible alternative options to improve accessibility for mothers with low socioeconomic status. Mothers with low socioeconomic status and healthcare providers of mothers with low socioeconomic status will benefit from the findings of this research. This study was conducted within the Singapore context. Findings could be generalizable to other cultural contexts with similar multi‐ethnic populations. STROBE checklist.No patient or public contribution. [ABSTRACT FROM AUTHOR]

The purpose of this study was to evaluate the effect of male partners' targeted antenatal and postnatal breastfeeding education and support interventions on maternal breastfeeding self-efficacy in central Ethiopia. A two-arm parallel group cluster randomized controlled trial was carried out among couples in a community setting in the Hadiya Zone, central Ethiopia. A total of 408 couples from 16 clusters were randomly assigned to either the intervention (n = 204) or control group (n = 204). The analysis was conducted using an intention-to-treat approach. A generalized estimating equation (GEE) analysis was done to evaluate the effectiveness of the interventions. Maternal BFSE was significantly higher among mothers whose male partner received breastfeeding education and support interventions than those who did not receive the interventions (130 (65.0%) v 90 (45.9%), P < 0.001). The net effect of the intervention on improving maternal BFSE was 20.9% [95% CI: 16.9%–24.9%]. In the GEE model, maternal BFSE was 48% [RR = 1.48, 95% CI: 1.23, 1.79] higher in the intervention group than the control group. Involving male partners in breastfeeding promotion activities can enhance the mother's self-efficacy and confidence in breastfeeding. Trial registration: ClinicalTrials.gov identifier (NCT number), NCT05173454. Registered on 30/12/2021. [ABSTRACT FROM AUTHOR]

Introduction: In Singapore, the healthcare system strongly encourages mothers to breastfeed and breastfeeding initiation is near-universal. However, sustained breastfeeding rates remain low. Little is currently known about how breastfeeding information disseminated in the healthcare setting influences women's breastfeeding experiences. This study explored breastfeeding promotion and educational resources from the perspective of Singaporean mothers and healthcare workers. Methods: Semi-structured interviews with 14 mothers of infants aged 1– 5 months and who had used obstetric, maternity, and/or paediatric services in Singapore, and 20 health workers with experience in general, obstetric, maternal, or paediatric care recruited using purposive sampling methods. Interview transcripts were coded using an inductive method. Results: Breastfeeding communications were viewed as too moralized and too focused on nudging women to breastfeed, with relatively little emphasis on timely, practical information or solutions for mothers unable to latch. Hence mothers tended to rely on alternative resources such as blogs. They lacked in-depth knowledge of the benefits of breastfeeding and viewed it as detrimental to maternal mental wellbeing due to the perceived stress and guilt when experiencing difficulties, notably with milk supply and latching, and from the inability to meet breastfeeding expectations. Husbands, older family members, confinement nannies, and employers were considered influential individuals to encourage breastfeeding, but they commonly discouraged breastfeeding due to social and cultural factors which led to supplementation with formula. Conclusion: For better breastfeeding outcomes, future informational sources on breastfeeding should be morally neutral, practical, set realistic expectations for the demands of breastfeeding, and target influential individuals such as family members, confinement nannies and employers. [ABSTRACT FROM AUTHOR]

Background: Breastfeeding is crucial for child health and development, yet its practices and their implications on children's nutritional status vary. Aim & Objectives: This study aimed to explore the determinants of breastfeeding practices and their effects on the nutritional status of children in an Indian population. Methodology: This study is conducted in four villages of Udaipur district, Rajasthan, among 120 mother-child pairs. The data is collected on anthropometric measurements, socioeconomic factors, and child health parameters. Results: We found that only 37.5% of children were exclusively breastfed. Significant associations were observed with birth month (P=<0.001) and nearly significant associations with mode of delivery (P=0.06) and undernutrition (P=0.07). Conclusion: These findings highlight the need for larger-scale research to further investigate these associations and enhance breastfeeding practices to improve child health outcomes. [ABSTRACT FROM AUTHOR]

Adolescent mothers face numerous challenges while breastfeeding. This study aimed to assess the breastfeeding needs of adolescent mothers. For this systematic review, Web of Science, PubMed, Scopus, Cochrane Library, SID and Magiran databases were searched. The initial search yielded 2,290 studies, of which 41 were included in this review. Adolescent mothers' breastfeeding requirements were grouped into 8 categories: (1) social support from healthcare providers, partners and families; (2) school support for breastfeeding mothers; (3) breastfeeding counselling based on cultural sensitivities; (4) educational assistance from health providers for adolescent mothers' families; (5) changing harmful cultural values and judgments about adolescent mothers' breastfeeding; (6) additional home or outpatient visits in the days following hospital discharge; (7) peer support and counselling; and (8) economic needs. To promote breastfeeding, policymakers and healthcare providers should devise specifically tailored programmes and interventions to cater to the specific requirements of adolescent mothers. [ABSTRACT FROM AUTHOR]

This study was conducted at Beijing Luhe Hospital, from January 2022 to October 2023. The aim of this study was to investigate the influence of malnutrition on the vulnerability to neonatal pneumonia. The study aimed to investigate the concept that malnourished children, who are admitted to the Neonatal Intensive Care Unit and pediatric hospital within the first 28 days of life, may have reduced immune responses, which could potentially increase their susceptibility to respiratory infections. The sample consisted of 150 newborns and a comprehensive dataset was gathered encompassing demographic information, birth weight, gestational age, breastfeeding status, clinical manifestations of pneumonia, and nutritional status. The nutritional assessment was performed utilizing the growth guidelines established by the World Health Organization. The results highlighted a notable correlation between malnutrition and heightened susceptibility to newborn pneumonia. Infants who were malnourished had a greater prevalence of pneumonia, extended durations of hospitalization, increased reliance on mechanical ventilation, and raised rates of mortality in comparison to their well-nourished counterparts. The practice of exclusive breastfeeding was identified as a protective factor that decreased the incidence of pneumonia. Additionally, early nutritional interventions have been found to dramatically enhance the prognosis. These findings emphasized the crucial importance of nutritional status in the management of newborn pneumonia and support the incorporation of nutritional evaluations and interventions into neonatal care. [ABSTRACT FROM AUTHOR]