Background
Methods
Infant feeding definitions
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Exclusive breastfeeding (EBF): Breastfeeding only, with no other food or liquid, or water, with the exception of drops or syrups consisting of vitamins, mineral supplements or medicine. This means that the infant did not receive any type of prelacteal food and no supplementary food.
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Almost exclusive breastfeeding (AEBF): The infant received prelacteal food before the onset of breastfeeding, but no supplementary food was offered after breastfeeding was established [29].
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Mixed feeding: The infant was fed with breast milk, infant formula and/or other types of food.
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Exclusive infant formula feeding: The infant was fed with infant formula, but without any breast milk.
Study design and sample
Data collection
Statistical analysis
Qualitative study
Ethical considerations
Results
Mothers’ demographic and anthropometric status
Total | Urban | Rural |
p-value | |
---|---|---|---|---|
n = 201 |
n = 102 |
n = 99 | ||
Age, years | 26.0 ± 4.2 | 26.9 ± 3.7 | 25.0 ± 4.5 | 0.001 |
Weight pre-pregnancy, kg | 50.5 ± 6.8 | 51.1 ± 6.9 | 49.8 ± 6.7 | 0.193 |
Height, m | 1.58 ± 0.05 | 1.59 ± 0.05 | 1.57 ± 0.05 | 0.006 |
BMI a, pre-pregnancy, (kg/m2) | 20.35 ± 2.65 | 20.33 ± 2.54 | 20.36 ± 2.78 | 0.943 |
BMI <18.5, n (%) | 42 (22.2) | 21 (21.9) | 21 (22.6) | |
BMI 18.5 ~ 24.9, n (%) | 137 (72.5) | 71 (74.0) | 66 (71.0) | |
BMI 25 ~ 29.9, n (%) | 8 (4.2) | 4 (2.1) | 4 (4.3) | |
BMI ≥30, n (%) | 2 (1.1) | 0 | 2 (2.2) | |
Parity | 1.12 ± 0.33 | 1.09 ± 0.29 | 1.16 ± 0.37 | 0.151 |
Education | ||||
≤12 years (senior high school), n (%) | 141(70.9) | 55 (53.9) | 86 (88.7) | <0.001 |
>12 years (i.e. university or above), n (%) | 58 (29.1) | 47 (46.1) | 11 (11.3) | |
Monthly income, RMB b
| 2683 ± 2542 | 3074 ± 3086 | 2241 ± 1648 | 0.026 |
Birth outcomes
Total | Urban | Rural |
p - value | |
---|---|---|---|---|
n = 201 |
n = 102 |
n = 99 | ||
Premature birth (<37 weeks), n (%) | 4 (2.0) | 4 (4.0) | 0 | |
Term birth (37–42 weeks), n (%) | 186 (93.5) | 90 (89.1) | 96 (98.0) | |
Postmature birth (≥42 weeks), n (%) | 9 (4.5) | 7 (6.9) | 2 (2.0) | |
Gestational weight gain (GWG) b, kg | 15.7 ± 5.3 | 16.7 ± 5.2 | 14.6 ± 5.2 | 0.007 |
If BMI < 18.5; GWG, kg | 15.8 ± 5.5 | 18.4 ± 5.3 | 13.1 ± 4.3 | |
If BMI 18.5 ~ 24.9; GWG, kg | 15.8 ± 4.9 | 16.1 ± 4.7 | 15.4 ± 5.0 | |
If BMI ≥ 25; GWG, kg | 14.0 ± 9.9 | 16.3 ± 14.3 | 12.8 ± 8.4 | |
Type of delivery | ||||
Vaginal delivery, n (%) | 66 (33.0) | 35 (34.3) | 31 (31.6) | 0.764 |
Caesarean section, n (%) | 134 (67.0) | 67 (65.7) | 67 (68.4) | |
Sex of newborns | ||||
Girls, n (%) | 119 (59.2) | 58 (56.9) | 61 (61.6) | 0.566 |
Boys, n (%) | 82 (40.8) | 44 (43.1) | 38 (38.4) | |
Birth weight, kg | 3.27 ± 0.40 | 3.32 ± 0.40 | 3.21 ± 0.39 | 0.053 |
Girls (n = 119, 58, 61), kg | 3.25 ± 0.39 | 3.27 ± 0.40 | 3.23 ± 0.37 | 0.607 |
Boys (n = 82, 44, 38, kg | 3.29 ± 0.41 | 3.39 ± 0.38 | 3.18 ± 0.42 | 0.021 |
Low birth weight < 2.5 kg, n (%) | 6 (3.0) | 3 (2.9) | 3 (3.0) | – |
Normal 2.5 ~ 4 kg, n (%) | 188 (93.5) | 95 (93.1) | 93 (93.9) | |
High birth weight ≥ 4 kg, n (%) | 7 (3.5) | 4 (3.9) | 3 (3.0) | |
Birth length a, cm | 49.5 ± 1.5 | 49.8 ± 1.7 | 49.2 ± 1.4 | 0.005 |
Girls (n = 114; 56, 58), cm | 49.3 ± 1.4 | 49.4 ± 1.4 | 49.1 ± 1.5 | 0.280 |
Boys (n = 78; 42, 36), cm | 49.8 ± 1.7 | 50.3 ± 1.9 | 49.2 ± 1.2 | 0.005 |
Birth length < 50 cm a, n (%) | 79 (41.1) | 32 (32.7) | 47 (50.0) | 0.019 |
Infant feeding practice on postnatal wards
Total | Urban | Rural | |
---|---|---|---|
n = 200 |
n = 102 |
n = 98 | |
Exclusive breastfeeding, n (%) | 16 (8.0) | 10 (9.8) | 6 (6.1) |
Almost exclusive breastfeeding, n (%) | 69 (34.5) | 30 (29.4) | 39 (39.8) |
Mixed feeding, n (%) | 112 (56.0) | 60 (58.8) | 52 (53.1) |
Exclusive infant formula feeding, n (%) | 3 (1.5) | 2 (2.0) | 1 (1.0) |
Total | Urban | Rural | |
---|---|---|---|
n = 196 |
n = 99 |
n = 97 | |
Within 1 h after birth, n (%) | 13 (6.6) | 8 (8.1) | 5 (5.2) |
1–6 h after birth, n (%) | 27 (13.8) | 15 (15.2) | 12 (12.4) |
7–24 h after birth, n (%) | 14 (7.1) | 8 (8.1) | 6 (6.2) |
2nd day after birth, n (%) | 54 (27.6) | 25 (25.3) | 29 (29.9) |
3rd day after birth, n (%) | 54 (27.6) | 20 (20.2) | 34 (35.1) |
4th day after birth or later, n (%) | 34 (17.3) | 23 (23.2) | 11 (11.3) |
Exclusive/almost exclusive breastfeeding (EBF/AEBF)
Factors | OR | 95 % CI |
p- value |
---|---|---|---|
Breastfeeding initiated ≤ 2 days | 1.97 | (1.11–3.50) | 0.020 |
Birth length of newborns < 50 cm | 0.48 | (0.26–0.87) | 0.016 |
Mother’s education > 12 years | 0.46 | (0.24–0.88) | 0.019 |
Mothers have knowledge about the importance of colostrum | 0.35 | (0.14–0.86) | 0.023 |
