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Indian Pediatr. 1990 Aug;27(8):861-3.
Awareness about infant feeding among young lady teachers.
Singh H1, Kaur L.
Author information
Abstract
PIP:
The study of 100 women from Ferozepur (Punjab) who recently completed their Bachelor of
Education degrees fulfills the purpose of ascertaining the level of knowledge about infant
feeding practices, including breast feeding and attitudes. The results of the open-ended
questionnaire indicate that 96% of the teachers though breast milk was the best, 61% thought
that honey was the most appropriate 1st feed, followed by milk (27%), water (6%), and others
(6%). Preferred methods of feeding were cotton wicks (48%), bottle (36%), finger (6%), and
spoon (2%). 36% thought that up to 1 year was an appropriate breast-feeding period, 36% up
to 3 years was appropriate, and 28% had no opinion. All teachers preferred diluted milk with
water content ranging from 1/8 to 3/4. 86% though babies should be cared for by mothers
rather than in a nursery. 42% had no knowledge about the proper technique for feeding; 74%,
burping; 90%, weaning; and 75%, colostrum. The findings about breast feeding and diluted
milk were consistent with country traditions. The lack of knowledge about proper feeding and
the use of bottles, fingers, and cotton wicks, which contribute to infection, diarrhea, and
malnutrition, indicates a need for better health education. The school needs to incorporate
breast feeding and proper infant care into the curricula. Also recommended were health
slogans in contrasting colors which could be printed on utility bills, or wall hangings
displayed prominently in public and office areas where public traffic is high.
PMID:
2279811
[PubMed - indexed for MEDLINE]
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Indian J Matern Child Health. 1990;1(3):92-3.
Awareness about infant feeding practices

among nursing personnel.
Singh H, Soni RK.
Abstract
PIP:
The study examined knowledge of and attitudes toward breast and supplementary feeding of
infants among 100 newly trained nurses in India. The nurses had recently completed three
years of training in A-grade nursing skills. 100% of respondents agreed that breast feeding
was the best option, and water was acceptable as the first feed. Feeding of infants was
considered to be appropriate within the first 6 hours of birth and for 1-3 years. 60% preferred
bottle feeding. 88% considered that the new-born should be kept with the mother rather than
in the nursery. 66% knew that breast feeding was good for the mother's health. 68% preferred
time-scheduled feeding. 90% desired milk diluted with water as a breast milk substitute.
Respondents listed the following advantages of breast milk: nutritious (mentioned by 30% of
respondents), good for the baby's health (20%), hygienic (20%), better for mother-child
bonding (20%), time saving (18%), offering resistance against disease (18%), economical
(11%), given at appropriate temperature (7%), easily digestible (6%), and easy to feed (2%).
Respondents listed the following indications for bottle feeding: mother ill (mentioned by 40%
of respondents), lactation failure (18%), cracked nipple (15%), other breast problems (11%),
baby not sucking (8%), cleft lip/palate (6%), death of mother (6%), mother using oral
contraceptives (4%). The study revealed a preference for 1/8 to 3/4 dilution of milk, because
of milk's presumed heaviness. The practice of milk dilution is one of the important reasons
for childhood malnutrition, and it demands urgent attention. There was a serious lack of
knowledge about colostrum and techniques of feeding, burping, and weaning. Findings also
confirmed the preference for bottle, cotton wicks, and fingers for providing milk substitutes.
Continuing nursing education should provide better instruction on infant feeding practices.
PMID:
12319244
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PLoS One. 2015 May 19;10(5):e0126575. doi: 10.1371/journal.pone.0126575. eCollection
2015.
Awareness and Attitude towards

Breastfeeding among Two Generations of
Indian Women: A Comparative Study.
Pandey D1, Sardana P1, Saxena A2, Dogra L3, Coondoo A2, Kamath A4.
Author information
Abstract
INTRODUCTION:
Present study was aimed to analyze the impact of education, employment and financial
independence in breastfeeding practices among Indian women.
METHODOLOGY:
Present explorative questionnaire based survey included 256 women (128 pairs) in the final
analysis. A pair means--a) pregnant lady (in her third trimester) representing younger
generation and b) her mother/mother in law representing the elder generation.
RESULTS:
We found that the overall awareness regarding 'breast milk' being the best food for baby was
excellent (overall 97.3%; younger generation: 96.9%; elder generation: 97.7%). Overall
knowledge regarding the correct technique (28.9% younger generation and 21.9% elder
generation) and frequency of breastfeeding (20.3% of younger generation and 34.4% of elder
generation) was very poor. Less than 60% (younger generation: 57.8%; elder generation:
58.6%) were aware that the only major contraindication for breastfeeding is a mother infected
with human immunodeficiency virus (HIV). On comparing responses obtained from the two
generations of women, difference was not statistically significant among most of the issues
related to breastfeeding. With regards to the attitude, despite better awareness, only 94.5%
women in younger generation and 89.1% women in elder generation were planning to give
mother's milk as the first feed to the newborn. Similarly, less than 75% of women were ready
to breast-feed the newborn immediately after birth. This was contradictory to the fact that
86% of pregnant women were aware that the baby should be breast-fed within an hour of
birth.
CONCLUSION:
Awareness with regards to breastfeeding issues had not changed significantly with the
educational progress of Indian women. Despite the good level of awareness in the society
regarding breastfeeding, attitude to practice the same is lacking.
PMID:
25993040
PMCID:
PMC4437785
DOI:
10.1371/journal.pone.0126575
Free PMC Article
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Indian Pediatr. 1994 Sep;31(9):1079-82.
Breast feeding pattern in neonates.

Srivastava SP1, Sharma VK, Kumar V.
Author information
Abstract
The present study comprised 100 mothers of newborn babies with regard to their belief and
practices about lactation. A vast majority (98.2%) of the mothers were breast feeding, 87.9%
mothers used prelacteal feeds of one sort or the other. Only 0.5% breast fed their babies
within 6 hours and nearly 50% started after 48 hours. Colostrum was discarded by 82.9% of
mother and nearly 73% wanted to continue breast feeding beyond 1 year. The age of weaning
preferred was after 1 year by 91%. Only 24.7% mothers had undergone antenatal check ups.
Hence, much needs to be done with regards to proper antenatal care and advice to discourage
wrong and harmful feeding practices.
PIP:
The study examined the breast feeding patterns and knowledge and attitudes about breast
feeding and food supplementation of the newborn. The sample included 1000 women who
delivered infants at the Patna Medical College and Hospital, Patna, India. 982 (98.2%) of the
mothers were breast feeding at the time of the interview. The 18 mothers not breast feeding
indicated poor milk output, breast disease, and lactation failure as the reasons for not breast
feeding. 87.9% supplemented with prelacteal feeds: 47.5% with sugar water, 16.0% with
plain water, 13.5% with cow's milk, 7.8% with honey, and 3.1% with milk powder. 82.89% of
mothers discarded colostrum. Breast feeding was initiated within 6 hours of birth by only
0.5% of mothers. Almost 50% began suckling on the third day, 48 hours after birth. 52 of the
79 mothers who initiated breast feeding after the fourth day had undergone cesarean section
delivery. 24.7% had received prenatal care. 40.63% desired breast feeding for 1-2 years, and
31.46% of mothers planned to breast feed as long as the baby wanted. 92.6% reported that
sex of the baby would not determine breast feeding or child care patterns. 7.41% indicated
that family and social factors were a pressure to discriminate between male and female
infants. Unhygienic practices such as offering foods with a finger tip, cotton wick, or dropper
was practiced more widely among women with lower socioeconomic backgrounds and
illiterate mothers. Breast feeding was initiated significantly earlier by multiparous women.
Mothers who fed their infants colostrum were unaware of the healthful benefits. Over 90% of
mothers considered food supplementation appropriate only after one year of age, which delay
can lead to malnutrition. 94% of mothers considered dry fruits and ghee or other expensive
items were necessary for the lactating mother, while low-cost items such as pulses, skimmed
milk, and green vegetables were ignored.
PMID:
7883365
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Indian J Pediatr. 1984 Jan-Feb;51(408):13-9.
Breast feeding pattern in urban infants in

Chandigarh.
Kumar V, Sharma R, Vanaja K, Real M.
Abstract
PIP:
The pattern of breastfeeding and the factors which determine the practice were assessed in
670 mothers from urban areas of Chandigarh. Unsupplemented breastmilk was administered
to only 36.6% of babies up until 4 months of age. Women from the lower socioeconomic
class, uneducated, and poorly educated mothers were more successful than those from the
upper socioeconomic clases or those with higher education (P0.01). The success rate for
breastfeeding was higher among babies born at home (50.0%) as compared to those born in
the hospital (32.3%). Similarly, high proportions of male infants were successfully breastfed
(40.3%) as compared to females (31.6%). Among those infants weaned breastfeeding was
discontinued before 1 month of age in more than 60%. The main reason that breastfeeding
failed was insufficient milk. Promotional efforts for unsupplemented breastfeeding should
consider some of the above factors for their success. author's modified
PMID:
6746069
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Indian J Pediatr. 1998 Nov-Dec;65(6):867-72.
Breast feeding patterns in an urban

resettlement colony of Delhi.
Chhabra P1, Grover VL, Aggarwal OP, Dubey KK.
Author information
Abstract
Studies on duration and patterns of breast feeding based on recall may lead to a bias about the
exact feeding status. The present study was designed to overcome this bias using the 'current
status analysis method'. Mothers of 650 infants from 0 to 12 months of age attending a Health
Centre were interviewed about the current feeding patterns of the infants and other
socioeconomic variables. Month-wise prevalence of feeding patterns was determined. It was
observed that breast feeding was maintained at a high level (more than 90%) throughout
infancy while exclusive breast feeding showed a rapid decline. At 1 month, 74% and at 4
months, 46% of infants were exclusively breast-fed. The median duration of exclusive breast
feeding was 3.83 months. Mothers with lesser education and lower family income were more
likely to exclusively breast feed (p < 0.05). The time interval between birth and first breast
feed was 24-48 hours in most (48.9%) of the infants. Majority (76.9%) of the infants received
pre-lacteal feeds. Hospital-born infants received their first feed earlier and were less likely to
receive pre-lacteal feeds as compared to those born at home (p < 0.001). Thus, the practice of
exclusive breast feeding has to be promoted amongst pregnant and lactating mothers by
health personnel. Also knowledge regarding infant feeding has to be imparted in schools and
colleges.
PMID:
10773952
Breast feeding practices among health care professionals in a tertiary care hospital from
South India
Raghavan Renitha1, Thirunavukkarasu Arun Babu1, Manish Kumar2, Sadagopan Srinivasan3
1
Assistant Professor, Department of Pediatrics, Sri Lakshmi Narayana Institute of Medical
Sciences, Osudu, Agaram Village, Puducherry, India
2
Senior Resident, Department of Pediatrics, Jawaharlal Institute of Post Graduate Medical
Education and Research, Puducherry, India
3
Professor and Head, Department of Pediatrics, Jawaharlal Institute of Post Graduate
Medical Education and Research, Puducherry, India
Date of Web Publication
Abstract
21-Aug-2012
Personal breastfeeding experiences of health care professionals play a major role in

influencing their attitudes and expertise regarding counseling and managing breastfeeding
issues in patients. This study was done with an objective of studying the current breastfeeding
practices among health care professionals (HP) and their spouses and the factors influencing
them. All children < 5 years of age, residing in hospital's residential quarters, were included.
A detailed breastfeeding history demographic data were obtained following a semi-structured
interview with mothers. Among 81 children included for analysis, in 73 children (90.1%), an
initiation of breastfeeding was within 24 hours of birth and in 36 children (44.4%), it was
within first hour of life. 43 children (58.1%) were exclusively breast fed for 6 months. Mean
duration of EBF was 5.3 months and total duration of breastfeeding was 13.2 months. Gender
of HP, gender of the child and socio-economic factors were not found to significantly affect
breastfeeding practices among HP.
Keywords: Breastfeeding practice, Exclusive breastfeeding, Health care professional,
Weaning
How to cite this article:
Renitha R, Babu TA, Kumar M, Srinivasan S. Breast feeding practices among health care
professionals in a tertiary care hospital from South India. Indian J Public Health
2012;56:149-51
How to cite this URL:
Renitha R, Babu TA, Kumar M, Srinivasan S. Breast feeding practices among health care
professionals in a tertiary care hospital from South India. Indian J Public Health [serial
online] 2012 [cited 2016 Sep 27];56:149-51. Available from: http://www.ijph.in/text.asp?
2012/56/2/149/99910
Health care professionals (HP) play a major role in promoting breastfeeding among mothers
in institutional setups. Successful promotion depends upon their knowledge, attitude,
motivation and communication skills. Though we expect health care professionals including
doctors, nurses and various other health workers to be well informed regarding breastfeeding
issues, studies have shown that it is not completely true. [1],[2]
Personal breastfeeding experience or feeding by spouse has been recognized as an important
source of breastfeeding information and practical experience for health professionals. [3]
Health care professionals with personal breastfeeding experience for at least 2 weeks, are
more likely to actively promote breastfeeding and can confidently assist breastfeeding in
women. [4] Females with personal breastfeeding experiences are more confident in handling
breastfeeding issues than male HPs whose spouse has breast fed. [5] The breastfeeding
practices among health professionals can reflect their knowledge and attitudes, which may
significantly play a role in managing breastfeeding problems in nursing mothers. This can
also give us a feedback about the areas to reinforce while training the health care
professionals.
This study was done with an objective of studying the breastfeeding practices among health
care professionals and their spouses, living in staff quarters of a tertiary care hospital in South
India and the factors influencing them.
This descriptive study was done during a 2 year period from September 2007 to November
2009, in the hospital campus of a tertiary care teaching hospital, located in South India. All
children < 5 years of age, residing in hospital's residential quarters, were included in the
study. Temporarily residing or visiting children were excluded. House to house visit was
done, and qualitative and quantitative data was collected following a semi-structured
interview with mothers. The purpose of the study was explained to the mothers and an
informed consent was obtained before data collection. Demographic details like age and sex
of the child, education, per capita income and occupation of the parents, whether father or
mother was health professional etc. were recorded. A detailed breastfeeding history was
obtained. Parents were enquired about the duration of exclusive breastfeeding and total
breastfeeding and whether colostrum was given. The study protocol was approved by the
institute ethics committee. Data entry and analysis were done using SPSS for Windows
Version 16.0 (SPSS Inc, Chicago, IL, USA). Percentages were calculated for categorical
variables. Means and standard deviations (SD) were calculated as required for numerical
variables. The Chi-square test was used to compare two groups. For comparison of the mean
of different groups, unpaired t test and one-way ANOVA were used. P value < 0.05 was
considered statistically significant.
A total of 96 permanently residing, under-5 years old children were included in the study, and
15 children with incomplete data were excluded from analysis. Out of 104 families with
children < 5 years of age, 67 families agreed to participate in the study. The mean age of the
children in months was 28.74 16.7 (1 to 59) [mean SD (range)]. Among 45 female health
professionals, 7, 20 and 18 were doctors, nurses and other health related workers,
respectively. Among 36 male health professionals, 5, 8 and 23 were doctors, nurses and other
health related workers, respectively. All children except 1 were breast fed. The 1 child who
didn't receive breast feeding was an adopted child. 23 out of 67 mothers (34.33 %) had
previous breastfeeding experience. 36 children (44.4%) were breastfed within first hour of
life and 73 children (90.1%) were breastfed within first 24 hours of life. 1 child received
sugar water on first day of life. Exclusive breastfeeding (EBF) for a minimum period of 6
months was studied. Excluding 7 babies who were still receiving EBF at the time of the
study, 43 children (58.1%) were exclusively breastfed for 6 months. Mean duration of EBF
was 5.3 months and total duration of breastfeeding was 13.2 months. Comparison of
breastfeeding characteristics between feeding by health professionals and their spouses
revealed no significant differences [Table 1]. There was no difference in breastfeeding
practices in relation to the sex of the child [Table 2]. Number of families falling in the socioeconomic class 1 to class 5 were 12 (14.8%), 29 (35.8%), 18 (22.2%), 22 (27.2%) and 0,
respectively. Breastfeeding practices were studied in different socio-economic classes and no
significant difference was found between them.
Table 1: Comparison of breast feeding characteristics between feeding by health
professional and their spouse
Click here to view
Table 2: Comparison of breast feeding characteristics with the sex of the child
Click here to view
The study found that the percentage of babies receiving breastfeeding within 1 hour of birth
was 44.4 %, which was higher when compared with the national family health survey - 3 data
(23.4%). [6] Similarly, percentage of infants receiving EBF for 6 months was 58.1%, which
was again higher than the national data (46.3%). [6] Total duration of breastfeeding was 13.2
months, which was low when compared to similar studies from India. [7] Though
breastfeeding beyond 6 months of age is associated with a decrease in childhood morbidity
and mortality, here the target population had lesser total duration of breast feeding. [8]
Though it was assumed that HPs would be well-informed regarding breastfeeding, only 58%
of their children received EBF for 6 months. One of the possible reasons could be that they
were working and significant proportions of them were taking night shifts as well. But, this
cannot be completely true because even the spouses of male HP were not significantly
different from the female HP. Working mothers also had practical issues related to storing
breast milk and lack of support for breastfeeding, especially in a nuclear family setup.
The perception that their infant was not satisfied by breast milk alone was the most common
reason cited by mother to stop breastfeeding irrespective of the weaning age. Concerns about
lactation and nutrition problems were the most cited reasons for cessation of breastfeeding
during the first 2 months. [9]
Personal breastfeeding experience has been consistently associated with more frequent
breastfeeding promotion activity and an increased self-confidence in handling related issues.
[4]
There is no convincing evidence that female HP had an increased knowledge and
confidence in handling breastfeeding issues than the spouses of male HP. [4],[10] In this study,
the female HP exclusively breast fed for a shorter duration and stopped breastfeeding early
when compared to the spouses of male HP, but there was no statistically significant difference
between them.
Previously done studies to find gender differences in breastfeeding had shown contrasting
results. While some studies had shown no difference, a recent study had shown that the
likelihood of stopping breastfeeding was significantly higher for female children compared to
male children. [11],[12],[13] This proves that the gender differential in breastfeeding practices
favoring male children does exist. However, there were no significant differences in breast
feeding between male and female children in this study. This might be due to the educational
status and profession of the parents.
Mothers belonging to higher socio-economic strata and literates are known to initiate
weaning early and breastfeed for a shorter duration. [11],[13] In this study, there were no
significant differences in breastfeeding among different socio-economic classes, partly
because the numbers in individual classes were less and most of our study population was
literate.
One of the limitations of this study is the relatively small sample size, which was due to the
highly selective target population. Information on breastfeeding duration was based on the
interview from mothers, which had the potential to introduce recall bias.
In conclusion, breastfeeding practices among health professionals were better than the
national data, in terms of feeding within first hour of birth and an exclusive breastfeeding for
6 months. Gender of HP, gender of the child and socio-economic factors were not found to
significantly affect breastfeeding practices in HP.
References
1.
Guise JM, Freed GL. Resident physician's knowledge of breastfeeding and infant
growth. Birth 2000;27:49-53.
2.
Williams EL, Hammer LD. Breastfeeding attitudes and knowledge of pediatricians-intraining. Am J Prev Med 1995;11:26-33.
3.
Tennent R, Wallace LM, Law S. Barriers to breastfeeding: A qualitative study of the

views of health professionals and lay counsellors. Community Pract 2006;79:152-6.
4.
Freed GL, Clark SJ, Curtis P, Sorenson JR. Breast-feeding education and practice in
family medicine. J Fam Pract 1995;40:263-7.
5.
Goldstein AO, Freed GL. Breast-feeding counselling practices of family practice

residents. Fam Med 1993;25:524-9.
6.
National Family Health Survey, India. Key indicators for India from NFHS-3;.2006
[Last cited on 2010 Sep 15]. Available from: http://www.nfhsindia.org/pdf/India.pdf.
7.
Madhu K, Chowdary S, Masthi R. Breast feeding practices and newborn care in rural
areas: A descriptive cross-sectional study. Indian J Community Med 2009;34:243-6.
[PUBMED]
Molbak K, Gottschau A, Aaby P, Hojlyng N, Ingholt L, Silva AP. Prolonged breast
feeding, diarrhoeal disease, and survival of children in Guinea-Bissau. Br Med J
1994;308:1403-6.
8.
9.
Li R, Fein SB, Chen J, Grummer-Strawn LM. Why Mothers Stop Breastfeeding:

