Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Social and Demographic Determinants for Breastfeeding in a Rural, Suburban and City Area of South East China

Academic journal article Contemporary Nurse : a Journal for the Australian Nursing Profession

Social and Demographic Determinants for Breastfeeding in a Rural, Suburban and City Area of South East China

Article excerpt

Breastfeeding is a traditional practice in China, but rates have declined during the recent eco- nomic boom. According to a joint United Nations Children's Fund (UNICEF) and World Health Organization (WHO) press release, the breast- feeding rate for the first 4 months of life in China dropped from 76% in 1998 to 64% in 2004 (UNICEF, 2004). Despite considerable efforts to promote breastfeeding practices in China, most cities and provinces did not reach the national target of 'exclusive breastfeeding' of 80% within 6 months (Xu, Qiu, Binns, & Liu, 2009). In contrast, the national immunization survey from 2004-2008 indicates that in the United States breastfeeding initiation rates have dramatically increased from 51.5% in 1990 (Ryan, Wenjun, & Acosta, 2002) to 73.4% in 2004-2008 (Centers for Disease Control and Prevention, 2010).

Extensive research has been done to identify factors that influence breastfeeding initiation and duration. The literature, however, suggests that predictors of breastfeeding may vary in dif- ferent parts of the world. For instance, studies in Australia, Iceland, Ireland, Scotland, as well as the USA have found that breastfeeding rates are higher among women who are older and have higher levels of education (Baghurst et ah, 2007; Cairney & Barbour, 2007; Tarrant & Kearney, 2008; Taylor, Risica, Geller, Kirtania, & Cabral, 2006; Thome, Alder, & Ramel, 2006). Additionally, higher incomes have also been asso- ciated with increased breastfeeding rates in areas such as Sweden (Wallby & Hjern, 2009), and rural Jamaica (Chatman et al., 2004). A study by Qiu, Zhao, Binns, Lee, and Xie (2009) in Zhejiang China, which looked at initiation and prevalence of breastfeeding, however, suggests that younger mothers with lower educational levels and family income are more likely to breastfeed. The influ- ence of grandmothers on breastfeeding practices is also mixed. In Brazil, a mothers' daily contact with their own mother had a negative impact on breastfeeding (Susin, Giugliani, & Kummer, 2005), while a study performed by Grassley and Eschiti (2008) on mothers in Texas, USA sug- gested that grandmothers' values or philosophies regarding breastfeeding was considered to posi- tively influence their daughters' breastfeeding practices. In the Susin et al. (2005) study, a major- ity of grandmothers (56%) advised the use of a non-milk substance; contact frequency was deter- mined through interviews conducted at the first home visit when children were completing their first month. Almost 40.0% of the mothers had daily contact with their own respective mother, and analyses demonstrated an association between contact and occurrence of breastfeeding abandonment (Susin et ah, 2005). In the study by Grassley and Eschiti, focus group interviews were held and then analyzed using the content analysis method. In South Asia, an intervention, which involved a leaflet with information on health benefits of breastfeeding as well as on good prac- tice, to educate both mothers and grandmothers increased the likelihood of breastfeeding (Ingram, Johnson, & Hamid, 2003). Meanwhile, when comparing urban versus rural areas, the results of studies comparing breastfeeding initiation are not consistent. For example, (Kamudoni, Maleta, Shi, & Holmboe-Ottesen, 2007) used a cross- sectional household study that consisted of 157 rural and 192 semi-urban mother-infant pairs in Malawi and found that semi-urban mothers were more likely to engage in exclusive breastfeeding; however, other studies found women in rural areas more likely to practice breastfeeding (e.g., Batal, Boulghourjian, Abdallah, & Afifi, 2006; Qiu et al., 2009). Given that the predictors for breastfeeding vary around the world suggests the need to understand how these potential predic- tors operate and contribute to different perspec- tives and practices of breastfeeding.

Economically, China has undergone a rapid surge and transition. …

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