Caesarean section | 0.55 | (0.31–1.00) | 0.051 |
Classified reasons | Representative quotes |
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Lack of knowledge about early initiation of breastfeeding | • “The doctors and nurses didn’t tell us to start breastfeeding immediately (after childbirth)…The grandparents also didn’t mention that.”
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No breast milk at the beginning | • “Immediately after birth we had no idea that there would be some breast milk available soon after delivery”
• “I could not see/feel any breast milk after delivery. Therefore, there was no milk ready to be sucked out.”
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Caesarean section | • “Because I had a Caesarean section, the wound was still painful after birth. Therefore, I started to breastfeed my baby on the third day after delivery”
• “After the Caesarean section, we expressed a bit of colostrum for the baby by hand”
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Large nipples | • “The baby refused to suck, because the nipples were too big for him. About three days later, he was ready to start sucking.”
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Classified reasons | Representative quotes |
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Knowledge about EBF | • “Many mothers never heard about exclusive breastfeeding.”
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Amount of breast milk is not enough | • “We know breast milk is the best, but we were afraid that the amount is not enough. We don’t know when the baby is full.”
• “Because sometimes, if the breast milk is not enough, the baby will cry, so we give him infant formula in addition.”
• “I am afraid that my breast milk is not enough and consequently my baby will not grow/develop properly.”
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• “I have no idea. I want to breastfeed exclusively, but the amount of my breast milk is not enough.”
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• “Many of my friends in my generation didn’t have breast milk after childbirth at all.”
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• “In fact, most of the mothers are willing to breastfeed their babies because breast milk is the best. But there is no way to breastfeed exclusively, because their breast milk is not enough.”
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Breast milk is not nutritious enough (influence of advertising) | • “Probably the nutrient content in my milk is not enough, therefore I use infant formula as supplement.”
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• “Because infant formula has many advantages, it is rich in some nutrients like DHA (docosahexaenoic acid), taurine that are good for baby’s development. But the content of these nutrients is low in mothers’ milk.”
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• “Infant formula preference is often influenced by advertising for it everywhere.”
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Necessary to add water | • “Someone with experience told us water is necessary besides breast milk.”
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Parents’ concerns | • “As we only have one child, all parents cherish their babies and worry too much that their baby may get hungry.”
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• “Everyone treasures the baby so much and thinks that with infant formula the baby will develop better. Many mothers believe that ‘infant formula is necessary in addition to breast milk.’”
• “The feeling that “all the other babies are fed with infant formula” makes mothers think it is wrong if they don’t give infant formula to their own babies. Mothers are afraid of the development of their babies falling behind others.”
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Mother’s figure | • “Mothers choose infant formula instead of breastfeeding for the shape of their breasts; it’s a common problem. Anyway,I don’t care about my figure, I will insist on breastfeeding.”
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• “At present, mothers have different perceptions. Some mothers do not want to breastfeed, just like my friend who believes breastfeeding is harmful for her figure.”
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Convenience | • “Some mothers are using infant formula for convenience.”
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• “The babies fed with infant formula will not be hungry easily. Their mothers do not need to wake up and feed the babies so frequently in the night. It’s more convenient.”
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Wound pain after C/S | • “It’s painful after Caesarean section. It may influence exclusive breastfeeding (hard to hold the baby).”
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