Mothers' Self-reported Reasons for Stopping During the First Year. Pediatrics
2008;122:S69-76.
10. Williams EL, Hammer LD. Breastfeeding attitudes and knowledge of pediatricians-intraining. Am J Prev Med 1995;11:26-33.
11. Kumar S, Nath LM, Reddaiah VP. Factors influencing prevalence of breastfeeding in a
resettlement colony of New Delhi. Indian J Pediatr 1989;56:385-91.
12. Swenson IE, Thang NM, Tieu PX. Individual and community characteristics influencing
breastfeeding duration in Vietnam. Ann Hum Biol 1993;20:325-34.
13. Malhotra R, Noheria A, Amir O, Ackerson LK, Subramanian SV. Determinants of
termination of breastfeeding within the first 2 years of life in India: Evidence from the
National Family Health Survey-2. Matern Child Nutr 2008;4:181-93.
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Asia Oceania J Obstet Gynaecol. 1989 Dec;15(4):339-42.
Breast feeding practices and maternal

employment.
Monga D, Rai U, Kumari S.
Abstract
Little information exists about the relationship between maternal employment and breast
feeding practices and knowledge about lactation. The study was conducted on 318 employed
and 299 non-employed women prospectively. Lactational practices were significantly
influenced by employment status, with 81.9% non-employed vs. only 49.7% employed going
in for exclusive breast feeds in the first 3 months (p less than .001). Correspondingly, 46.8%
employed women started combined breast and bottle feeds from birth (p less than .001).
Within the employed group, parity and social class did not significantly alter the infant
feeding practices. Employed women were better informed about feeding and weaning as
compared to their non-employed counterparts (36.8% vs. 18.4% p less than .001). Women
from higher social class also tended to be more aware (59.8% vs. 7.2%: p less than .001).
Multiparas had an edge over primiparas with respect to knowledge about lactation (36.1% vs.
20.1% p less than .01).
PMID:
2624576
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Swasth Hind. 1981 Feb;25(2):46-7.
Breast milk is the best.

Saroja K.
Abstract
PIP:
Throughout the world, the concept that the best milk is breast milk is gaining momentum
from ever increasing supportive scientific evidence. In India the average mother even with
her poor nutritional status has the ability to breastfeed her infant for prolonged periods,
sometimes extending to nearly 2 years. Human milk generally forms the only source of
dietary protein for poor Indian infants, and the nutritional status of poor infants and children
would be much worse than what it is today if not for breast milk. The positive economic and
health implications of breast milk are obvious; it is the most hygienic, safest, and suitable
nourishment a mother can provide for her infant. Recently, there has been an unfortunate
trend toward artificial feeding among the average Indian mother. This practice is spreading
among rural mothers and mothers of low socioeconomic groups. Due to poverty and
ignorance many mothers neither can prepare the artificial milk feeding formula hygienically
nor feed their children well, and the children are not only deprived of essential nutrients but
are exposed to unnecessary intestinal infections introduced through unsterilized bottles and
nipples. The Protein Advisory Group of the UN has warned against early abandonment of
breastfeeding, particularly in poor families, as devastating to the health and survival of
infants. The practice of artificial feeding also has adverse economic implications. The
expenditure incurred in the processing, packing, distributing, preparing, and refrigerating
cow's milk is enormous and one that a developing country like India cannot afford. Breast
feeding also has the advantage of a certain amount of contraceptive effect. Generalizations
for the promotion of breastfeeding include the following: 1) unsupplemented human milk is
all that is needed to sustain growth and good nutrition for the first 6 months of life; 2) the
volume and composition of human milk among poor women is surprisingly good despite
their low nutrition status; and 3) limited studies have suggested that improvement in both the
quantity and quality of breast milk is feasible. Modifications that should be made in health
services are outlined.
PMID:
12279196
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Cent Call. 1976 Nov;11(11):10-3.
Breast-feeding and the child.

Ghosh S.
Abstract
PIP:
Currently, the almost universal practice of breast-feeding in India is being challenged. The
bottle is quickly replacing the breast in the urban areas with disastrous consequences for the
infant. Unless checked, this trend will spread further. Reasons for this shift include lack of
knowledge and commitment by the health professionals themselves as well as lack of real
concern for their clients on the part of the manufacturers of breast-milk substitutes. It is the
health workers who need education concerning breast-feeding, rather than mothers in urban
and rural areas. Recent research has supported the traditional belief that breast-feeding
prevents conception, and this in itself is an important reason to encourage mothers to
continue this practice. Advice regarding breast-feeding should start ideally in the prenatal
period. The following advantages of breast-feeding should be emphasized: it is the simplest
way to feed the baby, for warm, bacteria free milk is available all the time; breast milk costs
much less than its substitutes; it is easily digestible and is especially suitable for the
premature babies; it confers passive immunity on the baby and contains those substances
which prevent diarrhea; and it gives the mother a feeling of satisfaction and achievement. The
mother's emotional response and her desire to feed the baby are the most important part of the
physiology of lactation. A relaxed mother is able to feed her baby better; sudden worry or
anxiety adversely affects lactation. Specific instructions concerning breast-feeding are
presented.
PMID:
12334742
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Asia Pac Popul J. 1990 Mar;5(1):71-88.
Breast-feeding and weaning practices in

India.
Khan ME.
Abstract
PIP:
Despite the importance of breastfeeding (BF), there are surprisingly few studies on the
subject in India. However, the literature that is available reveals that this practice is almost
universal, but many customs surrounding BF and weaning are not conducive to the health of
the child. Initiation of BF is generally quite late and colostrum is discarded. Moveover,
prelactation feeding is generally unhygienic. Although BF is universal, there are signs that in
certain population segments, such as the urban and the educated, the duration of BF is
becoming shorter. It is recommended that the infant start to breastfeed preferably within 6
hours of birth. Generally, newborn Indians are breastfed for the 1st time 48 to 72 hours after
birth. Successful lactation can be started at this time in India. Prelactation goods include
boiled water, tea, sugar, honey, jaggery (a course brown sugar made from palm sap) or
glucose with plain water and diluted animal milk. Often the mode of feeding is not hygienic.
It is generally good for babies to be exclusively breastfed for 4 months after birth. However,
in India, particularly out of the cities, women breastfeed exclusively for up to 8 months and in
some cases for 12 months. This delay is a major cause of infant malnutrition. When Indian
children are very young (0-3 months) they are usually fed on demand. For children aged 3-6
months, frequency of suckling episodes does not go down significantly among nonworking
women; however, it drops considerably among those working women who do not take their
children to work. The mean age at which children are given solid supplemental food varies
considerably across India. The common solid foods include rice, rice with milk and ghee,
biscuits, roti (unleavened bread), and boiled potatoes. 99% of women in urban areas; and
89% of those in rural areas believe that human milk is better than commercial milk or animal
milk. It is nutritional and has antibodies. About 1/5 of the rural women said that it is good
because it does not coast anything. women are generally unaware of contraceptive properties
of breast milk. The duration of lactation foes down to almost 1/2 if the women goes back to
work and leaves the child home. author's modified
PMID:
12283351
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Breastfeed Med. 2010 Dec;5(6):303-7. doi: 10.1089/bfm.2010.0005. Epub 2010 Oct 6.
Breastfeeding knowledge and practices

among rural women of punjab, India: a
community-based study.
Garg R1, Deepti S, Padda A, Singh T.
Author information
Abstract
OBJECTIVES:
Irrespective of the fact that breastfeeding in India is almost universal, psychosocial and
cultural barriers still exists to early breastfeeding. The exact reasons for this delay are not
clearly known. Hence we conducted this study to assess breastfeeding knowledge and
practices and the factors influencing them among women in rural Punjab, India.
METHODOLOGY:
We interviewed 1,000 women in a community-based analytical cross-sectional study that was
carried out in 20 villages of the District of Amritsar, Punjab, India, in 2005-2006 by standard
cluster sampling. Time at initiation of breastfeeding and variables like understanding about
the importance of colostrum, nutrition during lactation, and motivation by health workers
were assessed. Statistical analysis was done by percentages compared with the test.
RESULTS:
Two hundred twenty-five respondents (23.8%) started breastfeeding their babies on the first
day of birth, but in terms of early breastfeeding only 128 (13.5%) respondents put their
babies on the breast within 4 hours of birth. Of the 1,000 respondents, 356 (35.6%) of the
respondents were unaware of the importance of colostrum, 733 (77.6%) were not given
advice on benefits of breastfeeding/weaning, and 306 (33.5%) of respondents had not
increased their diet during lactation.
CONCLUSIONS:
Early breastfeeding knowledge and practices were suboptimal among the mothers in rural
Punjab. Health education on breastfeeding and nutrition remains the dark area. Research and
public health efforts like one-to-one "breastfeeding counseling and health education on
nutrition" to the mother by health workers should be promoted.
PMID:
20925495
DOI:
10.1089/bfm.2010.0005
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J Trop Pediatr. 2009 Jun;55(3):183-8. doi: 10.1093/tropej/fmn110. Epub 2008 Dec 12.
Breastfeeding knowledge and practices

amongst mothers in a rural population of
North India: a community-based study.
Kishore MS1, Kumar P, Aggarwal AK.
Author information
Abstract
BACKGROUND:
National family health survey-3 of India has revealed startling lower exclusive breastfeeding
(EBF) rates (16.9%) in the state of Haryana compared with national data (46%). The barriers
to breastfeeding in this population are not clearly known. Therefore, a study was conducted in
a rural population of the state to study their breastfeeding practices, knowledge regarding
usefulness of breastfeeding and factors influencing the breastfeeding practices.
METHODS:
In six villages of Panchkula district of Haryana, all the mothers of infants between 0-6
months were interviewed using a pretested semi-structured questionnaire. Time at initiation
of breastfeeding, duration of EBF and their understanding about the usefulness of
breastfeeding were assessed. Position of the baby during breastfeeding and attachment of the
baby's mouth to the breast were assessed by direct observation while feeding. Breastfeeding
knowledge of the mother was evaluated.
RESULTS:
Out of the 77 mothers, 30% and 10% exclusively breastfed their infants till 4 and 6 months of
age, respectively. There was 'good attachment' in 42% mother-infant pairs and infants were
held in 'correct position' by 60% mothers. Thirty-nine percent of the mothers had 'satisfactory'
breastfeeding knowledge. On multivariate logistic regression analysis, lack of breastfeeding
counseling was significantly associated with decreased rates of EBF at 4 months and 6
months (p-value 0.01 and 0.002, respectively) and 'full' breastfeeding (FBF) at 6 months of
age (p-value 0.002).
CONCLUSIONS:
EBF/FBF practices and breastfeeding knowledge are suboptimal among the rural North
Indian mothers. Breastfeeding counseling with emphasis on correct technique can improve
the EBF/FBF rates.
PMID:
19074494
DOI:
10.1093/tropej/fmn110
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Indian J Public Health. 1996 Oct-Dec;40(4):120-5.
Breast-feeding practices in a tribal

community of Melghat region in
Maharastra State.
Zodpey SP1, Deshpande SG, Vasudeo ND.
Author information
Abstract
This cross sectional study was conducted at Chitta-Ranjan Das Mobile Hospital camp
stationed at Dharni, to assess the current status of breast-feeding practices in a tribal
community of Melghat region of Maharashtra State, using the key Breast-feeding indicators
as recommended by W.H.O. working group on Infant Feeding in 1991. The tribal mothers of
462 children in the age group of 0-24 months were interviewed for breast-feeding practices.
69.69% of the children received their first breast feed after 24 hrs. of birth, however none of
the children was breast fed within 2 hrs. of birth. The exclusive breast-feeding rate was 0.22
and the predominant breast-feeding rate was 0.79. Timely complementary feeding rate was
0.22. The continued breast-feeding rates at 1 year and 2 years were 0.88 and 0.64,
respectively. The ever breast-fed rate, timely first-suckling rate and exclusive breast-feeding
rate were 1.00, 0.00 and 0.22 respectively. The median duration of breast-feeding was 23
months. Hence this study confirms the traditional breast-feeding practices in Indian culture.
PMID:
9119430
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Indian J Pediatr. 2010 Jun;77(6):689-90. doi: 10.1007/s12098-010-0079-0. Epub 2010 Jun 8.
Breastfeeding practices in baby friendly

hospitals of Indore.
Nigam R1, Nigam M, Wavre RR, Deshpande A, Chandorkar RK.
Author information
Abstract
An interview based cross sectional study was conducted in two of the designated Baby
Friendly Hospitals of Indore in the year 2008. None of the hospitals were having a written
breastfeeding policy, which is routinely communicated to all the health workers and no
regular training regarding the Programme was being imparted. There is a need to develop a
BFHI Monitoring System to ensure that the status is kept in check. Training regarding
essential Criteria of BFHI should be there for all the staff.
PMID:
20532695
DOI:
10.1007/s12098-010-0079-0
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Indian J Pediatr. 2014 Feb;81(2):143-9. doi: 10.1007/s12098-013-1153-1. Epub 2013 Aug 1.
Breastfeeding.
Mathur NB1, Dhingra D.
Author information
Abstract
The benefits of breastfeeding for the infant and nursing mother are well established. The
World Health Organisation (WHO) recommends exclusive breastfeeding up to 6 mo and
continued breastfeeding up to 2 y. Exclusive breastfeeding is the most effective intervention

to reduce infant mortality and is estimated to prevent 13 % of under 5 child mortality in low
income countries. However, rate of exclusive breastfeeding is alarmingly low in our country.
Mothers who face problems in breastfeeding immediately resort to top feeds. It is the
responsibility of the health professionals to identify and manage breastfeeding problems
appropriately. UNICEF/World Health Organisation, through Baby Friendly Hospital Initiative
(BFHI), have recommended good health care practices that support breastfeeding and
increase likelihood of optimum breastfeeding. This paper briefly discusses breastfeeding and
related feeding problems seen in clinical practice.
PMID:
23904066
DOI:
10.1007/s12098-013-1153-1
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Nutrition. 2002 May;18(5):380-2.
Early postoperative feeding and outcome in

neonates.
Suri S1, Eradi B, Chowdhary SK, Narasimhan KL, Rao KL.
Author information
Abstract
OBJECTIVES:
The results of neonatal surgery in the Western world have rapidly improved over the past
three decades. Early nutrition support is thought to be one of the key factors. We used
transgastric, transanastomotic feeding jejunostomy tubes in every infant undergoing upper
gastrointestinal surgery when the expected period of fasting has exceeded 7 d.
METHODS:
Newborns with duodenal atresia, malrotation, and jejunal atresia were treated consecutively
between November 1998 and November 1999. We analyzed the outcome of such a practice.
There were 17 consecutive babies recruited into the study. Ten babies had duodenal atresia,
one associated with esophageal atresia and tracheo-esophageal fistula, six had malrotation,
and one had jejunal atresia. The weights of the babies varied between 1.2 and 3.78 kg (mean
= 2.1 kg) and they were referred between the ages of 1 and 23 d. Three babies were younger
than 32 wk of gestation and weighed less than 1.5 kg; all had multiple bowel atresia,
including one with associated pyloric atresia. None of these three survived. Enteral feeding
was started by postoperative day 2 in 14 cases. Period of feeding varied between 3 and 20 d,
with a mean of 10.4 d in the surviving babies. Three of the tubes had minor mechanical
complications.
RESULTS:
The weight loss or gain during the period of hospitalization was not significant (P = 0.3)
Breast milk was the most common nutrient. Thirteen of the 14 babies weighing more than 1.5
kg were discharged and are being followed; the remaining baby died from neonatal
septicemia. Excellent results can be obtained with aggressive enteral nutrition support in
newborns undergoing upper intestinal surgery.
CONCLUSIONS:
Transgastric, transanastomotic feeding jejunostomy was well tolerated by the newborns and
is preferable to parenteral nutrition.
PMID:
11985940
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J Pediatr. 1974 Mar;84(3):462-4.
Editorial: Doulas, confidence, and the

science of lactation.
Jelliffe DB, Jelliffe EF.
Abstract
PIP:
The psychophysiology and practice of breast-feeding is discussed. Successful lactation
involves stimulation of the nipple and areola by the nursing baby, which causes the secretion
of prolactin. This is followed by the milk-ejection reflex. This reflex is psychosomatic in
nature and leads to contraction of the myoepithelial cells, which results in expulsion of the
milk. These reflexes can be inhibited by anxiety, doubt, and other forms of emotional tension.
Prolactin secretion is proportional to the stimulation of the nipple and areola. Western
practices such as oversedation of the newborn, the use of prelacteal bottle feeds, and the
separation of mother and the newborn seriously limit the amount of suckling time. In rural
India it is customary for another woman to remain with the mother during childbirth and the
neonatal period while the mother is secluded for several weeks. The routines practiced in
Western societies do not enhance the prolactin and milk-ejection reflexes. No-cost
modifications of procedures during pregnancy, childbirth, and the newborn period would
substantially improve upon the success of breast-feeding.
PMID:
4812001
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J Hum Lact. 2013 Nov;29(4):572-8. doi: 10.1177/0890334412474718. Epub 2013 Feb 20.
Factors associated with prelacteal feeding

