References

Abou-ElWafa HS, El-Gilany A-H Maternal work and exclusive breastfeeding in Mansoura, Egypt. Family Practice. 2019; 36:(5)568-572 https://doi.org/10.1093/fampra/cmy120

Ajzen I The theory of planned behavior. Organ Behav Hum Decis Process. 1991; 50:(2)179-211 https://doi.org/10.1016/0749-5978(91)90020-T

Ajzen I The theory of planned behavior: frequently asked questions. Hum Behav Emerg Tech. 2020; 2:(4)314-324 https://doi.org/10.1002/hbe2.195

Alzaheb RA Factors influencing exclusive breastfeeding in Tabuk, Saudi Arabia. Clin Med Insights: Pediatrics. 2017; 11 https://doi.org/10.1177/1179556517698136

Bajoulvand R, González-Jiménez E, Imani-Nasab M-H, Ebrahimzadeh F Predicting exclusive breastfeeding among Iranian mothers: application of the theory of planned behavior using structural equation modeling. Iran J Nurs Midwifery Res. 2019; 24:(5) https://doi.org/10.4103/ijnmr.IJNMR_164_18

Binns CW, Fraser ML, Lee AH Defining exclusive breastfeeding in Australia. J Paediatr Child Health. 2009; 45:(4)174-180 https://doi.org/10.1111/j.1440-1754.2009.01478.x

Buckland C, Hector D, Kolt GS, Fahey P, Arora A Interventions to promote exclusive breastfeeding among young mothers: a systematic review and meta-analysis. Int Breastfeed J. 2020; 15:(1) https://doi.org/10.1186/s13006-020-00340-6

Buyken AE, Karaolis-Danckert N, Günther A, Kersting M Effects of breastfeeding on health outcomes in childhood: beyond dose-response relations. Am J Clin Nutrition. 2008; 87:(6)1964-1965 https://doi.org/10.1093/ajcn/87.6.1964

Chen S, Mao W, Jiang W Can Jiangsu province achieve the health-related sustainable development goals and healthy Jiangsu 2030 goals? A systematic analysis on the current situation and projected attainment. Lancet. 2018; 392 https://doi.org/10.1016/S0140-6736(18)32690-4

De Roza JG, Fong MK, Ang BL, Sadon RB, Koh EYL, Teo SSH Exclusive breastfeeding, breastfeeding self-efficacy and perception of milk supply among mothers in Singapore: a longitudinal study. Midwifery. 2019; 79 https://doi.org/10.1016/j.midw.2019.102532

Dina RA, Djuwita R The role of exclusive breastfeeding in reducing pneumonia prevalence in children under five. J Gizi Pangan. 2021; 16:(28)89-98

Duan Y, Yang Z, Lai J Exclusive breastfeeding rate and complementary feeding indicators in China: a national representative survey in 2013. Nutrients. 2018; 10:(2) https://doi.org/10.3390/nu10020249

Du L, Li W, He L Analysis of breastfeeding status and influencing factors of infants under 6 months in Shanghai. Maternal Child Health Care China. 2018; 33:(19)4488-4492

Galipeau R, Dumas L, Lepage M Perception of not having enough milk and actual milk production of first-time breastfeeding mothers: is there a difference?. Breastfeed Med. 2017; 12:(4)210-217 https://doi.org/10.1089/bfm.2016.0183

Guo H, Zhou R, Li M The use of Kumpfer's resilience framework in understanding the breastfeeding experience of employed mothers after returning to work: a qualitative study in China. Int Breastfeed J. 2022; 17:(1) https://doi.org/10.1186/s13006-022-00459-8

Horwood C, Surie A, Haskins L Attitudes and perceptions about breastfeeding among female and male informal workers in India and South Africa. BMC Public Health. 2020; 20:(1) https://doi.org/10.1186/s12889-020-09013-9

Inano H, Kameya M, Sasano K Factors influencing exclusive breastfeeding rates until 6 months postpartum: the Japan Environment and Children's Study. Sci Rep. 2021; 11:(1) https://doi.org/10.1038/s41598-021-85900-4

