Exploring the Concept of Positive Deviance Related to Breastfeeding Initiation in Black and White WIC Enrolled First Time Mothers

Positive deviance inquiry is effective in identifying advantageous health behaviors and improving health outcomes among disadvantaged resource-poor populations. The objective of this study was to apply the positive deviance concept to explore the characteristics of positive deviants for breastfeeding among WIC-enrolled first-time mothers in Louisiana. The cross sectional study included data on 2,036 WIC-enrolled first time mothers (52.6% black) from the LaPRAMs, 2000?C2004. Chi-square test was used to compare groups. Multivariable logistic regression was applied to calculate adjusted OR and 95% CI by breastfeeding initiation status. The average age was 21.3?years, 31.5% had less than 12?years of education, and 44.6% of the sample reported having initiated breastfeeding. Black mothers were less likely to initiate breastfeeding than their white counterparts (OR 0.39 (95% CI: 0.31, 0.48)). Among 641 WIC-enrolled first time mothers with less than 12?years of education, 28.4% were identified as positive deviants for breastfeeding initiation. Among the black mothers 19.8% were positive deviants compared to 40.3% of the white mothers. Breastfeeding in the hospital after delivery (P?<?0.0001) and having received help on how to breastfeed in the hospital (P?<?0.0001) were significantly associated with breastfeeding initiation in white and black mothers. In addition, the black positive deviants were more likely, OR 2.80 (95% CI: 1.20, 6.56) to have initiated breastfeeding if their baby was low birth weight. Breastfeeding practices shortly after delivery including assistance and education from staff in the hospital, are related to breastfeeding initiation among less educated WIC-enrolled mothers.     

Determinants of Breastfeeding Initiation and Duration Among African American DC WIC Recipients: Perspectives of Recent Mothers

BackgroundIn Washington, DC, African American women receiving the Special Supplemental Nutrition Program for Women, Infants and Children (WIC) benefits have the lowest breastfeeding rates compared with other WIC-eligible populations.ObjectivesThe purpose of this research was to use the social cognitive theory and elements of social support as a guiding framework to better understand the factors affecting breastfeeding initiation and duration among African American WIC recipients in low-income areas of Washington, DC.MethodsSemistructured interviews were conducted with 24 women receiving WIC services in DC to learn about their infant feeding practices and decisions. Using a pragmatic approach, an integrated inductive and deductive coding strategy was used.ResultsBreastfeeding experiences were influenced by barriers at multiple levels: community (i.e., perceptions of breastfeeding in one's network), interpersonal (i.e., few supportive providers), and individual constraints (i.e., pain, supply, and latching issues) as well as environmental difficulties of finding resources to help overcome these challenges. Social support from a close family member, friend, or partner often helped to minimize many of these barriers and facilitated breastfeeding.ConclusionsSocial support seems to bolster efficacy and help women to overcome various barriers to breastfeeding in their immediate environment; however, social support from providers was limited. WIC offers recipients in DC many helpful breastfeeding resources. Although several respondents were aware of these resources, overall use in the sample was low. Continued outreach may help further facilitate breastfeeding in African American mothers by providing additional sources of social support.     

An Evaluation of Breastfeeding Promotion Through Peer Counseling in Mississippi WIC Clinics

Objective: This study evaluates the effectiveness of a peer counseling program at increasing breastfeeding by participants in the Mississippi Special Supplemental Nutrition Program for Women, Infants and Children (WIC). Methods: Data from the 1989–1993 Pediatric Nutrition Surveillance System were analyzed to compare breastfeeding rates in clinics with and without peer counseling programs. A questionnaire completed by program staff to describe the program in greater detail helped identify characteristics associated with greater success. Results: The incidence of breastfeeding rose from 12.3% to 19.9% in those clinics with peer counseling programs, but only from 9.2% to 10.7% in clinics without a program. Clinics that started a program earlier showed greater changes in breastfeeding incidence. However, the presence of lactation specialists or consultants in the clinic appeared to be more important than the presence of less-trained peer counselors. Peer counselors who spent more than 45 minutes per participant were more effective than those spending less time. Conclusions: The peer counseling program significantly increased the incidence of breastfeeding, particularly in clinics with lactation specialists and consultants. Success can be enhanced by ensuring that peer counselors spend a great deal of time with the participants.     

Baby Friendly Hospital Designation and Breastfeeding Outcomes Among Maryland WIC Participants

Maternal and Child Health Journal - The Baby-Friendly Hospital&nbsp;Initiative is an effective intervention to support maternal practices around breastfeeding. However, little is known about...     