and timely initiation of breastfeeding in
hospital-delivered infants in India.
Patel A1, Banerjee A, Kaletwad A.
Author information
Abstract
BACKGROUND:
Early initiation of breastfeeding continues to remain uncommon in India, and the practice of
giving prelacteal feeding is still prevalent.
OBJECTIVES:
We determined the rates of timely initiation of breastfeeeding and prelacteal feeding, factors
associated with these practices, and the association between the 2.
METHODS:
Five hundred women who delivered live infants at a tertiary care hospital in India were
included. The study outcomes were timely initiation of breastfeeding and prelacteal feeding.
Multiple logistic regression was used to estimate the odds ratios (OR) of both timely
initiation and prelacteal feeding.
RESULTS:
Timely initiation and prelacteal feeding rates were 36.4% and 16.9%, respectively. Factors
associated with timely initiation were higher maternal education (adjusted OR 2.00, 95%
confidence interval [CI] 1.10, 3.60), counseling on breastfeeding during antenatal visits
(adjusted OR 3.60, 95% CI 2.00, 6.20); absence of obstetric problems (adjusted OR 3.48,
95% CI 1.68, 7.23); vaginal deliveries (adjusted OR 37.57, 95% CI 17.40, 81.11); and
increasing gestational age of newborn (adjusted OR 1.20, 95% CI 1.00, 1.40). Factors
significantly associated with higher rates of prelacteal feeding were lower maternal education
(adjusted OR 2.13, 95% CI 1.06, 4.35), Muslim religion (adjusted OR 2.27, 95% CI 1.18,
4.36), and delivery by cesarean section (adjusted OR 2.56, 95% CI 1.56, 4.19). There was a
significant association between delayed initiation and prelacteal feeding (P < .001).
CONCLUSION:
The rates of timely initiation of breastfeeding were undesirably low, and the practice of
prelacteal feeding existed even in tertiary care hospitals. Identifying factors associated with
these practices might be a strategy for optimizing timely initiation and discouraging
prelacteal feeding in hospital-delivered babies.
KEYWORDS:
India; breastfeeding; infant feeding; prelacteal; timely initiation
PMID:
23427115
DOI:
10.1177/0890334412474718
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Pediatr Clin India. 1970 Jul;5(3):191-7.
Feeding of newborns and infants (cultural

aspects).
Lala VR, Desai AB.
Abstract
PIP:
A total of 435 mothers in the postnatal ward of the Civil Hospital in Ahmedabad, India were
interviewed to determine the cultural beliefs and traditional practices influencing the feeding
of newborns and infants. A thorough physical and neurological examination of the newborns
was conducted. All newborns and mothers were followed for a period varying from 3-7 days
to detect any complications either in the newborn or the mother related to feeding patterns.
The various methods of feeding were observed. In most of the cases the deciding factor to
giving the 1st feed was the cry of the baby. As a 1st feed, various liquid preparations were
used by the mothers. 66.2% of the mothers offered boiled water as a 1st feed. In the postnatal
ward boiled water is an easily available preparation for newborns and is usually provided by
the ward sister whenever the mother requests it. In most of the cases the mother herself was
the initiator. 40.3% of the mothers began supplementing breast milk with milk or solid food
before the age of 1 year, and 18% by the age of 1 1/2 years. 27.3% of the mothers kept their
children on breast milk only until the age of 1 year, and 12.7% until the age of 2 years. 46.5%
of the mothers did not give milk at all during infancy and childhood. The most common age
for introducing solid food was 1-1 1/2 (61.4%); only 10.2% of the mothers introduced solid
food during the 1st year of life. The various sweet carbohydrate preparations used as 1st feed
are known as "Galthuthi." 25.9% of the mothers gave "Galthuthi" to their newborns during
the 1st 3 days of life and 16.9% of the mothers used it as a 1st feed. Most mothers were
giving it as a custom or community tradition. The infants exposed to "Galthuthi" are exposed
to gastrointestinal infections. The common practice of giving fresh milk as a prelacteal feed
during the 1st 3 days of life appears to be harmful to subsequent breastfeeding. It seems that
prelacteal feed is not harmful as long as it is given in a hygienic manner. The custom of
beginning breastfeeding on the 3rd day is an ancient one. This custom and tradition must be
changed gradually as colostrom is rich in nutrients and infants should not be deprived of such
nutritious feed. The feeding pattern in infancy is the primary etiological factor in malnutrition
of India's school children, and prolonged breastfeeding, late supplementation, or early
weaning are the most common causes.
PMID:
12265032
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Indian J Pediatr. 2006 Apr;73(4):295-8.
Grandmothers' influence on child care.

Sharma M1, Kanani S.
Author information
Abstract
OBJECTIVE:
This paper compares child care-giving and child's nutritional status among rural families
where grandmothers were present and those where grandmothers were absent.
METHODS:
From 27 villages in rural Vadodara, four were randomly selected and all the families (n=31)
with children (3-24 months) where grandmothers were present (GMP) were compared with
39 families where grandmothers were absent (GMA). Semi structured questionnaires were
used to assess beliefs-practices of mothers and grandmothers regarding breastfeeding and
complementary feeding (BF-CF). Nutrient intake of the children and nutritional status were
measured using standard procedures.
RESULTS:
Some deleterious practices were present in a similar proportion of both GMP and GMA
groups: giving prelacteals, delaying initiation of BF, exclusive breastfeeding < 3 months and
delaying initiation of CF. Favorable practices present in significantly more GMP were: active
feeding and use of anganwadi services. Grandmother's help enabled mother to practice more
care-giving behaviors. However, children in both the groups had low calorie intake
CONCLUSION:
Role of family members in childcare and the benefits of including them in interventions to
improve child survival, health and nutrition status need to be further researched.
PMID:
16816489
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Natl Med J India. 2012 Jul-Aug;25(4):201-6.
Impact of feeding and breastfeeding

practices on the nutritional status of infants
in a district of Andhra Pradesh, India.
Meshram II1, A L, K V, N V BG.
Author information
Abstract
BACKGROUND:
Infant feeding practices have a major role in determining the nutritional status of children and
are associated with household socioeconomic and demographic factors. We did a crosssectional household study to assess feeding practices of infants and young children in rural
areas of Medak district, Andhra Pradesh.
METHODS:
A total of 805 child-mother pairs were included using systematic random sampling. Agespecific feeding patterns were described using frequencies, proportions and survival analysis.
Logistic regression was done with feeding practice as dependent and sociodemographic
factors as independent variables.
RESULTS:
Breastfeeding was universal in the study area. Only 22% of mothers initiated breastfeeding
within one hour whereas 44% initiated it within three hours after delivery. The median
duration of exclusive breastfeeding was 5.5 months. Pre-lacteal use was high (44.7%). Only
41% of infants were exclusively breastfed for 6 months and 58% of infants (6-11 months)
received complementary feeding at 6-9 months of age. Timely initiation of breastfeeding and
exclusive breastfeeding for 6 months was significantly more likely among mothers belonging
to scheduled castes and scheduled tribes (OR 0.27, 95% CI 0.10-0.76 and OR 0.24, 95% CI
0.08-0.76). Timely initiation of complementary feeding was more likely among scheduled
caste and scheduled tribe communities (OR 0.24, 95% CI 0.11-0.54).
CONCLUSION:
Early initiation of breastfeeding (within an hour of birth) and other feeding practices were
associated with community, type of family and education of mother. Efforts are needed to
promote early initiation of breastfeeding, exclusive breastfeeding for 6 months and ageappropriate complementary feeding among infants.
Copyright 2012, NMJI.
PMID:
23278776
Infant and Young Child Feeding Perceptions and Practices among Mothers in a
Rural Area of West Bengal, India
N Das, D Chattopadhyay, S Chakraborty,1 and A Dasgupta2
Author information Copyright and License information
This article has been cited by other articles in PMC.
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Abstract
Background:
There are many wrong practices and perceptions of Infant and Young Child Feeding (IYCF)
prevalent among different socio-demographic groups.
Aim:
To observe IYCF perceptions and practices among mothers in a rural area of West Bengal.
Subjects and Methods:
Clinic-based cross-sectional descriptive study by interviewing mothers of 0-23 month old

children. Appropriate response to each selected key question was assigned a score of + 1 for
objective assessment. Data analysis was done by standard statistical methods using the
statistical software SPSS 13.0 (Kolkata, India) for windows version. Percentages were
calculated for descriptive statistics. Chi-square test of significance was employed whenever
required.
Results:
65.8% (225/342) mothers did not initiate breast feeding within 1 h of birth, 41.7% (90/216)
mothers of children aged 6 months or more did not exclusively breastfeed their babies up to 6
months and 28.1% (96/342) used bottles for baby-feeding. Perception scores among younger
than 20-year-old mothers were found to be highest; however, practice score increased
significantly with age. Though perception and practice of mothers with some education were
significantly better they wane with higher education. Lowest practice score was found in the
richest per capita income group.
Conclusion:
Emphasis should be given to IYCF education sessions.

Keywords: Infant and young child feeding, Practice, Perception, Rural
community
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Introduction
Infant and young child nutrition need utmost attention of scientists and planners for the very
simple reason that growth rate in the early years of life is maximum and infant and young
child feeding (IYCF) practices comprising breastfeeding as well as complementary feeding
have major role in determining the nutritional status of children.
Malnutrition has been responsible, directly or indirectly, for 60% of all deaths among
children less than 5 years of age in India annually.[1] Many of these deaths are possibly
associated with inappropriate feeding practices during early years of life. Only 35% of infants
world-wide are exclusively breastfed during the 1st 4 months of life and complementary
feeding begins either too early or too late with foods, which are often nutritionally inadequate
and unsafe. Poor feeding practices in infancy and early childhood, resulting in malnutrition,
contribute to impaired cognitive and social development, poor school performance and
reduced productivity in later life.
A set of indicators to assess infant feeding and evaluate the progress of breastfeeding
promotion efforts was recommended by world health organization (WHO) in 1991.[2] In
2001 WHO recommended exclusive breastfeeding for 1st 6 months of life.[3,4] Based on an
in-depth research work started at 2002 by members of WHO working group to review and
develop potential indicators of complementary feeding practices that address the
multidimensionality of complementary feeding,[5] a revised set of population-based
Indicators of IYCF was developed in 2007.[6]
The present study was undertaken in a rural area of Hooghly district of West Bengal to assess
the IYCF perceptions and practices of mothers having children 0-23 months of age using the
WHO standard feeding indicators and also the influence of some socio-demographic
variables on their perceptions and practices.
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Subjects and Methods

This clinic-based cross-sectional observational descriptive study through interview of the
mothers of children in a rural area (Singur, Hooghly) of West Bengal was undertaken during
June-August 2009.
Among the four sub-centers under the service area covered by rural health unit and training
center, Singur, two sub-centers, namely, Paltagarh and Diara were randomly selected for the
study.
During the 3 months study period the mothers of children aged 0-23 months attending the
clinics for immunization or treatment of minor illnesses were included in the study. After
taking informed consent, data were collected regarding IYCF perceptions and practices by
interviewing the mothers using pre-designed, pre-tested, semi-structured questionnaire in
Bengali, the local language.
The different variables considered were socio-demographic characteristics like age of the
children; age, literacy status, occupation, and parity of the mothers; family type, per capita
income (PCI) and different aspects of infant and IYCF perception and practice like timing of
breastfeeding initiation, colostrum feeding, pre-lacteal feeds, duration of exclusive
breastfeeding, bottle feeding and introduction of complementary feeding. For determining the
status of IYCF practices six core indicators and three optional indicators were selected (out of
the 8 core indicators and 7 optional indicators as suggested by WHO) based on of local
culture and customs. This is a set of simple, valid and reliable indicators to assess IYCF
practices, amenable to population-level measurement.[6] In order to have objective
assessment a short-list of five selected key questions each on IYCF perception and practices
of mothers was incorporated in the schedule. Appropriate responses as per recommended
WHO guidelines were assigned a score of + 1. Hence, maximum possible score for each
individual were five in each of perception and practice.
Age groups of the children are described in intervals of months completed. Most indicators
are based on current status data, i.e., feeding practice for the day preceding the survey, as the
study was conducted in a rural area, mostly inhabited by people of poor socioeconomic
status. Moreover, previous-day recall method is widely used and found appropriate to
describe infant feeding practices in populations.[6] Standard criteria that define selected
infant feeding practices were followed.[6]
Data analysis was done by standard statistical methods. Percentages were calculated for
descriptive statistics. Chi-square test of significance was employed whenever required.
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Results
Socio-demographic profile
In this study, 75.4% (258/342) of the mothers were aged between 20 and 29 years, while
17.5% (60/342) mothers were in their teens (15-19 year). 126 (36.8%), 135 (39.5%), 18
(5.3%) and 63 (18.4%) out of 342 children were 0-5 months, 6-11 months, 12-17 months and
18-23 months of age respectively. 14% (48/342) of the mothers were illiterate and 17.5%
(60/342) passed the secondary level. 82.5% (282/342) mothers were housewives. 70.2%
(240/342) mothers were from extended families, while 38.6% (132/342) belonged to lowest
economic class with per capita monthly income of Rs. 800 or less. 63.2% (216/342) mothers
were Primigravidae and 76.3% (261/342) delivered at Government hospital.
Table 1 depicts the 9 indicators (6 core and 3 optional) considered in this study for
determining the magnitude of appropriate IYCF practices. 34.2% (117/342) children were put
to breast within 1 h of birth. 58.7% (74/126) infants aged 0-5 months were fed exclusively
with breast milk, while 66.6% (48/72) infants aged 6-8 months received solid, semi-solid or
soft foods. However, 100% (12/12) children aged 12-15 months continued to be breast-fed.
56.2% (54/96) of the 28.1% (96/342) mothers who used bottle for feeding stated that it was
convenient when they were busy.
Table 1
Correct feeding practices among the study population by using standard world
health organization indicators
While 23.7% (81/342) mothers perceived that breastfeeding should be initiated within the 1st
h of birth [Table 2], 52.7% (180/342) believed that it should be initiated within 2-3 h after
birth, and 8.7% (30/342) were unaware about the timing of initiation of breastfeeding. Out of
342 mothers 207 (60.5%) stated that the duration of exclusive breastfeeding is 6 months and
76.3% (261/342) mothers agreed that babies could be breast fed even during serious illness
and after immunization.
Table 2
Perception and practice regarding indicators of infant and young child feeding
among mothers (n=342)
The association between IYCF perception and practice score of the study population and the
socio-demographic variables are shown in Tables Tables33 and and4.4. Though the
perception score among under-20 mothers was found to be highest, paradoxically practice
score increased significantly with age. Though perception and practice of mothers with some
education were significantly better, they wane with higher education. Though perception was
better in mothers of higher PCI groups, lowest practice score was found in richest PCI group.
Table 3
Perception score of study population and association with socio.demographic
factors (n=342)
Table 4
Practice score of study population and association with socio-demographic
factors (n=342)
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Discussion
According to the national family health survey-3 data[7] the percentage of children who are
breast fed within 1 h of birth in rural India and in rural West Bengal are 21.5% and 24.5%
respectively; whereas in this study this was better at 34.2%. Similarly, a proportion of
children aged 0-5 months who were exclusively breastfed was more at 58.7% in this study
than rural India (48.3%) or rural West Bengal (57.1%). The value of another indicator, i.e.,
children aged 6-8 months receiving solid or semi-solid food and breast milk was again a little
better at 66.6% than rural India (53.8%) and rural West Bengal (55.3%). The possible reasons
for the differences noted are that the national survey had been conducted about 4 years earlier
and that this study had the limitation that it was not conducted on a probability sample but on
mothers coming for vaccination or for treatment for mild sickness of the children (hence the
larger number of younger children in the sample).
WHO recommends that breastfeeding should be initiated immediately after birth, preferably
within 30 min of delivery.[8] The delay in initiation will lead to a delay in the development of
Oxytocin reflexes, which are very important for the contraction of the uterus and breast milk
reflex.[9] Though 23.7% mothers perceived that breastfeeding should be initiated within 1st h
of birth in this study, actually a higher 34.2% initiated breastfeeding within 1st h of birth of
the baby, which is still lower than what are found in another study.[10] In this case, even
76.3% delivery at Government hospital could not achieve a figure higher than 34.2%.
A total of 89.5% mothers agreed that colostrum should be offered to the newborn; but in
practice 23.7% discarded it possibly due to decisions taken by other members of the family. A
large proportion of mothers at 42.1% had given pre-lacteal feeds to the baby, mainly in the
form of plain water, honey, jaggery water and sugar water. These practices were more
common in illiterate mothers which are similar to the findings in other studies.[11,12,13]
Thus literacy plays a very vital role in understanding the protective value of colostrum and
the danger of pre-lacteal feeding. Parmar et al.[13] reported that 51.8% of home-delivered
and 37.2% of institutionally delivered mothers gave pre-lacteal feeds to their children. The
lower percentage of pre-lacteals in institutional deliveries also in our study highlights the
importance of appropriate health education during perinatal period.
Of 216, children aged 6 months or more, 126 (58.3%) were exclusively breast fed until 6
months. This was almost same as 58.7% mothers of infants aged 0-5 months stated that their
babies were exclusively breast fed in the 24 h recall period. The limitation of this study was
the possible recall bias of the mothers of older children. However, the observation of this
study was lower than that observed by Kulkarni et al.[12] (70.2%) and Banapurmath et al.
[14] (60%).
A total of 28.1% babies were bottle fed in this study. When the standard of environmental
sanitation is poor and education is low, bottle feeding is likely to be as nutritionally poor and
bacteriologically dangerous. The feeding bottle is a vital factor in the infamous malnutritioninfection cycle, often reported to be a major cause of infant and child mortality.[15,16]
A total of 28% mothers knew that semi-solid food (complementary feeding) is to be started
along with breastfeeding from 6 months of age. This is even lower than what reported by
others.[12,17,18] 44.8% mothers believed that complementary feeding should be started at an
older age (8-12 months). The commonest reason for delayed complementary feeding was the
notion the child will vomit everything. Another important reason was ignorance. A
study[19] had shown that improvement of feeding practices was possible through proper
utilization of existing health services helping the mothers understand the rationale of the
practices so that good feeding practices can be sustained.
There are some controversies raised by this study. All mothers over 30 have had a high
practice scores, even though half of them had a low score for perception. Contrary to popular
belief the perception and practice of mothers wane with high education. These may be due to
the effect of co-variables, which need further research. Lowest practice score was found in
richest PCI group at 41.7%. The poor practice of mothers with high educational and
economic status may be explained by the fact that they represent most of the working
mothers who have a significantly low IYCF practice score. Better perception score in mothers
of nuclear family because these mothers are more socially and economically empowered. It
may also be hypothesized that with increase of mother's age she becomes more matured; but
she does not necessarily become more responsible with better socio-economic status.
Summary of key findings is that 65.8% mothers did not initiate breast feeding within 1 h of
birth, 41.7% mothers of children aged 6 months or more did not exclusively breastfeed their
babies up to 6 months and 28.1% used bottles for baby-feeding in this study. Thus, the study
highlights that inappropriate IYCF practices are still very much prevalent in the rural
community. Lack of adequate knowledge of the mothers, culturally prevailing
misconceptions and lack of sustained support and motivation of mothers, particularly
working mothers are major contributors to the prevailing situation. Thus, emphasis should be
given to IYCF education program during all contacts with eligible mothers. The interactions
between health-care providers and the nursing mothers should be more frequent to ensure
sustained correct infant and child care practices.
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Acknowledgement
The authors sincerely acknowledge the support of Prof. Ranadeb Biswas Head, Department
of PSM, All India Institute of Hygiene and Public Health, Kolkata at every stage of the study.
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Footnotes
Source of Support: Nil.
Conflict of Interest: None declared.
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References
1. 2nd ed. New Delhi: Ministry of women and child development (food and
nutrition board); 2006. Government of India. Introduction. National guidelines on
infant and young child feeding: Ministry of women and child development (food
and nutrition board) Govt of India; pp. 928.
2. World Health Organization. Geneva: World Health Organization; 1991.
Definitions of key indicators. Indicators for assessing breast feeding practices;
pp. 114. WHO/CDD/SER/91.14.
3. World Health Organization. Geneva: World Health Organization; 2001. The
optimal duration of exclusive breast feeding: Report of an expert consultation
(WHO/FCH/CAH/01.24) pp. 12.
4. Geneva: World Health Organization; 2001. Fifty-fourth world health assembly.
Resolution WHA 54.2. Infant and young child nutrition; pp. 14.
5. Washington, DC: Pan American Health Organization; 2003. WHO/PAHO.
Guiding principles for completing feeding of the breastfed child; pp. 137.
6. Geneva: World Health Organization; 2008. WHO, UNICEF, USAID, AED,
UCDAVIS, IFPRI. Definitions. Indicators for assessing infant and young child
feeding practices: Part 1; pp. 119.
7. New Delhi: Ministry of health and family Welfare, Govt.of India; 2007.
Government of India. National fact sheet India: 2005-2006 National family health
survey (NFHS-3) pp. 13.
8. World Health Organization, UNICEF. Geneva: Mother and Child Division; 1989.
Ten steps to promote successful breastfeeding. Protecting, promoting and
supporting breast-feeding: The special role of maternity services. iv.
9. Iarukov A, Nino A, Iarukova N, Doicheva E, Eolev D. The early breastfeeding of