Jama A, Gebreyesus H, Wubayehu T Exclusive breastfeeding for the first six months of life and its associated factors among children age 6-24 months in Burao district, Somaliland. Int Breastfeed J. 2020; 15:(1) https://doi.org/10.1186/s13006-020-0252-7

Jordan S, Cushing-Haugen K, Wicklund K, Doherty J, Rossing M Breast-feeding and risk of epithelial ovarian cancer. Cancer Causes & Control. 2012; 23:919-927 https://doi.org/10.1007/s10552-012-9963-4

Breastfeeding: a missed opportunity for global health. The Lancet. 2017; 390 https://doi.org/10.1016/S0140-6736(17)32163-3

Li Q, Tian J, Xu F, Binns C Breastfeeding in China: a review of changes in the past decade. Int J Environ Res Public Health. 2020; 17:(21) https://doi.org/10.3390/ijerph17218234

Li J, Zhao C, Wang Y Factors associated with exclusive breastfeeding practice among mothers in nine community health centres in Nanning city, China: a cross-sectional study. Int Breastfeed J. 2021; 16:(1) https://doi.org/10.1186/s13006-021-00416-x

Nanishi K, Green J, Shibanuma A Challenging the utility of 24-hour recall of exclusive breastfeeding in Japan. BMJ Global Health. 2023; 8:(12) https://doi.org/10.1136/bmjgh-2023-013737

Nnebe-Agumadu UH, Racine EF, Laditka SB, Coffman MJ Associations between perceived value of exclusive breastfeeding among pregnant women in the United States and exclusive breastfeeding to three and six months postpartum: a prospective study. Int Breastfeed J. 2016; 11:(1)1-10 https://doi.org/10.1186/s13006-016-0065-x

North K, Gao M, Allen G, Lee ACC Breastfeeding in a global context: epidemiology, impact, and future directions. Clin Ther. 2022; 44:(2)228-244 https://doi.org/10.1016/j.clinthera.2021.11.017

Ogunba B Breastfeeding–the environmentally friendly and ideal method of infant feeding. Niger J Environ Health. 2019; 2:(1)30-36

Prentice AM Breastfeeding in the modern world. Ann Nutr Metab. 2022; 78:29-38 https://doi.org/10.1159/000524354

Sandhi A, Lee GT, Chipojola R, Huda MH, Kuo SY The relationship between perceived milk supply and exclusive breastfeeding during the first six months postpartum: a cross-sectional study. Int Breastfeed J. 2020; 15:(1) https://doi.org/10.1186/s13006-020-00310-y

Sangin S, Chuenarrom N, Cheidchim R Factors predicting six-month exclusive breastfeeding in eastern region of Thailand. Nurs Sci J Thailand. 2020; 38:(3)22-34

Schwarz EB, Brown JS, Creasman JM Lactation and maternal risk of type 2 diabetes: a population-based study. Am J Med. 2010; 123:(9) https://doi.org/10.1016/j.amjmed.2010.03.016

Scoccianti C, Key TJ, Anderson AS European code against cancer 4th edition: breastfeeding and cancer. Cancer Epidemiol. 2015; 39:S101-S106 https://doi.org/10.1016/j.canep.2014.12.007

Sousa VD, Rojjanasrirat W Translation, adaptation and validation of instruments or scales for use in cross-cultural health care research: a clear and user-friendly guideline. J Eval Clin Pract. 2011; 17:(2)268-274 https://doi.org/10.1111/j.1365-2753.2010.01434.x

Su Q, Sun X, Zhu L Breastfeeding and the risk of childhood cancer: a systematic review and dose-response meta-analysis. BMC Med. 2021; 19:(1) https://doi.org/10.1186/s12916-021-01950-5

Tangsuksan P, Ratinthorn A, Sindhu S, Spatz DL, Viwatwongkasem C Factors influencing exclusive breastfeeding among urban employed mothers: a case-control st. Pacific Rim International. J Nurs Res. 2020; 24:(1)54-72

Testing an integrated health promotion model using social media for breastfeeding women: structural equation modeling. 2018. http//fau.digital.flvc.org/islandora/object/fau%3A40762 (accessed 11 April 2024)

World Health Organization. Exclusive breastfeeding for optimal growth, development and health of infants. 2019. https//www.who.int/elena/titles/exclusive_breastfeeding/en/ (accessed 11 April 2024)