Trends in Breastfeeding Disparities in US Infants by WIC Eligibility and Participation

Objective

To examine the trends in breastfeeding disparities across Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) eligibility and participation statuses in the last 2 decades.

Breastfeeding Practices Among First-Time Mothers and Across Multiple Pregnancies

To investigate maternal characteristics associated with breastfeeding initiation and success. Women enrolled in the Mothers Outcomes After Delivery study reported breastfeeding practices 5?C10?years after a first delivery. Women were classified as successful breastfeeding initiators, unsuccessful initiators, or non-initiators. For the first birth, demographic and obstetrical characteristics were compared across these three breastfeeding groups. For multiparous women, agreement in breastfeeding status between births was evaluated. Multivariate regression analysis was used to identify characteristics associated with non-initiation and unsuccessful breastfeeding across all births. Of 812 participants, 740 (91%) mothers tried to breastfeed their first child and 593 (73%) reported breastfeeding successfully. In a multivariate analysis, less educated women were less likely to initiate breastfeeding (odds ratio (OR) for non-initiation 1.97; 95% confidence interval (CI) 1.23, 3.14). There was a notable decrease in breastfeeding initiation with increasing birth order: compared to the first birth, the odds for non-initiation after a second delivery almost doubled (OR 1.83, 95% CI 1.42, 2.35) and the odds for non-initiation after a third delivery were further increased (OR 2.44, 95% CI 1.56, 3.82). Successful breastfeeding in a first pregnancy was a predictor of subsequent breastfeeding initiation and success. Specifically, women who did not attempt breastfeeding or who reported unsuccessful attempts to breastfeed at first birth were unlikely to initiate breastfeeding at later births. Cesarean delivery was not associated with breastfeeding initiation (OR 1.01; 95% CI 0.68, 1.48) or success (OR 1.33; 95% CI 0.92, 1.94). Breastfeeding practices after a first birth are a significant predictor of breastfeeding in subsequent births.     

Dietary Patterns of Breastfeeding Mothers and Human Milk Composition: Data from the Italian MEDIDIET Study

(1) Background: Several studies have reported associations between maternal diet in terms of single foods or nutrients and human milk compounds, while the overall role of maternal diet and related dietary patterns has rarely been investigated. (2) Methods: Between 2012 and 2014, we enrolled 300 healthy Italian mothers, who exclusively breastfed their infant. During a hospital visit at 6 weeks postpartum, a sample of freshly expressed foremilk was collected and information on maternal dietary habits in the postpartum period was obtained through an interviewer-administered food frequency questionnaire. We applied principal component factor analysis to selected nutrients in order to identify maternal dietary patterns, and assessed correlations in human milk macronutrients and fatty acids across levels of dietary patterns. (3) Results: Five dietary patterns were identified, named “Vitamins, minerals and fibre”, “Proteins and fatty acids with legs”, “Fatty acids with fins”, “Fatty acids with leaves”, “Starch and vegetable proteins”. These dietary patterns were correlated with some milk components, namely fatty acids, and in particular ω-3 and its subcomponents. (4) Conclusions: This study showed that overall maternal dietary habits during breastfeeding may influence human milk composition, suggesting the importance of adequate maternal nutrition during lactation not only for the mother herself but also to provide the infant with milk containing adequate amount and quality of nutrients for a balanced nutrition.     

Prenatal and Postnatal Fruit and Vegetable Intake Among US Women: Associations with WIC Participation

Objective Evaluate variation in fruit and vegetable intake by Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) participation and poverty status among pregnant, and postpartum women participating in the Infant Feeding Practice Study II (IFPSII). Methods IFPSII (2005–2007) followed US women from third trimester through 1 year postpartum through mailed questionnaires measuring income, WIC participation, breastfeeding; and dietary history questionnaires (DHQ) assessing prenatal/postnatal fruit and vegetable consumption. Poverty measurements used U.S. Census Bureau Federal Poverty thresholds to calculate percent of poverty index ratio (PIR) corresponding to WIC’s financial eligibility (≤185 % PIR). Comparison groups: WIC recipients; WIC eligible (≤185 % PIR), but non-recipients; and women not financially WIC eligible (>185 % PIR). IFPSII participants who completed at least one DHQ were included. Intake variation among WIC/poverty groups was assessed by Kruskal–Wallis tests and between groups by Mann–Whitney Wilcoxon tests and logistic regression. Mann–Whitney Wilcoxon tests examined postnatal intake by breastfeeding. Results Prenatal vegetable intake significantly varied by WIC/poverty groups (p = 0.04) with WIC recipients reporting significantly higher intake than women not financially WIC eligible (p = 0.02); association remained significant adjusting for confounders [odds ratio 0.66 (95 % confidence interval: 0.49–0.90)]. Prenatal fruit and postnatal consumption did not significantly differ by WIC/poverty groups. Postnatal intake was significantly higher among breastfeeding than non-breastfeeding women (fruit: p < 0.0001; vegetable: p = 0.006). Conclusions for Practice Most intakes did not significantly differ by WIC/poverty groups and thus prompts research on WIC recipient’s dietary behaviors, reasons for non-participation in WIC, and the influence of the recent changes to the WIC food package.     