newborn infants. Ankush Ginekol (Sofiia) 1992;31:135. [PubMed]
10. Madhu K, Chowdary S, Masthi R. Breast feeding practices and newborn care
in rural areas: A descriptive cross-sectional study. Indian J Community Med.
2009;34:2436. [PMC free article] [PubMed]
11. Sharma M, Kanani S. Grandmothers influence on child care. Indian J Pediatr.
2006;73:2958. [PubMed]
12. Kulkarni RN, Anjenaya S, Gujar R. Breast feeding practices in an urban
community of Kalamboli, Navi Mumbai. Indian J Community Med. 2004;XXIX:179
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13. Parmar VR, Salaria M, Poddar B, Singh K, Ghotra H, Sucharu Knowledge,
attitudes and practices (KAP) regarding breast feeding at Chandigarh. Indian J
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14. Banapurmath CR, Nagaraj MC, Banapurmath S, Kesaree N. Breastfeeding
practices in villages of central Karnataka. Indian Pediatr. 1996;33:4779.
[PubMed]
15. World Health Organization. Geneva: World Health Organization; 2006.
International code of marketing the breast milk substitutes: Frequently asked
questions; pp. 111.
16. Lal V, Rai SK. The Culture of Bottle-feeding. Indian J Community Med.
2009;34:2478. [PMC free article] [PubMed]
17. Aggarwal A, Verma S, Faridi MMA, Dayachand Complementary feeding:
Reasons for inappropriateness in timing, quantity and consistency. Indian J
Pediatr. 2008;75:4953. [PubMed]
18. Gajanan Welhal, Lalitha I, Bhattacharjee G, Kothari A. New Delhi: Swasth
Hind; 1993. Nutritional knowledge in relation to breast and supplementary
feeding practices in urban slums of Bombay; pp. 2367.
19. Sethi V, Kashyap S, Seth V. Effect of nutrition education of mothers on infant
feeding practices. Indian J Pediatr. 2003;70:4636. [PubMed]
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Indian J Pediatr. 1992 Mar-Apr;59(2):193-6.
Infant feeding practices among patients of

pediatricians and general practitioners.
Gupta A1, Sobti J, Rohde JE.
Author information
Abstract
In an attempt to document the infant feeding practices among patients of pediatricians and
general practitioners, a study was carried over a period of one month and data of 10,374
infants were recorded using a pre-printed proforma marked by a simple 'tick' for each patient.
The results showed: (i) initiation of breastfeeding was delayed in nearly half of the cases
beyond 24 hours; (ii) introduction of bottle feeding in more than half of infants by the age of
4 months and (iii) introduction of solid foods later than eight months in almost half of infants.
While breastfeeding is practised by 78% of women, only one in five practice exclusive
breastfeeding till 4-6 months, and very few avoid bottle feeds. Much education and change in
behaviour is needed if optimal benefit of breastfeeding in India is to be realised.
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Indian Pediatr. 1987 Oct;24(10):907-10.
Infant feeding practices among tribal

communities of Andhra Pradesh.
Vimala V, Ratnaprabha C.
Abstract
PIP:
Some of the major obstacles to the practice of breast feeding among tribal communities are
ignorance and taboos concerning food and feeding. 100 nursing mothers in 12 tribal villages
were observed in a study of infant feeding practices. Information about the existing feeding
practices was collected; in addition, the study researched attitudes and values concerning the
topic of infant feeding. 95% of the women breast fed their babies. Many of the mothers
(42%) understood that supplementary foods could be given by the end of the 1st year.
Although breast feeding practice was high, the majority of the women (83%) did not believe
that it was necessary to make changes in their diets or work styles during the lactating period.
66% of the women did not comprehend how lactation performance could decrease. Only 17%
of the mothers took good care during the period of lactation. Education programs should be
designed to encourage a unique work and dietary routine for mothers who are breast feeding.
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Indian J Public Health. 1993 Jan-Mar;37(1):26-8.
Infant feeding practices in a rural

community of west Bengal.
Ray B1, Biswas R, Choudhury G, Biswas AB.
Author information
Abstract
A study on breast feeding and weaning practices was carried out in a sample of 57 lactating
mothers of rural community. Although early start and prolonged breast feeding was an
universal practise, but timely weaning was neglected and offered to 54.5% of infants only. On
the contrary, introduction of artificial milk to young infants was a culturally accepted baby
feeding.
PIP:
A cross-sectional investigation into the breast feeding and weaning practices of lactating
mothers in 2 randomly selected villages in Sonarpur Block of South 24-Parganas district of
West Bengal was conducted from June 1, 1990, to July 31, 1990. 57 lactating mothers were
sampled and found to universally practice early and prolonged breast feeding. Although
52.6% of infants were offered sweet water and only 24.6% were offered breast milk as first
feed, all 57 were put on breast milk within 24 hours of delivery. Maternal illness was
primarily responsible for 8.8% of the infants being withdrawn from breast milk during the
first 6 months of infancy. All 26 infants older than 6 months continued to receive breast milk.
Timely weaning, however, was neglected and offered to only 54.5% of infants. The
introduction of artificial milk to young infants was culturally accepted and practiced in 35
cases. 77.2% of these subjects received such milk before reaching 6 months of age; the
introduction took place in 62.9% of cases due to insufficiencies of maternal breast milk.
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Indian Pediatr. 1994 Sep;31(9):1083-7.
Infant feeding practices in Bombay slums.

Bavdekar SB1, Bavdekar MS, Kasla RR, Raghunandana KJ, Joshi SY, Hathi GS.
Author information
Abstract
A study was conducted in two slum areas in a Bombay suburb covering a total population of
4879. One hundred and fifty-three mothers having children below two years were
interviewed. Ninety six per cent infants below the age of 4 months received breast milk,
though exclusive breastfeeding was practised only in 37% infants. Timely complementary
feeding rate was only 0.48. Twenty three per cent of mothers used bottle for administration of
supplementary food or water. Only 15.7% of mothers used commercial milk formula and
8.5% used commercial weaning food.
PIP:
The study examined patterns of breast feeding among 153 mothers who had children under 2
years old and who lived in 2 slum areas of Bombay: Juhu Khadda and Ruia Park. The
interviews and 24-hour food recall survey were conducted in January 1993. The total slum
population was 4879 persons. Exclusive breast feeding was practiced among infants under 4
months of age by only 37% of mothers (27 infants). The high breast feeding rate of 96% at 4
months obscured the issue of frequency. Breast feeding was practiced by 78% of mothers at 1
year and 61% of mothers at 2 years. Only 48% of infants were fed weaning foods between
the ages of 6 and 10 months; 8.5% of these infants received commercial milk formula. 23%
used a bottle for giving water or milk to infants. About 16% used a commercial milk formula.
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Nutr Rev. 1985 Jul;43(7):204-5.
Infant feeding practices in India.

[No authors listed]
Abstract
PIP:
The results of a cross-sectional study of infant feeding practices in a metropolitan city,
suburban area, large town, and small town in each of 3 regions of India (Bombay, Calcutta,
and Madras) suggest that breast-feeding remains the preferred form. At the age of 12 months,
70-90% of infants surveyed were still receiving breast milk. On the other hand, only 35-66%
of mothers exclusively breastfed, even up to 4 months, and the practice of discarding
colostrum and not putting the infant to the breast for the 1st 24 hours after birth persists.
Although use of commercial milk and cereal was higher in the urban samples, 20-30% of
rural infants were receiving these products, generally as supplements to breast milk. The
incidence of gastrointestinal disorders was significantly higher among infants who were
receiving commercial products, reflecting their preparation with polluted water. Among
infants under 6 months of age, 1-15% suffered from Grade III malnutrition. However, 6070% had body weights comparable to standards in Western countries as a result of the
beneficial effects of breastfeeding. The survey further identified significant regional
differences in infant growth status and morbidity. In general, Bombay had the healthiest
trends and Calcutta had the least healthy trends, with Madras occupying an intermediate
position. On the basis of these findings, the sponsors of the survey, the Nutrition Foundation
of India, recommend 1) promotion of exclusive breastfeeding up to 6 months of age, at which
point supplements such as fresh milk and local foods can be introduced; 2) improvements in
environmental sanitation and hygiene; 3) education of mothers regarding infant care during
infection; and 4) regulation of infant formulas. It is also proposed that maternal nutritional
status be improved through food subsidies and that working mothers be provided with
facilities for breastfeeding their infants.
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Infant feeding practices of peri-urban areas

of Gorakhpur.
Kushwaha KP, Mathur GP, Prakash O.
Abstract
PIP:
A study of infant feeding practices in the peri-urban areas of Gorakhpur interviewed 155
lactating mothers. prelacteal feeds were administered mainly by cotton swab (665%).
However, the Indian Academy of Pediatrics survey observed a greater (50%) use of the bottle
followed by cotton swab (24%). For most of the cases, animal's milk was used for prelacteal
feed. In the present study, animal milk was used in 73.9% of the cases as supplemental
feeding to breast milk. A 2-3 day period of prelacteal feed is still a common practice in the
surveyed area. No health or nutritional education was available for any of the mothers. Low
weight infants were prevalent, and all of these were bottled fed. Bottles were repeatedly used
without hygiene and sterilization. The most popular reason for the initiation of bottle feeding
was insufficient breast milk. Despite the current effects and knowledge of bottle feeding,
many doctors prescribe commercial baby milk. It is, therefore, incumbent upon the Indian
Academy of Pediatrics to dispense information on the benefits of breast feeding to every
practicing medical practitioner.
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3448009
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Malays J Reprod Health. 1984 Dec;2(2):96-104.
Infant feeding study: knowledge and

attitudes of selected pregnant women.
Kandiah M, Ooi Guat San.
Abstract
PIP:
The purpose of this study was to investigate attitudes toward infant feeding among women in
their 3rd trimester of pregnancy. A total of 74 primiparous and multiparous mothers ranging
in age from 18-45 who were attending antenatal clinics near Kuala Lumpur were interviewed,
78.3% of which were Malay, 12.2% Chinese, and 9.5% Indian. Most were from middle class
families, and only 6.5% had never attended school. Although 91.9% considered breastmilk as
being the best food for babies, only 63.5% preferred to breastfeed; 8.1% chose powdered
milk and 28.4% chose mixed feeding. Most of those who chose not to breastfeed were
Chinese, working women, and/or women from higher income groups. Information on the
intended duration of breastfeeding showed that multiparous women and working women did
not intend to breastfeed for more than 6 months. Most women did not believe that either
breast milk or powdered milk alone was sufficient for infants up to 5 months of age, and
intended to supplement with solid food before that age. Since 93.2% of the respondents had
already decided on feeding methods by their last trimester, it is important that nutritional
information be given during this time.
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Infant feeding with commercial milk

formula in an urban community of central
India.
Shrivastava DK, Sahni OP, Kumar A.
Abstract
PIP:
A study group composed of mothers of 250 infants who were being fed only commercial milk
formula were observed in an urban Indian community. Most mothers estimated the amount of
powder and water as they could not understand the directions for use of the commercial milk
formula. The mothers were also purchasing daily or weekly feeding needs from open tins as
they could not afford the price of full tins. The sterilization of bottles was not prevalent.
Christians, as compared with Jain and Muslim communities, were more inclined to practice
breast feeding. Many mothers used formula feeds because they believed they more easily
digestible and better nutritionally. As well, many perceived, erroneously, that there was a
greater economy to using formula feeds. Others believed that breast feeding caused liver
trouble or recurring diarrhea in their infants and therefore switched to formula milk. Most of
the women were influenced primarily by health personnel with only 14% being influenced by
advertising. Thus, education of the benefits of breast feeding and the risks of commercial
milk formula must begin within the medical schools of India and finally reach the affected
population: mothers and infants.
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3448007
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Infant feeding--knowledge and attitudes in

a rural area of Karnataka.
Chandrashekar S1, Chakladar BK, Rao RS.
Author information
Abstract
A study of the knowledge and attitude towards infant feeding was conducted in South India
on a group of 300 mothers whose babies' ages from 3 days to 17 months. Most of the mothers
opined that breast-feeding had to be initiated within 24 hours of birth. However, only 32%
felt that breast milk should be the first feed, whereas 68% considered prelacteal feeds a
necessity. 71% of the mothers considered 3 to 5 months to be the optimum duration of
exclusive breast-feeding. 90% felt that cow's milk was an ideal supplement. 78.3%
subscribed to the view that breast-feeding should continue beyond one year. A sizeable
proportion expressed the need to discontinue breastfeeds during babies' or maternal illness,
particularly diarrhoea. Our results will form the babies of the content and the target groups in
our future health education programme.
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Knowledge and attitude among child

development project officers towards breast
feeding.
Kapil U, Paul D, Manocha S.
Abstract
A study was conducted to determine the knowledge and attitude about breast feeding (BF)
amongst child development project officers (CDPOs) working in Integrated Child
Development Services Scheme. A semi structured pretested questionnaire was administered.
It was found that majority of respondent had correct knowledge about feeding of colostrum,
age of initiation of breast feeding and introduction of semi-solid foods. Majority of CDPOs
had the knowledge that consumption of dry fruits, milk and desi ghee would increase that
breast milk secretion. The percentage of subjects who were aware that BF should be
discontinued if mother is suffering from illness like breast cancer (48%) tuberculosis (57%),
malaria (67%) and Diarrhoea (84%). There is need of continuing education of CDPOs for
updating their knowledge.
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Indian Pediatr. 1990 Dec;27(12):1281-5.
Knowledge and attitude amongst well-to-do

adolescent school girls towards breast
feeding.
Kapil U1, Bhasin S, Manocha S.
Author information
Abstract
A study was conducted to determine the knowledge and attitude about breastfeeding amongst
adolescent school girls (n = 74) studying in an urban public school in Delhi. A pretested semistructured questionnaire was administered. The majority of respondents had correct
knowledge about the age of initiation of breast feeding (76%), introduction of semi-solid
foods (61%), feeding of colostrum (58%) and superiority of breast milk over commercial
preparations of milk (81%). Most believed wrongly that consumption of dry fruits (89%) and
high intake of milk and pure ghee (78%) would increase breast milk secretion. The
percentages of girls wrongly believing that breast feeding should be discontinued if mother
was suffering from tuberculosis, malaria and diarrhea were 96, 85 and 81 respectively. There
is need for including adolescent girls in continuing education activities about maternal and
child health.
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2093675
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Indian Pediatr. 1995 Mar;32(3):346-50.
Knowledge and attitudes of Anganwadi