Wu Q, Wacharasin C Validity and reliability of the Chinese version of the perceived insufficient milk questionnaire. Br J Midwifery. 2022; 30:(10)564-571 https://doi.org/10.12968/bjom.2022.30.10.564

Wu X, Sun X, He S Analysis of the status and influencing factors of the exclusive breastfeeding among six months infants. Chinese J Child Health Care. 2017; 25:(1)90-93

Wu YH, Ho YJ, Han JP, Chen SY The influence of breastfeeding self-efficacy and breastfeeding intention on breastfeeding behavior in postpartum women. Hu Li Za Zhi. 2018; 65:(1)42-50 https://doi.org/10.6224/jn.201802_65(1).07

Wu X, Gao X, Sha T Modifiable individual factors associated with breastfeeding: a cohort study in China. Int J Environ Res Public Health. 2019; 16:(5) https://doi.org/10.3390/ijerph16050820

Wu Q, Tang N, Wacharasin C Factors influencing exclusive breastfeeding for 6 months postpartum: a systematic review. Int J Nurs Knowl. 2022; 33:(4)290-303 https://doi.org/10.1111/2047-3095.12360

Zhou ZY, Zhou L, Si J Analysis on the situation and influencing factors of exclusive breastfeeding of second newborn. Maternal Child Health Care China. 2024; 39:(7)1303-1306 https://doi.org/10.19829/j.zgfybj.issn.1001-4411.2024.07.036

Zhu HX, Jiang P, Zhu YX, Lei J, Liu Y, Zhang BY Logistic regression analysis on influencing factors of exclusive breastfeeding in 1918 pairs of mothers and infants. Zhongguo Fuyou Baojian. 2019; 34:(03)648-654 https://doi.org/10.7620/zgfybj.j.issn.1001-4411.2019.03.54

Zhu Y, Zhang Z, Ling Y, Wan H Impact of intervention on breastfeeding outcomes and determinants based on theory of planned behavior. Women Birth. 2017; 30:(2)146-152 https://doi.org/10.1016/j.wombi.2016.09.011

Determinants of exclusive breastfeeding among Chinese mothers in the first 6 months

02 May 2024
Volume 32 · Issue 5

Abstract

Background/Aims

Exclusive breastfeeding duration remains suboptimal among Chinese mothers. Understanding the factors that influence exclusive breastfeeding is essential for developing targeted interventions to promote breastfeeding practices. This study aimed to identify determinants of exclusive breastfeeding in the first 6 months after birth in Xuzhou City, China.

Methods

This prospective study enrolled 178 mothers, using structured questionnaires for data collection. Subsequent analysis used multiple linear regression to explore factors associated with exclusive breastfeeding duration.

Results

On average, participants exclusively breastfed for 67 days. Influencing factors included breastfeeding intention, perception of insufficient milk and maternity leave.

Conclusions

Targeted interventions have the potential to prolong exclusive breastfeeding duration, such as ensuring women develop accurate perceptions of their breast milk supply and extending maternity leave. Implementing these interventions is crucial to achieving the target of 6 months of exclusive breastfeeding, consequently contributing to optimal health benefits for mother–infant dyads in China.

Breastfeeding provides unparalleled health benefits for mothers and their infants (Prentice, 2022), and there is a dose-response relationship (Buyken et al, 2008; Su et al, 2021). Health outcomes can be enhanced by breastfeeding more often and for longer. The World Health Organization (WHO, 2019) recommends exclusive breastfeeding for the first 6 months postpartum, without introducing other liquids except for medically prescribed supplements.

Exclusive breastfeeding provides all the necessary nutrients for infants in the first 6 months of life. Exclusive breastfeeding for 6 months can reduce infant mortality by reducing the prevalence of conditions such as diarrhea and respiratory and gastrointestinal infections (Dina and Djuwita, 2021; North et al, 2022). It has also been estimated to save the lives of at least 800 000 babies every year (Ogunba, 2019), and maternal risk of breast cancer when exclusively breastfeeding is only 2% (Scoccianti et al, 2015), ovarian cancer by 27–35% (Jordan et al, 2012) and type 2 diabetes by at least 50% (Schwarz et al, 2010).

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