Innovative Use of Influential Prenatal Counseling May Improve Breastfeeding Initiation Rates Among WIC Participants

ObjectiveTo determine whether integrating influence strategies (reciprocation, consistency, consensus, feeling liked, authority, and scarcity) throughout Chickasaw Nation Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) clinics (1) changed participants' perception of the WIC experience and (2) affected breastfeeding initiation rates.MethodsTwo-part, quasi-experimental design.SettingFour WIC clinics.ParticipantsParents and caregivers of children birth to 3 years.InterventionBehavior change intervention based on Social Cognitive Theory using Caildini's Principles of Influence. Traditional-model groups (control) received services prior to the intervention; influence-model groups (experimental) received services after initiation of the intervention.Main OutcomesThe preliminary demonstration project surveyed 2 groups to measure changes in their perceptions of the WIC environment. Secondary data analysis measured changes in breastfeeding initiation in 2 groups of postpartum women.AnalysesFrequency analysis, independent sample t tests, chi-square for independence, step-wise logistic regression.ResultsThe demonstration project resulted in 5 improved influence measures (P < .02), aligning with the influence principle of “feeling liked.” The model had a small effect (φ = 0.10) in distinguishing breastfeeding initiation; women in the influence model were 1.5 times more likely (95% CI, 1.19–1.86; P < .05) to initiate breastfeeding compared with women in the traditional model, controlling for parity, mother's age, and race.Conclusions and ImplicationsConsistent with Social Cognitive Theory, changing the WIC environment by integrating influence principles may positively affect women's infant feeding decisions and behaviors, specifically breastfeeding initiation rates.     

儿童母亲纯母乳喂养相关知识、行为及网络利用调查

目的 抽样调查儿童母亲有关婴幼儿喂养的信息、知识和行为情况,了解儿童母亲纯母乳喂养知识行为现状及网络利用情况.方法 在北京市西城区2所社区预防接种门诊,对前来参与预防接种的儿童母亲(排除未给婴儿添加辅食的儿童母亲)进行相关知识行为调查.结果 被调查的215位儿童母亲中,有56.3％不知道或者不能正确理解纯母乳喂养的概念,知道确切的纯母乳喂养持续时间的仅占27.9％,有32.3％对于婴幼儿纯母乳喂养存在知行不一的现象.87.4％的儿童母亲关注网络中的婴幼儿喂养相关知识,69.9％的儿童母亲会采取搜索引擎的搜索方式.当儿童母亲在网络中找到解决的办法时,90.5％的儿童母亲会选择采纳.结论 儿童母亲对纯母乳喂养相关知识了解不够,应该加强婴幼儿喂养知识的普及工作,绝对数量的儿童母亲关注网络中的婴幼儿喂养知识.     

Social and Institutional Factors that Affect Breastfeeding Duration Among WIC Participants in Los Angeles County, California

Hospital practices and early maternal return to work are associated with breastfeeding duration; however, research has not documented the long-term effects of many hospital policies or the effect of early return to work on breastfeeding outcomes of WIC participants. This study investigated the impact of in-hospital breastfeeding, receipt of a formula discharge pack, and maternal return to work on the long-term breastfeeding outcomes of 4,725 WIC participants in Los Angeles County, California. Multivariate logistic regression analyses were used to assess determinants of exclusive breastfeeding at 6?months and breastfeeding at 6, 12, and 24?months. In-hospital initiation of breastfeeding, exclusive breastfeeding in the hospital, receipt of a formula discharge pack, and maternal return to work before 3?months were all significantly associated with breastfeeding outcomes after controlling for known confounders. Mothers who exclusively breastfed in the hospital were eight times as likely as mothers who did not breastfeed in the hospital to reach the AAP recommendation of breastfeeding for 12?months or longer (P?<?.01). Only 6.9% of the sample reported exclusively breastfeeding for 6?months or more, and just one-third reported any breastfeeding at 12?months. Nine in ten respondents received a formula discharge pack in the hospital. Mothers who received a discharge pack were half as likely to exclusively breastfeed at 6?months as those who did not receive one (P?<?.01). Medical providers should educate, encourage, and support WIC mothers to breastfeed in the hospital and refrain from giving formula discharge packs.     