workers about infant feeding in Delhi.
Bhasin SK1, Kumar R, Singh S, Dubey KK, Kapil U.
Author information
Abstract
PIP:
In North Delhi, India, 83 community workers (anganwadi workers) in the ICDS project
Alipur participated in a survey designed to assess their knowledge and attitude about breast
feeding and to identify gaps in their knowledge of breast feeding. 98.7% knew that breast
feeding should be begun immediately after birth. 92.7% knew that the newborn should
receive the colostrum. Only 56.6% knew that top milk should not be diluted. 93.9% correctly
knew that unhygienic bottle feeds are a leading source of diarrhea and that breast feeding
should be continued during a diarrheal episode. Yet 48.2% did not know that mothers with
tuberculosis should continue breast feeding and that infants with a fever should continue to
receive breast milk. 25.4-48% of the anganwadi workers had incorrect perceptions on breast
feeding and social considerations (e.g., 31.4% considered breast feeding to be embarrassing
outside the house). Only 57.8% considered breast feeding to benefit maternal health. Only
50.5% knew that mothers should totally avoid bottle feeding. 75.9% incorrectly thought that
almonds and dry fruits increase breast milk secretion. These overall encouraging findings
about breast feeding may be due to the increased focus on the importance of teaching breast
feeding during preplacement training and possibly due to repeated health education messages
on breast feeding through the mass media. The findings indicate a need for educating
anganwadi workers about continuation of breast feeding during diseases, however.
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Knowledge, attitudes and practice

regarding infant feeding among mother
substitutes.
Jethi SC, Shrivastava DK.
Abstract
PIP:
With more women entering the workforce, the issue of infant nutrition has become more
complex. Mother surrogates, or substitutes, are increasingly taking over the responsibility of
infant care. 80 mother substitutes, aged 7-70, were interviewed in Jabalpur town, India, from
October 1983-July 1984. Substitutes originated from nuclear families consisting of
grandmothers, aunts, elder sisters, brothers, and servants. They were questioned concerning
breast feeding, top milk initiation, feeding technique, and weaning. Results pointed to a
variety of opinions on feeding practices and nutrition. 50% of younger mother substitutes and
the majority of older, uneducated ones believed in initiating breast feeding from the 2nd day
onward. 50% of young and 64% of older substitutes did not consider giving colostrum, and
various reasons why are cited. 20% of all and 42% of highly educated substitutes were aware
of the advantages of breast feeding. 65% of young and 60% uneducated did not know age of
initiation of top milk. 45% advocated bottle feeding, with 25% preferring spoon feeding.
With regard to "tinned milk" 40% did not use it, 25% were unaware of it, and of 30% using
tinned milk, only 1/3 knew the correct technique of reconstitution. The majority of young and
uneducated substitutes thought proper weaning age to be after 6 months. 50%, aged 21-40
years, believed in adding solid food from below 6 months. 90% of the young mother
substitutes were against solids being introduced by the age of 4 months. A majority of the
substitutes suggested weaning foods such as dal, rice, roti, and biscuits with a few
considering tinned cereals as proper weaning foods. This response may point to the reason
why protein and energy deficiency may be observed around weaning age in many infants
throughout the 3rd world.
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Indian J Pediatr. 1990 May-Jun;57(3):395-400.
Maternal knowledge regarding breast

feeding and weaning practices.
Pant I1, Chothia K.
Author information
Abstract
The study assessed the knowledge of mothers of the high income group of urban Baroda,
related to breast feeding and weaning. Forty mothers with children aged 4 to 18 months were
studied. Knowledge and practices regarding breast feeding and weaning were assessed using
pretested questionnaires. Results indicated that only half the mothers breast fed their babies
on the first day. Breast feeding was stopped when the child was 3-6 months; top feeding and
solid supplements were initiated at 4-6 months. Mainly commercial baby foods were used for
weaning. Most mothers avoided 'dals' for the child because these were believed to be difficult
to digest and produced gas in the child's stomach. Fifty percent of the mothers were not in
favour of feeding the sick child with small frequent meals.
PIP:
The study assessed maternal knowledge among high-income women in urban Baroda
concerning breast feeding and weaning. 40 mothers with children ages 4-18 months were
studied. Knowledge and practices regarding breastfeeding and weaning were assessed using
pretested questionnaires. Results indicated that only 1/2 of the mothers breastfed their babies
on the 1st day; breastfeeding was stopped when he child was 3-6 months, and top feeding and
solid supplements were introduced at 4-6 months. Mainly commercial baby foods were used
for weaning. Most mothers avoided "dals" for the child because these were believed to be
difficult to digest and produced gas in the stomach. 50% of mothers were not in favor of
feeding a sick child with small frequent meals. author's modified
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Indian Pediatr. 1995 Dec;32(12):1287-96.
Predictors of exclusive breastfeeding in

early infancy: operational implications.
Sachdev HP1, Mehrotra S.
Author information
Abstract
OBJECTIVES:
To evaluate the independent predictors of exclusive breastfeeding in early infancy.
DESIGN:
Cross sectional multivariate comparison of different breastfeeding categories.

SETTING:
Urban teaching hospital Outpatient Department.
SUBJECTS:
Mothers of 501 children between the age group of 0-6 months were questioned in detail on a
standardized pretested proforma about various sociodemographic, parental, infant, feeding
related, antenatal and perinatal characteristics likely to affect breastfeeding practices.
Mother's height and weight and infant's weight were also recorded.
RESULTS:
The exclusive breastfeeding, predominant breastfeeding, bottle feeding, ever breastfed and
timely first suckling rates were 44.9%, 67.8%, 31.5%, 99.4% and 10.4%, respectively.
Amongst the 29 factors subjected to univariate analyses, 16 clinically relevant or significant
(p < 0.1) variables were included for multiple logistic regression models. The significant (p <
0.05) positive independent association for exclusive and partial breastfeeding were (OR)
infant's present weight (1.45 to 9.64); breastmilk as first feed (1.53 to 2.22); and lower age of
child (1.02 to 1.05). Additional important predictors for exclusive breastfeeding versus total
top feeding) were (OR) breastfeeding propagation (1.34 and 2.99); less educated mother
(1.09 and 1.23); normal vaginal delivery (1.60) and taller mother (1.21).
CONCLUSIONS:
Breastfeeding propagation plays a key role in promoting exclusive breastfeeding. Other
independent negative predictors represent a high risk subset for whom intensive propagation
is desirable since these factors by themselves may not be amenable to intervention.
PIP:
To identify the correlates of breast feeding practices in the early postpartum period,
interviews were conducted with 501 mothers who delivered infants at Lok Nayak Jai Prakash
Narain Hospital from August 1993 to July 1994. There were 80-87 infants in each monthly
postpartum interval from 0 to 6 months. Exclusive breast feeding until 6 months of age was
practiced by 307 mothers (61.3%); 158 infants (31.5%) were partially breast-fed and 36
(7.2%) were receiving no breast milk. Insufficient milk supply, inferred from the infant's
crying, was the reason given for breast milk supplementation by 52.3% of mothers who
initiated this practice; among mothers who had totally weaned their infant, 28% cited breast
rejection by the baby as the cause. Multiple logistic regression analyses identified infant's
present weight, breast milk as first feed, and lower age of child as significant (p 0.05)
predictors of exclusive breast feeding. Also important to predicting exclusive breast feeding
were breast feeding propagation, less-educated mother, normal vaginal delivery, and taller
mother. Lower birth weight was an additional significant independent predictor of nonexclusive breast feeding. These findings suggest a need for educational campaigns aimed at
supporting breast-feeding mothers, especially those who perceive their milk supply to be
inadequate.
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Indian J Matern Child Health. 1991;2(3):84-6.
Socio-cultural factors influencing

nutritional status of infants -- a longitudinal
study.
Hasan J, Khan Z, Sinha SN.
Abstract
PIP:
During 1985-1986 in India, health workers went to the homes of 200 infants, 1-11 months old
at the time they were brought into the study, and followed them until they reached one year.
The researchers aimed to evaluate the role of weaning in determining the nutritional status of
infants as well as to identify the sociocultural factors affecting weaning practices in the rural
area near Aligarh. 99% of the infants received a prelacteal feed, especially ghutti (94%),
within 6 hours of delivery. 99% were breast fed. Breast feeding began between 6 and 72
hours of birth. Almost all mothers believed ghutti cleanses the intestines and that colostrum is
harmful. They discarded the colostrum. 73.5% of infants received top diluted milk. Mothers
did not feed undiluted milk to their infants because they believed it causes diarrhea. 50.5% of
mothers did not give their infants semi-solid foods until after 9 months. 20.5% did not give
any semi-solid or solid food at one year. They all thought that semi-solid food causes
diarrhea. 62.5% of infants received family food. 15% received biscuits. 98% had poor
knowledge about nutritional requirements of infants, other than that breast milk is the natural
food of infants. Most mothers practiced poor hygiene. Infants less than 6 months old were
significantly more likely to have normal nutrition for age than those older than 6 months old
(65.5% vs. 32.4%). Nutritional status declined with age, reflecting the unhygienic weaning
practices in the area. At the end of 12 months, 6.8% suffered from severe grades of
malnutrition. Nutritional status was not associated with social class. Educational status of
mothers and fathers was significantly associated with nutritional status. These findings show
that inadequate knowledge about proper weaning, not lack of food, is the limiting factor in
infant nutrition. Education about the importance of proper weaning and weaning foods
imparted by grass-root level workers is needed.
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Some infant feeding and rearing practices

in a rural community in Pondicherry.
Narayanan I, Puri RK, Dhanabalan M, Rao DC, Fernandez A, Balakrishnan S.
Abstract
PIP:
The feeding and common childrearing practices in a rural area in Pondicherry, India are
reported. The study was conducted in the village of T. Palayam which is located 14 miles
away from the town of Pondicherry. A house to house survey was conducted by doctors and
field staff. The village of T. Palayam had a total population of 1823 and consisted of 2 main
communities--Reddiars and Harijans. The population of Reddiars was in a better
socioeconomic position than Harijans. Also, most parents in Reddiars were literate in contrast
to Harijans where the majority was illiterate. In both sections the deliveries were at home,
most of them being attended by untrained persons. In the majority of the cases, 92.8% of the
Harijans and 93.7% of the Reddiars, the 1st feed consisted of water and sugar. In the Harijan
community, breastfeeding was continued up to 2-3 years and in a few instances up to 4 years.
There was no supplementation with cow's milk. Among the Reddiars, 47% of the babies were
receiving artificial milk in the 1st 6 months of life. In 90% of the cases, cow's milk diluted
with an equal proportion of water was used. Solids were started only after the age of 2 years
by the Harijans. The infants were then offered rice, bread, or other foods depending on what
was eaten by the rest of the family. In the Reddiar community, in 73% of the cases, solids
were started at the end of the 1st year. The habit of giving oil baths to infants was universally
practiced in both of the communities. The earlier cessation of breastfeeding in the Reddiar
community had obvious deleterious effects. It is a source of infection, and it can lead to
malnutrition because of the low nutritive value of the substitute, namely diluted milk.
Another detrimental food fad was the practice of restriction of the diet during illnesses.
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Midwifery. 2003 Dec;19(4):318-27.
South Asian grandmothers' influence on

breast feeding in Bristol.
Ingram J1, Johnson D, Hamid N.
Author information
Abstract
OBJECTIVES:
To assess South Asian grandmothers' health beliefs and cultural practices around baby
feeding, knowledge of breast feeding and their ability to support successful breast feeding. To
design a suitable antenatal intervention for grandmothers to support their breast-feeding
daughters/in-law in an area of low exclusive breast feeding and to assess the acceptability and
feasibility of the initiative by means of structured interviews.
DESIGN:
Qualitative focus groups and interviews. Evaluation of an intervention.
SETTING:
Community health centre and family homes in Easton, Bristol, where 32% of women having
babies are South Asian.
PARTICIPANTS:
14 Pakistani, Bangladeshi or Indian grandmothers in focus groups or interviews. 16 South
Asian families in the intervention.
INTERVENTION:
An intervention for grandmothers to support exclusive breast feeding was based around a
leaflet, which covered the health benefits of breast feeding, good positioning and attachment,
feed management, and how families can support breast feeding. The intervention was
delivered to mother and grandmother pairs at around 36 weeks gestation, and was translated
into three languages.
FINDINGS AND CONCLUSIONS:
South Asian women are not a homogeneous group and differences were seen in cultural and
religious practices and in breast-feeding rates between the Pakistani, Bangladeshi and Indian
communities. To ensure that the health education message of exclusive breast feeding, how to
overcome problems and the importance of family support reaches all women, linkworkers
with appropriate training should be available to speak the languages relevant to the ethnic
groups in the area. An antenatal educational intervention for extended family members to
promote good breast-feeding practice was appreciated by the South Asian families involved
and seemed to be influencing behaviour, particularly in giving colostrum, water or artificial

milk and the use of dummies/pacifiers.
IMPLICATIONS FOR PRACTICE:
Recording details of baby-feeding method at eight weeks systematically by ethnic group will
enable local rates to be monitored, particular groups targeted with information and positive
reinforcement provided. Linkworkers with appropriate training should be available to speak
the languages relevant to the ethnic groups in the area. Involving influential local interpreters
in an educational intervention will help to educate the wider population in practices to
support exclusive breast feeding.
PMID:
14623511
Format: Abstract
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J Trop Pediatr. 2009 Feb;55(1):49-54. doi: 10.1093/tropej/fmn037. Epub 2008 May 22.
The determinants of exclusive breast

feeding in urban slums: a community based
study.
Tiwari R1, Mahajan PC, Lahariya C.
Author information
Abstract
The actual rate of Exclusive Breast Feeding (EBF) (up to the age of 6 months) is dismally
low in urban slums of India. The reasons and determinants of this are debatable. The study
was planned to understand the determinants of EBF in the infants in urban slums. A
community-based cross sectional study was done in urban slums of Gwalior, India. The data
were collected by interviewing the caregivers of 279 infants aged between 6 and 11 months
from November 2005 to July 2006. Only 11 (3.8%) mothers knew that EBF should be done
till six months and 22 (7.8%) actually practiced EBF. A total of 178 (63.8%) and 212 (76.0%)
newborns were given pre- and post-lacteal feeds with 26.2% discarding colostrum. Only 22
(7.8%) practiced EBF. The early breastfeeding (BF) initiation, Ante Natal Clinic (ANC)
visits, mothers' education and immunization visits were significantly associated with higher
probability of EBF. There were a number of myths and misconceptions about BF in this
urban slum population. The correct information about BF was more common amongst the
women who had frequent contacts with health facilities due to any reason or during ANC or
immunization visit. Similarly, it is the continuum of good health and feeding practices and the
mothers who start early BF or get their child immunized regularly are more likely to EBF
their children. Considering the widely prevalent myths and low rate of utilization of health
services along with high potential benefits of EBF, every opportunity of mothers' interaction
with the health facility should be utilized for promoting correct and EBF practices.
PMID:
18499736
DOI:
10.1093/tropej/fmn037
Format: Abstract
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Women Birth. 2014 Dec;27(4):298-306. doi: 10.1016/j.wombi.2014.07.002. Epub 2014 Aug
6.
Theory and social practice of agency in

combining breastfeeding and employment:
A qualitative study among health workers
in New Delhi, India.
Omer-Salim A1, Suri S2, Dadhich JP2, Faridi MM3, Olsson P4.
Author information
Abstract
BACKGROUND:
Women's agency, or intentional actions, in combining breastfeeding and employment is
significant for health and labour productivity. Previous research in India showed that mothers
use various collaborative strategies to ensure a "good enough" combination of breastfeeding
and employment. Bandura's theoretical agency constructs previously applied in various
realms could facilitate the exploration of agency in an Indian context.
AIM:
To explore manifestations of agency in combining breastfeeding and employment amongst
Indian health workers using Bandura's theoretical constructs of agency and women's
experiences.
METHODS:
Qualitative semi-structured interviews were conducted with ten women employees within the
governmental health sector in New Delhi, India. Both deductive and inductive qualitative
content analyses were used.
FINDINGS:
Bandura's features and modes of agency revealed that intentionality is underpinned by
knowledge, forethought means being prepared, self-reactiveness includes collaboration and
that self-reflectiveness gives perspective. Women's interviews revealed four approaches to
agency entitled: 'All within my stride or the knowledgeable navigator'; 'Much harder than
expected, but ok overall'; This is a very lonely job'; and 'Out of my control'.
CONCLUSIONS:
Agency features and their elements are complex, dynamic and involve family members.
Bandura's theoretical agency constructs are partially useful in this context, but additional
social practice constructs of family structure and relationship quality are needed for better
correspondence with women's experiences of agency. The variation in individual approaches
to agency has implications for supportive health and workplace services.
Copyright 2014 Australian College of Midwives. Published by Elsevier Ltd. All rights
reserved.
KEYWORDS:
Breastfeeding; Employment; India; Qualitative interviews; Women's agency
PMID:
25108676
DOI:
10.1016/j.wombi.2014.07.002
Format: Abstract
Send to
Rev Gaucha Enferm. 2005 Dec;26(3):333-44.
[Beliefs and practices of nursing mothers

and of their families in relation to
breastfeeding].
[Article in Portuguese]
Gonalves Ade C1, Bonilha AL.
Author information
Abstract
This is a qualitative study of the descriptive-exploratory kind that had the objective of finding
out the beliefs and practices of nursing mothers and of their families in relation to
breastfeeding. The research subjects were nine nursing mothers and eight relatives from a
poor section of Porto Alegre, Brazil. The data were collected through semi-structured
interviews. The emerged themes concern to beliefs and practices considering the benefits of
breastfeeding to the breastfed baby and to the nursing mother, many of them with origin
within the family context. The study enhances the importance for health professionals to learn
and to support their practices on those beliefs to reach successful breastfeeding.
PMID:
16523600
Format: Abstract
Send to
Cad Saude Publica. 2013 Jun;29(6):1186-94.
[Breastfeeding from the perspective of

programmatic vulnerability and care].
[Article in Portuguese]
Souza SN1, Mello DF, Ayres JR.
Author information
Abstract
Based on experiences and reflections reported by health professionals, the aim of this study
was to critically analyze the actions, situations, and decisions in healthcare services that
involve breastfeeding, examining aspects that favor or limit its possibilities. This was a
qualitative study based on the conceptual framework of vulnerability and healthcare, using
focus groups with 25 healthcare professionals participating in the Committee on
Breastfeeding in Londrina, Paran State, Brazil. The material was produced with a
comprehensive format, focusing on questions that involved the breastfeeding process and its
approaches and decisions. The study raises issues for understanding how the way mothers
and families deal with breastfeeding is linked to organization of the practices and individual
and social aspects, requiring integration between practical and technical/scientific knowledge.
The article portrays the complexity of healthcare for women and children, allowing an
enhanced approach to routine healthcare and the related strategies for breastfeeding.
PMID:
23778550
Free full text
Format: Abstract
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See comment in PubMed Commons below
Sante Publique. 2016 Mar-Apr;28(2):235-43.
[Infant feeding practices in Nouakchott:

between medical guidelines and
grandmothers’ instructions].
[Article in French]
Diagana MS, Kane H.
Abstract
The World Health Organization recommends exclusive breastfeeding up to the age of six
months and continuation of partial breastfeeding up to the age of two years, in addition to
nutritionally adequate and safe food. In Mauritania, despite some progress, most mothers do
not comply with these recommendations. The aim of this study, conducted in Nouakchott,
was to evaluate breastfeeding and feeding practices, and measure factors associated with
achievement of the optimal duration of exclusive breastfeeding. The methodology combined
quantitative and qualitative approaches. A descriptive cross-sectional study was conducted by
questionnaires among 330 mothers from different departments of the capital. Twenty semistructured interviews were then conducted with Mauritanian grandmothers in order to
understand their roles and perceptions about infant feeding. Before the age of 6 months, the
exclusive breastfeeding rate was 18.4%, the predominant breastfeeding rate was 44.3% and
the partial breastfeeding with milk rate was 28.1%. In addition, 9.2% of infants received
supplementary feeding. We found that 50.5% of mothers were aware of the optimal duration
of exclusive breastfeeding, but only 14.2% complied with this recommendation. The factors
significantly associated with compliance with the optimal duration of exclusive breastfeeding
were maternal age over 35 years and multiparity. Interviews revealed that grandmothers knew
about some of the nutritional recommendations, but denied their relevance based on their
experience. Their advice contradicted certain medical recommendations. Our study revealed
inadequacies concerning the mothers knowledge and more frequently their practices in terms
of infant feeding. The gap between knowledge and practice can be essentially explained by
the relative importance attributed to recommendations by the mothers, as well as the
confrontation between medical recommendations and grandmothers traditional knowledge.
PMID:
27392058
Format: Abstract
Send to
Matern Child Health J. 2012 Aug;16(6):1276-83. doi: 10.1007/s10995-011-0887-5.
Analysis of breastfeeding policies and

practices in childcare centres in Adelaide,
South Australia.
Javanparast S1, Newman L, Sweet L, McIntyre E.
Author information
Abstract
Breastfeeding policies and practices were analysed in childcare settings in the metropolitan
area of Adelaide, South Australia. Childcare centres were purposively selected based on their
geographical location, type and socioeconomic score of the area. Qualitative inquiry
approach was employed by undertaking interviews with childcare centres' director or baby
house coordinator to explore their perception towards breastfeeding practice and support
within their centre. Breastfeeding related policy documents, where available, were also
collected during the interviews to triangulate data. A total of 15 face-to-face interviews were
conducted. Six childcare centres had a written policy specifically on breastfeeding support,
although the technical issues of handling breastmilk were included in most centres' food and
nutrition guidelines. Most participants believed that decision to breastfeed is the personal
choice of parents, and hence saw the childcare centre's role as supporting parental choice
whether it is breastfeeding or not. The provision of physical space to breastfeed and facilities
to store the expressed breast milk were the most common practices in support of parents who
had chosen to continue breastfeeding. Participants perceived mothers' work-related issues
such as distance from the centre, time, and unsupportive workplace the most important
barriers that led to early introduction of bottle feeding or breastfeeding cessation. Most
childcare centres support breastfeeding in a more passive than active way. Breastfeeding
promotion needs to be an integral part of childcare centres training, policy and practice if an
increased rate of breastfeeding is to be achieved particularly amongst working mothers.
PMID:
21948219
DOI:
10.1007/s10995-011-0887-5
Format: Abstract
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Midwifery. 2013 Aug;29(8):956-64. doi: 10.1016/j.midw.2012.12.001. Epub 2013 Feb 20.
Applying organisation theory to understand

barriers and facilitators to the
implementation of baby-friendly: A
multisite qualitative study.
Nickel NC1, Taylor EC, Labbok MH, Weiner BJ, Williamson NE.
Author information
Manitoba Centre for Health Policy, Department of Community Health Sciences,

Faculty of Medicine, University of Manitoba, 408-727 McDermot Avenue, Winnipeg,
MB, Canada. Nathan_Nickel@cpe.umanitoba.ca
Abstract
OBJECTIVES:
(a) to apply an organisation-level, pre-implementation theory to identify and describe factors
that may impact hospitals' readiness to achieve the Ten Steps and (b) to explore whether/how
these factors vary across hospitals.
DESIGN:
a multisite, descriptive, qualitative study of eight hospitals that used semi-structured
interviews of health-care professionals. Template analyses identified factors that related to
organisation-level theory. Cross-site comparative analyses explored how factors varied across
hospitals.
SETTING:
thirty-four health-care professionals from eight North Carolina hospitals serving low-wealth
populations. The hospitals are participating in a quality improvement project to support the
implementation of the Ten Steps. This study occurred during the pre-implementation phase.
FINDINGS:
several factors emerged relating to collective efficacy (i.e., the shared belief that the group, as
a whole, is able to implement the Steps) and collective commitment (i.e., the shared belief
that the group, as a whole, is committed to implementing the Steps) to implement the Ten
Steps. Factors relating to both constructs included 'staff age/experience,' 'perceptions of
forcing versus supporting mothers,' 'perceptions of mothers' culture,' and 'reliance on lactation
consultants.' Factors relating to commitment included 'night versus day shift,' 'management
support,' 'change champions,' 'observing mothers utilize breastfeeding support.' Factors
relating to efficacy included 'staffing,' 'trainings,' and 'visitors in room.' Commitment-factors
were more salient than efficacy-factors among the three large hospitals. Efficacy-factors were
more salient than commitment-factors among the smaller hospitals.
KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:
interventions focused on implementing the Ten Step may benefit from improving collective
efficacy and collective commitment. Potential approaches could include skills-based, handson training highlighting benefits for mothers, staff, and the hospital, and addressing contextspecific misconceptions about the Steps.
Copyright 2012 Elsevier Ltd. All rights reserved.
KEYWORDS:
Baby-Friendly Hospital Initiative (BFHI); Breastfeeding; Maternity practices; Organisational

change
PMID:
23434025
DOI:
10.1016/j.midw.2012.12.001
Format: Abstract
Send to
Midwifery. 2015 May;31(5):532-9. doi: 10.1016/j.midw.2015.02.001. Epub 2015 Feb 9.
Barriers to breast-feeding in obese women:

A qualitative exploration.
Keely A1, Lawton J2, Swanson V3, Denison FC4.
Author information
Abstract
OBJECTIVE:
to explore the factors that influence breast-feeding practices in obese women who had either
stopped breast-feeding or were no longer exclusively breast-feeding 6-10 weeks following
the birth of their babies, despite an original intention to do so for 16 weeks or longer.
Specifically (i) to identify the barriers to successful breast-feeding and reasons for
introducing formula and/or stopping breast-feeding, and (ii) to explore the womens views
and experiences of current breast-feeding support services.
DESIGN:
descriptive, qualitative study comprising semi-structured face-to-face interviews. Interviews
were audio recorded and transcribed. The data were analysed using thematic analysis.
SETTING:
participants recruited from one large maternity unit in Scotland and interviewed in their
homes.
PARTICIPANTS:
28 obese women at 6-10 weeks following birth.
FINDINGS:
three major themes emerged from the data analysis: the impact of birth complications, a lack
of privacy, and a low uptake of specialist breast-feeding support. Impact of birth
complications: 19 of 28 women had given birth by caesarean section and some felt this led to
feeling 'out of it' post-operatively, a delay in establishing skin-to-skin contact, and in
establishing breast-feeding. Lack of privacy; several women described reluctance to breast
feed in front of others, difficulties in achieving privacy, in hospital, at home and in public.
Low uptake of postnatal breast-feeding support; despite experiencing problems such as
physical difficulties during breast-feeding or a perception of low milk supply, breast-feeding
support services were underused by this sample of women. A small number of the women in
this study used breast-feeding clinics and reported finding these useful. A further small
number felt they benefitted from the support of a friend who was successfully breast-feeding.
CONCLUSION AND IMPLICATIONS FOR PRACTICE:
midwives should be mindful of the presence of additional factors alongside maternal obesity,
such as caesarean delivery, physical difficulties when breast-feeding, poor body image, and
lack of confidence about sufficient milk supply. Scope for innovation within hospital policies
with regard to both the facilitation of early skin-to-skin contact and privacy in postnatal
accommodation could be explored in future research. Women should be provided with
information about the provision and specific purpose of breast-feeding support groups and
services and encouraged to access these services when appropriate. Future research could
assess the usefulness of sustained breast-feeding support by health professionals, as well as
partner involvement and formal peer support for this group of women. The education and
training needs of health professionals in terms of supporting this group of women to breast
feed may also usefully be explored.
KEYWORDS:
Breast-feeding; Caesarean section; Obesity
Comment in
Caesarean section and image consciousness among barriers to breast feeding for
obese women. [Evid Based Nurs. 2016]
PMID:
25726006
DOI:
10.1016/j.midw.2015.02.001
Format: Abstract
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Indian J Public Health. 2012 Jan-Mar;56(1):75-81. doi: 10.4103/0019-557X.96982.
Bovine milk usage and feeding practices for

infants in India.
Mayuri M1, Garg V, Mukherji C, Aggarwal D, Ganguly S.
Author information
Abstract
BACKGROUND:
Milk and dairy products from animal sources (cow's milk or buffalo's milk) are an important
part of Indian diet and its consumption starts at an early age.
OBJECTIVE:
The purpose of this study is to understand the processing, storage and modifications carried
out before bovine milk is fed to the infants and compare it with recommendations by Health
Care Professionals (HCPs).
MATERIALS AND METHODS:
The study involved assessments involving HCPs and mothers of children below 1 year of age
through both qualitative and quantitative methods. Feeding recommendations by HCPs were
assessed through a quantitative method.
RESULTS:
The children are commonly initiated on bovine milk post 3 months of age. The milk is not
covered while boiling in 70% cases and boiled at suboptimal temperature (moderate: 62% or
low: 31%). Half of the families store milk outside refrigerators openly in the kitchen or
rooms. The milk is modified in the majority of cases (81%) before being fed. Modification of
the milk was often done with sugar (85%), followed by water (49%), biscuits, fennel seeds,
cardamom or infant cereals before feeding the baby. Addition of water was more prevalent
among mothers of infants between 3 and 6 months. HCPs do not advise consumption of
bovine milk by infants unless there is no other option available.
CONCLUSION:
A clear gap exists between recommended and actual practices for infant feeding in India.
There is a huge opportunity to educate mothers on importance of breast feeding and benefits
of implementing appropriate processing, storage, and consumption practices of bovine milk.
PMID:
22684180
DOI:
10.4103/0019-557X.96982
Free full text
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Midwifery. 2014 Mar;30(3):359-63. doi: 10.1016/j.midw.2013.03.008. Epub 2013 May 4.
Breast feeding among Brazilian

adolescents: practice and needs.
Monteiro JC1, Dias FA2, Stefanello J3, Reis MC4, Nakano AM3, Gomes-Sponholz FA3.
Author information
Abstract
OBJECTIVES:
to characterise breast feeding practices among Brazilian adolescents and identify their breast
feeding needs.
METHODS:
the study was undertaken in Ribeiro Preto, Brazil in two stages. The first stage analysed data
from the Second National Survey of Breast-feeding Prevalence, held in August 2008, which
included 229 adolescent mothers. The second stage was a qualitative approach, and involved
interviews with 10 adolescent mothers in a primary care unit. The data from the first stage
were analysed in June 2010 based on descriptive statistics. The data obtained from the
interviews were transcribed and organised using thematic content analysis.
FINDINGS:
breast feeding was reported by 75% of the adolescent mothers. Of the 144 mothers with
infants aged <180 days, 84% reported that they were breast feeding: 19% were breast feeding
exclusively, 17% were breast feeding predominantly, 49% were providing complementary
feeding, and 16% had weaned their infants. Analysis of the interviews led to the identification
of three thematic units: concern for the child's health; breast feeding difficulties; and health
team and family support.
CONCLUSIONS:
the majority of the adolescent mothers presented conditions that were favourable to breast
feeding (e.g. did not work outside the home, only had one child, breast fed in the first hour
post partum). However, the practice of breast feeding still failed to meet the
recommendations of the World Health Organization. The interviews led to identification of
the breast feeding needs and demands of adolescent mothers, many of which were related to
the needs of their infants. It is important to know what adolescent mothers think about breast
feeding, in order to encourage the establishment of practices to keep breastfeeding as longer
as possible in a satisfactory way for both mothers and infants.
KEYWORDS:
Adolescent; Breast feeding; Maternal and child health
PMID:
23652288
DOI:
10.1016/j.midw.2013.03.008
Format: Abstract
Send to
Women Birth. 2016 Apr 22. pii: S1871-5192(16)30017-8. doi: 10.1016/j.wombi.2016.04.006.
[Epub ahead of print]
Breastfeeding among Somali mothers living

in Norway: Attitudes, practices and
challenges.
Wandel M1, Terragni L2, Nguyen C3, Lyngstad J2, Amundsen M2, de Paoli M4.
Author information
Abstract
BACKGROUND:
Data from previous studies indicate a short duration of breastfeeding, especially exclusive
breastfeeding, among infants of immigrant mothers living in Norway and other Western
countries. Norway has a long tradition of supporting breastfeeding.
AIM:
To explore infant feeding practices among Somali-born mothers in Norway, and the ways in
which they navigate among different information sources.
METHODS:
Qualitative in-depth interviews and focus groups were carried out with mothers of children 6,
12 and 24 months of age. Women were recruited by a multi-recruitment strategy. Twenty-one
mothers participated in interviews and twenty-two in five focus groups. The analysis was
guided by Grounded Theory.
FINDINGS:
The mothers had positive attitudes to breastfeeding, but were unfamiliar with the concept of
exclusive breastfeeding. Early introduction of water and infant formula was a common
practice that interfered with exclusive breastfeeding. The mothers experienced challenges of
dealing with conflicting recommendations and expectations regarding infant feeding. They
navigated among different sources of information, taking into consideration traditional
values, experiences and habits from living in Norway, and research-based knowledge. Their
prioritization of the different information sources varied with different life situations,
children's age, and the extent to which the mothers trusted the information sources.
DISCUSSION AND CONCLUSIONS:
Despite the strong focus on breastfeeding in Norway, Somali-born mothers encounter
obstacles in their breastfeeding practices. These may be due to lack of information about
exclusive breastfeeding and to the conflicting information they received. Breastfeeding
practices may be enhanced by promoting culturally sensitive communication, and relations of
trust at health-care centers.
Copyright 2016. Published by Elsevier Ltd.
KEYWORDS:
Breast feeding; Health communication; Immigrants; Infant feeding; Somali
PMID:
27117640
DOI:
10.1016/j.wombi.2016.04.006
[PubMed - as supplied by publisher]
Format: Abstract
Send to
Midwifery. 2012 Apr;28(2):252-7. doi: 10.1016/j.midw.2011.02.012. Epub 2011 Apr 2.
Breast-feeding attitudes and practices

among Vietnamese mothers in Ho Chi Minh
City.
Lundberg PC1, Ngoc Thu TT.
Author information
Abstract
OBJECTIVE:
to describe breast-feeding attitudes and practices among Vietnamese women in Ho Chi Minh
City.
DESIGN:
a descriptive qualitative study was used. The theory of planned behaviour provided the
conceptual framework.
SETTING:
the Well-baby Clinic, Department of Obstetrics and Gynaecology of a university hospital in
Ho Chi Minh City, Vietnam.
PARTICIPANTS:
23 voluntary Vietnamese mothers.
DATA COLLECTION AND ANALYSIS:
semi-structured in-depth interview with five open-ended questions and observation was used.
The interviews were tape-recorded and transcribed verbatim. The data from the interviews
and observations were analysed by use of content analysis.
FINDINGS:
five categories of breast-feeding attitudes and practices were identified: breast-feeding best
but not exclusive, cultural and traditional beliefs, infant feeding as a learning process, factors
influencing decision to breast feed, and intention to feed the child.
KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE:
cultural and traditional beliefs and practices, and socio-economic situation, influenced the
Vietnamese mothers' breast feeding. Health-care professionals should consider cultural
context and socio-economic issues when preparing infant feeding education and intervention
programmes. Appropriate knowledge about cultural values should be included in health-care
education in order to provide culturally congruent care to Vietnamese mothers in Vietnam as

well as in Western countries.
PMID:
21458893
DOI:
10.1016/j.midw.2011.02.012
Format: Abstract
Send to
J Clin Nurs. 2012 Apr;21(7-8):1109-18. doi: 10.1111/j.1365-2702.2011.03848.x. Epub 2011
Sep 20.
Breastfeeding experiences of Turkish

women.
Demirtas B1, Ergocmen B, Taskin L.
Author information
Abstract
AIMS:
To describe the experiences of Turkish women regarding traditional breastfeeding practices.
BACKGROUND:
Breastfeeding is a popular practice in Turkey. Nevertheless, the rate of exclusive
breastfeeding in the first six months of life is quite low. Merely about 16% of infants aged
between 2-3 months are exclusively breastfed, whereas those fed with supplementary foods
are 78%. In the light of this data, we argue that traditional breastfeeding practices may be the
underlying reason for low rate of breastfeeding. Significant as it is, however, this subject
matter has largely been overlooked in the literature in Turkey.
DESIGN:
A descriptive, qualitative study based on in-depth interviews, with a purposive sample of 24
mothers of four to- 24-month-old babies.
METHODS:
The background information of the mothers was obtained from the Mother and Child Health
and Family Planning Centre that offers specific services for mothers. Mothers were visited at
home and data were gathered through semistructured and in-depth, audio-taped interviews.
The collected data were analysed using the content analysis method.
RESULTS:
Three themes emerged from the participants' descriptions of their breastfeeding experiences:
(1) influence of the older family members, (2) influence of social learning and (3) influence
of the religion.
CONCLUSION:
This study concluded that traditional breastfeeding practices are still prevalent among
mothers, regardless of their age and level of education. Breastfeeding behaviour of mothers
was mostly shaped by various cultural social and religious influences imposed on them by
their family, close social network and religious community.
RELEVANCE TO CLINICAL PRACTICE:
Nurses can encourage mothers for exclusive breastfeeding by means of individual- and
social-based training programmes, which they will prepare in view of traditional
breastfeeding practices.
2011 Blackwell Publishing Ltd.
PMID:
21929556
DOI:
10.1111/j.1365-2702.2011.03848.x
Format: Abstract
Send to
J Paediatr Child Health. 2005 Jul;41(7):338-43.
Determinants of breast-feeding within the

first 6 months post-partum in rural
Vietnam.
Duong DV1, Lee AH, Binns CW.
Author information
Abstract
OBJECTIVE:
This study explored the determinants of breast-feeding practices within the first 6 months
post-partum among women residing in rural Vietnam.
METHODS:
The study was conducted in Quang Xuong district, in the Thanh Hoa Province of Vietnam. In
the first phase, 463 women were prospectively studied at weeks 1, 16 and 24 post-partum.
During the second phase, 16 focus group discussions were undertaken to obtain
complementary information.
RESULTS:
Exclusive breast-feeding dropped from 83.6% at week 1 to 43.6% at week 16 and by week
24, no infant was exclusively breast-fed. A logistic regression analysis found 'mother's
education level', 'mother's decision-making on breast-feeding', 'mother's comfort to breastfeed in public places', 'father's occupation', 'feeding preference of father' and 'having
sufficient food for the family' significantly influenced the exclusive breast-feeding practice.
Qualitative data provided in-depth information on factors relating to mother, infant, close
relatives and providers.
CONCLUSION:
Providing appropriate training and supportive supervision on breast-feeding counselling to
health workers and supporting working mothers to exclusively breast-feed their infants
through community mobilization were recommended to improve breast-feeding in rural
Vietnam.
PMID:
16014137
DOI:
10.1111/j.1440-1754.2005.00627.x
Format: Abstract
Send to
Matern Child Nutr. 2011 Apr;7(2):148-59. doi: 10.1111/j.1740-8709.2010.00264.x. Epub
2010 Sep 7.
Determinants of infant feeding choices by

Zambian mothers: a mixed quantitative
and qualitative study.
Chisenga M1, Siame J, Baisley K, Kasonka L, Filteau S.
Author information
Abstract
Choosing an infant feeding mode is complex for human immunodeficiency virus (HIV)infected African women. We documented infant feeding choices by 811 mothers of infants
aged less than 18 months enrolled in the Chilenje Infant Growth, Nutrition and Infection
Study of fortified complementary or replacement foods. We also conducted 20 interviews and
4 focus group discussions among women and nurses to explore the issues in depth. Practices
of most HIV-infected women did not closely follow national or international guidelines: 26%
never initiated breastfeeding, and 55% were not breastfeeding by 6 months post partum.
Women of lower socio-economic status and those not meeting criteria for safe replacement
feeding were more likely to initiate breastfeeding, to continue longer and to stop at 6 months
when provided with free food within the trial. Most HIV-negative women and women of
unknown HIV status continued breastfeeding into the infant's second year, indicating limited
'spillover' of infant feeding messages designed for HIV-infected women into the uninfected
population. Qualitative work indicated that the main factors affecting HIV-infected women's
infant feeding decisions were the cost of formula, the advice of health workers, influence of
relatives, stigma and difficulties with using an exclusive feeding mode. Rapidly changing
international recommendations confused both mothers and nurses. Many HIV-infected
women chose replacement feeding without meeting criteria to do this safely. Women were
influenced by health workers but, for several reasons, found it difficult to follow their advice.
The recently revised international HIV and infant feeding recommendations may make the
counselling process simpler for health workers and makes following their advice easier for
HIV-infected women.
PMID:
21410882
DOI:
10.1111/j.1740-8709.2010.00264.x
Format: Abstract
Send to
Matern Child Nutr. 2013 Jan;9(1):41-56. doi: 10.1111/j.1740-8709.2012.00436.x. Epub 2012
Aug 22.
Exploring Middle-Eastern mothers'

perceptions and experiences of
breastfeeding in Canada: an ethnographic

study.
Jessri M1, Farmer AP, Olson K.
Author information
Abstract
The aim of this study was to explore from the Middle-Eastern mothers' perspective, the
experience of breastfeeding and their perceptions of attributes of the health care system,
community and society on their feeding decisions after migration to Canada. New immigrant
mothers from the Middle East (n=22) were recruited from community agencies in
Edmonton, Canada. Qualitative data were collected through four focus groups using an
ethnographic approach to guide concurrent data collection and analysis. Survey data were
collected on socio-demographic characteristics via pre-tested questionnaires. All mothers, but
one who was medically exempt, breastfed their infants from birth and intended to continue
for at least 2 years. Through constant comparison of data, five layers of influence emerged
which described mothers' process of decision making: culture/society, community, health care
system, family/friends and mother-infant dyad. Religious belief was an umbrella theme that
was woven throughout all discussions and it was the strongest determining factor for
choosing to breastfeed. However, cultural practices promoted pre-lacteal feeding and hence,
jeopardising breastfeeding exclusivity. Although contradicted in Islamic tradition, most
mothers practised fasting during breastfeeding because of misbeliefs about interpretations
regarding these rules. Despite high rates of breastfeeding, there is a concern of lack of
breastfeeding exclusivity among Middle-Eastern settlers in Canada. To promote successful
breastfeeding in Muslim migrant communities, interventions must occur at different levels of
influence and should consider religious beliefs to ensure cultural acceptability. Practitioners
may support exclusive breastfeeding through cultural competency, and respectfully
acknowledging Islamic beliefs and cultural practices.
Comment in
The ideational dimension of maternal and infant nutrition: the importance of

conflicting values. [Matern Child Nutr. 2013]
PMID:
22909247
DOI:
10.1111/j.1740-8709.2012.00436.x
Format: Abstract
Send to

Women Birth. 2010 Jun;23(2):74-80. doi: 10.1016/j.wombi.2009.12.001. Epub 2010 Jan 6.
'I only give advice if I am asked': examining

the grandmother's potential to influence
infant feeding decisions and parenting
practices of new mothers.
Reid J1, Schmied V, Beale B.
Author information
School of Nursing and Midwifery, University of Western Sydney (UWS), Australia.

je.reid@uws.edu.au
Abstract
BACKGROUND:
Australia has high breastfeeding initiation rates however, at 3 and 6 months exclusive
breastfeeding rates fall below global recommendations. Research suggests significant others
in a woman's life can influence infant feeding decisions and practices but how and why they
do so needs investigation.
RESEARCH QUESTION:
This study explored grandmothers' perceptions of their role in supporting new families and
examined the potential for grandmothers to influence infant feeding decisions and parenting
practices of new mothers in an area of Sydney, Australia, with low breastfeeding maintenance
rates.
PARTICIPANTS AND METHOD:
A qualitative, descriptive study was conducted in South Western Sydney, Australia. Eleven
grandmothers participated in one to one interviews and three of these also participated in a
group discussion.
RESULTS:
Analysis revealed three themes: 'Presence'; 'Position'; and 'Power versus Preservation' which
provide insight into the complexity of the grandmother-new mother relationship and describe
the potential influence that grandmothers may have on infant feeding and parenting.
DISCUSSION AND CONCLUSION:
The findings highlight challenges and dilemmas faced by grandmothers in their supportive
role for the new mother in her breastfeeding and early parenting experience and the
difficulties grandmothers face in balancing potential risks and rewards in their interactions
with the new family.
2009 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.
PMID:
20053594
DOI:
10.1016/j.wombi.2009.12.001
Format: Abstract
Send to
Rev Panam Salud Publica. 2014 Nov;36(5):306-13.
Infant and young child feeding in four

departments in Haiti: mixed-method study
on prevalence of recommended practices
and related attitudes, beliefs, and other
determinants.
Laterra A1, Ayoya MA2, Beaulire JM2, Bienfait M2, Pachn H1.
Author information
Hubert Department of Global Health, Emory University, Atlanta, Georgia, United

States of America, alaterra@gwmail.gwu.edu.
Nutrition Section, UNICEF Country Office, Port-au-Prince, Haiti.
Abstract
OBJECTIVE:
To determine and describe the prevalence and patterns of three recommended practices for
infant and young child feeding-exclusive breastfeeding (EB), continued breastfeeding (CB),
and achievement of minimum dietary diversity-in four regions in Haiti, and to identify the
attitudes and beliefs that inform these practices and any other factors that may facilitate or
impede their implementation.
METHODS:
This study utilized a mixed-methods approach consisting of 1) a cross-sectional survey (n =
310) and 2) 12 focus group discussions among women 18 years old with children 2 years
old. Multivariable logistic regression analyses were conducted to identify factors associated
with 1) EB during the first six months of life, 2) CB for children 2 years old, and 3) receipt
of a diverse variety of complementary foods. Qualitative data were recorded, transcribed
verbatim, and analyzed for common themes. Data were collected in June and July 2013 in
four departments in Haiti: Artibonite, Nippes, Ouest, and Sud-Est.
RESULTS:
Prevalence of EB, CB, and achievement of minimum dietary diversity was 57.0%, 11.9%,
and 21.2% respectively. EB was statistically significantly associated with infant's age when
controlling for annual household income, location of most recent birth, or receipt of CB
counseling (odds ratio (OR) = 0.67 (95% CI: 0.47-0.97)). CB was not statistically
significantly associated with rural place of residence, receipt of CB counseling, parity, or
infant's age. Meeting minimum dietary diversity was not significantly associated with parity,
receipt of postnatal care, rural place of residence, location of most recent birth, receipt of
infant and young child feeding counseling, or level of schooling. Beliefs surrounding the
relationship between the mother's health and her diet on the quality of breast milk may
prohibit EB and CB. Qualitative data revealed that dietary diversity may be low because 1)
mothers often struggle to introduce complementary foods and 2) those that are traditionally
introduced are not varied and primarily consist of grains and starches.
CONCLUSIONS:
Prevalence of the three recommended infant and young child feeding practices examined in
this study is suboptimal, particularly CB and achievement of minimum dietary diversity.
Future communication and programming efforts should address the misunderstandings and
concerns identified through the qualitative methods used in this research.
PMID:
25604100
[PubMed - in process]
Format: Abstract
Send to
Breastfeed Rev. 2014 Nov;22(3):13-9.
Infant feeding practices among Sudanese

women now living in regional south east
Queensland, Australia.
Tyler L, Kirby R, Rogers C.
Abstract
The purpose of this research was to highlight and compare immigrant Sudanese women's
infant feeding choices and patterns before and after moving to a regional city in Queensland,
Australia. Semi-structured interviews were conducted with 10 Sudanese mothers who had
birthed and breastfed babies both in Africa and Toowoomba. This qualitative research project
supported previous research indicating a trend for immigrant women's breastfeeding duration
to decline when they moved to another country. The outcomes of this research suggest that
the reasons for this decline are complex. The authors conclude that a lack of social support,
language difficulties and wanting to fit in with particular Western practices are contributing
factors.
PMID:
25522458
Format: Abstract
Send to
AIDS Care. 2007 Oct;19(9):1101-9.
Infant feeding practices: realities and mind

sets of mothers in Southern Africa.
Buskens I1, Jaffe A, Mkhatshwa H.
Author information
Abstract
Exclusively breastfed infants in developing countries are at lower risk of HIV transmission
than mixed-fed infants. Ethno-graphic research was conducted in eleven low-resource
settings across South Africa, Namibia and Swaziland to understand how the perceptions and
experiences of counselling health workers, pregnant women and recent mothers could be
used to improve infant feeding counselling. Despite prevention of mother-to-child
transmission (PMTCT) programmes, very early mixed-feeding remains the norm; traditional
conceptualisations of 'water as life' and 'milk as a fluid' are holding up against current
PMTCT education, with milk considered liquid 'drink' rather than 'real food'. This aggravates
an 'insufficient milk syndrome' where disempowered mothers perceive their breastmilk, and
themselves, as deficient - 'not good enough'. Infant feeding is embedded within traditional
relationships of intimacy; both relatives and breadwinner have influence and even authority
over options and modes of infant feeding. In patriarchal and violent societies, traditional
power differentials prohibit easy or complete HIV disclosure or condom negotiation; HIV
status remains hidden from most partners and relatives. This context of secrecy means that
the traditional advice and authority, which the mothers feel they dare not disregard, is often
blind to the mother and her infant's HIV status and survival needs.
PMID:
18058394
DOI:
10.1080/09540120701336400
Format: Abstract
Send to
Food Nutr Bull. 2008 Mar;29(1):15-24.
Infant-feeding practices and beliefs about

complementary feeding among low-income
Brazilian mothers: a qualitative study.
Lindsay AC1, Machado MT, Sussner KM, Hardwick CK, Peterson KE.
Author information
Abstract
BACKGROUND:
Breastfeeding and weaning practices are important determinants of growth and development
not only in infancy but also later in life.
OBJECTIVE:
To describe infant-feeding practices and beliefs about complementary feeding among lowincome Brazilian mothers.
METHODS:
Qualitative methods included focus group discussions with low-income mothers enrolled in a
Family Health/Community Health Workers program in Cear, Northeast Brazil.
RESULTS:
Breastfeeding is widely practiced in this area, and overall, mothers are knowledgeable about
the benefits of breastfeeding for their infants and themselves. Practices of prolonged
breastfeeding and delayed supplementation of infants with semisolid foods emerged as a

problem among very poor women. In addition, the results showed common problems related
to complementary feeding practices, such as the early introduction of solid foods and the use
of expensive commercial cereals and formula for weaning. Cultural factors and taboos
appeared to have an important influence on mothers' infant-feeding practices and eating
patterns of their children.
CONCLUSIONS:
The results have implications for the design of breastfeeding promotion and interventions to
improve complementary feeding. Improvements of the national Food Grant Program are also
suggested, which are needed by low-income mothers to improve their infant-feeding
practices.
PMID:
18510201
Format: Abstract
Send to
J Hum Lact. 2011 Feb;27(1):25-32; quiz 63-5. doi: 10.1177/0890334410390039. Epub 2010
Dec 22.
Knowledge, beliefs, and practices regarding

exclusive breastfeeding of infants younger
than 6 months in Mozambique: a
qualitative study.
Arts M1, Geelhoed D, De Schacht C, Prosser W, Alons C, Pedro A.
Author information
Abstract
Only 37% of infants younger than 6 months in Mozambique are exclusively breastfed. A
qualitative assessment was undertaken to identify the knowledge, beliefs, and practices
around exclusive breastfeeding--specifically, those of mothers, fathers, grandmothers, and
nurses--and to identify the support networks. Results show many barriers. In addition to
receiving breast milk, infants receive water, traditional medicines, and porridges before 6
months of age. Many mothers had heard of the recommendation to exclusively breastfeed for
6 months. However, other family decision makers had heard less about exclusive
breastfeeding, and many expressed doubts about its feasibility. Some of them expressed
willingness to support exclusive breastfeeding if they were informed by health workers.
Nurses know the benefits of exclusive breastfeeding and pass this information on verbally but
have insufficient counseling skills. Interventions to improve exclusive breastfeeding should

target family and community members and include training of health workers in counseling
to resolve breastfeeding problems.
PMID:
21177988
DOI:
10.1177/0890334410390039
Format: Abstract
Send to
Public Health Nutr. 2015 Dec;18(18):3371-85. doi: 10.1017/S1368980015000452. Epub
2015 Mar 5.
'Life does not make it easy to breast-feed':

using the socio-ecological framework to
determine social breast-feeding obstacles in
a low-income population in Tijuana,
Mexico.
Bueno-Gutierrez D1, Chantry C2.
Author information
1Nutrition Department,University of California Davis,3135 Meyer Hall,One Shields

Avenue,Davis,CA 95616,USA.
2Center for Healthcare Policy and Research,UC Davis Children's
Hospital,Sacramento,CA,USA.
Abstract
OBJECTIVE:
Breast-feeding rates reflect sociodemographic discrepancies. In Mexico, exclusive breastfeeding under 6 months of age has deteriorated among the poor, rural and indigenous
populations from 1999 to 2012. Our objective of the present study was to identify the main
social obstacles to breast-feeding in a low-income population in Tijuana, Mexico.
DESIGN:
Qualitative study using a socio-ecological framework for data collection.
SETTING:
Low-income communities in Tijuana, Mexico.
SUBJECTS:
Mothers (n 66), fathers (n 11), grandparents (n 27) and key informants (n 25).
RESULTS:
One hundred and twenty-nine individuals participated in the study: six focus groups (n 53)
and fifty-one interviews among mothers, fathers and grandparents; and twenty-five
interviews among key informants. Seven social themes were identified: (i) embarrassment to
breast-feed in public; (ii) migrant experience; (iii) women's role in society; (iv) association of
formula with higher social status; (v) marketing by the infant food industry; (vi) perception of
a non-breast-feeding culture; and (vii) lack of breast-feeding social programmes.
CONCLUSIONS:
Socio-structural factors influence infant feeding practices in low-income communities in
Tijuana. We hypothesize that messages emphasizing Mexican traditions along with modern
healthy practices could help to re-establish and normalize a breast-feeding culture in this
population. The target audience for these messages should not be limited to mothers but also
include family, health-care providers, the work environment and society as a whole.
KEYWORDS:
Breast-feeding; Low income; Obstacles; Socio-ecological framework
PMID:
25740254
DOI:
10.1017/S1368980015000452
[PubMed - in process]
Format: Abstract
Send to
Matern Child Health J. 2012 Dec;16(9):1926-32. doi: 10.1007/s10995-011-0939-x.
Long-term breastfeeding support: failing

mothers in need.
Cross-Barnet C1, Augustyn M, Gross S, Resnik A, Paige D.
Author information
Abstract
This qualitative study analyzes mothers' reports of breastfeeding care experiences from
pregnancy through infancy. Most research on medical support for breastfeeding examines a
specific practice or intervention during an isolated phase of care. Little is know about how
mothers experience breastfeeding education and support from the prenatal period through
their child's first year. A convenience sample of 75 black and white WIC participants with
infants was recruited at three Maryland WIC agencies. In-depth interviews covered mothers'
comprehensive experiences of breastfeeding education and support from pregnancy through
the interview date. Most mothers received education or support from a medical professional
prenatally, at the hospital, or during the child's infancy, but most also reported receiving no
education or support at one or more of these stages. Mothers often felt provided education
and support was cursory and inadequate. Some mothers received misinformation or
encountered practitioners who were hostile or indifferent to breastfeeding. Mothers were not
given referrals to available resources, even after reporting breastfeeding challenges. Mothers
received inconsistent messages regarding breastfeeding within and across institutions.
Mothers need consistent, sustained information and support to develop and meet personal
breastfeeding goals. Medical professionals should follow guidelines issued by their own
organizations as well as those from the US Surgeon General, Healthy People 2020, and the
Baby Friendly Hospital Initiative. Prenatal, postnatal, and pediatric care providers should
coordinate to provide consistent messages and practices within and across sites of care.
PMID:
22246714
DOI:
10.1007/s10995-011-0939-x
Format: Abstract
Send to
J Adv Nurs. 2010 Aug;66(8):1810-8. doi: 10.1111/j.1365-2648.2009.05156.x. Epub 2010 Jun
16.
Managing breastfeeding and work: a