Design and Implementation of a Nutrition and Breastfeeding Education Program for Black Expecting Mothers and Fathers

ObjectiveTo describe the intervention and research methods of Project Dads in Nutrition Education, an intervention that adds nutrition and breastfeeding education to the existing Healthy Start program in Georgia for Black expecting mothers and fathers to improve nutrition literacy, health outcomes, and breastfeeding rates.DesignThis 2-year community-based participatory research study employs a cluster randomization factorial design.SettingSix Healthy Start program sites (3 intervention and 3 control sites) in Georgia counties with high infant and maternal mortality rates.ParticipantsApproximately 480 Black, expecting, Healthy Start program participants (20 couples [mother and father] and 40 single mothers from each site) will be enrolled over the study period.Intervention(s)Project Dads in Nutrition Education will strengthen the capacity of the Georgia Healthy Start program to integrate an evidence-based nutrition education program, breastfeeding education, and father engagement into its routine services.Main Outcome Measure(s)Changes in prepost survey assessment of participants’ nutrition literacy and eating behaviors; changes in prepost survey assessment of participants’ breastfeeding knowledge, attitudes, intent, initiation, and duration; and health and food diary collected 3 times (ie, at baseline, 3 months, and 6 months after enrollment).AnalysisProcess evaluation throughout the study to document implementation. Generalized linear mixed modeling will be used to determine the impact of the intervention.     

Long-Term Breastfeeding Support: Failing Mothers in Need

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.     

First- and Second-Trimester WIC Participation Is Associated with Lower Rates of Breastfeeding and Early Introduction of Cow's Milk during Infancy

Background

Existing literature suggests prenatal participation in the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) may reduce breastfeeding among low-income mothers. However, little is known about whether the timing of WIC entrance during pregnancy influences infant feeding decisions.

Objective

This study assesses the association between the timing of prenatal participation in WIC and various infant feeding practices, including breastfeeding initiation, breastfeeding for at least 4 months, exclusive breastfeeding, formula feeding, and early introduction of cow's milk and solid food.

Design

Cross-sectional survey matching of birth certificate data to mothers' interviews 9 months after the child's birth. Mothers provided information on participation in the WIC program, infant feeding practices, and sociodemographic characteristics.

Subjects

A nationally representative sample of 4,450 births in 2001 from the Early Childhood Longitudinal Survey-Birth Cohort.

Analyses

Multivariate logistic regression techniques (using STATA 9.0 SE, Stata Company, College Station, TX) estimated the relationship between the timing of prenatal WIC participation and infant feeding practices.

Results

Entry into the WIC program during the first or second trimester of pregnancy is associated with reduced likelihood of initiation of breastfeeding and early cow's milk introduction; and entry during the first trimester is associated with reduced duration of breastfeeding. WIC participation at any trimester is positively related to formula feeding.

Conclusions

Prenatal WIC participation is associated with a greater likelihood of providing babies infant formula rather than breastmilk after birth. Findings also indicate that there are critical prenatal periods for educating women about the health risks of early cow's milk introduction. Given the health implications of feeding infants cow's milk too early, WIC may be successful in educating women on the health risks of introducing complementary foods early, even if direct counseling on cow's milk is not provided.     

Maternal Confidence in Child Rearing: Comparing Data from Short-term Prospective Surveys Among Japanese and Vietnamese Mothers

Objective: To investigate the confidence women feel about child rearing in Japan and Vietnam. Methods: We conducted a prospective study of 210 Japanese mothers who registered as pregnant in Sukagawa City, Fukushima, and 132 Vietnamese mothers who attended a university hospital in Ho Chi Minh City. Follow-up surveys were conducted via mail approximately 6 weeks after newborn delivery among the Japanese cohort, and at the time of a one-month checkup at the hospital among the Vietnamese cohort. Results: The follow-up rate among these subjects was 67% (N = 140) in Japan and 65% (N = 86) in Vietnam. The proportion of mothers who were not confident about child rearing was 48% (N = 67) in Japan and 63% (N = 54) in Vietnam. In both countries, mothers in the unconfident group reported less happiness and relaxation time with children than mothers in the confident group. Maternal confidence was associated with child rearing experience, although the significance of this factor diminished in a multivariate analysis of the Vietnamese data. While unintended pregnancy and unemployment were related to confidence in child rearing in Japan, educational history was associated with confidence in Vietnam. Conclusion: This exploratory study found a high proportion of Japanese and Vietnamese mothers are not confident in child rearing, which calls attention to this understudied issue of confidence among Asian mothers.