Foucauldian secondary analysis.
Payne D1, Nicholls DA.
Author information
Abstract
AIM:
This paper is a report of a secondary analysis of the experiences of employed breastfeeding
mothers.
BACKGROUND:
Health promotion policies exhort mothers to feed their infants breastmilk exclusively for the
first 6 months and partially until the age of 2 years. More mothers are returning to paid
employment less than a year after having a baby. Combining breastfeeding and paid work is
an issue for nursing and midwifery as predominantly female professions caring for women
and their children.
METHOD:
Foucauldian discourse analysis was used for a secondary analysis of interviews performed in
2005 with 20 women who continued to breastfeed on their return to work. The discursive
positions and disciplinary practices were identified and analysed.
FINDINGS:
Combining breastfeeding and paid work required negotiating the positions of good mother
and good worker. Being a good mother conferred health benefits on infants. Being a good
worker required the mothers to constrain their breastfeeding practices. The practices
performed by the mothers involved stockpiling breastmilk, maintaining milk supply,
preparing the baby ready for absence, making sacrifices and remaining silent and invisible as
a breastfeeding worker.
CONCLUSION:
Breastfeeding workers have the potential to threaten the focus of the workplace. They
discipline themselves to minimize their disruptive potential. Such strategies serve to maintain
the marginalization of breastfeeding in the workplace and to keep women's efforts to continue
breastfeeding invisible. The work of breastfeeding workers needs to be better recognized and
supported.
PMID:
20557398
DOI:
10.1111/j.1365-2648.2009.05156.x
Format: Abstract
Send to
Food Nutr Bull. 2016 Mar;37(1):73-84. doi: 10.1177/0379572115624289. Epub 2016 Jan 21.
Maternal Perceptions and Views About

Breastfeeding Practices Among Emirati
Mothers.
Radwan H1, Sapsford R2.
Author information
Abstract
BACKGROUND:
Understanding women's breastfeeding perceptions and experiences is increasingly recognized
as a vital tool to provide effective support that would encourage the extension of the
breastfeeding period.
OBJECTIVE:
To identify and explore the perceptions and views that influence the feeding and weaning
decisions of Emirati mother.
METHODS:
A qualitative study using indepth interviews was undertaken with a convenience sample of 45
Emirati mothers who had infants aged between 6 months and 2 years. Participants were
interviewed in the health centers in 3 cities in United Arab Emirates. Data were recorded
through field notes and analyzed thematically using grounded theory analysis.
RESULTS:
The following themes emerged: influences of others on the decisions to breastfeed, sources of
information, infants' behavior and participants' views and decisions about when to introduce
supplementary feeding, knowledge of and attitudes toward current World Health
Organization recommendations, and mothers' perception of the benefits of breastfeeding.
Grandmothers in this study played an important role in the breastfeeding practices of Emirati
mothers. They supported breastfeeding, however, some encouraged giving the infants
prelacteal feeds for a variety of reasons: colic, hunger, promoting growth, and hydration.
Fathers, according to the mothers, either supported or ignored breastfeeding practices.
CONCLUSION:
Health promotions and health care facilities failed to deliver the message of exclusive
breastfeeding. Mothers in our study were resorting to the expertise of the grandmothers and
receiving information and advice about child feeding from them. The findings highlight the
need for successful intervention programs to be implemented for mothers and grandmothers
through health care providers.
The Author(s) 2016.

KEYWORDS:
breastfeeding; complementary food; early childhood nutrition; maternal and child nutrition
PMID:
26793991
DOI:
10.1177/0379572115624289
Format: Abstract
Send to
Minn Med. 2013 Dec;96(12):46-50.
Mexican and Somali immigrant

breastfeeding initiation and counseling: a
qualitative study of practices.
Textor L1, Tiedje K2, Yawn B1.
Author information
Abstract
Breastfeeding is highly beneficial to mothers and children. Yet even among women who
intend to breastfeed their babies, it is not always initiated or sustained. We decided to
examine whether cultural beliefs affect breastfeeding practices. Specifically, we looked at
those of immigrant Mexican and Somali women who gave birth at a community hospital in
southeastern Minnesota and those of the nurses and lactation educators who supported them.
To study this, we conducted focus groups with health professionals (N=10) and in-person
interviews with Somali and Mexican mothers (N=9). Although the mothers in this study
stated their intention to breastfeed, our data show they faced significant challenges to early
breastfeeding initiation and exclusive breastfeeding, including their belief that they did not
initially produce enough milk. We found the nurses' and lactation educators' discomfort with
counseling people from another background as well as language differences and lack of
cultural understanding were also barriers to early breastfeeding initiation and exclusive
breastfeeding. This study highlights how the beliefs of new mothers and the attitudes of
nurses and educators can affect breastfeeding outcomes.
PMID:
24597197
Format: Abstract
Send to
Soc Sci Med. 2010 Mar;70(6):951-8. doi: 10.1016/j.socscimed.2009.11.023. Epub 2010 Jan
13.
Moral work in women's narratives of

breastfeeding.
Ryan K1, Bissell P, Alexander J.
Author information
Abstract
Women's narratives of their breastfeeding experiences are sites of construction and
reconstruction of self as they undertake moral work in relation to feeding their baby. We
engaged Foucault's 'technologies of the self' and his notion of ethics (the relationship with
self) to examine that moral work (individual actions rather than adherence to universal moral
codes) in relation to women's subjectivity constructed in interviews with 49 women from the
UK. Four categories of moral work were identified: biographical preservation, biographical
repair, altruism and political action. We describe each of these and conclude that women's
embodied experience and sense of self are disciplined within current, limited, often punishing
discourses by undertaking painful moral work in order to maintain or repair their subjective
positions. We suggest the development of new subject positions around infant feeding
practices.
PMID:
20074841
DOI:
10.1016/j.socscimed.2009.11.023
Format: Abstract
Send to
J Clin Nurs. 2006 Jan;15(1):29-34.
Mothers' experiences of feeding situations an interview study.

Bramhagen AC1, Axelsson I, Hallstrm I.
Author information
Abstract
AIM:
The aim of the study was to describe parents' experiences concerning feeding situations and
their contact with the nurse at the Child Health Service (CHS).
BACKGROUND:
Some of the most important tasks for the nurse at the CHS are to monitor growth, detect
feeding difficulties and give advice concerning food intake and feeding practices.
METHOD:
Eighteen mothers differing in age, education, ethnicity and number of children and recruited
from different CHS were interviewed. The narratives were transcribed verbatim and analysed
by content analysis at manifest and latent levels.
RESULT:
All mothers' described that food and feeding were essential parts of their lives requiring a
great deal of time and involvement. Two major categories of mothers' attitudes in feeding
situations were identified - a flexible attitude and a controlling attitude. Mothers with a
flexible attitude were sensitive to the child's signals and responded to them in order to obtain
good communication. Mothers who expressed a need for control established rules and
routines regarding the feeding situations. Mothers with a controlling attitude expressed
receiving inadequate support from the nurse at the CHS.
CONCLUSION AND CLINICAL IMPLICATION:
This study shows that some mothers experience inadequate support from the nurse at the
CHS. Knowledge about mothers' experiences of feeding situations and their different
attitudes towards the child during feeding might improve the CHS nurses' knowledge and
help them understand and more adequately support mothers who experience feeding
difficulties.
Comment in
Commentary on Bramhagen AC, Axelsson I and Hallstrm I (2006) Mothers'

experiences of feeding situations--an interview study. Journal of Clinical Nursing 15,
29-34. [J Clin Nurs. 2008]
PMID:
16390521
DOI:
10.1111/j.1365-2702.2005.01242.x
Format: Abstract
Send to
Int J Nurs Pract. 2014 Jun;20(3):293-301. doi: 10.1111/ijn.12148. Epub 2013 Aug 15.
Non-family support for breastfeeding

maintenance among career women in
Taiwan: a qualitative study.
Chang SM1, Rowe J, Goopy S.
Author information
Abstract
The purpose of the study was to describe the influence of non-family-based support on
breastfeeding practices among career women in Taiwan during the first four postnatal
months. A qualitative, case study approach was used to investigate the phenomenon. A
purposive sample of 14 women was recruited and took part in two to three in-depth
interviews. The data were transcribed and analysed using descriptive content analysis. It was
found that non-family supports had significant influence on their efforts to maintain
breastfeeding. Women faced a number of challenges to breastfeeding. The services provided
by in-centre care organizations, the resources and organizations accessed through the Internet,
and the support provided by colleagues in their workplaces supported women's efforts to
maintain breastfeeding. Given the low breastfeeding maintenance rates in Taiwan and the
changing societal structure where fewer families rely on family support, the findings
highlight the resources, programmes and nursing practice which might support women's
needs and promote breastfeeding among career women.
2013 Wiley Publishing Asia Pty Ltd.
KEYWORDS:
breastfeeding; breastfeeding maintenance; breastfeeding promotion; breastfeeding support;

career women
PMID:
24889002
DOI:
10.1111/ijn.12148
Format: Abstract
Send to
J Obstet Gynecol Neonatal Nurs. 2011 Mar-Apr;40(2):166-78. doi: 10.1111/j.15526909.2011.01232.x.
Perspectives of hospital-based nurses on

breastfeeding initiation best practices.
Weddig J1, Baker SS, Auld G.
Author information
Abstract
OBJECTIVE:
To assess the variation in breastfeeding knowledge and practices of registered nurses in
hospital women and family-care units and the informal and formal hospital policies related to
the initiation and support of breastfeeding.
DESIGN:
This qualitative study employed a focus group approach to solicit perceptions of hospitalbased nurses regarding breastfeeding best practices.
SETTING:
Eight state hospitals stratified by socioeconomic status (SES) and size served as settings to
recruit participants for this study.
PARTICIPANTS:
Forty female registered nurses from labor and delivery (n=9), postpartum (n=13), labor and
delivery/recovery/postpartum care (LDRP) (n=12) and neonatal intensive care unit (NICU)
(n=6) constituted eight focus groups.
RESULTS:
The majority of nurses reported being knowledgeable of evidence-based best practices related
to breastfeeding initiation. However, in non-Baby Friendly/Baby Friendly Intent (nonBF/BFI) settings, nurses' knowledge often was not in accordance with current best practices
in breastfeeding initiation, and reported hospital policies were not based upon evidence-based
practices. Barriers to best practices in breastfeeding initiation included hospital lactation
policies (formal and informal), nurses' limited education in breastfeeding initiation best
practices, high rates of surgical delivery, and lack of continuity of care with the transition of
responsibility from one nurse to another from labor and delivery to transition care to
postpartum care.
CONCLUSIONS:
A significant disparity between nurses' intention to support breastfeeding and their knowledge
suggests a need for education based on the World Health Organization Baby Friendly
standards for nurses at non-BF/BFI hospitals. A significant barrier to supporting breastfeeding
is lack of hospital policy and inappropriate or outdated policy.
2011 AWHONN, the Association of Women's Health, Obstetric and Neonatal Nurses.
PMID:
21410755
DOI:
10.1111/j.1552-6909.2011.01232.x
Format: Abstract
Send to
Matern Child Nutr. 2014 Jan;10(1):102-11. doi: 10.1111/mcn.12012. Epub 2012 Dec 11.
Social circumstances that drive early

introduction of formula milk: an
exploratory qualitative study in a periurban South African community.
Ijumba P1, Doherty T, Jackson D, Tomlinson M, Sanders D, Persson L.
Author information
Health Systems Research Unit, Medical Research Council, Durban, South Africa;
International Maternal and Child Health (IMCH), Department of Women's and
Children's Health, Uppsala, Sweden.
Abstract
Breastfeeding is widely endorsed as the optimal strategy for feeding newborns and young
infants, as well as improving child survival and achieving Millennium Development Goal 4.
Exclusive breastfeeding (EBF) for the first 6 months of life is rarely practised in South
Africa. Following the 2010 World Health Organization (WHO) infant feeding
recommendations (EBF for HIV-positive mothers with maternal or infant antiretroviral
treatment), South Africa adopted breastfeeding promotion as a National Infant Feeding
Strategy and removed free formula milk from the Prevention of Mother-to-Child
Transmission of HIV programme. This study aimed to explore the perceptions of mothers and
household members at community level regarding the value they placed on formula feeding
and circumstances that drive the practice in a peri-urban community. We conducted in-depth
interviews with HIV-positive and HIV-negative mothers in a community-randomised trial
(Good Start III). Focus group discussions were held with grandmothers, fathers and teenage
mothers. Data were analysed using thematic analysis. The following themes were identified;
inadequate involvement of teenage mothers; grandmothers who become replacement
mothers; fear of failing to practise EBF for 6 months; partners as formula providers and
costly formula milk leading to risky feeding practices. The new South African Infant Feeding
Strategy needs to address the gaps in key health messages and develop community-orientated
programmes with a focus on teenage mothers. These should encourage the involvement of
grandmothers and fathers in decision-making about infant feeding so that they can support
EBF for optimal child survival.
2012 John Wiley & Sons Ltd.
KEYWORDS:
HIV; community perceptions; focus group discussion; formula feeding; qualitative research;
social circumstances
PMID:
23230962
DOI:
10.1111/mcn.12012
Format: Abstract
Send to
J Clin Nurs. 2010 Apr;19(7-8):1021-9. doi: 10.1111/j.1365-2702.2009.02956.x.
Understanding the cultural context of

Chinese mothers' perceptions of
breastfeeding and infant health in Canada.
Chen WL1.
Author information
Abstract
AIMS AND OBJECTIVES:
The purpose of this study was to explore Chinese mothers' perceptions about breastfeeding
and infant health in the Canadian context.
BACKGROUND:
Chinese mothers' breastfeeding perceptions are challenging for health professionals in North
America, but few studies have focused on this issue in depth.
DESIGN:
An interpretive qualitative methodology was used.
METHODS:
Data were collected through semi-structured individual interviews with 15 purposively
sampled Chinese mothers two months after delivery in Vancouver, British Columbia.
Interviews were audiotaped and transcribed verbatim. Constant comparative analysis was
used to develop coding categories and identify themes.
RESULTS:
Two main themes emerged: (1) the idea of harmony within change and (2) the meaning of
infant health. The first represents mothers' perceptions about breastfeeding: the value of
common sense, purity of breast milk and the laws of nature. The second represents notions of
infant health, including its indicators and the relationship between mother's health and infant
health.
CONCLUSIONS:
Chinese mothers' concepts of breastfeeding are associated with Western biomedical thought,
traditional Chinese medicine and personal experiences, especially those embedded in the
traditional Chinese cultural context. Perceptions of breastfeeding and infant health regarding
notions of harmony within natural dynamic patterns must be considered when promoting
breastfeeding.
RELEVANCE TO CLINICAL PRACTICE:
This study highlights the cultural context affecting Chinese mothers' breastfeeding practices.
Nurses and other health professionals require sensitivity when assessing Chinese mothers'
breastfeeding practice so that they are able to provide appropriate postnatal and breastfeeding
support.
PMID:
20492046
DOI:
10.1111/j.1365-2702.2009.02956.x
Format: Abstract
Send to
Midwifery. 2011 Oct;27(5):731-6. doi: 10.1016/j.midw.2010.02.006. Epub 2010 Apr 18.
Vietnamese women's cultural beliefs and

practices related to the postpartum period.
Lundberg PC1, Trieu TN.
Author information
Abstract
OBJECTIVE:
to describe cultural beliefs and practices related to the postpartum period among Vietnamese
women in Ho Chi Minh City.
DESIGN:
a descriptive cross-sectional study using triangulation.
SETTING:
the Postpartum Clinic, Department of Obstetrics and Gynaecology of a university hospital in
Ho Chi Minh City, Vietnam.
PARTICIPANTS:
115 Vietnamese women, 95 in the first group and 20 in the second group.
DATA COLLECTION AND ANALYSIS:
a questionnaire was used with the first group and a semi-structured in-depth interview was
used with the second group. Both groups were subjected to the same four open-ended
questions. The data obtained were first analysed separately by use of qualitative content
analysis and then cross-checked.
FINDINGS:
four categories were identified: hygiene, behavioural precautions (lying by a fire, keeping
warm after birth, staying indoors and resting in bed, and avoiding house work and sexual
activity), dietary precautions, and breast feeding and lactation.
KEY CONCLUSION AND IMPLICATIONS FOR PRACTICE:
traditional beliefs and practices, often beneficial to the women and their babies but sometimes
potentially harmful, greatly influenced the Vietnamese women during the postpartum period.
Therefore, health-care professionals need to give appropriate information and care to the
women and their families while paying due attention to the cultural context. These demands
make it imperative that knowledge about cultural values be included in their education, not
least in Western countries which have become multicultural.
PMID:
20400214
DOI:
10.1016/j.midw.2010.02.006
Format: Abstract
Send to
Matern Child Nutr. 2009 Apr;5(2):138-50. doi: 10.1111/j.1740-8709.2008.00163.x.
Women's experiences of infant feeding

support in the first 6 weeks post-birth.
Sheehan A1, Schmied V, Barclay L.
Author information
Abstract
Research suggests women find the first 2 to 6 weeks to be the most difficult time for
breastfeeding. It has been identified that women need and seek support with breastfeeding
during this time. Support is a difficult concept to define. When discussed by professionals,
support for breastfeeding is generally viewed in terms of providing information and
educational interventions. There is little understanding of the different elements of
breastfeeding support strategies and the mechanisms by which support operates. Further,
there is a paucity of qualitative research specifically reporting women's experiences and
expectations of professional support. This paper describes women's expectations and
experiences of 'infant feeding support' provided by health professionals in the first 6 weeks
post-birth. The findings are drawn from a grounded theory study exploring women's infant
feeding decisions in the first 6 weeks post-birth. Participants were recruited from a variety of
socio-demographic areas of Sydney and the NSW Central Coast, Australia in 2003-2004. The
women in this study discussed aspects of what they considered helpful and/or unhelpful in
terms of professional support. In addition, they also provided insight into aspects of
interactions that were deemed important to them as new mothers learning to feed their babies.
The results are presented in three sections: expecting support, experiencing support and
evaluating support. The findings help to better understand components of professional
practices and behaviours that can be considered supportive. The support behaviours are far
more complex than simply increasing education and knowledge of infant feeding. They
demonstrate the need for sensitive individualized care and show that this type of support can
increase women's confidence to breastfeed.
PMID:
19292748
DOI:
10.1111/j.1740-8709.2008.00163.x

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